Why medical bills are killing us.

[youbet]

Who should pay for the research? .

I think there should be less research, especially along the lines of trying to find new wonder cures. Admittedly, it will be hard for the gov't to intervene. Perhaps eliminating tax incentives and reducing patent protection would help. That is, if a new wonder drug, developed without tax incentives and with limited patent protection, returns the cost of development to the developer, good. But if it doesn't and the developer loses money, then that will be incentive to hold our outrageous drug development costs down or spread them around the world more evenly.

I'm particularly annoyed when a new "wonder drug" under patent protection sells for big bux here in the States but later is quietly introduced into other parts of the world for less money. If I recall correctly, bringing these drugs back into the USA is discouraged by FDA and other rules. A big scam IMHO.

Rearch into cost reducing current drugs is OK as long as the resulting reduced manufacturing costs more than offset the cost of the research.

 

[samclem]

I think there should be less research, especially along the lines of trying to find new wonder cures.

I think we'll have to disagree on this one. I want the best and brightest looking for ways to halt cancers, to develop antibiotics to stay one step ahead of disease resistance, to treat debilitating illnesses that steal life from our years. I've got no problem if lots of folks make lots of money doing that, and if private investors are thereby encouraged to put their own money at risk to produce the next big thing. I would have had no objection if Jonas Salk had become wealthier than a Rockefeller.

The problem (IMO) is the drugs that are only marginally better (or even not better at all) but which are hyped to the extreme directly to patients. Doctors write prescriptions because patients ask for the drugs (responding to the ads)--why should the doctor say no? The patient is his customer and he's making a request, the new drug is safe (if also expensive and not any better than the available old alternative) and it doesn't cost the doctor or the patient anything extra. Now, if the patient is paying 10% out of pocket for the drug, then maybe he'll listen when the doc recommends the old standby. The patient is at least sure to give it a try.

 

[DeborahB]

I think there should be less research, especially along the lines of trying to find new wonder cures. Admittedly, it will be hard for the gov't to intervene. Perhaps eliminating tax incentives and reducing patent protection would help. That is, if a new wonder drug, developed without tax incentives and with limited patent protection, returns the cost of development to the developer, good. But if it doesn't and the developer loses money, then that will be incentive to hold our outrageous drug development costs down or spread them around the world more evenly.

I'm particularly annoyed when a new "wonder drug" under patent protection sells for big bux here in the States but later is quietly introduced in other parts of the world for less money. If I recall correctly, bringing these drugs back into the USA is discouraged by FDA and other rules. A big scam IMHO.

Rearch into cost reducing current drugs is OK as long as the resulting reduced manufacturing costs more than offset the cost of the research.

I have to take exception to the concept of doing less research. I am a cancer survivor and have been involved in cancer support groups for 17 years. I've also been involved in other areas of consumer health care issues. I think it's our research priorities that are a large part the issue. We need a lot of basic science research. I don't know that it will cure heart disease or obesity or cancer (which is really many different diseases). It certainly will help develop targeted therapies for many diseases by offering a less systemic approach. Using cancer as an example, we need therapies that target the cancer cells and don't poison the whole person.

I agree, the "wonder drug" approach is awful. Lipitor is a prime example and there are many more. The prices charged here for medication are appalling. But this is a big issue and not one to be resolved easily. Some of those "wonder drugs" are being taken off the market when they go off-patent despite the fact that there are people who need them as therapy.

I'm on a lot of medications. I am not grossly obese or a smoker. I am glad there are some options available for me to help my health - but the costs are obscene.

As I said, I would like to see much more money used for basic scientific research.

 

[DeborahB]

I think we'll have to disagree on this one. I want the best and brightest looking for ways to halt cancers, to develop antibiotics to stay one step ahead of disease resistance, to treat debilitating illnesses that steal life from our years. I've got no problem if lots of folks make lots of money doing that, and if private investors are thereby encouraged to put their own money at risk to produce the next big thing. I would have had no objection if Jonas Salk had become wealthier than a Rockefeller.

The problem (IMO) is the drugs that are only marginally better (or even not better at all) but which are hyped to the extreme directly to patients. Doctors write prescriptions because patients ask for the drugs (responding to the ads)--why should the doctor say no? The patient is his customer and he's making a request, the new drug is safe (if also expensive and not any better than the available old alternative) and it doesn't cost the doctor or the patient anything extra. Now, if the patient is paying 10% out of pocket for the drug, then maybe he'll listen when the doc recommends the old standby. The patient is at least sure to give it a try.

