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Index » Radio Paradise/General » General Discussion » Capitalism and Consumerism... now what? Page: Previous  1, 2, 3, 4, 5, 6, 7  Next
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kurtster

kurtster Avatar

Location: drifting
Gender: Male


Posted: Aug 29, 2016 - 8:06pm

 NoEnzLefttoSplit wrote:

fair point.. there are some exciting candidates out there for treating cancer. Wonder how many lives they would save if released now.

 
fwiw ... I am probably alive today simply because a drug I needed to produce stem cells for harvest just came out of clinicals within a month before I received it.  I was either the first or one of the first to use it, post clinicals, can't remember.  That and I was already being treated at one of only 4 hospitals in the country that was authorized to use it.  If it came out a month or two later, and / or was being treated somewhere else, I more than likely would not be here today.

Things take time.  People die waiting all the time.  Problem is when that time is manipulated improperly by thumbs on the scale and there is a lot of that for many different reasons.  Eliminating or thwarting competition via regulations is one of the most prevalent reasons, however.  Viagra is one great example of that process.  Reported waiting times versus actual waiting times at the VA that kill people is another example of a corrupt system.

Proximity to care is another issue and one that will not be solved by UHC.  We will not have a Cleveland Clinic on every corner.  I got my sister to actually come up from Dallas this past week to see my hematologist / oncologist and got her an appointment within a week of asking.  Long story short, what I have gathered so far, is that the care she was about to receive in Dallas may have caused her more harm than good.  She's now in some of the best hands in the world getting competent care.  Its also one of the reasons I can never move away from Cleveland.  I'll never find the level of care that I have here anywhere else.  That and I know who are the good doctors or how to find out, which is another part of the equation.

UHC will not solve the problems that we want it to solve.  It will just lower the overall standard of care for everyone.  More, not less will die as a result.  Is that what we really want ?
 
Lazy8

Lazy8 Avatar

Location: The Gallatin Valley of Montana
Gender: Male


Posted: Aug 29, 2016 - 4:34pm

 black321 wrote:
And we have ample examples of how unregulated markets led to deaths, financial collapse...

Pick any drug company 10q or 10k (manufacturing to retail) and you will see comments on how reduced reimbursement rates are hurting profit margins.

As for ACA, it could have been packaged a lot better, but i rather have a system we're everyone is insured than not.  Insurance 101 - Diversify your risk pool...get everyone in the pool or else you have adverse selection.  If ACA is allowed to play out, in the long run the costs should be more evenly spread out. With increased diversification, volatility drops and so does risk, which is a cost and will lead to a lower price.

Inevitably we all need health care. Previously, the insured where already paying the cost of the uninsured...through bad debt expense passed on to the consumer.   Unless you completely deregulate health care and allow doctors to turn away patients without insurance, or demand cash up front, you need everyone in the pool to pay their share.  And I believe everyone, regardless of means, should have access to health care. 

Yes, those examples are called anecdotes. I can find some too! Wouldn't it be fun to compare? We could both do sanctimonious do it for little Wanda pleas based on them. It'll be fun!

So reimbursement rates have been driven down—but premiums are still up. How can that be? I have an explanation: the reimbursement rates for prescriptions are only a small fraction of the cost of healthcare, which is largely driven by other factors.

When you expand a risk pool by adding healthy people you spread he costs of covering sick people over more healthy people. But healthy people by and large already had insurance. There were exceptions: folks who didn't see the value proposition in insurance, since they weren't likely to need it and would just end up carrying the load for others. A lot of them still don't have insurance—it's cheaper to pay the penalty for not having insurance than it is to buy insurance. Or they wait until they get sick to get it, which is a strategy that works when they can't be turned down for a pre-existing condition.

If the ACA had been pitched honestly we'd have been told your rates will go up, the value will go down, and the extra you'll be spending will subsidize sick people who wouldn't otherwise have insurance there would be less to complain about today. You could make a case for that. But it wasn't pitched that way. It was sold dishonestly—even the name (Affordable Care Act) is a lie.

Go ahead and argue that it was the right thing to do, and that the ends justified the means. But to do so means that the public isn't to be trusted with decisions like this. They're just pawns to be manipulated by elites who know what's best for us and we should just shut up and pay the bill.

