Tangentially related, but the whole fucking healthcare system in the US is fucked. I know anecdotal evidence isn't always the most convincing, but it seems like everyone I know has some sort of...
Exemplary
Tangentially related, but the whole fucking healthcare system in the US is fucked. I know anecdotal evidence isn't always the most convincing, but it seems like everyone I know has some sort of horror story involving ridiculous costs for something that would be a fraction of the cost somewhere else.
Here's a brief one in case anyone wants to feel stressed for some reason: Needed an ultrasound a few months back. Had recently switched insurances. Previous ultrasound had been 300, which already probably sounds insane to someone fortunate enough to not have ever had to deal with the American healthcare system. So I was curious to find out how much it would be on this new insurance plan. Get to the reception area and find out there's a problem with the insurance since the new insurance place never sent them the information, so they had to call billing, and insurance, and like five other people to figure out how much they would charge me for the ultrasound.
See, they don't have a set price. It's not like a haircut or a massage or a tree trimming or pretty much any service where 'my service costs X amount so that's how much I charge'. Instead, after like thirty minutes of waiting for this lady to make calls to everyone under the sun that might have something to do with my insurance, she finally tells me that it'll be $1400 because that's what I had left on my deductible. I tell her very politely WTF and that clearly something must be wrong. So she makes a few more calls and gets back to me: "well your insurance tells us that the maximum we can charge you for this is $800 so that's what we're going to go with."
Still, WTF. I thought 300 was bad, and it is, but 800 is a joke. But given the situation at the time, there was not much I could do other than pay the 800 and fight it out later. So I did. They were literally charging me the maximum they could possibly charge, and explicitly told me so.
Fast forward literally 6 months later, I had made over 20 calls with the hospital and both the previous and new insurance places (not an exaggeration, I made sure to keep records of every single call). Finally things got resolved and whoops what do you know, both ultrasounds should have actually only been $50, so I got refunded $250 and $750, nevermind the literal hours of my life wasted on hold and re-explaning my situation to agents that promised me they were looking into it.
The whole fucking thing is a scam and anyone who defends this system either has never had to deal with it or is a fucking sadist.
"Oh but I hear that in Canada, hospital wait times are soooooo long" - they're long as shit over here in the states too, have you tried scheduling a non-emergency surgery any time recently? They're months out.
"But in insert_european_country_here they pay sooooo much in taxes to have universal healthcare!" - yeah but they don't fucking pay thousands and thousands in health insurance just for the privilege of being able to then pay thousands more when they need to utilize said insurance. Doubling my taxes but getting rid of my health insurance payments and deductibles would save me tons of money each year, not to mention stress and time not having to be on the phone advocating for my poor wallet.
Not specific to anything you specifically said, other than the *"The whole fucking thing is a scam and anyone who defends this system either has never had to deal with it or is a fucking sadist."....
Exemplary
Not specific to anything you specifically said, other than the *"The whole fucking thing is a scam and anyone who defends this system either has never had to deal with it or is a fucking sadist.".
The way I've been lead to believe is the following: A good portion of the 'costs' of hospital pricing for medications and treatment is with the insurance companies and the hospitals. The hospital overcharges the price of medication, the insurance company will only pay an agreed upon amount, and the difference is considered a 'loss' by the hospital, and considered a loss by the pharmaceutical company. That way, both the hospital and the pharma corps can write it off on their taxes as a loss. It's all a scam. An individual can not normally get those 'agreed' upon costs.
Example: Medication #1 is $70k, but insurance will "only" agree to pay $1k, which will leave the hospital to mark off $69k as a loss, or they only paid $40k, but the PBA sold it to them at a loss of $20k, etc etc down the line.
Ouch. I have good health insurance in the USA...paid a grand total of $600 for two C-section births. But as I mentioned elsewhere, it also covers approximately 0% of any non-generic drug. So a...
Ouch. I have good health insurance in the USA...paid a grand total of $600 for two C-section births.
But as I mentioned elsewhere, it also covers approximately 0% of any non-generic drug. So a doctor had prescribed some patented eyedrops that cost $300, instead of two generics that do the exact same thing and cost $0.11. The patent literally just covers that they managed to combine both medicines in one drop, and they shilled to an eye doctor to get it prescribed by default.
And my employer does not provide vision and has bad dental coverage. Really weird how health insuranace companies managed to wiggle out of paying for certain treatments of very particular bones and muscles. Treating eye disease? Covered. Checking vision to insure eye disease isn't fucking it up in same appointment? Not covered.
Man, the phone calls. Dealt with a bunch of those last year. Just shows that there's no point where everything just works. You can have the insurance and the money, but you still have to make a...
Man, the phone calls. Dealt with a bunch of those last year. Just shows that there's no point where everything just works. You can have the insurance and the money, but you still have to make a bunch of calls to make sure all the right payments are going through and to make sure you're not getting scammed.
And the worst part is that every single 'fix' takes like 2-4 weeks to be able to see if it actually did anything or not. "Okay we've updated the insurance start date in our system, now it should...
And the worst part is that every single 'fix' takes like 2-4 weeks to be able to see if it actually did anything or not.
"Okay we've updated the insurance start date in our system, now it should reprocess automatically within 2-4 weeks"
then a month later nothing has changed, I'd call back and "oh I see here that the previous insurance hasn't sent us your coverage termination date with them, so I'll forward this to our benefits coordination team and they should reach out to them and resolve this in the next 2-4 weeks"
and again another month later "oh I see that they coordinated the benefits but the bills weren't reprocessed so go ahead and call the hospital and tell them to send us the bill again so we can process them correctly this time"
etc. ad nauseam
It's much, MUCH easier to just not deal with that and end up paying for shit you shouldn't have been charged for in the first place. Like I'm not a 'can I speak to the manager' type of person, but there really is no other way to deal with healthcare in America unless you want to just accept whatever they charge you and save yourself the headache of checking whether it's actually 'right', and god help you if it isn't.
For me, it's gotten to the point where I just try to keep it all in network, and put enough each year in my HSA to pay for my yearly maximum. I know I'm probably paying more for the individual...
For me, it's gotten to the point where I just try to keep it all in network, and put enough each year in my HSA to pay for my yearly maximum. I know I'm probably paying more for the individual items, but at least I can pay with pre tax dollars, and everything is "free" once I hit the maximum anyway. It's either that or spend hours and hours on the phone only to probably hit the maximum anyway. It's exhausting.
