Health care problems and solutions in politics

[Radagast]

Require all employers with at least 25 employees to include health insurance benefits to part and full time workers.

As a non-American, it seems to me that the downside of tying insurance to employment is that it makes losing your job even worse.

Put a low price cap on brand name drugs for people whose doctors submit forms they can't take the generic drug.

Is there really anybody who can't take the generic drug? They are identical, after all.

Now I think we handle pharmaceuticals quite well in Australia. There is a massive government subsidy, but drugs are not totally free. In addition, the government leverages its bargaining power to keep prices down. However, the downside is that the latest and most expensive drugs are not available in Australia. No system is perfect.

 

[GodLovesCats]

Radagast, neurologists told me they have seen problems with the generic form of one of my medications. They prescribe the brand name version of that drug. When I asked why, the answer was it is an old drug. There is no reason to doubt this can happen with a variety of medications for different purposes. NO they are NOT always identical!

 

[Radagast]

Radagast, neurologists told me they have seen problems with the generic form of one of my medications. They prescribe the brand name version of that drug. When I asked why, the answer was it is an old drug.

That seems incomprehensible to me. Over here, "generic" means same drug, same dose, different manufacturer.

I can see that there might be difference between different extended-release formulations of the same drug, but under those circumstances, the FDA in the United States generally acts to have the inferior drug declared not to be a generic equivalent.

 

[GodLovesCats]

Radagast, even though it is the same drug, sometimes quality decreases when other companies make the medication. Not all drugs are worse in their generic form, but one I used to take it. For some patients, the generics are less effective. Other patients have problems with the different inert ingredients.

 

[GodLovesCats]

Moving past our personal stories, what do you all think is the best plan for changing the system to having public health care for every American, not just the poor, old, and disabled?

 

[Radagast]

Radagast, even though it is the same drug, sometimes quality decreases when other companies make the medication.

If that's true, it's illegal, and people should go to jail. If the box says "amoxicillin 500 mg," then every tablet or capsule should contain 500 mg of amoxicillin.

The one exception I can think of (and this relates to neurology) is that there might be a difference between different extended-release formulations of the same drug. That is, both tablets contain the exact same amount of the exact same drug, but one releases it "more evenly" during the day, and hence has better outcomes.

However, like I said, under those circumstances, the FDA in the United States generally acts to have the inferior drug declared not to be a generic equivalent.

For example, there were two generic extended-release formulations of methylphenidate on sale, supposedly equivalent to Concerta, but there were problems with the way that the generics released the drug during the day, and these made a genuine difference to the children taking them. The FDA took action to have them not listed as generics for Concerta.

 

[Radagast]

Moving past our personal stories, what do you all think is the best plan for changing the system to having public health care for every American, not just the poor, old, and disabled?

One problem is that there simply isn't enough money to give everyone the healthcare they could usefully receive. Some rationing has to happen.

Who is best equipped to decide on rationing: the patient, the insurance company, the hospital, or the government?

Here in Australia, we go with a combination system: quite good public healthcare that has long waiting lists for non-urgent cases; and an optional insurance-based system that's heavily regulated, and therefore not predatory. I like what we've got.

 

[GodLovesCats]

There is no difference in the dose size. It is all about the quality. Nothing is illegal; it is just some patients have bad responses to generic forms of certian drugs.

 

[Radagast]

There is no difference in the dose size. It is all about the quality. Nothing is illegal

Selling poor-quality drugs is very definitely illegal.

it is just some patients have bad responses to generic forms of certian drugs.

Like I said, the one situation where I can see that happening is with different extended-release versions of the same drug.

 

[GodLovesCats]

I thought an Aussie described a single payer system earlier.

IMO if stricter rules are placed on healht inssurance companies, we can make them work better. But none of them can be more effective than a government funded system because they are all for profit.

 

[GodLovesCats]

Not poor quality drugs, but lesser quality than the original. Part of the problem is when I get generics not all pills look the same. Companies make them in different shapes and colors. Sometimes the pill sizes are different by dimensions for the same milligram amount. That stuff shows they only care about the dosage and active ingredient.

It is a problem for regular pills too, not just the extended release forms.

 

[Radagast]

I thought an Aussie described a single payer system earlier.

We don't have a "single-payer" system. We have:

1. Heavily subsidised pharmaceutical items, so that a typical pack of tablets costs around $20 at the pharmacy. The benefit here is the government's bargaining power, which keeps costs down. The downside is that not all drugs are on the approved list -- some of the newer or more expensive drugs we just can't get here.

2. Subsidised GP visits, so that a GP visit costs between $0 and $100, depending on the doctor.

3. Free public hospitals. These are fantastic for emergency conditions, but have very long waiting lists for elective surgery.