+1 (we cross-posted)

 

[youbet]

I think we'll have to disagree on this one. I want the best and brightest looking for ways to halt cancers, to develop antibiotics to stay one step ahead of disease resistance, to treat debilitating illnesses that steal life from our years.

Yes, we will have to disagree on that one. Obviously, I too favor cures for cancer, etc. And I too want "the best and brightest looking for ways to halt cancers, to develop antibiotics to stay one step ahead of disease resistance, to treat debilitating illnesses that steal life from our years."

Our difference seems to be on focus. I think we can acheive most of what we both would like in drug developement without a 100% allocation of health care resources in that area. And I think the costs of the research can be spead around the world more equitably.

I would have had no objection if Jonas Salk had become wealthier than a Rockefeller.

Since the resources to make Salk wealthier than a Rockefeller would have come at the expense of other members of society, that might have been a tad on the painful. Those cheap innoculations at the clinic might have required a family's life savings just to save junior's life.

 

[youbet]

As I said, I would like to see much more money used for basic scientific research.

Just curious, what areas of health care would you be willing to pull resources from in order to have more money used for basic scientific research?

Using today as a baseline, would you like 10%, 25%, 50% or XX% more spent on basic scientific research at the expense of other health care needs?

Isn't the issue of having finite resources a bitch?

 

[DeborahB]

Just curious, what areas of health care would you be willing to pull resources from in order to have more money used for basic scientific research?

Using today as a baseline, would you like 10%, 25%, 50% or XX% more spent on basic scientific research at the expense of other health care needs?

Isn't the issue of having finite resources a bitch?

I don't think we have to pull resources from health care to do more basic research - just put more $ into doing research. Pull it from one of the many money-wasting and possibly redundant areas of the government budget. I don't know which one.

But it doesn't have to come out of the healthcare "pot", IMHO. In fact, had we gone to single payer insurance.... who knows, we might have saved money?

Of course if you want to discuss pot...

 

[youbet]

just put more $ into doing research. Pull it from one of the many money-wasting and possibly redundant areas of the government budget. I don't know which one.

As I said, resource allocation is tough stuff. No one wants to recognize that resources are finite and no one wants to recognize that we can't allocate 100% of our resources to each of a zillion different projects and initiatives. The 100% has to be spread between ALL of them.

Regarding your idea of pulling the money from one of the many money wasting and possibly redundant areas of the government budget............ based on the discussions in Washington today, every penny the gov't planned on spending in 2013 is absolutely, positively critical. And you want to pull some for your projects? Not possible according to our politicians. Every penny they're spending, and more, is needed to be spent just as they've planned. Aren't they jerks?

Anyway, I'm delighted you had favorable results with your cancer. I recently had a friend go through chemo for NHL and he was told that the available drugs just a few years ago would have been harder on his body and less likely to have cured him. Still, my point is about resource allocation. Cures are good. But do we spend 100%, 99%, 98%, XX% of our total resources on developing them?

If we can't do everything we want, what do we do?

 

[Texas Proud]

I think there should be less research, especially along the lines of trying to find new wonder cures. Admittedly, it will be hard for the gov't to intervene. Perhaps eliminating tax incentives and reducing patent protection would help. That is, if a new wonder drug, developed without tax incentives and with limited patent protection, returns the cost of development to the developer, good. But if it doesn't and the developer loses money, then that will be incentive to hold our outrageous drug development costs down or spread them around the world more evenly.

I'm particularly annoyed when a new "wonder drug" under patent protection sells for big bux here in the States but later is quietly introduced into other parts of the world for less money. If I recall correctly, bringing these drugs back into the USA is discouraged by FDA and other rules. A big scam IMHO.

Rearch into cost reducing current drugs is OK as long as the resulting reduced manufacturing costs more than offset the cost of the research.

One of the big problems with this line of thinking is that nobody knows what will happen with the research....

IOW, research trying to find the unknown... sometimes you find it, most of the time you do not...

I do not see how we would be living as long as we do without this research... also, research is not limited to drugs... there are a lot of new machines and procedures that are better than previous ones because of research...


And you last stmt just makes no sense... how do you know BEFORE you do any research if it will be reduce mfg costs...

 

[youbet]

One of the big problems with this line of thinking is that nobody knows what will happen with the research....

IOW, research trying to find the unknown... sometimes you find it, most of the time you do not...

I do not see how we would be living as long as we do without this research... also, research is not limited to drugs... there are a lot of new machines and procedures that are better than previous ones because of research...

