Coping with "Medicare for all"

It’s getting tiresome, all the “fake news” from years ago now suddenly being real problems. Like no one could possibly have ever predicted these definitely unforseeable consequences…

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What’s wrong with prescription drugs price caps? Literally every other country in the world pays less than we do for the same drugs because they enforce price caps. Here drug manufacturers try to guilt trip us by claiming if we do the same here, it’ll chill new drug research. I don’t buy it but maybe we could even survive without them researching more Wegovy BS drugs for overeating whales and lobbying Congress to have Medicare/Medicaid cover it.

This is a hard question. Broadly, price caps just result in rationing and poor capital allocation - just like the gasoline lines during the OPEC embargo in the 70s. With drugs, it’s more complicated. Issues include:

  • if you say in advance, for example, that you will only pay $50/mo for insulin, no one will go to the trouble to develop expensive new and better forms of insulin (which is what happened under our more capitalist system). Patients and investors both lose, but the taxpayer (or health insurance companies) saves money if it would have been covered at the creators’ higher price point. “Let 'em die, and die for cheap” is the unspoken motto of socialist medicine.

  • If you say retroactively, for example, to a company that developed this Hep C cure which costs 6 figures (and leads to much much better quality of life for sick people for their whole long lives) that you’ll only pay $10k for it, either the company stops making it at all and the sick people stay sick (which is what happened with some other drug recently over these price cap negotiations), or the government seizes the patent and lets it be made generically and basically steals all the capital investment from the shareholders of the company that made it. This is a big violation of the capitalistic norms and heavily discourages any other drug companies from spending any money at all researching expensive treatments even if they would have large and valuable markets. Would you pay $100k to get a cure for any type of cancer? I sure would, and many people would, but maybe the Medicare budget wouldn’t and so under a price cap system it would never get made.

  • the US is a very big market, so often it’s the primary profit source, with EU being secondary. Companies have issues with pricing the same drug in different markets, ideally selling it to rich Americans for a lot, rich but socialist EUers for a fair bit, and poor third world folks for whatever they can get and make a small profit while getting good PR for “helping out”. This situation sort of puts the US medical market as a primarily determining force in what gets researched and funded by the big pharma companies.

  • if drugs are really supposed to be available “at cost” or something, the US should provide public government funded R&D for the whole biotech sector. Of course they do a little with the NIH, CDC, etc, but the vast majority is presently privately funded. The problem here is that drugs and healthcare really are a public good, but that the government tends to be extra bad at efficiency and would probably hire a bunch of indigenous felons to research how racism causes diabetes rather than curing cancer (since cancer probably kills more white people who tend to have longer life expediencies than currently favored minorities with worse health habits and lifestyles). More on that in the next post…

I think our drug pricing is like what Churchill said about democracy “the worst form of government, except for all those others that have been tried.” I could certainly be convinced that the role of insurers for health coverage might want to be meaningfully different tho, they seem to add a lot of overhead and complexity that gets gamed without a lot of value.

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You should prefer white medical providers since it’s clearly much harder to get a job as one these days, straight and male even better.

https://twitter.com/libsoftiktok/status/1770486244994105782

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The argument that drug price controls will hinder research of new drugs is definitely a worry.

While new drugs have become available, I’m not convinced that the free pricing US market has demonstrably lead to better health outcomes statistically than in countries which have imposed cap on drug prices. Maybe it’s because these countries have reaped the benefits of these new drugs without incurring the costs associated with their research. But it’s difficult to ascertain the actual impact without introducing some price controls.

That argument also does not work well. Of course any individual would pay almost anything to stay alive. But even more so when it does not cost them directly or they are unable to pay. You and I could pay $100k for our own treatments. Most Americans cannot self-fund a $100k treatment.

But the more telling question for me is "Are you fine with paying $100k of your own money for the same treatment for every patient other than yourself (and loved ones)? Are you willing to get taxed considerably more for it than in other countries because Medicare/Medicaid covers its cost fully without controls? Answer is no longer as simple when framed in the context of you or I paying for someone else’s treatment with our hard-earned money. Take end of life costs for example. If it’s me who’s about to die, of course I’m 200% for getting the best care at any cost (that I effectively don’t pay and gets subsidized by others). But my answer is a bit more circumspect when asked whether I’d pay that same amount for someone I don’t know, let alone for say a convicted murderer/rapist, an illegal immigrant, someone who’s abused welfare system their whole life, a 115-yr old person, etc. Am you willing to subsidize any outsized healthcare cost in all cases? Personally, I’m not in favor of a system that does not implement a strict cost/benefit analysis to any spending which is what I consider a system without price caps.