4. A large private hospital system covered by health insurance. The insurance companies are heavily regulated but also very efficient and competitive (for example, most claims are handled by computers -- nobody processes paper forms). This system works well for most people.

But none of them can be more effective than a government funded system because they are all for profit.

This would be the same government that pays $10,000 for Air Force toilet seats? The government wastes a lot of money.

 

[GodLovesCats]

I can't comment on the toilet seats, but yes, the government does waste a lot of money.

 

[MorkandMindy]

This is an unusual instance. The complications include that the plane is long out of production so the part is unavailable. It is not a toilet seat, it is a cover that goes next to the toilet and is a weird shape. I agree it is a crazy amount to pay. I would have thought that after making the mold they could have done a production run for 100 each and put them back in stock.

Apparently there is no conflict over intellectual property so they are now planning to make any future covers and similar items by 3D printing at 300 dollars each.

 

[MorkandMindy]

...

This would be the same government that pays $10,000 for Air Force toilet seats? The government wastes a lot of money.

The medical system/total mess wastes more than 10,000 dollars on each bureaucrat and administrator involved in the immensely complex maze wasting their own lives and everyone else's money.

I have been on the left since the 1970s and never understood the complaints of the right about big government and regulations.

Now that I've found myself without medical cover I've had to read the rules to make my appeals,

just have a quick look at one document: Social Security Act §1905

 

[MorkandMindy]

Not in my case. I've been months without my blood pressure medication, the medical system includes a lot of people in my category who are very inexpensive but have simple long term problems. My medication costs 8 dollars a month. I'm not allowed to buy it without a doctor's prescription which requires a doctors appointment and that means a yearly one because I haven't had one for a long time, and that costs big money.

I can drive 5 hours down into Mexico and get the prescription for a lot less, only it isn't accepted in the US, because of the monopoly given to US doctors.

The fault with the free market system is usually monopolies, especially government imposed ones.

I have a good update - being poor and having a number of letters of rejection from Medicaid and Medicare, each claiming the other covers me, I suddenly had a lateral thinking event and went to indigent care.

Yes it involves a lot of waiting but it is a pretty obvious answer once you think of it.

Summary
Initially I was just depressed by the rejections but eventually the immensely complex wording of the long government documents and the total lack of help from officials and the utter futility of it all began to amuse me. And in the end it all turned out fine.

 

[GodLovesCats]

What is indigent care?

 

[Silverback]

Many countries (including mine) use a single payer/universal healthcare system. I don't understand the objection to a single payer system which seems to be shared by many Americans.

OB

You are correct, most Americans do not favor a single payer system. I think it goes back to our founding as a nation, and the distrust of authority that was written into our founding documents.

Most Americans still view anything given to them by the Government as suspect, and the first words are "why am I getting this" and "if my taxes are going to rise just keep it".

There is also a pride issue at play here as well, many would see a single payer system as charity, and charity is deeply looked down upon in the US.

My generation, I'm 58 was taught if you don't have enough money, then you need to get a second job, and not to look to the Government for help, if you still don't have enough money, then family should help you.

These views are deeply ingrained in our culture, but cracks are starting to appear with the younger generation, and things may change at some point...maybe. However, when these young people start to hit age 30 or, so, their views start to change a bit and the thought of giving their hard earned $ to people who feel they are entitled to what they work for becomes less palatable, and research, depending on who is doing it, bears this out.

Speaking for myself, I think a single payer system would be a disaster in the US, I lived in Greece from 2001-2003, their single payer system is pretty bad, and last I read it was ranked just above Canada's system (so I will avoid getting sick in Canada at all costs)

Less choice, longer wait times, and worse outcomes would be the result in the US. Even those who get care at free clinics would hate it. Making changes to the affordable Care Act would be our best bet.

 

[Occams Barber]

You are correct, most Americans do not favor a single payer system. I think it goes back to our founding as a nation, and the distrust of authority that was written into our founding documents.

Most Americans still view anything given to them by the Government as suspect, and the first words are "why am I getting this" and "if my taxes are going to rise just keep it".

There is also a pride issue at play here as well, many would see a single payer system as charity, and charity is deeply looked down upon in the US.

My generation, I'm 58 was taught if you don't have enough money, then you need to get a second job, and not to look to the Government for help, if you still don't have enough money, then family should help you.

These views are deeply ingrained in our culture, but cracks are starting to appear with the younger generation, and things may change at some point...maybe. However, when these young people start to hit age 30 or, so, their views start to change a bit and the thought of giving their hard earned $ to people who feel they are entitled to what they work for becomes less palatable, and research, depending on who is doing it, bears this out.