ScottN

ScottN Avatar

Location: Half inch above the K/T boundary
Gender: Male


Posted: Aug 29, 2016 - 4:12pm

 black321 wrote:

And we have ample examples of how unregulated markets led to deaths, financial collapse...

Pick any drug company 10q or 10k (manufacturing to retail) and you will see comments on how reduced reimbursement rates are hurting profit margins.

As for ACA, it could have been packaged a lot better, but i rather have a system we're everyone is insured than not.  Insurance 101 - Diversify your risk pool...get everyone in the pool or else you have adverse selection.  If ACA is allowed to play out, in the long run the costs should be more evenly spread out. With increased diversification, volatility drops and so does risk, which is a cost and will lead to a lower price.

Inevitably we all need health care. Previously, the insured where already paying the cost of the uninsured...through bad debt expense passed on to the consumer.   Unless you completely deregulate health care and allow doctors to turn away patients without insurance, or demand cash up front, you need everyone in the pool to pay their share.  And I believe everyone, regardless of means, should have access to health care.  
 
Universal Health Care is the responsible future.  HC belongs in the public sector.  Everyone needs, uses, or benefits directly and indirectly, by its availability.
Think police, fire, roads, education, national defense, libraries, all manner of publicly funded and very widely, if not universally, available services.

Better thinkers and writers than I can articulate the case for UHC.  Imo, arguing against UHC is in some way inevitably a defense of (sometimes exorbitant) profit at the expense of the ill.

$600 epipens —I know, you get two (approx $4 each manufacturing cost) is today's poster child of HC-for-profit excesses. Vastly more egregious examples can easily be found

The ACA is/was a very imperfect first step to UHC. There are many ways to get to UHC.   How many people financially ruined by an illness before we act? 


black321

black321 Avatar

Location: An earth without maps
Gender: Male


Posted: Aug 29, 2016 - 2:58pm

 Lazy8 wrote:
 Well, we do have pretty much the whole of human experience to compare, and it's pretty obvious that freer markets = more of the bulletted tendencies. We ran this big experiment on it; we called it the 20th century. Pretty conclusive. If you need a reference...

I'm failing to see which rates the ACA is supposed to have lowered. It accomplished its number one goal: more people have insurance. That happened because people who already had insurance are now paying for those that didn't, so their rates went up. The people who didn't have it generally cost more to insure, so adding people to the pool made things cost more, not less.

There was no serious effort to reduce the actual cost of medical care, just to shift it.


 
And we have ample examples of how unregulated markets led to deaths, financial collapse...

Pick any drug company 10q or 10k (manufacturing to retail) and you will see comments on how reduced reimbursement rates are hurting profit margins.

As for ACA, it could have been packaged a lot better, but i rather have a system we're everyone is insured than not.  Insurance 101 - Diversify your risk pool...get everyone in the pool or else you have adverse selection.  If ACA is allowed to play out, in the long run the costs should be more evenly spread out. With increased diversification, volatility drops and so does risk, which is a cost and will lead to a lower price.

Inevitably we all need health care. Previously, the insured where already paying the cost of the uninsured...through bad debt expense passed on to the consumer.   Unless you completely deregulate health care and allow doctors to turn away patients without insurance, or demand cash up front, you need everyone in the pool to pay their share.  And I believe everyone, regardless of means, should have access to health care. 

 


Lazy8

Lazy8 Avatar

Location: The Gallatin Valley of Montana
Gender: Male


Posted: Aug 29, 2016 - 2:17pm

 black321 wrote:
Your bullets include a number of assumptions that are as easy to prove as the existence of God....since we've never actually seen a true "free market."  There are costs to both regulations and competitive markets.  Again, the key is to find the right balance. 

As for the ACA and consolidation, you are right.  The ACA's impact on lowering rates has created an environment where more cos. are chasing scale to maintain profits.  

Well, we do have pretty much the whole of human experience to compare, and it's pretty obvious that freer markets = more of the bulletted tendencies. We ran this big experiment on it; we called it the 20th century. Pretty conclusive. If you need a reference...

I'm failing to see which rates the ACA is supposed to have lowered. It accomplished its number one goal: more people have insurance. That happened because people who already had insurance are now paying for those that didn't, so their rates went up. The people who didn't have it generally cost more to insure, so adding people to the pool made things cost more, not less.

