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Won't somebody, anybody, think about Aetna You have absolutely no proof that hospitals are going to be doing layoffs, the only scenario you can lay out is one where the poor loving insurance companies can't post record profits Dumper Humper fucked around with this message at 01:11 on Oct 21, 2020 |
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Oct 21, 2020 01:08
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M4A literally has a funds allocated to deal with potential layoffs. It's not some sort of new idea and obstacle. And that's not counting the surge in the economy once people aren't dumping money into healthcare and can spend it on consumer goods and services. or like, food.
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Oct 21, 2020 01:23
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Dumper Humper posted:Won't somebody, anybody, think about Aetna Hospitals and long term care centers are where the vast majority of healthcare dollars are currently being spent. You can burn for profit insurance companies to the ground, cool, but that alone isn't going to make a meaningful dent in aggregate healthcare expenditures per capita relative to other countries.
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Oct 21, 2020 01:24
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KingNastidon posted:Hospitals and long term care centers are where the vast majority of healthcare dollars are currently being spent. You can burn for profit insurance companies to the ground, cool, but that alone isn't going to make a meaningful dent in aggregate healthcare expenditures per capita relative to other countries. Don't vast majorities generally total vastly more than 50%, instead of around 40% combined as your link shows? Also hospitals can also be profit centers.
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Oct 21, 2020 01:29
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Jaxyon posted:Don't vast majorities generally total vastly more than 50%, instead of around 40% combined as your link shows? They do sum to >50%? Here's another source from CMS. I don't know what hospitals being profit centers has to do with this discussion. I don't care if they go non profit, but the existing profit margin is likely a drop in the bucket relative to aggregate infrastructure spend, salaries+benefits, etc. US salaries in the healthcare sector generally outpace peer countries and US requires more small, regional clinics/hospitals because population density is lower than Europe.
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Oct 21, 2020 01:41
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KingNastidon posted:They do sum to >50%? Here's another source from CMS. That source also does not add up to more than 50%
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Oct 21, 2020 01:45
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KingNastidon posted:They do sum to >50%? Here's another source from CMS. Hospitals + long term care facilities is about 38% on your second link, matching your first link. 3 of the countries in the top 10 lowest population density have healthcare systems that are universal and cost a fraction of what the US does. Australia, Iceland, and Canada.
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Oct 21, 2020 01:47
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Jaxyon posted:3 of the countries in the top 10 lowest population density have healthcare systems that are universal and cost a fraction of what the US does. Australia, Iceland, and Canada. Sorry, I've been informed that thinking that the US, the richest country on Earth, could afford to implement a lower costing universal healthcare system is "assuming a make-believe situation"
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Oct 21, 2020 01:51
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Dumper Humper posted:\You have absolutely no proof that hospitals are going to be doing layoffs, the only scenario you can lay out is one where the poor loving insurance companies can't post record profits We ludicrously over treat in the US. My wife just had several thousand dollar procedure done to confirm that a couple thousand dollar procedure was indeed a false positive. That couple thousand dollar procedure is scheduled every two years to keep an eye on something she's had her whole life and has not caused any symptoms, all to avoid the doctor getting sued if the extremely small chance of it actually causing something bad did occur. I've had 3 CT scans in the past 3 years for the same recurring problem that I'd never had a scan for in the 10 years prior, all because I moved to a state where more defensive medicine is practiced. If hospitals don't end up doing layoffs, we haven't finished fixing the healthcare system.
