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Index » Radio Paradise/General » General Discussion » Capitalism and Consumerism... now what? Page: 1, 2, 3, 4, 5, 6  Next
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sdwright
Sink or Swim
sdwright Avatar

Location: underwater
Gender: Female
Zodiac: Taurus
Chinese Yr: Snake


Posted: Feb 18, 2018 - 9:06am

Keeps the U.S. spinning round and round...
miamizsun

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Location: (3261.3 Miles SE of RP)
Gender: Male


Posted: Feb 9, 2018 - 10:32am


the free market at work...
Red_Dragon

Red_Dragon Avatar



Posted: Jan 16, 2018 - 10:14am

The Invention of Capitalism: How a Self-Sufficient Peasantry was Whipped Into Industrial Wage Slaves
Lazy8
human
Lazy8 Avatar

Location: The Gallatin Valley of Montana
Gender: Male


Posted: Sep 1, 2016 - 1:00pm

My apologies for taking so long to reply. Been busy writing Karl Rove's speeches for him and drinking beer with my mom.

kcar wrote:
"But healthy people by and large already had insurance."

Not true.  

https://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_States

According to the United States Census Bureau, in 2012 there were 48.0 million people in the US (15.4% of the population) who were without health insurance.

The causes of this rate of uninsurance remain a matter of political debate. Rising insurance costs have contributed to a trend in which fewer employers are offering health insurance, and many employers are managing costs by requiring higher employee contributions. Many of the uninsured are the working poor or are unemployed. Others are healthy and choose to go without it. Some have been rejected by insurance companies and are considered "uninsurable". Some are without health insurance only temporarily. Some choose faith-based alternatives to health insurance.

...

It has been estimated that nearly one-fifth of the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage, and the remaining 56% need financial assistance (8.9% of all Americans). An estimated 5 million of those without health insurance are considered "uninsurable" because ofpre-existing conditions. A recent study concluded that 15% of people shopping online for health insurance are considered "uninsurable" because of a pre-existing condition, or for being overweight. This label does not necessarily mean they can never get health insurance, but that they will not qualify for standard individual coverage. People with similar health status can be covered via employer-provided health insurance, Medicare, or Medicaid.


So, yeah: 85% of people already had insurance, and those who didn't were disproportionately unhealthy. You haven't contradicted me here.

"If the ACA had been pitched honestly we'd have been told your rates will go up, the value will go down, and the extra you'll be spending will subsidize sick people who wouldn't otherwise have insurance there would be less to complain about today. You could make a case for that. But it wasn't pitched that way. It was sold dishonestly—even the name (Affordable Care Act) is a lie."

Wow, do you work for Karl Rove or some other purveyor of disinformation? No one had a firm idea prior to the start of the ACA about what was going to happen. The insurance companies like United HealthCare that lost big money over the past two years sure didn't. Many of them offered premiums that were too low—not out of some need to mislead people but because they miscalculated costs. The government didn't lie in its predictions about the number of healthy people who signed up for insurance; the latest figure is that about half the expected number signed up, which decreases the risk pool. It's a big problem, but it's not one that the federal government quietly knew would happen. 

Spare us your whining about elites manipulating pawns. The ACA was an initial step to the reform of massively complex and enormous health care system. It has correctable problems. So did Medicare and Medicaid during their first years. Or were those also nefarious schemes foisted upon us by our overlords?

Before I start on the actual substance of this I'd like to make a point about process.

Let's say for the moment that I actually did work for Karl Rove. That wouldn't change the argument. If you want to attack me personally I guess, um...go for it. I'm a big boy. If you want to attack the argument...try harder. Seriously. You're making this too easy.

Let's start with the mystery of what would actually happen after the passage of the ACA. Really? No one knew what was going to happen? How exactly is that an argument for a massive change in policy? Let's create an enormous new regulatory and entitlement regime—10K pages of regulations, 159 new agencies, 9K new employees at the IRS alone, not to mention all the state exchanges and insurance rule changes—and...see what happens?

I wasn't accusing the Obamacare supporters of lying about some arcane statistic, I was accusing them of lying about the overall effect of the act. That is, that it would lower insurance premiums for most people and not just slow the growth in insurance premium, but lower them. The number Obama himself cited over and over was "up to $2500 per family". If you're wondering, no that didn't happen.

Now maybe all those who said those things actually believed them. There were certainly enough pitchmen out there repeating those claims as if they did. Lots of people who actually know how insurance works told them (and us) differently, but that was in the way of passing a massive pile of legislation in Congress, and the way our press and pundit class keeps track of things passing a bill is all that matters. The effects of that bill are unimportant—one side won, the other lost, the scoreboard changes. And somehow piling on taxes and mandates for higher coverage and bringing more sick people into risk pools was supposed to lower costs. It was a ridiculous notion then as now, but it sold and that's all that counts.

