What’s with Pharmacy’s?

Streetwiseguy said:

In reply to frenchyd :

Higher taxes.

Pretty sure that the higher costs of taxes to have health care  is still  massively cheaper than what Americans pay for health care.  The most expensive health care other than America ( off the top of my head )  is Switzerland.   And America spends over  200% more than they do.  
    We don't really see the real cost of our health care because most of us get it either from work  or  Medicare.   
      If work is paying  most of it, those costs are in leu of higher pay. Perhaps that's the real reason, adjusted for Inflation Americans haven't had a pay raise since the 1970's. 
     The way to get what most of the rest of the world  already has is simply eliminate 2 words from Medicare.   Over 65. 
 

Then our taxes would go up$1.00 for every $2.00 we are already paying.  Companies would happily increase  pay that much to save the extra $2.00 they are already paying.  

In reply to 03Panther :

That's a good idea.  But don't we need to get the doctors to sign off on that little bit of fraud? I mean they write the prescriptions.  

In reply to No Time :

I hope that as long as we can stay civilized.  Even though this subject sometimes flirts on the edge of political discussion.  
      It can remain unlocked.  
    

No Time said:

Some companies have special programs to help reduce cost for medication. If you are paying out of pocket it can be beneficial to check the pharma company's website for rebate programs that help the consumer. 

Thank you but my concern has been not the cost of it.  But the availability of it. 
   With my family's income and health insurance, complaining about costs is like complaining about the cost of good caviar's .    Just boreish.  
    Yes it is a very big concern for most, especially the young families and a lot of the elderly. But that should remain a seperate subject.  

frenchyd said:

Streetwiseguy said:

In reply to frenchyd :

Higher taxes.

Pretty sure that the higher costs of taxes to have health care  is still  massively cheaper than what Americans pay for health care.  The most expensive health care other than America ( off the top of my head )  is Switzerland.   And America spends over  200% more than they do.  
    We don't really see the real cost of our health care because most of us get it either from work  or  Medicare.   
      If work is paying  most of it, those costs are in leu of higher pay. Perhaps that's the real reason, adjusted for Inflation Americans haven't had a pay raise since the 1970's. 
     The way to get what most of the rest of the world  already has is simply eliminate 2 words from Medicare.   Over 65. 
 

Then our taxes would go up$1.00 for every $2.00 we are already paying.  Companies would happily increase  pay that much to save the extra $2.00 they are already paying.  

Your numbers do not add up. But that's one of the problems with politicians offering to give everyone free stuff, and people believing that they can or will. I've never accepted welfare, and I have to pay for my own insurance. I know why my insurance went up over 900%, in the same period my income went up around 25%
We have all tried to keep the political side out of the problem, but your math does not work. It's the kinda smoke and mirrors math that too many believe, just cause they are told it works. 

frenchyd said:

Thank you but my concern has been not the cost of it.  But the availability of it. 
   With my family's income and health insurance, complaining about costs is like complaining about the cost of good caviar's .    Just boreish.  

I really like that answer! Very ethical, and I apreacate it. 
For the availability, have the dr adjust the dosage, to support a surplus periodically. If the doc understands the supply issue, it should work out. If he won't help, might just have to convince one y'all need more than actual use. 

JThw8 said:

frenchyd said:

In reply to JThw8 :

Do we need HMO's or is it simply a way to get money for management?   They certainly haven't made things cheaper.   
      Then Management can leverage that money into  rules that increase costs to cash paying customers.  How much of that $800  is used as Kick backs and rebates?   My wife's Co-pay is $45. Which is what I believe they should cost  (IMHO).   
     
 Can someone explain to me how things are done in the rest of the world?   I mean.  Where  people are assumed to have a right to health care?    
  Do they have expensive insurance?  Or have to pay outrageous medical bills?  

HMOs are still insurance.  The insurance industry in america is corrupt and that sadly wont change any time soon.

As to other countries, as others have noted, higher taxes.   I spend a bit of time in Denmark and have many friends there.  They do have socialized medicine.  They also have what we would consider insane taxes.  One particularly relevant to us car folks for example.  The tax on registering a car is 180%.   Think about that for a minute.   They do have a great public transit system and honestly if I lived there I probably wouldn't own a car.  On top of that the socialized medicine isnt all its cracked up to be according to my friends who live there.  And there's no dental included in that, all that comes out of pocket.

