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Sharks Eat Bear posted:I like that the thread is moving to (3), because unlike UHC/single-payer, I'm not aware of any really robust international examples of nationalized drug development from basic research through regulatory approval*. Even though I think nationalized drug R&D is The Correct Thing, I personally lack the expertise or cleverness to imagine how it would work. This isn't to say that it's unworkable, but I think there's value in discussing what it would look like, given we can't just point to the rest of the world and say "it would work like that" as with UHC. We want to discuss a detailed plan because if we just say "nationalize the rest" then there's not really any discussion to be had? That doesn't mean that "nationalize the rest" is a bridge too far. There's two discussions, that I can see, and to your credit you're the exception to my problem with other posters in this thread. Yours: "I think that there's solutions to the "medical innovation issue", if it exists, and we can discuss what that looks like" Others: "I think there's an "medical innovation issue" with single payer and that concerns me, and is a possible problem with single payer and you shouldn't talk about single payer as if there's no problems(even if nobody has)" -- I'm fine with the former, and frustrated by the latter. Especially since the entire original discussion was sparked with a complaint by a person who had zero interest in supporting their objecting with facts or even speculation beyond one line. I think the latter argument is disingenuous along lines of people who post in police reform threads that they get the problems with police but still have too many questions about abolition or defunding to support it.
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Oct 26, 2020 21:59
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Jaxyon posted:We've already nationalized a bunch of research via the NIH. I think you have at least 3 drug development professionals largely agreeing that single payer is fine and that better drug development can be done, while giving good insight into what it would take to achieve a different system and what that might look like.. and one saying it won't work for reasons. Jaxyon posted:Others: Who's saying this? Certainly not me. I'd appreciate it if you stop trying to pick fights and actually contribute to the discussion.
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Oct 26, 2020 23:15
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knox_harrington posted:Who's saying this? Certainly not me. I'd appreciate it if you stop trying to pick fights and actually contribute to the discussion. KingNastidon, for one. I'm not trying to pick fights but I'm a tad frustrated here. Maybe I'm conflating people but having posted a bunch of data to be met with walls of anecdotes and conjecture and told I am not contributing a bit annoying.
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Oct 26, 2020 23:27
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Jaxyon posted:KingNastidon, for one. Think this is a pretty uncharitable representation of the back-and-forth. Going back to page 4-5, we were discussing how much various entities contribute to total healthcare spend in the US and where cuts would come from. There were posts rejecting that cuts would touch sectors that contribute the most to total healthcare spend. Transitioning to a single payer system and reducing costs to be in-line with somewhere like UK is going to require more than eliminating CEO salaries and I find it interesting to talk about that because politicians and media rarely do, for better or worse. This eventually led to pharma, as these conversations often do, as a target of these cuts. We've talked about the different scopes of NIH and pharma. The likely effects of lower drug reimbursement rates on how pharma companies would respond as private for-profit entities. How innovation should be defined and whether any reduction in innovation is an acceptable trade off of lower healthcare spend. And lastly potential approaches to replacing these entities in the future as to minimize any downsides that could exist. Good discussion! But we're getting hung up on some topics (NIH vs. pharma, rationale behind why drugs are moved through clinical programs under status quo, feasibility of nationalizing global entities) because it relies on a level of alignment aren't getting to and end up talking past each other. What do you want me to reconsider or respond to? I'd love for the conversation to diversify from pharma and talk more about insurers, hospitals, long-term care centers, HCPs, etc. I know very little about the structure and finances of these orgs and would be interesting to hear about hot button issues or their perceptions of a transition to a single payer system.