Yes, we were lied to. We were (that is, congress was) sold an absurd set of lies, easily seen thru, but they were things people wanted to believe.

"Go ahead and argue that it was the right thing to do, and that the ends justified the means. But to do so means that the public isn't to be trusted with decisions like this. "

WTF is this supposed to mean? The ACA was in full public view in Congressional committee discussions and floor debates. There was a massive amount of analysis and discussion of the bill and the law after its passage. The general public, the health insurance companies, health care providers and state officials all had access to information and commented on that information. The ACA had no deep, dark secrets or lies foisted upon the public. Find some other conspiracy theory to push.

All 906 pages were available at some point to read, sure. Have you read it? Have you read 10% of it? I tried, but I have a life, as do most people. My midmost actually sat down and read the entire incomprehensible thing. When he was done he questioned the utility of it—even the Supreme Court didn't get thru the whole wretched mess when they were arguing over its constitutionality.

So as a practical matter the availability of the text of the bill is irrelevant to this question. Yes, it was debated. One party opposed it, one party praised it. Both sides were exaggerating or lying about (or at least ignorantly mis-predicting) the effects of it—but one side promised lower insurance costs and that interpretation resonated with what people wanted to be true. It wasn't, but people still have unrealistic expectations of what legislation can really accomplish, and here were congressional leaders—their champions!—and the president of the United States promising them a reduced-price (if not free) lunch and extra servings and for a while they fell for it.

If you reduced the stated aims of the ACA to get more people who don't currently have it health insurance, even at a higher cost to those who do you could claim mission accomplished. And it wouldn't have taken 906 pages of law to do that, or 159 new agencies. It also wouldn't have passed. So in a way I'm trying to give supporters of Obamacare the benefit of a doubt—that they had a noble goal and achieved it, but did so by misleading people about the side effects.

Or you could claim that you really meant all that about lowering insurance costs, in which case it was a dismal and easily-predicted failure.

BTW that 2.3% medical device tax was hardly a big deal. 

https://www.brookings.edu/opinions/5-questions-about-the-medical-device-tax-and-its-potential-for-repeal/

A report from the nonpartisan Congressional Research Service, released last week, concluded that the tax is unlikely to hurt the profits of device companies, estimating that it will reduce industry output and employment by no more than .2 percent. CRS states, “The effect on the price of health care, however, will most likely be negligible because of the small size of the tax and small share of health care spending attributable to medical devices.” A separate report from Ernst & Young last month finds that domestic revenues for medical technology firms grew 4 percent to $336 billion in 2013, the first year the tax went into effect – about the same rate from 2012, indicating that the industry seems financially stable for now.


It's also been suspended for two years as of Dec. 2015: 

http://www.fiercebiotech.com/medical-devices/updated-medical-device-tax-suspended-1-8t-federal-budget

It was a big deal not because the numbers are so enormous, but because it was such a stunningly economically illiterate thing to do at all.

Let's lower the cost of health care by...raising the cost of the products used to provide it. Seriously, could even a Keynesian make a case for this? And suspending the implementation of an a stupid policy does not justify the policy, nor make those who wrote it look less stupid.
kcar

kcar Avatar



Posted: Aug 30, 2016 - 1:09pm

 kurtster wrote:

You're kidding, right ?   We have to pass it to find out what's in it ?

You can keep your doctor.  You can keep your plan.

 

From Factcheck.org:  

It’s true that insurance companies discontinued health plans that had covered millions of people who had bought them directly rather than through an employer. That’s because those plans didn’t meet the coverage standards of the new law.

But those policyholders didn’t lose the ability to have insurance. In most cases, insurers offered them an alternative plan, though there were some instances of companies exiting the individual market altogether.

Whether offered an alternative or not, individuals could shop for insurance on the federal and state marketplaces, or through a broker or insurance carrier directly. Many were likely eligible for federal subsidies to help pay for insurance, resulting in better coverage and lower rates for some. But the specific plan they had was indeed discontinued. (More than half of those with canceled policies were likely to be eligible for federal assistance, according to Urban Institute research, and about 80 percent of all those buying plans on the exchanges are expected to qualify for subsidies, according to the Congressional Budget Office.)