There was no serious effort to reduce the actual cost of medical care, just to shift it.
aflanigan

aflanigan Avatar

Location: At Sea
Gender: Male


Posted: Aug 29, 2016 - 1:22pm

 Lazy8 wrote:

Yes, actually, you are railing against capitalism. Scroll down.

I don't mean to imply (and don't think I did) that everything would be perfect if the market in medical devices were free. A free market guarantees no particular outcome, but it does tend toward:
  • Efficiency—inefficient operators are out-competed
  • Variety—if there's money to be made filling a niche someone will try to make that money
  • Innovation—you can't improve your competitive position without improving product, price, or delivery
  • Accountability—when a business treats you poorly you can take your trade elsewhere
The cost of regulatory compliance adds barriers to entry into markets. Got a great idea for a new drug or device? Get started! It will be a decade or more before the company you start can make a dime on your investment. Both large and small companies can innovate but when a small company does it the goal nowadays is to be acquired by a large company. There's no realistic hope for a startup in pharma to make it to the stock exchange on its own, and the business has been consolidating—companies are merging/acquiring to spread that regulatory burden over more volume.

The ACA has accelerated that trend. It had a lot of effects on pharma, some of them easily predictable (the medical device tax raising the cost of medical devices, for instance) and some of them less so (pharma companies rebating directly to consumers to cover increased co-pays on some name-brand drugs).

 
My opinion is that the "tendency toward efficiency" of the unregulated, un-interefered with global or national economy is rather chimerical. (Not to say that our system is all that efficient).
As far as innovation goes, the US instituted regulation/interference in the form of a patent system to encourage innovation (they weren't the first, but they thought it important enough to devote a clause in the Constitution giving Congress specific power to engage in such promotion of innovation). It seems to have worked so well that most other advanced economies have copied it. We have no examples of unregulated economies free of patent systems that are out-innovating us.


black321

black321 Avatar

Location: An earth without maps
Gender: Male


Posted: Aug 29, 2016 - 1:12pm

 Lazy8 wrote:

Yes, actually, you are railing against capitalism. Scroll down.

I don't mean to imply (and don't think I did) that everything would be perfect if the market in medical devices were free. A free market guarantees no particular outcome, but it does tend toward:
  • Efficiency—inefficient operators are out-competed
  • Variety—if there's money to be made filling a niche someone will try to make that money
  • Innovation—you can't improve your competitive position without improving product, price, or delivery
  • Accountability—when a business treats you poorly you can take your trade elsewhere
The cost of regulatory compliance adds barriers to entry into markets. Got a great idea for a new drug or device? Get started! It will be a decade or more before the company you start can make a dime on your investment. Both large and small companies can innovate but when a small company does it the goal nowadays is to be acquired by a large company. There's no realistic hope for a startup in pharma to make it to the stock exchange on its own, and the business has been consolidating—companies are merging/acquiring to spread that regulatory burden over more volume.

The ACA has accelerated that trend. It had a lot of effects on pharma, some of them easily predictable (the medical device tax raising the cost of medical devices, for instance) and some of them less so (pharma companies rebating directly to consumers to cover increased co-pays on some name-brand drugs).

 

Your bullets include a number of assumptions that are as easy to prove as the existence of God....since we've never actually seen a true "free market."  There are costs to both regulations and competitive markets.  Again, the key is to find the right balance. 

As for the ACA and consolidation, you are right.  The ACA's impact on lowering rates has created an environment where more cos. are chasing scale to maintain profits. 
NoEnzLefttoSplit

NoEnzLefttoSplit Avatar

Gender: Male


Posted: Aug 29, 2016 - 12:24pm

 Lazy8 wrote:
 NoEnzLefttoSplit wrote:
hmm... there are reasons for those controls.. to stop patients getting killed by new treatments for instance.

There's always a good reason. But there's always a burden imposed by the control. That burden isn't always visible, but it's real. How many people died from AIDS while AZT was in late clinicals? The approval process helped kill them.