Ironically, the way my "good" health insurance is structured, if I have even 1 out of network doctor, which I now do because he was sick of their bullshit, it's better for me to have all...
Ironically, the way my "good" health insurance is structured, if I have even 1 out of network doctor, which I now do because he was sick of their bullshit, it's better for me to have all out-of-network doctors because I'll hit my out-of-pocket (OOP) maximum faster.
The out-of-network deductable is higher than the in-network deductable (more bullshit), and the out-of-network individual OOP maximum is higher than individual in-network OOP maximum, but the out-of-network OOP family maximum is less than 1/3 the in-network OOP maximum. Try to say that 5 times fast.
My healthcare costs would actually go down if I explicitly sought out out of network providers. And then I could see a bunch of other doctors for free because I hit my maximum.
And the best part is that those out-of-network doctors would get paid more than the in-network doctors, because my insurance only pays out what they determine they should pay based around what they bully doctors feel is fair to pay for that service. And out-of-network doctors get paid the Medicare rate.
Doctors literally have to choose between helping patients afford their treatments and getting paid appropriately.
The most important part of this, other than the CEOs trying to weasel themselves out of this saying "they do not understand drug pricing, and thus can't be asked about it" is the following:
The most important part of this, other than the CEOs trying to weasel themselves out of this saying "they do not understand drug pricing, and thus can't be asked about it" is the following:
Early this week, the HELP Committee released a report that found Bristol Myers Squibb, Johnson & Johnson and Merck spend more on executive compensation, stock buybacks and dividends than they do on research and development.
"In other words, these companies are spending more to enrich their own stockholders and CEOs than they are in finding new cures and new treatments," Sanders reiterated in his opening statement at the hearing. "Now, the average American who hears all this is asking a very simple question. How does all of this happen? "
Gotta love Sanders, his message never changes and there's never any question that he believes it. Not sure he'd be a great dinner guest, but it will be very sad when he retires. And without many...
Gotta love Sanders, his message never changes and there's never any question that he believes it.
Not sure he'd be a great dinner guest, but it will be very sad when he retires. And without many heirs apparent.
Somehow smart enough to know what's right and simultaneously foolish enough to do it in congress. I think there are many people who care more about helping people than money. Most of them aren't...
Somehow smart enough to know what's right and simultaneously foolish enough to do it in congress.
I think there are many people who care more about helping people than money. Most of them aren't going to fight tooth and nail for the anti-privilege of doing that in politics.
Why is it "foolish" to know what's right and do it in Congress? It is not foolishness, it is bravery and integrity. Our government would be a lot better if more congresspeople did the right thing...
Why is it "foolish" to know what's right and do it in Congress? It is not foolishness, it is bravery and integrity. Our government would be a lot better if more congresspeople did the right thing instead of focusing on political theatre. We're supposed to have a government by the people, for the people.
FiercePharma, of all places, actually has a better article on the hearings. The literal money quote is at the end:
FiercePharma, of all places, actually has a better article on the hearings.
The literal money quote is at the end:
After the CEOs departed, a panel of experts answered additional questions from the senators. Peter Maybarduk, the director of the Access to Medicines program at Public Citizen, flipped the PBM discussion.
“We heard some wild stuff up here this morning, including a lot of blaming the middlemen,” Maybarduk said. “Drugmakers’ high prices are the whole reason that we have a middlemen problem. It’s because we have exceedingly high prices at the outset that there’s an attractive market for middlemen to enter. But the fish rots from the head. If you break up the market, if you look at where the revenue is, drugmakers capture two-thirds, $323 billion, and pharmacy benefit managers are a small slice, $23 billion. You can’t fix the problem of the pharmaceutical industry by going off middlemen who are just trying to skim off the top. You have to get to the root of the problem which is the monopoly power.”
I don't think this argument makes any sense. If our system didn't suck, drugs would still cost a ton to develop, but pharmacy benefit management doesn't have to cost a ton. If pharma is actually...
I don't think this argument makes any sense. If our system didn't suck, drugs would still cost a ton to develop, but pharmacy benefit management doesn't have to cost a ton.
If pharma is actually doing work and delivering medicines, they would be expected to have some high level of revenue, although the system has allowed it to be inflated. $23B is huge given that the entire pharmacy benefit management industry delivers nothing if we don't have a terrible healthcare system. Even if you could convince the every pharma CEO to lower their prices by some amount, this useless middleman behavior would still exist. In any case, I don't think asking people to act against their own self-interest is going to have concrete results.
Obamacare ended up being less than the initial promise, but I hoped that we'd continue moving in a better direction on healthcare. Unfortunately, it seems we're not really getting any closer to fixing our broken system.
Just so folks in other countries have an idea of the magnitude of U.S. drug price distortion, here's an example. Enbrel is the current most effective treatment for the commonest forms of...
Just so folks in other countries have an idea of the magnitude of U.S. drug price distortion, here's an example. Enbrel is the current most effective treatment for the commonest forms of autoimmune arthritis, with worldwide sales > $15 billion/year. The U.S. current list price for this drug is $1,800 per week. Enbrel's patent doesn't expire until 2029, and recently licensed biosimilar drugs still cost 80% of Enbrel's price. Humira, another similar drug, is also locked in a thicket of patents preventing cheaper competing versions.
And my doctor dropped this one on me: Drug companies fund research to discredit drugs they held patents to when they expire. I have no direct evidence of it, but it does seem to line up for...
And my doctor dropped this one on me: Drug companies fund research to discredit drugs they held patents to when they expire. I have no direct evidence of it, but it does seem to line up for Abilify.
You'll notice all the studies about other risks to Abilify started coming out in 2016, about 1 year after the aripiprazole generics started hitting the market. And at the same time, a new patented long-term injectible, Aripiprazole lauroxil, hit the market.
Aripiprazole is about one of the most effective and well-tolerated drugs in its class.
Yeah, it's obscene. I'm panicking a little because lab work just came back. I'm on one of the least tolerable (but cheap because TNF-alpha inhibitors superceded it) RA drugs. It's working, but it...
