What does "underinsured" mean in the US?

[Brandon716]

Spot on. A lot of doctors are retiring due to all of these factors. The problem with Medicare/Medicaid is that once you factor in the costs (overhead, staff, treatment, ect.), doctors either break even or lose money on this. This has to countered by charging higher fees to those with insurance.

As you noted, Americans (I am one) demand the best. We want to extend our lives by 6 months (even in a frail state) that will cost an insane amount of money on the dime of others. We'll also sue doctors if they do something or don't.

We also need to take better care of ourselves. Personal responsibility is gone (and the downfall of our country). Another problem is we get charged higher drug prices due to lack of price control (we basically pay for the rest the world). That's a sticky issue.

Just curious, how does Canada handle foreigners (not counting legal residents) in regards to treatment? I hate the idea of having a job tied to your insurance. I think in a way, and Canada-style system allows for risks.

The United States doesn't pay for the rest of the world's drug supply, research, and development. Its an idea that was propagated by pharma industry trade groups for many years and has become standard talk in Washington, but it doesn't make it true.

 

[kEiThZ]

^ It may not foot the bill entirely, but the US is the largest pharmaceutical market in the world. Add in the US NIHs, CDC, etc. and the US makes well above its fair share towards pharmaceutical research. The problem, however, is that US pharma being so market driven will focus their research on not so significant problems...like the next Viagra instead of say cystic fibrosis.

In Canada's case, Canadian pharma is largely composed of generic drug manufacturers (like Novapharm) who patent ride to produce cheap drugs. This is no accident. It's the result of a conscious government decision to limit drug costs by only paying a certain amount for certain medication. I am doubtful that such a system would be sustainable without the significant amount of pharmaceutical research done outside Canada that allows our generic drug manufacturers to patent ride (albeit with a 20-25 year lag). Drug prices would rise significantly if we had to pay for our own research.

 

[Northern Light]

Patents

Hmm,

I find the supposition that long patents are required to produce major drug discoveries highly suspect.

Let's see, let's name the major diseases to gain a vaccine, or cure (drug-based) since the 20 year patent became the norm!

Ummmm

Ummmm

Maybe the HPV vaccine.....maybe....

What else?

Insulin for Diabetes and a host of vaccines for everything from Polio to Mumphs came in during eras of much shorter patents (10-15 years).

In general I think patents of an extended nature only serve to enrich drug company share-holders and not the wealth of medical knowledge or the broader public health.

Keep in mind, most major discoveries have been the product of publicly funded research through Universities or government grants, rather than private corporations in search of profit.

As noted in my sig, I'm not a nanny-statist, nor do I have any problem with free enterprise, but I do have a problem with over-stating the benefits of the latter, particularly in the context of an inherently anti-free market mechanism (the patent) which could only exist by government fiat and which serves to thwart competitive production of medical narcotics.

I'm not prepared to support the notion that U.S. drug companies contribute significantly (in a disproportionate way) to broader health care, the public good or the field of knowledge around critical health issues.

If you removed peripheral health and cosmetic concerns, and then judged the research not by dollars invested but by results produced per dollar, I don't think you find much justification for the current patent regime or for U.S. style health care.

Drug prices in the U.S. are not a function of delivery of greater health results to or for Americans or the broader population, but rather, greater profit for modest and narrow benefit to a small few.

 

[Brandon716]

Go here:

http://finance.yahoo.com

Research the big pharma in the US. You'll soon learn the amount they spend on R&D is minimal compared with marketing.

So much of the "innovation" is indeed revising pills already created, such as a slew of new penis pills to compete with Viagra. All they do is spend a billion to change a molecule so they can introduce Cialis. Ba-da-bing, ba-da-boom. There you got a billion worth of new "innovation" when we need research on cancer and hiv.

Serious diseases and conditions are underfunded bigtime all around the world.

 

[Northern Light]

Medical devices

I should add that patents for medical devices, as opposed to drugs seem to deliver better results.

Most notable modern MRIs and CATscans as well as artificial hearts and limbs.

Why the difference, I'm not sure.

 

[kEiThZ]

Go here:

http://finance.yahoo.com

Research the big pharma in the US. You'll soon learn the amount they spend on R&D is minimal compared with marketing.

http://www.pmprb-cepmb.gc.ca/CMFiles/ss-0217e14HCB-492003-5262.pdf
- See page 19.

I don't doubt that they spend significantly more on marketing and their per capita ratios are messed. However, drug research expenditures (in aggregate) by US pharma are still far higher than the rest of the world. And that's the tragedy of the situation....

