I have no idea why these groups have survived scrutiny for their literal multi-hundred million dollar lobbying/bribery of politicians.
My closest guess is that we all know "My" physician or a well paid nurse that benefits from the bribery.
I should add that the same thing applies to glasses.
Drive up to the border and walk across on a day trip to the pharmacy. I believe the first few miles into the country are a NAFTA special economic zone with very relaxed paperwork requirements.
https://www.fda.gov/industry/import-basics/personal-importat...
This is probably illegal, but not enforced.
I’m insured so it’d actually be cheaper for me personally to go in to the doctor and ask for a prescription. But I got tired of taking time out of my day for this - these are just beta blockers for fuck’s sake.
And what guarantee do you have of their contents?
Nearly all of our (US) pharmaceuticals already come from India anyways. Manufactured there from Chinese bulk precursors.
I trust a third-party GC/MS plot way more than any brand slapped on a package.
[1] https://en.m.wikipedia.org/wiki/Gas_chromatography–mass_spec...
That seems extremely arduous.
The point is that you don't trust this specific supply chain/manufacturer, which is part of the approval process.
"India/China" is not some monolithic entity that is either good or bad, there are some manufacturers that you can trust, and some you cannot.
Quality control in drug manufacturing is what ensures that every single pill has the correct dose, and not some random batch accidentally having 100x the active drug you need - or 0.01%.
Maybe you can find someone that'll do telehealth.
Visits to the doctor should be cheaper and more efficient, but people shouldn't stop going to the doctor.
I suspect the sentiment is from commonly interacting with absolutely useless doctors. There are a lot of them.
My professional contacts have told me I'm doing senior level work but nobody will respond even for positions below that.
Edit: sorry it was site https://www.levels.fyi/company/Google/salaries/Software-Engi.... No idea how real it is.
By many measure: if you see a doctor, cross the street.
We don't and we shouldn't require everyone to be nannied just because some people might benefit - they can seek those services on their own if they wish. Requiring someone else's permission to maintain your personal health would be considered just as absurd if it weren't the status quo.
And, by the way, if you have an accountant, you should check in more than once a year. It's not fair to them to dump stuff only during tax time. Also, I do have to do regular tests to make sure my medical knowledge is up to date.
You have to qualify your statement with "if you have an accountant" because I don't have to have an accountant, it is an optional service I can seek if I want. In my case, I do my own taxes, and if I don't get as big a tax return as I could've back, it hurts nobody but me.
The requirement for you to do regular tasks for the privilege of practicing your profession is forced upon you because the the consequences of any lapse in your knowledge are borne by others, not you. I too have professional requirements, but I can choose a different profession and be absolved of all of them.
A chronic condition is not a choice. Dealing with your pain is not a privilege, it is a right. The idea that people should be forced to forego their right based on the idea that some others will benefit (a dubious claim for which I can find no evidence supporting) is absurd.
This is completely ridiculous, and yet my situation is downright reasonable compared to what a lot of people have to deal with.
The AMA does not really represent physicians. Less than 1/4 of doctors belong to the AMA. Many of them do not feel the AMA represents them. The AMA also accepts substantial donations from other sources, including corporate donors and foundations.
https://www.physiciansweekly.com/is-the-ama-really-the-voice...
A. Limit medical care to being provided by these people
B. Limit number of residencies
Who else would provide this care? This licensure is similar to other professions, like lawyers, and really doesn't take very much lobbying since the majority of the public want oversight of these sorts of professionals.
Residencies simply haven't kept pace with medical student numbers. They have gone up though. The main question is "where does the funding come from for residency training?". Medicare provides most of that funding, but that is a constrained resource. I find it hard to believe that the AMA lobbied for this provision.
"For over 30 years, the AMA’s state and federal advocacy efforts have safeguarded the practice of medicine by opposing nurse practitioner (NP) and other nonphysician professional attempts to inappropriately expand their scope of practice."
Here it is again: https://www.ama-assn.org/practice-management/scope-practice/...
So this is a source just saying they oppose inappropriate expansion. That they want PAs and NPs to practice as part of a team that includes a physician. I don't really see this as an issue. I also see PAs, NPs, and nurses as falling into the medical profession and subject to licensing, etc. So I see them as being on the inside of the system, not one of the "other people".
What I was specifically looking for was a source about the second part of this thread - the restriction of residency by the AMA.
If people wanted and needed licensure for health, hair cutting, whatever, you'd expect that they would be at the state house. But they're not.
