birdog1960 Posted June 2, 2015 Share Posted June 2, 2015 (edited) a top oncologist speaks out at a national cancer meeting: http://www.npr.org/2015/06/01/411271175/high-price-of-cancer-treatment-drugs-is-unsustainable-doctor-says. i agree completely with him. comments? from a forbes article on the issue: I don’t agree that our national inability to face death is the main problem here. Instead, it’s the baroque system of paying for medicines that we’ve created because of our fear of socialist price controls. Medicare’s not allowed to negotiate prices. Pressure on the price of drugs comes from two forces: from insurers forcing patients to pay some of the costs out of pocket, which can result in the human disaster of people forced to pay $60,000 for a lifesaving drug even though they have insurance, and from insurers negotiating with drug firms to get rebates on the back end. Pharma complicates this by having programs that help patients pay their copays, and by raising prices to counteract the discounts, so the prices get higher. Edited June 2, 2015 by birdog1960 Link to comment Share on other sites More sharing options...
Rob's House Posted June 2, 2015 Share Posted June 2, 2015 a top oncologist speaks out at a national cancer meeting: http://www.npr.org/2015/06/01/411271175/high-price-of-cancer-treatment-drugs-is-unsustainable-doctor-says. i agree completely with him. comments? from a forbes article on the issue: I dont agree that our national inability to face death is the main problem here. Instead, its the baroque system of paying for medicines that weve created because of our fear of socialist price controls. Medicares not allowed to negotiate prices. Pressure on the price of drugs comes from two forces: from insurers forcing patients to pay some of the costs out of pocket, which can result in the human disaster of people forced to pay $60,000 for a lifesaving drug even though they have insurance, and from insurers negotiating with drug firms to get rebates on the back end. Pharma complicates this by having programs that help patients pay their copays, and by raising prices to counteract the discounts, so the prices get higher. How would you determine the sale price of drugs and who would pay? Link to comment Share on other sites More sharing options...
birdog1960 Posted June 2, 2015 Author Share Posted June 2, 2015 i think you allow direct negotiations between medoicare and the manufacturers. a board of expert oncologists should be on medicares side of the table determining relative value of the drugs with eventual development of a national formulary. if pt want something outside formu;lary, they'd probably end up paying the exhorbitant prices they pay now anyway. Link to comment Share on other sites More sharing options...
KD in CA Posted June 2, 2015 Share Posted June 2, 2015 I don’t agree that our national inability to face death is the main problem here. After watching two parents die slowly, I strongly disagree with this statement. Inability to face death is BY FAR the main problem in US healthcare and the amount of money spent on futile treatments for the terminally ill is beyond comprehension (I've researched the #s before and don't feel like doing it again). I had some idiot doctor talking to me about 'next steps on radiation' 96 hours before my father died from aggressive cancer that by then had spread from his bladder to his brain and everywhere in between. How would you determine the sale price of drugs and who would pay? Why the government will determine the price and pay for it! Duh! What could go wrong? Link to comment Share on other sites More sharing options...
Nanker Posted June 2, 2015 Share Posted June 2, 2015 Maybe big pharma should cut their payments to investigators from $30k per patient to something more reasonable. I'm sure the good altruistic medical professionals would sign up for that in a heartbeat, now that they can't even get a coffee cup or a pen from their manufacturer's reps. Link to comment Share on other sites More sharing options...
birdog1960 Posted June 2, 2015 Author Share Posted June 2, 2015 (edited) After watching two parents die slowly, I strongly disagree with this statement. Inability to face death is BY FAR the main problem in US healthcare and the amount of money spent on futile treatments for the terminally ill is beyond comprehension (I've researched the #s before and don't feel like doing it again). I had some idiot doctor talking to me about 'next steps on radiation' 96 hours before my father died from aggressive cancer that by then had spread from his bladder to his brain and everywhere in between. Why the government will determine the price and pay for it! Duh! What could go wrong? this is certainly a part of the problem but there are many patients that are unwilling to give in to the inevitable: "i want everything done" is a common sentiment. that, however, is not the problem behind treatment with reasonable chances of success costing 100k or more. Maybe big pharma should cut their payments to investigators from $30k per patient to something more reasonable. I'm sure the good altruistic medical professionals would sign up for that in a heartbeat, now that they can't even get a coffee cup or a pen from their manufacturer's reps. agreed. legalized bribery should stop. but you can check who is on the payroll at propublica. it lists pharma payments to every US doc and percentages of generics prescribed. it's all public knowledge now, as it should be. http://www.propublica.org/series/dollars-for-docs Edited June 2, 2015 by birdog1960 Link to comment Share on other sites More sharing options...
