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Old 12-24-2016, 11:23 AM   #121
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Let's divide a drug price into two portions. Lets say the pill costs $100 of which $70 is development costs and $30 is manufacturing costs for the pill.
Don't forget about marketing/advertising costs.
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Old 12-24-2016, 11:24 AM   #122
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I don't buy this. We never agreed to subsidize other countries' drug prices. Why would this be allowed?
Frankly the US does subsidize the cost of drugs in other countries. European health systems regulate drug prices because market forces haven't worked well in healthcare to keep the costs down, as is evident in the US system.
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Old 12-24-2016, 11:28 AM   #123
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Originally Posted by Texas Proud View Post

I just did an estimate on what it would cost me and DW... with $40K income it was $273 for a silver plan.... they did not show any options... I am sure you can get them if you go to healthcare.gov....

So people who are saying $900 per month are not taking into account the ACA credit OR they are making a boatload of money....
Yes, going off of COBRA this month I was SHOCKED at the $1100 / month subsidy DW & I will receive for a Silver plan next year, if we manipulate our MAGI to $40K or less.

I'm not ashamed to say that I will play by THOSE rules until the system changes.


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Old 12-24-2016, 11:34 AM   #124
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So these companies are selling drugs at much cheaper prices in the US than the American companies? I don't think so.
Many other countries are fixing the costs of drugs. I think the argument is that any country not fixing the prices of drugs will likely be paying for some of the countries that do. Our regulatory burden is very high in the US for drugs and devices. There are plenty of drugs in Europe unavailable to the US because they haven't gotten though the regulations. Hell I think there is quite a bit of food we don't allow here that's eaten in large quantities int he rest of the world.
European and Japanese drug approval standards are at least as high as those used in the US. In Europe the drug approval path is more complicated than in the US because of both EU and national agencies so I don't think the approval mechanisms is a big part of the drug cost differences. I think those come down to price controls in Europe as the Governments are not afraid to regulate a market when it is not free enough to provide value to the customer.
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Old 12-24-2016, 11:40 AM   #125
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Yes, going off of COBRA this month I was SHOCKED at the $1100 / month subsidy DW & I will receive for a Silver plan next year, if we manipulate our MAGI to $40K or less.

I'm not ashamed to say that I will play by THOSE rules until the system changes.


_B
I was amazed that because my individual income was around $12k/year I had a choice between $0 Medicaid premiums or getting a $475/month check towards my ex-employer's health insurance full premium of $500/month. I chose the check for continuity of coverage and because my ex-employer's plan is a Cadillac one.
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Old 12-24-2016, 12:44 PM   #126
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So people who are saying $900 per month are not taking into account the ACA credit OR they are making a boatload of money....
401% of the FPL is not a "boatload" of money. It's not destitute, though in high cost areas it's barely even a middle class income, but not a boatload. That said, unless you are well over the 400% cliff, many households can probably find a way to engineer an MAGI under the cliff, especially if they have significant earned income; more so if they are over 50.
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Old 12-24-2016, 02:46 PM   #127
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401% of the FPL is not a "boatload" of money. It's not destitute, though in high cost areas it's barely even a middle class income, but not a boatload. That said, unless you are well over the 400% cliff, many households can probably find a way to engineer an MAGI under the cliff, especially if they have significant earned income; more so if they are over 50.
Some households acquired business interests prior to ACA where income engineering is not possible. Why should these folks be slammed with unaffordable health insurance premiums (according to the ACA's definition of 'affordability')?
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Old 12-24-2016, 02:46 PM   #128
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Frankly the US does subsidize the cost of drugs in other countries. European health systems regulate drug prices because market forces haven't worked well in healthcare to keep the costs down, as is evident in the US system.
If this is true, then Americans are being shafted. Who is supposed to be looking out for our interests so this does not happen?
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Old 12-24-2016, 03:35 PM   #129
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If this is true, then Americans are being shafted. Who is supposed to be looking out for our interests so this does not happen?
There are plenty of articles and papers that describe the higher cost of drugs in the US. It's a common thing for people to get their prescription drugs in Canada or Mexico to avoid the higher prices.

You should talk to your insurance company and representative politicians if this annoys you.
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Old 12-24-2016, 05:33 PM   #130
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Some households acquired business interests prior to ACA where income engineering is not possible. Why should these folks be slammed with unaffordable health insurance premiums (according to the ACA's definition of 'affordability')?
Can you provide an example to clarify the point? The ACA is designed to limit premiums to an "affordable" level, and even provides OOP cost-sharing subsidies for some households at lower income levels. What type of "business interest" causes a family to have an income situation where health care premiums are unaffordable by ACA standards.
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Old 12-24-2016, 05:56 PM   #131
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Can you provide an example to clarify the point? The ACA is designed to limit premiums to an "affordable" level, and even provides OOP cost-sharing subsidies for some households at lower income levels. What type of "business interest" causes a family to have an income situation where health care premiums are unaffordable by ACA standards.
(1) Anyone with a MAGI just above the cutoff for subsidies in a county where ACA health insurance premiums have skyrocketed may need to spend more than 8.13% of his/her MAGI to acquire the least expense Bronze plan, which according to the ACA would represent 'unaffordable' insurance for that unfortunate soul. That happens to be the case in my county.

