Medicare For All

[Swerd]

I held off commenting in this thread after it came back to life, because it just seems to go in circles, with no minds being changed. I expect that the circular arguments will continue until everybody gets tired of repeating himself. However, I will address a few comments, but I won't directly quote anyone…

Agreed – I feel the same.

It was suggested that little medical innovation is occurring in Canada - presumably because of our universal healthcare system. There is no question that most medical research happens in the US. But, if you look at it from a population perspective, the US doesn't really stand out.

What countries have led the world in medical research and innovation during the time period between 1995 and 2014?

Answer (1 of 6): Of course everyone can see that the US pumps out a lot of medical research. We are all grateful for that. The US also has a large and rather wealthy population as well. We cannot expect a small country like Sweden or Australia to be able to complete on the basis of sheer volume ...

www.quora.com

I spent a career working in the drug development industry in the USA, both private and US Government. When this article looked at medical R&D based by nation and population size, it ignores a major aspect of big pharmaceutical companies. Most are multi-national. For example, a company, such as Hoffman-La Roche (Roche), may have it's headquarters in Switzerland, it has major branches elsewhere including Japan and multiple locations in the USA. One of these branches, Genentech in San Francisco, was a major independant corporation which Roche purchased in 2009 for $47 billion. As a result, comparing R&D effort based on a nation's population is misleading.

On a related note, apparently the US subsidizes drug prices in the rest of the world.

The true story of America’s sky-high prescription drug prices

Why does an arthritis drug that costs $2,669 here cost $822 in Switzerland? It all boils down to one policy decision.

www.vox.com

I liked this article. It describes how the US fails to regulate drug prices, but doesn't explain how this bizarre practice developed. It was entirely a political decision, based on very large donations from Big Pharma companies to US politicians!

While this may be true, it's only because the US government can't/won't step in to exercise any control over prices. It's entirely likely that if drug prices were regulated, investment in research would drop. So, it could comes down to a choice between research to bring new drugs to market and access to existing drugs for all who need them.

In my own experience, the US government heavily subsidizes medical and pharmaceutical R&D in this country. Most medical schools and medical research institutions in the USA rely on federal research support in the form of grants from the National Institutes of Health, the National Cancer Inst., and the National Science Foundation. Many researchers owe their careers to this federal support. Similarly these medical schools and research institutes owe their existence to federal support. If an individual researcher receives a federal research grant, his/her employer (a university medical school or research institute) takes at least 50% to 75% overhead. If a grant is for $2 million/year, the employer takes at least half that much, $1 million/year, as it's share of the goodies.

In my own field, cancer R&D, much of the expensive and time consuming clinical trials was performed by people working at these federally supported institutions. True, money also came from the pharmaceutical companies, who owned the rights to the new drugs. But little of this R&D could happen without the major contribution from US taxpayers.

As a result of all this, I think it's absolutely wrong – to the point of being politically corrupt – to allow the pharmaceutical companies to set drug prices in the USA without regulation.

 

[Mikado463]

Swerd, thank you for your follow up !

 

[Irvrobinson]

I liked this article. It describes how the US fails to regulate drug prices, but doesn't explain how this bizarre practice developed. It was entirely a political decision, based on very large donations from Big Pharma companies to US politicians!

I agree. Lobbying and political contributions, especially PACs, pollute everything in American politics. Unfortunately, all of this nonsense is protected under the 1st Amendment.

In my own experience, the US government heavily subsidizes medical and pharmaceutical R&D in this country. Most medical schools and medical research institutions in the USA rely on federal research support in the form of grants from the National Institutes of Health, the National Cancer Inst., and the National Science Foundation. Many researchers owe their careers to this federal support. Similarly these medical schools and research institutes owe their existence to federal support. If an individual researcher receives a federal research grant, his/her employer (a university medical school or research institute) takes at least 50% to 75% overhead. If a grant is for $2 million/year, the employer takes at least half that much, $1 million/year, as it's share of the goodies.

