Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[Cooked Crack]

On 5/2/2019 at 6:45 PM, visionary said:

 

Lewis Black really hit rock bottom. From Daily Show correspondent to convicted billionaire opioId CEO.

Edited July 2, 2019 by Cooked Crack

[Busch1724]

43 minutes ago, Cooked Crack said:

 

 

 

Thoughts and prayers...

[Cooked Crack]

23 minutes ago, Busch1724 said:

 

 

Thoughts and prayers...

Would have been cheaper if they went this route. 

[China]

Trump officials tell one court Obamacare is failing and another it’s thriving

 

As they push a federal court to repeal the Affordable Care Act, Trump administration lawyers are arguing the law is no longer workable because Congress eliminated a penalty on people who don’t have health insurance.

 

But for months, senior administration officials and lawyers have been making the exact opposite case in other settings, a review of government reports, court filings and public statements made by Trump appointees shows.

 

In fact administration officials, including White House economists, this year repeatedly have hailed the strength of insurance marketplaces created by the 2010 law.

 

And in stark contrast to their claims in federal court in New Orleans, they have stressed that the 2017 legislation eliminating the so-called mandate penalty has had little to no impact on markets and consumers, let alone on the broader healthcare law, often called Obamacare or the ACA.

 

“Another year of stable enrollment,” Seema Verma, who oversees the marketplaces as administrator of the Centers for Medicare and Medicaid Services, crowed in March after the agency released a report showing 11.4 million people signed up for coverage on the marketplaces for 2019.

 

That was down only slightly from the 11.8 million consumers who signed up for 2018, before repeal of the mandate penalty took effect.

 

It’s unclear whether stable enrollment figures and statements from Verma and other administration officials will affect how the U.S. 5th Circuit Court of Appeals views the latest challenge to the healthcare law. The suit, brought by Texas and a group of other Republican-led states, threatens to strip health insurance from tens of millions of Americans and roll back the law’s protections for Americans with preexisting medical conditions.

 

Click on the link for the full article

[LadySkinsFan]

[visionary]

 

[AsburySkinsFan]

12 minutes ago, visionary said:

 

Or....oooorr.....or just maybe enact legislation that allows medicare and medicaid to negotiate prices with the pharmaceutical companies!

God why is it that we always have to do everything the hard way!?

[TheGreatBuzz]

Can someone give me the 30 second explanation why the same drug is 10 times more here than in a place like Canada? 

[twa]

16 minutes ago, TheGreatBuzz said:

Can someone give me the 30 second explanation why the same drug is 10 times more here than in a place like Canada? 

 

restricted market

 

add

 if you crave more

 

Quote

 

the Canadian government won't approve a drug for the Canadian market if it costs more than a government body deems appropriate.

https://reason.com/2018/01/03/are-canadian-pharmacies-the-solution-to/

 

 

Edited July 31, 2019 by twa

[Bang]

16 minutes ago, TheGreatBuzz said:

Can someone give me the 30 second explanation why the same drug is 10 times more here than in a place like Canada? 

because it can be.

pay it, or suffer. 
Capitalism, baby.

 

~Bang

[Cooked Crack]

23 minutes ago, TheGreatBuzz said:

Can someone give me the 30 second explanation why the same drug is 10 times more here than in a place like Canada? 

 

[PeterMP]

1 hour ago, TheGreatBuzz said:

Can someone give me the 30 second explanation why the same drug is 10 times more here than in a place like Canada? 

 

Okay.  When people talk about prices, a lot of times they are talking about the US sticker price vs. the government negotiated price in Canada.

 

So those numbers seem to be really large differences (e.g. 10X).

 

But most people don't pay US sticker prices because (US) insurance companies also negotiate discounts, and from there, if you don't have insurance for many drugs companies have some sort of discount program (generally, insurance negotiated prices aren't public knowledge).

 

(The epipen discussion in the above video is an example.  Most people aren't actually paying $300 because they have insurance.  And the company that make epipends has a discount program.

 

https://www.epipen.com/paying-for-epipen-and-generic

 

So unless you don't have insurance and don't qualify for the discount program or don't apply, you don't pay $300.  It is essentially a made up cost.)

 

With that said, most agree even negotiated prices in other countries are cheaper than the comparable price in the US.  Countries do a better job of negotiating prices than individual US insurance companies.  As part of that, there are drugs that you can't buy in a country like Canada that you can buy in the US.

 

No US insurance company has the power to say you can't sell this drug to anybody in the US.  Governments in other countries can (and do) so they have a better negotiating place.