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Oct 21, 2020 01:56
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Dumper Humper posted:That source also does not add up to more than 50% Hospital Care (33 percent share) Physician and Clinical Services (20 percent share): Other Health, Residential, and Personal Care Services (5 percent share) Nursing Care Facilities and Continuing Care Retirement Communities (5 percent share): Dental Services (4 percent share) Home Health Care (3 percent share) Other Professional Services (3 percent share) Other Non-durable Medical Products (2 percent share) Total: 75% Retail Prescription Drugs (10 percent share) Durable Medical Equipment (2 percent share) Total: 12% I can't tell you why the publication doesn't sum up to 100%, but hey you want to entrust federal orgs like CDC and CMS with your family's healthcare. Go wild with this KFF dashboard if you want. The point being is that you aren't going to realize all these savings by burning for profit insurance and pharma to the ground. There will need to be cuts elsewhere to realize the 50-60% cuts to be inline with UK and NHS and honest advocates shouldn't shy away from that. Doctors are rich people and you should want to eat them, too. Jaxyon posted:Hospitals + long term care facilities is about 38% on your second link, matching your first link. What percent of the total population of Australia, Iceland, and Canada are centered around a few major metros? I'm not saying US having a sizeable rural population is the primary barrier to lowering healthcare costs, but it's a unique consideration when comparing us against peer countries.
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Oct 21, 2020 01:56
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KingNastidon posted:Hospital Care (33 percent share) OH I see if you include things that aren't what you claim like dental, non-hospital doctor visits, "other services" and devices", you make the number go up! lets see what you said earlier: KingNastidon posted:Hospitals and long term care centers are where the vast majority of healthcare dollars are currently being spent. But I do agree that if you include numbers which aren't the two things you mentioned, you can maybe make yourself not be incorrect. quote:What percent of the total population of Australia, Iceland, and Canada are centered around a few major metros? I'm not saying US having a sizeable rural population is the primary barrier to lowering healthcare costs, but it's a unique consideration when comparing us against peer countries. I'd imagine that if you were making the argument that it's a major obstacle(which is not one that most experts on single payer plans in the US make), you'd have knowledge of your own argument. Do you want some time to go gather that?
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Oct 21, 2020 02:03
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wins32767 posted:We ludicrously over treat in the US. My wife just had several thousand dollar procedure done to confirm that a couple thousand dollar procedure was indeed a false positive. That couple thousand dollar procedure is scheduled every two years to keep an eye on something she's had her whole life and has not caused any symptoms, all to avoid the doctor getting sued if the extremely small chance of it actually causing something bad did occur. I've had 3 CT scans in the past 3 years for the same recurring problem that I'd never had a scan for in the 10 years prior, all because I moved to a state where more defensive medicine is practiced. Just think about how many bureaucrats, lobbyist, bean counters, claims deniers, etc. there are who all must be paid. The people who own that industry have a lot of money, and they use it to buy Joe Biden and Nancy Pelosi.
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Oct 21, 2020 02:08
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Jaxyon posted:OH I see if you include things that aren't what you claim like dental, non-hospital doctor visits, "other services" and devices", you make the number go up! I'm was assumption that "physician and clinical services" are provided in some sort of hospital, clinic, or other healthcare center. I apologize for not being more precise. Jaxyon posted:I'd imagine that if you were making the argument that it's a major obstacle(which is not one that most experts on single payer plans in the US make), you'd have knowledge of your own argument. Do you want some time to go gather that? Don't think I ever said that the United States' lower population density was a "major obstacle" to adoption of single payer. It's actually irrelevant to whether we maintain our current for-profit multi-payer system or transition to single payer. Rather, the need for small regional hospitals/clinics may limit how far we can drive down costs relative to peer countries even under a future single payer system. KingNastidon posted:I don't know what hospitals being profit centers has to do with this discussion. I don't care if they go non profit, but the existing profit margin is likely a drop in the bucket relative to aggregate infrastructure spend, salaries+benefits, etc. US salaries in the healthcare sector generally outpace peer countries and US requires more small, regional clinics/hospitals because population density is lower than Europe.
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Oct 21, 2020 02:10
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KingNastidon posted:I'm was assumption that "physician and clinical services" are provided in some sort of hospital, clinic, or other healthcare center. I apologize for not being more precise. Literally no other nation in the world bases their UHC system around a for-profit system. But you don't think that's relevant?
