Health care situation in US?

[AqD]

Trying to understand the situation there. It appears the high cost is the direct result of monopoly, due to government's licensing. So, why would the immediate/overwhelming answer to address the cost seem to be implementing an universal healthcare or extending insurance coverage? Considering:

1. Despite the current coverage (most employees are covered yes?) insurance companies seem unable to negotiate down the prices themselves.
2. The government does have tremendous negotiation power without being the single payer, by simply allowing copycat drugs or reducing patent duration.
3. Wouldn't an universal healthcare / national wide coverage under the current situation only mean instead of the sick, everyone has to pay those ridiculous prices through tax? except it'd be hidden and nobody would complain anymore.

[The spartan]

Trying to understand the situation there. It appears the high cost is the direct result of monopoly, due to government's licensing. So, why would the immediate/overwhelming answer to address the cost seem to be implementing an universal healthcare or extending insurance coverage? Considering:

1. Despite the current coverage (most employees are covered yes?) insurance companies seem unable to negotiate down the prices themselves.
2. The government does have tremendous negotiation power without being the single payer, by simply allowing copycat drugs or reducing patent duration.
3. Wouldn't an universal healthcare / national wide coverage under the current situation only mean instead of the sick, everyone has to pay those ridiculous prices through tax? except it'd be hidden and nobody would complain anymore.

I thought the government can't negotiate prices with the drug companies, it is just a private sector thing to be handled and that private insurers try to counter the rising prices via haggling down the listed price. It is usually the single payer aspect of universal health care that puts an end to that silly cycle.

[AqD]

I thought the government can't negotiate prices with the drug companies, it is just a private sector thing to be handled and that private insurers try to counter the rising prices via haggling down the listed price. It is usually the single payer aspect of universal health care that puts an end to that silly cycle.

But why can't they? They grant the rights to hold patents - and if they grant the same right to copycat drugs, a monopoly could be ended in days - that'd make a very serious threat and card for negotiation.

If they cannot or unwilling to negotiate now, why would they do it when they become the single payer? The current private insurance companies are not doing it (if not actively collaborating to drive it up). So why would an universal health care, though with much stronger position, have any inherent reason to negotiate down prices? most people might cease caring at all, since they wouldn't be directly paying it out of their pocket and suffering any direct consequence - I don't recall anyone in countries with it are ever concerned about high drug costs, only what's covered (or not).

[Love Mountain]

[qutoe]But why can't they? They grant the rights to hold patents - and if they grant the same right to copycat drugs, a monopoly could be ended in days - that'd make a very serious threat and card for negotiation.[/quote]

Because the law doesn't allow them to. It's unfortunate. Here's a https://www.politifact.com/wisconsin/statements/2017/jan/17/tammy-baldwin/tammy-baldwin-federal-government-prohibited-negoti/]link[/URL]

If they cannot or unwilling to negotiate now, why would they do it when they become the single payer? The current private insurance companies are not doing it (if not actively collaborating to drive it up). So why would an universal health care, though with much stronger position, have any inherent reason to negotiate down prices? most people might cease caring at all, since they wouldn't be directly paying it out of their pocket and suffering any direct consequence - I don't recall anyone in countries with it are ever concerned about high drug costs, only what's covered (or not).

If Medicare for all is actually signed, a lot of healthcare legislation is going to be re-written. It's not a stretch to imagine that Medicare Part D is going to be one of the first things they re-write. Insurance companies do negotiate prices with Pharmaceutical companies. They negotiate prices on everything. They have to, how else do you think they stay in business? They are actually very powerful and becoming more so, as insurance providers continue to consolidate themselves.

[swabian]

@AqD: You can't really compare the costs of a vital product that was cheap during year A to what it costs during year B, especially not if it's a few decades from A to B. It's not only that people have rising incomes as the generations pass by, it's also that the services they expect to be available become more expensive over time. Medical doctors, nurses, pharmacologists, industries, etc, are all a part of this process as well and they all want adequate payment for their efforts.

However there should not be anybody dying from diabetes in a halfway modern country. I have a hard time to believe that peoples lives are at stake because they can't afford the insuline in the US or EU.

[AqD]

@AqD: You can't really compare the costs of a vital product that was cheap during year A to what it costs during year B, especially not if it's a few decades from A to B. It's not only that people have rising incomes as the generations pass by, it's also that the services they expect to be available become more expensive over time. Medical doctors, nurses, pharmacologists, industries, etc, are all a part of this process as well and they all want adequate payment for their efforts.

The point is that uninsured price for the same things cost several times more compared to elsewhere, including those with much higher cost of life in general.

What could possibly justify more than 5x price difference of same insulin drugs in US compared to India?

However there should not be anybody dying from diabetes in a halfway modern country. I have a hard time to believe that peoples lives are at stake because they can't afford the insuline in the US or EU.

But why would you pay $100 for something that's $1 elsewhere, no matter how insignificant it might be? A proper market is supposed to facilitate continuous lowering of costs and improving of products/services, while what's in US seems entirely opposite.

[swabian]

The point is that uninsured price for the same things cost several times more compared to elsewhere, including those with much higher cost of life in general.

What could possibly justify more than 5x price difference of same insulin drugs in US compared to India?



But why would you pay $100 for something that's $1 elsewhere, no matter how insignificant it might be? A proper market is supposed to facilitate continuous lowering of costs and improving of products/services, while what's in US seems entirely opposite.

This is called "outsourcing". A worker in India is cheaper than a worker in the US...

[AqD]

That can justify medical service cost, but not the cost of the same drugs.

Is iphone sold at 5x price in US compared to India?

