We have been previously discussing our ridiculous medical insurance system where citizens are hit with obscene charges — often by design to ensnare those unwilling or unable to challenge the charges. It can range from an $18,000 charge for a napping child to $15,000 for tiny screws to $89,329 for a $750 serum. The system exists because Congress allows it to exist in conformity with an army of lobbyists for the pharmaceutical and medical industries. The latest example was laid out by National Public Radio (NPR). Professor Janet Winston, 56, who teaches Humboldt State University, was charged $48, 329 for allergy testing at Stanford Health Care.
Winston was given a series of allergy tests at Stanford for a six-hour drive because she could not even get an appointment with a dermatologist for months — another persistent problem in our broken medical system.
Once at Stanford, they did a good job in determining that she was allergic to a variety of things, which explained her persistent rashes, including the ketoconazole cream prescribed to treat her persistent rash, the antibiotic neomycin, and a clothing dye as well as metals gold, nickel and cobalt. She then got a bill for $48,329, including $848 for the time Winston spent with her doctor.
Her health insurer, Anthem Blue Cross, paid Stanford a negotiated rate of $11,376.47. Stanford then billed Winston $3,103.73 as her 20 percent share of the negotiated rate. The bill showed the same pattern of intentional inflation of costs, which experts told NPR was “nuts.” That included the common 10-1 multiplication of costs that we have seen in other cases. For example, Stanford charged $399 per allergen when the actual test costs around $35.
I remain astonished that the public has not held Congress responsible for allowing this absurd and destructive system to continue without serious reforms. This is about systemic and abusive charges that raise serious questions of fraud, but it is all legal.
Unconscionable. Price gouging.
One of the problems is that there is not much of a free market economy in healthcare. There is serious room for improvement in that area. To start, all prices should be posted up front. Another layer between provider and consumer is health insurance. Consumers don’t seem to care how much something costs, only what they actually pay for it. Because of insurance, that is only a tiny fraction. The removes the system of consumers rejecting ridiculous prices, and providers adjusting. In addition, this is the outcome of multiple tiers of consumers’ ability to pay. There are several castes of patient – those with great, high paying benefits like employer policies, those with policies that pay less than cost, such as Obamacare, Medicare, Medicaid, and Medical, and those without any coverage at all. Those with insurance get nailed the most, because they can squeeze so much out of their policies. However, those with lower caste insurance typically cannot see a good doctor, because the doctor either cannot afford to accept their policy, or he or she has to over charge other insureds to make up for the loss. That is why most doctors offices either won’t take Medicare patients, or have a limit.
This is not a simple problem of Company A charged way too much. It is systemic of a problematic system. One of the first things we need to do is get rid of employer policies. Remove employers from the health care business. Only have individual policies, which makes everyone one big pool.
The start of all this, the allergy testing, reminded me of a lovely little Rachel Weisz movie, The Brothers Bloom about two con artists and a sheltered, absurdly rich shut in. Rachel’s character was allergic to everything, so she grew up alone in her mansion, every surface plastic wrapped, denied any friends, and limited in her activities and food. It turned out she was allergic to the nickel in the needle used to test her for allergies. She was imprisoned for her entire life for no reason.
Karen
You illustrate the illusion better than I. ‘Free market economy’, what the market will bear.
It’s not really a free market economy. Patients aren’t paying most of the bill. There is an inserted 3rd party, the health insurance company. Prices are not posted upfront, but come as a surprise. There are not set prices, but rather they vary according to what insurance company they are charging.
If prices were posted, and patients had to pay the bill, they would shop around. You can get any number of allergy tests at Quest. All you need is a doctor visit, who then orders the test. There is a Quest Diagnostic in Eureka, CA. To get the allergy test order, she didn’t have to drive to Stanford. She could have gotten an appointment at an Urgent Care.
It would be nice if there was a more consumer friendly business model. For instance, doctors could review test results over the phone, for a phone consult fee instead of making people come in for doctor visits just to review the data. Or Skype. Or FaceTime.
Karen
To treat health care as a commodity and leave it to the ‘free market’ is asking to get screwed. The health care insurance industry has really only come into its present oligarchical and monopolist state since the time of Nixon. Over these past few decades the US health care system has fallen to 25th place in the world from one of the top five. Health care costs three times as much per capita in the US as it does for better systems in Canada, France, Great Britain, etc. Regarding efficiency of services received for dollars spent, the US ranks 99th, next to dead last, just ahead of Algeria.
There is no choice in the equation. One can choose to take public transportation and not pay for a car. One cannot choose when it comes to health. The fact that it has been left to the ‘free market’ means only that the market is free to charge whatever it can; or what the market can bear.
This business with Stanford is an exaggeration of a problem. Going to Quest would have cost less but with allergy tests, half of which produce false positives, to get accurate readings she might have made the right choice. The issue is the cost the hospital billed, the amount the insurance company paid-when we all pay for that, and what she was expected to pay. This is private enterprise secured parasite behavior. There is no real choice here and the system is obviously designed to screw the consumer.
This is another example of the unique American illusion of a freedom or right of some sort, keeping government out of our private lives, competition, or just plain stupidity.
https://www.cbc.ca/news/health/surgery-wait-times-longest-in-18-years-1.1104913
Surgery wait times longest in 18 years | CBC News
Wait times to receive medical treatment in Canada are the highest they’ve been in 18 years, according to a new report.
The median wait time is 19 weeks between the referral from a general practitioner and the start of elective treatment, finds the report, released by the Fraser Institute Monday.
“At 104 per cent longer than it was in 1993, this is the longest total wait time recorded since the Fraser Institute began measuring wait times in Canada,” reads the report.
Wait times for a referral to a specialist rose to 9.5 weeks in 2011 from 8.9 weeks in 2010. And the wait time between a visit to a specialist and actual medical treatment increased to 9.5 weeks from 9.3 weeks, according to the report.
Even among the provinces with the shortest wait times there have been declines. Though Ontario has the shortest total wait time for surgery among the provinces, with an average wait of 14.3 weeks between a visit to a GP and the receipt of treatment, that’s up from 14 weeks in 2010.
Conversely, Prince Edward Island had the longest total wait time at 43.9 weeks.
Wait times for different types of medical procedures also vary in length. Patients wait the longest between a GP referral and plastic surgery, an average of 41.6 weeks, while those waiting for medical oncology begin treatment in 4.2 weeks.
“Canadians are being forced to wait almost 4 ½ months, on average, to receive surgical care, prolonging the pain and suffering patients and their families are forced to endure,” said Mark Rovere, a co-author of the report. “Despite significant increases in government health spending, Canadians are still waiting too long to access medically necessary treatment,” Rovere said.
