Affordable Care Act - catastrophic plans cancelled

[letsgetsailing3]

Originally Posted by colemj

I was correcting your statement about global market share. You were using it to make a point, but you were way off.

The largest gross spending is not the same as the largest market share. You are still using these data incorrectly to support your predetermined point.

Obtaining the answer to your last question is your homework. I will give you two hints: 1) "negotiating" does not involve free-markets and no regulation 2) there is no such entity as the "US" in determining market prices - no more so than for tv's or automobiles. Market prices are determine IN the US.

Mark

I'll give you a hint: There is nothing "free-market" about the current state of U.S. health care.

I can shop on the internet for the lowest price for a TV. Can I do the same for health services? Would I want to if I could? No. But would I like to see some cost transparency in the U.S. pharmaceutical market? Do I like seeing people pay $5 for an aspirin at the hospital?

Yes, health care and pharmaceuticals are much more complex than that, but they are not so complex that U.S. citizens should be paying double what other countries pay for health care. And they are not so complex that politicians should be making it more difficult, not less difficult for pharmaceutical prices to be negotiated by the government.

While the U.S. can't negotiate for medications on the whole, I can certainly see the benefit of allowing Medicare or other large entities to negotiate with pharmaceutical companies. Why wouldn't the Federal government be able to negotiate, given how much of the market they influence?

[Jimbo485]

Originally Posted by letsgetsailing3

http://en.wikipedia.org/wiki/United_States

Are you using slang against such countries as:

Estados Unidos Mexicanos
Estados Unidos do Brasil
and various others....?

Look at the name of your country in your own passport. You are burying yourself deeper in your own ignorance....

Sorry, I can't help any further..... but I have to observe that it is this same attitude that stunts your health care, puts a man on the moon, invades a country on the basis of a lie, etc...

[letsgetsailing3]

Originally Posted by goboatingnow

The figures published show that Switzerland UK and Germany about equal the US markets . Furthermore where multi national companies book spend and profits is not the same as where they actually do the work

However you look at it , you cannot justify the US pricing on the nonsensical notion that some how US pharma is subsidising the world. That's just nonsense. US drugs pricing is a function of the crazy system. Don't try and justify it along the lines of " they took our jobs"


Dave

I didn't argue any of that, though I think you could with some difficulty make the case that as the worlds largest consumer of drugs, the U.S. is subsidizing world pharmaceuticals. You'd be crazy not to admit that the U.S. has a big influence on the pharmaceutical industry.

What I am arguing is that the Federal government (like Medicare) shouldn't be prohibited from negotiating with pharmaceutical companies.

[letsgetsailing3]

Originally Posted by Jimbo485

Are you using slang against such countries as:

Estados Unidos Mexicanos
Estados Unidos do Brasil
and various others....?

Look at the name of your country in your own passport. You are burying yourself deeper in your own ignorance....

Sorry, I can't help any further..... but I have to observe that it is this same attitude that stunts your health care, puts a man on the moon, invades a country on the basis of a lie, etc...

Dude, get over it. The United States refers to one country, and one country only.

You can hate that, or you can accept it, but that's the way it is.

[colemj]

Originally Posted by letsgetsailing3

I'll give you a hint: There is nothing "free-market" about the current state of U.S. health care.

I can shop on the internet for the lowest price for a TV. Can I do the same for health services? Would I want to if I could? No. But would I like to see some cost transparency in the U.S. pharmaceutical market? Do I like seeing people pay $5 for an aspirin at the hospital?

Yes, health care and pharmaceuticals are much more complex than that, but they are not so complex that U.S. citizens should be paying double what other countries pay for health care. And they are not so complex that politicians should be making it more difficult, not less difficult for pharmaceutical prices to be negotiated by the government.

While the U.S. can't negotiate for medications on the whole, I can certainly see the benefit of allowing Medicare or other large entities to negotiate with pharmaceutical companies. Why wouldn't the Federal government be able to negotiate, given how much of the market they influence?

Nice deflection. When data prove your specific claims about pharmaceuticals wrong, you conflate them with the entirety of "US health care".

I'm not debating the free market status of US health care access, but pharmaceutical pricing is absolutely based on free-market capitalistic forces in the US (almost entirely - see below).

What an aspirin costs you in a hospital is irrelevant to the wholesale pricing of aspirin in the market. The hospital is charging that price, not the pharmaceutical company making it. Go across the street and pay 1 cent for an aspirin at the drugstore instead. BTW, they put a mark-up on it also.

In fact, you can shop around on the internet for your drugs and find better prices. This is the reason Walmart, Costco and the big-box drugstores have such large businesses. They sell drugs cheaper than others.

Not to mention you can order your pharmaceutical products from other countries.