I am not going to deny them credit for that. The only reason we have cheap generics in Canada is because major pharmas (mostly in the US and some in Europe) spend billions developing new drugs. I may think that a lot of their time and effort is wasted on useless endeavours. However, they do produce the odd wonder drug on occasion, that we Canadians get to rip off 20 years later. I am grateful for that.

 

[Brandon716]

Yes, the US funds an extremely high amount of R&D, of which much of the most important research comes through programs unrelated to pharma industry. University research funded through both government programs through the National Institutes of Health and also other non-profits, for example.

But the US is far and above larger than industrialized competitors. We're over 2x the size of Japan. We're over 3x the size of our nearest European competitor.

China is still developing so its hard to compare... But I'd like to see per capita rankings with other advanced nations or a comparison to all of Europe collectively.

BTW, the reason you have cheap drugs in Canada isn't because the US develops them. Its because your government has taken an active role in controlling prices while still letting big pharma make plenty off of the Canadian people.

 

[kEiThZ]

I find the supposition that long patents are required to produce major drug discoveries highly suspect.

I have never disagreed with the notion that patents protect profits (which some consider unfair). And I'd generally agree that 20 year patents are too long. But as I argue below, how do you draw the line? A US pharma could spend hundreds of millions of dollar to make an AIDS cocktail that keeps a person alive for a few more years. In the US, they can sell it for thousands. In India, a generic manufacturer will get a government licence to violate the patent in the name of compassion and pump out the drugs a tiny fraction of what the US pharma gets to charge at home. Now how do you draw the line in that situation? What do you do to ensure that these pharmaceutical companies keep researching AIDS drugs?

Drug prices in the U.S. are not a function of delivery of greater health results to or for Americans or the broader population, but rather, greater profit for modest and narrow benefit to a small few.

There is however some truth to the fact that Americans are stuck with the task of making up for the profits of tighter controls and the proliferation of generics in the rest of the world. Consider for example our generics industry. We practically built the industry from the ground up to create affordable drugs for our health care system. It works well for us. But is it fair that we are essentially robbing the investment return of a pharmaceutical company elsewhere? That company will make the shortfall up where it can. Unfortunately for the US consumer that's usually in their home market.

It's quite easy to say that it's all about profit and narrow benefit. What's the alternative? Even in Canada, nobody has suggested that the government nationalize the entire pharmaceutical industry to produce cheaper drugs and focus on more relevant health issues. The reality is that pharmaceutical manufacturers are corporations just like any other and they have to produce profits. They are not in business to be charitable. If they can't bring home the bacon, their shareholders will go elsewhere and the companies won't be around for long. You have to find a balance between public good and private profit. And that's a tough one. I don't for a second pretend to know what the right mix/ratio is. But I do think blatant condemnation of the pursuit profit is wrong, unless, you are willing to advocate for wholesale government take over of every aspect of health care (not just pharmaceuticals but also makers of x-ray machines, MRI/CAT scan machines, etc.). There's very little that can be done short of that threshold. Some ban on advertising might help a little. But at the end of the day you can't stop a company from prioritizing drugs for ED over Heart Disease without outright nationalization.

 

[kEiThZ]

BTW, the reason you have cheap drugs in Canada isn't because the US develops them. Its because your government has taken an active role in controlling prices while still letting big pharma make plenty off of the Canadian people.

I don't disagree (fully). But my question is, would those drugs even exists if big pharma didn't get the protection it does at home (in the US and Europe)?

And note that a huge part of our government's 'active role' essentially consists of buying generic drugs and refusing to pay more than certain amounts for branded meds. That's how we've kept the costs down. It's a model that any US state could easily emulate. However, I don't think anybody can deny that this would hurt the bottom line of the pharmaceutical industry, which could result in cuts to R&D.

From my perspective, the best thing the US can do is ban the advertising of pharmaceuticals. Saving all those marketing costs and effort might help re-focus the pharmaceutical industry.

 

[Brandon716]

I don't disagree (fully). But my question is, would those drugs even exists if big pharma didn't get the protection it does at home (in the US and Europe)?

And note that a huge part of our government's 'active role' essentially consists of buying generic drugs and refusing to pay more than certain amounts for branded meds. That's how we've kept the costs down. It's a model that any US state could easily emulate. However, I don't think anybody can deny that this would hurt the bottom line of the pharmaceutical industry, which could result in cuts to R&D.

From my perspective, the best thing the US can do is ban the advertising of pharmaceuticals. Saving all those marketing costs and effort might help re-focus the pharmaceutical industry.

