Why do you want Health care Reform?

[Wild Cobra]

The other question is wether those cost savings would actually be passed down to the consumer, or be pocketed by the provider. I don't really see an actual implicit incentive for the provider to pass the savings along, do you?

It's called compe ion. When a provider can increase his customer base by charging less for the same service, he will. Compe ion takes pricing down to a fair level. They can only compete so far before having to maintain a livable profit.

[ElNono]

I doubt that's an accurate number. What number is that based on? Profits? Definitely not gross expenditures.

Here's one of the articles from the Public Library of Science. This one actually contains older data than the one I recall reading, but basically amounts to the same.

LINK

Now, there has been some changes in the last few months regarding direct promotion to doctors (mostly prompted exactly because of this). I don't really have any newer numbers to see how this affects their marketing budget.

[SnakeBoy]

The other question is wether those cost savings would actually be passed down to the consumer, or be pocketed by the provider. I don't really see an actual implicit incentive for the provider to pass the savings along, do you?

I'm not talking about savings for the doctor, I'm talking about tests & procedures that are being done that the doctor wouldn't otherwise do. That would result in lower insurance costs.

I'll give you an example. I had a bump on my head that I got when I banged my head as a kid, just a fatty tissue cyst, pretty common no big deal. A few years ago I decided to get it removed because of my slowly receding hairline. So I went to the surgeon my wife recommended. First thing, he sends me for an MRI to make sure it wasn't attached to the skull. I was like wtf that's pretty obvious and my wife says that's called CYA. Then he does the simple surgery in the hospital OR with an anesthesiologist present. Total cost $12K.

My sister had the same damn thing. Her husband is in the military. So she goes to get hers removed and the military surgeon does the procedure in the office, just a local anesthetic. 30 minutes in the office and he's done. That's a of alot cheaper. And my surgeon didn't get one dime from the MRI or the hospital OR, it was all CYA.

[Wild Cobra]

Here's one of the articles from the Public Library of Science. This one actually contains older data than the one I recall reading, but basically amounts to the same.

LINK

Now, there has been some changes in the last few months regarding direct promotion to doctors (mostly prompted exactly because of this). I don't really have any newer numbers to see how this affects their marketing budget.

OK, I followed one of the links:

PRESCRIPTION DRUGS
FDA Oversight of Direct-to-Consumer Advertising Has Limitations, part of text:

Pharmaceutical companies spend more on research and development
initiatives than on all drug promotional activities, including DTC
advertising. According to industry estimates, pharmaceutical companies
spent $30.3 billion on research and development and $19.1 billion on all
promotional activities, which includes $2.7 billion on DTC advertising, in
2001. Pharmaceutical companies have increased spending on DTC
advertising more rapidly than they have increased spending on research
and development. Between 1997 and 2001, DTC advertising spending
increased 145 percent, while research and development spending
increased 59 percent. Promotion to physicians accounted for more than 80
percent of all promotional spending by pharmaceutical companies in 2001.
Total promotional spending was equivalent to 12 percent of drug sales in
the United States in 2001.

OK..

$30.3 billion R&D
$19.1 billion promotional

80% of the $19.1 billion was to physicians. Sounds like free drugs to hand out to get the new drugs flowing. Are you complaining about free new drugs from the doctors office?

20% of that, which would now be the maximum for commercials is now $3.8 billion. That's a pretty small part of the profits.

Granted, the numbers may have increased, but still. If only 20% of that promotional money is in commercials, it is a small part of the total.

[ElNono]

I don't know. Life is tough, and as nice as it would be to help everyone out, it just doesn't happen. Never has, and never will.

As far as healthcare is concerned, I have to assume you mean in the United States? Life is tough everywhere, but somehow other places manage to help everyone out in that department.

I think this is the Big Elephant in the room. What do we do with these people.
And I've yet to hear of a proposal in this thread that addresses this specifically that's really practical and realistic.
Some of them only need temporary help, just as it happened with my wife, without driving them to the verge of bankruptcy, which takes years to recover from.
Now, I'm not suggesting the government needs to fill out that role. But if it's not the government, then who? How? Nobody? Screw them all?
Or as Marcus would say: Let's just simply accelerate the demise of the sick and poor and move on?

