Link: ACA holding...

Bamabuzzard

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IIRC, malpractice insurance for professions like ob-gyns and anesthesiologists can run closer to $100k per year.
That is correct. The more specialized the higher the cost of malpractice insurance. My brother in law is a CRNA and he told me the anesthesiologists he works for ALWAYS is complaining about the high cost of his premiums. Also, the cost of premiums can vary significantly from state to state. Louisiana is crooked, and always has been so it wouldn't surprise me if surgeons in the state weren't paying some of the highest in the country.
 

Bodhisattva

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I was curious and did a quick search. The median malpractice claim payment for an adult anesthesiologist was $90,000 in 1993, and $111,000 for a pediatric anesthesiologist. Corrected for inflation, that's almost $200,000 today.
That is correct. The more specialized the higher the cost of malpractice insurance. My brother in law is a CRNA and he told me the anesthesiologists he works for ALWAYS is complaining about the high cost of his premiums. Also, the cost of premiums can vary significantly from state to state. Louisiana is crooked, and always has been so it wouldn't surprise me if surgeons in the state weren't paying some of the highest in the country.
If a mistake is made, then restitution should be made. But, I've heard plenty of stories where the surgical staff is working on a very sick patient and he dies on the table. Without surgery the patient would have died. The doctors did their best, but they are not God. A lawsuit filed by the family comes in short order. At some point, admitting you're loved one treated his body like cesspool for 40 years is the honest thing to do. This shouldn't be a money grab. Would you rather the doctors not have tried? Because risk aversion on the part of the doctors is an understandable reaction at some point.
 

CharminTide

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But, isn't this instance more of a shift in cost rather than a reduction? It just seems like so much of this is a shell game.
Definitely. But the idea is that if (essentially) everyone were on Medicare, there would not be a built-in private insurer buffer to allow this cost shifting. If there were no uninsured patients, the contingency of medical bankruptcy would not need to be covered either. Overall U.S. healthcare expenditures would decrease. Medicare will not pay $900 for your neighbor's C-Pap accessories, and no one else of consequence would still be in the market, so medical device companies would not be able to overcharge them and offset this. They'd simply have to adapt to a lower revenue stream. Same deal with procedures, and hopefully prescription drugs.
 

Chukker Veteran

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I know there is some legislation that shields gun manufacturers from being sued over their products.
But it's open season on suing doctors?

There ought to be a way to lessen the risk of frivolous suits against doctors while maintaining accountability for malpractice. That would, in turn, lessen malpractice insurance rates.
 

Bodhisattva

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Definitely. But the idea is that if (essentially) everyone were on Medicare, there would not be a built-in private insurer buffer to allow this cost shifting. If there were no uninsured patients, the contingency of medical bankruptcy would not need to be covered either. Overall U.S. healthcare expenditures would decrease. Medicare will not pay $900 for your neighbor's C-Pap accessories, and no one else of consequence would still be in the market, so medical device companies would not be able to overcharge them and offset this. They'd simply have to adapt to a lower revenue stream. Same deal with procedures, and hopefully prescription drugs.
Gotcha. Well, I hope a balance can be struck so that patients get timely, quality care and there's still the incentive for production of better drugs and medical equipment.
 

Bamabuzzard

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I know there is some legislation that shields gun manufacturers from being sued over their products.
But it's open season on suing doctors?

There ought to be a way to lessen the risk of frivolous suits against doctors while maintaining accountability for malpractice. That would, in turn, lessen malpractice insurance rates.
I think there are mechanisms in place on the state level. I talk trash about Louisiana but they do have a cap on lawsuits. In 2016 I sat on a jury for a malpractice suit in which a guy had basically treated his body like utter crap for 30 years, had hyper tension for 15 years and wanted to sue two cardiologists, the hospital and anyone they could find for over $1.5 million. Each person on the jury had a binder of this guy's medical records for the majority of his adult life. The problem wasn't the cardiologists he was trying to sue, but rather the way he treated his body and ignored his health. When the roosters came home to roost, the doctors did the best they could with the situation they were dealing with. They saved the guy's life, basically gave him another 15 years to live. But there we were wasting taxpayers' dollars and everyone's time.
 

CharminTide

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Gotcha. Well, I hope a balance can be struck so that patients get timely, quality care and there's still the incentive for production of better drugs and medical equipment.
That's always the goal. Public Health teaches the (increasingly controversial) concept of the Iron Triangle, which identifies the basic pillars of healthcare as quality, cost, and access. The idea is that changing to one or two of these pillars will affect the third. It's all about finding the proper balance.