The majority of the public wants whatever they are lobbied to believe they need. The majority also supports the War on Drugs and criminalizing the sex trade, and for the same reason: fear tactics used to convince them that the mere option of doing an ostensibly harmful activity, is to the detriment of themselves and society at large, even though the activity would harm no one but the party engaged in it.
Plenty of medical procedures could be done by nurses and other non-physician medical professionals, yet this entire option is barred to the public. There should be a free market, with consenting adults free to choose for themselves who to hire to perform services for them.
Ok, can you show me the lobbying that swayed their opinion on this topic then? If they are just gullible like you claim, then do you think these incapable people will have the capacity to choose well after removing license requirements for providers?
"Plenty of medical procedures could be done by nurses and other non-physician medical professionals, yet this entire option is barred to the public."
This is not banned at all. Physician assistants and nurse practitioners exist and can perform some medical procedures/tasks. Even pharmacists. Granted I've personally had some negative experiences with some PAs and try to choose actually physicians for most things.
"There should be a free market, with consenting adults free to choose for themselves who to hire to perform services for them."
That would be nice in many ways, but I can see a downside too. Once someone is found to be incompetent, fraudulent, and harmful, how would they be barred from the profession to prevent the issue from happening to others? Usually things like insurance and bonding are requirements to cover any issues for people in this and other licensed fields.
I only deduce it happens.
I mean the lobbying happens in ordinary conversations like these, where people with a vested interest in gatekeeping argue it's in the public interest. I'm deducing it happens based simply on the incentives that exist for concentrated interests, in the form of insiders, to engage in it.
It also manifests as major political representatives legitimizing said licensure, and rationalizing the principle behind it to the public, in exchange for support from insiders within the regulated industry.
>>If they are just gullible like you claim, then do you think these incapable people will have the capacity to choose well after removing license requirements for providers?
Yes, because people do far more research for personal consumer choices, where their level of knowledge has a substantial personal impact, than for political positions where their level of knowledge has a minimal impact, or minimal likelihood of impact, on their personal life.
>>That would be nice in many ways, but I can see a downside too. Once someone is found to be incompetent, fraudulent, and harmful, how would they be barred from the profession to prevent the issue from happening to others?
I don't see how the absence of licensure would prevert courts from issuing restrictions on individuals found guilty of criminal misconduct.
The government requiring a conviction in court before restricting someone's right to free association is how it should be. That is what the principles of a free society demand.
That might cover fraud, but that doesn't cover incompetence or other harm.
"The government requiring a conviction in court before restricting someone's right to free association is how it should be."
That is one way to look at it, yet is is not how the legal system works today. The courts have determined that licensure is a lawful restriction on association.
"Yes, because people do far more research for personal consumer choices, where their level of knowledge has a substantial personal impact, than for political positions where their level of knowledge has a minimal impact, or minimal likelihood of impact, on their personal life."
It may have a more direct impact, but that does not mean they will have better outcomes. For one, you will be taken to the nearest hospital in an emergency - you have no choice. The important part is "their level of knowledge". Most people do not possess the level of knowledge to evaluate a medical professional and the information given to them by that medical professional. Most people accept it as truth and do not care to do any research on credible sites like PubMed.
If someone acts non-fradulently, and honestly conveys their lack of experience, their lack of competency in carrying out the service is no one's fault than the consumer.
>>The courts have determined that licensure is a lawful restriction on association.
I'm arguing this legal framework, not saying that's how it currently is.
>>It may have a more direct impact, but that does not mean they will have better outcomes. For one, you will be taken to the nearest hospital in an emergency - you have no choice.
Only 8% of healthcare spending is on emergency services, which can and should have government involvement to avoid abuse of geography-based monopoly by service providers.
But the remaining ~92% of healthcare spending is made through non-time-sensitive decisions where an individual has plenty of to assess the market options.
>>Most people do not possess the level of knowledge to evaluate a medical professional and the information given to them by that medical professional.
Just as people delegate this analysis to a cadre of politicians in the current monopolistic system, people would be able to delegate analysis to reputable experts in a free market.
You're ignoring the part where it cannot be conveyed, like when people are mentally ill, incapacitated, etc.
"But the remaining ~92% of healthcare spending is made through non-time-sensitive decisions where an individual has plenty of to assess the market options."
Just because it's non-emergency does not mean the person is capable if choosing. You have people who are mentally ill and incapacitated who are treated in settings other than the ER. The highest spending happens at the end of life stage.
"I'm arguing this legal framework, not saying that's how it currently is."
