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ACA Running Thread

That's for the hot pharma reps to take care of.
 
i'm of two minds. i find it pretty disgusting but I also think primary care physicians can be kind of shitty and require a lot of pro-active questioning and self-advocacy to get the best care.
 
speaking of drugs and the UK, an interesting article from earlier this year

https://hbr.org/2017/04/the-cost-of...ses-is-threatening-the-u-s-health-care-system

"Patients and providers greeted approval with near ecstasy, but the celebration was bittersweet. Five days after the FDA approved, the drug, Biogen announced each dose would cost $125,000. Given that patients need six doses in the first year and three per year after that, it means the drug costs $750,000 per patient in the first year and $375,000 annually thereafter."

"In the United Kingdom, the National Institute for Health and Care Excellence (NICE) determines the cost effectiveness, or value, of newly approved drugs based on their impact on quality-adjusted life years. These determinations inform the National Health System’s (NHS) treatment-coverage decisions. In contrast, the FDA is prohibited from considering cost or value in its decision making, and there is no U.S. governmental equivalent of NICE."
 
What that shows how outrageous and greedy the drug companies are. As stated in the article:

"There are at least 10,000 SMA patients in the United States. A little over half have SMA1 or SMA2 (the more severe forms). If just this segment were treated with nusinersen, the total cost in the first year would be $3.8 billion and the annual cost thereafter would be $1.9 billion. (These figure do not account for administration costs.) The actual total cost will be larger because, since the treatment is effective and SMA patients will hopefully live longer, the number of SMA patients that will require ongoing treatment will increase over time."

There's no way in hell the company spent anything like that kind of money in developing the drug. It would be stunning and beyond logical if they spent 5% of the annual revenues of one year to develop the drug. It's totally immoral to charge those kinds of prices.

Companies should make money but that type of price gouging should absolutely be illegal.
 
at least one group claims that Spinraza was discovered through funding from the NIH:

https://www.bostonglobe.com/busines...starts-year/AvFCPo8gB6dsyDawPcTOdL/story.html

"A consumer advocacy group alleges the organizations that discovered the drug — Cold Spring Harbor Laboratory and Ionis Pharmaceuticals — failed to properly file paperwork noting research was supported, in part, by federal funds. And this failure could allow the federal government to take title to the patents, should it determine there is a need to prevent a monopoly that impedes access to lower-cost versions."
 
thatguy2016 said:
speaking of drugs and the UK, an interesting article from earlier this year

https://hbr.org/2017/04/the-cost-of...ses-is-threatening-the-u-s-health-care-system

"Patients and providers greeted approval with near ecstasy, but the celebration was bittersweet. Five days after the FDA approved, the drug, Biogen announced each dose would cost $125,000. Given that patients need six doses in the first year and three per year after that, it means the drug costs $750,000 per patient in the first year and $375,000 annually thereafter."

"In the United Kingdom, the National Institute for Health and Care Excellence (NICE) determines the cost effectiveness, or value, of newly approved drugs based on their impact on quality-adjusted life years. These determinations inform the National Health System’s (NHS) treatment-coverage decisions. In contrast, the FDA is prohibited from considering cost or value in its decision making, and there is no U.S. governmental equivalent of NICE."
Click to expand...

Ridiculous. I don't know that a NICE-equivalent is the answer, but arbitrary price gouging needs to be addressed before anything else. You can't just have a government takeover of HC because then the government ends up paying the ridiculous prices for drugs (maybe not 125k per dose, but something still ridiculous like 80k, which would be politically spun as a bargain) and effectively further subsidizes the industry, which it already does plenty of with the NIH grants that lead to the studies that support drug development.

As much as I don't want to see some government run HC because I know that we are incapable of creating an efficient and effective system for it, the players in the HC industry do everything they can to make it an inevitability. It's like any other industry and if you abuse your power within it, the government will eventually be called upon to rein it in. One cannot complain about government interfering in their business when they price gouge to this extent.
 
We created usury laws when lending got out of hand. We could do something similar for price-gouging medical providers (including pharma).
 
thatguy2016 said:
at least one group claims that Spinraza was discovered through funding from the NIH:

https://www.bostonglobe.com/busines...starts-year/AvFCPo8gB6dsyDawPcTOdL/story.html

"A consumer advocacy group alleges the organizations that discovered the drug — Cold Spring Harbor Laboratory and Ionis Pharmaceuticals — failed to properly file paperwork noting research was supported, in part, by federal funds. And this failure could allow the federal government to take title to the patents, should it determine there is a need to prevent a monopoly that impedes access to lower-cost versions."
Click to expand...