The argument that US is a big market seems a bit circular. It’s not a big market in terms of number of patients relative to the EU for example. It’s only a big market because it’s where the most profits can be made due to lack of pricing control. I don’t see how that justifies the lack of price controls. It only explains why research is more focused on researching drugs for the US market first but still does not justifies the costs.

Disclaimer: I work for a company selling products to the pharma industry.

Turns out they do have a program like that, I just wasn’t aware of it. it’s run by the NIH and used to fund college researchers who write particularly good diversity statements in their applications.

https://www.wsj.com/articles/the-nih-sacrifices-scientific-rigor-for-dei-f828a6c7

NIH for several years has pushed this practice across the country through its Faculty Institutional Recruitment for Sustainable Transformation program—First for short—which funds diversity-focused faculty hiring in the biomedical sciences.

[their] rubric penalizes job candidates for espousing colorblind equality and gives low scores to those who say they intend to “treat everyone the same.” It likewise docks candidates who express skepticism about the practice of dividing students and faculty into racially segregated “affinity groups.”

These responses aren’t merely administrative; the requirements carry serious weight throughout the NIH First programs, often valued on par with conventional measures of academic excellence. … The records underscore that scientists simply can’t get hired in the program without an outstanding DEI score.

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Medicaid for all includes a lot more people than it used to, now extended to anyone to can show up at a hospital

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Good luck getting care if you have a medical emergency and show up at an emergency room jampacked with kids with the sniffles.

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There are ways around the “uninsured ER” wing. I have yet to find a way around it besides using concierge docs. :frowning:

Going to ERs in the better parts of town may make a difference, at least according to neighbors in the medical profession around here.

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First threatening drug companies who don’t lower prices in election years, now… setting up committees to figure out why so many drugs are in short supply?

https://www.wsj.com/health/healthcare/drug-medication-shortages-us-olympic-amoxicillin-107fa9d8

  • Hundreds of Drugs Now in Shortage, University of Utah Drug Information Service Says – WSJ
  • Ozempic, Epinephrine and Amoxicillin Among Drugs in Shortage in U.S. – WSJ

Drug shortages in the U.S. have reached an all-time high.

Supplies are low for everything from lifesaving injections to diabetes medications, according to data from the University of Utah Drug Information Service, which tracks shortages.

Continuing shortages reached a similar peak in 2014, then abated for several years. They’ve been on a mostly steady upswing since 2021.

I can’t seem to remember what happened in 2021 - must of been a riot of insurrectionists destroying drug factories or something.

What will Biden come up with next? More government is the solution to the problem, of course.

Fixing the problem will probably involve changing the business model, including taking steps that would increase the prices of generic medicines so sales can support manufacturers and attract additional companies, according to researchers and policymakers.

The White House earlier this month proposed spending between $3.26 billion and $5.11 billion over a decade to help address shortages. The plan would include linking Medicare payments to hospitals in part on whether hospitals do a good job buying drugs from companies that demonstrate quality over the long term, rather than just the cheapest price. The proposal would need approval and money from Congress.

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I think we discussed this already, but end of life expenses are actually a huge part of the cost problem. It’s very expensive and completely unnecessary. If I’m definitely about to die, I’d just want some morphine to make it painless, and whatever else they got to make it quick and cheap.

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Uh, I hate to tell you, but we’re all definitely about to die … gimme your arm. :rofl:

On a serious note, I suspect this may be part of what’s driving Canada to kill their mentally ill.