The report, Waiting your Turn, surveyed specialist physicians in 10 provinces across 12 specialties between January 12 and May 20, 2011. Survey questionnaires were sent to 12 different specialties:
https://www.huffingtonpost.ca/nadeem-esmail/canada-free-health-care_b_3733080.html
“Many Canadians and commentators in other countries lauding Canada’s government-dominated approach to health care refer to Canadian health care as “free.” If health care actually were free, the relatively poor performance of the health care system might not seem all that bad. But the reality is that the Canadian health care system is not free — in fact, Canadian families pay heavily for healthcare through the tax system. That high price paints the long wait times and lack of medical technologies in Canada in a very different light.”
Note the source – Huffpo
https://www.citynews1130.com/2018/05/23/canadians-waiting-longer-medical-care-report/
Karen
Health care per capita in Canada is a third of what it is in the US, irrespective of where the money comes. The insurance administration is only what is necessary and from 5 to 7 times less than in the US with its 1,200 private insurance companies, their employees, the extra employees needed on the Doctor’s side and in hospitals to deal with the mess. The US is next to last when it comes to what you get for what you pay. Health care is paid for through premiums as well as taxes. The bottom line is that it ranks 14th in the world while the US ranks 25th at three times the cost, regardless of who pays.
I don’t want to insult Canada’s healthcare system or even compare it to ours for that is up to the Canadians to decide, not me. You don’t know how much healthcare is costing Canada. You only know the figures of the known costs but there are many costs that are unknown and therefore not calculated.
How much work is lost when A Canadian has to wait for weeks or months to be adequately treated? Why are Canada’s waiting lines getting longer? One likely answer is the costs are getting higher so to control cost access is being denied. Is quality being denied as well? That takes years to find out, but what we do know is that medical outcomes (will I live or will I die; will I get better?) are worse than in the US and that the US has the best overall medical outcomes.
How much more money would Canada have to spend in order for the multiple birth babies to have been delivered in Canada instead of the mother being sent to the US? Would Natasha Richardson be alive today if her ski accident occurred at a 5 star US ski location? Probably yes, but Catscan machines all over the place and air evacuations are very expensive.
I can go on and on Isaac to counter any of your arguments, that are based on pure ignorance and ideology, but that does no good when dealing with closed minds.
The rankings you refer to have little to do with healthcare systems and more to do with an evaluation system that forgets about outcomes wanting mostly to deal with what makes it appear all people are equal. A bullet to the head of every patient with a serious disease would drastically increase the ratings that you talk about.
Allan
These studies are done on a regular basis. They typically result in improvements to the system(s). However, they are composed of non-life threatening situations and situations in the early stages of interaction between the patient and the doctor. People don’t die in Canada because they have to wait and people don’t lose their life’s savings, homes, etc.
An old school pal had a heart attack and within two weeks had triple bypass surgery, in the hospital and stabilized the first day, no waiting; didn’t cost a cent over his premiums, no copay, no cost. There are many many more stories of immediate treatment for every one where someone had to wait. I could list many instances where an acquaintance was admitted immediately and given Mayo Clinic treatment.
There are situations where one waits, just as there are here in the US. I know of many cases here in the US where the patient pays almost a thousand a month for insurance and it takes a year or so to treat a problem. In Canada you can opt through supplemental private clinics to get immediate treatment for things that may be prioritized, such as cataracts, to make you wait a few months, and the provincial insurance will reimburse their cost, which ranges from 60 to 80 percent. You can then deduct the remainder off of taxes. In the end when you pay on average a hundred a month, it still works out better than in the US.
In the US you get great treatment if your premiums are high and included in your salary or the cost to your employer. The worker may pay a couple hundred a month but the employer is paying three times or more. This is one of the reasons employers in the US are against universal single payer systems; they would not be able to combine low salaries with ‘benefits’. Even then, you are limited to what doctors and hospitals are in that particular system, obligated to pay many thousand a year out of pocket, deductibles, copays, etc.
The Cadillac insurance plane that gets you Mayo Clinic treatment is still available in Canada as the basic with supplementary ins. So, dollar for dollar it’s a third the cost per capita and you don’t have to wait if you pay more. In almost all cases the wait time for non life threatening situations-those that are used in these surveys-can be cut in half by the patient insisting. This is very much similar with Kaiser in California. This non profit system will make people wait all day in a waiting room and weeks for appointments unless one insists or works the system.
It doesn’t matter how you compare the systems, in the US the patient pays two thirds of every dollar to unnecessary employees, stock investors, CEO multi million dollar salaries, and general dysfunction.
“they are composed of non-life threatening situations and situations in the early stages of interaction between the patient and the doctor. People don’t die in Canada because they have to wait”
Really? In otherwords when a doctor doesn’t know what is wrong with a patient (weeks after the patient called the doctor) and calls in a specialist with a waiting time of weeks and then that specialist orders testing with a waiting time of weeks and that specialist calls in a surgeon with a waiting time in weeks a problem that may have been treated earlier and successfully may now be untreatable so the patient dies. Of course to you Issac that patient didn’t die of a delay he just died weeks or months after the treatment should have been performed.
Your anecdotal references are worth as much as you are being paid for them. Absolutely nothing. Take note that urgent and emergency treatment must be performed at all US hospitals. That isn’t perfect but that isn’t waiting weeks to have treatment.
Urgent and emergency treatment is performed with little to no waiting in Canadian hospitals as well. People are not dying on gurneys in the halls. No one waits weeks for emergency treatment. You are very selective mixing up your examples apples to BS.
In the end, the World Health Organization ranks Canada 13th to 15th over all and the US 24th to 26th for quality of health care, per capita. That much better health care costs a third in Canada of what the lesser quality care costs in the US, per capita. The efficiency of what’s spent for what is received in the US is 99th out of a hundred countries. The surveys and news do not report the satisfied or the expedient in either country. Pretty much the only news is bad news or news of problems or things out of the ordinary. Dog bites man versus man bites dog.
If you have health insurance coverage of equal effectiveness in the US to that of health coverage in Canada, similar wait times, similar quality, etc. it will cost a third per capita in Canada of what it costs in the US. In the provinces, as health care is administered province by province, most people are covered under a basic system that covers accidents and catastrophes. In these urgent and emergency cases there is no waiting and care is immediate and equal to that of the US.
If one develops, in one’s later years, conditions that necessitate ongoing treatment, there can be a wait to diagnose and address the conditions, in some instances. However, supplemental insurance is available and together with the basic premiums of the provinces is still less than what one would pay in the US. Canadians have the options of enhancing their insurance with private policies. Most Canadians do not miss work or die waiting for treatment. Statistics do show however that more Americans defer going to the doctor due to the costs and succumb to heart attacks and other fatal illnesses because of the fear of being cleaned out. You can present yourself at a hospital in the US and get treatment, but if you have the money, they will get it or ruin your credit. No one avoids seeking medical help in Canada for financial reasons. This is not the case in the US.
Another point is that basic provincial health care is not always the same throughout all professions and conditions. A teacher might have a comprehensive insurance that includes supplementary insurance, dental, etc. Those in the military, especially those retired military have extras in their policies. Some jobs offer comprehensive health care insurance as well. The bottom line is that it is better quality for a third the price, per capita. One can always be selective by cherry picking one’s info. One has to go from the general in statistics to the specific, analyzing as one goes. Allen your arguments illustrate no organization whatsoever.