Now, about your claim that pharmaceutical pricing is not free-market in the US. Consider the fact that when government is involved, the prices of drugs drop dramatically. The prices paid in Medicare are substantially lower than those on the open market. Medicare, VA, medicaid, etc DO negotiate with pharmaceutical companies. Directly. And those ARE US government entities, so the US government IS negotiating.

This system has been in place for many, many years. It is up to you to determine why those programs are only for select individuals. I will give you a hint: it is not because the government is making it more difficult for the government to negotiate.

Seriously, you are either going to need to disabuse yourself of these unexamined and passionate beliefs you hold, or you will need to give up arguing them in public. They just do not hold up to any fact-checking or reality at all.

Mark

[goboatingnow]

Originally Posted by colemj

Those data are from 2009. Since that time, Pfizer and Novartis have pulled out of the UK and GlaxoSmithKline has scaled back their operations significantly. I'm afraid the next round of data collection will not have the UK in the top research spending.

I'm sure there are a lot of people who think they have received their money's worth with pharmaceuticals. Drugs have done a lot of good, and many have replaced much more costly and invasive older treatments. Some are keeping people alive where no other treatment would or could.

As for cost, why shouldn't free market forces be in effect here? Why shouldn't pharmaceutical companies price their product to what the market will pay? Currently, the US market is willing to pay higher prices. No one forces anyone to buy drugs. Markets in other countries do not support those prices so the costs are lower.

The opposite is true for electronics, clothing, etc in the US vs. the UK.

It is certainly an interesting exercise to figure out and understand why this is.

But one cannot be a free-market, no regulation, no social programs, everyone for themselves libertarian capitalist and complain about drug pricing. (I'm not saying you are - I'm talking in the general sense).

Mark

The laws of supply and demand are what control the price of commodities. However in healthcare there is effective infinite demand, in so much that people are not in a position to refuse treatments or associated drugs. Take the supply of bread as an equivalent. If the price increased ten fold, the consumption of bread drop drop significantly as consumers switched to other substitutes. Hence that feedback loop helps control retail pricing .

In Healthcare , you have , in general, no option ton" shop elsewhere " or to forgo the product. If you are ill , you need treatment. Hence inherently health cannot be viewed as a free market activity.

Then overlay a health insurance market and you have two interest groups which act to increase prices because in fact the user no longer buys or cares about the end product, only the cost of the secondary product, the insurance.

The reason electronics are cheaper in the USofA ( and I would argue they are not that much different ) is firstly , it's an elective purchase, secondly you have lower sales tax and thirdly a homogenous large market.

I often thought that of the Gov, just gave you am agreed cash equivalent , and you shopped for the best value ( and could keep the difference ) consumer power would drive down health. pricing

An example I'm familiar with is Ireland , where most people pay for GP visits and buy drugs, with little state aid. GP visits range €50 -€80 euros a consultation and drugs are about 135% of EU average. GP pricing must remain competitive otherwise the clients will not visit ( a lot of GP care is elective ) hence the resistance to arbitrary price rises

Drugs remained high because of price fixing agreements that are only being slowly removed , mainly as a result of the arrival of generics. Hence the free market works in the case of GPs , because the consumer has a choice, it doesnt work in prescription drugs , because here the user doesn't have a choice , ie he or she needs the drugs and hence pays the inflated price

In other countries like Portugal , common prescription drugs are available over the counter and hence are very cheap.


Drugs vary from country to country , primarily depending on healthcare policy and consumer spending power.

Healthcare cannot work as a free market enterprise. It needs to be tightly regulated and controlled, to ensure that excessively profiteering does not take place

Dave

[colemj]

Originally Posted by letsgetsailing3

I think you could with some difficulty make the case that as the worlds largest consumer of drugs…

Again,they are not the world's largest consumer of drugs (33% historically, 15-20% in recent times). They spend more in absolute terms, but not in relative terms (they are in second there).

Until you understand that, your arguments are going to be very weak.

Mark

[letsgetsailing3]

Originally Posted by colemj

Nice deflection. When data prove your specific claims about pharmaceuticals wrong, you conflate them with the entirety of "US health care".

I'm not debating the free market status of US health care access, but pharmaceutical pricing is absolutely based on free-market capitalistic forces in the US (almost entirely - see below).

What an aspirin costs you in a hospital is irrelevant to the wholesale pricing of aspirin in the market. The hospital is charging that price, not the pharmaceutical company making it. Go across the street and pay 1 cent for an aspirin at the drugstore instead. BTW, they put a mark-up on it also.

In fact, you can shop around on the internet for your drugs and find better prices. This is the reason Walmart, Costco and the big-box drugstores have such large businesses. They sell drugs cheaper than others.

Not to mention you can order your pharmaceutical products from other countries.