B-Large Posted June 2, 2015 Share Posted June 2, 2015 People living longer, everyday more "stuff" that can be done to keep you alive, nobody wants to pay for it, almost everybody wants it, almost everybody believe it's imperative people get it no matter what, and providers, suppliers, developers and makers want to make a lot off of it. While I think negotiating for drugs will help, this Heathcare problem will only continue to get worse until we resolve basic core issues that really have not been addressed. We essentially decided by default that as a nation we will finance healthvare with a blank check, whatever it takes approach, because we refuse to determine how much we will spend and what limits to treatment we are comfortable with. People rail on Canada for their approach, but what they have essentially done is determined how much they are willing to spend and as a nation come to terms with limits of care, ie waiting for a hip replacement instead of having immediately and delaying other elective procedures. Canada has also addressed the drug issue by setting a cap on spending, Pharma companies know they can only charge so much for a drug, because there just isn't any more money (Peovincial healthcare will only pay $1 for a Lipitor, and Pharma companies know Americans will/ have to pay $10 or maybe more.... Think if we only were willing to spend $2, all,the sudden we are not subsidizing other nations... Hmmm). I guess my point is we need to decide is we want. Do we want a system like we have now that treat everybody, continue to eat up GDP, is embarrassingly wasteful and inefficient, not as effective as it should be and people are making big bucks off our backs.... Or do we want a system that caps spending, gets out as much efficiency as possible but isn't the "whatever it takes no matter the cost" system. The ACA did not address these problems, so it will only get worse until we do. Link to comment Share on other sites More sharing options...
KD in CA Posted June 2, 2015 Share Posted June 2, 2015 this is certainly a part of the problem but there are many patients that are unwilling to give in to the inevitable: "i want everything done" is a common sentiment. Which is why it shouldn't be up to the patient unless they are footing the bill. And beyond that, we don't even allow the patient (or their proxy) to say "I've had enough, I want to die now". We allow people to make end of life decisions regarding pets yet refuse to do the same for people. Link to comment Share on other sites More sharing options...
birdog1960 Posted June 2, 2015 Author Share Posted June 2, 2015 Which is why it shouldn't be up to the patient unless they are footing the bill. And beyond that, we don't even allow the patient (or their proxy) to say "I've had enough, I want to die now". We allow people to make end of life decisions regarding pets yet refuse to do the same for people. actually, we do. everyone has the right to refuse treatment. hospice is widely used. Link to comment Share on other sites More sharing options...
Chef Jim Posted June 2, 2015 Share Posted June 2, 2015 The end of life costs in this country are astronomical. It's a combination of patients not wanting to die and the medical profession trying to keep them alive. The amount of money that people need to have just to fund major medical issues and insurance through their lifetimes is by some estimates $250-$300million.. And that number is most likely to double every 10-12 years. actually, we do. everyone has the right to refuse treatment. hospice is widely used. Oh come on man. You know that this country does a very good job of keeping people alive at all costs. And the medical profession is very much involved in this. Link to comment Share on other sites More sharing options...