Yeah, it's obscene. I'm panicking a little because lab work just came back. I'm on one of the least tolerable (but cheap because TNF-alpha inhibitors superceded it) RA drugs. It's working, but it also looks like it's slowly destroying my liver and kidneys, and blood cell counts are marginal. I now get to take blood pressure medication due to yet another side effect, and my hair is falling out.
Time for the insurance fight to get TNF-alpha inhibitors covered, and I'm f*cked if I lose insurance.
That really sucks. I hope you pull through it, here's hoping for the best. TW: Dark joke If you do die, please make sure "Killed by <insurance company> because they wouldn't cover the drug that...
That really sucks. I hope you pull through it, here's hoping for the best.
TW: Dark joke
If you do die, please make sure "Killed by <insurance company> because they wouldn't cover the drug that would treat me best" gets put on your tombstone.
I'm on Humira, and the story is strikingly similar. It's a special kind of messed up to have to spend hours on the phone getting insurance to accept prescriptions for a medication that then causes...
I'm on Humira, and the story is strikingly similar. It's a special kind of messed up to have to spend hours on the phone getting insurance to accept prescriptions for a medication that then causes other slightly less severe (but still VERY troubling) symptoms.
Also, the whole pricing strategy is such an obvious money grab. The list price is in the thousands, but they offer "savings programs" for those who are persistent which drop the price to ~$10 a month. I'm not sure how this is even legal, because it's artificially circumnavigating supply/demand that would normally have caused the price to drop due to no one being able to afford it.
Direct link to testimony proceedings of the CEOs. Direct link to testimony proceedings from healthcare advocates and researchers. C-SPAN is a wonderful resource like that. It is a travesty that...
It is a travesty that Sanders didn't win the nomination in 2016. Sanders has a level of firey intensity, calling out corruption and inequality would have given a Tump far better run for his money than Clinton.
Edit: Some random commentary as I watch:
Fuck Bill Cassidy. To briefly paraphrase "How dare we witch-hunt these lovely people whom have merely succeeded in capitalism, this is in no way going to help us write meaningful legislation. It's a waste of time." He then goes on to say we need to investigate how the legislation didn't result in drug price decreases for some mysterious reason.... that he heavily implied was undoubtedly the failure of governmental interference in the free market.
I wanna know which Americans can afford to sue to get access to new drugs that other countries don't get. I certainly can't afford to get access to any of the new drugs cause my insurance covers approximately 0% of new ones....compared to Bill's cited "only 20%" that Canada covers....and my insurance is pretty damn good compared to most.
Here's some policy Bill: Forcibly restructure all healthcare-adjacent companies to be strictly non-profit with clearly defined publicly-audited pay grades.
The J&J CEO is full of shit about rebates and discounts. Those mostly only apply for a few initial doses, and often just in the form of "samples" that pharmaceutical reps hand out to doctors while wining and dining them.
Sander's questioning was fire. It was on-brand, and kinda worked to dispel this notion that America is seeing the benefits of all these new drugs when almost nobody can afford them...and that's translating to lower life expediencies than countries that do prioritize lower drug costs. I liked how he directly grilled the CEO to get him to commit to not raising his $51 million dollar compensation package until the $70k treatment is lowered in cost in the USA. That CEO spent many words to avoiding saying the word "No" when asked to reply with "Yes" or "No." The same drug (IIRC) is available in Canada for $900, and is still profitable there....it costs something like $15/year to manufacture.
Ok, I'm easing up on my shade of Bill I threw earlier. He actually asked some genuinely good questions about gene therapy. He's still a free-market-solution guy, so I dislike that...but he's at least asking some of the right questions about how to make the not-free-market-solution which directly impacts his state be able to afford it.
Sen. Murphy from CT asking the right questions: Are the heavily discounted costs other countries paying covering all of the expenses of the drug? Surprise: Yes they are, there are no free rides. More money being paid out to shareholders via buybacks and dividends than spent on all R&D. CEO answer: "If we don't pay dividends, our operations are not sustainable"....big fat Doubt on that one.
The message all of these CEOs are consistently pushing: We price the drugs in the USA according to the value they bring. The hidden, unspoken part of that: We charge as much as we can in the USA, regardless of how much it properly costs to research, develop, and manufacture these drugs.
Tommy "We have the greatest healthcare system in the world" Tuberville of Alabama first blames the federal government for involvement in the free market, but then continues on to throw freebies at the execs, and then also throw out some anti-vaxxer propaganda saying Biden was wrong to kick out almost 90k military members for them refusing the mandatory COVID vaccine. He of course also ignores that the influenza vaccine, as well as pretty much every single other vaccine, is also mandated. Tommy should probably not be serving in Congress, certainly not on this committee.
Sen Patty Murray from WA asks the CEOs to explain in plain terms how they can explain to their constituents why these costs are necessary. They do not introduce any new ideas, they just regurgitate how they have discount and rebate programs (which these constituents have likely either already used or been denied). Or how these countries have to wait 3-5 years for these medicines....neglecting it often takes 10 years in the USA for the patent to expire and become remotely affordable for most people...... They also blame the intermediaries again.....but we've already established these intermediaries are a drop in the bucket.
I notice the republicans are all really giving the CEOs a lot of time to rail on PBMs. Does somebody around here have some expertise that can speak to the good/harm PBMs do? Genuinely curious, but suspicious how all the CEOs point the finger to that and how none of the Democrats really harp on the problems of PBMs. I found this source, which got me started.....and while I have no love of health insurance companies my gut says that this is all deflection to avoid having the public look at the real problem.
I dislike how all of these CEOs are using big numbers like "Over the last 10/20 years we spent X billion dollars." It makes it harder to make like for like comparisons when the senators use single-years. In this case, it was 100 billion over 5 years.... 20 billion a year to mostly go to Eliquis. They continue to fail to explain why they need to do that instead of just bringing it reasonably in line with what the rest of the world pays.
I'm so frustrated by these questions being asked by the people who caused this to happen, have the power to stop it, and will do nothing. The fact that they picked one single type of medication to...
people in Japan and Canada live longer, on average, than they do in the United States.
I'm so frustrated by these questions being asked by the people who caused this to happen, have the power to stop it, and will do nothing. The fact that they picked one single type of medication to price control last time explains everything.
As someone who's worked in Pharmaceutical R&D for almost 8 years now, this has always been the frustrating part to me. Why are our drug prices higher in the US? Healthcare cost in general? -...