Do you actually have more details for how that framework would work? So far all I'm hearing is that we should nor have licenses for medical professionals. How does that work with medical professionals powers to suspend drivers licenses, commit people, help in emergencies (good samaritan laws), etc. How does this affect malpractice insurance and torts, especially if you're saying that any incompetence can simply be stated by the provider to avoid court intervention? How would this system work in relation to controlled substances and expensive equiptment maintenance/procurement? How are the safety programs legally enforceable or logically possible without training? We already see that VEARS has terrible quality data. There are many adverse events that go unreported, especially by the lower trained PAs/NPs (my experiences).
"Just as people delegate this analysis to a cadre of politicians in the current monopolistic system, people would be able to delegate analysis to reputable experts in a free market."
You keep calling this a monopoly, but it is not a monopoly. There are numerous providers competing with each other. There's simply a training/licensure requirement. How are reputable experts foing to be any different than the current system? My guess is that they will create their own license system and force people through that too. Insurances, which cover the vast majority, will still require licenses to ensure that people aren't getting care that will be ineffective and cost them even more. This includes stuff like Medicare and Medicaid that the government controls.
Do you have a thesis paper or something that we can see? We really need more information about what exactly you are proposing beyond 'remove licenses, free market will work', how that will affect the numerous aspects of the system as well as it's integration with other systems, and what research there is to support it.
We already have provisions for when someone cannot make decisions for themselves, like guardianship. We do not need to subject the entire population to guardianship-like subordination.
>>You keep calling this a monopoly, but it is not a monopoly.
It is a monopoly: the licensure rules have a monopoly over all providers. Your argument seems to be that people cannot choose for themselves, so it's better we impose this monopoly on them.
But if they can't choose an effective delegate in the marketplace, who says they can choose an effective politician to vote for in an election, who will then appoint the regulator that vets their market options? It's better to go with a decentralized approach, where each individual is free to choose their own delegate, rather than a centralized one where the entire population votes every four years for one delegate that gets the power to vote for every one, whether they consent or not.
>>Do you have a thesis paper or something that we can see? We really need more information about what exactly you are proposing beyond 'remove licenses, free market will work',
I think the burden of proof is on those who advocate for continuing to limit people's right to freely contract and purchase the goods/services they want.
https://www.ama-assn.org/press-center/press-releases/ama-fun...
This naïveté is typical of HN. You’d read a press release from ISIS and conclude they’ve built a paradise. You need more knowledge than you can Google up. You need to be aware of what they did and do over the last 30 years.
But it’s okay, you can believe falsehoods. No skin off my back.
It was actually more expensive. I've stopped asking and feel it's a urban myth.
Large hospital systems totally separate business and care, so it can be difficult to negotiate a discount. Smaller and independent providers are often more accommodating. However, you need to ask for a discount, you can't simply offer to pay cash (i.e. "If I pay cash, can I get 40% off"). The providers can counter your offer, but can't discount you off the bat or else they invite legal action from insurers.
https://www.rand.org/news/press/2021/01/28.html
> Prescription Drug Prices in the United States Are 2.56 Times Those in Other Countries
The medicine prices are MUCH lower in other parts of the world - including in places where the cost of living is much higher than in the US such as Norway and Switzerland.
The cost of Insulin is 8x higher in the US than in comparable countries around the world.
https://pharmanewsintel.com/news/insulin-prices-8x-higher-in...
"The Chamber [of Commerce] spent nearly $82 million on lobbying in 2020"
But generally in line with the list posted by the GP:
"Facebook and Amazon were the only companies in the top 10 spending list and spent nearly $19.7 million and more than $18.7 million on lobbying in 2020, respectively"
I too, am surprised as how little this is for these gigantic companies ($20M for FB? 1/1000th of their quarterly revenue?) and more generally, how little money this is... in comparison with the entire US government budget?
Sorry, this is probably all obvious? Just a bit.. sad?
[0] https://thehill.com/business-a-lobbying/536082-us-chamber-nu...
PHRMA plays big in politics, 501c4 space etc.
They also are known for the revolving door which is hard to quantify, but surely it makes a big difference on regs. Look at the Purdue, they got the regulator responsible for approving the label to actually sit in a hotel room and help write their oxy label together...
Here's an article shows "in the US from 1999 to 2018, found that the pharmaceutical and health product industry spent $4.7 billion, an average of $233 million per year, on lobbying the US federal government; $414 million on contributions to presidential and congressional electoral candidates, national party committees, and outside spending groups; and $877 million on contributions to state candidates and committees."
Source: https://www.kqed.org/stateofhealth/205822/northern-californi...
What do you think? - Is this something tech CAN do today, with an open source application and publicly available data?