The FactCheck.org piece reports on two estimates that calculate about 2.6 million people had to change policies because their existing policy didn't meet ACA coverage standards. 
From the same FactCheck article.  "AFP" stands for "Americans for Prosperity", a conservative 501(c)(4) non-profit political advocacy group. :

The AFP ad also makes the claim that “millions of people can’t see their own doctors,” but there’s no evidence that all those who had individual market policies discontinued ended up not being able to keep their own doctors. Anecdotally, we know of some folks who were able to keep the same doctor on a new insurance policy. But those are only a few individual stories. One of our guiding principles here is the saying, “The plural of anecdote is not data.” 


black321
See For Yourself
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Location: A sunset in the desert
Gender: Male
Zodiac: Capricorn
Chinese Yr: Horse


Posted: Aug 30, 2016 - 8:51am

 Lazy8 wrote:
 
So reimbursement rates have been driven down—but premiums are still up. How can that be? I have an explanation: the reimbursement rates for prescriptions are only a small fraction of the cost of healthcare, which is largely driven by other factors.

When you expand a risk pool by adding healthy people you spread he costs of covering sick people over more healthy people. But healthy people by and large already had insurance. There were exceptions: folks who didn't see the value proposition in insurance, since they weren't likely to need it and would just end up carrying the load for others. A lot of them still don't have insurance—it's cheaper to pay the penalty for not having insurance than it is to buy insurance. Or they wait until they get sick to get it, which is a strategy that works when they can't be turned down for a pre-existing condition.

If the ACA had been pitched honestly we'd have been told your rates will go up, the value will go down, and the extra you'll be spending will subsidize sick people who wouldn't otherwise have insurance there would be less to complain about today. You could make a case for that. But it wasn't pitched that way. It was sold dishonestly—even the name (Affordable Care Act) is a lie.

Go ahead and argue that it was the right thing to do, and that the ends justified the means. But to do so means that the public isn't to be trusted with decisions like this. They're just pawns to be manipulated by elites who know what's best for us and we should just shut up and pay the bill.
 
Rates are going down for care providers as well.  Again, go read a 10K of a hospital group like HCA or Tenet Health if you are so inclined.

Health care is essentially a commodity that everyone needs and the best if not only way to lower costs is to include everyone in the insured pool to reduce volatility, which will lower costs.  The expected losses or the amount of people getting sick and getting care will not change (unless of course you dont provide care for uninsured when they get sick, or conversely factor in the fact that with more insured, people will take preventive measures and use the emergency rooms less). 

p.s, for what it's worth,  I'm not arguing for or against ACA specifically, but I am for some form of universal care where everyone has health care coverage. 
kurtster

kurtster Avatar

Location: drifting
Gender: Male
Zodiac: Libra
Chinese Yr: Dragon


Posted: Aug 30, 2016 - 5:28am

 kcar wrote:

"Go ahead and argue that it was the right thing to do, and that the ends justified the means. But to do so means that the public isn't to be trusted with decisions like this. " 

WTF is this supposed to mean? The ACA was in full public view in Congressional committee discussions and floor debates. There was a massive amount of analysis and discussion of the bill and the law after its passage. The general public, the health insurance companies, health care providers and state officials all had access to information and commented on that information. The ACA had no deep, dark secrets or lies foisted upon the public. Find some other conspiracy theory to push.
 

 
You're kidding, right ?   We have to pass it to find out what's in it ?

You can keep your doctor.  You can keep your plan.




kcar

kcar Avatar



Posted: Aug 30, 2016 - 1:41am

 Lazy8 wrote:
 black321 wrote:
And we have ample examples of how unregulated markets led to deaths, financial collapse...

Pick any drug company 10q or 10k (manufacturing to retail) and you will see comments on how reduced reimbursement rates are hurting profit margins.

As for ACA, it could have been packaged a lot better, but i rather have a system we're everyone is insured than not.  Insurance 101 - Diversify your risk pool...get everyone in the pool or else you have adverse selection.  If ACA is allowed to play out, in the long run the costs should be more evenly spread out. With increased diversification, volatility drops and so does risk, which is a cost and will lead to a lower price.

Inevitably we all need health care. Previously, the insured where already paying the cost of the uninsured...through bad debt expense passed on to the consumer.   Unless you completely deregulate health care and allow doctors to turn away patients without insurance, or demand cash up front, you need everyone in the pool to pay their share.  And I believe everyone, regardless of means, should have access to health care. 

Yes, those examples are called anecdotes. I can find some too! Wouldn't it be fun to compare? We could both do sanctimonious do it for little Wanda pleas based on them. It'll be fun!

So reimbursement rates have been driven down—but premiums are still up. How can that be? I have an explanation: the reimbursement rates for prescriptions are only a small fraction of the cost of healthcare, which is largely driven by other factors.