We count the cost of releasing a drug too early but we don't count the cost of releasing a drug too late. Just pointing out that that cost is not zero, and we don't let patients and doctors balance and manage the risk/reward ratio of new treatments. The FDA makes that call for them, and it only sees the downside of saying "yes", never the upside.

 
fair point.. there are some exciting candidates out there for treating cancer. Wonder how many lives they would save if released now.
Lazy8

Lazy8 Avatar

Location: The Gallatin Valley of Montana
Gender: Male


Posted: Aug 29, 2016 - 12:21pm

 NoEnzLefttoSplit wrote:
hmm... there are reasons for those controls.. to stop patients getting killed by new treatments for instance.

There's always a good reason. But there's always a burden imposed by the control. That burden isn't always visible, but it's real. How many people died from AIDS while AZT was in late clinicals? The approval process helped kill them.

We count the cost of releasing a drug too early but we don't count the cost of releasing a drug too late. Just pointing out that that cost is not zero, and we don't let patients and doctors balance and manage the risk/reward ratio of new treatments. The FDA makes that call for them, and it only sees the downside of saying "yes", never the upside.
NoEnzLefttoSplit

NoEnzLefttoSplit Avatar

Gender: Male


Posted: Aug 29, 2016 - 12:15pm

 Lazy8 wrote:

Yes, actually, you are railing against capitalism. Scroll down.

I don't mean to imply (and don't think I did) that everything would be perfect if the market in medical devices were free. A free market guarantees no particular outcome, but it does tend toward:
  • Efficiency—inefficient operators are out-competed
  • Variety—if there's money to be made filling a niche someone will try to make that money
  • Innovation—you can't improve your competitive position without improving product, price, or delivery
  • Accountability—when a business treats you poorly you can take your trade elsewhere
The cost of regulatory compliance adds barriers to entry into markets. Got a great idea for a new drug or device? Get started! It will be a decade or more before the company you start can make a dime on your investment. Both large and small companies can innovate but when a small company does it the goal nowadays is to be acquired by a large company. There's no realistic hope for a startup in pharma to make it to the stock exchange on its own, and the business has been consolidating—companies are merging/acquiring to spread that regulatory burden over more volume.

The ACA has accelerated that trend. It had a lot of effects on pharma, some of them easily predictable (the medical device tax raising the cost of medical devices, for instance) and some of them less so (pharma companies rebating directly to consumers to cover increased co-pays on some name-brand drugs).

 
hmm... there are reasons for those controls.. to stop patients getting killed by new treatments for instance.
Lazy8

Lazy8 Avatar

Location: The Gallatin Valley of Montana
Gender: Male


Posted: Aug 29, 2016 - 12:11pm

 black321 wrote:
Now don't go putting words in my mouth.  I'm not railing against capitalism.  It's an economic system and probably the best one we've been able to come up with to date. But it is not perfect.  And neither are regulations.  It's ying/yang, good/bad, every silver lining got's a touch grey...human nature to f#$k it up.  You seem to imply if we had truly "free markets" everything would be peaches and cream and abuse would disappear.  I don't believe that, end of story.  So it's push and pull from both sides to get the best of what we can get. 

p.s., ACA has resulted in increased pressure to reduce Rx reimbursement rates and the only change to the delivery model is that more retailers are using distributors/wholesalers for generics instead of buying direct (looking to share procurement/scale savings)

 
Yes, actually, you are railing against capitalism. Scroll down.

I don't mean to imply (and don't think I did) that everything would be perfect if the market in medical devices were free. A free market guarantees no particular outcome, but it does tend toward:
  • Efficiency—inefficient operators are out-competed
  • Variety—if there's money to be made filling a niche someone will try to make that money
  • Innovation—you can't improve your competitive position without improving product, price, or delivery
  • Accountability—when a business treats you poorly you can take your trade elsewhere
The cost of regulatory compliance adds barriers to entry into markets. Got a great idea for a new drug or device? Get started! It will be a decade or more before the company you start can make a dime on your investment. Both large and small companies can innovate but when a small company does it the goal nowadays is to be acquired by a large company. There's no realistic hope for a startup in pharma to make it to the stock exchange on its own, and the business has been consolidating—companies are merging/acquiring to spread that regulatory burden over more volume.