As someone who's worked in Pharmaceutical R&D for almost 8 years now, this has always been the frustrating part to me. Why are our drug prices higher in the US? Healthcare cost in general? - Because they can get away with it. I can tell you that the industry considers the US a very big market, which is mainly due to the lack of real restrictions on drug prices/healthcare cost..... which is just sad for us living here.
I'd suspect that the R & D side of a pharmaceutical company has very little if any contact with the consumer marketing and pricing side of the organization. My brother-in-law is an oncologist with...
I'd suspect that the R & D side of a pharmaceutical company has very little if any contact with the consumer marketing and pricing side of the organization.
My brother-in-law is an oncologist with keen insight into consumer drug costs. He literally stopped practicing because so many of his patients couldn't afford medicines, and the latest/greatest/most-hyped drugs had so little benefit. The example he mentioned was $250,000 for a course of a drug that might prolong the typical patient's life by 3 months.
Thinking he might do better in research, he semi-retired to do pharma drug study consulting, and that's when he heard about the calculations for breakthrough drug pricing. It has little to do with the cost to develop, manufacture, and trial the drug itself. Pricing has a great deal to do with estimates of the monetary value of a human life (in U.S. dollars), the maximum productivity/life expectancy gain from use of the drug, and what the insurance market can bear. By this calculus, a shot of penicillin (or brand-new Antibiotic X) for a kid's ear infection would cost $1,000,000 if left solely to a drug company with a patent monopoly.
That's an even better story to get in front of a journalist. These are the kinds of tales that give a human element to build support: Workers within a system getting burnt out because they see the...
That's an even better story to get in front of a journalist.
These are the kinds of tales that give a human element to build support: Workers within a system getting burnt out because they see the harm that it's causing.
Without revealing too much, there's a lot of problems with outpatient facilities due to bad management resulting in ever-increasing burnout from medical staffers whom just want to help their patients. Things like lowering headcount, increasing patients/person, and increasing hours and reducing PTO.
You're probably right about access, but you never know who gets pulled in what meetings and how, or has access to email backups. I've certainly been in a strange few myself.
None of this is secret. The problem is so widespread that doctors use the phrase "financial toxicity" as if it's just another drug side effect. As we saw with the mutilated, deformed pile of...
None of this is secret. The problem is so widespread that doctors use the phrase "financial toxicity" as if it's just another drug side effect.
As we saw with the mutilated, deformed pile of healthcare legislation latterly called Obamacare, the problem isn't just "coverage". As we saw with SARS-CoV-2, new drug discovery for a neglected family of viral diseases was greatly accelerated with targeted Federal funding. Paxlovid and vaccines were profitably distributed with price controls. There's no practical reason we couldn't arrive at the same price negotiation mechanisms as other countries, Federally oversee and guarantee modest margins on generic drug manufacture, combat patent shenanigans, and price control on the basis of comparative efficacy (no more incentives to prescribe barely-tweaked new "me-too" drugs).
The real reason we're in such dire straits is capitalism so unrestrained that politicians, middlemen, and healthcare institutions are partaking of Pharma's ill-gotten gains. In fact, you can go on OpenSecrets.org and see who's taking direct campaign or dark-money cash ($378,585,382 in 2023) from Pharma-related entities.
It would be nice if someone got caught doing such an old-fashioned thing as taking bribes, but those are elegant weapons from a more civilized age where soliciting money to legislate a certain way was actually illegal.
Yea, but you gotta craft the narratives. Facts on their own aren't inspiring that make for blockbuster movies that sway public opinion. I'm thinking of that nuclear war movie that swayed Reagan.
Yea, but you gotta craft the narratives. Facts on their own aren't inspiring that make for blockbuster movies that sway public opinion.
I'm thinking of that nuclear war movie that swayed Reagan.
It's funny that all the docudramas about Purdue Pharma came out after the lawsuit settlements over their opioid promotion. Libel lawsuit threats are a hell of a drug for suppressing coverage of...
It's funny that all the docudramas about Purdue Pharma came out after the lawsuit settlements over their opioid promotion. Libel lawsuit threats are a hell of a drug for suppressing coverage of corporate crimes.
There've been some recent cases with international proof and enforcement, but it's still hard to craft a singular dramatic narrative that gets widespread, effective public attention.
At least in the USA, I'm envisioning something starting with a car accident could do the trick. Perhaps escalates into discovering a cancer that they can't afford to treat. Almost every driver...
At least in the USA, I'm envisioning something starting with a car accident could do the trick. Perhaps escalates into discovering a cancer that they can't afford to treat.
Almost every driver I've met has at least one close call or is actively fighting auto+medical insurance companies to get their medical costs covered. That could be that more-easily-relatible factor.
And here I am, completely forgetting that a major plot line of Breaking Bad was the unaffordability of cancer treatment in the U.S. That's a fictional drama, of course, but again, it's not like...
And here I am, completely forgetting that a major plot line of Breaking Bad was the unaffordability of cancer treatment in the U.S. That's a fictional drama, of course, but again, it's not like anyone is surprised at this point.
I'm also in pharma, generics, but it's still somewhat the same game. Minus the patents and spending millions to extend them. Margins are still 50+% Orders, pricing, delivery and all that are part...
I'm also in pharma, generics, but it's still somewhat the same game. Minus the patents and spending millions to extend them. Margins are still 50+%
Orders, pricing, delivery and all that are part of a convoluted system where a lot of the costs are administrative in addition a lot of the infrastructure is built to maximize how much a company can charge the government since it cannot negotiate drug pricing.
Most drugs go through a wholesaler distribution network. The pharma company charges the wholesaler a price slightly below list price. The wholesaler will then sell and deliver the product to the end customer... But it's not like a normal distribution pricing system... Oh no. They sell at contract price which can be significantly less than the list price (can be 90% cheaper). But wait you say... How can you do that and stay in business? Chargebacks. They then request the difference in the price back to the Pharma company. There are systems and middleware and people to manage that whole process. Then there are the fees, rebates. The benefit with the huge range in price between the wholesale acquisition price and the contract price is for when someone isn't on contract. They get sold at list.. this helps raise the price a company can charge the government. When you're 1 of 2 suppliers... This can be a lot of money. Just imagine what happens if one of those companies had to stop manufacturing due to an FDA audit or natural disaster.