When you expand a risk pool by adding healthy people you spread he costs of covering sick people over more healthy people. But healthy people by and large already had insurance. There were exceptions: folks who didn't see the value proposition in insurance, since they weren't likely to need it and would just end up carrying the load for others. A lot of them still don't have insurance—it's cheaper to pay the penalty for not having insurance than it is to buy insurance. Or they wait until they get sick to get it, which is a strategy that works when they can't be turned down for a pre-existing condition.

If the ACA had been pitched honestly we'd have been told your rates will go up, the value will go down, and the extra you'll be spending will subsidize sick people who wouldn't otherwise have insurance there would be less to complain about today. You could make a case for that. But it wasn't pitched that way. It was sold dishonestly—even the name (Affordable Care Act) is a lie.

Go ahead and argue that it was the right thing to do, and that the ends justified the means. But to do so means that the public isn't to be trusted with decisions like this. They're just pawns to be manipulated by elites who know what's best for us and we should just shut up and pay the bill.
 
"But healthy people by and large already had insurance."

Not true.  

https://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_States

According to the United States Census Bureau, in 2012 there were 48.0 million people in the US (15.4% of the population) who were without health insurance.

The causes of this rate of uninsurance remain a matter of political debate. Rising insurance costs have contributed to a trend in which fewer employers are offering health insurance, and many employers are managing costs by requiring higher employee contributions. Many of the uninsured are the working poor or are unemployed. Others are healthy and choose to go without it. Some have been rejected by insurance companies and are considered "uninsurable". Some are without health insurance only temporarily. Some choose faith-based alternatives to health insurance.

...

It has been estimated that nearly one-fifth of the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage, and the remaining 56% need financial assistance (8.9% of all Americans). An estimated 5 million of those without health insurance are considered "uninsurable" because ofpre-existing conditions. A recent study concluded that 15% of people shopping online for health insurance are considered "uninsurable" because of a pre-existing condition, or for being overweight. This label does not necessarily mean they can never get health insurance, but that they will not qualify for standard individual coverage. People with similar health status can be covered via employer-provided health insurance, Medicare, or Medicaid. 

"If the ACA had been pitched honestly we'd have been told your rates will go up, the value will go down, and the extra you'll be spending will subsidize sick people who wouldn't otherwise have insurance there would be less to complain about today. You could make a case for that. But it wasn't pitched that way. It was sold dishonestly—even the name (Affordable Care Act) is a lie."

Wow, do you work for Karl Rove or some other purveyor of disinformation? No one had a firm idea prior to the start of the ACA about what was going to happen. The insurance companies like United HealthCare that lost big money over the past two years sure didn't. Many of them offered premiums that were too low—not out of some need to mislead people but because they miscalculated costs. The government didn't lie in its predictions about the number of healthy people who signed up for insurance; the latest figure is that about half the expected number signed up, which decreases the risk pool. It's a big problem, but it's not one that the federal government quietly knew would happen. 

Spare us your whining about elites manipulating pawns. The ACA was an initial step to the reform of massively complex and enormous health care system. It has correctable problems. So did Medicare and Medicaid during their first years. Or were those also nefarious schemes foisted upon us by our overlords? 

"Go ahead and argue that it was the right thing to do, and that the ends justified the means. But to do so means that the public isn't to be trusted with decisions like this. " 

WTF is this supposed to mean? The ACA was in full public view in Congressional committee discussions and floor debates. There was a massive amount of analysis and discussion of the bill and the law after its passage. The general public, the health insurance companies, health care providers and state officials all had access to information and commented on that information. The ACA had no deep, dark secrets or lies foisted upon the public. Find some other conspiracy theory to push.
 
 
BTW that 2.3% medical device tax was hardly a big deal. 

https://www.brookings.edu/opinions/5-questions-about-the-medical-device-tax-and-its-potential-for-repeal/


A report from the nonpartisan Congressional Research Service, released last week, concluded that the tax is unlikely to hurt the profits of device companies, estimating that it will reduce industry output and employment by no more than .2 percent. CRS states, “The effect on the price of health care, however, will most likely be negligible because of the small size of the tax and small share of health care spending attributable to medical devices.” A separate report from Ernst & Young last month finds that domestic revenues for medical technology firms grew 4 percent to $336 billion in 2013, the first year the tax went into effect – about the same rate from 2012, indicating that the industry seems financially stable for now. 