“Urgent and emergency treatment is performed with little to no waiting in Canadian hospitals as well.”
You must have missed what I said so I will repeat it. I wrote “Really? In otherwords when a doctor doesn’t know what is wrong with a patient (weeks after the patient called the doctor) and calls in a specialist with a waiting time of weeks and then that specialist orders testing with a waiting time of weeks and that specialist calls in a surgeon with a waiting time in weeks a problem that may have been treated earlier and successfully may now be untreatable so the patient dies. Of course to you Issac that patient didn’t die of a delay he just died weeks or months after the treatment should have been performed.” I think that information was from a CBC report.
“In the end, the World Health Organization ranks Canada 13th to 15th over all and the US 24th to 26th for quality of health care, per capita.”
You must have missed another comment of mine. What does the WHO ranking consist of? Is it outcomes (will I live or will I die) or is it a list of many things many of which have little to do with outcomes. I’m interested in whether I live or die, outcomes, not the BS the WHO is dealing with. I’m not saying America doesn’t pay too much. It does. I’m not saying America doesn’t have healthcare problems. It does. But you are not dealing with the points I have made that demonstrate American care is top notch compared to the rest of the world. I am not saying Candian care is bad but I will say one of the reasons for the increased waiting lines was likely due to the provinces attempts to cut costs. Did they cut quality as well? Only time will tell but on the respected outcome study I posted on this list Canada always ranks lower than the US.
“Most Canadians do not miss work or die waiting for treatment.”
One should hope most Canadians don’t die waiting for treatment or the country would be totally empty.
“No one avoids seeking medical help in Canada for financial reasons.”
But they do come to the US for treatment when they have the money and don’t want to wait. There is now a thriving business in Canada linking Canadians to American hospitals providing reduced prices.
Tell me Issac how are the Inuits doing healthwise? Last I heard not to good despite Canada’s healthcare system which I believe is fairly good but not the best even if the US is removed from consideration. However, I think you rank better than Britain as do quite a few other western nations so you can go to bed happy.
There is a menu of allergy assays that can be performed by any lab, including Stanford. I am not aware of any proprietary testing that Standford does that cannot be had anywhere else. I could be wrong, but it was my understanding that she could not get in to see a local dermatologist to order the tests, and that is why she drove to Stanford.
I have ideas, not answers. In my opinion, the country should make small scale beta tests of a variety of proposals to improve health care, and then evaluate which one(s) work best. It was a terrible idea to roll something out nationwide, create this disaster, and then declare that it is too big to fail.
Much truth but;
“Consumers don’t seem to care how much something costs, only what they actually pay for it. ”
isn’t quite fair….consumers have no control over what is being pushed in healthcare today. They are the pie and trying very hard not to get eaten. Also, the system is unbelievably confusing and burdensome to navigate for consumers….who has the energy when they are sick or elderly to jump through the ridiculous hoops and obstacles?
This isn’t blaming consumers, but rather pointing out that consumers don’t fight to save their insurance companies money; they fight to reduce their own portion. If someone were charged $70,000 for a hospital stay, but had to pay $50, most people would pay the bill, grumble about the cost of medical care, and then go on about their day. It’s not until or unless a consumer is stuck with a $70,000 bill his insurance won’t pay that they start really fighting. Or panicking.
I agree that it is very confusing to sort it all out or find the right specialist.
I didn’t mean to sound disparaging about consumers. This behavior applies to me, too. I know how much I paid for health costs over the year, but don’t have the same grasp on what my insurance company paid.
“isn’t quite fair”
Becka, it isn’t fair to the consumer and it has become less and less fair as government has intervened more and more. Obamacare itself that was supposed to be consumer oriented was no such thing as it priced the paying customers out of the market. It reduced employment, wages and the number of jobs available. It made all sorts of awful deals with states and large corporate entities. That is the way government works when it is too big and isn’t financially restrained. That bill wasn’t even complete.
Ask yourself why Medicare would pay almost twice as much for a colonoscopy done by a hospital than done by an outpatient center.
Becka, it isn’t fair to the consumer and it has become less and less fair as government has intervened more and more.
Allan, your problem here is not ‘government intervention’ but deficits in contract and commercial law which allow this nonsense. When these charges are unenforcible in court (which they should be), they’ll stop issuing them. They negotiate charges with insurance carriers and then hit the uninsured with these bills. The bills are absurd, so their actuarial calculation isn’t based on collecting the face value but on recouping their costs and then screwing an additional increment out of the customer through intimidation tactics. The customer-victim never saw the charges up front or had any inkling of what they would be. If you want to have the efficiencies which come from price systems, the prices have to be known to market participants, but in that case, you have to be able to make apples-to-apples comparisons. That requires controlled vocabulary. But you complain about that too.
“Allan, your problem here is not ‘government intervention’ but deficits in contract and commercial law which allow this nonsense.”
DSS, you can put it in that form but it is government (and its institutions) that passes the laws and interprets faulty laws that are passed. However we may agree that a part of the solution is in making sensible choices regarding the laws and their interpretation. For example when a contract is not made a judge will decide equitable compensation. However, that judge has to be competent as to what equitable compensation means especially in the professional sectors. A person enterring a hospital unconcious didn’t sign a contract yet all too frequently will be billed at hospital rates. (For another debate, I would place the responsibility of containment of cost onto the hospital and therefore the physician and other contractors. Take note this idea (in this case market based) requires a lot more context to be totally understood.)
Government has helped create large monopolies of insurers, hospitals and lately physicians as well. These corporations are now increasing the number of vertical monopolies previously more often associated with HMO’s (Kaiser).
Transparency and third party payer are among the major problems that urgently need correction. One cannot get real market based transparency until the third party issue is corrected. The corporations can mostly deal with policy that puts them all on equal footing.The patient at present is almost completely left out of the bulk of the financial considerations.
“That requires controlled vocabulary. But you complain about that too.”
I complain about your vocabulary based on the topic under discussion. You are like a Randian who when losing a debate starts using the Randian vocabulary. You always have the option of using common vocabulary or defining your terms.
The reason for this nonsense and tragedy is the American illusion of freedom. Health care in the US is a commodity, governed by the first rule of capitalism, ‘what the market will bear’; or in other words, stealing as much as one can get away with. This system presents no advantages to the consumer, all advantages to the oligarchs who, in turn, market their representatives to the voters. The illusion lies in that somehow this activity represents the opportunities of any and every American to ‘get rich’ or win the lottery. It’s like guns; to well regulate, as demanded by the second amendment, presents a threat to those who ignorantly refer to that same amendment.
How does one recognize a spineless puppet in Congress, the Senate, the White House? When the public needs and demands reform, they kowtow to their benefactors. Regardless of whether or not these scum are on the left or the right, they are bought and paid for, spineless, and traitors to the representative democracy of the American Republic. The founding fathers would consider this treason.
