On Tue, 16 Sep 2008 17:33:16 -0400, Ed Huntress wrote:


"Curly Surmudgeon" wrote in message
. ..
On Tue, 16 Sep 2008 15:58:22 -0400, Ed Huntress wrote:


"Curly Surmudgeon" wrote in message
. ..
On Tue, 16 Sep 2008 13:55:31 -0400, Ed Huntress wrote:


"Curly Surmudgeon" wrote in message
. ..

snip


Lets not get sidetracked into the health insurance debate for it
masks the underlying problem. The fundamental problem is that our
health care system has been hijacked by corporate powers making
healthcare too expensive.

Nonsense. The main thing that makes it so expensive is that medical
technology marches forward, not backward, and there's always more
stuff to
apply to medical problems -- increasingly expensive stuff.

That is one factor but there are many others such as malpractice
insurance but the overriding component is that a corporate monopoly
has seized control of the industry at large.

Sure, Curley, malpractice insurance is a factor, and there are many
other factors. It's not a single thing that's done all of it. But if
you spend some time sorting out where the costs are you'll see that
most of it boils
down to the fact that doctors can -- and do -- employ more expensive
drugs, procedures, and so on.

That's what I was attempting to communicate, there are many factors, but
the underlying commonality is corporate monopoly of the health care
industry.

I think this would take more time to sort out than either of us want to
give it.

Agreed.

Technology has brought down the costs of some treatments but it's
increased the cost of many more, and added hundreds, or thousands, of
completely new ones. Couple that with the malpractice insurance mess,
which leads to excessive testing and so on, and all of the technology
is simply employed more. Just amortizing an MRI machine results in
incredible costs for an MRI. I think my last one was $880, and took
maybe 30 minutes of machine time and the time of two technicians. It's
a multi-million-dollar machine and they charge shop time on
amortization, just like in a machine shop. g In the old days, they'd
just apply an educated guess to what's wrong in that joint or brain.

Not my point.

But it's *my* point, in response to your point. d8-) We do more in
medicine because we can.

Ok, we were speaking to different vectors.

Meantime, here's another one: I have a nice new insulin pump with
feedback sitting in a box next to me, to be stuck into/onto me
tomorrow. It cost $6,000. 35 years ago I had a 25-cent syringe and a
$10/month bottle of insulin, and that was it, pard'. Pumps didn't
exist. Neither did home blood-glucose monitoring. I just took a stab at
it -- literally. g I got lucky and survived it with my limbs,
kidneys, and eyes. Good luck for me.

And if you weren't forced to have health care would you have paid for
the pump?

Yes, now I would. I just went through six sessions of laser eye surgery
for PDR. I don't want to do it again. I'll pay for the best control I can
get.

Physicians Desk Reference? Dunno "PDR." Most diabetics would opt for
injections when the pump is out of pocket, except for those in extreme
distress.

Note, I've designed medical instrumentation. One product is not too
dissimilar to your insulin pump, it took a blood sample from a drip line
and tested for lactate acid giving real time results. I am very
familiar with the industry.

Well, maybe I should interview you for an article I've had in the can for
a year. It's about medical-device manufacturing and meeting the FDA and
customer requirements. I have eight interviews done, but I'm losing energy
for it.

Use my email in the header.

And it marches forward because people will pay for it, as an
alternative to living in misery or dying.

That substantiates my point. Let me give an example:

My daughter had her first yeast infection. A simple anti-fungal yeast
prescription was all that was required yet the doctor/hospital
demanded a pregnancy test (she was/is virgin), blood panels, hormone
tests, etc. running the price up to $4,600. Then they wanted to
negotiate. Note that not a single curative action was taken.

Right, but that's only marginally a "corporate powers" issue. That's
mostly a "we don't want to be sued" issue. Take it up with the tort
reformers. We can sure use some tort reform.

I don't think it is a tort issue but a corporate hospital trying to
fleece patients. The outcome was that we paid to prevent a negative
credit rating then sued in small claims recovering almost all the
charge. The judge read the riot act to the hospital agent.

OK, there are some of those.


Now, if you want to know what I do when I suspect a doctor/hospital is
just running up my costs to keep the cash flowing to their own lab, I
tell them "please write a prescription for the test procedure, and I'll
check around to see where I want it done." Then I go look up the
procedure and see if I really want to have it done at all.

Do you have health insurance?

Yup.

Most people take everything they can get
when the price is subsidized by insurance, a different situation arises
when cost is out of pocket.

I'm not most people. I try to protect my clients' money, or my customers'
money -- even the money of my service providers. It's a genetic trait,
because I come from a long line of hardboiled New England rock-farming
skinflints.

Not too different here, Scottish ancestry raised by Hoosier grandparents.

Most hospitals, particularly, are in desperate cash-flow situations
now. It's not greed that drives it. It's their survival.


In Argentina no prescription is required, just a visit to a local
pharmacy with a short discussion to an educated pharmacist and a $7
prescription which I mailed to her. Cured the infection in 3 days.

So, did she have this infection in the US or in Argentina?

In the USA, she's still in college.

Health Care is essentially unavailable in the US without insurance.
That is hijacking health care holding Americans hostage.

Actually, that's not the case. Emergency rooms can't refuse you, and
many people use ERs as their primary-care physicians. Then the rest of
us pay for it.

True but the root cause is that health care insurance is unavailable at
rational cost. Kaiser for my wife and I would be $1600/month in the USA
and is about $25 in Argentina.

So, Argentina has subsidized or government-run insurance. I'm all for it.

