Tuesday, February 12, 2008

Ever Wonder Why....2/27

I received this promo from Dell and Microsoft:

Your choice of a PC can dramatically improve the lives of people living with AIDS in Africa. Windows® is proud to partner with Dell™ and (RED)™ to give you an opportunity to buy (PRODUCT) RED next time you buy a PC.

For every purchase of a Dell (PRODUCT) RED PC, Windows and Dell will make a contribution of $50 to $80, depending on the product purchased, to The Global Fund to help improve the lives of people in Africa affected by AIDS. $50 is enough to pay for almost four months of life-saving antiretroviral treatment for one person suffering from AIDS.

It's simple. You choose Windows Vista Ultimate (PRODUCT) RED, we give to The Global Fund, and people in Africa benefit.

It is a beautiful choice with a powerful impact.

My question, to the drug manufacturers, and our elected officials is, Why does four months of antiretroviral cost $80 in Africa, and why shouldn't it be the same price here?

Last I heard, the treatments, not just the cocktail, cost thousands per month. So why are we paying (at levels that threaten to bankrupt our healthcare system) the much higher price for the same drugs? Is it because they can get away with it?

But, it isn't only that. What has happened to our healthcare system? Years ago, in a fee-for-service era, you got sick, you went to your doctor. He listened, you talked. He talked, you listened. You paid him. Simple. Now, with the system we have, you pay the HMO, they pay the doctor, a percentage of what he bills, so he feels the need to cram more patients into the time slots. Little talk, less listening. Less paid. The price of progress.

This really isn't the fault of a free-market system. It happens in socialized medicine as well. The money you would have paid to the HMO, would go to the government. They would 'manage' the system. The physician receives less, as does the patient. ...And the level of caring is even less. ...And what program has government 'managed' correctly, or under budget?....keep thinking.....


Anonymous said...

Economics in a capitalistic system. You charge what the market will bear. It is your job as a public, for profit drug company to maximize the bottom line. Drug companies are huge, lobby well,and have more influence (as stanky as they may be) than most any other industry, with the possible exception of the oil companies.Look at the profits and compare to the oil companies. Why should we be paying so much for oil? Because we have to, we will, and we are powerless as long as we will tolerate it! Same reason we accept the discombobulated health care system.But there is still enough money in a mediocre hospital in a small town in east Texas to attract corporate Nashville, and only because the citizens of Paris don't care enough to expect better for themselves. If you always do what you've always done,.......

Anonymous said...

You forgot to mention that HMOs listen to no one.

And if you want to use fee-for-service, you are charged far more than the HMOs pay. Hardly seems fair to penalize for cash.

Anonymous said...

OK. I go to Brookshires and pick up milk,bread and eggs. I go to the check out counter and I give the checkout person $1 for my co-pay and leave with the goods. Brookshires then has to have hired people to bill the "Groceries HMO" in Seattle the remainder of the bill for $13 using a 42 cent stamp and a 15 cent envelope or send via electronic mail over a service which costs $15-20 a month with an entering tech which costs a monthly wage plus benefits. In addition, I have now taken stock which Brookshires has to replace to serve the next person which Brookshires has to pay for with cash, since no one else has "third party payors". In addition, the HMO has the "power" to "deselect" Brookshires if the HMO deems them non-compliant with the rules set in place by the HMO driven legislature. Calculating "the cost of doing business" becomes in the red very quickly when daily wage earners with benefits are entered in.
Solution: Now get ready for it......Can the middle man. Get rid of the insurance companies,remove Medicare,Medicaid, and third party payors. Let the patient and Dr./hospital enter into negotiations to determine payment. Without a doubt, the cost of healthcare will fall. No one can afford these astronomical costs. The only way to stop it is to get the middle man out.

Anonymous said...

The USA is one of 2 countries that allow prescription drug television commercials. The drug companies run the FDA.

We need change!

Anonymous said...

I hate to be mean here, but i have to point out that Docs used to drive buicks, not Mecerdes. The AMA used to be the worlds strongest union. I think that it still is. Everybody here is gonna have to suck it up or croak!

Anonymous said...

All I know is if we go to socialized medicine it's only gonna get worse.

Anonymous said...

I had three uncles that were Doctors. One was an oral surgeon, and they were able to opt out of medicare. guess which two got rich? Not the one that opted out of medicare. they all three were screaming, "SOCIALIZED MEDICINE". The monster that is medicine now is going to change. We in America have the right to Life, Liberty and the persuit of Happiness. I cannot do that if I am sick, now can I? I gotta trust the government more than I trust, the Doctors, hospitals, Blue cross, the drug companies. etc. Now, I don't mean to say that I don't distrust the government, but I damn sure do not trust our current medical system. All I see is greed. From the Big huge houses, cars, ad nauseaum. Greed, greed, and more greed!