“Health care in the US is a commodity, governed by the first rule of capitalism.” Okay. Do you know what you need to survive more urgently, usually, than healthcare? Food. You need food to live. Food is a commodity. Is there a movement that food is a human right that should be made free to everyone, rich and poor? Why shouldn’t food be free, even if you’re rich? You need it to live!!! And why would we be charged for water? You die from thirst even faster than from starvation. Water should be a human right provided free to all socioeconomic classes. Clothing – well, you need clothing to avoid freezing to death or to protect against too much sun. Clothing and sunscreen are basic human rights, never to be treated as commodities, and free to rich and poor. Shelter – now there’s something you need to survive. Shelter should be free to all people, rich and poor, and never treated as a commodity. Everyone’s houses should be torn down, property seized by government, as property should not be a commodity, and everyone should live in tenement houses, all of the same size. No pets, because that’s not fair to everyone. Doctors may not profit off of their services, because that is treating medicine as a commodity they sell. Obviously, no one will be able to make any profit, because someone has to pay for this. Socialism makes profit illegal and outlaws owning private property. So…Socialism is the only fair system that does not treat health care, housing, food, water, or clothing as commodities.
Welcome to Venezuela.
You should also note that European universal health care systems use privatization to support their onerous systems…private companies that treat health care as commodities.
“We have been previously discussing our ridiculous medical insurance system where citizens are hit with obscene charges ”
Wow. They charge like Lawyers……
My wife spent 6 hours at the CPMC SF ER when she had an allergic reaction to medication. Blue Cross billed us 20% of the $3,800 bill which included $175 for a plastic disposable syringe that probably cost 25 cents. It is like the old stories about the Pentagon contractors billing hundreds of dollars for a $15 wrench. America just cannot afford such waste in the healthcare system.
I wonder if JT would be all for the govt. looking into lawyer fees and regulating them?
Also, before we pile on pharmaceutical companies, just try to invent a new drug and bring it on the market to see just how fun and cheap the red tape is. There is something ironic about the govt. over regulating an industry and then turning around and blaming that, that industry charges too much.
Jim: did you know that most of the cost of prescription drugs is due to advertising? In fact, Big Pharma spends far more on consumer direct-market advertising than it does on research and development, and this is for a product that patients cannot purchase without a prescription. They do it so that patients, who do not have the knowledge to figure out what is best for their condition, will pressure their doctors to give them the drug that seems to work so well for the happy people in the commercials. This is added to the pressure put on doctors by Big Pharma reps who show up at their offices bearing free lunch, free goodies, etc.. In fact, doctors only know what information Big Pharma tells them. Without access to raw data, doctors really don’t know whether premarket testing for efficacy and safety was sufficient or appropriate, nor whether it was done for a sufficiently long period of time. Any casual TV watcher can attest to the numerous attorney advertising for clients who were injured by drugs and devices, which leads any reasonable person to question the adequacy of premarket testing for safety and efficacy. Any reasonable person would assume that there wouldn’t be that many cases of injured patients if the drug or device was properly cleared before it was put on the market.
Stopping advertising of prescription drugs would go a long way toward lowering the cost of prescription drugs.
“most of the cost of prescription drugs is due to advertizing” probably takes the prize of being the most inaccurate statement made say far today.
“SO far today”
Look it up, if you don’t believe me, but don’t call me a liar unless you have proof to the contrary.
Natacha, you’re never not lying. Everything you say is emotions-driven and your emotional life continually misleads you while it’s irritating everyone else.
Another ad hominem attack instead of responding on the merits. How Trumpian of you. How emotional of you. How pathetic of you.
The response on the substance is above. You can read and digest it once you’ve learned how to read an analog wristwatch.
See below from “Health Science”:
Pharma Companies Spend 19x more on Marketing than Research, and Returns are Dropping
Drug prices are going up while R&D spending is going down
Health Science
Christina Sarich
By Christina Sarich
Posted On December 21, 2016
The pharmaceutical industry swears the high cost of drugs is due to research and development costs, conveniently omitting the actual amount of money spent on the marketing of these drugs, which is exorbitantly more. A recent Deloitte report suggests that pharmaceutical companies are taking a hit because investments made in R&D on new drugs simply are not paying off anymore. [1]
image-pharma-money-marketing
As we previously reported, pharmaceutical companies spend more money on marketing drugs than research and development. Johnson & Johnson for example recently spent $17.5 billion on marketing and only $8.2 billion on research and development. Similarly Pfizer spent $11.4 billion on marketing and only $6.6 billion on research and development. [2]
Deloitte’s research into a total of 12 pharmaceutical companies’ R&D expenditures for the previous year is telling, even though the comparatively small amount of money spent on R&D isn’t paying off for Big Pharma like it used to.
According to the Pew Charitable Trusts, more than $27 billion was spent on marketing to physicians by the pharmaceutical industry in the year 2012. You can do a search to find out if your doctor has been taking money from Big Pharma.
Read: Composing Only 5% of the World Population, Americans Take 50% of All Pharmaceutical Drugs
As reported by BusinessInsider:
“In 2010 Deloitte began following the top 12 pharmaceutical companies by R&D (or research and development) spending recorded the previous year. This 12-company cohort has since launched 186 products with estimated total revenue of $1.258 trillion, and it has collectively advanced 306 drug candidates with total forecast lifetime revenue of $1.414 trillion into late-stage development.” [1]
Though these figures are eye-popping, returns on R&D are a tiny 4.2% compared to the baseline of 10.1% observed in more recent years.
Returns have also been lower every year with the exception of 2014. There could be multiple factors causing the drop in returns, but sales forecasts have fallen by 50% to $416 million per year while development costs per drug have increased by 33%.
According to a report in BMJ, prescription drug companies aren’t putting a lot of resources toward new, groundbreaking medications, because it simply isn’t paying off. As outlined by the study authors, it seems that it is more profitable for the company to create variations of products that are already on the market.
“[P]harmaceutical research and development turns out mostly minor variations on existing drugs,” the authors write. “Sales from these drugs generate steady profits throughout the ups and downs of blockbusters coming off patents.”
The authors say that for every $1 pharmaceutical companies spend on “basic research,” $19 goes toward marketing and promotion.
What’s more, drug makers are also facing more stringent reviews of their drugs once they go to market. For example, GlaxoSmithKline was recently hit with analysis from the U.S. budget watchdog, the Institute for Clinical and Economic Review, which found Glaxo’s new severe asthma therapy Nucala is overpriced by 63% or more.
The loss of billions in R&D returns in a trillion dollar industry is likely also the reason many companies promote off-label drug use and push clinical trials through the FDA using what is likely their own biased research.