The ACA has accelerated that trend. It had a lot of effects on pharma, some of them easily predictable (the medical device tax raising the cost of medical devices, for instance) and some of them less so (pharma companies rebating directly to consumers to cover increased co-pays on some name-brand drugs).


black321

black321 Avatar

Location: An earth without maps
Gender: Male


Posted: Aug 29, 2016 - 8:57am

 Lazy8 wrote:

Capitalism didn't fail, a market was constrained from providing a solution to a problem by regulatory intervention. The market didn't provide an outcome you find desirable, but its mechanisms functioned as they were allowed to. Mylan tried to maximize the money it made, and it worked the system. The incentives in that system made that result all but inevitable. And that system is anything but a free market.

The profit motive provides the food you eat, the clothes you wear, the roof over your head, the computer you're using to argue against it. I daresay it works on you too: you work for pay.* The profit motive and the markets it engenders provide the vast bounty of things you enjoy. It works everywhere...except healthcare?

Oh, sure, you can buy aspirin for pennies. Competing compounds as well; bandages, toothpaste, antibiotic ointments (ponder for a moment what a miracle Neosporin would have seemed to Karl Marx), sophisticated devices for taking care of your teeth—all sold at a profit by greedy industrialists—but that's not real healthcare! No way could mere grubby businessmen deliver real healthcare! Healthcare should be untainted by commerce, pure, driven only by faceless bureaucrats with no stake in successful outcomes.

Please. Rail against those greedy capitalists all you like but don't imagine for a moment you can do without them and their filthy profit motive.

So the market created an inefficient, burdensome system to inject middlemen into the delivery of drugs, contrary to previous practice. And this only happened in the last few years. Somehow all those greedy businessmen at both ends of the drug delivery system decided to cut someone else in on their trade. I wonder what miracle of capitalism caused that?

Tell me, what else happened in the last few years? Anything ringing a bell?

*Unless you're a trustafarian whose parents took advantage of that filthy incentive to amass a fortune big enough to free their offspring from the drudgery of toil and invested it—with the goal of making a profit!—to keep you in clothes and computers.

 
Now don't go putting words in my mouth.  I'm not railing against capitalism.  It's an economic system and probably the best one we've been able to come up with to date. But it is not perfect.  And neither are regulations.  It's ying/yang, good/bad, every silver lining got's a touch grey...human nature to f#$k it up.  You seem to imply if we had truly "free markets" everything would be peaches and cream and abuse would disappear.  I don't believe that, end of story.  So it's push and pull from both sides to get the best of what we can get. 

p.s., ACA has resulted in increased pressure to reduce Rx reimbursement rates and the only change to the delivery model is that more retailers are using distributors/wholesalers for generics instead of buying direct (looking to share procurement/scale savings)
Lazy8

Lazy8 Avatar

Location: The Gallatin Valley of Montana
Gender: Male


Posted: Aug 26, 2016 - 3:40pm

 black321 wrote:
The profit motive led Mylan and company to raise prices above a reasonable level.  That is the failure of capitalism.  The regulation failure was in the way the FDA deals with injectors...keeping competitors out of the market. the only winner in all this was the high deductible plan...getting the consumer involved in the cost of their healthcare. 
Obviously if we stripped out the regulations completely, there would be no incentive for cos. to invest billions in new drugs if a generic could be released as soon as a competitor was able to find a way to produce a copy.

p.s.there is no regulation that requires a mfg to sell to a wholesaler, or forbids a retailer to acquire direct from mfg (in fact up until about 2 years ago, most retailers did procure most generics direct from mfg).  The market itself set this up.
 
Capitalism didn't fail, a market was constrained from providing a solution to a problem by regulatory intervention. The market didn't provide an outcome you find desirable, but its mechanisms functioned as they were allowed to. Mylan tried to maximize the money it made, and it worked the system. The incentives in that system made that result all but inevitable. And that system is anything but a free market.

The profit motive provides the food you eat, the clothes you wear, the roof over your head, the computer you're using to argue against it. I daresay it works on you too: you work for pay.* The profit motive and the markets it engenders provide the vast bounty of things you enjoy. It works everywhere...except healthcare?

