A Billionaire Pledges to Fight High Drug Prices, and the Industry Is Rattled
wsj.com
wsj.com
I called around, and finally settled on a facility that told me they could check for strep for just $59. I go in, get my throat culture, then get my bill.
"Well yeah, the throat culture was only $59. But the nurse had to do it and it's $120 to see a nurse. Also, the doctor has to check in before any operation is performed, and that's $200. After all other fees, your total bill is $400".
There's no way that should be legal. I was quoted $60.
As a country, the US hasn't decided whether healthcare is a fundamental right or privilege. As a result, we constantly make political decisions that straddle the line without ever really going one way.
The biggest culprit is the "fee-for-service" model of reimbursement, where healthcare providers (physicians) are reimbursed based on the quantity of care rather than patient outcomes. Each procedure has a code (CPT) that is used to bill insurance. Billing for each of these codes is completely arbitrary and up to provider/payer negotiations. The fee-for-service model is a clear example of a perverse incentive.
Who reimburses the fee-for-service model? Either the government (Medicare/Medicaid isn't even entirely government-run, as many states rely on a for-profit Medicare Administrative Contractor) or private health insurance companies. The perverse incentives can now be seen from both the provider's side and the payer's side: hospitals and physicians negotiate to get the best reimbursement rates that they can. And of course, because these insurance companies want to make money, they make it "difficult" for providers to get paid for each procedure and will find any reasonable way to deny the claim from going through. Because of this, providers artificially raise the amount charged to the payers as high as they think they can get away with in the hopes that insurance will pay up.
Meanwhile, patients suffer greatly as there's no transparency.
I've seen evidence (firsthand) that value based care can work, but it's hard to get provider networks on board when they are the ones who aren't getting paid when readmission rates are too high.
Charge a hospital based on patient outcomes? How would that work?
Granted there would be major devils in the details especially if it causes "underwater" patients.
I had worked as an engineer and was closely aligned to the fraud division for one of the larger insurers some time ago.
Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures.
[1] If you're going to try to say that what is "unforeseen" is relative it's not that relative, you can get an independent committee of doctors and provide a percentage based on their experience how much often that event is expected in that situation
Software development is inherently nonrepetitive and therefore unpredictable.
Healthcare is much closer to auto repair than software development.
Sure, on a car that's running that you can't turn off, with parts you can't replace, a maintenance history you can't see, and an ECU that actively misrepresents what's going on.
That is a dangerously naive view of software. Even apps that look like simple CRUD end up riddled with specialized business logic. Apps which truly are a few screens of simple CRUD end up as spreadsheets or Microsoft Access. We've gotten pretty good at not reinventing wheels.
Say what you will about the challenge of it, doctoring is fundamentally procedural and repetitive. Patients don't really show up with whole new undiscovered diseases anymore.
O'boy. What doctor do you go to?
Rolled ankle
100% [of patients get charged]: Office visit: $50
58%: X-rays: $55 - $95
22%: boot/cast: $240
3%: surgery: ??
<1%: other: ??
""" When you are estimating tasks that are done over and over, you can look to your historical execution time for insights. We average chopping X logs per hour.
If I hand you a Rubik's Cube and ask you to tell me how long it will take you to solve it...what is your answer going to be? If you've done it before you might have an idea. Maybe you just kept plugging away until you finally solved it? Maybe you've watched one of those videos about how to solve a Rubik's Cube, have practiced it and are confident that you could do it in 3 minutes flat? Maybe you have no idea?
Complexity and experience will dictate your answers, but then those estimates still only reflect your perception of the task...not everyone else on your team.
At best those numbers are a guess.
Every step in a software project is solving problems. You don't know how long it will take to solve the problem. You don't know how many new problems you might run into along the way. Can the new problems be solved by you or do they need to be solved by other people? """
[1]: https://www.brightball.com/articles/reality-driven-developme...
>Vox's database shows that patients are especially vulnerable to these surprise bills when out-of-network doctors work at in-network hospitals.
“It does happen quite a lot in the emergency room,” says Christopher Garmon, an assistant professor at the University of Missouri Kansas City.
Garmon published a study last year that found as many as one in five emergency room visits led to a surprise bill from an out-of-network provider involved in the care.
https://www.vox.com/2018/5/23/17353284/emergency-room-doctor...