I understand. But remember, we also don't know what the impact of shifting additional resources away from other endeavors and into drug research will have on society. As discussed above, perhaps the pirated resources would have just been wasted on, for example, dumb gov't projects. Or, maybe those resources would have been used to keep terrorists from getting poison into the Dallas drinking water supply. Or have payed for a doc to work in a impoverished area. We don't know. We're allocating some percentage of our resources to drug research today. How much more do you want to pull from other endeavors? When will we know we've hit the "sweet spot" and aren't spending money on diminishing returns?

Resource allocation is hard. And controversial.

And you last stmt just makes no sense... how do you know BEFORE you do any research if it will be reduce mfg costs...

I can tell you didn't work in manufacturing process development. Before beginning a manufacturing process cost reduction project we'd identify what we would change and what the resulting savings would be. For example, we might note that adding a clean room environment to the process at a cost of $1MM would eliminate the $2MM of rejected lots we had last year. We'd base this on research that showed working in the clean room environment reduced the ppm level of contaminants by X%. And so on and so forth. Then we'd do the project, measure the outcome, and hopefully meet our goal. We weren't always successful but generally anticipated savings targets were met.

 

[samclem]

Still, my point is about resource allocation. Cures are good. But do we spend 100%, 99%, 98%, XX% of our total resources on developing them?

If we can't do everything we want, what do we do?

Let the drug companies and investors figure this out. If we fix the system so that it more closely resembles a market (where those receiving a benefit get the freedom to decide how much it is worth to them), then the drug companies will be rewarded according to the true value of their products. It'll be very clear to them (and to investors) how much to spend on research. Nobody tells Boeing or Ford how much to spend except the folks running the company.

A bigger problem is the need to find a way to incentivize private investment in basic research --stuff that can't be patent protected and won't result in a product in the near term. Schools, foundations, etc do good work, but it's not an especially efficient way of doing things. There would be more money and (more importantly) more efficiency and focus if business principles were in play. But, I do not know how to do that.

 

[youbet]

Let the drug companies and investors figure this out. If we fix the system so that it more closely resembles a market (where those receiving a benefit get the freedom to decide how much it is worth to them), then the drug companies will be rewarded according to the true value of their products.

I have no problem with that. You're talking about letting a more or less free market make resource allocation decisions. Remove tax incentives, lighten up patent protections (figuring out how much to lighten up will be controversial) and let the free market roll.......... That would be congruent with my original position.

We're probably more in agreement that it first seemed.

 

[Texas Proud]

I understand. But remember, we also don't know what the impact of shifting additional resources away from other endeavors and into drug research will have on society. As discussed above, perhaps the pirated resources would have just been wasted on, for example, dumb gov't projects. Or, maybe those resources would have been used to keep terrorists from getting poison into the Dallas drinking water supply. Or have payed for a doc to work in a impoverished area. We don't know. We're allocating some percentage of our resources to drug research today. How much more do you want to pull from other endeavors? When will we know we've hit the "sweet spot" and aren't spending money on diminishing returns?

Resource allocation is hard. And controversial.

I can tell you didn't work in manufacturing process development. Before beginning a manufacturing process cost reduction project we'd identify what we would change and what the resulting savings would be. For example, we might note that adding a clean room environment to the process at a cost of $1MM would eliminate the $2MM of rejected lots we had last year. We'd base this on research that showed working in the clean room environment reduced the ppm level of contaminants by X%. And so on and so forth. Then we'd do the project, measure the outcome, and hopefully meet our goal. We weren't always successful but generally anticipated savings targets were met.

Agreed that research allocation is hard... which is why the free market is better at allocating resources than gvmt fiat....


Your last example is not valid... doing drug research is not the same as doing a cost study in a manufacturing environment... there was no research in your example.. there was a cost/benefit analysis....

The 'research' was the group that actually did the testing of the first clean room to determine IF you could reduce contaminants.... someone had to build the clean room and determine the results... and maybe after spending that $1 million to build the first one, it was determined that it saved very little... therefor, nobody else was going to build clean rooms...

After the reseach is done, it is easy to do that cost/benefit analysis you mentioned... but prior to it being done, you only have an idea (or WAG) of how much it will save... but you are not sure until it has been done...

 

[youbet]

Agreed that research allocation is hard... which is why the free market is better at allocating resources than gvmt fiat....

More agreement. Today, there is lots of politics and gov't involved in resource allocation decisions involving research.

