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  #41  
Old 10 July 2018, 02:15 AM
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Originally Posted by jimmy101_again View Post
US tort law might also be a significant problem.
I’m curious. How do national public healthcare systems handle things like malpractice where the medical profession makes a bona fide error or mistake, but that falls short of negligence?

With military healthcare, we’ve got this thing called the Feres Doctrie that basically says members of the military can’t sue the government for injuries incurred on active duty, even when it involves medical malpractice by military (or even civilian paid by the military) doctors. Seems to come up every couple years after a botched operation or something. Does, say, Canada allow for malpractice suits against medical professionals? A google search suggests it’s possible, but difficult.
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  #42  
Old 10 July 2018, 03:58 AM
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This article might interest you:
https://www.theguardian.com/commenti...gligence-cases
Quote:
By 2020 the NHS will be paying out £3.2bn a year in claims. How much is that? Here’s the rough scale of it: every 1% extra in pay to NHS staff in England costs £500m. So, for that negligence money, they could have a hefty rise, according to the Institute for Fiscal Studies. Or the 50,000 empty NHS posts could be filled, at a cost of £2-3bn, according to the Public Accounts Committee.

Medical negligence claims have soared since the introduction of no-win-no-fee deals, as lawyers now tout for business, even advertising in NHS waiting rooms. The bonanza for lawyers has been remarkable: today’s report finds that in 61% of successful cases, the legal costs are higher than the damages paid out.
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  #43  
Old 10 July 2018, 05:24 AM
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I will say that one of the things that changed my mind about universal health care, some years back (before I was as liberal as I am now, and when I was a bit skeptical about the idea of the government running it) was one time when I asked an attorney friend of mine how we can make the country less lawsuit-happy, and "universal health care" was her immediate answer. if you have a single-payer or socialized system covering and paying for everyone, then lawsuits for medical costs become kind of irrelevant.

(Oh, not entirely. If someone's malicious act or gross negligence results in medical costs to a bunch of people, then the government/insurerer may try to recover from that person, assuming they have enough assets to make a difference -- more likely in the case of a corporation. But you can set up some kind of legal framework that would I think reduce those sorts of lawsuits by a large factor.)

The other major things, from a relatively selfish point of view, was realizing that not having to worry about health insurance would give me a lot more lifestyle options, besides "having a full-time job with good insurance." Starting a business, or working a number of part time jobs, or working as a contractor (which I have done quite a lot of anyway). And, knowing that I had friends who had serious health issues (but not serious enough to quality for disability, though one of them certainly ought to have for the last year or so of his life) that also had trouble finding work.

Now it's all that, plus believing that we can create a system that covers everyone, better than most private insurance does now, and at a lower per capita cost, if we just want to do it badly enough.
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  #44  
Old 10 July 2018, 12:32 PM
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Originally Posted by ASL View Post
things like malpractice where the medical profession makes a bona fide error or mistake, but that falls short of negligence?
Definitional hijack: I don't think it does count as malpractice if there's a genuine error or mistake, but no negligence or other improper behavior. Even the best doctor, doing the best they can, is going to occasionally get something wrong, because our knowledge isn't perfect.

-- it occurs to me that I'm thinking of things like misdiagnoses, or prescribing what turns out to be the wrong dose or medication for the particular patient although it would have been the right dose or medication for some other patients. You may be thinking of things like leaving surgical equipment inside the patient, or operating on the wrong leg. ETA: I think those latter things might count as negligence, though.
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  #45  
Old 10 July 2018, 02:44 PM
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I have never been able to work out why a country as Christian as the US ignores the teaching of Christ when it comes to the poor. The cognitive dissonance must be deafening.
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  #46  
Old 10 July 2018, 03:03 PM
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AISI, there are two reasons for that.

The first is that they feel that the Christian way to help the poor is through private donations, not publicly mandated support. The second is that many Christians (other religions and atheists too probably) are a strong believers in the prosperity doctrine. ETA: Various people may believe soley in one or in some combination of the two.

Gen "If God had meant for them to have heathcare, He wouldn't have made them poor." Yus
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  #47  
Old 10 July 2018, 03:16 PM
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Originally Posted by thorny locust View Post
Definitional hijack: I don't think it does count as malpractice if there's a genuine error or mistake, but no negligence or other improper behavior. Even the best doctor, doing the best they can, is going to occasionally get something wrong, because our knowledge isn't perfect.