 

The difference in per capita prescription drug spending between the US and other countries is tied to the differences in the prices and the fact that in the US people tend to take a more expensive mix of drugs.

 

(We were doing better in terms of prescription drugs because generics were much cheaper in the US 5-10 years ago.  But the price of generics in the US have gone up a lot the last few years.)

 

(and the video suggest that production costs dictate prices, which isn't true.  It is possible that the company that makes Solvaldi in the US could sell it for what the do in the UK and make a profit.)

Edited July 31, 2019 by PeterMP

[PeterMP]

@TheGreatBuzz

 

I should add where the stated price of drugs matter is the non-VA government programs that can't negotiate drug prices.

 

We, through the government, are over paying for prescription drugs (dramatically) compared to other countries.  It is affecting our government spending and deficit then.

 

It doesn't affect individuals (except in maybe some rare cases), but it is another way our government is subsidizing industry.

[China]

To Save Money, American Patients And Surgeons Meet In Cancun

 

CANCUN, Mexico — Donna Ferguson awoke in the resort city of Cancun before sunrise on a sweltering Saturday in July.

 

She wasn’t headed to the beach. Instead, she walked down a short hallway from her Sheraton hotel and into Galenia Hospital.

 

A little later that morning, a surgeon, Dr. Thomas Parisi, who had flown in from Wisconsin the day before, stood by Ferguson’s hospital bed and used a black marker to note which knee needed repair. “I’m ready,” Ferguson, 56, told him just before being taken to the operating room for her total knee replacement. For this surgery, she would not only receive free care but would receive a check when she got home.

 

The hospital costs of the American medical system are so high that it made financial sense for both a highly trained orthopedist from Milwaukee and a patient from Mississippi to leave the country and meet at an upscale private Mexican hospital for the surgery.

 

Ferguson gets her health coverage through her husband’s employer, Ashley Furniture Industries. The cost to Ashley was less than half of what a knee replacement in the United States would have been. That’s why its employees and dependents who use this option have no out-of-pocket copayments or deductibles for the procedure; in fact, they receive a $5,000 payment from the company, and all their travel costs are covered.

 

Parisi, who spent less than 24 hours in Cancun, was paid $2,700, or three times what he would get from Medicare, the largest single payer of hospital costs in the United States. Private health plans and hospitals often negotiate payment schedules using the Medicare reimbursement rate as a floor.

 

Click on the link for the full article

[Larry]

3 hours ago, China said:

To Save Money, American Patients And Surgeons Meet In Cancun

 

CANCUN, Mexico — Donna Ferguson awoke in the resort city of Cancun before sunrise on a sweltering Saturday in July.

 

She wasn’t headed to the beach. Instead, she walked down a short hallway from her Sheraton hotel and into Galenia Hospital.

 

A little later that morning, a surgeon, Dr. Thomas Parisi, who had flown in from Wisconsin the day before, stood by Ferguson’s hospital bed and used a black marker to note which knee needed repair. “I’m ready,” Ferguson, 56, told him just before being taken to the operating room for her total knee replacement. For this surgery, she would not only receive free care but would receive a check when she got home.

 

The hospital costs of the American medical system are so high that it made financial sense for both a highly trained orthopedist from Milwaukee and a patient from Mississippi to leave the country and meet at an upscale private Mexican hospital for the surgery.

 

Ferguson gets her health coverage through her husband’s employer, Ashley Furniture Industries. The cost to Ashley was less than half of what a knee replacement in the United States would have been. That’s why its employees and dependents who use this option have no out-of-pocket copayments or deductibles for the procedure; in fact, they receive a $5,000 payment from the company, and all their travel costs are covered.

 

Parisi, who spent less than 24 hours in Cancun, was paid $2,700, or three times what he would get from Medicare, the largest single payer of hospital costs in the United States. Private health plans and hospitals often negotiate payment schedules using the Medicare reimbursement rate as a floor.

 

Click on the link for the full article

 

I'm not getting something here.  

 

Supposedly, the doctor is getting three times what Medicare pays.  

 

And this is less than half of what the private insurer pays?  This insurer's standard payment is six times what Medicare pays?

[bcl05]

The vast majority of health care costs do not go to the doctors.  Most go to hospitals, facilities, administrators, etc.  There are countless middlemen between health care providers and patients.  When insurance pays for knee surgery, that cost can be astronomical, even if the actual physician payment is rather small.  So I can definitely imagine a situation where one could triple the payment to the physician but still cut overall costs in half by reducing all that overhead/logistical/facility fee type cost.  