Obamacare for (some) illegals

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UCLA’s illegal affirmative action is as bad as you feared.

firsthand knowledge of the admissions process say it has prioritized diversity over merit, resulting in progressively less qualified classes that are now struggling to succeed. Race-based admissions have turned UCLA into a “failed medical school,” said one former member of the admissions staff

Within three years of Lucero’s hiring in 2020, UCLA dropped from 6th to 18th place in U.S. News & World Report’s rankings for medical research. And in some of the cohorts she admitted, more than 50 percent of students failed standardized tests on emergency medicine, family medicine, internal medicine, and pediatrics

Guess who’s not getting in? Too many Asians, just like at Harvard.

a steep drop in the number of Asian matriculants and tracks the subjective impressions of faculty who say that students have never been more poorly prepared… “I don’t know how some of these students are going to be junior doctors,” the professor said. “Faculty are seeing a shocking decline in knowledge of medical students.”

“All the normal criteria for getting into medical school only apply to people of certain races,” an admissions officer said. “For other people, those criteria are completely disregarded.”

Led by Lucero, who also serves as the vice chair for equity, diversity, and inclusion of UCLA’s anesthesiology department, the admissions committee routinely gives black and Latino applicants a pass for subpar metrics, four people who served on it said, while whites and Asians need near perfect scores to even be considered.

The bar for underrepresented minorities is “as low as you could possibly imagine,” one committee member told the Free Beacon. “It completely disregards grades and achievements.”

Remember - demand a white or Asian doctor when your health matters. At least they had to have passing grades to get in!

As the demographics of UCLA have changed, the number of students failing their shelf exams has soared, trends professors at the medical school say are connected. Between 2020, the year Lucero assumed her post, and 2023, when the first classes she admitted were taking their shelf exams, the failure rate rose dramatically across all subjects, in some cases increasing tenfold relative to the 2020 baseline, per internal data.

“UCLA still produces some very good graduates,” one professor said. “But a third to a half of the medical school is incredibly unqualified.”

Half as many courses, more social justice. Don’t worry, the grads are still qualified to explain “fat-phobia” to you if someone calls you out for being obese, even if they can’t pass a basic medical exam.

The collapse in qualifications has been compounded by UCLA’s decision, in 2020, to condense its preclinical curriculum from two years to one in order to add more time for research and community service. That means students arrive at their clinical rotations with just a year of courses under their belt—some of which focus less on science than social justice.

“This has been a colossal failure,” one professor posted in April on a forum for medical school applicants. “The new curriculum is not working and the students are grossly unprepared for clinical rotations.” Nearly a fourth of UCLA medical students failed three or more shelf exams in 2021…

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Interesting comments on Kaiser’s medical record from an inside if anecdotal perspective. they are often held out as a great example of more centralized medical treatment, not quite a “government” system but an example of how a good one might work if one were so inclined to such things. These comments were not exactly inspiring on the care side, although I’m sure they do well on the cost side.

Kaiser is the poster child for the statistical practice of medicine. They pretty much invented it. That can be good, or very bad.

  • If you have a well understood condition, chances are they will have a good practice team…
  • If you have “garden variety” ailments, Kaiser can also be good. They don’t seem to hire/retain the best doctors, but they seem … good enough
  • if you have something unusual, you have to be ready to REALLY fight to get proper treatment.
  • If you are getting older and it might be expensive to treat you, they seem to try to severely limit your treatment and force you (or your family) to fight for care.

about 10% of our workforce was on Kaiser, but over half the malpractice lawsuits we saw were against Kaiser. Don’t know whether that was because their practices were just worse than average or something unrelated (maybe they just didn’t settle?), but it seemed like a big disparity.
(and) some of the suits were breathtakingly bad.

more details in the link above.

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At the risk of sounding cynical, maybe that’s not a bad thing to throw a cost vs. benefit analysis into end of life care options. That’s a main source of costs. Spending millions on extending life by a few months of low-quality of life survival should not be a slam dunk decision.

good enough

Welcome to the initiation of socialized medicine. Want more … intro to hospice … don’t be a burden when you can cast away … etc. :slight_smile:

Yikes!!!

At the risk of sounding cynical or economical, how about applying your argument / analysis to Down’s syndrome kids? Rather than adding easier offended / triggered “peoples”, I’ll leave it as is.

That only applies if you insist that your version of life is the only quality life.

The end of life cost verses benefit calculation is about the cost of laying in a hospital bed in a coma for a couple extra weeks. It is not about living the life of a 6 year old for the next 50 years.

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