Bit of a tangent, but I'm all about the U.S. leading the world in medical drug research and device development. We cured hepatitis C a few years ago. I know a few people who worked on the team that did it, and their work is amazing. But I don't think the promise of corporate drug research requires us to submit to the pricing whims of pharmaceutical companies while the rest of the world aggressively negotiates deals on the very same prescription drugs. Even though I think research is the key to the future, I cannot support a situation where America largely subsidizes global pharmaceutical R&D, yet is increasingly unable to afford the very drugs we help develop.
 

crimsonaudio

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Definitely. But the idea is that if (essentially) everyone were on Medicare, there would not be a built-in private insurer buffer to allow this cost shifting. If there were no uninsured patients, the contingency of medical bankruptcy would not need to be covered either. Overall U.S. healthcare expenditures would decrease. Medicare will not pay $900 for your neighbor's C-Pap accessories, and no one else of consequence would still be in the market, so medical device companies would not be able to overcharge them and offset this. They'd simply have to adapt to a lower revenue stream. Same deal with procedures, and hopefully prescription drugs.
It is - without question - the most logical solution. I have pushed back against universal healthcare for years simply because I've known far too many on medicare and under VA care that weren't allowed many of things I'm allowed under private insurance - but I certainly pay for that privilege.

Ultimately, it's just a matter of time before single payer is the standard in the US - the sooner we move, the sooner we can work to refine it.
 

crimsonaudio

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That's always the goal. Public Health teaches the (increasingly controversial) concept of the Iron Triangle, which identifies the basic pillars of healthcare as quality, cost, and access. The idea is that changing to one or two of these pillars will affect the third. It's all about finding the proper balance.



Bit of a tangent, but I'm all about the U.S. leading the world in medical drug research and device development. We cured hepatitis C a few years ago. I know a few people who worked on the team that did it, and their work is amazing. But I don't think the promise of corporate drug research requires us to submit to the pricing whims of pharmaceutical companies while the rest of the world aggressively negotiates deals on the very same prescription drugs. Even though I think research is the key to the future, I cannot support a situation where America largely subsidizes global pharmaceutical R&D, yet is increasingly unable to afford the very drugs we help develop.
My brother was cured of HepC due to this drug - the cost was to be something like $100k for the course of treatment (which was only a few months, iirc) while the same exact medication was sole for tens of dollars in India. Amazing, stunning breakthroughs like this need to remain funded, but there's no reason why the cost should be so outrageous here and so cheap elsewhere.
 

CrimsonNagus

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Who in this country can afford $100K treatments? The top 1%?

So because the top 1% control all the money, the rest of us poor folks still have to subsidize the rest of the world's drugs. How about make them pay $100K and give me the $10 version.
 

CharminTide

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When I look at the bottom lines of Big Pharma, I have to take some issue with this...
Gilead released Sovaldi/Harvoni in 2014 -- the drugs that treat hepatitis C. Since then, Medicare and Medicaid have paid Gilead north of $20 billion for these two drugs alone. And since Medicare/aid cannot negotiate drug prices, they just fork over whatever Gilead demands.

Again, I'm all for drug R&D. But Gilead could have asked for twice the price, and taxpayers would have had no recourse at all. That's not a subsidy, that's a broken system.
 

NationalTitles18

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FWIW, my brother is developmentally disabled and blind, so he's on Medicare - they approved him for this treatment.

He would have had zero hope of treatment with private insurance, of that much I'm certain.
I've seen folks on Medicaid/Medical treated with this, so it's not just the rich getting treatment.

Gilead released Sovaldi/Harvoni in 2014 -- the drugs that treat hepatitis C. Since then, Medicare and Medicaid have paid Gilead north of $20 billion for these two drugs alone. And since Medicare/aid cannot negotiate drug prices, they just fork over whatever Gilead demands.

Again, I'm all for drug R&D. But Gilead could have asked for twice the price, and taxpayers would have had no recourse at all. That's not a subsidy, that's a broken system.
I can't argue that the system is not broken. We both know it is.

That said, even with the exorbitant costs, Hep C treatment is still cost effective vs no treatment.
 

TIDE-HSV

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I've seen folks on Medicaid/Medical treated with this, so it's not just the rich getting treatment.