Your last example is not valid... doing drug research is not the same as doing a cost study in a manufacturing environment... there was no research in your example.. there was a cost/benefit analysis....

The 'research' was the group that actually did the testing of the first clean room to determine IF you could reduce contaminants.... someone had to build the clean room and determine the results... and maybe after spending that $1 million to build the first one, it was determined that it saved very little... therefor, nobody else was going to build clean rooms...

After the reseach is done, it is easy to do that cost/benefit analysis you mentioned... but prior to it being done, you only have an idea (or WAG) of how much it will save... but you are not sure until it has been done...

OK, I'm not going to argue semantics with you. I was never a theoretical scientist working on open-ended research. I was a blue-collar factory worker focused on making stuff. Admittedly, things like research, cost-benefit analysis, design, development, performance improvement, variation reduction and repeatability and similar start to blend together for me. I always had dollar goals and deadlines to meet. Never got to just play, open-ended, in the lab to see what might happen.......

So, OK, whatever you say......

 

[DeborahB]

As I said, resource allocation is tough stuff. No one wants to recognize that resources are finite and no one wants to recognize that we can't allocate 100% of our resources to each of a zillion different projects and initiatives. The 100% has to be spread between ALL of them.

Regarding your idea of pulling the money from one of the many money wasting and possibly redundant areas of the government budget............ based on the discussions in Washington today, every penny the gov't planned on spending in 2013 is absolutely, positively critical. And you want to pull some for your projects? Not possible according to our politicians. Every penny they're spending, and more, is needed to be spent just as they've planned. Aren't they jerks?

Anyway, I'm delighted you had favorable results with your cancer. I recently had a friend go through chemo for NHL and he was told that the available drugs just a few years ago would have been harder on his body and less likely to have cured him. Still, my point is about resource allocation. Cures are good. But do we spend 100%, 99%, 98%, XX% of our total resources on developing them?

If we can't do everything we want, what do we do?

Thanks I didn't have to have chemo (which was unusual) - just major surgery - and am cancer-free as far as I know. Despite that, it totally screwed up my life.

The simplemindedness and stupidity of politics never fails to impress me. They continue to exceed expectations... but not (generally) in a good way. All programs are essential....

The reason I'm focused on basic science research is it's applicable to more than one disease. AIDS research was like that, for example - a lot of information came out of that research that could be applied in other areas. It's easier and smarter to justify funding and spend money on research that might have broad applications.

The system is FUBAR.... I think, at the moment.

 

[explanade]

Some of the biggest drug companies are based in Switzerland. But the Swiss, who are rich, pay less than we do.

Oh and here's another dirty secret. The biggest drug companies spend more on marketing than on R&D. Not just TV commercials but hiring attractive women to call on doctors to prescribe their products.

They reap huge margins too and even if a patent expires, they modify a few molecules and get a new patent.

 

[DeborahB]

Oh and here's another dirty secret. The biggest drug companies spend more on marketing than on R&D. Not just TV commercials but hiring attractive women to call on doctors to prescribe their products.

If you're in a doctor's office, you can almost always tell who the pharmaceutical rep is: expensive suit, extremely careful grooming - I believe I heard they like women who were cheerleaders. I'm serious!

 

[youbet]

I believe I heard they like women who were cheerleaders.

I like 'em too! Ya got a problem with that?

 

[youbet]

Some of the biggest drug companies are based in Switzerland. But the Swiss, who are rich, pay less than we do.

So that's why my doc, that no good bastard, wears a Swiss watch and has a bowl of Swiss chocolates on his desk! Once he's had his way with the Swiss cheerleader, looked at his Swiss watch and munched on the Swiss chocolates, he bills me for it all!

 

[DeborahB]

So that's why my doc, that no good bastard, wears a Swiss watch and has a bowl of Swiss chocolates on his desk! Once he's had his way with the Swiss cheerleader, looked at his Swiss watch and munched on the Swiss chocolates, he bills me for it all!

He obviously needs to learn to share.

 

[Midpack]

I'll help. You will love this one Midpack!

However, smokers die some 10 years earlier than nonsmokers, according to the CDC, and those premature deaths provide a savings to Medicare, Social Security, private pensions and other programs.

Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents.

Do smokers cost society money? - USATODAY.com

It's all how you interpret the data, I guess. It is kind of humorous that the data could be interpreted different ways from what is traditionally believed. I would certainly guess the bean counters at Medicare and the Social Security Offices would probably prefer everyone over the age of 18 to light up.