Insurance is through her work, so I had to coax her through logging in to her account so that I could try to find an in-network ER list.
After spending ~30 minutes grumbling at the website over the complete lack of anything resembling clarity, I had a list of 3 hospitals that appeared to be in-network (and a sinking feeling that this could easily cost thousands of dollars). Set off around 2am. Arrived at first. 5+hour wait. Went to the next, no wait. They didn't manage to do much aside from giving a few tests that came up negative, administered fluids, gave her a steroid shot, and did a blood panel.
Her blood panel had one abnormal result that the doctor was willing to admit her for observation over (and had admitted people in the pass for less), but the doctor also noted that the parameter can vary a lot person to person; some people would be fine at that level. I had a sinking feeling in my stomach and decided it would be better to take her home to keep an eye on her than risk financial ruin. I think we were there 2-3 hours.
When the bill came months later, it was $2600 because the doctor was out of network.
For all technological advancements in US, the healthcare system is quite backwards. It’s not a new problem. Tons of countries do it well “Canada, Australia, Sweden ...”
The US political and healthcare system refused to accept other models since there is sooooo much money to be made at the expense of “some-other” people dying and going bankrupt.
House insurance, car insurance, all other forms of insurance are transparent, US healthcare is the most “mafia-like money extortion” system.
Right, as soon as the patient is admitted, it's a cardiothoracic surgery issue, or an oncology issue, or a high-risk obstetrics issue, or a critical care issue, or a neurosurgery issue, or a nephrology issue, or a general surgery issue, or an in-patient psych issue, or an ENT issue, or an opthalmology issue, or a geriatrics issue, etc.
Too expensive to fix healthcare issue. You’ll probably die or make it worse if you don’t fix it. “How much is your life worth to you?”
You can get a ton more random money by holding people’s lives over them. That is in summary the US healthcare system. Full of middlemen squeezing every penny they can out of you because they can.
Whoever campaigns for a transparent healthcare system, I’m voting for them.
Our broken healthcare system kills more people than all terrorist attacks and natural disasters combined because people can’t afford to pay the bill mafia.
That’s just a very sad state of affairs.
How does that contrast with "care provided by emergency departments?"
That is true, but emergency care disproportionately results in bankruptcies compared to other forms of care.
Moderate sarcasm.
But really that’s a deeper issue with insurance causing most of that. If you don’t have insurance, most hospitals will severely discount the costs that you are originally charged if you just work with them. It shows those prices are bullshit to begin with.
My locality has a ballot initiative up this year that would put a % cap on what hospitals can charge over their costs, and boy oh boy are the industry mouthpieces out in force to oppose it! They are having a field day with patients’ wallets, they know it, and they don’t want it to end.
It might take a day. It may take a decade. It may take you the customer to change your entire approach.
This is not feasible. You can not disregard hidden defects and the cost of fixing them unless you do not really want reliabilty. If you do not want it, then don't complain.
In IT this requested lack of reliability is accepted. In healthcare and auto repair it is barred by law.
EDIT: i hate autocorrection.
This idea that medicine is different than other fields is crazy.
It costs $75 to pull the car into the garage, the lift fee is $105, it's $21 to open the hood, $64 to unplug the wires from the old plugs, $64 to plug the wires into the new plugs, then there's $18 to close the hood (gravity assist discount), and another $75 to put the car back in the parking lot.
Don't worry, changing your plugs is only $16.
You would be asking what goes into that hourly rate.
Turns out it cost $30 for flurodie and $60 for xrays. Fluoride is only covered in kids, and xrays every 2 years. I call up dentist office and you know what they tell me? They don't provide treatment based on insurance coverage.
Right...they provide treatment based on how much money they can rip you off on. Fluoride for adults is new. We have fluoride in the water and in the toothpaste.. I don't recall having it in the past and my Google search tells me where's a debate on whether it's even beneficial. I only see that it benefits the dentist's pockets.
The parent post expanded on that point by trying to list all the other charges for a common car service in the style that would be similar to what one would see if they were admitted to the hospital for an procedure. He then reiterated the point that the cost estimate only included the cost of parts (the 4 spark plugs).