Now, about your claim that pharmaceutical pricing is not free-market in the US. Consider the fact that when government is involved, the prices of drugs drop dramatically. The prices paid in Medicare are substantially lower than those on the open market. Medicare, VA, medicaid, etc DO negotiate with pharmaceutical companies. Directly. And those ARE US government entities, so the US government IS negotiating.

This system has been in place for many, many years. It is up to you to determine why those programs are only for select individuals. I will give you a hint: it is not because the government is making it more difficult for the government to negotiate.

Seriously, you are either going to need to disabuse yourself of these unexamined and passionate beliefs you hold, or you will need to give up arguing them in public. They just do not hold up to any fact-checking or reality at all.

Mark

It seems to me that the terms "unexamined and passionate" refer to your views.

There are a few conditions that must be met for a market to be considered a "free market". Those aren't met in the health care industry.

[letsgetsailing3]

Originally Posted by colemj

Again,they are not the world's largest consumer of drugs (33% historically, 15-20% in recent times). They spend more in absolute terms, but not in relative terms (they are in second there).

Until you understand that, your arguments are going to be very weak.

Mark

Even if the U.S. were the second largest purchaser of pharmaceuticals, the same concept would apply.

Take a deep breath, and try for a moment to understand what's being said.

[letsgetsailing3]

Originally Posted by goboatingnow

The laws of supply and demand are what control the price of commodities. However in healthcare there is effective infinite demand, in so much that people are not in a position to refuse treatments or associated drugs. Take the supply of bread as an equivalent. If the price increased ten fold, the consumption of bread drop drop significantly as consumers switched to other substitutes. Hence that feedback loop helps control retail pricing .

In Healthcare , you have , in general, no option ton" shop elsewhere " or to forgo the product. If you are ill , you need treatment. Hence inherently health cannot be viewed as a free market activity.

Then overlay a health insurance market and you have two interest groups which act to increase prices because in fact the user no longer buys or cares about the end product, only the cost of the secondary product, the insurance.

The reason electronics are cheaper in the USofA ( and I would argue they are not that much different ) is firstly , it's an elective purchase, secondly you have lower sales tax and thirdly a homogenous large market.

I often thought that of the Gov, just gave you am agreed cash equivalent , and you shopped for the best value ( and could keep the difference ) consumer power would drive down health. pricing

An example I'm familiar with is Ireland , where most people pay for GP visits and buy drugs, with little state aid. GP visits range €50 -€80 euros a consultation and drugs are about 135% of EU average. GP pricing must remain competitive otherwise the clients will not visit ( a lot of GP care is elective ) hence the resistance to arbitrary price rises

Drugs remained high because of price fixing agreements that are only being slowly removed , mainly as a result of the arrival of generics. Hence the free market works in the case of GPs , because the consumer has a choice, it doesnt work in prescription drugs , because here the user doesn't have a choice , ie he or she needs the drugs and hence pays the inflated price

In other countries like Portugal , common prescription drugs are available over the counter and hence are very cheap.


Drugs vary from country to country , primarily depending on healthcare policy and consumer spending power.

Healthcare cannot work as a free market enterprise. It needs to be tightly regulated and controlled, to ensure that excessively profiteering does not take place

Dave

I pretty much agree with all of this.

[colemj]

Originally Posted by goboatingnow

The laws of supply and demand are what control the price of commodities. However in healthcare there is effective infinite demand, in so much that people are not in a position to refuse treatments or associated drugs. Take the supply of bread as an equivalent. If the price increased ten fold, the consumption of bread drop drop significantly as consumers switched to other substitutes. Hence that feedback loop helps control retail pricing .

In Healthcare , you have , in general, no option ton" shop elsewhere " or to forgo the product. If you are ill , you need treatment. Hence inherently health cannot be viewed as a free market activity.

Then overlay a health insurance market and you have two interest groups which act to increase prices because in fact the user no longer buys or cares about the end product, only the cost of the secondary product, the insurance.

The reason electronics are cheaper in the USofA ( and I would argue they are not that much different ) is firstly , it's an elective purchase, secondly you have lower sales tax and thirdly a homogenous large market.

I often thought that of the Gov, just gave you am agreed cash equivalent , and you shopped for the best value ( and could keep the difference ) consumer power would drive down health. pricing

An example I'm familiar with is Ireland , where most people pay for GP visits and buy drugs, with little state aid. GP visits range €50 -€80 euros a consultation and drugs are about 135% of EU average. GP pricing must remain competitive otherwise the clients will not visit ( a lot of GP care is elective ) hence the resistance to arbitrary price rises

Drugs remained high because of price fixing agreements that are only being slowly removed , mainly as a result of the arrival of generics. Hence the free market works in the case of GPs , because the consumer has a choice, it doesnt work in prescription drugs , because here the user doesn't have a choice , ie he or she needs the drugs and hence pays the inflated price

In other countries like Portugal , common prescription drugs are available over the counter and hence are very cheap.


