Who'd a thunk it? Obamacare not repealed

[Gilberto de Piento]

What innovations are being prevented by regulation? Like buying insurance across state lines and importing drugs from Canada or something more revolutionary?

[Dragline]

Innovations in the health care area in the US are typically not prevented by regulation, but protected as monopolies by regulation, first by the patent system and then by the FDA approval of generics system. There are many ways to game these systems and many very successful players.

But there are a lot of weird rules as well, for instance about what is a "supplement" vs a "drug" and what that means. Truly "experimental" treatments are often restricted. But a lot of those things are scams, too.

[RealPerson]

Innovations in the health care area in the US are typically not prevented by regulation, but protected as monopolies by regulation, first by the patent system and then by the FDA approval of generics system. There are many ways to game these systems and many very successful players.

All other developed countries have patent laws for pharmaceuticals and regulation of generics as well, so they all create monopolies. How does that explain the huge price difference between the US and the rest of the developed world?

[ThisDinosaur]

@RealPerson
Marketing. US drug companies spend more on marketing than on research. To my knowledge, no other country with a large pharmaceutical industry markets directly to patients. And most of the substantial research is funded by the NIH anyway.

[7Wannabe5]

Don't forget about the recent immigrants with advanced degrees in pharmaceutical sciences who risk losing their resident status if they don't rubber stamp the result of drug trials for their employers. In blighted regions of rural and urban America it is extremely easy to find a clinic staffed by somebody who will write you a prescription for whatever you say you need. It is much more difficult to find a primary care physician who will straight-up tell you to go to Whole Foods and buy something over-the-counter rather than writing you a prescription in order to save you some money and side-effects. I drive 45 minutes in Zipcar, so I can keep seeing the one I did find.

[Dragline]

Innovations in the health care area in the US are typically not prevented by regulation, but protected as monopolies by regulation, first by the patent system and then by the FDA approval of generics system. There are many ways to game these systems and many very successful players.

All other developed countries have patent laws for pharmaceuticals and regulation of generics as well, so they all create monopolies. How does that explain the huge price difference between the US and the rest of the developed world?

Those regs and protections are much stronger in the U.S. than elsewhere and US courts are more willing to enforce them. But the principal other difference is that the drug prices themselves are regulated in other countries much more so than in the U.S. A well-run single payer system has a lot of bargaining power and, frankly, just does not prescribe as many drugs as in the U.S. For example:

"The US consumes 80% of the world’s legal and illegal opioids; they are the country’s most abused prescription drug. Trends also indicate that the use of weak opioids is declining, while the use of strong, more easily abused opioids is increasing." http://www.pharmexec.com/us-opioid-mark ... ays-report

[BRUTE]

overprescription in the US is more of a cultural and litigation issue, brute would think, than single payer vs. whatever else.

@Dragline: again, yes, all humans like free money. pity that the "existing single payer system" doesn't work. Medicaid is so bad that 5 million Americans who are eligible for free health care (!) didn't get it. actual care provided is very sub-par for most on it. Medicare is popular because it's free money, but it's unsustainable, it'll run out pretty quickly unless young humans are made to pay more to finance the old. classic Ponzi scheme. and let brute not get started about the amazing single payer VA.

in fact, just the fact that the VA is single payer should tell humans all they need to know.

[ThisDinosaur]

Brute, all insurance is a ponzi scheme.

[IlliniDave]

What innovations are being prevented by regulation? Like buying insurance across state lines and importing drugs from Canada or something more revolutionary?

It depends on your state. I don't know that any of the stuff is revolutionary, but a small example I encountered: the small practice that my "family doctor" works in bought some blood analysis equipment a number of years back. For a token cost they could do standard blood work in minutes while the patient was there. But the insurance providers squawked (they don't like it when providers recommend services that the provider also provides) and lobbied the state gov't who threw up a mountain of red tape so essentially they'd have to gain state certification as a diagnostic laboratory to continue. That was cost prohibitive, so they got rid of their machine.

Now I have to make an appointment to go in and have blood drawn, then schedule a second appointment to go back and have them tell me about it. In the meantime they have to package up the blood and ship it somewhere to have a third party lab test it and send the results back. So now I miss part of two days work instead of just one, and between what the MD charges to take and process the blood, then what the outside lab charges for the analysis, and what the MD charges for me coming back for a second appointment, it's an increase in cost of more than 50%.

My MD tried a small innovation to help her patients get service faster and cheaper, and ran into the Borg. It's not just about people w/out money being refused service. The system is so bound up it's nearly immovable.

[BRUTE]

Brute, all insurance is a ponzi scheme.

brute disagrees. pooling of funds to guard against low-risk, high-cost incidents can be very useful. unfortunately, there's almost no "insurance" in "health insurance", it's 50% generational wealth transfer and 50% subsidies.