[ElNono]

OK, I followed one of the links:

PRESCRIPTION DRUGS
FDA Oversight of Direct-to-Consumer Advertising Has Limitations, part of text:


OK..

$30.3 billion R&D
$19.1 billion promotional

80% of the $19.1 billion was to physicians. Sounds like free drugs to hand out to get the new drugs flowing. Are you complaining about free new drugs from the doctors office?

20% of that, which would now be the maximum for commercials is now $3.8 billion. That's a pretty small part of the profits.

Granted, the numbers may have increased, but still. If only 20% of that promotional money is in commercials, it is a small part of the total.

The 2004 numbers (according to the pharma lobby group) are right there on the article:

Based on the data provided by IMS [4], the Pharmaceutical Research and Manufacturers of America (PhRMA), an American industrial lobby group for research-based pharmaceutical companies, also contends that pharmaceutical firms spend more on research and development (R&D) than on marketing: US$29.6 billion on R&D in 2004 in the US [5] as compared to US$27.7 billion for all promotional activities.[4]

Actually, that paper went back to the raw data and run the calculations again. Their conclusion was:

Using the IMS figure of US$15.9 billion for the retail value of samples, and adding the CAM figures for detailing and other marketing expenses after correcting for the 30% estimate of unaccounted promotion, we arrived at US$57.5 billion for the total amount spent in the US in 2004, more than twice what IMS reported (see Table 1).

But even if you use the 'official' numbers, you're still at around 50-50.

[ElNono]

I'm not talking about savings for the doctor, I'm talking about tests & procedures that are being done that the doctor wouldn't otherwise do. That would result in lower insurance costs.

I'll give you an example. I had a bump on my head that I got when I banged my head as a kid, just a fatty tissue cyst, pretty common no big deal. A few years ago I decided to get it removed because of my slowly receding hairline. So I went to the surgeon my wife recommended. First thing, he sends me for an MRI to make sure it wasn't attached to the skull. I was like wtf that's pretty obvious and my wife says that's called CYA. Then he does the simple surgery in the hospital OR with an anesthesiologist present. Total cost $12K.

My sister had the same damn thing. Her husband is in the military. So she goes to get hers removed and the military surgeon does the procedure in the office, just a local anesthetic. 30 minutes in the office and he's done. That's a of alot cheaper. And my surgeon didn't get one dime from the MRI or the hospital OR, it was all CYA.

I'm well aware of the cover your ass syndrome.
At the same time, you also have these kind of doctors. (it's actually a long read, but if you have the time, I believe it's well worth it).

[SnakeBoy]

80% of the $19.1 billion was to physicians. Sounds like free drugs to hand out to get the new drugs flowing. Are you complaining about free new drugs from the doctors office?

Now your making stuff up. I posted this a while back but 3-4 years ago my wife's practicing banned drugs reps because they were interfering with the practice. They were bringing breakfast and lunch for everyone at the office (about 30 people) every single day. And these were pricey meals from places like the palm. They weren't doing that to give out free drugs, they were doing that to try and get the doctors to pimp their drugs.

[SnakeBoy]

I'm well aware of the cover your ass syndrome.
At the same time, you also have these kind of doctors. (it's actually a long read, but if you have the time, I believe it's well worth it).

Yeah I've read that before. Physician owned hospitals are a bad idea. Fixing healthcare is really complicated. I'm not saying better tort reform is the full solution, just a piece of the solution.

[Wild Cobra]

As far as healthcare is concerned, I have to assume you mean in the United States? Life is tough everywhere, but somehow other places manage to help everyone out in that department.

Do do that, we would drop our citizens standard of living to that of the European Nations. You want that?

Is that worth it to you, to make universal medicine happen? Do you want to pay another 10% or more in taxes to make such a program work?

Ever live in Europe? I have. Their middle class lives about as good as our poor here do.

[Wild Cobra]

But even if you use the 'official' numbers, you're still at around 50-50.

Still, the promotional amount to doctors really matters. If that 80% number still applies, then 40% ius to doctors, primarily in free medicine for them to give their patients.