-- it occurs to me that I'm thinking of things like misdiagnoses, or prescribing what turns out to be the wrong dose or medication for the particular patient although it would have been the right dose or medication for some other patients.
What you said, that's basically what I meant. So not even malpractice, but the sort of thing that inevitably happens when diagnoses and treatment require some degree of professional judgement/discretion and it's not as simple as running a blood test (but then again, even a blood test can return a false positive or negative) and prescribing this one pill that no one is ever allergic to.

Medical professionals will make mistakes, people will die, and it may not even be anyone's "fault" but even if it is someone's "fault" they may not have been grossly negligent and to some people I think "justice" entails being able to sue the pants off sais medical professionals. The idea of having the government be in control and deciding that a higher threshold needs to be met for a lawsuit to keep down costs seems to offend some people's sensibilities.

I think others are put off by the idea that the government might decide that, no, your 90 year-old (or even 30 year-old) mom who has a terminal illness can't have the five million (or even half-million) dollar experimental treatment that doctors say is her only hope (but almost certainly won't work anyways) and you're going to have to accept that there are limits to what medical science can do for her (and what taxpayers can foot the bill for). I think that's where the much maligned idea of "death panels" comes from. The idea that the government deciding which treatments will be covered under which circumstances (and not even on an individual basis) is effectively diminishing the value of human life. As if it would be better for the government to just cut its losses and spend zero dollars, rather than a finite amount, if it's unwilling to spend infinity dollars.
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Originally Posted by gopher View Post
I have never been able to work out why a country as Christian as the US ignores the teaching of Christ when it comes to the poor. The cognitive dissonance must be deafening.
1) Whatever you want to believe Christ said, you can probably find the words in the gospel to support your position.
2) God will provide, right?
3) And even if He doesn't, this life is just to a filthy rag to dust off your feet off with before the next one, right? So just get your soul in order and you should be fine.

Maybe we should be less Christian and more humanist, but that's just me.
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  #48  
Old 10 July 2018, 04:51 PM
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Originally Posted by crocoduck_hunter View Post
No. Everybody should donate. That's how insurance works: everybody pays a little bit in so that when someone is faced with a big medical issue, it doesn't cost them an exorbitant amount. That's the whole point.
Yep. And that doesn't contradict any of the points I made. The US has a dysfunctional health care system, everybody knows that. But the problem isn't $50K treatments and the manufacturers shouldn't have to donate their product. The US health care system is based on profit and not on delivering good health care, or efficient health care, or effective healthcare, or fair healthcare.

The challenge is that all the organizations making money are making LOTS of money and that, in the US at least, means the chances of significant change are basically zero. In addition, since medical pricing in the US is 100% vodoo even a competitive marketplace isn't an effective control on the cost of the care.

Insurance companies really don't care how much a treatment costs, indeed it is completely irrelevant to their business model. All they care about is that the price is predictable. Any elevated costs are simply passed on to the buyers of the insurance.

Many US health insurance buyers don't care what a treatment costs since they have insurance and that insurance is paid by someone else (e.g., their employer).

MDs and hospital don't care what care costs since the cost is passed on to the consumer (typically through their insurance).

You would think the US gov't would care what healthcare costs since they pay a fair amount of it. But they are blocked by interest groups from doing things that other countries do, like negotiate drug prices.
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  #49  
Old 10 July 2018, 05:46 PM
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None of the points you made were really related to my previous post.
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  #50  
Old 10 July 2018, 07:05 PM
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Originally Posted by jimmy101_again View Post
But the prices are set based on the value to the customer. A $50K cure for Hep-C ends up being cheaper for the patient (and the health care system overall) than living with the disease.
Cite please.
I understand that companies can, and do, set their own prices for meds, but I see no evidence that they do so because they base it on the "value to the customer". I would call what some of them do to be price gouging.
The customer often doesn't have a choice.
And those price increases are paid by the insurance companies. They don't care- they simply raise the rates on all the consumers. So we pay more.

And if a customer doesn't have insurance and can't afford that medication then we all end up paying more for them as they get sicker and use the emergency room as a doctor's office for the various ailments they needn't have had if they had had the initial treatment in the first place. But hey-they might die, so there's a win cost-wise.