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Oct 27, 2020 00:31
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When it comes to all this talk about "innovation," I think it's necessary to actually translate that to lives saved (or other direct benefits to people). For example, there's a certain percentage (though I'm not sure how high that percentage is) of R&D that doesn't actually translate to anything meaningful for patients and is just intended to replace medications that might have patents ending soon. At this point, benefits from medical "innovation" are likely experiencing significant diminishing returns relative to decades past, and the biggest actual determining factor in health outcomes is going to be simple access to care and resources available to provide care. I'm pretty sure that the difference in the actual impacts of "innovation" would be pretty small under a single-payer or NHS-like system (and might even be better if you increased funding to the NIH/NIDA/etc at the same time, since a lot of very important research is forced to be stingy with resources currently), and would unquestionably be dramatically eclipsed by the benefits to simply making healthcare easily accessible to everyone.
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Oct 27, 2020 01:08
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Let's bump this nice long-term policy thread to have something else to talk about other than the impending US civil war [that is definitely going to happen and not just people obsessing over social media coverage of the fringes in a country of 330 million people]Ytlaya posted:When it comes to all this talk about "innovation," I think it's necessary to actually translate that to lives saved (or other direct benefits to people). For example, there's a certain percentage (though I'm not sure how high that percentage is) of R&D that doesn't actually translate to anything meaningful for patients and is just intended to replace medications that might have patents ending soon. People have been talking about objective HEOR metrics like QALY from the very first page. It's important to distinguish between R&D done explicitly for the sake of creating a me too vs. the eventual pivotal Ph3 not being meaningfully differentiated from its competitors. What motivation does a company have to spend a bunch of money intentionally developing a mediocre therapy that 1) won't gain market share relative to established branded therapies or generics and 2) will face greater pressure from payors in terms of formulary placement or discounting? Ytlaya posted:At this point, benefits from medical "innovation" are likely experiencing significant diminishing returns relative to decades past, and the biggest actual determining factor in health outcomes is going to be simple access to care and resources available to provide care. I'm sure there were people saying the same things about diminishing returns of innovation in 2000 or 1975 or 1950. If you have a casual interest in the hematology/oncology space The Emperor of All Maladies is a nice pop sci book about how established standards of care have rapidly changed over short periods of time. I don't think anyone here has explicitly said that broader access to care will reap benefits. Rather, what the downstream impacts could be in order to realize that broader access at a lower aggregate cost. If you aren't interested in the second part of that discussion because you feel it's irrelevant or unimportant then don't participate in it. Ytlaya posted:I'm pretty sure that the difference in the actual impacts of "innovation" would be pretty small under a single-payer or NHS-like system (and might even be better if you increased funding to the NIH/NIDA/etc at the same time, since a lot of very important research is forced to be stingy with resources currently), and would unquestionably be dramatically eclipsed by the benefits to simply making healthcare easily accessible to everyone. The magnitude of impact is very hard to estimate until there's clearer direction in any policy proposal how they'll handle reimbursement rates. There's still disagreement about the direction of the impact under current proposals, which is probably important to agree upon first. Going back to log in the river analogy, private entities touching healthcare will adapt to whatever change comes through. The details do really matter from a long term planning perspective though.
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Nov 1, 2020 20:47
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The ACA is good. It personally helped me and people I know, and has helped literally millions more get healthcare and treatment that they wouldn't have otherwise. The idea that the ACA is what prevents us from having a better healthcare system is bullshit. The claim goes that since it wasn't perfect, it's an obstacle to that better system. You can see the sleight of hand in Willa's post - the ACA could have had a public option and price controls, and it doesn't. It could and should have had those things, and it was also a mistake on Obama's part to spend so long negotiating with Republicans. But I don't believe that a public option would flip Willa's opinion, or anyone else who criticizes the ACA. So we're back at the same point - the very real, very helpful ACA that exists, and the very hypothetical, very nonexistent UHC that couldashouldawoulda. UHC wouldn't have passed the Senate that existed in 2010, and I don't believe that anything better than the ACA would have been passed in the last ten years. And those things that Willa pointed to, the single payer and the price controls, haven't been passed either. ACA is a thousand times better than what existed before, and that's the only honest metric on which you can judge its success.