[Gaidin]

yo, swabian, insulin isn't the only one:
http://www.wtvm.com/story/32834908/e...al-value-at-1/

[swabian]

yo, swabian, insulin isn't the only one:
http://www.wtvm.com/story/32834908/e...al-value-at-1/

I really was not aware and i did not try to make fun of that. This is very obviously BS.

[Gaidin]

Speaking of the price of insulin. Standard salary people typically live with about two paychecks in the bank, plus or minus. Something goes wrong outside your control(see last December), you end up rationing your expensive insulin that used to be cheap a decade ago, and you literally knowingly go to sleep risking you drop into a coma.

[swabian]

Speaking of the price of insulin. Standard salary people typically live with about two paychecks in the bank, plus or minus. Something goes wrong outside your control(see last December), you end up rationing your expensive insulin that used to be cheap a decade ago, and you literally knowingly go to sleep risking you drop into a coma.

What do you want me to say? "Sorry"? It's hard to comprehend how the most advaced country in the world has such deep flaws.

[Gaidin]

The people that live this don't call it advanced. One of my meds used to only be 30$ a month and then a generic came out. But you don't just switch your primary neurological drug lest it screw up your seizures. So now it's 150$ a month. Depending on the time of year and insurance policy. Yes, even for meds you can have a deductible. My January-February buy for a 90 day supply would cost me 800$.

So no. Don't get carried away with how advanced you want to call this country. The technology and research may be up there. But the policies are downright "sit on this and rotate sir".

[95thrifleman]

It's something the USAphiles tend to ignore when they slag off European healthcare.

[Love Mountain]

I don't particularly mind super advanced or exotic drugs commanding an impossible price that only the ultra-rich can afford. That being said, it's a moral disaster that Epi-Pens and other similar medical products which have already paid off their R&D cost dozens of times over, continue to be milked for money. I don't think that should be allowed. I don't know how a good balance can be achieved but I'm tired of seeing such obvious price gouging.

On the other hand, I also think that a lot of issues that affect the people who live paycheck-to-paycheck most, can be simply avoided if people stopped living paycheck to paycheck... A lot of people simply lack the financial know-how or worse, the discipline, to improve their situation and protect themselves from financial disaster. That's another part of the problem that needs to be solved. High healthcare Premiums wouldn't be such a big deal if people were simply richer.

[swabian]

High healthcare Premiums wouldn't be such a big deal if people were simply richer.

Well, that's rich lol. I thought you were the guy who knows how to interprete everything as an economical process. So if everyone would just be the hell rich… the world, no sorry, the USA would be a better place. Cheezes farkin crust, are you somehow self-aware when you produce pointless truisms like that?

[Gaidin]

@Suki, A lot of people literally don't have the salary to do any better. A lot of people don't have the medical health to legally drive and so have to live in a region 3 times as expensive than one they could drive from. "Stop living paycheck to paycheck" is a complicated question to answer here.

[Love Mountain]

Well, that's rich lol. I thought you were the guy who knows how to interprete everything as an economical process. So if everyone would just be the hell rich… the world, no sorry, the USA would be a better place. Cheezes farkin crust, are you somehow self-aware when you produce pointless truisms like that?

They don't need to be rich. They need to be "richer" and have better financial security. A simple way to isolate people from medical emergencies would be to have a payroll tax that automatically deducted a percentage of people's paychecks into a health saving account. A very unfortunate part of the population is in the "coverage gap" where they are too "rich" to be covered by Medicaid and too poor to qualify for healthcare subsidies. That needs to be fixed, but there are many people, young individuals for example, who simply refuse to grab insurance or to budget their incomes properly.

@Suki, A lot of people literally don't have the salary to do any better. A lot of people don't have the medical health to legally drive and so have to live in a region 3 times as expensive than one they could drive from. "Stop living paycheck to paycheck" is a complicated question to answer here.

I'm aware that a lot of people have no other choice than to live from paycheck to paycheck. I sympathize with those people, but there are a ton of people who simply live that way because they either don't know any better, or refuse to. I'll point you to record car sales in America and the rising number of 60-72 month car loans. Both are indicative of people buying cars they can't really afford. That's middle-class folks living beyond their means, the same demographic that often complains about high healthcare premiums. Household debt is rising, student debt is at a record. When we talk about household budgets, these are all things we need to tackle. Part of it is the government, the other part of it is people making better choices. I think both sides of the equation need to be really looked at.

That's why I think some Republican favored legislation, like Health Savings Accounts, should really be considered. At the same time, ACA's individual mandate was another really important part of the puzzle. The government should provide better options and regulate the market, but citizens need to be forced to buy into it as well. Otherwise none of this is ever going to work.

[Gaidin]

That's why I think some Republican favored legislation, like Health Savings Accounts, should really be considered. At the same time, ACA's individual mandate was another really important part of the puzzle.

These two sentences are kind of funny to put together.

[Cyclops]

The US health system is a mess. Its effectively a milking machine, with corporations using awful US IP laws and evil business practices to screw consumers (e.g. Pharmabro and the malaria drug price hike). As an aside these incredibly stupid IP laws are "shared" with trade partners under free trade agreements (generally they mean "the US is free to screw your country with horrible trade laws"), very happy Trump scrapped the US Pacific deal and worked out our own.

As a result of privatisations and "reform" beginning in the 1970's under Ford (Dick Cheney was involved) the US system has gone from overall a fairly well run system to a mess. Of course as the US has a bunch of jurisdictions and systems overlapping there are better and worse parts but overall it delivers healthcare outcomes very inefficiently and expensively. The spartan and somewhat Malthusian UK national health, the slightly bloated Australian system and even the rule-bound French systems all deliver much more efficient and safer outcomes overall.

At the top level the US rules, it has great tech, great research and does amazing boob jobs. For the average consumer it can be a nightmare.