It's also been suspended for two years as of Dec. 2015: 

http://www.fiercebiotech.com/medical-devices/updated-medical-device-tax-suspended-1-8t-federal-budget 


kurtster

kurtster Avatar

Location: drifting
Gender: Male
Zodiac: Libra
Chinese Yr: Dragon


Posted: Aug 29, 2016 - 8:06pm

 NoEnzLefttoSplit wrote:

fair point.. there are some exciting candidates out there for treating cancer. Wonder how many lives they would save if released now.

 
fwiw ... I am probably alive today simply because a drug I needed to produce stem cells for harvest just came out of clinicals within a month before I received it.  I was either the first or one of the first to use it, post clinicals, can't remember.  That and I was already being treated at one of only 4 hospitals in the country that was authorized to use it.  If it came out a month or two later, and / or was being treated somewhere else, I more than likely would not be here today.

Things take time.  People die waiting all the time.  Problem is when that time is manipulated improperly by thumbs on the scale and there is a lot of that for many different reasons.  Eliminating or thwarting competition via regulations is one of the most prevalent reasons, however.  Viagra is one great example of that process.  Reported waiting times versus actual waiting times at the VA that kill people is another example of a corrupt system.

Proximity to care is another issue and one that will not be solved by UHC.  We will not have a Cleveland Clinic on every corner.  I got my sister to actually come up from Dallas this past week to see my hematologist / oncologist and got her an appointment within a week of asking.  Long story short, what I have gathered so far, is that the care she was about to receive in Dallas may have caused her more harm than good.  She's now in some of the best hands in the world getting competent care.  Its also one of the reasons I can never move away from Cleveland.  I'll never find the level of care that I have here anywhere else.  That and I know who are the good doctors or how to find out, which is another part of the equation.

UHC will not solve the problems that we want it to solve.  It will just lower the overall standard of care for everyone.  More, not less will die as a result.  Is that what we really want ?
 
Lazy8
human
Lazy8 Avatar

Location: The Gallatin Valley of Montana
Gender: Male


Posted: Aug 29, 2016 - 4:34pm

 black321 wrote:
And we have ample examples of how unregulated markets led to deaths, financial collapse...

Pick any drug company 10q or 10k (manufacturing to retail) and you will see comments on how reduced reimbursement rates are hurting profit margins.

As for ACA, it could have been packaged a lot better, but i rather have a system we're everyone is insured than not.  Insurance 101 - Diversify your risk pool...get everyone in the pool or else you have adverse selection.  If ACA is allowed to play out, in the long run the costs should be more evenly spread out. With increased diversification, volatility drops and so does risk, which is a cost and will lead to a lower price.

Inevitably we all need health care. Previously, the insured where already paying the cost of the uninsured...through bad debt expense passed on to the consumer.   Unless you completely deregulate health care and allow doctors to turn away patients without insurance, or demand cash up front, you need everyone in the pool to pay their share.  And I believe everyone, regardless of means, should have access to health care. 

Yes, those examples are called anecdotes. I can find some too! Wouldn't it be fun to compare? We could both do sanctimonious do it for little Wanda pleas based on them. It'll be fun!

So reimbursement rates have been driven down—but premiums are still up. How can that be? I have an explanation: the reimbursement rates for prescriptions are only a small fraction of the cost of healthcare, which is largely driven by other factors.

When you expand a risk pool by adding healthy people you spread he costs of covering sick people over more healthy people. But healthy people by and large already had insurance. There were exceptions: folks who didn't see the value proposition in insurance, since they weren't likely to need it and would just end up carrying the load for others. A lot of them still don't have insurance—it's cheaper to pay the penalty for not having insurance than it is to buy insurance. Or they wait until they get sick to get it, which is a strategy that works when they can't be turned down for a pre-existing condition.

If the ACA had been pitched honestly we'd have been told your rates will go up, the value will go down, and the extra you'll be spending will subsidize sick people who wouldn't otherwise have insurance there would be less to complain about today. You could make a case for that. But it wasn't pitched that way. It was sold dishonestly—even the name (Affordable Care Act) is a lie.

Go ahead and argue that it was the right thing to do, and that the ends justified the means. But to do so means that the public isn't to be trusted with decisions like this. They're just pawns to be manipulated by elites who know what's best for us and we should just shut up and pay the bill.

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Posted: Aug 29, 2016 - 4:12pm

 black321 wrote:

And we have ample examples of how unregulated markets led to deaths, financial collapse...

Pick any drug company 10q or 10k (manufacturing to retail) and you will see comments on how reduced reimbursement rates are hurting profit margins.

As for ACA, it could have been packaged a lot better, but i rather have a system we're everyone is insured than not.  Insurance 101 - Diversify your risk pool...get everyone in the pool or else you have adverse selection.  If ACA is allowed to play out, in the long run the costs should be more evenly spread out. With increased diversification, volatility drops and so does risk, which is a cost and will lead to a lower price.