This is just one part of the administrative costs. Now add in your doctor, the hospital, health insurance. Probably other shit I don't know about.
There's not much to imagine, there's a huge mess every time a factory gets shut down for failing an FDA inspection, like happened with Ozempic. That one has been in the news, though they quickly...
This is in no way a defense of the finance machines behind healthcare-they are diabolical. Part of the reason prices are cheaper elsewhere is because they are so expensive here. In other words, us...
This is in no way a defense of the finance machines behind healthcare-they are diabolical.
Part of the reason prices are cheaper elsewhere is because they are so expensive here. In other words, us subsidizes other places. The corrupt/ineffectual regulatory strucuture here is of course a huge enabling apparatus. Probably because regulators and legislators are holding significant equity posotions in the various finance, development, and distribution companies.
The solution, in my view, for all of the problems to to rebirth civic organizations. Places like Lions and Kiwanis, even the freemasons amd elks. These orgs brought communities together and empowered them to select political leadership that actually mirrored better civic values. Here’s hoping.
This is the standard justification, but do we have actual empirical evidence for it? I understand that having a source of income would theoretically increase willingness to make large investments,...
Part of the reason prices are cheaper elsewhere is because they are so expensive here. In other words, us subsidizes other places.
This is the standard justification, but do we have actual empirical evidence for it? I understand that having a source of income would theoretically increase willingness to make large investments, but just because econ 101 plausibly justifies it doesn't mean it happens in practice.
From /u/vord's summary of C-SPAN coverage above: So if other countries aren't getting "free rides", pharmaceutical companies are not actually subsidizing their lower drug prices.
Sen. Murphy from CT asking the right questions: Are the heavily discounted costs other countries paying covering all of the expenses of the drug? Surprise: Yes they are, there are no free rides. More money being paid out to shareholders via buybacks and dividends than spent on all R&D. CEO answer: "If we don't pay dividends, our operations are not sustainable"
So if other countries aren't getting "free rides", pharmaceutical companies are not actually subsidizing their lower drug prices.
And that ultimately, the CEO has highlighted how demanding ever-increasing profitability is neither sustainable nor desirable for society when the goal is to make the good as accessible as...
And that ultimately, the CEO has highlighted how demanding ever-increasing profitability is neither sustainable nor desirable for society when the goal is to make the good as accessible as possible.
The ideal goal for society is to create as many wonderful medicines as we can and then distribute them as widely, freely, and quickly as possible. This is directly at-odds with profiting from the creation of drugs, and reveals a paradox in IP law when it comes to such directly beneficial innovations.
Even assuming the ceo gave a truthful answer, I don’t mean to suggest the subsidy is intentional. Rather, it’s something along the lines of, since we can make so much money in the us, we don’t...
Even assuming the ceo gave a truthful answer, I don’t mean to suggest the subsidy is intentional. Rather, it’s something along the lines of, since we can make so much money in the us, we don’t have to fight other countries regulations so hard.
Bernie kindly reminded the CEOs before proceeding that while they're not strictly under oath, it is illegal to knowingly lie to congress. I gotta say, listening to these things for myself has been...
I gotta say, listening to these things for myself has been 5x more educational than relying on secondhand reports. I suppose that's part of why those news sources don't link to C-SPAN footage.
Tangentially related, but the whole fucking healthcare system in the US is fucked. I know anecdotal evidence isn't always the most convincing, but it seems like everyone I know has some sort of horror story involving ridiculous costs for something that would be a fraction of the cost somewhere else.
Here's a brief one in case anyone wants to feel stressed for some reason: Needed an ultrasound a few months back. Had recently switched insurances. Previous ultrasound had been 300, which already probably sounds insane to someone fortunate enough to not have ever had to deal with the American healthcare system. So I was curious to find out how much it would be on this new insurance plan. Get to the reception area and find out there's a problem with the insurance since the new insurance place never sent them the information, so they had to call billing, and insurance, and like five other people to figure out how much they would charge me for the ultrasound.
See, they don't have a set price. It's not like a haircut or a massage or a tree trimming or pretty much any service where 'my service costs X amount so that's how much I charge'. Instead, after like thirty minutes of waiting for this lady to make calls to everyone under the sun that might have something to do with my insurance, she finally tells me that it'll be $1400 because that's what I had left on my deductible. I tell her very politely WTF and that clearly something must be wrong. So she makes a few more calls and gets back to me: "well your insurance tells us that the maximum we can charge you for this is $800 so that's what we're going to go with."
Still, WTF. I thought 300 was bad, and it is, but 800 is a joke. But given the situation at the time, there was not much I could do other than pay the 800 and fight it out later. So I did. They were literally charging me the maximum they could possibly charge, and explicitly told me so.
Fast forward literally 6 months later, I had made over 20 calls with the hospital and both the previous and new insurance places (not an exaggeration, I made sure to keep records of every single call). Finally things got resolved and whoops what do you know, both ultrasounds should have actually only been $50, so I got refunded $250 and $750, nevermind the literal hours of my life wasted on hold and re-explaning my situation to agents that promised me they were looking into it.
The whole fucking thing is a scam and anyone who defends this system either has never had to deal with it or is a fucking sadist.
"Oh but I hear that in Canada, hospital wait times are soooooo long" - they're long as shit over here in the states too, have you tried scheduling a non-emergency surgery any time recently? They're months out.
"But in insert_european_country_here they pay sooooo much in taxes to have universal healthcare!" - yeah but they don't fucking pay thousands and thousands in health insurance just for the privilege of being able to then pay thousands more when they need to utilize said insurance. Doubling my taxes but getting rid of my health insurance payments and deductibles would save me tons of money each year, not to mention stress and time not having to be on the phone advocating for my poor wallet.
Not specific to anything you specifically said, other than the *"The whole fucking thing is a scam and anyone who defends this system either has never had to deal with it or is a fucking sadist.".
The way I've been lead to believe is the following: A good portion of the 'costs' of hospital pricing for medications and treatment is with the insurance companies and the hospitals. The hospital overcharges the price of medication, the insurance company will only pay an agreed upon amount, and the difference is considered a 'loss' by the hospital, and considered a loss by the pharmaceutical company. That way, both the hospital and the pharma corps can write it off on their taxes as a loss. It's all a scam. An individual can not normally get those 'agreed' upon costs.