[Laura Ingalls]

overprescription in the US is more of a cultural and litigation issue, brute would think, than single payer vs. whatever else.

@Dragline: again, yes, all humans like free money. pity that the "existing single payer system" doesn't work. Medicaid is so bad that 5 million Americans who are eligible for free health care (!) didn't get it. actual care provided is very sub-par for most on it. Medicare is popular because it's free money, but it's unsustainable, it'll run out pretty quickly unless young humans are made to pay more to finance the old. classic Ponzi scheme. and let brute not get started about the amazing single payer VA.

in fact, just the fact that the VA is single payer should tell humans all they need to know.

Who are these five million? People that never signed up for any coverage or people that were eligible and bought other coverage?

I think most people avoid Medicaid out of fear of looking or feeling "poor" not legitimate medical reasons.

[BRUTE]

brute has not met them. but avoiding medical care for fear of "looking or feeling poor" seems like.. uh... a whole different problem.

[classical_Liberal]

...

[bryan]

In the US system, everyone qualifies for single-payer if they are either old enough, broke enough or broken down enough. Its just a dumb, badly constructed system. That's why we pay more for inferior results overall.

This reminds me of my GF's first use of her insurance (Medi-Cal) since being un-insured for a couple years. Basically she needed some antibiotics and a check-up but her PCP was booked up (but she could show up and see if anyone else didn't show up..) for weeks. So she called a few Urgent Care Clinics but they all said they don't accept Medi-Cal. She calls the 24/7 nurse who then tells her to just go to the ER and tell them she has Medi-Cal and needs some antibiotics. Hmmm.

[fiby41]

Also might consider having legal document refusing extreme treatment tattooed on to butt. Just brainstorming here.

That would be taking tramp stamps to whole another level.

[OTCW]

In my state, there are more opioid prescriptions than there are people. Need to fix that kind of thing, plus obesity, sedentary lifestyle, type 2 diabetes, junk fueled diets, smoking, etc in order to fix healthcare IMO. What the national debate is centered on now is who pays for our health insurance.

I don't think we aren't discussing anything that will lead to an improvement in actual health, but politicians can easily see what side of the line they want to be on by gaging reaction to who they suggest pays for what.

[BRUTE]

opioid prescriptions are not the problem - resulting crime and overdoses are. that's easy to fix by legalizing opioids. it'll be super cheap, almost no humans will die because it'll be pure because it'll be cheap, almost no crime resulting because it'll be cheap and won't empower the local criminals who're currently dealing it.

smoking and metabolic syndrome are much harder to fix, because they're cultural problems with lots of momentum.

brute agrees that "who pays for it" does almost nothing to improve the situation.

it's a side effect of a 4 year election cycle. it does not pay off for politicians to fix anything in the long run, all they can benefit from must happen within 4 years. changing a culture of nutrition took several generations of heavy lobbying and law making and propaganda. it's not going to reverse over night - or within 4 years.

[Laura Ingalls]

opioid prescriptions are not the problem - resulting crime and overdoses are. that's easy to fix by legalizing opioids. it'll be super cheap, almost no humans will die because it'll be pure because it'll be cheap, almost no crime resulting because it'll be cheap and won't empower the local criminals who're currently dealing it.

smoking and metabolic syndrome are much harder to fix, because they're cultural problems with lots of momentum.

brute agrees that "who pays for it" does almost nothing to improve the situation.

it's a side effect of a 4 year election cycle. it does not pay off for politicians to fix anything in the long run, all they can benefit from must happen within 4 years. changing a culture of nutrition took several generations of heavy lobbying and law making and propaganda. it's not going to reverse over night - or within 4 years.

Alcoholics and Opiod abusers both cost the culture plenty. Drunks can be constantly loaded on $15 of cheap vodka a day. Legalize heroin and making it cheap won't make the addicted functional and it doesn't seem to have social users

[OTCW]

For the record, I was talking about legal (prescription) opioids. And there is a legitimate place for them, but abuse leads to addiction. Pill mills are a big part of the problem. Not trying to start an debate over opioid use, but when prescriptions for it are that out of control, there is a definite cost factor that shouldn't exist that affects the price of overall healthcare. Only point I was making. The other societal costs are probably for another debate.

[BRUTE]

legal opioids are extremely expensive - because they're so restricted. users end up falling back on the illegal ones for cost reasons, which is where it becomes dangerous, because they're cut and are easy to overdose on.

most opioid users are completely functional, just as most alcoholics are. and heroin would be at $15/lbs if it were legal - it's a plant that can be industrially grown on fields. almost zero cost to society absent prohibition, certainly less than smoking or alcohol, which are way more unhealthy even in pure forms.