Bernstein's number one threat to the US

[brewer12345]

As the items got more expensive, the cost was mind boggeling. I remember one.  A new toilet seat $396.00  Some items had 3000% markups.  The interviewer just kept asking WHY?  WHY?  WHY??

Part of this is clearly gummint waste, but a lot of it is not.  I have owned sharres of PLMD for several years now.  They are in a couple of businesses, but basically they supply diabetes testing materials and pharmaceuticals to Medicare beneficiaries via mail-order.  They have to comply iwth over 100,000 pages (!) of regulations.  Guess how much that costs?  Then there are "qui tam" lawsuits to deal with.  These are based on a Civil War era law that allows anyone to sue a contractor to the gummint (even without the gummint having anything to do with the suit) and if they win, the initiator of the suit gets part of the payout.  This stuff is expensive and makes the business far more risky than it needs to be.  As a result, suppliers price their products appropriately.  The toilet seat probably costs $18.  Complying with the useless regulations and dealing with lawsuit risk costs another $380.

 

[mikew]

A lot of doctors won't accept Medicare patients

How do other countries do it.  Many third world countries have wonderful medical hospitols and care for their people dispite their low standard of living.

One way is to let Americans pay for development of new drugs then demand discounts.

Another is that the average health care is good but difficult diseases are not treated as well as in the US.

 

[SteveR]

 Complying with the useless regulations and dealing with lawsuit risk costs another $380.

One reason for health care costs going up so fast for so long is litigation costs.  FDA recently said that they may have been a bit premature in ordering a recall of Vioxx.  That has not stopped the ambulance chasers going after Merk.  4000 lawsuits are pending so far.  

The approval process for drugs takes 12-14 months and requires tons of clinical data to support the safety of the drug.  However, no matter how carefully done they are there is always a chance of some condition or drug combination that can cause a problem that is not seen until the drug is used in the general public.  That is why FDA requires reporting of additional experience data for the first several years after a drug is approved.  

 

[justin]

Still the $18 aspirin price strikes me as very high.

I know I've been to the doctor for back pain on one occasion, and he said "take some Advil, and stretch a little". I paid $15 to have him tell me to take 2 advil? Of course the ins. co. paid another $50 or so. The $18 for aspirin doesn't seem that high, since a doctor probably recommended it (his time is valuable). That was probably his standard charge for a 0.1 hour unit of time.

 

[wabmester]

The spread of generic drugs replacing inovator drugs is a huge cost savings for consumers but will eventually be seen in the reduction of new and inovative drugs.  The easy ones have already been discovered and the costs to develp and manufacture new drugs is huge.

Perhaps this is naive of me, but don't you think the genome map will basically create a new inflection point in drug creation? I have no idea what drug development entails, but I imagine it is currently extremely hit and miss. For many of the current crop of drugs, they have no idea what the mechanism of action is. In theory at least, mapping the human genome should allow researchers to directly compare genes of sick vs well people for a wide variety of maladies, and then target very specific expression control, protein synthesis control, etc.

I'm not sure when it'll happen, but personally I look forward to a new wave of drugs in which the mechanism of action is actually known. I was never a big fan of the current sledge hammer approach to medicine.

 

[SteveR]

I know I've been to the doctor for back pain on one occasion, and he said "take some Advil, and stretch a little".  I paid $15 to have him tell me to take 2 advil?  Of course the ins. co. paid another $50 or so.  The $18 for aspirin doesn't seem that high, since a doctor probably recommended it (his time is valuable).  That was probably his standard charge for a 0.1 hour unit of time. 

I believe the poster was talking about hospital charges and not individual Dr. office visit charges.  The $18 aspirin includes a ton of mark up for Dr., nurses, and overhead.  The medical products industry sells their wares to most hospitals through buying groups where they may represent 100s of hospitals.  The prices are lock by contract for all members of the buying group for the specified duration of the contract.  So, prices are frozen for the hospital and the lowest rate possible.  That gives them a lot of room for mark up.  That $18 aspirin actually cost the hospital less than a penny each.

The next time you get an IV remember that the manufacturer sold that to the hospital for less than you can get a liter of Coca Cola at the grocery store.