What is the threshold for NIH funding contributing to a drug's discovery? I mean, if you go back far enough there has to be NIH funding involved for just about every drug discovery I would think. And if for some reason there isn't, maybe the NIH needs to more narrowly focus their grants to ensure that their tentacles can be found everywhere in the field.
 
when the ACA eliminated lifetime maxima from insurance contracts, I wondered who the first obviously greedy drug manufacturer would be to take advantage and set a price that could reasonably be expected to top $1 million in a short time

I'm surprised it took this long, but Biogen is the winner
 
ELC, you are missing the point. The government needs to flex its purchasing muscles like they do in every other western country. We don't and it why pharma charges American insurance companies and consumers 50-500% more than in the UK, Canada, Germany. etc.

Big pharma talks tough, but if Medicare, the VA and other state governments got together and negotiated real prices things would change dramatically. They buy more than any other entity in the world and should have far lower prices than countries that buy 5-15% of what we purchase. In what world is it OK to buy 1000% more than Company B and pay 200% more. It makes no sense.

If Congress is too weak to stand up to pharma, then everyone in Congress (regardless of party) who votes to support this insane system should be replaced by someone with common sense and cajones.
 
good luck getting a republican congress and WH to stand up against Big Pharma

lolz you guys crack me up
 
EatLeadCommie said:
What is the threshold for NIH funding contributing to a drug's discovery? I mean, if you go back far enough there has to be NIH funding involved for just about every drug discovery I would think. And if for some reason there isn't, maybe the NIH needs to more narrowly focus their grants to ensure that their tentacles can be found everywhere in the field.
Click to expand...

Probably the first time in history that the NIH has been accused of having "tentacles", as if government funding for development of life-saving drugs is somehow a bad thing.
 
DistrictDeacon said:
Probably the first time in history that the NIH has been accused of having "tentacles", as if government funding for development of life-saving drugs is somehow a bad thing.
Click to expand...

If the government does it, it's automatically bad.
 
I think there is a sweet spot between what price-gouging Big Pharma charges and Medicare/Medicaid rates. Enough to turn a profit and motivate innovation; but still reasonable. For those that agree, it is just a matter of negotiating where that price is and how to get it.

One thing that has been pretty much abandoned or at least minimized is the research that public institutions (colleges and universities) do in farm and pharma. Their research was publicly funded, and results were then public domain. When Big Pharma cries "but what about my research! I need these prices for my research!" we need to understand there are alternatives if they do not feel they can financially support their own research.

Aside: there should be a national holiday for Jonas Salk. He gave away his polio cure at great opportunity cost to himself. I shudder to think where we'd be if he worked for Big Pharma.
 
How much money would we need to realistically adequately fund high risk pools? What is in the bill now, $8B-$16B?

Wouldn't there need to be hundreds of billions of dollars to sufficiently fund them (even a conservative estimate)?
 
Deacsfan27 said:
How much money would we need to realistically adequately fund high risk pools? What is in the bill now, $8B-$16B?

Wouldn't there need to be hundreds of billions of dollars to sufficiently fund them (even a conservative estimate)?
Click to expand...

The $8-16B is in addition to the underfunded pool the GOP created.
 
ImTheCaptain said:
good luck getting a republican congress and WH to stand up against Big Pharma

lolz you guys crack me up
Click to expand...

Fuck the parties. With the internet, the people can do things. If your Member of Congress is a Republican, fire him if he opposes this or does nothing. Do the same if you are represented by a Democrat.

Use the internet, I can't believe it isn't done more.
 
DeaconSig said:
Shill on Ch. shill on.
Click to expand...

As a shill, and per your IM, I’m against the house bill as it does more harm than good. The insurance industry as a whole has largely been critical of it and pretty much opposed.
There is some directional good here: recognition around keeping CSR APTC funding to stabilize markets over the next several years, the shift in the age curve, more and flexibility on benefit design, and yes high risk pools.

The bad though is pretty bad. The main culprit is moving towards an income-agnostic tax credit. That will no doubt drive many low income / older people from the market. And the Medicaid changes are pretty bad too. The manner in which the ACA expanded Medicaid was flawed but this plan is pretty disruptive.

All that being said, will people die in the streets? Will millions go bankrupt? Will someone with cancer pay $125,000 a year for insurance? Pretty much hyperbole IMHO. This will be a step back with respect to access without a doubt. I’m not sure how 25M will lose coverage as some claim (current ACA enrollment is ~20M). Actual costs will likely drop some but the real cost net of subsidy will go up for many. And we end up with a slightly better 2010 individual market.

Could they have really transformed health care here? Maybe bit they wimped out. Got hit by a fractured party or were handcuffed by reconciliation issues. They also could have “fixed” arts of the ACA but those fixes really would have masked the issues (total premium) costs and just kicked the can down the road.
 
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