Rationing Health Care - it's a lie!

[Darat]

And here is a report that explores one way drug companies try to influence the negotiations in their favour: http://www.independent.co.uk/life-s...rug-firms-bankroll-attacks-on-nhs-947316.html

 

[Rolfe]

The argument made a long slot on the C4 news as well. Apparently Twitter is alive with people sticking up for the NHS. A US critic was brave enough to appear. When her turn came, what she actually came out with was the nonsense about the USA bankrolling drug development costs. Since the discussion had until that point been about the death panels and pulling the plug on grandma, Krishnan was a bit floored. I could see why. You've asked someone on the programme to defend the side that's talking about death panels, and what she actually says is, well, it's not fair because you're getting better value for your money.

Krishnan then asked her if she didn't defend the death panels thing, and she got a bit evasive. She kept talking about "socialist countries" and how she did believe there was rationing. I think Krishnan got it a bit wrong there, because instead of asking whether US insurance companies paid out unlimited sums without question, he turned to the uninsured.

I think most people are simply baffled by all this.

Rolfe.

 

[Ziggurat]

That is simplifying things to a unrealistic extreme, negotiating a supply contract is rarely, if ever, just about the price.,

No, it's not just about price, it's sometimes about volume too. So you don't threaten to walk away completely, only partly. The same principle remains even in more complex contracts: you've got to forgo purchases in order to get lower prices. Otherwise you've got no leverage.

 

[Ziggurat]

The pharma companies quite aggressively promote their new drugs with doctors. Their marketeers who visit the doctors are not hindered by actual medicinal knowledge (rather not, because then they could be caught lying), and skirt on the border (and sometimes over) of what is permissible.

And why should what an ignorant marketer says matter to the doctors? If they're being bribed in some fashion, that's a problem. But it's a problem for any drug, me-too or not.

 

[Darat]

And why should what an ignorant marketer says matter to the doctors? If they're being bribed in some fashion, that's a problem. But it's a problem for any drug, me-too or not.

Advertising works.

 

[Rolfe]

I am pretty sure this year one of the high-ticket drugs was approved by NICE after the manufacturer agreed to pay for half the cost of the first round of treatment. I thought I'd read about it on the BBC news site but I can't find it. Does it strike a bell with anyone else?

ETA: Found it!

This is an example of the type of complex negotiation that actually happens: http://info.cancerresearchuk.org/news/archive/newsarchive/2009/june/19234946

Yes, I think that's the one I was trying to find. I couldn't remember who had decided to pay for the first round. There was actually a very balanced documentary about this, which showed the deliberations of the NICE expert panel when they approved it. How's that for transparency? The chairman was interviewed, and what he said was that it was a very difficult job, but since every doctor was inclined to go to bat personally for their own patients, it was important that consultants who didn't have that personal investment in the decision tried to weigh it up on its merits. They also had to bear in mind that funds were not unlimited, and would the money spent potentially have improved the lives of many other people with less glamourous needs?

The drug company was very keen to get the drug approved, for a reason we haven't really touched on yet. In the USA, their market penetration isn't 100%. Everybody who might benefit doesn't get it. So even if the price is higher, they're not making as much as they might. Conversely in a system like the NHS, approval is the passport to compete market penetration. Guaranteed sales.

On the other hand they weren't going to give it away. They made a "special introductory offer" of a half price initial course, if the NHS would agree to pick up the tab if the patients survived to need it. This swayed the panel, and they agreed to the funding. Everybody seemed happy.

This is normal, capitalist negotiating tactics. I don't know why NB thinks that the pharmaceutical industry is in unique need of price protection.

Rolfe.

PS. I should point out that the negotiation on the basis of the non-patent part of the order was purely my invention, based on how I know I would bargain or be bargained with in the veterinary diagnostics field - and to give an illustration of how it's not necessarily as simple as "take it or leave it". I don't know that the NHS actually does that. In contrast, the above example is real.

 

[Delscottio]

No, it's not just about price, it's sometimes about volume too. So you don't threaten to walk away completely, only partly. The same principle remains even in more complex contracts: you've got to forgo purchases in order to get lower prices. Otherwise you've got no leverage.

Not in all cases, to get lower prices you can make it cheaper for the supplier to actually supply you.