I just expanded on that by listing the other labor related charges for the procedure that still wouldn't be included in the estimate.
In terms of car repair, you just have to know about the hourly rate of the shop and the number of hours they state a particular repair will take. In a hospital setting, you have no idea how many people will interact with you and what their charges will be (which appear to be unrelated to how much time they actually spent with your case).
Because every single one I've been to also includes labor cost in the estimate.
If I need antibiotics, my employer provided insurance covers the full cost and I pay a fixed $10 or so fee to the pharmacy.
You live a few hundred km south of me I bet, and in every way except this our world is very similar.. but you guys have far deeper problems then just transparency. Your entire view of healthcare is wrong.
One day I'll figure it out but at 24 years old it's not a huge deal to me.
-I went to urgent care for some swelling on my neck that escalated quickly. 45 minutes later I was getting a MRI. This was on a Friday. They called and said it was cancer.
-Monday I was seen by a ear nose throat doctor. Yes, cancer indeed.
-Tuesday I saw a oncologist.
-At this point I decided to move to Portland since my sister lives up here. So the oncologist referred me to another ENT doctor in Portland.
-About a week later I saw a dentist and radiologist on the same day. Everyone agreed that due to the bad shape my teeth are/were in and the location of the cancer my teeth need to come out.
-A few days later another oncologist
-All my teeth removed (this has been rough)
-Tomorrow a "simulation" and PET scan to see if the cancer has spread
-Tuesday is something called a swallowing test
-Wednesday is a check up with the oral surgeon
-Friday is some intake thing for the feeding tube and a meeting with the nutritionist.
-Next Monday feeding tube installed.
-Next Tuesday another check-up with the G.I doctor.
-Next Wednesday radiation and chemo start.
So yeah.. I have no clue how much this shit is costing and I don't really care since I have Medicare. I just wish everyone had the same luxury.
For example, I got a quote this summer for an outpatient MRI that was 20% the cost of a hospital MRI, faster, and would accomplish the same thing. Now I tell everyone I know about this. If enough people do this, the hospital will not be as free to increase the cost and might even lower it (or at least start providing quotes!)
This price-shopping process is slowed by all the shenanigans that keep prices and services provided confusing, and demand to improve this is hampered by insistence that patients are never in a state of mind to shop for the best healthcare provider. It’s simply untrue—and there are workarounds in the worst cases like healthcare POAs and family members donating time.
Calling around and shopping is what people do on practically every other service or good they buy now.
In terms of how they would be set, Medicare already spends a ton of time created a system of DRG codes for every condition along with a set payment (adjusted by COL and other things).
Of course Medicare rates are sometimes less than the cost to provide the care. But I see us just getting to the point that the govt will just say “tough shit”.
You dont call around for quotes of $100+ services?
Why?
Free services mean a few people will overuse and abuse.
It is perfectly sustainable if you have a population that isn't ideologically opposed to taxes. You can fix that with education.
> and bad capitalism.
Good capitalism or bad capitalism, who cares? This sounds like a pointless ideological concern, again.
> Free services mean a few people will overuse and abuse.
It seems spiteful to me to deny universal healthcare to the majority because a minority might abuse it.
The most efficient provider should get his or her business. That way we can treat more people for strep and increase human welfare.
There's obviously some variation here, and for that an hourly rate makes sense.
Health care should be more like car repair: go in for a quote, then pay when you decide on a provider. Obviously emergencies are different, but things like strep or broken bones are pretty common, so they should have a set price.
That's an assertion, not an argument supported by observations. In the European countries the government sets prices for procedures, and it works well, life expectancy there isn't lower than it is in the US.
Americans pay out the nose for drug prescriptions, which fund the vast majority of research and development budgets, which then benefit all people, worldwide.
And all of those countries make more revenue selling to the US than they do any other country by a long shot.
What you haven't answered is whether the research can be supported without the American market subsidizing of that research.
It is in fact, expensive to develop new drugs and something has to pay for that development.
If the world wants and needs better drugs, there are other ways to fund research. If we give a damn, we can find such solutions.
Citation needed.
Given that the US has this system and US healthcare is multiples more expensive with worse or similar outcomes in essentially every field, I suggest we can put that theory to rest now.
(definitely not defending the US system)
The US does not have this system.