I can't argue that the system is not broken. We both know it is.

That said, even with the exorbitant costs, Hep C treatment is still cost effective vs no treatment.
Tony, I'm curious as to the rationale for this statement...
 

NationalTitles18

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Tony, I'm curious as to the rationale for this statement...
Left untreated it often leads to liver transplants - they ain’t cheap.


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That's part of it, but add in end of life costs for those not treated and lost production and so forth and those costs add up quickly.

https://www.hcvguidelines.org/evaluate/cost

Cost-Effectiveness of Current Direct-Acting Antiviral Regimens for Hepatitis C Treatment

[FONT=&quot]Since the first direct-acting antivirals (DAAs) received US Food and Drug Administration approval in 2011, several cost-effectiveness investigations have compared DAA-based regimens to previous standard-of-care regimens to calculate ICERs. They have also investigated the cost-effectiveness of eliminating HCV treatment restrictions. Compared to interferon-based regimens, the ICER for DAAs has consistently been estimated at <$100,000/QALY for all genotypes and fibrosis stages.[/FONT]
[FONT=&quot]Several studies have compared DAA regimens against one another. In general, when given a choice between recommended HCV DAA regimens, the less costly regimen is preferred as a more efficient use of resources (even if it requires multiple tablet dosing). Because of the similar efficacy of most DAA regimens, cost becomes the critical factor driving cost-effectiveness. Recent studies have also estimated the cost-effectiveness of HCV treatment in special populations, including patients awaiting liver transplantation, HIV/HCV coinfected patients, those with chronic kidney disease, and persons who inject drugs—all with favorable ICERs. At this time, it is reasonable to conclude that DAA regimens provide good value for the resources invested. [/FONT]
[FONT=&quot][/FONT]

Cost vs Affordability for HCV Treatment

[FONT=&quot]Despite a growing body of evidence that HCV treatment is cost-effective and may even be cost saving over the long term in some cases, many US payers—especially those offering Medicaid insurance products—continue to limit access to HCV treatment. Access has improved as cost has decreased but limitations remain. Proposed reductions in healthcare spending for Medicaid would likely exacerbate the problem as the value of the HCV medications would remain unchanged but the resources available to provide them would shrink.[/FONT]

Conclusions

[FONT=&quot]Several recent studies have demonstrated the economic value of HCV treatment and made it clear that HCV therapy is cost-effective ([/FONT]Chahal, 2016[FONT=&quot]); ([/FONT]Chatwal, 2015[FONT=&quot]); ([/FONT]Chidi, 2016[FONT=&quot]); ([/FONT]Linas, 2015[FONT=&quot]); ([/FONT]Martin, 2016a[FONT=&quot]); ([/FONT]Najafzadeh, 2015[FONT=&quot]); ([/FONT]Rein, 2015[FONT=&quot]); ([/FONT]Tice, 2015[FONT=&quot]); ([/FONT]Younossi, 2015a[FONT=&quot]). The high cost of these medications combined with the high prevalence of disease has led to limiting access for some patients. The issue is complex. Although the wholesale acquisition costs of HCV drugs often make treatment appear unaffordable, the reality is that insurers, PBMs, and government agencies negotiate pricing and few actually pay this much-publicized price. Negotiated pricing and cost structure for pharmaceutical products in the US are not transparent, however. Thus, it is therefore difficult to estimate the true budgetary impact of providing HCV drugs. Competition and negotiated pricing have reduced prices but cost continues to limit the public health impact of new DAA therapies. Insurers, government, and pharmaceutical companies should work together to bring medication prices to the point where all persons in need of treatment are able to afford and readily access it.[/FONT]
 

TIDE-HSV

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Left untreated it often leads to liver transplants - they ain’t cheap.


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I understand that. My point is that it's "cost effective" in the same manner as any extortion is, "protection money" to the mob, for example. In Europe, for example, drug companies are dragged in and forced to open their books and justify their costs, as they are not here. That's the true reason for the low costs. Then they turn to the US, where there is no check and balance system, and say "Fork over two billion"...
 

Valley View

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Life, liberty, the pursuit of happiness, free housing, free phones, free food and affordable health insurance...if only our founding fathers had a clue.
We have some new House members who will make everything free for everyone. The big, evil corporations will pay for it. They make so much they will never miss it, and the investors and stockholders don't care about any profit either. No problem!!
 

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