KD in CA Posted June 2, 2015 Share Posted June 2, 2015 actually, we do. everyone has the right to refuse treatment. hospice is widely used. No, we don't. "Refusing treatment" isn't "dying now". We had the option to starve my mother for the last 3 weeks of her life (ALS) to speed up the process in Hospice. Had she been a dog, we could have given her an injection the day we got there and ended the misery. p.s. the following year they closed that facility, the only Hospice facility in SW CT. Much more lucrative to keep them in the hospital. Link to comment Share on other sites More sharing options...
birdog1960 Posted June 2, 2015 Author Share Posted June 2, 2015 (edited) The end of life costs in this country are astronomical. It's a combination of patients not wanting to die and the medical profession trying to keep them alive. The amount of money that people need to have just to fund major medical issues and insurance through their lifetimes is by some estimates $250-$300million.. And that number is most likely to double every 10-12 years. Oh come on man. You know that this country does a very good job of keeping people alive at all costs. And the medical profession is very much involved in this. i've discussed advance directives with 4 people so far today. that's typical. will everyone i talked to refuse heroic measures? of course not. but discussing it openly is the way to proceed towards better end of life choices. No, we don't. "Refusing treatment" isn't "dying now". We had the option to starve my mother for the last 3 weeks of her life (ALS) to speed up the process in Hospice. Had she been a dog, we could have given her an injection the day we got there and ended the misery. p.s. the following year they closed that facility, the only Hospice facility in SW CT. Much more lucrative to keep them in the hospital. sorry to hear that. hospice can be a godsend if done right. i would never agree to being involved in active euthanasia, however. some doctors will: http://www.npr.org/sections/health-shots/2015/05/21/408455816/coded-talk-about-assisted-suicide-can-leave-families-confused Edited June 2, 2015 by birdog1960 Link to comment Share on other sites More sharing options...
Nanker Posted June 2, 2015 Share Posted June 2, 2015 People living longer, everyday more "stuff" that can be done to keep you alive, nobody wants to pay for it, almost everybody wants it, almost everybody believe it's imperative people get it no matter what, and providers, suppliers, developers and makers want to make a lot off of it. While I think negotiating for drugs will help, this Heathcare problem will only continue to get worse until we resolve basic core issues that really have not been addressed. We essentially decided by default that as a nation we will finance healthvare with a blank check, whatever it takes approach, because we refuse to determine how much we will spend and what limits to treatment we are comfortable with. People rail on Canada for their approach, but what they have essentially done is determined how much they are willing to spend and as a nation come to terms with limits of care, ie waiting for a hip replacement instead of having immediately and delaying other elective procedures. Canada has also addressed the drug issue by setting a cap on spending, Pharma companies know they can only charge so much for a drug, because there just isn't any more money (Peovincial healthcare will only pay $1 for a Lipitor, and Pharma companies know Americans will/ have to pay $10 or maybe more.... Think if we only were willing to spend $2, all,the sudden we are not subsidizing other nations... Hmmm). I guess my point is we need to decide is we want. Do we want a system like we have now that treat everybody, continue to eat up GDP, is embarrassingly wasteful and inefficient, not as effective as it should be and people are making big bucks off our backs.... Or do we want a system that caps spending, gets out as much efficiency as possible but isn't the "whatever it takes no matter the cost" system. The ACA did not address these problems, so it will only get worse until we do. The American public IS subsidizing other nations and their patients. They have national formularies that have established price controls. So, riddle me this: If the bankrolling of pharma development by American patients and their health insurance is reduced by 90%, do you really think there is a future for new drug development? We're being played the fool on the world stage by the foreign governments. Pharma will drop their shorts to get market share across the world - BECAUSE they know they'll get their development costs returned when they eventually do develop a block-buster from one out of six compounds they develop. The rest of the world is riding on the American consumer's back. Maybe tariffs are in order for drugs made by foreign manufacturers (right, the public would love that). Or heavy export fees that will keep American drugs here (right, the public would love that). Maybe the FDA or some other agency should do price fixing of foreign manufacturer's products so they get paid ten cents on their developmental cost dollar. See how loudly THEY would scream then. Link to comment Share on other sites More sharing options...
B-Man Posted June 2, 2015 Share Posted June 2, 2015 (edited) BD is correct. I talked with three different families yesterday about Advanced Care wishes. At our Senior Center, our goal is to hit 100% with our MOLST forms. Sure there are some who want "everything done" But many of our seniors do not and we facilitate that by calling the ER's and hospitals whenever any of our participants are heading there. . Edited June 2, 2015 by B-Man Link to comment Share on other sites More sharing options...