Centralised distribution points, agreements in amounts of and length of time for credit (interest rates for missed payments??), the guarantee of receiving your money (I would assume it like investing in Govermentt bonds - you will get paid) and centralised invoicing can lead to cheaper prices.

 

[3point14]

That's the collective deciding what's good for the collective.

I'd prefer to make the decisions about my own healthcare myself. If that means I can't get as much cool stuff at Walmart as someone who decides to get no health insurance, oh well.

Catching up on the thread, and haven't read past this bit, and sorry if the point has been made before, but there is, unless you are seriously, seriously rich, no way that you get to make your own healthcare decisions. Very few people can afford IC for any length of time or a triple bypass or chemo without recourse to a collective fund or some other entity. In expensive matters you're always going to be at the mercy of someone else making your healthcare decisions for you because you can't afford the big ticket items yourself. (unless, as mentioned you're very rich)

The other entity is going to be an insurance company (offering a finite amount of cover options and always with a primary motive of trying to make a profit and always, in the US at least, with an absolute limit on how much they'll spend on you before they cut you off) or the government (offering , me at least, an infinite amount of cover based solely on clinical need and primarily trying to keep the country healthy)

Anyone without a seriously large amount of money at their personal disposal is always going to be reliant on some other entity to make their healthcare decisions, don't fool yourself otherwise.

 

[GreyICE]

Excuse me, I was using the 2008 numbers. If you would actually open up the link I provided you could see for yourself how the company actually shrunk from 2007 to 2008.

Yeah, see, I was using 2009 facts. It actually being 2009, and you referring to this year, and the entire merger thing happening this year... you don't actually know anything about the company. You found some numbers on fortune 500 and are running with them. See the merger is happening and now they're cutting back some of the overlap... so you'd see that the company actually GREW really substantially, with the $68 billion merger and all.

 

[3point14]

I didn't say they were legally accountable. They are financially accountable. If they don't provide what their customers want, the customers stop giving them money. That's a rather important accountability for anyone whose goal is to make money.

But in order to make profit they need only healthy customers. They don't want sick customers. Which rather defeats the object of the exercise.

 

[GreyICE]

No, I've been arguing that countries that set price controls screw over the USA (and other countries who don't have socialized medicine) who don't have price controls. That's what I've been arguing the whole time. It's not fair to the people who live in the USA.

I like it when new medications come online. I don't mind a company making an 8% rate of return for developing their new and awesome innovations. I would definitely be willing to pay a bit more. I don't mind paying someone to develop and create awesome new things. Why? Because new and awesome things improve our lives. Their ability to make a rate of return is the reason why they innovate things that improve our lives.

I do something similar for a living. I create designs that enable other people to construct homes and hospitals and schools. My particular profession owns the right to those designs for quite literally forever (life + 99 years or whatever obscene amount it is now) But why should I charge at all for these designs? The things my profession creates are life-saving (they protect people in earthquakes and hurricanes), they're absolutely necessary for our current society to function the way it does. Should I not get paid for my work?

The argument that I think you're trying to make is that I shouldn't be able to charge what I feel is a reasonable amount for the new and awesome innovations I create solely because they protect peoples lives. If the real-world really worked that way I would quit my job (since I wouldn't be making anything doing it) and spend my days laughing at those who took away my ability to earn a living as they tried to construct new buildings in seismic regions.

In the end, new innovation depends upon people getting something for their work. Some people are okay with the acclaim from their peers. The rest of us prefer cold hard cash.

The entire sub-argument of an argument I made much earlier is: The USA ends up paying more than its fair share of the profit and R&D of new drugs. And I think that this is wrong. I also think price fixing by countries with socialized medicine is wrong and is one of the reasons why Americans pay more for healthcare. No one has disagreed with this point. But I've been bombarded by people exclaiming that, "if only the USA price fixed too, then everyone would be happy!". I think that would stifle innovation.

Call me whatever you like. I at least know what the definition of "Rate of Return" is.

Oh, the cry squad is here. See, the sad part is, I know your field. The designs you create are probably innovate. But lets face it, there are options. I don't like the price you're charging? Whatever. There's another firm who will do something similar cheaper than you - unless you're charging fair market price.