The numbers are big. The NIH + NCI budgets sum to nearly $50B/year, but these are basic research, not product-specific drug R&D, or am I wrong? The drug industry claims that bringing a new drug to market costs $2.6B in R&D, but a paper I recently read claims the cost is more like $700M. I'm not expert enough to judge between the two claims, but I suspect the lower estimate is closer to reality.

A Tough Road: Cost To Develop One New Drug Is $2.6 Billion; Approval Rate for Drugs Entering Clinical Development is Less Than 12%

Developing a new prescription medicine that gains marketing approval is estimated to cost drugmakers $2.6 billion according to a recent study by Tufts Center for the Study of Drug Development and published in the Journal of Health Economics. This is

www.policymed.com

Cost of Developing a Single Cancer Drug

This analysis of US Securities and Exchange Commission filings provides a contemporary estimate of research and development spending to develop 10 new cancer drugs.

jamanetwork.com

In my own field, cancer R&D, much of the expensive and time consuming clinical trials was performed by people working at these federally supported institutions. True, money also came the pharmaceutical companies, who owned the rights to the new drugs. But little of this R&D could happen without the major contribution from US taxpayers.

Actually, this is true of most if not all major universities in every technical field. For example, so many technical people in PhD programs these days are awarded research assistantships funded by the NSF. (For those who aren't familiar with these programs, for all practical purposes a research assistantship pays you to get a PhD, including tuition and fees, and a stipend to live on.) If I'm not mistaken, my son's assistantship in chemical engineering was funded by the NSF this way, and a colleague of mine has a son with an assistantship funded by the NSF in mechanical engineering. I think it's safe to say that a very significant portion of the US university scientific research community training is funded by the USG, and this model is followed by many countries, such as China. Even though we have three PhDs in our extended family funded this way, I'm not sure what I think about it as public policy. (It is easy to be biased.) A significant amount of university technical research is also funded by the NSF, a whole lot in my field, computer science, so it is difficult to just point at the Pharma companies.

As a result of all this, I think it's absolutely wrong – to the point of being politically corrupt – to allow the pharmaceutical companies to set drug prices in the USA without regulation.

For some drugs the answer is so obvious. Like insulin. My reaction to reading articles about insulin pricing is akin to Trump and his Ukraine dealings - how could they be so stupid? Trying to exploit such a vulnerable population with drugs that are decades old? Idiotic. Begging for punitive government action.

I was just reading yesterday about the antibiotics problem. Research is expensive, but people only take antibiotics for a short period of time, and may not need them again for years. Used properly, not enough sales volume, so antibiotics are critical but not profitable enough. Then there's the $100K per year statins, the $1K/pill Hepatitis C cures, and $700 Epipens. It gives me a headache thinking about it. And having the government regulate pricing still opens it up to political appointments and lobbying. I think if drug prices were regulated it would have to be with a structure like the Federal Reserve - an independent agency not subject to external influence. Or perhaps you just trust government agencies more than I do.

 

[Out-Of-Phase]

The Trump and Republican 2020 Health Care Plan

But based upon their 2017 Obamacare repeal and replace efforts, as well as a major document recently issued by the House Republican Study Committee, what might a Republican plan look like?

www.forbes.com

Republican 2020 Health Care Plan (forgive the link, the website is bias to right-center)

 

[Swerd]

I agree. Lobbying and political contributions, especially PACs, pollute everything in American politics. Unfortunately, all of this nonsense is protected under the 1st Amendment.

It's protected only because of a 5-4 Supreme Court decision that equated money with free political speech. I agree that it is nonsense.

The numbers are big. The NIH + NCI budgets sum to nearly $50B/year, but these are basic research, not product-specific drug R&D, or am I wrong? The drug industry claims that bringing a new drug to market costs $2.6B in R&D, but a paper I recently read claims the cost is more like $700M. I'm not expert enough to judge between the two claims, but I suspect the lower estimate is closer to reality.