Either way-we pay more. So curbing inappropriate inflated drug prices through regulation would be helpful barring any immediate move to universal healthcare.
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  #51  
Old 10 July 2018, 07:25 PM
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'Give me 50K or you're gonna die' is not a statement that, anywhere outside of healthcare, we'd consider as offering to provide value to the consumer.

If the drug actually costs 50K to produce and deliver in proper form to the person who it's expected to cure, that's a different matter. But that's very often not what's going on. And, for the cases in which it is, as crocoduck_hunter said, that's what insurance -- or, I'll add, taxes to produce a functioning society -- is supposed to be meant for.
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  #52  
Old 10 July 2018, 07:40 PM
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Originally Posted by Beachlife! View Post
So there are drugs produced in Canada, but not available in the United States? Why don't the Canadian manufacturers export them? It would make it more cost effective.
From what I understand, the US has a law forbidding the import of drugs into the US that can be produced in the US. That is why it is technically illegal for Americans to fill prescriptions in Canada and bring them back to the US with them (or use an online pharmacy in Canada).


Now for an unrelated aside:

Oddly enough, this is one of the tools in the trade war toolbox. If the US ramps up, there is already discussion of declaring US pharmacological patents null in Canada, allowing for widespread generic production of drugs for export.

That would mean "big pharma" would be taking a huge hit as we would start exporting our generics all over the world and the American companies would end up being hit (and the US government listens to American companies, even if they don't listen to their people).

This worked for a small Caribbean country, Antigua, in a trade dispute with the US over gambling rights. Antigua allowed for companies to run online gambling, and the US declared it illegal and started prosecuting people who did business in Antigua. When the dispute was heating up, the US went heavy handed, so Antigua prepared to declare all US copyrights (movies, music, television etc) void, thus allowing for legal streaming and file sharing from Antigua. That got the US entertainment industry's attention, and the US government to come to the table. However, despite negotiating a settlement, the US has yet to pay Antigua the monies owed. Antigua still has copyright as its ace in the hole.
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  #53  
Old 10 July 2018, 07:46 PM
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Originally Posted by thorny locust View Post
'Give me 50K or you're gonna die' is not a statement that, anywhere outside of healthcare, we'd consider as offering to provide value to the consumer.
To be fair, a big part of that is the way you phrased it. There would be a similar reaction to "Give me $5,000 or your house will burn down." if that's how you phrased an electrician's quote for critical wiring repairs.
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  #54  
Old 10 July 2018, 08:02 PM
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Originally Posted by GenYus234 View Post
To be fair, a big part of that is the way you phrased it. There would be a similar reaction to "Give me $5,000 or your house will burn down." if that's how you phrased an electrician's quote for critical wiring repairs.
A big difference that there is always another electrician who may well offer to do the job for $4,000. Often, with patents and other protections, they very well is not another option for the drug that could save the life.
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  #55  
Old 10 July 2018, 08:05 PM
jimmy101_again jimmy101_again is online now
 
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Quote:
Originally Posted by thorny locust View Post
'Give me 50K or you're gonna die' is not a statement that, anywhere outside of healthcare, we'd consider as offering to provide value to the consumer.

If the drug actually costs 50K to produce and deliver in proper form to the person who it's expected to cure, that's a different matter. But that's very often not what's going on. And, for the cases in which it is, as crocoduck_hunter said, that's what insurance -- or, I'll add, taxes to produce a functioning society -- is supposed to be meant for.
The pricing structure you described is usually called "cost plus". The price is based on what it cost to produce the product plus some amount of profit. Businesses hate cost plus and try to instead set the price based on value to the customer. They can easily do that if they have patent protection. Without patent protection they often try things like building brand loyalty. So the cost of a can of Coke(tm) is based on what a person will spend for the can based in part, on their brand loyalty. People will often pay more than cost plus.

For a $50K Hep-c treatment the lifetime cost to the patient (or the insurance company) of the untreated disease is more than $50K. Feel free to augment that untreated cost with whatever value a human's life is worth.** So buying the drug saves the patient money in the long run. That is pricing based on value to the customer. (In addition, there is significant benefit to society as a whole for a Hep-c cure since it is a communicable disease and the rate of transmission depends on the number of people in the population with the disease. If a Hep-c cure not only cures one person but also prevents one transmission event then the benefit to society is increased.)