Drugs vary from country to country , primarily depending on healthcare policy and consumer spending power.

Healthcare cannot work as a free market enterprise. It needs to be tightly regulated and controlled, to ensure that excessively profiteering does not take place

Dave

It is an emotional argument that healthcare demand is infinite. One does have the choice to forgo the product, and one does not have a "right" to unlimited access to free or inexpensive product.

That sounds harsh, but the same is true for electricity, water, sewage, etc. I'm certainly not proposing the argument I'm making here - just being realistic. I personally believe the opposite.

It is a society that determines how much the market should be available to everyone and how that will be accomplished. The US has made a certain decision, as have all other countries.

And you conflated pharmaceuticals with the entirety of "healthcare", when the debate was more narrow and specific.

Pharmaceutical prices in the US are high because there are no government pricing regulations and controls (outside the social services programs). In other words, it is high because pharmaceutical companies are operating in a free market in the US.

In those areas where the government is paying for healthcare, the prices are in line with other countries with similar controls.

Mark

[colemj]

Originally Posted by letsgetsailing3

It seems to me that the terms "unexamined and passionate" refer to your views.

There are a few conditions that must be met for a market to be considered a "free market". Those aren't met in the health care industry.

I've described your deflection in conflating "pharmaceuticals" with "healthcare access". Please explain to me how the free market conditions are not being met with pharmaceuticals pricing only.

I'm not debating healthcare access or pricing in whole.

Mark

[colemj]

Originally Posted by letsgetsailing3

Even if the U.S. were the second largest purchaser of pharmaceuticals, the same concept would apply.

Take a deep breath, and try for a moment to understand what's being said.

Look, you keep making up data in support of beliefs you hold. $5 aspirins, US is >50% of consumption market, socialist regulations are causing high US drug prices, etc.

I keep proving those "facts" wrong. You keep ignoring that and making the same claims while telling me that they are all true regardless of the "actual" data.

Try for a moment to understand what is being said.

Mark

[Eumelia]

Something I'm very curious about...maybe you world travelers could chip in...do other countries have as big of a problem with resistant strains as we do in the US? Things like MRSA, VRSA, ESBL, VRE, MRAB and others are caused by the overuse of antibiotics in all US hospitals. Is the same true of other countries? Here in the US you can go into the hospital for minor surgery and contract one or more of these life-threatening infections. These are a large contributor to health-care costs and the problem will continue to increase.

[goboatingnow]

Originally Posted by colemj

It is an emotional argument that healthcare demand is infinite. One does have the choice to forgo the product, and one does not have a "right" to unlimited access to free or inexpensive product.

That sounds harsh, but the same is true for electricity, water, sewage, etc. I'm certainly not proposing the argument I'm making here - just being realistic. I personally believe the opposite.

It is a society that determines how much the market should be available to everyone and how that will be accomplished. The US has made a certain decision, as have all other countries.

And you conflated pharmaceuticals with the entirety of "healthcare", when the debate was more narrow and specific.

Pharmaceutical prices in the US are high because there are no government pricing regulations and controls (outside the social services programs). In other words, it is high because pharmaceutical companies are operating in a free market in the US.

In those areas where the government is paying for healthcare, the prices are in line with other countries with similar controls.

Mark

I disagree , the purchaser does not have in reality any choice to forgo the purchase. What you Are suggesting is nonsensical , does a cancer patient have any opportunity to forgo treatment , no not if sanity prevails.

Water is tightly controlled in most countries , for exactly the same reason , people must have it and hence profiteering must be controlled , most water supplies are either in public hands, publically controlled , or monopoly providers in a very controlled marketplace , even then you have the option to drive a well.

Electricity is the same, it typically exists in a price controlled marketplace.

Society does not determine what's available, most countries make set no controls on the type,duration and availability of any treatment. The treatment may it be available or not be covered , but that is a tiny proportion of treatments and not a factor in health pricing.

The free market does not mean that ONLY producers are free to set prices, it actually means a system where both suppliers and purchasers are free to act, suppliers set pricing ,purchasers choose to buy from whoever they choose.. That's a free market. Constrain one side or the other and its not a free market. Health can never be free,because people cannot be reasonably asked to trade death for lower prices.

But we agree, your last line is the truth. Healthcare only works in a tightly controlled negotiated marketplace,where governments , being a single huge consumer ( with the added ability to change laws) can dictate pricing, allowing a certain profit margin without excessive profiteering. Hence the single payer healthcare is really the only model that's works ( and then only imperfectly )

Dave