The Bureau of Economic Analysis published data on pharmaceutical manufacturing in 2007. (Their ordinary data series are usually not so granular). They report $132 bn in gross output of which $2.3 bn is attributable to service charges from advertising agencies and $19 bn is attributable to employee compensation. I suspect they employ people other than sales representatives. Nominal gross output in chemical industries grew by about 11% between 2007 and 2012. No clue where this $27 bn figure is coming from.
Anonymous – this study was done when drug companies would give out pens, calendars, clocks, etc. to doctors offices. Now they are prevented from doing that. I used to get some great pens from them.
You also have to remember that the advertising is for all their drugs, not just their new drugs, so their is an apples and oranges comparison. The R and D drugs are not even on the market yet. They still have to advertise aspirin, cold medicine, etc.
hey Paul they still hand out swag. I had a great selection of scotch and whiskeys at a friends house. he’s a doctor and his bar is fully stocked with drug rep gifts. why they give booze as a kickback now as opposed to something else i don’t know.
Mr Kurtz – no wonder my GP had to 6 months off to sober up.
Kurtz, supposedly the swag is now limited. Booze is not the typical way of gift giving especially since the government cracked down on even the gift of inexpensive pens though some of the shenanigans I am sure continue in some form or another.
Think of why a drug rep would want to give a gift. The reason I think of would be so that the physician prescribes certain drugs to the patient. How does the drug rep know that his gifts (if given) are paying off?
Think about that for the moment. The one way I can think of would be if the drug company got the information from the pharmacies whether on line or not. If that is the case why didn’t the government prevent that information from being sold to the drug companies? That is a much easier and surer way to solve the problem.
Next time you go to your friends house ask him which bottles were given by which drug rep and which bottles he bought for himself or were given by patients, friends, etc. I’d like to know.
First of all, I said that your statement was wildly inaccurate.
I didn’t call you a liar, so don’t distort what I said.
You made the statement that “most of the cost of prescription drugs is due to advertizing”, with absolutely no evidence to back up that false claim.
So now, rather than you providing actual evidence to back up a patently false claim, you punt and say that I am the one to provide the evidence that you are wrong.
I no longer habe any Q. reports, annual reports, or 10-Ks from the drug companies.
I’m not going to dig them online and do uour work for you, and it’s very unlikely that you would do even minimal research anyway.
If a drug company spents, say, $100 Billion a year, maybe c. 17% of that is in the area of “promotion”.
That includes not only TV and other ads, it includes salaries for the pharmacy reps. who communicate with doctors.
It includes free sample given to doctors.
In some cases, there are very questionable relationships between some doctors and the drug companies.
There is a lot more transparency in that area than there used to be; you can look up how much a doctor took in compensation from which companies.
The bulk of “promotion costs” may well be advertising, but not every doctor is up on every drug, every study of a drug, etc.
So part of the “promotion costs” are the pharmacy co . reps who communicate with the doctors.
If R&D costs are 15 % of TOTAL SPENDING by the drug industry, then we’re less than one-third of the total spending by the industry.
( Some of these figures are disputed, so I’m not using the extremes at either end. Also, as I mentioned, I’m not referring to reports that I used to have on hand, but I’m “ballparking” very close to actual numbers.
So a company spends $17 Billion on “promotion”, $15 Billion on R&D.
Out of the $100 Billion that co. spends, we’re at $32 $Billion.
There is no shortage of articles on the subject of R&D v.promotion costs.
And most of them are not comprehensive, and end up giving a distorted picture.
If one pretends that R&D + promotion / marketing costs are 100% of a drug company’s total spending, he can (inaccurately) conclude that most of the cost is due to advertizing.
You can’t just discard the remaining 68% of spending in other areas.
There are manufacturing costs, there are salaries ( beyond the sales reps.) of their labor force.
There us probably as much advertizing on TV saying ” if you took this drug and experienced ab thru z, “you may be eligible for compensation”.
So there are the costs associated with legal action; that is not only the settlements they make to avoid extensive litigation, it is the payment for legal fees associated with defending massive lawsuits.
I’m just scratching the surface here, but there is some actual information here.
Baseless, unsupported, and patently false claims, like the one you made, are a dime a dozen.
I normally don’t play the “prove me wrong” game when someone makes an unsupported, baseless claim.
If you still want to believe that 17% of drug company spending is responsible for most of the cost of drugs, have at it.
https://www.quora.com/Does-the-pharmaceutical-industry-spend-more-on-ads-than-research
The answer is yes, but most of those dollars are not targeted at consumers. However, healthcare would be better served if there was less spent on consumer advertising. My opinion only. But I was surprised that the dominate voices here were so set against pulling up easily available reports. Normally, they are happy to provide many links to support their positions.
but don’t call me a liar unless you have proof to the contrary.
It would require an enormous amount of curiosity to look up anything you posted, not for accuracy’s sake, but to discover that one moment in time you actually told the truth.
Like I told my 10 year old yesterday; when you build a reputation as a liar, you do not deserve to be taken seriously.
You’ve earned it. Own it.
“Like I told my 10 year old yesterday; when you build a reputation as a liar, you do not deserve to be taken seriously.
You’ve earned it. Own it.”
Excellent. I am sure your son understands that lesson. Anonymous never will.
Thank you Allan.
What, exactly, did I lie about? Did you see the articles above? Big Pharma does spend more on marketing than on research and development. The false equivalency of comparing health care and prescription drugs to consumer products is disingenuous. You can live without a new computer or a new car or new clothes. You can’t live without your insulin if you are a diabetic or chemotherapy if you have cancer. Jacking up the cost of drugs by advertising and marketing is morally wrong because the commodity at issue is life and death and patients have no choice.
except, marketing and advertising are forms of communication. you can’t just wave a magic wand to get the word out to doctors. there are myriad therapeutic treatments and advertising is way to get everyone’s attention for a novel medicine.
What’s amazing is she fancies sales reps can roll doctors. She’s an idiot so assumes everyone else is.
If the auto industry spends 8% of total spending on R&D, and 12% on advertizing/ marketing, then by anonymous’ “reasoning”, most of the cost of a car is due to advertizing.
Jim: did you know that most of the cost of prescription drugs is due to advertising?
He doesn’t know that, because it’s nonsense. The concatenation of companies under the rubric ‘Chemical products’ had $837 bn in total sales and $440 bn in intermediate inputs. That’s the works, Natacha.
People who work as sales and marketing managers and as sales reps number about 2.6 million people in this country, That’s 1.8% of the working population. No, their wage bill isn’t accounting for most of the charges in any industry.
All I know is back when I dealt with venture capitalists when I had my own company, we thought we had a worrisome burn rate. That was until we started talking to other entrepreneurs that were in the drug industry. The numbers that they told us about was jaw dropping. I believe that the other thing most do not know is, is that drug companies have to go through less red tape if they tweak an existing drug verses go through a virgin process. This stifles ingenuity and progress. Yes it is risky to create new drugs, but the risks for cures not yet discovered would outweigh the lawsuits of the failures. But now we’re are back to those high lawyer fees….
Jim 22,..