 

Now, not all the infrastructure of our health care system is wasteful (though it is multiplicatively redundant) so I am not sure that cancun is a reasonable solution... 

[skinsmarydu]

I spent 3 weeks in the hospital this summer & have never seen more wasted plastic in my life...and I've been in the food industry for almost 35 years. 🤯

 

[Bozo the kKklown]

 

[gbear]

When talking about drug prices, there are a few things working against the U.S.  Start with the largest purchaser of the medicines which is the U.S. government through Medicare, Medicaid and other public insurance.  They are forbidden by law from negotiating drug prices.  The result is the biggest purchaser pays the highest prices.  Then come all of the other private insurances.  They can try to negotiate the prices down, but they are starting their negotiation from the high starting point of what the biggest consumer is paying.  "Woohoo.  We negotiated a 15% savings...from the highest possible price that the government is paying which is still 2 times the cost people in other countries pay."

 

Then there is the issue that happens with the very expensive drugs in this country for things like cancer, MS, and a lot of other chronic conditions.  The drugs are more expensive, so insurance companies have developed a tier system of copays.  However, the pharmaceutical companies have developed copay assistance plans where they pay the higher copays for the patients and then raise the total cost of the drug to recoup the copay assistance plans' costs.  For example, I took a drug tysabri for my MS.  The first year I took it, the sticker price for the drug was roughly 90k a year.  Because the drug was on the expensive tier of my blue cross, the copay was $65 a month instead of the usual $20 for most drugs.  The pharmaceutical company didn't want to lose customers over the difference in cost to the patients, so they did the logical thing and offered to pay the copay.  Now I paid $0 a month for the drug, and the next year the pharmaceutical raised the cost of the drug to $95k.  Coincidentally, 5k is not unusual as a maximum out of pocket for good medical insurance.  So even if the drug was my only expense, they wouldn't be out more than 5K by picking up my copays for their drug.  While the average insurance probably has a higher copay max than $5k, the people with MS are sicker on average so 5K might still be close to the max they would be out...and all the while they are still pocketing the money the insurance is paying for the drug which is still loosely based on the Medicare/Medicaid rate I talked about above ($90-95k).  The impact of the tiered medication system and the copay assistance plans doesn't end there.  Once I meet my out of pocket maximum, I am more likely to get other medical procedures and tests because they now cost me nothing.  For years, I delayed my MRI until after my copay for the year was paid (mostly not by me).

 

There are more problems related to regulation, availability and knowledge of alternative medicines in the U.S. which inflates the demand for what we have available here.  Add to this the U.S. consumer's constant search for the panacea of the day to cure what ails us, and our supply vs. demand curve is set to constantly overspend so we can overmedicate. 

 

I won't pretend this is all that causes us to overspend on medicines.  I left untouched what hospitals charge and dozens of other cost inflators to stick with a couple easily understood pressures.

[LadySkinsFan]

[Bozo the kKklown]

 

[Cooked Crack]

 

[Bozo the kKklown]

 

[LadySkinsFan]

And this is exactly why healthcare should NOT be tied to employment. An unwelcome aspect of wage slavery.

[Renegade7]

18 minutes ago, bearrock said:

 

@Renegade7 I think the obamacare thread is as good a place as any to discuss the substantive merits of the competing proposals.

 

I just want to say this from the context of the 2020 election, which I think belongs here.  From the beginning, my point was that many voters don't trust the government to not screw up something this big.  A big part of that is the sudden and abrupt change MFA calls for.  Which is why Buttigieg and Klobuchar says they want MFA in the long term, but advocates for a more gradual approach. 

 

The question that I and a lot of voters are asking is not whether MFA is better than the current system.  It is whether it is better than the other competing proposals by people like Buttigieg and Klobuchar.  Warren and Sanders, to my knowledge, have not addressed it and the longer they go on without addressing it, more and more questions it will raise in the minds of the voters.  Warren is already getting some heat on the clarity of her positions regarding healthcare (not totally fair, but it's a perception issue).  It's only going to increase going forward.

 

I'll make a deal with you: if you want to say 4 years is too fast, make your case here and show how the non-MFA candidates have defended it.  If you do, I'll post more evidence for why the no-compete candidates are saying we can't have competiting insurance packages for any elongated period of time.  Please read the links I posted in the Election thread before responding.

 

 

Edited September 28, 2019 by Renegade7