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Oct 21, 2020 02:14
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Jaxyon posted:Literally no other nation in the world bases their UHC system around a for-profit system. But you don't think that's relevant? Health insurance profit margin is 3%. Health insurance profits alone aren't why US healthcare is so expensive. If UHC is to succeed in lowering the cost of American healthcare, the government will have to force everybody in the health care industry to accept less pay. silence_kit fucked around with this message at 02:32 on Oct 21, 2020 |
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Oct 21, 2020 02:19
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Jaxyon posted:Literally no other nation in the world bases their UHC system around a for-profit system. But you don't think that's relevant? I'm...I'm not arguing in support of the for-profit system in the US. My first post today was pointing out why capping personal expenditures in our current for-profit multi-payer system has its limitations. And how moving to a single payer system funded directly by progressive income taxes is a much more straight forward way to address individual healthcare costs vs. ability to pay. You could switch every single entity that touches the US healthcare system over to non profits and it wouldn't solve the problem. You're going to need cuts in infrastructure, headcounts, salaries, price controls on reimbursement, rationing, etc. I'm not saying that's a bad thing, for reasons many people here have pointed out, but just be honest about it.
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Oct 21, 2020 02:22
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KingNastidon posted:I'm...I'm not arguing in support of the for-profit system in the US. My first post today was pointing out why capping personal expenditures in our current for-profit multi-payer system has its limitations. And how moving to a single payer system funded directly by progressive income taxes is a much more straight forward way to address individual healthcare costs vs. ability to pay. You’re not saying it’s a bad thing, you’re just pointing it out as some sort of counter for no particular reason at all.
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Oct 21, 2020 02:24
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KingNastidon posted:You could switch every single entity that touches the US healthcare system over to non profits and it wouldn't solve the problem. You're going to need cuts in infrastructure, headcounts, salaries, price controls on reimbursement, rationing, etc. I'm not saying that's a bad thing, for reasons many people here have pointed out, but just be honest about it. Payroll yes. The US pays vastly too much to healthcare workers, insurance workers, hospital admins, etc. But the rest of that? US tends to rank lower in terms of all other healthcare metrics like bed availability, doctor to patient ratio, procedures done etc compared to any other OECD country and pays about twice as much as most. The idea that somehow there would be less access to care is what it sounds you're saying and that's basically the opposite of reality.
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Oct 21, 2020 02:36
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I think KingNastidon's posts are helpful and informative. SA Politics Posters have a problem where they are totally unwilling to acknowledge drawbacks to their favorite political policies, and in the few cases where they do acknowledge the drawbacks, they attribute the drawbacks to external factors, which at least in SA Politics Poster Ideal World, would not exist. I think UHC providing more equal access to health care at the cost of maybe fewer innovations in drug developments & medical treatments, and maybe worse quality of care for wealthy people is a worthwhile tradeoff.
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Oct 21, 2020 02:39
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Phone posted:You’re not saying it’s a bad thing, you’re just pointing it out as some sort of counter for no particular reason at all. If I don't talk about it and present these arguments, someone else certainly will. Presumably someone with much more money and reach than a C-tier somethingawful poster. I'm but a log in the river, floating along with the current of 150 million voters I have no influence over. Restructuring US healthcare system will be painful because so many people are getting a taste of that 18% of GDP. And not just individual voters, but the democratic party as I mentioned earlier. They need to convince their base college educated urban voters to lose their careers, accept lower salaries, and/or pay more income taxes [given high income/cost of living cities] potentially to their own financial detriment. They also need to sway some moderates/republicans to gain enough votes in the House/Senate to cede power to the federal government and its college educated shitlib bureaucrats that see them as backwater nazis. It's a hard problem that I enjoy talking about! You're quite smart, well versed on the subject, and always welcome your contributions. As long as they're talking about the issue itself vs. an attempt to stifle discussion.
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Oct 21, 2020 02:41
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KingNastidon posted:It really has nothing to do with profit motives of insurance companies. Right now insurance companies may need to bring in $1.03 in revenue per $1.00 in expenditures to show profit or give dividend to stockholders or whatever. If they were non profit then the only thing that changes is they only need to bring in $1.00 in revenue. This not how politics should work, though. The most important thing to talk about politically is "what result you want." The important specifics aren't the specifics of implementation, but the specifics of outcome. In the case of healthcare, it would be things like "needs to be free at point of service" and "covers everyone." For a country like the US with no practical limit to resources/wealth, such a goal can be made to work (and the details of how to make it as cost effective as possible and how to offset its costs are something for others to work out). Your position is like if people were arguing for ending a war and you demanded that anti-war people provide a detailed plan for disengagement. That isn't important for the purposes of supporting/opposing the goal, and anyone who spends 99% of their time emphasizing the complexities/difficulties of disengagement (and literally never expresses direct support for ending the war unless it's accompanying doubts/concerns about doing so) is likely not on your side.