Kinda, sorta both. Immigrants can buy into the state system but each
municipality has an open clinic where the costs are very cheap. A
front/side chest x-ray cost about $13, dental extraction of molar with
abscess cost a friend $6.70, etc. I've bought into private health care
at a local hospital chain. Ambulance service is free, I used it two
nights running when semi-conscious and unable to drive. Heh, I had
_chicken_pox_ at my age... Never knew it could be life threatening...

There's always a ready market for new drugs and new medical
technology.

True, and sometimes the costs are justified. But recognize that a
full 60% of new drugs are governmentally subsidized through university
research then turned over to pharmaceuticals for manufacture and
distribution with but a bare tithe to the university while Abbott et.
al. gains usuary profits on our own tax dollar.

sigh I'm well aware of how that works. My last job in a medical
communication agency involved a drug on which Sanofi-Aventis had paid
something like $135 million in development costs, and $110 million in
pre-approval marketing costs (which was paying my salary). Then the FDA
decided not to approve the drug. So my company laid half of us off.
d8-)

The basic research on that drug was not from a university, however. I
know that a lot of the basic research is done in universities. What you
may not know is that the testing that the pharma companies have to go
through after some basic-science lab makes a discovery often costs ten
times more than the basic research.

I'm familiar with the problem. The FDA should be an advisory, not
regulatory, agency. All the special interest groups like, encourage,
support, and fund that evil.

I completely disagree about having the FDA become an advisory agency,

We disagree then. I see the FDA as a self-serving bureaucracy controlled
by special interests. I do not like the idea of a governmental agency
telling me what medicines or treatments I can, and can't, have.

for
the same reason we got the FDA in the first place. Those greedy corporate
types you're complaining about wouldn't mind killing many more people if
they could get away with it. Testing on humans first is the way to make
more money.

That is not what I propose. Let the FDA provide online, honest, data on
drugs and let the buyer comment and beware.

Note that I've actually been through the FDA approval process. Not
responsible but as an independent contractor responsible for adhering
to the requirements on glucose monitors, inhalation dispensers and
patient monitoring systems.

Generics, Canadian, and other sources are often 90% cheaper.

Of course. Generics just ride on the research, testing, post-marketing
studies and marketing that was done for the original drug. All they
have to recover is manufacturing costs and quality-control reporting.
In Canada, they have price controls and just refuse to allow the drug
companies to amortize research and development. The Canadians, and the
French, and the Brits, and everyone else knows that they can collect
those costs in the US.

How long do you think a pharmaceutical should have a monopoly? Is 17
years not enough?

It depends on how you structure it. Some kind of regulated, extended and
mandatory licensing would reduce prices and keep up enough income to
fund big trials. And it's the big clinical trials that cost most of the
money in pharma. Patented medicines are too expensive, but generics are
too cheap.

Precisely why I want to change the FDA to an advisory agency. Today it
costs roughly half a billion dollars to bring a drug to market, that is
irrational and runs the prices up so that the general tax fund must
subsidize use.

And do you believe that a patent monopoly gives the right to blackmail
public health?

Nope, the whole system is fairly broken.

Good.

Don't jump to the conclusion that I'm a socialist. Neither am I a
greedy capitalist extremist. There is a large grey area to discuss.

Don't like it? Talk to your congressman. The money has to come from
somewhere, or nobody will have any new drugs.

Ha! My congressman is John Doolittle. I've tried to consult him
previously and been denied because I didn't contribute to his campaign
funds. He is now about to be tried for corruption.

Placer County, California is about 40% Mor(m)on and they own the
political process.

Health care insurance is just another facade by those who have
plundered our economy. Have you tried to get a doctors appointment
without insurance?

Ask Larry.

Non responsive.

Oh, Larry is quite responsive, and he has no insurance. He's the one
to ask.

I have no US insurance and refuse to bankrupt ourselves paying. It's
impossible in California to get a doctors appointment without insurance
and it's actually cheaper to live in Argentina and commute back and
forth getting my healthcare there. It more than pays for
transportation.

Do you know our friend Hamei, who used to hang out here? He used to fly
to China for his dental work. Now he lives there.

No, I've only been in this newsgroup for a couple of years and then
sporadically.

I've had insurance without a break for decades, excepting one gap of a
few months when my COBRA ran out and I was having trouble getting new
insurance. (My doctors knew it, and took me anyway.) So I don't know
what it's like now.

You are one of the lucky, many cannot get insurance because they are
under employed, unemployed, homeless.

Yeah, we know. I'm very lucky. The year before last I paid insurance out
of my pocket for six months, and it cost me almost $7,000.

How would you change that inequity?

This transitions into the quality of care issue too. Another factor
we've not discussed is the costs caused by AMA monopoly of providers.
Midwives and alternative treatments have essentially been banned to
create a monopoly. Then there is the FDA making many drugs
prescription only. In fact some years ago the FDA stated that they
would have made many current over the counter drugs a prescription item
if they had it to do over. They are now trying to rectify that by
regulating vitamins, minerals and even tobacco.

We Americans have an aversion to reading about dead people who took
drugs they were told were OK.

**** happens. Life is not guaranteed safe. The government is only
permitted to regulate fraud and crime, not what we ingest.

It's a complex topic. We agree that there is no one cause, unless you
agree with me that governmentally mandated monopolies are the root
cause.

I'd have to see your analysis of that. My own experience in the
industry, which lasted only a little over four years, tells me something
different. But it's a tangle that needs to be untangled. On that, I'm
sure we agree.

Yup.

--
Regards, Curly
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