– For every Genentech, Amgen, Biogen ( and a few other very successful biotech firms), there are scores of biotech companies in “the development stage”, with no products, no revenues, and obviously no profits.
As you said, the cash burn rate is astounding.
Alliances/ royalty agreements with major
drug companies, issuing additional shares, and the “potential” that a Stage 1 or Stage 2 clinical trial drug might eventually become a blockbuster can keep these companies viable for a long time, but the numbers ( revenues, EPS, etc.) often look terrible for decades.
I was involved in a stage 2 clinical trial when they pulled the plug, after successfully completing stage 2.
The drug showed real promise, and there were virtually no “red flag”, i.e. serious safety concerns.
It was just that the cost of proceeding to stage 3 and 4 was momumental, on top of the tens on $millions already invested in stages 1&2.
I’m not a big fan of the pharmaceutical industry in general, especially when companies keep jacking up prices for established products that have made enormous profits for decades.
That’s one area where administration “jawboning”, and even the
potential of government restraint,
may already be starting to have an effect.
But in general there is so much sloppy reporting done on the industry that “the other side of the coin” is seldom covered.
The incentives in the pharmaceutical sector mostly created by a dumb regulatory process create an absolute mess with high prices and all too many me too drugs without concern for price and in some cases efficacy.
Allan,
– I think that events like the Thalidomide tragedy from the 1960s had a lingering effect on the “regulatory route” to getting a drug to market.
( I think it was NOT approved in the U.S., but those in Europe and elsewhere, where the drug was approved, were those with the widespread adverse outcomes).
If anything, that reinforced/ justified the very rigid U.S. standards for drug approval.
The Merck Vioxx product was a revolutionary and effective non-narcotic treatment for pain, and was FDA- approved and marketed.
Merck did a study trying to determine if Vioxx had other benefits, attempting to find out if Vioxx had additional uses.
I think one promising study seemed to indicate that Vioxx reduced the risk of colon cancer.
In another study, Merck found that, rather than lowering the rate of heart attacks, the long-term use of Vioxx actually could INCREASE the rate of adverse cardiac events.
Merck itself pulled the product at that point; the FDA did not rescind the FDA approval.
There was widespread disappointment that an effective, non-narcotic, drug… without the obvious downside of risking addiction/OD, was no longer available.
With the massive litigation that followed, Merck not only lost all it had invested into developing that product, but incurred an additional $5-10 Billion in settlement/ litigation costs.
There were cases where Vioxx might legitimately be considered a major factor involving serious adverse events; there were also cases where people who had a heart attack after drinking 10 beers a day and smoking 2 packs of cigarettes per day took Vioxx, had a heart attack, and collected because of the use of Vioxx “might” have contributed to the heart attack.
I think an enormous class action settlement blurred those kinds of distinctions.
There was no shortage of plaintiffs lined up to collect, nor a shortage of law firms willing😉 to encourage and assist them.
I cite both the Thalidomide example and the Merck Vioxx example as indications that our stringent drug regulatory policies have some advantages.
But the disadvantages are evident as well, in preventing or delaying potentially valuable drugs
from reaching patients.
Actually, the Vioxx goes even beyond that example, and demonstrates the potential financial hazards to a company that has ALREADY jumped through all of the FDA hoops.
What is especially disappointing is that the media coverage of this was ridiculously deficient and one-sided.
So there is some exceptionally lousy reporting by those who’s attitude is “it all pays the same” as long as they seem to get paid by the word, whether they actually know anything or not, whether they actually cover the issues involved, or not.
I had to laugh at one of the legal commercials some time ago where the announcer said…
“Have you or a loved one suffered death from _____ ? Call now for free information…”
If I died from _____ would the attorney take my case? Will they accept a collect call from the afterlife? There’s no money in heaven I’m told and surely “666” numbers get blocked.
I imagine the dead calling in might really throw a monkey wrench into probate cases. One would think lawyers would have tired by now from having been stiffed by too many dead-beat clients to actually want deceased ones.
Darren Smith – there is currently one running here for blood thinners. If you have bleed to death and want to join their class action suit you need to call their 1-800 number.
Tom, I am familiar with both of those cases. We live in a litigious society where tensions are heightened by the news media. One day they will applaud the release of a drug that will ‘save all of mankind’ and sometime later will condemn the manufacturer calling for jail terms for the CEO. That liability extends to hospitals and physicians and is a major cause in this country for huge healthcare costs.
As you put it the dead person doesn’t get a dime. A few people win big just as if they were playing the lottery but overall excessive litigation increases costs making it hard for people to afford medical care, increases medicalization of society, and slows down the release of new products that can provide great benefits.
Or, just maybe, all they really care about is profits. Research into innovative treatments is expensive and the results are uncertain. Tweaking an existing formula just enough to get past the patent is more of a sure bet, so that’s what they do.
I have news for you, Natacha. Business which consistently lose money disappear. They either voluntarily close or they cannot pay their creditors and are liquidated.
We could all take a big step forward by eating less sugar all day long. But people are too stupid and weak to do that. Some days I think America deserves the bad results it often gets
“all they really care about is profits”
If there were no profits there would be no pharmaceutical industry.
How would it hurt to force medical services providers to publish their prices? And to present an estimate not to be exceeded without written consent? This technique has worked well to prevent overcharging in the auto-repair services.
Publishing prices will shame hospital administrators into eliminating the most outrageous overpricing.
Three terrorist attacks this week alone by right wing white men and you’re posting about allergy test costs? Shame
‘Cause you can only write about one thing!
I know about the pro-Trump guy who sent non functioning pipe bombs designed to be detected, and the anti-Trump anti-Semite coward who shot up a synagogue. The Left is blaming conservative Jews and Trump (both of whom the terrorist hated) for the attack. The shooter claimed that Trump was controlled by Jews, who were also helping the migrant caravan, and that Trump was too much of a globalist. So…I guess the Left wants Trump to stop supporting Jewish people and Israel to sooth the anti-semites???
https://www.dailywire.com/news/37686/horrible-media-leftists-blame-jewish-conservatives-emily-zanotti
Who was the 3rd one?
Oh, and just to get your facts straight, the pro-Trump guy was not white, but rather half Philippino who also claimed to be Native American. The Anti-Trump guy admired Hitler. He was openly anti-Semitic. I don’t know if he was racist, but it is likely considering his rhetoric. He believes that Trump is controlled by “ze Jews”. Trump did the right thing supporting Israel, and he is the first sitting President with a Jewish first family. Of course he’s going to be a target, as well as those poor, poor people. I’m just heartbroken for them.
If you want to turn a tragedy into a racist attack on white people, it is in extremely bad taste.