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May 3, 2021 16:59
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Posting from USNews thread:Willa Rogers posted:It's just stunning to me that 22 years later people are still claiming that Pres. Lieberman killed everything good in the ACA, after we watched Max Baucus ice the public option in committee & more dems than gop senators vote against drug-price controls when the ACA was being crafted. Willa Rogers posted:That liberals can write off minority uninsurance and underinsurance as "welp, shoulda expanded Medicaid" is a further data point in their racism, and also ignores that had the expansion been under a federal program such as Medicare then states wouldn't have been able to reject it. Stop inventing arguments that no one in the USNews thread was claiming. I never said Lieberman killed everything good in the ACA. I only mentioned him as a simple example, one of many, of why a single payer system had NO chance of being passed. And no one was writing off those who are currently uninsured/underinsured and saying a single payer healthcare system shouldn't be implemented. E: I'm realizing you might not have been talking about liberals in the USNews thread in that second quote. However, that is an extremely broad brush you're using. Kalit fucked around with this message at 17:15 on May 3, 2021 |
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May 3, 2021 17:04
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Tibalt posted:The ACA is good. It personally helped me and people I know, and has helped literally millions more get healthcare and treatment that they wouldn't have otherwise. Yes, its a self-fulfilling prophecy. UHC was never possible because Democrats actively fight against it. Also the ACA did nothing to slow or stop increasing rates and patient responsibility. It does get credit in shaking people's faith in the government's ability to deliver healthcare though. Saying it's "a thousand times better" is a hilarious amount of hyperbole and partisan nonsense.
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May 3, 2021 17:17
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Bishyaler posted:Saying it's "a thousand times better" is a hilarious amount of hyperbole and partisan nonsense. Considering the ACA saved my life (and has been saving the lives of homeless people), I think it's infinitely better than what we had before.
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May 3, 2021 17:21
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Bishyaler posted:Yes, its a self-fulfilling prophecy. UHC was never possible because Democrats actively fight against it. Also the ACA did nothing to slow or stop increasing rates and patient responsibility. It does get credit in shaking people's faith in the government's ability to deliver healthcare though. Saying it's "a thousand times better" is a hilarious amount of hyperbole and partisan nonsense. Because that's the only conceivable way that you think that the millions objectively helped by the ACA must be partisan hyperbole. People losing their job due to health issues that prevented them from working, and being denied insurance due to their condition, and ultimately being ruined by the catastrophic event - that happened all the time. And that's if you were the sort of person who had a job that offered health insurance. If you were someone who worked in an industry that didn't offer health insurance, but earned too much to qualify for Medicaid, the Obamacare exchanges were a godsend. I personally was able to afford insurance due to the ACA.
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May 3, 2021 17:41
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Tibalt posted:Let me guess- you never had to interact with US insurance before 2010, and have only the foggiest memories of what it was like. I've been under my own insurance since 1996. In what reality are ACA plans that cost $300 a month with a $7000 deductible and 50% coinsurance objectively good? Unless you're in for major surgery, that covers nothing. And if you were gainfully employed enough to eat a surprise $7000+ bill, you probably already had semi-decent insurance through your employer. So the working poor would've been paying $300 a month for slightly less crippling medical debt in case they ever needed care?
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May 3, 2021 18:28
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Can somebody find me one post, anywhere, ever where somebody in D&D said that the ACA is fine and so we don't need to expand healthcare coverage? Can anybody find me one post where somebody said that universal single-payer is a bad policy, and that they prefer the ACA to M4A, rather than just saying that it's unable to pass with the current construction of congress? I mean, I'm constantly assured those are positions that people hold, so it shouldn't be hard, right?
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May 3, 2021 19:08
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Mellow Seas posted:Can somebody find me one post, anywhere, ever where somebody in D&D said that the ACA is fine and so we don't need to expand healthcare coverage? Can anybody find me one post where somebody said that universal single-payer is a bad policy, and that they prefer the ACA to M4A, rather than just saying that it's unable to pass with the current construction of congress? I mean, I'm constantly assured those are positions that people hold, so it shouldn't be hard, right? I don't know if you'll find that in D&D, but you will find several prominent Democrats including Biden saying that expanding the ACA is the way forward, not M4A.