(2) There many examples of business interests where income minimization isn't possible. For example, being in a partnership where the majority of partners desire income maximization rather than income minimization or income 'management'. Each partner's share of the partnership's overall net income is included in that partner's MAGI. Another example would be having a minority interest in an S-corp.
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Old 12-24-2016, 06:42 PM   #132
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............You should talk to your insurance company and representative politicians if this annoys you.


I think "representative politician" is an oxymoron.
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Old 12-24-2016, 07:11 PM   #133
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If this is true, then Americans are being shafted. Who is supposed to be looking out for our interests so this does not happen?
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...You should talk to your insurance company and representative politicians if this annoys you.
I don't know if talking to your insurance company would help, but it might help to talk to your policitians.

Not as an individual, but you need a large crowd turn-out. And also if everyone brings a pitchfork.
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Old 12-24-2016, 08:53 PM   #134
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Yep the US system is very expensive and to make things worse the US has a lower life expectancy than most of the countries on the expenditure graph you posted.
The life expectancy differences have little to do with health care & much to do with lifestyle/choices - teenage pregnancies, murder, traffic deaths, drug overdoses.
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Old 12-24-2016, 09:02 PM   #135
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For every US company like Pfizer there's a European company like GSK, Bayer or Sanofi doing similar research and the costs or drugs in Europe are no where near as high as in the US. So there is world class research and drug innovation outside the US. I think US pharma has done a good PR job convincing us that the current US cost structures are necessary for innovation and good care, much like the rest of the US healthcare industry which is part of the reason why the US pays so much more than other countries for an arguably poorer system.
First, the data I've seen shows the US doing far & away the most drug research (& that doesn't include equipment. testing/procedures innovations.). It's not one for one in other countries. Second, the US does allow pharma to recover it's research costs in pricing where other countries don't. So US residents shoulders the entire research cost - my point that we ought to claw back those costs on imports from countries that just pay the marginal price for5 the last pill produced. Third, are USA drug companies moving research to ohter countries because it's done cheaper there? I'm not seeing it.
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Old 12-24-2016, 09:06 PM   #136
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Frankly the US does subsidize the cost of drugs in other countries. European health systems regulate drug prices because market forces haven't worked well in healthcare to keep the costs down, as is evident in the US system.
Agree we do subsidize them - but by us accepting the other countries preventing research costs from being recovered by regulating to pay only the marginal costs of drugs. We need to make them pay for the research costs one way or another rather than being on the shoulders of USA residents only.
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Old 12-24-2016, 10:24 PM   #137
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Why are bronze plans crappy? I can afford any plan I want. I will never qualify for a subsidy. I chose to buy the bronze HSA plans because I think it makes sense to pay for as much of the medical care for my family myself and buy protection for something I couldn't really afford.
The only reason I might complain about bronze plans is they are forced to cover stuff I would rather not have covered (pediatric dental, wellness visits, addition treatment etc).

It is crappy for the people who cannot afford to pay for the huge deductible....
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Old 12-24-2016, 10:29 PM   #138
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For every US company like Pfizer there's a European company like GSK, Bayer or Sanofi doing similar research and the costs or drugs in Europe are no where near as high as in the US. So there is world class research and drug innovation outside the US. I think US pharma has done a good PR job convincing us that the current US cost structures are necessary for innovation and good care, much like the rest of the US healthcare industry which is part of the reason why the US pays so much more than other countries for an arguably poorer system.

I would bet money that the drug companies you cited as being non-US are charging a much higher price on their drugs here then over there...

I think it is a US political problem that will not get fixed until the gvmt starts to do what other countries do... and since the US gvmt pays big money for health care, they should be able to do it...

But I will say... it is not only drugs that we pay way too much for.... look at the F-35 fighter jet.... costs way out of control... and the life cost of the system is over $2 trillion I had read someplace....
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Old 12-24-2016, 10:34 PM   #139
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401% of the FPL is not a "boatload" of money. It's not destitute, though in high cost areas it's barely even a middle class income, but not a boatload. That said, unless you are well over the 400% cliff, many households can probably find a way to engineer an MAGI under the cliff, especially if they have significant earned income; more so if they are over 50.
A boatload when compared to low income people who are getting a credit.... not when compared to higher earners like many on this board....

The stmt was in context of people saying they cannot afford to buy insurance.... and I say they are not looking properly or are just lying...
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Old 12-24-2016, 10:40 PM   #140
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(1) Anyone with a MAGI just above the cutoff for subsidies in a county where ACA health insurance premiums have skyrocketed may need to spend more than 8.13% of his/her MAGI to acquire the least expense Bronze plan, which according to the ACA would represent 'unaffordable' insurance for that unfortunate soul. That happens to be the case in my county.

(2) There many examples of business interests where income minimization isn't possible. For example, being in a partnership where the majority of partners desire income maximization rather than income minimization or income 'management'. Each partner's share of the partnership's overall net income is included in that partner's MAGI. Another example would be having a minority interest in an S-corp.

I do not understand what you are saying about partnership income.... if the partner is earning more than the 400%... they are making decent money.... same for an S-Corp....

I have a minor interest in an S-Corp... my income from it is in the $6 to $8K per year... yes, I put that down as income... I still get an ACA credit...


So yes, the cliff is an important number.... if you go over.... no credit... that is just the way it is... that happened to me the first year when I sold too much stock and had big cap gains, some salary for the year and DW had some also... I still bought insurance for the family....
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