Anonymous said...

Someone a whole lot smarter than me once said, "If you think healthcare is expensive now, wait until you see how much it costs when it's free".

One way or another, it ain't gonna be cheap, and I sure don't want our gummint in charge of the industry- should this happen, I'm getting out of the field (and no, I'm not a doctor, but I AM employed in healthcare).

Anonymous said...

"We in America have the right to Life, Liberty and the persuit of Happiness. I cannot do that if I am sick, now can I?"

Yeah life, liberty, and the persuit of happiness. You don't have the right to free healthcare or anything else. How did our society get to this point where so many believe they are "entitled" to so much just because they are americans? Here's an idea for you. You go to work take care of you self and family and quit thinking you are so entitled.

Anonymous said...

to the 12:52 post:

Yeah, we the people that were brought up to work hard, be forthright and honest in our everyday lives, take care of our families, educate our children, and foster the principles that originally made this country great, are sick to death of the "abusers" of a lot of our systems as we know them. Probably one of the greatest abuses is healthcare, when you throw out a "get it free" card, it's a given that there will be a certain percentage of the population that will take all the rope you can give them. Unfortunately, there are no guard dogs to hinder the abuse, or tighten that so-called rope. Personally, I am sick to death of paying for these wahoos. Me and everyone else as well,I'm sure. But with no one to eliminate this problem, it only grows and gets worse. And no matter who we vote for, THEY can't seem to control it either. There is no clear cut answer here, but I'd like to offer some pretty simple logic.......If you don't or have never worked, you don't get a thing. I don't care what your creed, religion, race or motto or what country you may be from. Take a hint from some of the folks who came before you, packed like sardines on ships to GET to this country, my family included. YOU are an AMERICAN, we speak ENGLISH, I don't care what your primary language is, and I tired of pressing "1" for English..........it's AMERICA, not Spain, Iran, France, Germany, etc.............speak the language, period. You want the goodies from this country...........EARN 'EM, they are no longer "free" because you come from a disadvantaged country, you're here now, apply yourself and EARN the right to programs available. NOTHING is free in this world, and neither is food, healthcare, etc.........you may have a right to access, but it is NOT a free lifetime ride. Get off your lazy butt and prove you have the right to help by earning it. And the key word here is "help", everyone needs help at certain times in their life, that does not mean it is a "forever" ride. We need to stop being such a bunch of mamby-pamby bleeding heart bunch of morons and get tough with things. Take care of the young, the elderly (that have EARNED their right to these programs a long ago) and the rest need to get with the program or move to their so called Mother country and see how they do there, before badmouthing a society that worked prior to THEIR abuses destroying it! Call me what you will, but I think a lot of people out there feel much the same way I do, and I'm sick of hiding behind some tired politically correct diatribe that's all nicey-nicey and gets NOTHING accomplished!

Anonymous said...

Color me curious?
What will you do if Your Trusted Government dictates what will happen with medicine in the USA and no one comes to the party? So far, I think that doctors and nurses can still OPT OUT and work less, not more. Wow, we might have to go back to driving Buicks. By the way, the Buick dealers I asked are not happy with your characterization, but proud just to be mentioned.
Oh, and by the way, my definition of a Union is quite different from yours.

Anonymous said...

Lets see, we got a diatribe on non paying immigrants, one that would choose to leave the battlefield, one that accused the blogger of not working and not "entitled" Did we get any positive ideas? No we did not. I meant to stir up comments from intelligent folks. I'm still waiting. Heal thyself. Figure out what we are gonna do to solve this. It is almost a slam dunk at this point that the government is going to be involved in this cure. (or kill) I want to hear some constructive comment on how come my health care costs me twelve grand a year. Gosh guys, I don't make that much and this is killing me. At least I am Paying so far, but I can't for long. Medical debt is no longer much of a factor on credit scores, almost everybody has some. If you haven't heard that outside the hallowed halls of the hospital, things are not good. Can you get rid of the "suits", would that help? They seem to have taken control from the medical people. Please help. Signed, Concerned ,bill paying, working , AMERICAN

Darren Duvall said...

There is no mandated membership in the AMA. I am proudly not a member. I will consider becoming one again when they stop trying to round off the square corners of life like every other leftist nanny-fied interest group.

I'm a doctor, but that doesn't mean I know everything or need to offer an opinion on every issue, the former TMA chief lobbyist referred to the AMA as "Boys' State for Doctors", and he was correct.