Speaking for myself, I think a single payer system would be a disaster in the US, I lived in Greece from 2001-2003, their single payer system is pretty bad, and last I read it was ranked just above Canada's system (so I will avoid getting sick in Canada at all costs)

Less choice, longer wait times, and worse outcomes would be the result in the US. Even those who get care at free clinics would hate it. Making changes to the affordable Care Act would be our best bet.

Not all countries are Greece.

I put the following post together for a similar discussion in Nov last year. Basically comparing the US healthcare system to a basket of 11 developed countries with nationalised healthcare, the US came last in 3 studies and second last in 1 study. The US also has the lowest life expectancy and highest infant mortality rates for infants under 12 months and under five years.

All this for a price double the OECD average.
OB

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I'm not sure about Third World, but the US is certainly at the bottom of the list when it comes to healthcare in First World developed countries.
The Commonwealth Fund (2017) looked at healthcare system performance in a basket of 11 developed countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK and the USA.). The USA rated last.
Comparing the same basket of countries against 4 other major studies of healthcare;

• Legatum (2017); Rankings :: Legatum Prosperity Index 2019. USA rated last.
• Lancet (2015); https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30818-8/fulltext USA rated last
• Bloomberg (2017); Bloomberg. Most efficient health care systems in the workd – Largest-biggest.com USA rated last
• WHO (2000); http://www.who.int/healthinfo/paper30.pdf USA rated second last behind New Zealand. Note this is a fairly old (2000) study. New Zealand has since improved.

Overall the USA rated last, in four out of five studies, when compared to economically similar countries, and second last in one study.

Comparing mortality rates using the same basket of 11 countries:

• Life expectancy: (UN 2010-2015 via Wikipedia) – USA lowest
• Infant mortality under 12 months: (CIA World Factbook via Wikipedia) – USA highest
• Infant mortality under 5 years: (World Bank via Wikipedia) - USA highest

To cap this off, the US spends double the OECD average on healthcare to get an inferior product:

• Health Spend per Capita – (OECD figures via Peterson Kaiser Health System Tracker) ; “On average, other wealthy countries spend about half as much per person on health than the U.S. spends” (Avg=$5,169, USA=$10,348)
• As a % of GDP: (OECD figures via Peterson Kaiser Health System Tracker), USA 17.3%, Avg=9.5%

 

[Silverback]

Not all countries are Greece.

I put the following post together for a similar discussion in Nov last year. Basically comparing the US healthcare system to a basket of 11 developed countries with nationalised healthcare, the US came last in 3 studies and second last in 1 study. The US also has the lowest life expectancy and highest infant mortality rates for infants under 12 months and under five years.

All this for a price double the OECD average.
OB

******************************************************
​

I'm not sure about Third World, but the US is certainly at the bottom of the list when it comes to healthcare in First World developed countries.
The Commonwealth Fund (2017) looked at healthcare system performance in a basket of 11 developed countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK and the USA.). The USA rated last.
Comparing the same basket of countries against 4 other major studies of healthcare;

• Legatum (2017); Rankings :: Legatum Prosperity Index 2019. USA rated last.
• Lancet (2015); https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30818-8/fulltext USA rated last
• Bloomberg (2017); Bloomberg. Most efficient health care systems in the workd – Largest-biggest.com USA rated last
• WHO (2000); http://www.who.int/healthinfo/paper30.pdf USA rated second last behind New Zealand. Note this is a fairly old (2000) study. New Zealand has since improved.

Overall the USA rated last, in four out of five studies, when compared to economically similar countries, and second last in one study.

Comparing mortality rates using the same basket of 11 countries:

• Life expectancy: (UN 2010-2015 via Wikipedia) – USA lowest
• Infant mortality under 12 months: (CIA World Factbook via Wikipedia) – USA highest
• Infant mortality under 5 years: (World Bank via Wikipedia) - USA highest

To cap this off, the US spends double the OECD average on healthcare to get an inferior product:

• Health Spend per Capita – (OECD figures via Peterson Kaiser Health System Tracker) ; “On average, other wealthy countries spend about half as much per person on health than the U.S. spends” (Avg=$5,169, USA=$10,348)
• As a % of GDP: (OECD figures via Peterson Kaiser Health System Tracker), USA 17.3%, Avg=9.5%

I don't disagree, that being said, I don't think it will work in the United States. What drags down our numbers is the 10% uninsured, and the 30% Underinsured (high premiums, high deductibles, and high co-pays). The US does not need free healthcare, it needs affordable healthcare...nothing should be free.