Inevitably we all need health care. Previously, the insured where already paying the cost of the uninsured...through bad debt expense passed on to the consumer.   Unless you completely deregulate health care and allow doctors to turn away patients without insurance, or demand cash up front, you need everyone in the pool to pay their share.  And I believe everyone, regardless of means, should have access to health care.  
 
Universal Health Care is the responsible future.  HC belongs in the public sector.  Everyone needs, uses, or benefits directly and indirectly, by its availability.
Think police, fire, roads, education, national defense, libraries, all manner of publicly funded and very widely, if not universally, available services.

Better thinkers and writers than I can articulate the case for UHC.  Imo, arguing against UHC is in some way inevitably a defense of (sometimes exorbitant) profit at the expense of the ill.

$600 epipens —I know, you get two (approx $4 each manufacturing cost) is today's poster child of HC-for-profit excesses. Vastly more egregious examples can easily be found

The ACA is/was a very imperfect first step to UHC. There are many ways to get to UHC.   How many people financially ruined by an illness before we act? 


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Posted: Aug 29, 2016 - 2:58pm

 Lazy8 wrote:
 Well, we do have pretty much the whole of human experience to compare, and it's pretty obvious that freer markets = more of the bulletted tendencies. We ran this big experiment on it; we called it the 20th century. Pretty conclusive. If you need a reference...

I'm failing to see which rates the ACA is supposed to have lowered. It accomplished its number one goal: more people have insurance. That happened because people who already had insurance are now paying for those that didn't, so their rates went up. The people who didn't have it generally cost more to insure, so adding people to the pool made things cost more, not less.

There was no serious effort to reduce the actual cost of medical care, just to shift it.


 
And we have ample examples of how unregulated markets led to deaths, financial collapse...

Pick any drug company 10q or 10k (manufacturing to retail) and you will see comments on how reduced reimbursement rates are hurting profit margins.

As for ACA, it could have been packaged a lot better, but i rather have a system we're everyone is insured than not.  Insurance 101 - Diversify your risk pool...get everyone in the pool or else you have adverse selection.  If ACA is allowed to play out, in the long run the costs should be more evenly spread out. With increased diversification, volatility drops and so does risk, which is a cost and will lead to a lower price.

Inevitably we all need health care. Previously, the insured where already paying the cost of the uninsured...through bad debt expense passed on to the consumer.   Unless you completely deregulate health care and allow doctors to turn away patients without insurance, or demand cash up front, you need everyone in the pool to pay their share.  And I believe everyone, regardless of means, should have access to health care. 

 


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Posted: Aug 29, 2016 - 2:17pm

 black321 wrote:
Your bullets include a number of assumptions that are as easy to prove as the existence of God....since we've never actually seen a true "free market."  There are costs to both regulations and competitive markets.  Again, the key is to find the right balance. 

As for the ACA and consolidation, you are right.  The ACA's impact on lowering rates has created an environment where more cos. are chasing scale to maintain profits.  

Well, we do have pretty much the whole of human experience to compare, and it's pretty obvious that freer markets = more of the bulletted tendencies. We ran this big experiment on it; we called it the 20th century. Pretty conclusive. If you need a reference...

I'm failing to see which rates the ACA is supposed to have lowered. It accomplished its number one goal: more people have insurance. That happened because people who already had insurance are now paying for those that didn't, so their rates went up. The people who didn't have it generally cost more to insure, so adding people to the pool made things cost more, not less.

There was no serious effort to reduce the actual cost of medical care, just to shift it.
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Posted: Aug 29, 2016 - 1:22pm

 Lazy8 wrote:

Yes, actually, you are railing against capitalism. Scroll down.

I don't mean to imply (and don't think I did) that everything would be perfect if the market in medical devices were free. A free market guarantees no particular outcome, but it does tend toward:
  • Efficiency—inefficient operators are out-competed
  • Variety—if there's money to be made filling a niche someone will try to make that money
  • Innovation—you can't improve your competitive position without improving product, price, or delivery
  • Accountability—when a business treats you poorly you can take your trade elsewhere
The cost of regulatory compliance adds barriers to entry into markets. Got a great idea for a new drug or device? Get started! It will be a decade or more before the company you start can make a dime on your investment. Both large and small companies can innovate but when a small company does it the goal nowadays is to be acquired by a large company. There's no realistic hope for a startup in pharma to make it to the stock exchange on its own, and the business has been consolidating—companies are merging/acquiring to spread that regulatory burden over more volume.