You're some irreplaceable talent? Pssh. There's a lot of engineers out there, ain't none of us irreplaceable. If you wanted to be a unique snowflake, you'd be an artist. Or an architect.

See, what you missed, captain engineer (god you love it. Really, 4 years of some tough schoolwork and you're an engineer. Some of my classmates had heads that could be used as building materials, and they're mostly working in some engineering firm somewhere - I still don't know how I don't watch more things like the dam that floated downstream happen around me) is that biology is not engineering. It's nowhere near that advanced yet. So when there's a pill that can treat your condition - it's the only pill. On the planet. For 20 years.

But you're dodging my question again. One pill that can save your life. $40,000? Is your life worth that?

I have an opinion on whether it is or is not...

P.S. Civil, really?

 

[3point14]

It's not altruism. It's called getting screwed over by your friends.

Imagine going to a pub with your mates. The four of you drink an equal amount and run up a bar tab of $50. Each of your three mates pays $10 bucks, calls it a fair value for what they received and then takes off. The bartender then makes you pay the last $20. That's what's going on here.

Now what happens if the USA finds a way to prevent other countries from fixing the price of medicine? Well then, our friends the Canadians, British and French are now paying $2.50 more and the USA is paying $7.50 less.

(Please don't take this metaphor too far)

Apologies for the string of posts, but what you're saying is that the UHC countries bully the pharmacutical companies into charging them less and in turn the pharmacutical companies bully the US into paying more? So it's not the US system that's broken, but everyone else's?

ETA: the pharma companies will not sell at a loss - if the US got it's act together and stopped paying what was demanded, the price everywhere else would go up to compensate. Or do I misuderstand the economics?

 

[Ziggurat]

But in order to make profit they need only healthy customers. They don't want sick customers. Which rather defeats the object of the exercise.

Healthy customers care about what happens to sick customers, because that tells them the value of the insurance they're paying for.

 

[Rolfe]

Healthy customers care about what happens to sick customers, because that tells them the value of the insurance they're paying for.

So where can I find the independent statistics giving me the percentage of each insurance company's customers who had their insurance cancelled on a technicality, once they had been diagnosed with the following conditions:

Mammary carcinoma
Non-Hodgkins lymphoma
Metastatic carcinoma of the prostate
Cervical spinal fracture leading to tetraplegia
Motor neurone disease
Chronic active hepatitis
Systemic lupus erythematosis

I don't know enough people to be able to make an assessment of the risk I'm running with any particular company for particular serious diseases. But if revoking coverage is such bad business, I must be able to find out the facts so that I can contribute to the inevitable boycott....

Rolfe.

 

[GreyICE]

Apologies for the string of posts, but what you're saying is that the UHC countries bully the pharmacutical companies into charging them less and in turn the pharmacutical companies bully the US into paying more? So it's not the US system that's broken, but everyone else's?

ETA: the pharma companies will not sell at a loss - if the US got it's act together and stopped paying what was demanded, the price everywhere else would go up to compensate. Or do I misuderstand the economics?

Of course. We have the burden of being the only right-thinking country on the planet. It's sad that the other little people just don't understand our system, but we bear the burden proudly.

You can obviously tell our healthcare system is sane by observing it.

 

[Ziggurat]

I don't know enough people to be able to make an assessment of the risk I'm running with any particular company for particular serious diseases. But if revoking coverage is such bad business, I must be able to find out the facts so that I can contribute to the inevitable boycott....

I currently have health insurance through my employer. If I get sick, I know that the insurance company will not revoke my health insurance on a technicality. I know this with absolute certainty. How do I know this, you might ask? Because I didn't have to fill out anything about my medical history when I signed up. Nothing, nada, zip. Revoking my health insurance isn't an option for my insurer. And that's the case for most people who get their insurance through work. For those who purchase plans individually, I do not know where to find those statistics, but I do know that you can protect yourself from being dropped on a technicality by filling out the application forms accurately, and buying a plan which allows automatic policy renewal.