Oh, sure, you can buy aspirin for pennies. Competing compounds as well; bandages, toothpaste, antibiotic ointments (ponder for a moment what a miracle Neosporin would have seemed to Karl Marx), sophisticated devices for taking care of your teeth—all sold at a profit by greedy industrialists—but that's not real healthcare! No way could mere grubby businessmen deliver real healthcare! Healthcare should be untainted by commerce, pure, driven only by faceless bureaucrats with no stake in successful outcomes.

Please. Rail against those greedy capitalists all you like but don't imagine for a moment you can do without them and their filthy profit motive.

So the market created an inefficient, burdensome system to inject middlemen into the delivery of drugs, contrary to previous practice. And this only happened in the last few years. Somehow all those greedy businessmen at both ends of the drug delivery system decided to cut someone else in on their trade. I wonder what miracle of capitalism caused that?

Tell me, what else happened in the last few years? Anything ringing a bell?

*Unless you're a trustafarian whose parents took advantage of that filthy incentive to amass a fortune big enough to free their offspring from the drudgery of toil and invested it—with the goal of making a profit!—to keep you in clothes and computers.
black321

black321 Avatar

Location: An earth without maps
Gender: Male


Posted: Aug 26, 2016 - 12:14pm

 Lazy8 wrote:
 black321 wrote:
The patent process for the injector is an obstacle that's not really addressed for pharmaceuticals (in terms of easing the speed to market for generics).  Regardless, if there were a dozen companies out there providing epinephrine, i dont think that would have moved the price much.  There have been a few alternatives introduced in the last few years (AuviQ product was recalled) but they all raised the price to similar levels, so so much for capitalism.  To me this is another example of not why regulation doesn't work, but bad/ineffective regulation.

p.s. lets not forget the role of the wholesalers, pharmacy benefit managers and retailers in taking their cuts.  Even if Mylan drops the price it charges wholesalers, that wouldnt help consumers...at least not yet...since the price is set between the payor (insurance, medicare...) and the PBM.  The entire US pharmaceutical industry is guilty of price gouging...to subsidize the much more stringent price controls that the rest of the world's govts. place on drugs.  

There probably are a dozen companies providing epinephrine. They aren't providing the delivery device because the FDA regulates them separately so they aren't used to playing in that space.

Competitors are going to try and make as much as they can while they can (assuming the FDA lets them, which so far it's not) so they introduce at a price similar to the existing product. Which then loses market share and cuts price to compensate, which lowers the price. Maybe not instantly, but the mechanism indisputably works. After all, you're typing your argument that capitalism is a failure (or that it failed in this one instance, or that capitalism always fails eventually, or whatever your argument is) into a device once outrageously expensive made affordable by...capitalism.

That whole chain of middlemen exists because we have an FDA and the byzantine regulation of the insurance and medical industries. If you want to pay them less take the product out of their hands: make it available without prescription. Relax the top-down control that makes them necessary. Let capitalism work.

 
The profit motive led Mylan and company to raise prices above a reasonable level.  That is the failure of capitalism.  The regulation failure was in the way the FDA deals with injectors...keeping competitors out of the market. the only winner in all this was the high deductible plan...getting the consumer involved in the cost of their healthcare. 
Obviously if we stripped out the regulations completely, there would be no incentive for cos. to invest billions in new drugs if a generic could be released as soon as a competitor was able to find a way to produce a copy.

p.s.there is no regulation that requires a mfg to sell to a wholesaler, or forbids a retailer to acquire direct from mfg (in fact up until about 2 years ago, most retailers did procure most generics direct from mfg).  The market itself set this up. 
Lazy8

Lazy8 Avatar

Location: The Gallatin Valley of Montana
Gender: Male


Posted: Aug 26, 2016 - 11:57am

 black321 wrote:
The patent process for the injector is an obstacle that's not really addressed for pharmaceuticals (in terms of easing the speed to market for generics).  Regardless, if there were a dozen companies out there providing epinephrine, i dont think that would have moved the price much.  There have been a few alternatives introduced in the last few years (AuviQ product was recalled) but they all raised the price to similar levels, so so much for capitalism.  To me this is another example of not why regulation doesn't work, but bad/ineffective regulation.

p.s. lets not forget the role of the wholesalers, pharmacy benefit managers and retailers in taking their cuts.  Even if Mylan drops the price it charges wholesalers, that wouldnt help consumers...at least not yet...since the price is set between the payor (insurance, medicare...) and the PBM.  The entire US pharmaceutical industry is guilty of price gouging...to subsidize the much more stringent price controls that the rest of the world's govts. place on drugs.  