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Oct 21, 2020 02:51
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DandyLion posted:Something that's not really talked about much is the concept of universal healthcare (intentionally) becomes non-viable once a plurality of the citizenry sink deep into 'lower class' wages. If most folks are no longer making enough money to even be taxed, how does the system pay for the medical care? And! Bbcause multiplication is communitive it doesn't matter how many or how few numbers you multiply by the tax rate because they'll add up to the same number. And because we tax higher incomes at higher rates than lower ones it's better if incomes go down because that means a higher percentage of the total is taxed at the higher rate so we get even more money for healthcare! It's amazing!
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Oct 21, 2020 02:54
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silence_kit posted:I think KingNastidon's posts are helpful and informative. SA Politics Posters have a problem where they are totally unwilling to acknowledge drawbacks to their favorite political policies, and in the few cases where they do acknowledge the drawbacks, they attribute the drawbacks to external factors, which at least in SA Politics Poster Ideal World, would not exist. I'm actually pretty well read on UHC and I think that you simply have no idea what you're talking about. The drawbacks of UHC aren't what you think they are. quote:I think UHC providing more equal access to health care at the cost of maybe fewer innovations in drug developments & medical treatments, and maybe worse quality of care for wealthy people is a worthwhile tradeoff. The US ranks in maybe the 30's in overall care vs OECD countries in terms of quality of care, costs roughly twice as much as most. Simply put UHC, for every other country in the world, means more equal access to care AND better care. I can post charts if you want but it's extremely easily accessed information. US drug innovation is almost entirely funded by the government so why do you think it would change with single payer? There's a good chance it would go up.
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Oct 21, 2020 02:57
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Ytlaya posted:This not how politics should work, though. The most important thing to talk about politically is "what result you want." The important specifics aren't the specifics of implementation, but the specifics of outcome. In the case of healthcare, it would be things like "needs to be free at point of service" and "covers everyone." For a country like the US with no practical limit to resources/wealth, such a goal can be made to work (and the details of how to make it as cost effective as possible and how to offset its costs are something for others to work out). I want the US government to grant its citizens immortal life. Anybody who is emphasizing the complexities/difficulties of this goal is not on my side.
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Oct 21, 2020 02:58
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silence_kit posted:I want the US government to grant its citizens immortal life. Anybody who is emphasizing the complexities/difficulties of this goal is not on my side. Hey if you want to actually talk substance rather than shitpost on things that are really easily understood and prevalent in every other developed country like UHC, that would be great.
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Oct 21, 2020 03:04
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Jaxyon posted:US drug innovation is almost entirely funded by the government so why do you think it would change with single payer? There's a good chance it would go up. Aren't you conflating basic research and product development here? I can't speak personally about drug development, because I don't work in drug development, but in other kinds of technologies, there is a huge amount of effort & spending needed to translate a basic research idea to real technology. Technology development is most certainly not the following series of events: a university professor comes up with an idea and performs a basic proof of principle demonstration and companies just copy his formula and create a useful product one month later. Like the drug trial success rate is really low. You'd think that if all of the basic research ideas in medicine were well-formed ideas, drug trial success rate would be nearly 100%. silence_kit fucked around with this message at 03:11 on Oct 21, 2020 |
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Oct 21, 2020 03:06
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silence_kit posted:Aren't you confusing basic research with product development here? I can't speak personally about drug development, but in other kinds of technologies, there is a huge amount of effort & spending needed to translate basic research to real technology. Technology development is most certainly not the following series of events: a university professor comes up with an idea and performs a basic proof of principle demonstration and companies just copy his formula and create a useful product one month later. Nope, you're confusing it. The actual innovation is almost entirely done on public funds, and then essentially given away to private companies to walk through the approvals process and market, and frequently Pharma companies will through their marketing budgets into their R&D costs to hide the fact that they're really just giant marketing firms pitching things that the taxpayers paid to come up with. They spend way more on advertising than they do on research. Also the US government is legally barred from negotiating price with them, after we give them monopoly rights on drugs we paid to develop. silence_kit posted:Like the drug trial success rate is really low. You'd think that if all of the basic research ideas in medicine were well-formed ideas, drug trial success rate would be nearly 100%. I have no idea why you'd think that, you may not be familiar with how science works. I never said anything about it all being cant-miss, I said it's government funded.