No one thinks that no end user cost (what people usually mean when they say free) <> no money spent.
My point: Let's stop comparing healthcare to road construction/maintenance. It's human lives. It works differently.
Also, speed limits can be comparable to turnpike's, the interstates are rarely "blocked" unless you mean congested, which is a different issue and one that more road at that location would actually make worse. Construction costs are comparable to turnpike construction and maintenance costs and are slow because, unlike a turnpike it's most visible and most delaying in areas like cities where you can't move cars to a shoulder, something that isn't an issue for turnpikes..
By whom? Traffic is just an argument for mass transit
>roads not really good
That’s an argument for more government not less. They’re fine where I live.
>speed limit low
It’s reasonable in cities and towns
>construction expensive and slow
Also high quality
You already have a beurocracy in “your” health care system. It’s just a private one and not a public one. The difference is cost involved in administrative overhead deciding who gets care and for what.
A nation needs a good health care system and a good road system to afford productive workers.
Both systems when implemented poorly cause human death and disability.
Huh? I don't see any argument at all. The fact is that it is, right now, blocked.
> That’s an argument for more government not less. They’re fine where I live.
Yeah, sure - I live in the Czech Republic, a place where we have more government and the worst roads you will ever see in a first world country.
It's definitely not an argument for "more government" - actually it's not an argument for either because you've provided zero arguments. Why it'd be better than it is now?
> Also high quality
The highways are definitely not high quality, it's just good enough. Visit Germany sometimes. Construction time has almost no relevance to quality, btw (if we don't talk about extremes).
> It’s reasonable in cities and towns
We are talking about interstates.
> You already have a beurocracy in “your” health care system. It’s just a private one and not a public one.
Yeah, I know. Again, what's your point? You stated facts that are well known by everyone interested in this topic. There are very clear advantages to a free market and there are very clear disadvantages of a public solution (and of course the contrary).
Have you ever thought about the fact that only people in the USA actually want a public system? Maybe a private system could work well if implemented correctly (see Switzerland, a country with one of the best healthcare in the world - that is private) - government is not a universal and definitely not always the best solution.
> The difference is cost involved in administrative overhead deciding who gets care and for what.
Is that the only difference, really? How much experience exactly do you have with public systems? Are you sure you have a complete picture? I have lived in several ones over my whole life. I prefer the US system.
BTW is there really a difference? You know the same thing needs to happen in a public system as not everyone is eligible for everything? How does it compare to waiting for 4 months until a doctor is available (in non-urgent cases)? How does it compare to generally substantially lower quality of care (not medical, but care - as in quality of food in hospitals, whether they treat you respectfully, whether you need to sleep on a hallway because all rooms are packed with 5+ people...)?
Do you know that only the most basic (we call it "medically necessary") treatments are paid and everything else needs to be paid out of pocket in full as there is no possibility to insure yourself for upper level of care (actually it's illegal)?
> Both systems when implemented poorly cause human death and disability.
Exactly. So let's stop with "hurr durr we need full government intervention" and let's focus on what's wrong, why it happened and how to fix it ASAP - and you're not going to fix anything ASAP if your way is to rebuild the whole thing and nationalize/bankrupt (or both, as is common with governments doing business) huge companies.
The USA system needs change, however I'm pretty sure that such dramatic change would leave the country in ruins (or more likely in a lot of dead bodies) simply because it's extremely hard to run such system even if you've been doing it and continuously improving it and gaining experience for the last 70 years and your country is 20x smaller - and there is no country in the world where a public system would have substantially better results than the US one.
Transparency won’t fix healthcare in the US, but it is a starting point. Hell, it’s fundamental to simple free market economics. It’s silly to say we have a free market healthcare system when there is virtually no cost information about goods and services until after purchase.
It seems that a major driver of insurance and medical costs is that doctors are allowed to charge different pricing for the same service. In this case, paying a monthly fee for insurance ended up costing me more.
This stuff is all bad, but it's useful to remember that primary care is actually a small fraction of the overall price of health care. Where we're really spending the money is on long-term and end-of-life care.
Agreed. When I visit my PCP, I normally meet with a NP. I’ve been quite happy with the quality of care received.
> Where we're really spending the money is on long-term and end-of-life care.