Example: Medication #1 is $70k, but insurance will "only" agree to pay $1k, which will leave the hospital to mark off $69k as a loss, or they only paid $40k, but the PBA sold it to them at a loss of $20k, etc etc down the line.
Ouch. I have good health insurance in the USA...paid a grand total of $600 for two C-section births.
But as I mentioned elsewhere, it also covers approximately 0% of any non-generic drug. So a doctor had prescribed some patented eyedrops that cost $300, instead of two generics that do the exact same thing and cost $0.11. The patent literally just covers that they managed to combine both medicines in one drop, and they shilled to an eye doctor to get it prescribed by default.
And my employer does not provide vision and has bad dental coverage. Really weird how health insuranace companies managed to wiggle out of paying for certain treatments of very particular bones and muscles. Treating eye disease? Covered. Checking vision to insure eye disease isn't fucking it up in same appointment? Not covered.
"According to most health insurance companies, teeth are luxury bones that I must pay more to continue enjoying"
~Dan Sheehan (random twitter dude)
Man, the phone calls. Dealt with a bunch of those last year. Just shows that there's no point where everything just works. You can have the insurance and the money, but you still have to make a bunch of calls to make sure all the right payments are going through and to make sure you're not getting scammed.
And the worst part is that every single 'fix' takes like 2-4 weeks to be able to see if it actually did anything or not.
"Okay we've updated the insurance start date in our system, now it should reprocess automatically within 2-4 weeks"
then a month later nothing has changed, I'd call back and "oh I see here that the previous insurance hasn't sent us your coverage termination date with them, so I'll forward this to our benefits coordination team and they should reach out to them and resolve this in the next 2-4 weeks"
and again another month later "oh I see that they coordinated the benefits but the bills weren't reprocessed so go ahead and call the hospital and tell them to send us the bill again so we can process them correctly this time"
etc. ad nauseam
It's much, MUCH easier to just not deal with that and end up paying for shit you shouldn't have been charged for in the first place. Like I'm not a 'can I speak to the manager' type of person, but there really is no other way to deal with healthcare in America unless you want to just accept whatever they charge you and save yourself the headache of checking whether it's actually 'right', and god help you if it isn't.
For me, it's gotten to the point where I just try to keep it all in network, and put enough each year in my HSA to pay for my yearly maximum. I know I'm probably paying more for the individual items, but at least I can pay with pre tax dollars, and everything is "free" once I hit the maximum anyway. It's either that or spend hours and hours on the phone only to probably hit the maximum anyway. It's exhausting.
Ironically, the way my "good" health insurance is structured, if I have even 1 out of network doctor, which I now do because he was sick of their bullshit, it's better for me to have all out-of-network doctors because I'll hit my out-of-pocket (OOP) maximum faster.
The out-of-network deductable is higher than the in-network deductable (more bullshit), and the out-of-network individual OOP maximum is higher than individual in-network OOP maximum, but the out-of-network OOP family maximum is less than 1/3 the in-network OOP maximum. Try to say that 5 times fast.
My healthcare costs would actually go down if I explicitly sought out out of network providers. And then I could see a bunch of other doctors for free because I hit my maximum.
And the best part is that those out-of-network doctors would get paid more than the in-network doctors, because my insurance only pays out what they determine they should pay based around what they
bully doctorsfeel is fair to pay for that service. And out-of-network doctors get paid the Medicare rate.Doctors literally have to choose between helping patients afford their treatments and getting paid appropriately.
The most important part of this, other than the CEOs trying to weasel themselves out of this saying "they do not understand drug pricing, and thus can't be asked about it" is the following:
Gotta love Sanders, his message never changes and there's never any question that he believes it.
Not sure he'd be a great dinner guest, but it will be very sad when he retires. And without many heirs apparent.
I suspect when at a dinner he'd rather talk about anything other than work unless directly asked about it.
Somehow smart enough to know what's right and simultaneously foolish enough to do it in congress.
I think there are many people who care more about helping people than money. Most of them aren't going to fight tooth and nail for the anti-privilege of doing that in politics.
Why is it "foolish" to know what's right and do it in Congress? It is not foolishness, it is bravery and integrity. Our government would be a lot better if more congresspeople did the right thing instead of focusing on political theatre. We're supposed to have a government by the people, for the people.
FiercePharma, of all places, actually has a better article on the hearings.
The literal money quote is at the end:
I don't think this argument makes any sense. If our system didn't suck, drugs would still cost a ton to develop, but pharmacy benefit management doesn't have to cost a ton.
If pharma is actually doing work and delivering medicines, they would be expected to have some high level of revenue, although the system has allowed it to be inflated. $23B is huge given that the entire pharmacy benefit management industry delivers nothing if we don't have a terrible healthcare system. Even if you could convince the every pharma CEO to lower their prices by some amount, this useless middleman behavior would still exist. In any case, I don't think asking people to act against their own self-interest is going to have concrete results.
Obamacare ended up being less than the initial promise, but I hoped that we'd continue moving in a better direction on healthcare. Unfortunately, it seems we're not really getting any closer to fixing our broken system.
Just so folks in other countries have an idea of the magnitude of U.S. drug price distortion, here's an example. Enbrel is the current most effective treatment for the commonest forms of autoimmune arthritis, with worldwide sales > $15 billion/year. The U.S. current list price for this drug is $1,800 per week. Enbrel's patent doesn't expire until 2029, and recently licensed biosimilar drugs still cost 80% of Enbrel's price. Humira, another similar drug, is also locked in a thicket of patents preventing cheaper competing versions.
And my doctor dropped this one on me: Drug companies fund research to discredit drugs they held patents to when they expire. I have no direct evidence of it, but it does seem to line up for Abilify.
You'll notice all the studies about other risks to Abilify started coming out in 2016, about 1 year after the aripiprazole generics started hitting the market. And at the same time, a new patented long-term injectible, Aripiprazole lauroxil, hit the market.
Aripiprazole is about one of the most effective and well-tolerated drugs in its class.
Yeah, it's obscene. I'm panicking a little because lab work just came back. I'm on one of the least tolerable (but cheap because TNF-alpha inhibitors superceded it) RA drugs. It's working, but it also looks like it's slowly destroying my liver and kidneys, and blood cell counts are marginal. I now get to take blood pressure medication due to yet another side effect, and my hair is falling out.