It’s hard to respond to someone like you without resorting to name-calling, but I’ll try. “The Left” is a Faux News catch-all phrase, which means anyone who doesn’t see Trump for the pathetic failure he really is. Most Americans did not vote for Trump. Most Americans do not approve of Trump, so can most of America be considered “The Left”? Most Americans do not approve of his endless lying, of his lack of leadership, of his attacks on the media and his xenophobia, misogyny and racism. The fact that Trump and Faux News try to divide this country into “us vs. them” camps based on support for him is, itself, disturbing, and was a direct cause of the pipe bomber’s terrorist attack.. A true leader tries to bring the country together, not divide it into opposing camps based on support for him.
BTW: please explain to me how a hoard of migrants more than 1,000 miles away on foot constitutes an immediate threat to this country. Trump claims they are an imminent threat, but since they are at least a 6 weeks’ walk away, I don’t understand, so help me out. While you’re at it, please cite the name of any Democrat in Congress who advocates for “open borders”. I can’t find any. This untruthful xenophobic and racist rhetoric help fuel the pipe bomber. Trump and Faux News are responsible.
What does it mean to be “white”? In the overall classification of the races of humankind there are the Negoid, the Caucasoid and the Mongoloid races. According to this classification, the pipe bomber was definitely white, and who knows what he intended? More Faux News spin. The devices he sent contained explosive material, and could have gone off in the hold of the airplanes that transported them due to pressure changes alone. He was rabidly pro-Trump, and it cannot be denied that all of the hateful rhetoric, like encouraging disciples to beat the crap out of protestors, the nonstop harping about Hillary Clinton, blaming Democrats for the “imminent threat” of migrant invasion and especially calling media the enemy of the people motivated him. Trump does not represent “the people”, most of whom voted against him.
Trump repeatedly claims that the media lie about him. Please, please, one of you Trumpsters, tell me one instance in which the media have lied about Trump. Please spell out the specific lie.
As to the alleged “Jewish first family”, this is pure fantasy. Kushner’s family is Jewish, and he wouldn’t marry Ivanka unless she converted and agreed to allow him to raise their children as Jews. Trump is not Jewish. As to moving the US Embassy from Tel Aviv to Jerusalem, why was this done? All three major religions have staked claim to Jerusalem. What business does the United States have in taking sides in this controversy by symbolically moving the embassy?
As to the synagogue shooter, there is no in-depth analysis of what motivated him, but Trump and Faux News are ready to blame “the Left”. How pathetic.
Anonymous – the press is willing to blame Trump for the synagogue shootings. And the lies by the press are too many to list.
“The Left” is a Faux News catch-all phrase, which means anyone who doesn’t see Trump for the pathetic failure he really is. Most Americans did not vote for Trump. Most Americans do not approve of Trump, so can most of America be considered “The Left”? Most Americans do not approve of his endless lying, of his lack of leadership, of his attacks on the media and his xenophobia, misogyny and racism. “
**************
I’m impressed anonymous wrote four demonstrably false/irrelevant statements in just four sentences. That takes know how. I have to admit I quit reading after that but am supremely confident that he keeps up the pace throughout.
I usually stop reading at the mention of misogyny and racism. From there on it is usually just the parroting of rhetoric.
True dat.
Hey, on a happy note, Comrade Merkel’s on her way out! The Popular Revolt claims another victory.
Like Churchill said: “You were given the choice between war and dishonour. You chose dishonour, and you will have war later.”
And like Lincoln said: “You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time.”
She was bad for Germany.
She was bad for everybody.
insert attorney joke here, paul
‘Nothing to Gain,’ Kavanaugh Accuser Raises Nearly $1 Million
https://www.realclearinvestigations.com/articles/2018/10/27/nothing_to_gain_kavanaugh_accusers_coffers_are_growing.html
“You had absolutely nothing to gain by bringing these facts to the Senate Judiciary Committee,” Sen. Dick Durbin said during her testimony last month. This sentiment was echoed by other Democrats, who presented it as evidence that Ford was telling the truth. “I want to thank you,” added California Sen. Kamala Harris, “because you clearly have nothing to gain for what you have done.
In fact, Ford stands to gain some $1 million and counting from national crowdfunding campaigns launched by friends and other supporters, while she is said to be fielding book offers.”
St. Chrissy is set for life. She will never have to work again if she invests her money well and keeps herself in the public eye. Nothing to gain? You are joking, right. She has become a hero to SJW’s and pussy hatted cat ladies everywhere.
HELP
I’m interested in sex change reassignment surgery costs. $15,000 – $100,000
Should I start a gofundme, join the military, or go to prison for the surgery?
Jackie, become an attorney. you’d make that money in no time….bonus points if you go from he to she and practice as a shim. while having black face/white face ventrally. Contact JT for his star pupil Michael Avenatti for guidance
http://avenatti.com/
Jackie – I think you would have to commit a crime for which you were guarenteed prison time, enough for the procedure and all the red tape involved. Do you have a specific crime selected?
Yes. Child pedophile charges. I want tax payers to pay for the best $100,000 sex surgery option.
Jackie – given that you are spelling your name with an ie, I am jumping to the conclusion that you are already female. If this is true, you will do no time for child pedophilia. At least not enough time for the operation. If you are a man, I would suggest several young targets. That will rack up the years in prison. Of course, you may never get out and you will be a rape object the entire time you are incarcerated. If you are fine with this, go for it.
Finally, a topic for your expertise.
YNOT – I watch a lot of Forensic Files. 😉
The reality is that most health problems today either cure themselves, can be cured with self-treatment of rest, exercise, diet, change in environment, or more complex conditions can be sorted out by reading scholarly medical journal articles online to make one’s own decisions. . The person in the article could have figured out for herself what she is allergic to and what steps need to be taken.Be your own advocate. Avoid today’s health care scams
It is the job of the state legislatures to repair this. Where is the Commission on Uniform State Laws?
1. Have a federal commission develop a set of standard billing codes with associated controlled vocabulary, perhaps an elaboration or derivative of the ICD-9 system.
2. Each state enact a specialized code governing medical service provision and long-term care provision, separate from the commercial code.
a. Requires medical billing be done according to a standard menu of codes (see above)
b. Requires hospitals, clinics, &c to publish their chargemasters, formatted according to that standard system.
c. Makes plain that no liability falls on patient or insurer that can exceed what’s on the chargemaster
d. Requires informed consent when feasible. Every veterinarian I’ve consulted in the last decade has provided an itemized estimate before major procedures. (One I’ve consulted is something of a bait-and-switch artist to be sure). This isn’t always possible in the realm of medical care, to be sure. Where it isn’t, the drill should be to provide the estimate to the health care proxy, if possible.
e. Establishes quick-and-dirty magistrate’s courts to handle billing disputes.
f. Places legal limits on real interest charges for overdue medical bills, but gives service providers a priority status in bankruptcy proceedings.
==
One thing we can attempt which will be unpopular would be federal legislation providing for medical plans to be vended across state lines – provided they incorporated an industry-standard deductible of $x per year or higher. You could set it at $4,000 this year and then index the level to the annual % change in nominal personal income per capita. State legislatures could then require the industry-standard on intrastate sales. More efficiency through real pricing.