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Oct 21, 2020 03:11
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Jaxyon posted:Nope, you're confusing it. I don't think this is true. I think you are talking out of your rear end here. If it was really this easy, then why do so many drug trials fail? This is also totally opposite of my personal and professional experience with applied science & technology in other areas. There is a huge gulf between basic research and real technologies, real products. Going from successful research project to real product doesn't happen very often, and in the very rare cases where it does happen, still much work is needed to be done after the basic research phase. silence_kit fucked around with this message at 03:23 on Oct 21, 2020 |
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Oct 21, 2020 03:12
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silence_kit posted:I don't think this is true. If it was really this easy, then why do so many drug trials fail? Who said it was easy? Do you want to engage with actual arguments or what quote:This is also totally opposite of my personal and professional experience with applied science & technology in other areas. There is a huge gulf between basic research and real technologies. That's great and when we talk about whatever area you work in that will be relevant but here's a study that was literally funded by the pharmaceutical industry that says they basically rely on NIH for everything. https://www.pnas.org/content/115/10/2329 Also for a bonus data, since you just post things and don't back any of them up, here's a study that says your'e wrong about spending less on healthcare bringing down innovation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/
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Oct 21, 2020 03:22
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Jaxyon posted:Who said it was easy? You did. If almost all spending was from the government, like you say, and if all drug companies do is slap a sticker on the government product, then why do most drug trials funded by drug companies fail?
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Oct 21, 2020 03:25
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silence_kit posted:I don't think this is true. I think you are talking out of your rear end here. If it was really this easy, then why do so many drug trials fail? It's not true. There are multiple sources that point to very low success rates for Ph1 -> Ph2 -> Ph3 -> FDA approval. When the external research partners (e.g., academic institutions) hand off the drug it's typically very early because they don't have the in-house trial design, regulatory, commercial expertise to move it through the process. That's why they're willing to give it up in the first place. No one is forcing these PhDs/MDs to out-license their research, they must know it's not just a "walk through the approval process."
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Oct 21, 2020 03:27
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silence_kit posted:You did. If almost all spending was from the government, like you say, and if all drug companies do is slap a sticker on the government product, then why do most drug trials funded by drug companies fail? Nope, didn't say any of that. I said the innovation is accomplished by the government and the companies walk them through the approval process. That doesn't mean that the drug companies don't do work, I just aid they aren't responsible for the innovation. This is with in argument that somehow our for-profit system creates innovation, which you've been completely unable to backup, so now you're trying to poke holes in my argument, while I specifically have posted a reviewed study that says you're wrong in my last post.