Your first point: Basic research and specific product drug development are part of the same process. They cannot be divided conceptually. Years, even decades, of basic research must first be done just to identify a single protein or gene product, as causing a disease or condition. They have to first be identified as potential drug targets that might be exploited pharmaceutically. Only after that, can small molecules (ie drugs) or large molcules (usually antibodies) be tested against them to find agents that are safe and effective at blocking or inhibiting the action(s) of these proteins. Separating these makes no sense.

Your second point about $2.6B vs. $700M to bring a new drug to the market. I don't know how to judge between those 2 numbers. There are probably good examples to support each. But either number, $2.6B or $0.7B are small compared to the amount of money Big Pharma spends on Marketing & Advertising. It would be interesting if we had good estimates on the amount of money Big Pharma spends on political lobbying – we don't – but I suspect it also might dwarf R&D costs.

I was just reading yesterday about the antibiotics problem. Research is expensive, but people only take antibiotics for a short period of time, and may not need them again for years. Used properly, not enough sales volume, so antibiotics are critical but not profitable enough. Then there's the $100K per year statins, the $1K/pill Hepatitis C cures, and $700 Epipens. It gives me a headache thinking about it. And having the government regulate pricing still opens it up to political appointments and lobbying. I think if drug prices were regulated it would have to be with a structure like the Federal Reserve - an independent agency not subject to external influence. Or perhaps you just trust government agencies more than I do.

That example of few new antibiotics coming down the new drug pipeline is an old one, but a good one. Big Pharma isn't interested in drugs that might cure or eliminate an acute problem in relatively small numbers of patients. They are much more interested in diseases with many, many patients, and treatments that require years & years of purchases. That's also why Big Pharma doesn't really care much about vaccines.

The government already regulates the prices and availability of medical procedures and non-pharmaceutical treatments (surgery, etc.) through Medicare. The Federal Clean Food and Drug Act, which created the FDA, a semi-independent agency, has for a long time regulated the safety and efficacy of pharmaceuticals. Only more recently has Congress directly prohibited Medicare from negotiating prices of pharmaceuticals. This was done at the specific request of Congress's Big Pharma benefactors. Congress (especially when controlled by the GOP) has also indirectly interfered with the FDA by drastically cutting its operating funds.

I think your distrust of 'government' is misguided. I don't trust the elected politicians because they have abandoned the interest of the voters to instead follow the wishes of their deep pocketed contributors.

 

[Irvrobinson]

The government already regulates the prices and availability of medical procedures and non-pharmaceutical treatments (surgery, etc.) through Medicare.

There's is actually a lot more subtlety to the Medicare situation than you are describing. The USG sets prices that Medicare pays for certain services and procedures, but those prices are not mandatory. Healthcare providers can refuse to accept Medicare coverage. Most providers accept Medicare, since that's often the age group where a majority of the patients are, but I've read that the rate of non-acceptance is increasing. This is because, as I'm sure you know, the government sets Medicare reimbursement rates substantially lower than what private insurance pays. The point is that the government doesn't set mandatory pricing, it simply dictates prices for the portion of the market it controls, and it's a take it or leave it situation. Most providers take it, which is what keeps Medicare & Medicaid viable.

What you're discussing for drug pricing, as is Medicare for All, is different and more disruptive: universal and mandatory pricing regulation. As I've mentioned before, the way the Medicare For All bill is currently written, drug pricing would be negotiated by a political appointee. If no agreement can be reached the government uses the authority granted in 28 USC Section 1498 to seize the appropriate drug patents and force the inventing company to provide new licensees research data. The political appointee has the power to propose appropriate compensation to the inventing company, and if they don't like it the case is decided in a special federal court, as happens today when your land is seized through the Eminent Domain process.

I'm thinking this is unlikely to get passed by Congress.