If you want companies and interest groups like the AMA or PhARMA out of government, the simplest way to do this is to get the government and their regulations on the one hand, and their dollars on the other, out of whatever industry. The AMA lobbies and PhARMA lobbies because the government is going to interfere and where there are interests there, there shall lobbyists be also.

As far as the $80 antiretrovirals go, it's either get generics from India for that price or don't sell them in Africa, if it's the price that offends. I think pharmaceutical companies make a ton of money, but I also think I would be short some family members if it wasn't for Lipitor and Mestinon, so it's a burden I'm willing to shoulder.

We can live quite a long time on the drugs currently developed, with the possible exception of antibiotics. There are lots of drugs that work for hypertension and hypercholesterolemia, and a couple of decent ones for diabetes. There's the majority of killers right there.

I seriously doubt the $80 a month crowd is paying for the R&D for when the current crop of antiretrovirals becomes ineffective. The question becomes when you want to draw the line and say "enough is enough" with R&D into new agents. As soon as there's public consensus, the government will help itself to next year's seed and we'll all have a banquet on the pharmaceutical companies' capital for a while. But when something else comes up, where is the R&D capital going to come from?

fac_p said...

How much is R&D and how much is profit? Manufacturing the drugs obviously isn't expensive--even in Africa they charge enough to meet cost plus. But, apparently there are combinations that are in the generics. And are effective.

Personally, I think that healthcare is reflective of the current tax laws. If you earn more, you pay more. (All Americans are rich, don't 'cha know?) Funny how the people that pay the most taxes probably use the services that they buy the least. Hardly seems fair....

So, Social Security (which was never intended to provide all of a retiree's support) is getting ready to become another means-tested welfare program. The government has done so well with keeping costs in check. What is it going to do to medical care?

The answer is another tax. A lowering of the availability of pricey medical treatments. A "less stratified" healthcare system. Everyone can get treated for a cold, but MRIs, some surgeries, and cutting edge treatments will be a thing of the past...except for Congress, who opted themselves out of standard retirement and healthcare a long time ago.

Anonymous said...

If the government has to be involved in financing health care, I think it should be done this way: Give every individual (no exceptions) up to $6000 per year to cover either insurance premiums or medical costs. (I think most people could find some sort of coverage for $500/month). If the individual's premiums and/or costs don't hit $6000, he gets only the amount he's actually spent. I have no way of knowing for sure, but I highly suspect this would be much more economical for the government as it would be assured there would be no more than $6000 spent per individual, and it would allow the individual all the choices he currently has without government interference. And anything with less government interference has to be the preferred route.

Darren Duvall said...

I think you're onto something there. The Single-Payor advocates will point to the installed base of medical imaging equipment, that most likely dwarfs anything in a single-payor country, and say, "We have the good things about the capitalist system, now when we do away with the inequity of the capitalist system we'll be fine."

Today, yeah. But what happens when the market driving innovation goes away? I'm going to be Medicare-eligible in a quarter-century or so. In the ten years since I left residency we've gone from single-slice CT to 320-slice CT, ultrasound has improved dramatically, MRI is faster and far more capable. I would very much prefer to see another 25 years of technological progress, on all fronts.

I doubt the US-NHS will provide the same degree of emphasis on innovation. It's much more likely a US-NHS will use the best of 1990s technology along "best practice" and "disease management" guidelines and tell us we're getting better healthcare overall, even if we're not all getting better healthcare individually.

And pat us on our heads and pass us a Soma.

Anonymous said...

hey 5:21 PM

Why are you on here crying about your bills? Let's get something straight. My job is to make sure that my family and myself have access to healthcare. I do that. I am not responsible for you or yours. Why do you think that my taxes should increase to provide you with care. When and how did you become my responsibility? Here's an idea for you. Move north to canada and get your FREE healthcare there. Then again we all know you wouldn't be satisfied with that either because you are "ENTITLED" to so much more; right.

Anonymous said...

to 5:21 PM

"Figure out what we are gonna do to solve this."

I don't have a problem. I work, I pay for my insurance, I pay my copay,deductable, etc... In other words I take care of my buisness and dont look to others (government/taxpayers) to solve my problems for me. I realise that my problems are just that; my problems and I as a RESPONSIBLE american take care of them myself. So there is your solution take care of yourself and quit looking for a handout from everyone else.

"Did we get any positive ideas? No we did not."

Oh I see. If anyone doesn't agree with you and doesn't accept the responsibility of taking care of you they are being negative. Well if disagreeing with you and choosing to support my family and myself instead of you makes me negative then I gladly accept your label. Your label doesn't really mean alot though does it; considering you are just looking for a handout from the taxpayers.