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Oct 21, 2020 03:32
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Jaxyon posted:Nope, didn't say any of that. I said the innovation is accomplished by the government and the companies walk them through the approval process. That doesn't mean that the drug companies don't do work, I just aid they aren't responsible for the innovation. If what drug companies do is just a layup, then why do they miss all of the time, and why do they spend huge amounts of money on all of these misses? You are totally dodging the question. I think the answer is: silence_kit posted:Going from successful research project to real product doesn't happen very often, and in the very rare cases where it does happen, still much work is needed to be done after the basic research phase. silence_kit fucked around with this message at 03:39 on Oct 21, 2020 |
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Oct 21, 2020 03:34
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silence_kit posted:If what drug companies do is just a layup, then why do they miss all of the time, and why do they spend huge amounts of money on all of these misses? You are totally dodging the question. Yeah I'm gonna go eat dinner, let me know when you want to talk about actual poo poo instead of thought experiements and strawmen. Meanwhile the industry itself said that the taxpayers funded basically every new drug of the past decade and I posted a study but cool you do you
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Oct 21, 2020 03:45
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Jaxyon posted:Meanwhile the industry itself said that the taxpayers funded basically every new drug of the past decade It makes sense that basic research funding would comprise a (small) portion of the total funding needed to develop any new drug. All technology development first started out as basic research. I don't think the article you posted actually supports your claim which is that the government pays for almost all drug development costs. I think your claim is totally cut out of whole cloth. silence_kit fucked around with this message at 04:46 on Oct 21, 2020 |
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Oct 21, 2020 04:39
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Jaxyon posted:Who said it was easy? Do you want to engage with actual arguments or what Full disclosure, I work in pharma. I’m basically a grunt and am deeply conflicted about the industry and have no ambition to advance my career at this point and I’m constantly thinking about finding a job in a different industry and one of these days I’ll actually do it. I understand if that makes me untrustworthy but I’m coming at this from the lens of “sharpening your arguments against the current US healthcare system”, not from a place of disagreement or opposition. And fwiw I will vote in favor of M4A and just about all progressive healthcare reform 10 times out of 10 even if it means i could lose my job or otherwise jeopardize my personal finances, because that poo poo is way more important than me. In other words, maybe I can be in like the middle of the line once the guillotining commences? --- As others have touched on, basic research is heavily funded by the US government, clinical development by pharma companies. So yes NIH research is involved in a huge amount/all of marketed drugs’ development and this is massively expensive, but clinical research is still much more expensive than basic research and is largely funded by pharma. Here’s an article that talks about this, I only can read the abstract so can’t vouch for the full paper: https://www.researchgate.net/public...eory_to_Therapy And although the success rates as you move through clinical trial phases are higher than they are in basic research, they’re still pretty low. So the problem isn’t so much the government’s capability to conduct clinical research, as it is their ability to keep paying for new trials while weathering all the failures. I don’t know if the M4A plan addresses this, I’m not that familiar with all the details, but I couldn’t find anything in a quick google. But if it doesn’t, then I do think, in a sense, drug development innovation would slow down. But personally I don’t actually think that’s a net bad thing for society given all the benefits of M4A, and the fact that US health outcomes are still extremely poor relative to the amount we spend on prescription drugs, and the fact that a lot of pharma “innovation” is pretty questionable in terms of benefit to patients (with some notable exceptions of truly incredible medical advances, but I do think those are the exceptions). More on this last point later... quote:Also for a bonus data, since you just post things and don't back any of them up, here's a study that says your'e wrong about spending less on healthcare bringing down innovation. The objective and methods of this paper are unconvincing in my opinion. From the methods: “[Drug patent] information was used to assign each [newly invented drug] to a country on the basis of inventor location. In addition, on the basis of the patent information, the patent was assigned to an inventor company. If the inventors listed on a patent were from multiple countries, we assigned only the first country listed as the source country.” The problem is that the vast majority of major pharma companies are multinationals that derive a plurality (to borrow an electoral term) of their revenues from the US because of our outrageous lack of price regulations. This paper is suggesting that because many inventors/companies are not from the US, that US drug spending isn’t responsible for funding the “innovation”, but it doesn’t account for the fact that many of the biggest pharma companies that make more money in the US than anywhere else because of pricing, are headquartered ex-US. Roche, Novartis, Astrazeneca, GSK, Sanofi, Novo Nordisk are