Time for the insurance fight to get TNF-alpha inhibitors covered, and I'm f*cked if I lose insurance.
That really sucks. I hope you pull through it, here's hoping for the best.
TW: Dark joke
If you do die, please make sure "Killed by <insurance company> because they wouldn't cover the drug that would treat me best" gets put on your tombstone.I'm on Humira, and the story is strikingly similar. It's a special kind of messed up to have to spend hours on the phone getting insurance to accept prescriptions for a medication that then causes other slightly less severe (but still VERY troubling) symptoms.
Also, the whole pricing strategy is such an obvious money grab. The list price is in the thousands, but they offer "savings programs" for those who are persistent which drop the price to ~$10 a month. I'm not sure how this is even legal, because it's artificially circumnavigating supply/demand that would normally have caused the price to drop due to no one being able to afford it.
Direct link to testimony proceedings of the CEOs.
Direct link to testimony proceedings from healthcare advocates and researchers.
C-SPAN is a wonderful resource like that.
It is a travesty that Sanders didn't win the nomination in 2016. Sanders has a level of firey intensity, calling out corruption and inequality would have given a Tump far better run for his money than Clinton.
Edit: Some random commentary as I watch:
Fuck Bill Cassidy. To briefly paraphrase "How dare we witch-hunt these lovely people whom have merely succeeded in capitalism, this is in no way going to help us write meaningful legislation. It's a waste of time." He then goes on to say we need to investigate how the legislation didn't result in drug price decreases for some mysterious reason.... that he heavily implied was undoubtedly the failure of governmental interference in the free market.
I wanna know which Americans can afford to sue to get access to new drugs that other countries don't get. I certainly can't afford to get access to any of the new drugs cause my insurance covers approximately 0% of new ones....compared to Bill's cited "only 20%" that Canada covers....and my insurance is pretty damn good compared to most.
Here's some policy Bill: Forcibly restructure all healthcare-adjacent companies to be strictly non-profit with clearly defined publicly-audited pay grades.
The J&J CEO is full of shit about rebates and discounts. Those mostly only apply for a few initial doses, and often just in the form of "samples" that pharmaceutical reps hand out to doctors while wining and dining them.
Sander's questioning was fire. It was on-brand, and kinda worked to dispel this notion that America is seeing the benefits of all these new drugs when almost nobody can afford them...and that's translating to lower life expediencies than countries that do prioritize lower drug costs. I liked how he directly grilled the CEO to get him to commit to not raising his $51 million dollar compensation package until the $70k treatment is lowered in cost in the USA. That CEO spent many words to avoiding saying the word "No" when asked to reply with "Yes" or "No." The same drug (IIRC) is available in Canada for $900, and is still profitable there....it costs something like $15/year to manufacture.
Ok, I'm easing up on my shade of Bill I threw earlier. He actually asked some genuinely good questions about gene therapy. He's still a free-market-solution guy, so I dislike that...but he's at least asking some of the right questions about how to make the not-free-market-solution which directly impacts his state be able to afford it.
Sen. Murphy from CT asking the right questions: Are the heavily discounted costs other countries paying covering all of the expenses of the drug? Surprise: Yes they are, there are no free rides. More money being paid out to shareholders via buybacks and dividends than spent on all R&D. CEO answer: "If we don't pay dividends, our operations are not sustainable"....big fat Doubt on that one.
The message all of these CEOs are consistently pushing: We price the drugs in the USA according to the value they bring. The hidden, unspoken part of that: We charge as much as we can in the USA, regardless of how much it properly costs to research, develop, and manufacture these drugs.
Tommy "We have the greatest healthcare system in the world" Tuberville of Alabama first blames the federal government for involvement in the free market, but then continues on to throw freebies at the execs, and then also throw out some anti-vaxxer propaganda saying Biden was wrong to kick out almost 90k military members for them refusing the mandatory COVID vaccine. He of course also ignores that the influenza vaccine, as well as pretty much every single other vaccine, is also mandated. Tommy should probably not be serving in Congress, certainly not on this committee.
Sen Patty Murray from WA asks the CEOs to explain in plain terms how they can explain to their constituents why these costs are necessary. They do not introduce any new ideas, they just regurgitate how they have discount and rebate programs (which these constituents have likely either already used or been denied). Or how these countries have to wait 3-5 years for these medicines....neglecting it often takes 10 years in the USA for the patent to expire and become remotely affordable for most people...... They also blame the intermediaries again.....but we've already established these intermediaries are a drop in the bucket.
I notice the republicans are all really giving the CEOs a lot of time to rail on PBMs. Does somebody around here have some expertise that can speak to the good/harm PBMs do? Genuinely curious, but suspicious how all the CEOs point the finger to that and how none of the Democrats really harp on the problems of PBMs. I found this source, which got me started.....and while I have no love of health insurance companies my gut says that this is all deflection to avoid having the public look at the real problem.
I dislike how all of these CEOs are using big numbers like "Over the last 10/20 years we spent X billion dollars." It makes it harder to make like for like comparisons when the senators use single-years. In this case, it was 100 billion over 5 years.... 20 billion a year to mostly go to Eliquis. They continue to fail to explain why they need to do that instead of just bringing it reasonably in line with what the rest of the world pays.
I'm so frustrated by these questions being asked by the people who caused this to happen, have the power to stop it, and will do nothing. The fact that they picked one single type of medication to price control last time explains everything.
Sanders brought this up when one CEO claimed Canada's lack of access to new medicines is reducing quality of care there.
As someone who's worked in Pharmaceutical R&D for almost 8 years now, this has always been the frustrating part to me. Why are our drug prices higher in the US? Healthcare cost in general? - Because they can get away with it. I can tell you that the industry considers the US a very big market, which is mainly due to the lack of real restrictions on drug prices/healthcare cost..... which is just sad for us living here.
You should get in contact with some journalists and drop some internal meeting notes and emails.
I'd suspect that the R & D side of a pharmaceutical company has very little if any contact with the consumer marketing and pricing side of the organization.
My brother-in-law is an oncologist with keen insight into consumer drug costs. He literally stopped practicing because so many of his patients couldn't afford medicines, and the latest/greatest/most-hyped drugs had so little benefit. The example he mentioned was $250,000 for a course of a drug that might prolong the typical patient's life by 3 months.