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May 3, 2021 21:36
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Posting from USNews to not continue a derail there:Bishyaler posted:Do I need to provide you with direct quotes from Biden saying that he opposes Medicare for All because it would involve retiring the ACA? I was talking about hanales claim of "stop reducing people’s arguments to things they aren’t saying", which was directed towards Tibalt. So, in that response, I wasn't trying to say whether you are correct/incorrect. Just that Tibalt wasn't putting words in your mouth when they replied to your post with " better they be sacrificed so that hypothetically a better thing could have happened in". But out of curiosity, do you think Biden would actually be supportive of Medicare for All if ACA had not gotten written into law back in 2010? Because that's a hell of a take.... Kalit fucked around with this message at 21:53 on May 3, 2021 |
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May 3, 2021 21:51
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Yes ACA was better than previous. No it's no substitute for universal healthcare. Source: Guy who finished paying off his cancer debt for the last 3 years only because the ACA made it a 3 year debt instead of being fired, expending his lifetime cap and dying in the street, and would have mutch rather have been able to stop working and rest instead of logging into the office VPN while in the hospital getting chemo drugs infused into him.
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May 4, 2021 14:34
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Kalit posted:
No. I think if the ACA had not passed in 2010, Democrats would be taking this opportunity to push a market-based solution like the ACA, just like they are attempting to expand the ACA now. They have accepted that ~45k deaths a year from lack of healthcare is preferable to taxing the rich and killing the health insurance industry.
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May 4, 2021 14:37
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Hold on - are telling me you literally don't believe that better things are possible? Well, cool, glad you admit that Obamacare is the best solution, despite the many acknowledged flaws. (USER WAS PUT ON PROBATION FOR THIS POST)
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May 4, 2021 14:51
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Tibalt posted:Hold on - are telling me you literally don't believe that better things are possible? Better things are easily possible if Democrats would practice what they preach. The problem is, they don't.
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May 4, 2021 14:56
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Bishyaler posted:Better things are easily possible if Democrats would practice what they preach. The problem is, they don't. That's not functionally different from the poster you're replying to
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May 5, 2021 01:58
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Tibalt posted:Hold on - are telling me you literally don't believe that better things are possible? lol "The neo-liberal's solution is not adequate for a solution that requires full socialization of medicare for the country to be effective" great take, i really didnt realize
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May 5, 2021 04:39
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Yesterday the FDA made a monumental decision to grant an Accelerated Approval to a new drug treatment for Alzheimer's Disease, made by the major biopharma company Biogen. This was one of the most hotly watched events in the pharma industry due to the unmet medical need in AD and the massive commercial potential since there are so many patients. The data package that Biogen submitted was considered extremely contentious to say the least; I'm not deeply versed in the data or drug development in AD, but my understanding is that their pivotal trials failed to show a clear benefit in patient outcomes. As a result the FDA convened an advisory committee to debate & vote on the potential approval and give a (non-binding) recommendation to the FDA on what to do. To nobody's surprise, the committee voted against the approval -- this is a slight over-simplification, but effectively 10 voted against it, 1 abstained, and nobody supported it. The two most shocking things about the approval IMO were: 1) That FDA decided to grant the accelerated approval, which is not just a term for an approval that happens quickly, but actually a very specific regulatory pathway for drug approval. The idea is basically that for diseases with high unmet need, a drug can be approved on a surrogate endpoint that's reasonably likely to predict an actual outcome benefit, in the absence of more robust outcome data. Biogen's drug was approved based on data showing that the drug can reduce beta amyloid plaques in patients brain, which has been the orthodox hypothesis as to what causes AD for the past couple decades but has become quite contentious as numerous studies haven't really been able to support this. Of note, an accelerated approval based on this type of surrogate data