Monday Morning eye-opener!
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Rob Graham wrote:
Not only did it present a completely absurd example, but it exaggerated (quite severly) the cost issue (check current pricing for Lamisil generics).
Shame you didn't get past the first bit. "The result in 2007 is that 47.7 million often relatively prosperous, middle-class Americans have been caught in the trap in between, unable to afford health insurance or land a job that comes with it." "The average yearly cost of a family insurance plan purchased by employers is now $12,106, plus an additional $4,479 paid by the employee;" "Britain spends just $2,560 per citizen on health care, Australia $3,128 and France $3,191" "Put more brutally, the US ranked 22nd in infant mortality (between Taiwan and Croatia), 46th in life expectancy (between St Helena and Cyprus) and 37th in health system performance (between Costa Rica and Slovenia). In the "efficiency" ratings, the US came last. More American women are dying in childbirth today than were decades ago." "18,000 Americans die unnecessarily every year because they have no medical insurance." "It is probably too late for that poor old fellow patient of mine, but the patent on Lamisil finally expired last June and 90 generic tablets can now be had for a bargain, er, $362." See if you'd read more of the article you'd know how ridiculous you appear. "why is it that America, the world's richest nation, provides such shamefully lousy health care for its people?" It's not big deal to me here in Europe, but when you get the chance, you've got to contribute to the soapbox man.
AndyKEnZ wrote:
The average yearly cost of a family insurance plan purchased by employers is now $12,106, plus an additional $4,479 paid by the employee;" "Britain spends just $2,560 per citizen on health care, Australia $3,128 and France $3,191"
So if we take France's $3191 per citizen, and multiply by the average US family of 4 we get $12,764 which doesn't seem so bad in comparison to the US $16,585. I would challenge those figures as well, knowing my own rates to be about $12,000 combined... And how will making the US Federal government the payer change one IOTA of this? Adding the presently uncovered (many by choice, not inability to pay) can only increase the cost (to someone). The only difference is that the "premiums" will turn into "taxes", and the administrator will change from a private company with a vested interest in doing business efficiently to a Federal Bureaucracy that has none. As I said. It is without merit. it argues for a "cure" that is not supported by it's own description of the "disease". Go to sleep Spain. We neither need nor want your advice.
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Rob Graham wrote:
doctor justify his choice of the NON-generic
In the USA, is there more money to be made by doctors by prescribing such expensive products rather than the generic substitutes? If so, where do these doctor's morality lay (if it is a case of morality) - is it in his/her bank balance or in his/her patients best interests ?
There have been a very few cases of Physicians taking kickbacks from Pharma companies, but that is extremely rare and hardly worth the mention. In most cases it is simple ignorance or laziness on the MD's part. They don't always know which drugs have generic equivalents, and often haven't the time to check. They are heavily targeted with advertising (including copious quantities of free samples) by the Pharma companies, so are likely to be aware of the "drug of the moment" which is bound to be a patent drug. Add to that that they know the patient isn't paying, and that they likely don't know the price themselves. All that is left to bring some order to this chaos is the insurer, who intercedes when cost or appropriateness seems out of line. MDs know this too, so in many respects, they just depend on the insurer to raise a red flag if something is out of line. The real question here is whether substituting a bureaucracy for the insurer would help at all. Would they also monitor cost and appropriateness aggressively? Would they be subject to inappropriate influence by lobbying or bribery? After all it's not their money they are administering, it's "just tax revenue".
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My employer offers plans with both hard and soft generic options. With the soft generic plans as a customer I could get the brandname at my choice for only an extra few $'s in the copay, with the insurance company eating the overwehlming majority of the additional cost.
-- If you view money as inherently evil, I view it as my duty to assist in making you more virtuous.
dan neely wrote:
With the soft generic plans as a customer I could get the brandname at my choice for only an extra few $'s in the copay, with the insurance company eating the overwehlming majority of the additional cost.