A provocative article indeed.

Kip Viscusi is a Vanderbilt economist as you noted, earlier at Duke University and also a prominent paid consultant of the tobacco industry and Phillip Morris specifically going back about 20 years.

Viscusi has stated that “As measured by short-run price responsiveness, people are no more addicted to cigarettes than they are to lawyers or the opera” people are no more addicted to cigarettes than they are to lawyers or the opera.”

He was used as an expert in Mississippi's lawsuit against the tobacco industry.

So I'm not quite ready to hitch my wagon to your source.

I wish I could see the numbers he used to arrive at his conclusions, I can't find them. Is he saying the average lifetime health care costs for a smoker are lower than the average non-smoker? Or is he saying the costs to society are lower due by using reduced Soc Sec and pension benefits and/or cigarette taxes to offset?

W. Kip Viscusi - SourceWatch

http://www.nber.org/papers/w4891.pdf?new_window=1

 

[Mulligan]

A provocative article indeed.

Kip Viscusi is a Vanderbilt economist as you noted, earlier at Duke University and also a prominent paid consultant of the tobacco industry and Phillip Morris specifically going back about 20 years.

Viscusi has stated that “As measured by short-run price responsiveness, people are no more addicted to cigarettes than they are to lawyers or the opera” people are no more addicted to cigarettes than they are to lawyers or the opera.”

He was used as an expert in Mississippi's lawsuit against the tobacco industry.

So I'm not quite ready to hitch my wagon to your source.

I wish I could see the numbers he used to arrive at his conclusions, I can't find them. Is he saying the average lifetime health care costs for a smoker are lower than the average non-smoker? Or is he saying the costs to society are lower due by using reduced Soc Sec and pension benefits and/or cigarette taxes to offset?

W. Kip Viscusi - SourceWatch

http://www.nber.org/papers/w4891.pdf?new_window=1

I certainly don't know "the truth", Midpack, but there are other sources/articles all over that says that. That is why I said it is how you want to interpret or maybe manipulate the data. I know I have read before that smokers generally do not get Alzheimer's thus stay out of expensive nursing homes due to the fact they die earlier. Also, I have read that lung cancer is generally a "cheaper cancer" to treat due to the fact it's generally not detected early and is in an advanced state when diagnosed, thus patient doesn't live as long. Whether this is all true, I don't know. But one thing is for sure, I am not going to start smoking to help lower healthcare costs for society.

 

[easysurfer]

Why are medical bills killing us?

Let's see..some that come to mind....

- many folks don't take care of their own health

- drug companies make big money

- costs vary so much that often cost isn't known until after the fact

 

[bUU]

The issue is your condescending and abrasive manner of posting.

I'll appreciate your assistance in rewording what I write to get the same questions answered, without offending the person I'm asking.

I don't think we have to pull resources from health care to do more basic research - just put more $ into doing research. Pull it from one of the many money-wasting and possibly redundant areas of the government budget. I don't know which one. But it doesn't have to come out of the healthcare "pot", IMHO. In fact, had we gone to single payer insurance.... who knows, we might have saved money?

I agree. We don't need to choose between various good options. We need to use our innovative minds to find a way to capitalize on all of the good options.

 

[Katsmeow]

I wish I could see the numbers he used to arrive at his conclusions, I can't find them. Is he saying the average lifetime health care costs for a smoker are lower than the average non-smoker? Or is he saying the costs to society are lower due by using reduced Soc Sec and pension benefits and/or cigarette taxes to offset?

I have read at various places that lifetime health costs for the obese and those for smokers are less than those for the non-obese and the non-smokers. This is because the obese and smokers tend to die sooner and therefore have lower lifetime health costs even after accounting for treating for illnesses associated with smoking and obesity. I see more support for this as to smoking (since they die earlier than the obese). However, how credible that research is I don't know:

The Burden of Healthy Living - Hit & Run : Reason.com

PLOS Medicine: Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure [Dutch article -lowest lifetime health costs for smokers, obese higher but not as high as non-obese non-smokers - This is the article most everyone cites to]

Alcohol, Obesity and Smoking Do Not Cost Health Care Systems Money - Forbes

Lifetime Medical Costs Of Obese People Actually Lower Than Costs For Healthy And Fit, Mathematical Model Shows

Center for Business & Public Policy

But not everyone agrees - Death, Taxes, Soda and Fat - NYTimes.com [talking about obesity not smoking]

As America's waistline expands, costs soar | Reuters [Again, about obesity not smoking]