There probably are a dozen companies providing epinephrine. They aren't providing the delivery device because the FDA regulates them separately so they aren't used to playing in that space.

Competitors are going to try and make as much as they can while they can (assuming the FDA lets them, which so far it's not) so they introduce at a price similar to the existing product. Which then loses market share and cuts price to compensate, which lowers the price. Maybe not instantly, but the mechanism indisputably works. After all, you're typing your argument that capitalism is a failure (or that it failed in this one instance, or that capitalism always fails eventually, or whatever your argument is) into a device once outrageously expensive made affordable by...capitalism.

That whole chain of middlemen exists because we have an FDA and the byzantine regulation of the insurance and medical industries. If you want to pay them less take the product out of their hands: make it available without prescription. Relax the top-down control that makes them necessary. Let capitalism work.
black321

black321 Avatar

Location: An earth without maps
Gender: Male


Posted: Aug 26, 2016 - 11:49am

Basically, I think this issue boils down to the failure of capitalism/free markets and ineffective regulations in health care.
Personally I believe health care is something that shouldn't or can't be left to the markets to figure out.  You can't deny someone health care, so you shouldn't expect them to be outside of the covered lives/insured pool.  Is it really that difficult to design and regulate an effective health care system? 
ScottFromWyoming

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Location: Powell
Gender: Male


Posted: Aug 26, 2016 - 11:38am

 black321 wrote:

Maybe, but I would think for most plans they wouldn't limit how many times you can get a script filled (you can only get stung by a bee 1x a year!?)  I have a high deductible plan and it does not put any limits on how many times i get an epi script filled ( i think one year had the double dose pens filled 3x). 

 
Obviously I have no experience with it, just trying to sort of congeal all the different factors here, and that was one. 
black321

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Location: An earth without maps
Gender: Male


Posted: Aug 26, 2016 - 11:32am

 ScottFromWyoming wrote:

For a set number per year, usually 2, right? So if you use yours or the ones you got from the pharmacy had already used up half their shelf life and you decided to replace them... the second round in a calendar year might not be covered? 

 
Maybe, but I would think for most plans they wouldn't limit how many times you can get a script filled (you can only get stung by a bee 1x a year!?)  I have a high deductible plan and it does not put any limits on how many times i get an epi script filled ( i think one year had the double dose pens filled 3x). 
ScottFromWyoming

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Location: Powell
Gender: Male


Posted: Aug 26, 2016 - 11:23am

 black321 wrote:

Even with a high deductible insurance plan, you still pay the lower negotiated price...but you're right, those without insurance pay the highest rate for drugs and doctor care.

 
For a set number per year, usually 2, right? So if you use yours or the ones you got from the pharmacy had already used up half their shelf life and you decided to replace them... the second round in a calendar year might not be covered? 
black321

black321 Avatar

Location: An earth without maps
Gender: Male


Posted: Aug 26, 2016 - 10:45am

 ScottFromWyoming wrote:

 

Somewhere else (maybe here, who knows? ) I read someone saying that pricing for drugs of any stripe are set by pricing it at an astronomical number, then seeing what the insurance will cover. That becomes the sticker price, with the understanding that insurance has already negotiated a rate far below that number so when they say "we'll pay $600" it means "we'll pay $100 and you'll write off the balance" but someone without insurance, or with a $5000 deductible, will pay the full $600. And Mylan just blamed consumers for having those high deductible plans because otherwise they wouldn't even see the cost and there wouldn't be any complaints and they'd have had a carefree August. And they blamed insurance companies for something too I couldn't follow the logic so it's left me.

 
Even with a high deductible insurance plan, you still pay the lower negotiated price...but you're right, those without insurance pay the highest rate for drugs and doctor care. 
The high deductible plans are great way to get costs down, by bringing the consumer back into the pricing decision...and as we see here, it is working.
As I noted below, the insurance company sets the price for drugs with the pharmacy benefit manager...thats what the Mylan CEO was attempting to explain. 
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