With the boomers entering the end-of-life phase of their lives it will be interesting to see if we will be able to change culturally and realize the huge sums of money spent with little benefit to the economy. I’m struggling with this myself currently as my parents are aging (quickly). They don’t have unlimited savings to spend on health care. While I have ample resources, I’m not convinced shelling out $1MM is worth it for them to live with a marginal quality of life for just a couple of years. Just writing that makes me feel like a terrible person but I try to think rationally and without emotions.
Edit to add: I’m genuinely curious about your thoughts on this, @tptacek. I’ve always respected and appreciated your opinion here on HN.
The free market works pretty dam well for those.
[1] If the technician later determines that it will take additional work and will cost more to fix your car than the original estimate, someone from the shop must contact you, describe the additional work and cost, and get your permission to proceed. -- https://www.bar.ca.gov/Consumer/Auto_Repair_Guide.html
You walk back past the reception desk, ask what the bill was, and they either say "that'll be $40 which you can claim back by taking the receipt around the corner to Medicare", or they'll say "Oh nothing to pay, it's all bulk billed".
You walk out having either spent nothing, or spent a few bucks which you get back after a five minute walk up the road.
That was my recent experience.
You don't go to a restaurant and get the pricing after you eat. Heck when you go to a buffet you don't get billed based on how many plates you get.
Edit: and wouldn't this lead to lawsuits against medical practitioners for extortion if it can be proved that they make a habit of doing this to patients?
This works terribly for most advanced economies, Britain and Canada in particular.
https://www.ctvnews.ca/health/health-care-wait-times-hit-20-...
The official government figures, where about half of patients get care within 24 hours, and about 90% within 48, are much more in line with my experience.
When you look at the stats aggregated by OECD, Canada is indeed among the worst public health services in the developed world, but it still provides better care to the median earner than the US health system, at half the aggregated cost per capita.
I'm sorely disappointed in your arguments so far. Your stats support your point and are legitimate but mine are not. Typical liberal nonsense.
The stats you provide are collected by an institute looking to further their ideology. They come from a far smaller data pool,and their collection method seems rather suspect. For example, they're asking the actual practitioner rather than anyone involved in scheduling.
Proof?
> The governments stats basically have to be kept. Running the system requires all of the necessary data to already be collected for other purposes, and their stats are drawn from that.
You trust a government entity to accurately report data that's not in it's best interest? When has that ever happened?
Can you explain what your criteria would be for a trustworthy source?
That's essentially the definition of a think tank. This one was founded by a libertarian and considered by many to be libertarian. Certainly cause to question their stats, and I didn't like what I saw.
>You trust a government entity to accurately report data that's not in it's best interest? When has that ever happened?
This is probably enough for you to question their stats, but you've done nothing to show they are wrong.
Combine that with multiple agencies such as Health Canada and OECD which have measured wait times an order of magnitude lower than you cited, I am not sure what else to say.
I challenge you to find a second source that is both consistent with your article, and breaks down the waiting times by type of treatment, including treatments that do not need follow ups with specialists.
Why not?
Most people are in serious pain and have their mobility severely compromised while they wait - I know from personal experience.
As to the invalidity:
The fact that I have never waited for more than a couple of days for treatment in over 25 years, and neither had anyone I know (with 2 exceptions, both of which were for elective surgery like breast reduction surgery) does imply that, at best, their median measurement is measuring a specific niche, rather than general treatment.
Combine that with the fact that multiple agencies have measures wait times as being an order of magnitude lower than your source, and yes, I do think your numbers are invalid.
Nobody's stupid enough to believe that one doesn't imply the other.
> The Fraser institute, which published this study, has a right wing bias and is funded by the Koch Brothers. It seeks to displace the public system in Canada with private healthcare modelled after the US. While they claim independence and give their research away freely, one should be aware of their interests.
You requested "proof". Given that the only quantifiable claims which could possibly be proven is that they are funded by the Koch brothers, and would like to replace the public system with a private one, I assumed you were asking for proof of that.
Now, if you were not asking for proof of that, can you quote the section of the above you did want proof of?
Can you point me to where I say that? You've just killed any potential discussion by arguing in bad faith. Why should I listen to anything you have to say on the subject now that I know your intentions are hostile and that you're not open to debate?