The ACA has accelerated that trend. It had a lot of effects on pharma, some of them easily predictable (the medical device tax raising the cost of medical devices, for instance) and some of them less so (pharma companies rebating directly to consumers to cover increased co-pays on some name-brand drugs).

 
My opinion is that the "tendency toward efficiency" of the unregulated, un-interefered with global or national economy is rather chimerical. (Not to say that our system is all that efficient).
As far as innovation goes, the US instituted regulation/interference in the form of a patent system to encourage innovation (they weren't the first, but they thought it important enough to devote a clause in the Constitution giving Congress specific power to engage in such promotion of innovation). It seems to have worked so well that most other advanced economies have copied it. We have no examples of unregulated economies free of patent systems that are out-innovating us.


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Posted: Aug 29, 2016 - 1:12pm

 Lazy8 wrote:

Yes, actually, you are railing against capitalism. Scroll down.

I don't mean to imply (and don't think I did) that everything would be perfect if the market in medical devices were free. A free market guarantees no particular outcome, but it does tend toward:
  • Efficiency—inefficient operators are out-competed
  • Variety—if there's money to be made filling a niche someone will try to make that money
  • Innovation—you can't improve your competitive position without improving product, price, or delivery
  • Accountability—when a business treats you poorly you can take your trade elsewhere
The cost of regulatory compliance adds barriers to entry into markets. Got a great idea for a new drug or device? Get started! It will be a decade or more before the company you start can make a dime on your investment. Both large and small companies can innovate but when a small company does it the goal nowadays is to be acquired by a large company. There's no realistic hope for a startup in pharma to make it to the stock exchange on its own, and the business has been consolidating—companies are merging/acquiring to spread that regulatory burden over more volume.

The ACA has accelerated that trend. It had a lot of effects on pharma, some of them easily predictable (the medical device tax raising the cost of medical devices, for instance) and some of them less so (pharma companies rebating directly to consumers to cover increased co-pays on some name-brand drugs).

 

Your bullets include a number of assumptions that are as easy to prove as the existence of God....since we've never actually seen a true "free market."  There are costs to both regulations and competitive markets.  Again, the key is to find the right balance. 

As for the ACA and consolidation, you are right.  The ACA's impact on lowering rates has created an environment where more cos. are chasing scale to maintain profits. 
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Posted: Aug 29, 2016 - 12:24pm

 Lazy8 wrote:
 NoEnzLefttoSplit wrote:
hmm... there are reasons for those controls.. to stop patients getting killed by new treatments for instance.

There's always a good reason. But there's always a burden imposed by the control. That burden isn't always visible, but it's real. How many people died from AIDS while AZT was in late clinicals? The approval process helped kill them.

We count the cost of releasing a drug too early but we don't count the cost of releasing a drug too late. Just pointing out that that cost is not zero, and we don't let patients and doctors balance and manage the risk/reward ratio of new treatments. The FDA makes that call for them, and it only sees the downside of saying "yes", never the upside.

 
fair point.. there are some exciting candidates out there for treating cancer. Wonder how many lives they would save if released now.
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Posted: Aug 29, 2016 - 12:21pm

 NoEnzLefttoSplit wrote:
hmm... there are reasons for those controls.. to stop patients getting killed by new treatments for instance.

There's always a good reason. But there's always a burden imposed by the control. That burden isn't always visible, but it's real. How many people died from AIDS while AZT was in late clinicals? The approval process helped kill them.

We count the cost of releasing a drug too early but we don't count the cost of releasing a drug too late. Just pointing out that that cost is not zero, and we don't let patients and doctors balance and manage the risk/reward ratio of new treatments. The FDA makes that call for them, and it only sees the downside of saying "yes", never the upside.
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Posted: Aug 29, 2016 - 12:15pm

 Lazy8 wrote:

Yes, actually, you are railing against capitalism. Scroll down.

I don't mean to imply (and don't think I did) that everything would be perfect if the market in medical devices were free. A free market guarantees no particular outcome, but it does tend toward:
  • Efficiency—inefficient operators are out-competed
  • Variety—if there's money to be made filling a niche someone will try to make that money
  • Innovation—you can't improve your competitive position without improving product, price, or delivery
  • Accountability—when a business treats you poorly you can take your trade elsewhere
The cost of regulatory compliance adds barriers to entry into markets. Got a great idea for a new drug or device? Get started! It will be a decade or more before the company you start can make a dime on your investment. Both large and small companies can innovate but when a small company does it the goal nowadays is to be acquired by a large company. There's no realistic hope for a startup in pharma to make it to the stock exchange on its own, and the business has been consolidating—companies are merging/acquiring to spread that regulatory burden over more volume.