But this discussion isn't just about revoking insurance, it's about accountability in general. And guess what: customer satisfaction surveys of different insurance providers, and different plans (I had more than one to choose from with my employer, and have in fact switched since I began my job), are not hard to come by. What happens if I'm not satisfied with my plan? I can switch to another one, as I've already done. What happens if I'm not satisfied with any of the options? I can make a stink to my employer. What happens if enough people make a stink? My employer will take their business elsewhere. The insurance company is indeed accountable to their customers, and will lose that customer if they do not provide a good enough service.

Oh, and my employer has also changed insurance providers since I started working here, too. This image you seem to have of customers trapped by insurance companies just isn't accurate.

 

[3point14]

I currently have health insurance through my employer. If I get sick, I know that the insurance company will not revoke my health insurance on a technicality. I know this with absolute certainty. How do I know this, you might ask? Because I didn't have to fill out anything about my medical history when I signed up. Nothing, nada, zip. Revoking my health insurance isn't an option for my insurer. And that's the case for most people who get their insurance through work. For those who purchase plans individually, I do not know where to find those statistics, but I do know that you can protect yourself from being dropped on a technicality by filling out the application forms accurately, and buying a plan which allows automatic policy renewal.

But this discussion isn't just about revoking insurance, it's about accountability in general. And guess what: customer satisfaction surveys of different insurance providers, and different plans (I had more than one to choose from with my employer, and have in fact switched since I began my job), are not hard to come by. What happens if I'm not satisfied with my plan? I can switch to another one, as I've already done. What happens if I'm not satisfied with any of the options? I can make a stink to my employer. What happens if enough people make a stink? My employer will take their business elsewhere. The insurance company is indeed accountable to their customers, and will lose that customer if they do not provide a good enough service.

Oh, and my employer has also changed insurance providers since I started working here, too. This image you seem to have of customers trapped by insurance companies just isn't accurate.

I see. The "I'm alright, Jack" argument.

 

[kellyb]

I currently have health insurance through my employer. If I get sick, I know that the insurance company will not revoke my health insurance on a technicality. I know this with absolute certainty. How do I know this, you might ask? Because I didn't have to fill out anything about my medical history when I signed up. Nothing, nada, zip. Revoking my health insurance isn't an option for my insurer. And that's the case for most people who get their insurance through work. For those who purchase plans individually, I do not know where to find those statistics, but I do know that you can protect yourself from being dropped on a technicality by filling out the application forms accurately, and buying a plan which allows automatic policy renewal.

If they end up not turning enough profit from your company because of people actually getting healthcare, they can "drop" the whole company by astronomically increasing the price.

What happens if enough people make a stink? My employer will take their business elsewhere.

Make a stink how? Threaten to quit?

 

[Delscottio]

I currently have health insurance through my employer. If I get sick, I know that the insurance company will not revoke my health insurance on a technicality. I know this with absolute certainty. How do I know this, you might ask? Because I didn't have to fill out anything about my medical history when I signed up. Nothing, nada, zip. Revoking my health insurance isn't an option for my insurer. And that's the case for most people who get their insurance through work. For those who purchase plans individually, I do not know where to find those statistics, but I do know that you can protect yourself from being dropped on a technicality by filling out the application forms accurately, and buying a plan which allows automatic policy renewal.

But this discussion isn't just about revoking insurance, it's about accountability in general. And guess what: customer satisfaction surveys of different insurance providers, and different plans (I had more than one to choose from with my employer, and have in fact switched since I began my job), are not hard to come by. What happens if I'm not satisfied with my plan? I can switch to another one, as I've already done. What happens if I'm not satisfied with any of the options? I can make a stink to my employer. What happens if enough people make a stink? My employer will take their business elsewhere. The insurance company is indeed accountable to their customers, and will lose that customer if they do not provide a good enough service.

Oh, and my employer has also changed insurance providers since I started working here, too. This image you seem to have of customers trapped by insurance companies just isn't accurate.

Out of interest is there a maximum your insurer will pay out?

ETA: Or you lose your job?

 

[Ziggurat]

If they end up not turning enough profit from your company because of people actually getting healthcare, they can "drop" the whole company by astronomically increasing the price.

In which case my employer will bring their business elsewhere. Dropping customers isn't a winning strategy in the market, you know.

Make a stink how? Threaten to quit?

By telling them that I am unsatisfied, and want something done. They are sensitive to employee satisfaction.