Well, part of the problem is that the state now assumes that consumers are not qualified to take care of themselves, and that the only people who are qualified are state-approved high-demand professionals. Oddly enough, opioid overdoses were not higher when you could just buy the stuff over the counter; but people have forgotten that people used to be responsible for their own well-being, and are convinced that they should not be trusted to defer to experts when they see fit.
Also, the US has seen a recent huge rise in opioid overdoses ...
Also do yourself a favour and never assume that your US libertarian bubble definition is the de facto standard around the globe. Europe has a long and dark history of the kind of (neo-)feudalism that you're peddling, it's not hard to spot.
It only gets some level of sanity (though not to reasonable level) if you involve insurance companies, who have some of the information necessary and the leverage to negotiate.
Right, so I'm supposed to pay $700 for some medication that has a chance of either making my heart stop or cure my condition and if it doesn't cure it, too bad.
Any marketplace where the buyer isn't informed of the price until after the transaction is ripe for disruption.
And how would the Insurance company know until they are billed for the procedure?
Those edge cases that are not routine procedures should have estimates provided in advance.
For those edge cases that are so time sensitive that an estimate cannot be provided to the consumer in advance... well, that's what insurance is for.
That happened under ACA, didn’t it?
I did not intend to suggest I am interested in otherwise discussing your personal interests in the political deceits and failures of either American party.
See point 5: "Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure."
https://web.archive.org/web/20161110004206/https://www.donal...
And that's exactly the problem with politics. They don't vote for improvements, if that makes the more radical changes they want less necessary and thus appear less necessary. Especially under the shitty US election system allowing only two parties. The one who looses in the end is the citizen who just wants better healthcare.
[0] this yt channel is where I get my US healthcare news from: https://youtu.be/tMsSF2vDf6k
ps: Its funny the republicans only managed to pass repeal back when they knew obama would veto it.
I'm not a politician. I don't work for nor run any part of the legislative branch. I'm not a Republican, I've never even voted for them. I have zero interest in speculating about what one or another party might do in the future. But I do care about facts. Now do your worst with this.
1. That point 5 seems to me to be something that in a rational universe, could get enough votes from both sides of the aisle to pass. Of course we live in a universe where neither party wants to give the other party anything they could call "a win". An the Republicans will explicitly not allow anything to come to a vote unless it has the support of the majority of republicans. They could write a bill and bring it to a vote if they wanted to.
2. It appears the real hold up is that they don't want to do anything that would make health care better unless they can first repeal the ACA. You can think about that however you like, I certainly have my opinion.
Reference: https://www.politifact.com/truth-o-meter/promises/trumpomete...
This is a bizarre summary of the failed repeal of the ACA with a bill that wouldn't have even included the proposal they supposedly wanted.
Reference: the article you linked to
The article I linked points out that this price transparency could not be achieved in the very first legislative step -- by the nature of that first bill, related exclusively to tax and revenue since it originated in the House.
Politics is an art of compromises, to achieve what is doable with sufficient majorities, as well as taking into account popular support in view of the next round of elections.
In this case, the only change that could pass was to remove the tax-shaped penalty so that people are allowed to ignore Obamacare plans. Next would have been a basic repeal of Obamacare (blocked by Senate Democrats and McCain). Finally would have been new and very different regulation, including price transparency (which could not even be attempted since step two was blocked, the consensus was that new regulations should only be passed after repealing Obamacare, and Republicans failed to build a majority around that approach).
http://www.nbcnews.com/id/34446325/ns/politics-health_care_r...
> The House GOP bill that has emerged as the leading option to repeal and replace the Affordable Care Act includes no added price transparency provision.
So the bill that McCain helped defeat didn't contain improved transparency according to your own source. And the GOP hasn't introduced significant legislation since to address the problem, therefore Democrats supporting (or not supporting) it is all hypotheticals based on no actual legislation.
You quibble about how they failed to repeal ACA and follow up with new regulation. Factually, Trump and the Rs failed with their 3-step plan, right after step 1 -- hence we remain stuck with the lack of price transparency under the Democrats' Obamacare.
So, blaming Republicans is not factual.
[1] Scroll down to point #5 in https://web.archive.org/web/20161110004206/https://www.donal...