We now have

50% R&D

40% Free drugs to patients

10% commercials

[Wild Cobra]

Now your making stuff up. I posted this a while back but 3-4 years ago my wife's practicing banned drugs reps because they were interfering with the practice. They were bringing breakfast and lunch for everyone at the office (about 30 people) every single day. And these were pricey meals from places like the palm. They weren't doing that to give out free drugs, they were doing that to try and get the doctors to pimp their drugs.

Maybe so, but I do know that doctors get a great deal of free medicine to give their patients. It promotes the doctor to write the prescriptions, especially when a patient says he likes it and wants more.

Dining and wining is part of most new venture transactions, right?

No, I'm not making things up. My doctor has told me about all the free stuff he gets to hand out.

Besides, let's say you're talking about a $1,000 meal. Was it a big enough office that maybe they were prepared to give $100,000 or more in free drugs out, to get new clients for those drugs?

I'm not saying I like these approaches. They would likely do just as well to simply ship free samples without using reps.

[ElNono]

Do do that, we would drop our citizens standard of living to that of the European Nations. You want that?

Would we now? Do you have information to back that up, or you're simply making it up?

Is that worth it to you, to make universal medicine happen? Do you want to pay another 10% or more in taxes to make such a program work?

Where that extra 10% or more number comes from? I'm on the record that I would be willing to pay an extra 5% in taxes if necessary for the right plan that covers everyone.

Ever live in Europe? I have. Their middle class lives about as good as our poor here do.

Wow, talk about random generalizations. Do you actually have anything to back that up? I do actually have family both in France and Italy, middle class family. And Europe is fairly big. Standards of living vary pretty radically among different countries.

[ElNono]

Still, the promotional amount to doctors really matters. If that 80% number still applies, then 40% ius to doctors, primarily in free medicine for them to give their patients.

We now have

50% R&D

40% Free drugs to patients

10% commercials

Actually, you don't need to assume or make up any numbers. The report I linked to includes figures for sample medicine ($15.9 billions in 2004). The tally looks more like this:

34% R&D

66% Promotional material (which can be broken down in 20% sample drugs and 46% for the rest)

Again, my original point stands, they do spend circa 50% on promotional material, and you would hardly make a dent on R&D. Furthermore, your guess that their research would be hampered and their demise assured is simply bollocks.

[spurster]

Currently, the US is paying a lot more for health care than other countries with poorer outcomes. If ideology and the love of money was not in the way, we would adopt a single-payer system using the best practices developed and tested in other countries.

If someone else has a system that does a job better at lower costs, why not use that system?

[ElNono]

Currently, the US is paying a lot more for health care than other countries with poorer outcomes. If ideology and the love of money was not in the way, we would adopt a single-payer system using the best practices developed and tested in other countries.

If someone else has a system that does a job better at lower costs, why not use that system?

Because it's all about me, me, me. Look at the average answers to my questions in this thread. To some of them, the motivation for reducing costs has very little if anything to do with increasing access to care (life is tough), and everything to do with saving a buck for themselves. The quality of care claim is actually fairly hilarious because I'm absolutely convinced that if they could pick between a cheaper suboptimal treatment vs a more expensive high quality treatment that both yield the same outcome, they'll go with the cheaper one every time, quality be damned.

That said, I do respect that some of them are coherent in what they say. The problem is with the incoherent people. If you claim that the government couldn't possibly handle a system as complex as healthcare properly, you can't turn around and say the government does a great job handling the military or national security (systems that are just as complex or more). At that point, you're just making excuses.

[Marcus Bryant]

Currently, the US is paying a lot more for health care than other countries with poorer outcomes. If ideology and the love of money was not in the way, we would adopt a single-payer system using the best practices developed and tested in other countries.

If someone else has a system that does a job better at lower costs, why not use that system?

Oh, if it were that simple. And, yeah, who should be concerned about silly things like liberty and the source of those "lower costs" when the ideological mirage of a benevolent state is at stake? Also, how about accurately assessing the source of the problems with the health care service industry, instead of jumping to a solution which is rife with plenty of problems which its proponents selectively choose to ignore?

[101A]

Naturally answers are proposed which do not address the heart of the matter. The basic problem is that most pay for routine health care services through a 3rd party payer. Most use a 3rd party payer as it is part of their or a family member's compensation or it is a government program. It's a standard workplace benefit owing to its exclusion from the income tax. When you pay a fraction of the cost of those routine services, then you are less likely to shop around and you are less likely to balk at additional, perhaps generally unnecessary services.