** Hep-C kills more American than all other communicable diseases reported to the CDC combined. (https://www.cdc.gov/nchhstp/newsroom...mortality.html)

Quote:
'Give me 50K or you're gonna die' is not a statement that, anywhere outside of healthcare, we'd consider as offering to provide value to the consumer.
That statement just doesn't make sense. "Value" means "what it is worth to the customer". Regardless of the cost to make a product the "value to the customer" is health and survival, which by any conceivable measure is significant.

There is certainly rational that supports universal health coverage which is always based on a variant of insurance. Everyone pays into a pool and that covers extremely costly treatments. That however has zero to do with the cost of the treatment.

Besides, MDs and hospitals make the "$50K or die" proposition thousands of times a day to patients. How much do you think a heart bypass operation costs? $50K would be cheap for that surgery.
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  #56  
Old 10 July 2018, 08:52 PM
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The rational value for a life-saving treatment to the person whose life is saved would be 'everything I have and can borrow'; because otherwise you're dead.

For some people, of course, that amount is far less than 50K; so the 'value provided to the consumer' amounts to 'too bad to be you, but you won't be for much longer'. (The fact that other treatments may be even less affordable isn't particularly helpful. The fact that sometimes in such cases the costs are adjusted doesn't change the overall argument; unless we're going to go to the version in my next paragraph.) And for those for whom it is 50K, leaving them alive but impoverished and in massive debt is a major problem -- not only for those individuals, but for everyone connected with them, which includes some people who don't think they're so connected.

But if that's really the basis of the pricing, then it should adjust to the individual. 'We'll save your life, but it'll cost everything you have'. That's value-to-the-consumer pricing. So would be 'We'll save your life, but it'll cost x percent of what you have.' What's actually going on isn't value-to-the-consumer pricing; it's what-we-think-the-market-will-bear pricing.

Calling it value to the consumer makes sense when the item for sale is more or less optional. Nobody has to buy Coke, at all. Most people in the USA can drink tap water. Everybody has to wear clothes; but pricing, say, designer blue jeans at value to the consumer is reasonable, because the consumer can buy cheap jeans instead, or buy them at the used-goods store; so if a company wants to charge 5K for a pair of its jeans and can get that, it's not a societal problem, because I can get wearable jeans for $5 a bagfull at the Next-to-New. Pricing drugs that are essential to keeping people alive that way is a societal problem, because generic aspirin, let alone used generic aspirin, isn't an alternative option.

-- the electricians I've dealt with mostly have been working on cost-plus, as near as I can tell. Farmers are lucky if we get to work on cost-plus.

I expect that heart-bypass operations are going to be expensive even at cost-plus, yes; and so are some drugs. That's not what I'm talking about. What I'm talking about is buying up patents and then hiking the price way above cost of production.
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  #57  
Old 10 July 2018, 08:54 PM
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Originally Posted by UEL View Post
From what I understand, the US has a law forbidding the import of drugs into the US that can be produced in the US. That is why it is technically illegal for Americans to fill prescriptions in Canada and bring them back to the US with them (or use an online pharmacy in Canada)...
It is illegal to import banned drugs or to import drugs that were manufactured in the US and exported to Canada. But, I know of no law banning the import of foreign made prescription drugs that are otherwise legal.
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  #58  
Old 10 July 2018, 08:54 PM
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Since I'm not getting a reply at this point, I'll supply a cite or two of my own while I wait.

Here are some reasons why companies have raised prices dramatically on drugs according to a couple sources:

Why generics drugs are so expensive

Why prescription drugs are more expensive in the US.

That one is a blog and short, but I thought it was straight forward and had links to what it was referencing in most places.

It looks like the New York Times has done a series of articles on this, too, but I'm out of free articles for the month, so I'll have to wait to read them.
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  #59  
Old 10 July 2018, 09:29 PM
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Originally Posted by Beachlife! View Post
But, I know of no law banning the import of foreign made prescription drugs that are otherwise legal.
You could very well be right. I am far from well versed in this. I only know what has popped up on the news over the past years.

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  #60  
Old 11 July 2018, 03:47 PM
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Originally Posted by Beachlife! View Post
It is illegal to import banned drugs or to import drugs that were manufactured in the US and exported to Canada. But, I know of no law banning the import of foreign made prescription drugs that are otherwise legal.
Quote:
In most circumstances, it is illegal for individuals to import drugs into the United States for personal use. This is because drugs from other countries that are available for purchase by individuals often have not been approved by FDA for use and sale in the United States.
Personal Importation (US-FDA)
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