Chef Jim Posted June 2, 2015 Share Posted June 2, 2015 BD is correct. I talked with three different families yesterday about Advanced Care wishes. At our Senior Center, our goal is to hit 100% with our MOLST forms. Sure there are some who want "everything done" But many of our seniors do not and we facilitate that by calling the ER's and hospitals whenever any of our participants are heading there. . How many people actually have an ACD? Link to comment Share on other sites More sharing options...
DC Tom Posted June 2, 2015 Share Posted June 2, 2015 actually, we do. everyone has the right to refuse treatment. hospice is widely used. That's funny. People are informed and responsible enough to make end-of-life decisions. But they're forced by the banks into bad mortgages because they're not responsible enough to make their own financial decisions. I wish you liberals would decide once and for all if people can be responsible for their choices or not. Link to comment Share on other sites More sharing options...
B-Man Posted June 2, 2015 Share Posted June 2, 2015 How many people actually have an ACD? Well, I don't know the actual numbers, my experience here in rural WNY tells me that it is (sadly) well below 33% but that is not due to the medical professionals "ignoring" the issue or "not allowing" the patient to make that decision. That is what I was responding to. . Link to comment Share on other sites More sharing options...
birdog1960 Posted June 2, 2015 Author Share Posted June 2, 2015 How many people actually have an ACD? i'm on the ethics committee for my hospital. a new commitee member (a pastor)asked this question last meeting. the best that could be said with certainty was that the numbers are steadily increasing. in my practice, it's about 50% for medicare patients. it deserves mentioning that addressing the issue is a requirement of the aca initiated wellness exams for medicare patients. it was a provision fought by many conservatives under the broad spectre of "death panels". Link to comment Share on other sites More sharing options...
Rob's House Posted June 2, 2015 Share Posted June 2, 2015 (edited) People living longer, everyday more "stuff" that can be done to keep you alive, nobody wants to pay for it, almost everybody wants it, almost everybody believe it's imperative people get it no matter what, and providers, suppliers, developers and makers want to make a lot off of it. While I think negotiating for drugs will help, this Heathcare problem will only continue to get worse until we resolve basic core issues that really have not been addressed. We essentially decided by default that as a nation we will finance healthvare with a blank check, whatever it takes approach, because we refuse to determine how much we will spend and what limits to treatment we are comfortable with. People rail on Canada for their approach, but what they have essentially done is determined how much they are willing to spend and as a nation come to terms with limits of care, ie waiting for a hip replacement instead of having immediately and delaying other elective procedures. Canada has also addressed the drug issue by setting a cap on spending, Pharma companies know they can only charge so much for a drug, because there just isn't any more money (Peovincial healthcare will only pay $1 for a Lipitor, and Pharma companies know Americans will/ have to pay $10 or maybe more.... Think if we only were willing to spend $2, all,the sudden we are not subsidizing other nations... Hmmm). I guess my point is we need to decide is we want. Do we want a system like we have now that treat everybody, continue to eat up GDP, is embarrassingly wasteful and inefficient, not as effective as it should be and people are making big bucks off our backs.... Or do we want a system that caps spending, gets out as much efficiency as possible but isn't the "whatever it takes no matter the cost" system. The ACA did not address these problems, so it will only get worse until we do. The element that throws the system off is envy and/or guilt masquerading as compassion. If you have a public health care system there necessarily have to be spending limits put in place because (as I've said here at least a dozen times) you can't provide everyone unlimited access to the most advanced medical technology known to man, because we literally don't have the resources for it. The problem the "compassionate" crowd has is you having the ability to willingly spend your own money on treatment that isn't covered. See, to them it's a problem, not because it hurts anyone else, but because it's not "fair" that you got to live where someone else didn't. So they'd prefer that you for too. And they call it compassion. Edited June 2, 2015 by Rob's House Link to comment Share on other sites More sharing options...
unbillievable Posted June 2, 2015 Share Posted June 2, 2015 I always wondered why people use "big" for Pharm, Tobacco, Oil... Is there a "small" oil? Link to comment Share on other sites More sharing options...
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