Where is the link to the GOP's actions rather than their empty promises?
Obama would have happily signed a pro-price transparently bill
Plus the poster I was responding to specifically made claims about the Republican's policies and what they claimed the Republicans had tried. If the Republicans don't bring up legislation the Democrats cannot be blamed for not voting for it (or Obama for not signing it).
During the 111th Congress, from the appointment of Al Franken until the death of Ted Kennedy, as well as during the term of his appointed successor Paul G. Kirk, the Democratic party held 58 seats in the Senate and caucused together with 2 more senators.
https://en.wikipedia.org/wiki/111th_United_States_Congress "gave the Senate Democratic caucus sixty votes, enough to defeat a filibuster in a party-line vote."
https://www.nytimes.com/2009/07/01/us/politics/01minnesota.h... "providing Democrats with something they had long hoped for: 60 votes, and thus at least the symbolic ability to overcome filibusters."
I replied to someone who falsely claimed that "Republicans who are supposedly for markets don't push for price transparency".
We all know that Democrats are the party entirely responsible for Obamacare and its lack of price transparency.
[Added for emphasis] Democrats created Obamacare without the full price transparency several people here seem to care about. Yet, you all choose to denounce Republicans -- who demonstrated in their attempt that they don't have a sufficient majority to repeal Obamacare, let alone introduce better healthcare regulation once it has been repealed.
> Actually Trump and the Republicans ran on a platform of price transparency, but Senate Democrats can block and have effectively blocked
The Democrats cannot block a piece of legislation that doesn't exist. You yourself set up the criteria and you've failed to meet it.
> I replied to someone who falsely claimed that "Republicans who are supposedly for markets don't push for price transparency".
Quite correctly. You cannot link to the Republican legislation that supposedly tackles this issue while they continue to control all three branches (inc. both houses of congress) because there is no legislation. They're tried nothing and accomplished even less.
The problem is that as there's no mandatory insurance in the US like there is in Germany, there is a very high chance that the patient may not be able to pay the bill, and so the hospital (or practice) is stuck with the costs. Which may go into six, sometimes seven digit sums. And this loss has to be eaten somewhere... in the form of everyone else having to pay way overinflated sums.
The only way to fix the US health system is to provide a national mandatory insurance for everyone which covers everything of basic healthcare, and then for the private industry they can offer insurance packages for higher-quality care (single rooms instead of shared ones, for example). Or, if that is not possible due to the insurance companies having bought off half of Congress, at the very least introduce a nationwide pricing list for medical procedures, with as few possibilities for deviation as it can be done (for example, services in the center of Manhattan can be more expensive than somewhere out in the woods because rent and staff are more expensive).
mandatory insurance in the US like there is in Germany
As for refugees specifically, I'd expect that to be mostly a question of whom they sign on with first. The public insurance has the same rate regardless of provider, so it wouldn't make much of a difference, and governmental support will probably pay that bill anyway.
They get treated first, payment is worked out later.
This already exists with Medicare.
From the article:
> Another reason Mr. Arnold got involved: Drug pricing was an issue no other philanthropist had claimed.
This makes some intuitive sense. America’s healthcare system manages to hide its costs so well while providing modern treatment that it may not seem like the most compelling humanitarian problem for a billionaire, i.e. a first-world problem compared to providing mosquito nets to prevent malaria.
'Hey boss, I saw the schedule. Not sure I I will be able to cover any of those shifts you gave me. By the way, pay me the same weather I do my job or not. Thanks'
Even after all these years of revisionism the school systems could still do with less hagiographic depictions of the revolutionary era.
https://www.cnn.com/2018/10/10/politics/drug-prices-legislat...
It’s a great way to make money legally.
- Friedrich Hayek, The Road to Serfdom, p.37
Free markets work as expected where the alternative is dying at worst: They fail completely. If you're lying unconcious in the ER and there's zero regulation in the country of unlimited capitalism worship, the hospital can charge whatever the fsck they want. And yet, there are still a few people in the US surprised they actually do so.
https://www.forbes.com/sites/chrisladd/2017/03/07/there-is-n...