The ACA has accelerated that trend. It had a lot of effects on pharma, some of them easily predictable (the medical device tax raising the cost of medical devices, for instance) and some of them less so (pharma companies rebating directly to consumers to cover increased co-pays on some name-brand drugs).

 
hmm... there are reasons for those controls.. to stop patients getting killed by new treatments for instance.
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Posted: Aug 29, 2016 - 12:11pm

 black321 wrote:
Now don't go putting words in my mouth.  I'm not railing against capitalism.  It's an economic system and probably the best one we've been able to come up with to date. But it is not perfect.  And neither are regulations.  It's ying/yang, good/bad, every silver lining got's a touch grey...human nature to f#$k it up.  You seem to imply if we had truly "free markets" everything would be peaches and cream and abuse would disappear.  I don't believe that, end of story.  So it's push and pull from both sides to get the best of what we can get. 

p.s., ACA has resulted in increased pressure to reduce Rx reimbursement rates and the only change to the delivery model is that more retailers are using distributors/wholesalers for generics instead of buying direct (looking to share procurement/scale savings)

 
Yes, actually, you are railing against capitalism. Scroll down.

I don't mean to imply (and don't think I did) that everything would be perfect if the market in medical devices were free. A free market guarantees no particular outcome, but it does tend toward:
  • Efficiency—inefficient operators are out-competed
  • Variety—if there's money to be made filling a niche someone will try to make that money
  • Innovation—you can't improve your competitive position without improving product, price, or delivery
  • Accountability—when a business treats you poorly you can take your trade elsewhere
The cost of regulatory compliance adds barriers to entry into markets. Got a great idea for a new drug or device? Get started! It will be a decade or more before the company you start can make a dime on your investment. Both large and small companies can innovate but when a small company does it the goal nowadays is to be acquired by a large company. There's no realistic hope for a startup in pharma to make it to the stock exchange on its own, and the business has been consolidating—companies are merging/acquiring to spread that regulatory burden over more volume.

The ACA has accelerated that trend. It had a lot of effects on pharma, some of them easily predictable (the medical device tax raising the cost of medical devices, for instance) and some of them less so (pharma companies rebating directly to consumers to cover increased co-pays on some name-brand drugs).


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Posted: Aug 29, 2016 - 8:57am

 Lazy8 wrote:

Capitalism didn't fail, a market was constrained from providing a solution to a problem by regulatory intervention. The market didn't provide an outcome you find desirable, but its mechanisms functioned as they were allowed to. Mylan tried to maximize the money it made, and it worked the system. The incentives in that system made that result all but inevitable. And that system is anything but a free market.

The profit motive provides the food you eat, the clothes you wear, the roof over your head, the computer you're using to argue against it. I daresay it works on you too: you work for pay.* The profit motive and the markets it engenders provide the vast bounty of things you enjoy. It works everywhere...except healthcare?

Oh, sure, you can buy aspirin for pennies. Competing compounds as well; bandages, toothpaste, antibiotic ointments (ponder for a moment what a miracle Neosporin would have seemed to Karl Marx), sophisticated devices for taking care of your teeth—all sold at a profit by greedy industrialists—but that's not real healthcare! No way could mere grubby businessmen deliver real healthcare! Healthcare should be untainted by commerce, pure, driven only by faceless bureaucrats with no stake in successful outcomes.

Please. Rail against those greedy capitalists all you like but don't imagine for a moment you can do without them and their filthy profit motive.

So the market created an inefficient, burdensome system to inject middlemen into the delivery of drugs, contrary to previous practice. And this only happened in the last few years. Somehow all those greedy businessmen at both ends of the drug delivery system decided to cut someone else in on their trade. I wonder what miracle of capitalism caused that?

Tell me, what else happened in the last few years? Anything ringing a bell?

*Unless you're a trustafarian whose parents took advantage of that filthy incentive to amass a fortune big enough to free their offspring from the drudgery of toil and invested it—with the goal of making a profit!—to keep you in clothes and computers.

 
Now don't go putting words in my mouth.  I'm not railing against capitalism.  It's an economic system and probably the best one we've been able to come up with to date. But it is not perfect.  And neither are regulations.  It's ying/yang, good/bad, every silver lining got's a touch grey...human nature to f#$k it up.  You seem to imply if we had truly "free markets" everything would be peaches and cream and abuse would disappear.  I don't believe that, end of story.  So it's push and pull from both sides to get the best of what we can get. 

p.s., ACA has resulted in increased pressure to reduce Rx reimbursement rates and the only change to the delivery model is that more retailers are using distributors/wholesalers for generics instead of buying direct (looking to share procurement/scale savings)
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