This is what I have. Brandnames are $20 co-pay; generics are $10-15, depending on the drug tier.
The early bird who catches the worm works for someone who comes in late and owns the worm farm. -- Travis McGee
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I checked with my local CVS drugstore last weekend and established that, in
America, 90 Lamisil tablets cost (I'm not making this up) a cool $1,379.99.CostCo[^] offers a Lamisil generic that goes for $43.74 for 90 tablets (without any insurance). This is a wonderful example of why consumer-driven plans are so important for the future of American health care. The author did not bother to shop around for suitable and affordable alternatives and instead assumed that the patient should be entitled to $1,379.99 worth of drugs (CostCo sells the same brand-name $235 less). When the consumer is separated from costs, this sense of entitlement becomes pervasive. Of course, with insurance, there is very little incentive to get the inexpensive generic (at a whopping 97% off) as the patient would likely pay the same or a similar co-pay regardless of which he chose. And people wonder why health care costs are rising so rapidly...
Anybody rape your wife yet? -IAmChrisMcCall
I checked with my local CVS drugstore last weekend and established that, in America, 90 Lamisil tablets cost (I'm not making this up) a cool $1,379.99. It is probably too late for that poor old fellow patient of mine, but the patent on Lamisil finally expired last June and 90 generic tablets can now be had for a bargain, er, $362. Unless I'm reading this wrongly the "$1,379.99." price is from before the patent expired and the drug manufacture could charge what they liked. Your right, now it's more accessable the price has dropped considerably. Tha author, at the time, did shop around, he still idn't find the cheapest figure but did point out it is much cheaper now the patent is gone.
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I checked with my local CVS drugstore last weekend and established that, in America, 90 Lamisil tablets cost (I'm not making this up) a cool $1,379.99. It is probably too late for that poor old fellow patient of mine, but the patent on Lamisil finally expired last June and 90 generic tablets can now be had for a bargain, er, $362. Unless I'm reading this wrongly the "$1,379.99." price is from before the patent expired and the drug manufacture could charge what they liked. Your right, now it's more accessable the price has dropped considerably. Tha author, at the time, did shop around, he still idn't find the cheapest figure but did point out it is much cheaper now the patent is gone.
originSH wrote:
I checked with my local CVS drugstore last weekend and established that, in America, 90 Lamisil tablets cost (I'm not making this up) a cool $1,379.99. It is probably too late for that poor old fellow patient of mine, but the patent on Lamisil finally expired last June and 90 generic tablets can now be had for a bargain, er, $362. Unless I'm reading this wrongly the "$1,379.99." price is from before the patent expired and the drug manufacture could charge what they liked. Your right, now it's more accessable the price has dropped considerably. Tha author, at the time, did shop around, he still idn't find the cheapest figure but did point out it is much cheaper now the patent is gone.
If he pointed out that the generic was "er, $362", then he was wrong as CostCo has it for under $50. Of course, Wikipedia also lists Fluconazole[^] as another cheaper alternative (which was available at the time and is roughly $26 for 90 tablets) to Lamisil. As I pointed out, his assumption that the cost is fixed and high (for what amounts to a cosmetic problem anyway) is erroneous and is something that can be fixed by empowering the consumer. -- modified at 11:56 Monday 8th October, 2007
Anybody rape your wife yet? -IAmChrisMcCall
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I checked with my local CVS drugstore last weekend and established that, in America, 90 Lamisil tablets cost (I'm not making this up) a cool $1,379.99. It is probably too late for that poor old fellow patient of mine, but the patent on Lamisil finally expired last June and 90 generic tablets can now be had for a bargain, er, $362. Unless I'm reading this wrongly the "$1,379.99." price is from before the patent expired and the drug manufacture could charge what they liked. Your right, now it's more accessable the price has dropped considerably. Tha author, at the time, did shop around, he still idn't find the cheapest figure but did point out it is much cheaper now the patent is gone.
originSH wrote:
Tha author, at the time, did shop around, he still idn't find the cheapest figure but did point out it is much cheaper now the patent is gone.