In fact he was outright pro-Universal Healthcare, eg: "Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance, where, in short, we deal with genuinely insurable risks, the case for the state helping to organise a comprehensive system of social insurance is very strong. "
https://thinkprogress.org/hayek-on-health-care-e29ae2d600e6/
The background to the law is this: previously if a private institution used federal grants to develop a new drug, the federal government retained patent rights. The federal government isnt particularly good at commercializing products so the Bayh-Doye act allows for private institutions to retain patents for innovations funded via government grants. The government retains certain rights to the patent (this is important).
With this situation you have a case where the American tax payer essentially pays twice for certain drugs, their taxes paid for the federal grant that discovered the drug and now they have to pay a private company to actually use the drug.
Well, the Bayh-Dole act grants the government "march-in" rights, which basically allows the government to license any patent derived using federal funds to a third party if the original partner “has not taken, or is not expected to take within a reasonable time, effective steps to achieve practical application of the … invention”.
The government has NEVER exercised it's march-in rights. I understand the hesitation to drastically change the market for a product by granting a 3rd party a patent that they would otherwise never have, but it's been made clear over the past few years that many pharmaceutical companies are acting in bad faith and abusing their market position by drastically increasing drug prices.
I think exercising Bayh-Dole on a high profile drug (EpiPen??) would shake the market back into reasonable price structures. It's a huge hammer the federal government is not wielding.
Healthcare isn't 'broken'. The high drug and medical prices are by design. That's the way system is designed and it's working as intended by regulators and industry leaders.
If they really wanted to 'fix' the healthcare, they can fix it. But there is no money in fixing it at this point. One guy with small amount of funding will do nothing to highly regulated space full of deeply entrenched incumbents. regulators, doctors, pharmacists, pharma, medical device, pbm, medical insurance, hospital systems, lawyers, and IT jobs at those companies.
I doubt Citizens United will ever be overruled
Fixed and transparent/fair costs (and promotion of it) will get a significant line in front of the clinic.
If someone's got a huge amount of money to play with this, it will be fun to see the incumbents getting trashed. In a way, it's "dumping" (but not really as it's still above cost)
Historical though, any attempted 'fix' simply results in shifting of profit from one incumbent to another, along with even more creative ways to get around them. Mfr. copay coupons mentioned in the article is a great example.
I'm all for change, but to me, American healthcare is mainly regulatory failure.
He funded research about the relationship between pharmaceutical packaging and drug costs, leading Medicare to pass new rules that took effect in 2017. The state of California, advised by an Arnold-funded group, passed a law in 2017 requiring drugmakers to justify steep price increases.
In other words, Arnold is spending money on:
- a consortium that will manufacture generics
- legal efforts to hasten the expiration of patents to provide more generics
- research on packaging
- lobbying legislatures to require justifications from drugmakers on price increases
None of this sounds like it's addressing the main problems leading to high costs:
1. The customer (patient) doesn't directly pay all costs. The economic incentive to keep prices low lies mostly with the insurance providers.
2. It takes more than a decade of research and hundreds of millions of dollars to develop a drug with a new mode of action.
3. At least 90% of these projects will fail to deliver a marketable product.
4. The amount of money spent on a drug project balloons the longer it remains viable.
5. Failure of a late-stage clinical candidate often leaves a drug company with two options: (1) kill the program; and (2) send yet another candidate through the pipeline.
6. Data on late-stage clinical failures are often tightly held in silos, preventing other companies from learning costly lessons.
Imagine going into a grocery store and not being able to check the price of your groceries before you decide to purchase them?
Why do we put up with this?
Ok, then open your books so we can see why you're pricing the way you are. Obviously, given all the recent attention this has gotten, the industry is not being very transparent about this. Why has no "outsider" been able to connect these dots and why are you (the industry) preventing them from doing so?
Imagine if everything you ate had to come from the county you live in. Would it really matter how much they charged? You would have to pay it, right?
Free marketeers: how does price transparency improve prices for emergency room visits?
But most medical care (the majority of the cost) is not rendered like that. Most of it is routine and predictable, and should be priced transparently as such.
Does "weird edge cases" cover the 790,000 people who have a heart attack every year[1]? If not, how does price transparency improve their ambulance ride or change which hospital is their destination?
So long as healthcare has quarterly shareholder meetings, we will forever be locked in this battle.