" I want to hear some constructive comment on how come my health care costs me twelve grand a year. Gosh guys, I don't make that much and this is killing me."

Well like you said it is YOUR healthcare. It isn't my healthcare so how can you expect me to shoulder YOUR share of the burden?
If you don't make twelve grand a year then get another job. Newsflash one of the few government programs that actually makes sense is financial aid for college. Try that then you can make more than twelve grand a year and you can pay it back with the higher taxes you will be paying. There's a constructive solution for you. The catch is you have to want to do it and it takes some effort on your part. Doubt that is going to happen, but I do look forward to hearing your excuse on why you can't do it.

"Signed, Concerned ,bill paying, working , AMERICAN"

If that is true sounds like you are already living the american dream to me. Quit trying to turn our capitalistic society toward socialism. There are plenty of other places with socialised medicine if thats what you want be our guest MOVE!!!

fac_p said...

When we accept the costs then we are enabling the system.

Get insurance for the catastrophic occurances and work out cash or barter for the check-ups and minor care instances. The costs are far less.

Darren: The cost for the African drugs was $80 for four months! Isn't that a hoot!

And, when I was younger, I worked nights and went to college days. I kept my family to the size that I could provide for on my income, excluding any assistance. I scabbed as a weekend laborer (not a right-to-work state) for less than the current minimum wage and I kept going.

And, if I suddenly was deprived of my current vocation, I would find a job--period. Whatever it took. Always have, always will.

Sorry, but no one owes me anything...but it would have been nice to have some return on the money I'll never collect that I paid into Social Security. I'd call it square if they just gave me the money I paid in--they can keep the employer's matching funds.

Isn't going to happen. just wishing....frank

Anonymous said...

Re: 5:21
I think you misunderstood me, i guess i was not clear. I am paying my insurance. Medical cost me 12,000 last year. That is not what I make a year. I make more, much more. I also have a college degree. I got it before Pell grants, student loans, etc. I did it the old fashoned way. I worked at Night and paid my own way. My employees are dropping the insurance plan like a hot potato. Cannot pay and feed the family. One told me his DOCTOR told him "to pay cash and if he had an expensive emergency to just simply not pay, thats' what everbody else is doing." I got the comment about bad medical on your credit history did not keep you from buying anything, cars, homes etc. from my banker. Look guys, if the market won't bear what medical costs are, then the capitalistic system dictates that something must change. it will. As for the Canada comment, that was totally out of whack. I don't think that reactons like that are very constructive, do you? Thanks frank, Dr. Darren, and 8:14 for the constructive comments.

Anonymous said...

P.S. google the world health organization for info as to our health care ranking. Dismal. We are 37th and behind Canada.

Anonymous said...

P.S. google the world health organization for info as to our health care ranking. Dismal. We are 37th and behind Canada.

.....which, IIRC, has a form of socialized medicine. Matter of fact, folks from that "enlightened" country have been known to come to our hospitals and docs to use our "dismal" healthcare to get services without waiting on the long lists for elective work, like they would in "enlightened" Canada.

So, 9:38 AM, what's your point?

Darren Duvall said...

I'm guessing the $80 cost is matching funds to tie into some grant money...again to buy either Brazilian or Indian generics, or "factory overages" from Merck. When the pot of Save The World money dries up, so will the $20/mo. medicines, if this is the case.

The other question I have is what antiretrovirals are those? Is it the full-court press HAART that they use in the US? Or something else? I don't know.

The number of viruses that have been cured with medical therapy is exactly zero-bagel-nada. Every one that is a distant memory in the West, like smallpox, polio, mumps, measles, etc. has been eradicated from our populations with a vaccine. Comes a point where a life form is so very basic that it's incredibly hard to kill, best to just train the human animal to not get it.

Been digging into the French insurance system, the trick is apparently to not pay the doctors very much, about a third what they pay US docs. They have proportionately more doctors, more hospital beds (65% public, versus 15% in the US), and fewer MRIs (about a third). They also pay more in taxes. Their docs are more numerous because of doctors' union negotiated work hour limits (35 hours a week max), so effectively it's not like they have docs on streetcorners with "Will Diagnose for Food" signs. That's half what I put in, so in FTE equivalents it's not quite the same.

Can't say that I like the implications of balancing the healthcare budget issue on my back, but as you say, Frank, I'm not afraid of work and I'll take care of my family no matter what comes down the road.

BTW, when I was in Paris we would have done just as well (in professional fees) to collect $30 flat-rate cash for whatever we did, from a finger film to an angiogram. We could probably go to $27 and not have to had employed a billing office. Something to be said for that system of economics.