I also wonder what will happen in the case of drugs not covered by patents, where scarcity drives high prices, like for insulin. Will the government force a company to produce more insulin? Will they be allowed to drop an unprofitable drug? Will the government subcontract to have competitors produce insulin, akin to a defense contract?

The situation looks and smells like a mess to me.

 

[Swerd]

I saw this article, titled Why price of Humira keeps rising despite FDA approval of generic competition, in this morning's Washington Post.

It's a good example of how US pharmaceutical manufacturers abuse the patent system, the legal system, and political processes, resulting in unregulated drug prices in the US. Until this problem gets fixed, no rational and affordable health insurance system can succeed.

The article tells about one example of a very high priced drug, Humira, how it has remained under patent protection for years after it's original patent expired in 2016. It was first approved for sale in 2002. Despite the 5 generic versions (biosimilars) approved for sale in the USA, none have yet come to market. Humira continues to rake in enormous revenue, about $20 Billion per year, and has increased it's price by 7% just for this year. Most other Big Pharma companies are working hard to imitate AbbVie, the maker of Humira.

 

[Out-Of-Phase]

And what is our President planning on doing about this?

 

[panteragstk]

And what is our President planning on doing about this?

Very good things. Wonderful things. The best things.


...sorry, couldn't resist.

 

[John Parks]

 

[Out-Of-Phase]

Universal Healthcare Pros and Cons

Proponents say it would stop medical bankruptcies and improve public health. Opponents say it is socialism and should be an individual's responsibility.

healthcare.procon.org

Healthcare Entitlement - you decide.

 

[John Parks]

Universal Healthcare Pros and Cons

Proponents say it would stop medical bankruptcies and improve public health. Opponents say it is socialism and should be an individual's responsibility.

healthcare.procon.org

Healthcare Entitlement

That's a fun website!

 

[Out-Of-Phase]

I like it.

It reminds me of C-Span.

 

[Mikado463]

And what is our President planning on doing about this?

and how about our Congress ...........

 

[Irvrobinson]

And what is our President planning on doing about this?

and how about our Congress ...........

The President proposes the annual budget, and within the laws written by Congress and signed by the President he or she can propose increases, decreases, or new expenditures in the budget to implement the laws. As I mentioned in an earlier post, Trump is doing that with Medicare with what are effectively cuts, though he's also moving some responsibilities between agencies, so his changes aren't perfectly clear. The President can't, for example, implement Medicare for All by executive order. Mostly the President can make speeches and use influence within his party, or negotiate with the other party for support in Congress, but not much else. On the slim chance that Sanders is elected President, my guess is that he gets virtually nothing done, because he's actually an independent and not a Democrat; he's just running as a Democrat. Without the support of his or her's party in Congress, a President is a bit toothless. And, as Trump found out, even if your party has majorities in both Houses of Congress you may still be stymied if you try to influence Congress to move in ways they don't really want to go. For example, his wall wasn't funded. Or they might do some stupid stuff you don't like but you're not in the mood to fight about, for example the inane 2017 Tax Cut and Jobs Act, which Trump ended up signing anyway.

Congress for the time being seems to be doing nothing about healthcare. And it's easy to understand why if you just spend a couple of hours watching CSPAN. Even if Sanders gets elected I'm convinced Medicare For All is dead in the water. Or it'll have so many special loopholes and exclusions that it would be unrecognizable by time it's ready to be signed. And, given the purist that Sanders has been for decades, my guess is that he would veto such messy legislation.

Just my opinion, but I think that the pharmaceutical companies have pissed off both parties so much, even Trump has dissed them publicly and threatened action, that once the election is over something could get done to control prices. If I were a betting man, I would think the odds are 2:1 in favor of something punitive by the end of 2021. If Trump is re-elected I think the chance of much beyond that seems unlikely. Maybe some legislation to prevent so-called surprise medical bills.