I don't think you've taken a chance to research how much of a proportion big pharma spends on executive bonuses and marketing and only throws pennies at research and development.

And you've also not noticed how much US research comes not from big pharma but from the university research setting. Many technologies are invented at a university setting, then big pharma takes it and finalizes it. They spend very very little on actual research for many important drugs.

Where they tend to create most innovation are designer drugs. I.E. penis pills, anti-depressants, new ways to keep women from getting pregnant. Its not exactly the cornerstone of science.

Its nice to have these drugs (they do serve a purpose), but so much important research - like HIV research - gets almost no funding from big private pharma.

 

[Brandon716]

This week has been a turning point in health reform, the Democrats are growing a spine even as Senator Kennedy has passed away as of today.

Unfortunately we have one less vote in the Senate, but they are preparing to pass a public option under reconciliation rules, which requires only 51 votes.

Meanwhile, here is how conservative Republican Tom Coburn of Oklahoma responds (quite surprisingly heartless, might I add) to a constituent with a life changing event:

http://youtube.com/watch?v=e3jwhLcW_c8

 

[tayser]

Here is a prime example of the different taxation structure.

New York state pay stub including tax withholding
source: www.paycheckcity.com
Scenario: 0 additional exemptions, 40,000 yearly income

Province of Ontario pay stub including tax withholding
source: http://www.paycheckcity.com/canada/coeatonca/cacalculator.aspx
Scenario: 0 additional exemptions, 40,000 yearly income

holy sh!tcakes, I actually pay less tax than someone from NY / ON?

Australia-wide (income tax is federal - doesn't exist at a state level):

Gross Monthly Earnings: $3,333.00
Tax Applicable: $503.00
Less Tax offsets: $0.00
Less Medicare Levy Adjustment: $0.00 [*** if you earn over $50k and don't have Private Health insurance, you pay an extra 1.5% in Medicare "Loading"]
Tax Withheld : $503.00
Net Pay: $2,830.00

inside the $503 monthly includes the 1% Medicare levy that all taxpayers pay.

I pay a further $64 for private health cover per month - I use it for items such as Optical (get $150 for frames and $120 for lenses every calendar year - eye check ups are bulk billed (paid for by Medicare - i.e. free)), Physio (health fund pays approx 70% of the consultation - my out of pocket expense is only $15 per visit), General Dental (free check up & clean every 6 months, fund pays about 50-60% of the cost for standard fillings and they'll pay 40-50% of the cost of things like getting Crowns/Root Canals etc) - and my cover has added bonuses which I can use on natural consultations or top up limits in other areas - and naturally there's the hospital cover (in public or private hospitals)....

But at the end of the day, you would never be put through the ringer like you were re: that rejection letter - that's utterly shambolic that you pay these stooges money every month and you get sweet fuck all in return.

 

[afransen]

What about pension deductions? I thought Australia had substantial compulsory pension deductions. No Employment Insurance either, or is it rolled into income taxes?

Of course, these comparisons fail to take into account sales taxes and excise taxes. I think NY would have an edge on Ontario with these taken into account.

 

[Blues]

This week has been a turning point in health reform, the Democrats are growing a spine even as Senator Kennedy has passed away as of today.

Unfortunately we have one less vote in the Senate, but they are preparing to pass a public option under reconciliation rules, which requires only 51 votes.

Meanwhile, here is how conservative Republican Tom Coburn of Oklahoma responds (quite surprisingly heartless, might I add) to a constituent with a life changing event:

http://youtube.com/watch?v=e3jwhLcW_c8

I wonder if the reconciliation rules will pass the courts.

I'm not a fan of the health care bill because it's not a "health care reform" bill at all.

 

[Blues]

I don't think you've taken a chance to research how much of a proportion big pharma spends on executive bonuses and marketing and only throws pennies at research and development.

And you've also not noticed how much US research comes not from big pharma but from the university research setting. Many technologies are invented at a university setting, then big pharma takes it and finalizes it. They spend very very little on actual research for many important drugs.

Where they tend to create most innovation are designer drugs. I.E. penis pills, anti-depressants, new ways to keep women from getting pregnant. Its not exactly the cornerstone of science.

Its nice to have these drugs (they do serve a purpose), but so much important research - like HIV research - gets almost no funding from big private pharma.

I do agree with you on the cutting/banning marketing promotion.

Just to note, the paents in the drug market usually don't last 20 years. Pharma companies will usually cut a deal when generic brands try to enter the market before it expires.

It's not cheap to bring a drug to the market (and that doesn't include all the failures). http://csdd.tufts.edu/NewsEvents/NewsArticle.asp?newsid=6