all massive companies that make most of their money from the US despite having European headquarters. If the authors wanted to support the conclusion that US drug spending doesn’t disproportionately fund “innovation” then I think they would have to adjust for the proportion of a company’s revenue that comes from the US? I’d have to think about that more, but point is that using inventor/company location as a proxy for contribution to “innovation” is not a solid premise at all. And again I think “innovation” is the word the industry uses as a euphemism for “all drug development, whether it’s actually innovative or not.” In a sense I think that whether the US does or doesn’t contribute proportionally more than other countries to drug development costs is already accepting the pharma industry’s framing that “drug development = innovation, and who doesn’t love innovation?!?!”, when the real issue is that a huge amount (I wouldn’t be surprised if it was a majority but don’t have a handy reference to back that up) of drug dev spending is on drugs that offer marginal at best value to medicine and society. --- Anyway just reiterating that I’m debating here for the sake of improving arguments in favor of M4A, I hope that intent comes through but obviously you have the right to tell me to suck poo poo or whatever and that’s fine too
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Oct 21, 2020 07:04
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Sharks Eat Bear posted:Full disclosure, I work in pharma. I’m basically a grunt and am deeply conflicted about the industry and have no ambition to advance my career at this point and I’m constantly thinking about finding a job in a different industry and one of these days I’ll actually do it. I understand if that makes me untrustworthy but I’m coming at this from the lens of “sharpening your arguments against the current US healthcare system”, not from a place of disagreement or opposition. And fwiw I will vote in favor of M4A and just about all progressive healthcare reform 10 times out of 10 even if it means i could lose my job or otherwise jeopardize my personal finances, because that poo poo is way more important than me. In other words, maybe I can be in like the middle of the line once the guillotining commences? I'm not aware of any plans to significantly change NIH funding and the drug development process in the event of single payer in the US, and given that most developed nations publish even more basic research than the US does(adjusted for population), I don't really see how drug development would change much. As for drug company financials, we both know that drug companies are more accurately described as marketing companies than researchers, spending twice as much on it. Getting a drug through FDA approval requires a lot of spend, and so does that dinner with "thought leaders" at the steakhouse. I have to imagine that without spending billion on stock buybacks and advertising that is only legal in 2 countries in the entire world, they could be a lot more efficient about research. And that's with the taxpayer covering all the actual developments and giving them more or less free to the industry. It should be noted that the original argument that was made here, among others, was that quality of care and medical innovation would suffer under single payer. And that was backed up by....nothing at all. I appreciate you putting in far more work than silence_kit in a fraction of the posts.
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Oct 21, 2020 08:39
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Sharks Eat Bear posted:But if it doesn’t, then I do think, in a sense, drug development innovation would slow down. But personally I don’t actually think that’s a net bad thing for society given all the benefits of M4A, and the fact that US health outcomes are still extremely poor relative to the amount we spend on prescription drugs, and the fact that a lot of pharma “innovation” is pretty questionable in terms of benefit to patients (with some notable exceptions of truly incredible medical advances, but I do think those are the exceptions). Yeah, this is the argument to make. A lot of new medical technology might be kind of frivolous, and it might not really be that bad to not be able to fund it and to have to go without it. The argument not to make is: 'the government funds almost all of drug development costs, and all drug companies do is slap their logo on the government product and run the drug marketing campaigns.' There is absolutely no way that that is even close to being true. I can't speak from personal experience in the pharmaceutical industry, but micro-electronics technology development totally does not work in that way. Like, the hardware in an iPhone isn't Apple assembling some kit put out by government researchers, and packaging it in a shiny glass slab (this was VitalSigns' belief in the earlier healthcare thread). That claim couldn't be any further from the truth. The total funding needed to translate basic micro-electronics research ideas into real products dwarfs the basic research funding. Jaxyon posted:It should be noted that the original argument that was made here, among others, was that quality of care . . . would suffer under single payer. I said that quality of care might suffer for wealthy Americans. That is not the same claim that you are repeating here. You posted international stats on how US healthcare is so bad, but I don’t think they disprove my point. Average quality of healthcare in the US can still rank as mediocre in the int’l stats while quality of healthcare for wealthy Americans can be excellent. This is because most Americans aren’t wealthy Americans. silence_kit fucked around with this message at 16:11 on Oct 21, 2020 |
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Oct 21, 2020 11:27