wasn't even on the table when this was brought to the advisory committee. The accelerated approval stands until there are results from a larger trial that confirms an actual clinical outcomes benefit, and if the confirmatory trial fails, in theory the approval should be rescinded. Yesterday the Biogen CEO disclosed that they have 9 years to complete a confirmatory trial, which many think is an unacceptably long time 2) That Biogen announced a list price of $56K, which was roughly double what most industry analysts were expecting. Biogen has defended this price by saying it's going to offer rebates/discounts to specific channels so that the net price will be lower, that it's cheaper than other new drugs for other diseases like immunotherapies for cancer (which btw have incredible amounts of proof of their effectiveness relative to Biogen's drug), and that they'll be investing in providing many support services for AD patients. These defenses are, of course, total obfuscation. What's worse is that most AD patients are covered via Medicare, which has very limited ability to negotiate price or impose formulary restrictions, which means that Biogen can basically gouge as much as they think they can get away with without causing a massive public and political outcry. And clearly they think they can gouge the gently caress out of us. Here's a quote from an analyst to put this in context: quote:Bernstein’s Ronny Gal... also noted that if 1 million patients use Aduhelm at the current price point, total Medicare part B spending would double. That figure is probably out of range, as there are about 500,000 new Alzheimer’s diagnoses a year in the US. But a more realistic scenario, he said, is “equally mind-boggling”: If half of newly diagnosed patients start Aduhelm at the current price, the total cost to Medicare will be equal to the top five drugs in Medicare part B combined: Keytruda, Eylea, Opdivo, Rituxan and Prolia. --- I actually do think this could have big ripple effects and further ramp up political pressure on drug pricing regulation. I also think there needs to be some sort of hearing/investigation into how the FDA came to its decision. I can't really understate how shocking it was, this editorial does a pretty good job summing it up. For context - this author is the founder/head of this popular industry newsletter and is not someone you'd peg as a critic of the industry at all. "John Carroll posted:Just how sadly misguided is the FDA on aducanumab?
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Jun 8, 2021 18:14
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The linked article characterizes the FDA as misguided. Is there any sign, to people more knowledgeable than me (ideally not going exclusively off cynicism)--whether this is the case or if it's outright regulatory capture/bribery? I realize we can't know without an investigation, just wondering if there's a bigger picture that could grant some context.
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Jun 9, 2021 17:41
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My $0.02 as someone in the industry who’s very familiar with a lot of the generalities but not the specific details of this approval... Bribes: unlikely Regulatory capture either in the FDA review chain of command or in terms of pressure from outside/above the FDA: entirely plausible and to your point, absolutely warrants investigation 10 years ago I viewed the FDA as one of the better regulatory agencies in the US (at least for drugs, not familiar with foods), and not one of the primary contributors to indescribable dysfunction of the US healthcare system (admittedly not a high bar). I really can’t overstate how shocking and upsetting this Alzheimer’s approval is, and how far a fall it signals compared to the relative strength of the agency in the past. Would be curious to hear from other posters who work in healthcare too
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Jun 9, 2021 20:56
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In case anyone's wondering: a couple of House dems announced they'd open an investigation into the Biogen Alzheimer's drug approval & pricing. Good riddance, hopefully it can move quickly and uncovers enough scandalous material to cause more public outcry and pressure for drug approval & pricing reform! https://finance.yahoo.com/news/house-panels-launch-investigation-alzheimer-225645951.html quote:Two House committees announced Friday that they are launching an investigation into the controversial approval and pricing of Biogen’s new $56,000-a-year Alzheimer’s drug.
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Jun 29, 2021 00:08
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I know John Oliver isn't that great but he does put together some informative videos. I didn't know this was a big thing, somehow, despite having zero faith in the US healthcare system. I'm sure there's some sort of German word for knowing something is the absolute worst and then finding an entirely new, additional layer of how awful it is that you previously weren't aware of. https://www.youtube.com/watch?v=oFetFqrVBNc
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Jun 29, 2021 00:32
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