No, the author did not shop around, but rather chose the highest price he could find to make his point. Your observation is correct, but there were generic substitutes available for the same application prior to the patent expiration, and the patented drug was available for less than cited. Lamisil is the trade-marked name for Terbinafine hydrochloride. Diflucan is a less expensive alternative that has been available for some time. The article is fraught with exaggeration and sophistry, not the least of which is comparing per person costs with US per family insurance premiums without calling attention to the differing basis, let alone the fact that one is cost the other price.
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originSH wrote:
Tha author, at the time, did shop around, he still idn't find the cheapest figure but did point out it is much cheaper now the patent is gone.
No, the author did not shop around, but rather chose the highest price he could find to make his point. Your observation is correct, but there were generic substitutes available for the same application prior to the patent expiration, and the patented drug was available for less than cited. Lamisil is the trade-marked name for Terbinafine hydrochloride. Diflucan is a less expensive alternative that has been available for some time. The article is fraught with exaggeration and sophistry, not the least of which is comparing per person costs with US per family insurance premiums without calling attention to the differing basis, let alone the fact that one is cost the other price.
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There have been a very few cases of Physicians taking kickbacks from Pharma companies, but that is extremely rare and hardly worth the mention. In most cases it is simple ignorance or laziness on the MD's part. They don't always know which drugs have generic equivalents, and often haven't the time to check. They are heavily targeted with advertising (including copious quantities of free samples) by the Pharma companies, so are likely to be aware of the "drug of the moment" which is bound to be a patent drug. Add to that that they know the patient isn't paying, and that they likely don't know the price themselves. All that is left to bring some order to this chaos is the insurer, who intercedes when cost or appropriateness seems out of line. MDs know this too, so in many respects, they just depend on the insurer to raise a red flag if something is out of line. The real question here is whether substituting a bureaucracy for the insurer would help at all. Would they also monitor cost and appropriateness aggressively? Would they be subject to inappropriate influence by lobbying or bribery? After all it's not their money they are administering, it's "just tax revenue".
The UKs NICE (National Institute for Clinical Excellence) http://www.nice.org.uk/[^] are essentially the body in the UK that has many controls over the prescription of drugs, and controversially, sometimes by cost and postcode. From their website ... * public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector * health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS * clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS. GPs in the UK are subjected to pharma salespersons etc so there is no difference with USA in that respect. The monetary system employed in the delivery of healthcare is, to say the very least, most complex from Government Departments downwards and presumably via here http://www.dh.gov.uk/en/index.htm[^] there may be links to show how UK health services finances are managed.
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I carefully stayed away from those issues as I do not feel I'm qualified to argue those points ... I was just nit-picking the previous post :P
originSH wrote:
do not feel I'm qualified to argue those points
I would suggest that neither was the Author of the article. Of course there is the other possibility: he was qualified, but a liar. What is most offensive to me is the implication that merely changing the payer would have changed the price of the drug, which is absurd on it's face. What would really happen is that everyone would end up paying whatever price the government as payer negotiated, which might well have been higher.
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originSH wrote:
do not feel I'm qualified to argue those points
I would suggest that neither was the Author of the article. Of course there is the other possibility: he was qualified, but a liar. What is most offensive to me is the implication that merely changing the payer would have changed the price of the drug, which is absurd on it's face. What would really happen is that everyone would end up paying whatever price the government as payer negotiated, which might well have been higher.
Rob Graham wrote:
What is most offensive to me is the implication that merely changing the payer would have changed the price of the drug, which is absurd on it's face. What would really happen is that everyone would end up paying whatever price the government as payer negotiated, which might well have been higher.
The government, however, has the potential to enforce law that forces a reduction in price (i.e. price controls). Of course, that's when the lines start forming.