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I also work in clinical drug development (my background is 60% academic clinical research and 40% industry). Drug development is incredibly expensive and characterising it as just marketing is disingenous and pretty lazy. Discovery and basic research is mostly better done at universities including work funded by the NIH, but then the universities spin off companies or sell the assets for further development (and get the money from that). The subsequent clinical development costs are really significant, often hundreds of thousands of USD per patient. This goes into collecting and verifying the clinical data, translational, biomarker, PK and Pd testing, safety monitoring, reporting, all over the cost of actually providing the drug and paying for the patients' treatment. Drug development costs don't finish at first approval either, the research costs continue in identifying new indications and ways the treatments can be used. Biotech and pharma companies are really well placed to do large comparative trials, and getting them done quickly, and also doing post approval studies to monitor how the drugs are doing. I am a huge supporter of socialised medicine and think the prohibition of drug price negotiation in the US is crazy. It must be the largest way drug cost increases are enabled in the US, though there are peverse incentives for health insurers to keep costs high as well. This does not look likely to be fixed unless there is a change to the way lobbying and money influences lawmaking in the USA. In addition to unconstrained drug costs there are other drivers. Hospital costs in the US are many times higher than in other countries, even at "non-profit" hospitals; again the solution has to be proper regulation and collective negotiating on pricing. While it is not a great proportion of costs, many medical and other healthcare salaries are absurd in the US. High university tuition costs are often held as the justification for this (as well as the terrible US medical residency system), so again better regulation, by lawmakers who are not unduly influenced by the people they are regulating, is key. There are huge overheads to the current insurance system. All unnecessary. Pharmacy benefit management companies? Unnecessary. The health system in the USA would actually be very straightforward to solve (though of course complex in implementation). Even here in ultra-capitalist Switzerland there is a way better system, and it is for-profit. I personally can't see the problems being solved until there is a shake-up in how politicians are paid and funded.
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Oct 21, 2020 12:59
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Just to echo what everyone else has said, drug development is horrifically expensive for both good and bad reasons. For most of the last decade I've worked on software for various parts of the clinical trial pipeline (phase 1, phase 3/4, now RWE). Disclaimer: this post is from me, not my employer, etc. For those that don't know, the pipeline looks roughly like this: Phase 1: Gathering data to see what the drug does to the body (pharmacodynamics) and what the body does to the drug (pharmacokinetics). Healthy volunteers are used here, but there is some ethical sketchiness (e.g. some people take part in phase 1 trials as a full time job) with the idea to try to determine what the side effect profile is like in humans and what's the maximum safe dosage. Subjects are effectively hospitalized for days at a time with tests and labs performed on strict schedules. Study sizes are usually from single digits into mid hundreds. Almost all these trials are single site and don't last longer than a month or two. Phase 2: Trying to establish effectiveness of the drug. Give the drug to a bunch of people with some illness and see if they get better. These are usually teens to low hundreds subject counts and have low numbers of sites (one to tens). The goal is to have a measurable impact on the progress of a disease. Various endpoints are defined as proxies since these studies are generally reasonably short (months to a couple years). Think "did the tumor shrink" rather than did someone live longer. Phase 3: Does it beat what's already available. These are thousands of people with very complex inclusion/exclusion criteria. Since you're trying to show is the drug better than existing treatments and you can get approval for a cohort (sub-population with common traits) rather than the population as a whole, there is a lot of effort that goes into patients that are part of multiple cohorts to ensure you have sufficient statistical power. These studies are usually several years long, and dropouts are really problematic since it can lower the statistical power of results for various cohorts below the level required for approval. These studies generally happen globally and a few dozen sites, the logistics start to get expensive. You need to train a few hundred people in how to perform various tests, collect regulatory documents, negotiate contracts in maybe a dozen different countries, ship drugs internationally, etc. For all of these stages, there are dozens to hundreds of people at the pharma company doing protocol design, data management, coordination, regulatory/quality management, etc. in addition to the dozen to hundreds of clinical staff involved. For a successful compound that makes it to approval, doing all of these steps costs north of a billion dollars, and the vast majority of compounds fail to get approved, usually during phase 1 (one example is a drug that caused horrible, want-to-tear-your-skin-off itching for a couple days after taking it). Getting to a compound that might work is really a small fraction of what it takes to actually generate a successful treatment. wins32767 fucked around with this message at 21:25 on Oct 22, 2020 |
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Oct 21, 2020 17:48
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