Thinking he might do better in research, he semi-retired to do pharma drug study consulting, and that's when he heard about the calculations for breakthrough drug pricing. It has little to do with the cost to develop, manufacture, and trial the drug itself. Pricing has a great deal to do with estimates of the monetary value of a human life (in U.S. dollars), the maximum productivity/life expectancy gain from use of the drug, and what the insurance market can bear. By this calculus, a shot of penicillin (or brand-new Antibiotic X) for a kid's ear infection would cost $1,000,000 if left solely to a drug company with a patent monopoly.
That's an even better story to get in front of a journalist.
These are the kinds of tales that give a human element to build support: Workers within a system getting burnt out because they see the harm that it's causing.
Without revealing too much, there's a lot of problems with outpatient facilities due to bad management resulting in ever-increasing burnout from medical staffers whom just want to help their patients. Things like lowering headcount, increasing patients/person, and increasing hours and reducing PTO.
You're probably right about access, but you never know who gets pulled in what meetings and how, or has access to email backups. I've certainly been in a strange few myself.
None of this is secret. The problem is so widespread that doctors use the phrase "financial toxicity" as if it's just another drug side effect.
As we saw with the mutilated, deformed pile of healthcare legislation latterly called Obamacare, the problem isn't just "coverage". As we saw with SARS-CoV-2, new drug discovery for a neglected family of viral diseases was greatly accelerated with targeted Federal funding. Paxlovid and vaccines were profitably distributed with price controls. There's no practical reason we couldn't arrive at the same price negotiation mechanisms as other countries, Federally oversee and guarantee modest margins on generic drug manufacture, combat patent shenanigans, and price control on the basis of comparative efficacy (no more incentives to prescribe barely-tweaked new "me-too" drugs).
The real reason we're in such dire straits is capitalism so unrestrained that politicians, middlemen, and healthcare institutions are partaking of Pharma's ill-gotten gains. In fact, you can go on OpenSecrets.org and see who's taking direct campaign or dark-money cash ($378,585,382 in 2023) from Pharma-related entities.
It would be nice if someone got caught doing such an old-fashioned thing as taking bribes, but those are elegant weapons from a more civilized age where soliciting money to legislate a certain way was actually illegal.
Yea, but you gotta craft the narratives. Facts on their own aren't inspiring that make for blockbuster movies that sway public opinion.
I'm thinking of that nuclear war movie that swayed Reagan.
It's funny that all the docudramas about Purdue Pharma came out after the lawsuit settlements over their opioid promotion. Libel lawsuit threats are a hell of a drug for suppressing coverage of corporate crimes.
There've been some recent cases with international proof and enforcement, but it's still hard to craft a singular dramatic narrative that gets widespread, effective public attention.
At least in the USA, I'm envisioning something starting with a car accident could do the trick. Perhaps escalates into discovering a cancer that they can't afford to treat.
Almost every driver I've met has at least one close call or is actively fighting auto+medical insurance companies to get their medical costs covered. That could be that more-easily-relatible factor.
And here I am, completely forgetting that a major plot line of Breaking Bad was the unaffordability of cancer treatment in the U.S. That's a fictional drama, of course, but again, it's not like anyone is surprised at this point.
I'm also in pharma, generics, but it's still somewhat the same game. Minus the patents and spending millions to extend them. Margins are still 50+%
Orders, pricing, delivery and all that are part of a convoluted system where a lot of the costs are administrative in addition a lot of the infrastructure is built to maximize how much a company can charge the government since it cannot negotiate drug pricing.
Most drugs go through a wholesaler distribution network. The pharma company charges the wholesaler a price slightly below list price. The wholesaler will then sell and deliver the product to the end customer... But it's not like a normal distribution pricing system... Oh no. They sell at contract price which can be significantly less than the list price (can be 90% cheaper). But wait you say... How can you do that and stay in business? Chargebacks. They then request the difference in the price back to the Pharma company. There are systems and middleware and people to manage that whole process. Then there are the fees, rebates. The benefit with the huge range in price between the wholesale acquisition price and the contract price is for when someone isn't on contract. They get sold at list.. this helps raise the price a company can charge the government. When you're 1 of 2 suppliers... This can be a lot of money. Just imagine what happens if one of those companies had to stop manufacturing due to an FDA audit or natural disaster.
This is just one part of the administrative costs. Now add in your doctor, the hospital, health insurance. Probably other shit I don't know about.
There's not much to imagine, there's a huge mess every time a factory gets shut down for failing an FDA inspection, like happened with Ozempic. That one has been in the news, though they quickly started blaming increased demand.
This is in no way a defense of the finance machines behind healthcare-they are diabolical.
Part of the reason prices are cheaper elsewhere is because they are so expensive here. In other words, us subsidizes other places. The corrupt/ineffectual regulatory strucuture here is of course a huge enabling apparatus. Probably because regulators and legislators are holding significant equity posotions in the various finance, development, and distribution companies.
The solution, in my view, for all of the problems to to rebirth civic organizations. Places like Lions and Kiwanis, even the freemasons amd elks. These orgs brought communities together and empowered them to select political leadership that actually mirrored better civic values. Here’s hoping.
This is the standard justification, but do we have actual empirical evidence for it? I understand that having a source of income would theoretically increase willingness to make large investments, but just because econ 101 plausibly justifies it doesn't mean it happens in practice.
From /u/vord's summary of C-SPAN coverage above:
So if other countries aren't getting "free rides", pharmaceutical companies are not actually subsidizing their lower drug prices.
And that ultimately, the CEO has highlighted how demanding ever-increasing profitability is neither sustainable nor desirable for society when the goal is to make the good as accessible as possible.
The ideal goal for society is to create as many wonderful medicines as we can and then distribute them as widely, freely, and quickly as possible. This is directly at-odds with profiting from the creation of drugs, and reveals a paradox in IP law when it comes to such directly beneficial innovations.
Even assuming the ceo gave a truthful answer, I don’t mean to suggest the subsidy is intentional. Rather, it’s something along the lines of, since we can make so much money in the us, we don’t have to fight other countries regulations so hard.
Bernie kindly reminded the CEOs before proceeding that while they're not strictly under oath, it is illegal to knowingly lie to congress.
I gotta say, listening to these things for myself has been 5x more educational than relying on secondhand reports. I suppose that's part of why those news sources don't link to C-SPAN footage.