Social security yes, but it seems to me that reducing the cost of Medicare and Medicaid should be very much possible. We need to provide healthcare but it should be possible to make that less expensive
[1] https://www.cms.gov/inflation-reduction-act-and-medicare/med...
Is "we just won't fund your drug, even though people will die and you're the only option on the market" actually something that could happen? Would that be politically palatable to anybody?
I guess there's patent invalidation and forced genericization, but that would kill innovation real quick.
I think a far better idea would be to impose very strict caps on admin / non-medical costs, potentially at the expense of paying a bit more to fraudsters, changing FDA regulations to minimize (death from side effects + death from no available drugs) instead of just the former, as well as becoming a lot more aggressive about expensive and unnecessary procedures that doctors perform to get rich quick.
On the side, he may open the door for generic substitutes as well from CAN etc.
A simple price directive would be set at the same time, without any negotiation:
The price US medicare will pay will only be the average price for each drug, in all OECD countries.
With no legal precedent supporting him but absolutely no resistance from the branches of government meant to keep him in check.
The government has all the cards, negotiation is really just a matter of will.
If there is only 1 company to negotiate with, the government is really the only entity that can threaten to simply create a competitor and give them the IP rights (by legal fiat) to do so. If you tell the existing company that your alternative solution is to compete with them using taxpayer money, they might choose to take the lesson of history and accept the government's negotiating position.
Presumably the government also has the option to permit purchase of pharmaceuticals from other countries. "Oh, you've raised the cost of X? That's okay, we'll buy it from licensed suppliers in the EU for a tenth of the price."
Actually is that possible? Are the EU suppliers allowed to resell at the gov negotiated price? Or are the gov negotiated price only for internal market?
(I've been wondering since I don't understand why swiss drug price are so much higher given that EU suppliers are next door)
Most EU countrys payed $40-$60 (per unit, shipped by 3rd party courier, who do their own billing), SE Asia and Australia $60-$80 and the US $1500-$2000. Before I left we started also shipping to Canada, dunno about the prices anymore, but substantially less.
The head of our institute was apparently involved in the negotiations and although I didn't get a chance to talk to him directly, the popular story was that our guys showed up, were presented with a pretty much done deal and told that the price and payment terms were nonnegotiable. Also, during meetings, he would refer to the Amis often as "Die, die nicht mehr alle Tassen im Schrank haben", which roughly translates to "The crazy ones."
Also, the product they wanted specified a significantly less complex and cheaper pooling procedure than we were able to offer...
Literally all the leverage.
I continue to post this, not even fully convinced - Im scared I wouldnt be able to afford good care without govt subsidies, but I am open to the idea at least. I dont think care in the USA would be worse overall
Im curious if you think malpractice insurance is also a significant, unnecessary cost? What if we made it harder to sue doctors? On the flip side, malpractice is still a real problem - probably not one that will be fixed by removing medical licences :D just hoping you see this comment since I am genuinely interested in your answer
By me in FL, it's hard to find a doctor that actually has a private practice now. Most are corporate owned clinics where doctors are just employees.
That kind of change though would leave someone with the bag and tends to never get voted or happen so we stay stuck in the over priced pharma, insurance, beating around the bush health game were in. Everyone is incentivezed to keep the bandaids rolling. Don't tell people their drug habits (I mean eating habits) are killing them.
Ohh wait, we got a new pgp blocker for you!
How about just skip breakfast.....
But throwing medicine to the whims of the market is absurd. We're going to pick surgeons by reading reviews on Google?
Most of the spiraling healthcare costs are attributable to administrative bloat, hospital profits, insurance companies and pharmaceutical profits. What you’re suggesting would just result in lower quality care in general and has effectively already been implemented with the rise of ‘supervised’ and unsupervised mid-level providers. I.e. NPs, PAs, CRNAs etc. It hasn’t resulted in any decrease in healthcare costs for the patient.
Let me give you some context for insight. If I see a patient in clinic for an intravitreal injection my fee will be $150-250 before overhead, the pharmaceutical company will be paid by medicare or private insurance around ~ $2000 for the drug that I inject. Double that for a bilateral injection.
If I operate at a hospital, my fee is $5-600. The hospital bills medicare a $4000 facilities fee plus additional fees for anesthesia, consumables etc. to the tune of over $10000 per eye.
If you want to lower healthcare costs a good start would be negotiating drug prices, repealing the clause in the ACA that bans physicians from owning hospitals, banning non-competes for healthcare professionals and getting rid of certificates of need that make it unnecessarily difficult to build outpatient surgery centers. In short, ideas that require a more nuanced understanding of our healthcare system.
btw I appreciate being called uninformed (which I dont dispute and find no offence in) rather than stupid or pigheaded or whatever. The point of talking about things is to share and increase our understanding.
However in the grand scheme of things this still isnt that bad, and I do think doctors/nurses deserve a good compensation, so given the problems associated, maybe we dont go with removing medical licences as a solution to healthcare costs