Greater government intervention in health care services is debated under the assumption that the government currently is not greatly involved. It is precisely its history of involvement which has led us to the mess we are in. Now we can understand that and move towards a solution based on that understanding, and recognize that any kind of reform should be based on the reality that the provision of health care services is a service, and as such is subject to all of the basic laws of economics which apply to every other good and service produced by a private party, or we can pretend that it is something else, and come up with an even greater monstrosity of stupidity, and continue to address everything but the root cause.

Of course, these debates are usually nonproductive. If someone believes the Earth was formed 5,000 years ago, in spite of all evidence to the contrary, because their faith tells them so, then it's generally not worth spending the time discussing matters of science and history with them. Such it usually is with those who advocate greater state involvement in health care services. It's not politics to them, it's religion, and they should be regarded as the ignorant fundamentalists they are.

[DarkReign]

Well you should shop around more DR. The assurant policy that was almost double we had around 5 years ago was actually the plan my wife's practice was providing for their employee's. Some physicians my wife wanted to didn't take that plan so she found some independent insurance lady who went through a gazillion plans. We settled on this one through Blue Cross/Blue Shield. It was a long process (took a few months), insurance lingo makes my head explode.

What is HAP?

We did the shopping around bit. 4 separate companies (BC/BS, HAP and two other minor people I cant remember).

HAP is Health Alliance Plan. http://www.hap.org/

[Shelly]

I wonder if morePCP docs are going to start going the way of concierge medicine.

My friend just told me that her family doc is going this way this month and they want $3,000 EACH for her AND her husband. Her kids will be covered. She's now looking for a new doc because she cannot afford that and really doesn't visit the doctor that much to offset the cost.

Seems like it's only PCP that are going this route. I don't see how specialist docs could survive practicing this way.

[ElNono]

I wonder if morePCP docs are going to start going the way of concierge medicine.

My friend just told me that her family doc is going this way this month and they want $3,000 EACH for her AND her husband. Her kids will be covered. She's now looking for a new doc because she cannot afford that and really doesn't visit the doctor that much to offset the cost.

Seems like it's only PCP that are going this route. I don't see how specialist docs could survive practicing this way.

My PCP has been only seeing MDVIP patients only for a couple of years now.

[ploto]

My friend just told me that her family doc is going this way this month and they want $3,000 EACH for her AND her husband. Her kids will be covered. She's now looking for a new doc because she cannot afford that and really doesn't visit the doctor that much to offset the cost.

It makes no sense to me because you still need insurance for specialists, lab work, prescriptions, and hospital care. What healthy person would ever spend $3000/yr at their PCP? And the notion that you now will get full access to the physician, well supposedly so do hundreds of other people.

It's all about making money and physicians thinking it is more lucrative to have a set number of people pay cash up front instead of dealing with insurance claims. Really it is separating the have's from the have not's even moreso in the provision of health care.

[boutons_deux]

boutique medicine is free-market, capitalistic rationing of health care, not that wrongies have any objection to it.

[Marcus Bryant]

boutique medicine is free-market, capitalistic rationing of health care, not that wrongies have any objection to it.

...as well as a "free-market, capitalistic" provision of health care services. Health care services are not some monolithic en y which exists regardless.

[Shelly]

My PCP has been only seeing MDVIP patients only for a couple of years now.

I'm confused--so you belong to this?

It makes no sense to me because you still need insurance for specialists, lab work, prescriptions, and hospital care. What healthy person would ever spend $3000/yr at their PCP? And the notion that you now will get full access to the physician, well supposedly so do hundreds of other people.

It's all about making money and physicians thinking it is more lucrative to have a set number of people pay cash up front instead of dealing with insurance claims. Really it is separating the have's from the have not's even moreso in the provision of health care.

When I first heard about this type of practice a few years ago, my understanding was that most of the patients were participating were older and had the means, like you stated. Or they're all hypochondriacs But obviously, some people are willing to pay for this. But seriously, how many times does one need to see a PCP?

However, my friend is bummed because she's been with her doc for a long time and really liked her.