DSS – last time they did that they added 1/3 more billing codes.
So what? The utility is to be able to compare charges one-to-one.
“So what? The utility is to be able to compare charges one-to-one.”
So what? It takes a huge amount of time to figure out the appropriate billing code and the numbers past the decimal point. The only one that knows and understands the diagnosis is the treating professional. The amount of training and time needed to accurately figure out the code numbers is oppressive. I think there are just under 70,000 billing codes.
So what? It takes a huge amount of time to figure out the appropriate billing code and the numbers past the decimal point
I used to work for a medical center with thousands of employees. The number of technicians they had to employ to analyze and code the charts was about a dozen. Training as a record technician sums to 27 credit-hours.
Bull. Not just your job description but how you used that anecdotal knowledge to account for the entire sector and unseen costs.
DSS, start looking at physician offices that are small. Take note of the difficulties entailed in dealing with these codes. Take note of the number of physicians that have been cited for fraud becuase Medicare assessed that the wrong billing codes were enterred. Take note of the fines paid just to stop the harrassment. Take note of the federal court decisions involving these audits finding against Medicare.
Take note that the larger groups started hiring people with advanced training up to PhD level and all the overhead that came from these code numbers.Take note how administrative costs for physicians offices spiraled.
Take note hospitals in order to meet the regulations hired specialists in the field not necessary in earlier years.
(I used Medicare for the example because costs are more discernable.)
You don’t know what you are talking about.
Bull. Not just your job description but how you used that anecdotal knowledge to account for the entire sector and unseen costs.
I did nothing of the kind. You made an assertion about the administrative costs associated with billing codes which was false. I gave you an example which showed you it was false (unless you fancy I worked for a fantastically efficient university medical center).
You don’t know what you are talking about.
1. There is no such thing as a research degree in medical billing or anything resembling it. There are degrees in information science, management information systems, accounting, finance.
2. There are over 9 million people currently working in the health care sector. Federal authorities prosecute a three-digit population for Medicare and Medicaid fraud.
https://revcycleintelligence.com/news/over-600-individuals-charged-in-2018-healthcare-fraud-takedown
You fancy these people got prosecuted because they didn’t understand medical billing codes? That’s just insane.
DSS my response was due to your dismissive attitude of Paul’s post and then my own along with your inability to search out the costs unseen by you due to the entire coding process. That process affects everyone from the physician to every single encounter taking place with a patient. I gave you a bunch of things to think about and provided you with the number of billing codes, 70,000. That number alone should have made you think twice.
You might understand the numbers but I don’t think you understand the process. Your anecdote of your job experience is a tiny segment of what is actually happening. I don’t believe your job anecdote offered any proof that you have such understanding.
You mentioned “an elaboration or derivative of the ICD-9 system.” They are now up to ICD -10 and increased the billing codes as told to you by Paul. You talk about medical billing, but it is not just medical billing it is also medical coding and a whole host of other things that are quite complex and involves cost, time and energy while increasing the complexity.
You think prosecution is the problem and state the low percentage of prosecution cases as your proof that the coding system is simple. The far more common item is audits and payments for what Medicare believes is inappropriate billing. I use the word believe because these questions have gone to federal court and Medicare has lost all too frequently. You think that doesn’t cost money?
I want you to tell me how that diagnosis code was determined by the technician. Did they pick it out of thin air. Where did they get it from? How did they know how to specify down to the last digit past the decimal point when even physicians frequently have difficulty figuring that out. Someone has to be able to navigate the 70,000 codes and someone has to compile the diagnostic features. Do you think you could do that?
You are advocating for additional complexity. Simplification must be the goal.
As always, you don’t know what you’re talking about.
To question this not just unamerican, it means you are a socialist! At 70+ years it’s far and away the most successful long con in the developed world. A text book case study for all lobbyists.
This kind of stuff is illegal:
“When the rule of law is ignored — when those “in power” or “powerful” are free to break it, then very bad things happen.
You may be misled to believe that in the main good things will happen. Like, for instance, if monopolists can abuse their power to screw you with health care pricing, cross-subsidize their businesses so you have “Prime” services and similar that there is an “on-balance” for all of this which leads to prosperity. You’ll get Medicare. You get “low prices” at WallyWorld and on Spamazon. You can finance that new car, or get creative to buy a house. And so it goes.
Never mind that all of these distortions are either illegal or someone sought — and got — a special exemption.
When it comes to the medical monopolies they didn’t bother seeking or getting anything. They just did it. They also got sued twice, went all the way to the US Supreme Court twice arguing they were exempt from said laws, and lost twice. But then an amazing thing happened — having lost twice no Sheriff showed up, no prosecutor subpoenaed anyone, no Grand Jury handed up indictments. These firms “lobbied” (read: bribed) and in deference to the “jobs jobs jobs!” screams despite their conduct being ruled unlawful twice by the highest court in the land they got away with it, and still do today — an unbroken period of more than 30 years!
Note that the states have virtually-identical laws to the Federal Government when it comes to anti-monopoly provisions. But instead of enforcing them some did the exact opposite; California, for example, wrote a section in their Business and Professional Code specifically referencing one of those Supreme Court decisions as justification for explicitly permitting lawless behavior in the medical industry. That section is blatantly unlawful on a criminal felony level; no state may override a federal interest question that has been settled by the US Supreme Court with a state law or regulation, yet California did exactly that and not one person has gone to prison for it, nor has one indictment been issued by the federal government.
https://market-ticker.org/akcs-www?post=234437
”
I do not think the medical industry is exempt from the Sherman Anti-trust Act, and other price fixing laws.
Squeeky Fromm
Girl Reporter
I remain astonished that the public has not held Congress responsible for allowing this absurd and destructive system to continue without serious reforms. This is about systemic and abusive charges that raise serious questions of fraud, but it is all legal.
I’m astonished you’re astonished.
Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security. — Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government.
Just add this to the growing list of grievances.
Thank you Jesus Obama. We need to pass it to find out what’s in it.
This particular bill was Obama’s fault ? How, exactly ?
Jay S – this particular problem was Jesus Obama’s. He is only partially responsible for the current Obamacare. However, I have a Cadillac insurance policy and he is screwing with my insurance, too.
Obamacare’s a mess, but the horrid pricing system in medical care antedates Obamacare.
The healthcare delivery system in this country is begging for government intervention.
Rallying cry of statists: The government broke X, therefore we need more government!
Exactly. 21st century Tories.
The problem at hand is that these debts are enforceable even though they weren’t contracted with informed consent. The ‘pricing’ system is completely opaque. So, yes, you do need adjustments in law and public policy.
thats right,. the theory of recovery in court would be restitution for people outside of insurance plans, and the prices would be totally fabricated without reference to anything realistic.
for example, say a ten dollar sterile saline bag would be priced at $100, seen that one many times. schedule these phony bills for trial and the hospitals will chicken out every time.
We have ceased to be astonished about anything anymore.