Anybody rape your wife yet? -IAmChrisMcCall
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Rob Graham wrote:
Not only did it present a completely absurd example, but it exaggerated (quite severly) the cost issue (check current pricing for Lamisil generics).
Shame you didn't get past the first bit. "The result in 2007 is that 47.7 million often relatively prosperous, middle-class Americans have been caught in the trap in between, unable to afford health insurance or land a job that comes with it." "The average yearly cost of a family insurance plan purchased by employers is now $12,106, plus an additional $4,479 paid by the employee;" "Britain spends just $2,560 per citizen on health care, Australia $3,128 and France $3,191" "Put more brutally, the US ranked 22nd in infant mortality (between Taiwan and Croatia), 46th in life expectancy (between St Helena and Cyprus) and 37th in health system performance (between Costa Rica and Slovenia). In the "efficiency" ratings, the US came last. More American women are dying in childbirth today than were decades ago." "18,000 Americans die unnecessarily every year because they have no medical insurance." "It is probably too late for that poor old fellow patient of mine, but the patent on Lamisil finally expired last June and 90 generic tablets can now be had for a bargain, er, $362." See if you'd read more of the article you'd know how ridiculous you appear. "why is it that America, the world's richest nation, provides such shamefully lousy health care for its people?" It's not big deal to me here in Europe, but when you get the chance, you've got to contribute to the soapbox man.
AndyKEnZ wrote:
"why is it that America, the world's richest nation, provides such shamefully lousy health care for its people?"
Because it isn't a function of the Federal government, pure and simple.
AndyKEnZ wrote:
"The result in 2007 is that 47.7 million often relatively prosperous, middle-class Americans have been caught in the trap in between, unable to afford health insurance or land a job that comes with it."
this is an out right lie. Any so called prosperous middle-class American can afford health insurance. they might have to choose between that SUV with the fancy wheels and a Saturn in order to come up with the premiums but they damn sure can afford it.
Mike The NYT - my leftist brochure. Calling an illegal alien an “undocumented immigrant” is like calling a drug dealer an “unlicensed pharmacist”. God doesn't believe in atheists, therefore they don't exist.
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Rob Graham wrote:
What is most offensive to me is the implication that merely changing the payer would have changed the price of the drug, which is absurd on it's face. What would really happen is that everyone would end up paying whatever price the government as payer negotiated, which might well have been higher.
The government, however, has the potential to enforce law that forces a reduction in price (i.e. price controls). Of course, that's when the lines start forming.
Anybody rape your wife yet? -IAmChrisMcCall
Red Stateler wrote:
The government, however, has the potential to enforce law that forces a reduction in price (i.e. price controls). Of course, that's when the lines start forming.
And manufacturers stop manufacturing. Price controls just make things cheap but very rare and eventually non-existent. Sadly, it is price controls in places like Canada and Europe that lend credence to this approach. Of course it is never mentioned that one result of those price controls is to drive up the US price to compensate. If we also controlled the prices, then the supply would just dry up everywhere except on the black market.
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The UKs NICE (National Institute for Clinical Excellence) http://www.nice.org.uk/[^] are essentially the body in the UK that has many controls over the prescription of drugs, and controversially, sometimes by cost and postcode. From their website ... * public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector * health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS * clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS. GPs in the UK are subjected to pharma salespersons etc so there is no difference with USA in that respect. The monetary system employed in the delivery of healthcare is, to say the very least, most complex from Government Departments downwards and presumably via here http://www.dh.gov.uk/en/index.htm[^] there may be links to show how UK health services finances are managed.
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It is not a sense of entitlement that allows this price gouging, but rather the absence of transparency. It is difficult for the consumer here to do any price comparison, and there is little motivation when someone else is paying. There is another issue here with the high cost of patented drugs, but that is a different argument and has no easy solution (price control is not a solution, too many unintended consequences possible).
Rob Graham wrote:
It is difficult for the consumer here to do any price comparison, and there is little motivation when someone else is paying.
Agreed.