 

[panteragstk]

The President proposes the annual budget, and within the laws written by Congress and signed by the President he or she can propose increases, decreases, or new expenditures in the budget to implement the laws. As I mentioned in an earlier post, Trump is doing that with Medicare with what are effectively cuts, though he's also moving some responsibilities between agencies, so his changes aren't perfectly clear. The President can't, for example, implement Medicare for All by executive order. Mostly the President can make speeches and use influence within his party, or negotiate with the other party for support in Congress, but not much else. On the slim chance that Sanders is elected President, my guess is that he gets virtually nothing done, because he's actually an independent and not a Democrat; he's just running as a Democrat. Without the support of his or her's party in Congress, a President is a bit toothless. And, as Trump found out, even if your party has majorities in both Houses of Congress you may still be stymied if you try to influence Congress to move in ways they don't really want to go. For example, his wall wasn't funded. Or they might do some stupid stuff you don't like but you're not in the mood to fight about, for example the inane 2017 Tax Cut and Jobs Act, which Trump ended up signing anyway.

Congress for the time being seems to be doing nothing about healthcare. And it's easy to understand why if you just spend a couple of hours watching CSPAN. Even if Sanders gets elected I'm convinced Medicare For All is dead in the water. Or it'll have so many special loopholes and exclusions that it would be unrecognizable by time it's ready to be signed. And, given the purist that Sanders has been for decades, my guess is that he would veto such messy legislation.

Just my opinion, but I think that the pharmaceutical companies have pissed off both parties so much, even Trump has dissed them publicly and threatened action, that once the election is over something could get done to control prices. If I were a betting man, I would thinking the odds are 2:1 in favor something punitive by the end of 2021. If Trump is re-elected I think the chance of much beyond that seems unlikely. Maybe some legislation to prevent so-called surprise medical bills.

Exactly. That seems to be what the general public doesn't seem to understand. If a president tries to do something as big as social health care, congress has to be all for it. Won't happen any time soon, if ever.

I still say letting our horribly inefficient government running our healthcare system is a terrible idea, but I do think (for reasons you stated above) that we might actually do something in the way of regulating things more. Right now, the big pharma companies have so much power that they can do what they want. The FDA needs to actually have some power of what gets released. In an article someone else posted it was interesting to find that all they do is approve the drug if it does what it says and does it safely. Not whether it SHOULD be released. I'm willing to bet there are tons of "pointless" drugs that are a fraction of a percent better than what they're intended to replace. Someone much smarter than I can comment on that, but some articles make it seem like there are tons of duplicates that are put to market at a higher priced then marketed as "better".

I also don't want people in the insurance and hospital/medical care companies to lose their jobs over this, but I do wan their employers to stop trying to screw the average citizen. Things cost too much and are denied for seemingly no reason, and that's crap. If my doctor says I need something, the insurance should pay for it. In network/out of network is a scam. Hell, I read some doctors are so sick of it they're not even dealing with insurance any longer. If that trend continues to get popular, then what would insurance be for?

This makes my head hurt.

 

[Alex2507]

@killdozzer thanks for the dumb ratings. You're right to hide in anonymity you chicken sh!t moron.

It's Canada that sells milk in bags. That's the place I grew up and felt a little homesick for.

Know that people like you kept their mouths shut in both Canada and America ... or they had their mouths shut for them. I don't imagine you run that mouth in HR even now, just on AH ... where nobody knows you.

 

[panteragstk]

@killdozzer thanks for the dumb ratings. You're right to hide in anonymity you chicken sh!t moron.

It's Canada that sells milk in bags. That's the place I grew up and felt a little homesick for.

Know that people like you kept their mouths shut in both Canada and America ... or they had their mouths shut for them. I don't imagine you run that mouth in HR even now, just on AH ... where nobody knows you.

OMG someone pissed off Alex. What's happening?

 

[Alex2507]

What's happening?

I object to the two dumb ratings I got in this thread.

 

[Irvrobinson]

I object to the two dumb ratings I got in this thread.

I gave you two like ratings to help you feel better.