Denmark and other  Scandinavian countries do have high  taxes. But citizens in those countries are the happiest with their government  of any county in the world.   
    Going back to health care and avoiding the politics.    Those countries spend  as little as 40%  of what Americans do while living longer, healthier lives. Oh and they tend to be the tallest people.  
   On that subject, yes,  genetics does play a part.  But also diet and healthcare. 
Americans at one time were the tallest. But have shrunk significantly compared to other countries. 
   Back to the costs of healthcare and taxes.   Since they spend a lot less than Americans do.  Healthcare isn't driving their higher taxes.  It's other things. Like mothers get up to 2 years to take care of new born babies before going back to work.  ( fathers get a year)  both get regular paychecks that whole time.  

As noted above, they are absolutely NOT the happiest countries. People that think socialism works, tell you they are. But the folks that have to live with that, do not like it. And for good reason. 
Saying it with authority, despite making it up, doesn't make it true. 
 

I will very very rarely say that something should be taken over by government but I really struggle to understand why insulin is a for profit product. 
 

Can't afford to live? No problem.

-big pharma. 
 

Again, 

fortunately like frenchy I have health insurance and a pretty good job. I'm also in Canada so I get to see an endocrinologist yearly at no charge, as well as free blood work and quarterly, also visits to an ophthalmologist quarterly because of complications from diabetes. But all those medical services that are paid for by my taxes don't mean anything to someone who can't afford the insulin to control their blood glucose levels. 

frenchyd said:

No Time said:

Some companies have special programs to help reduce cost for medication. If you are paying out of pocket it can be beneficial to check the pharma company's website for rebate programs that help the consumer. 

Thank you but my concern has been not the cost of it.  But the availability of it. 
   With my family's income and health insurance, complaining about costs is like complaining about the cost of good caviar's .    Just boreish.  
    Yes it is a very big concern for most, especially the young families and a lot of the elderly. But that should remain a seperate subject.  

The topic of cost came up, around insulin, so I thought the info could be useful for some. 

As for supply, mail order seems like the solution if your insurance has affiliation with one of the mail order services. Instead of going to dozens of different pharmacies trying to find it locally, the mail order could be much more reliable and lower stress. 

frenchyd said:

In reply to JThw8 : 
     
 Can someone explain to me how things are done in the rest of the world?   I mean.  Where  people are assumed to have a right to health care?    
  Do they have expensive insurance?  Or have to pay outrageous medical bills?  

It varies a LOT country by country. The general rule is that you use public funding to cover the cost of medical service of everyone, but there are a LOT of steps in between those two points.

Among most developed, western nations, you generally don't have fully socialized medicine where the government manages the healthcare system itself. You usually still have private providers, with maybe publicly or semi-publicly owned hospitals - perhaps affiliated with universities and the like. In that way, the infrastructure of where you are going and who you are seeing is very similar to the U.S.

With that in place, you have some nations that will pool all funds collectively and let you more or less walk into any place you want. Effectively an equivalent of a "Medicare for All" type model.

You have a fair number of other countries that publicly collect funds, but then allow people to pick from a marketplace of often-private health insurance companies. I know this is the model in Germany. I want to say that if you are an EU citizen, half the insurance pool comes from payroll tax spread across the nation and half from income, property, or other general taxes. If you are a non-EU citizen on a long-term work or student visa, you are required to pay privately for health insurance. When I did this, my payments and copay were lower than in the U.S. when I split insurance costs with an employer, and my level of service was better. I was able to walk in to a private physicians office with an ear-ache, get seen, and buy antibiotics for less than my copays here. They did request that next time I needed to visit, I should call ahead earlier in the day.

In all of these cases, the average cost an individual will pay for health care over their lifetime (whether indirectly through taxes, to private insurance, or directly out-of-pocket to providers) is much lower in these other nations than it is in the U.S. The speed and quality of care depends heavily on the specific country/location, but the U.S. does not see the fastest, most complete, or highest quality care amongst developed nations despite the most $$/person.

It is not uncommon for people WITH INSURANCE in the U.S. in need of major surgeries to take a month off work, fly to Europe, pay out of pocket for an operation, and sit around recovering on vacation for a couple weeks before flying back to the U.S. sooner and for lower out-of-pocket cost than using their insurance to cover the same procedure in the U.S.

03Panther said:

As noted above, they are absolutely NOT the happiest countries. People that think socialism works, tell you they are. But the folks that have to live with that, do not like it. And for good reason. 
Saying it with authority, despite making it up, doesn't make it true. 
 

The government can do a good job of supplying services. The police, fire departments, roads and bridges, public schools, while usually not perfect all do work and I have no problem with my taxes paying for them.

Private business and capitalism does a great job supplying goods and services, and the free market typically does a good job of keeping  quality high and prices reasonable.

I think the problem with healthcare is the same problem with higher education, and that is mixing socialism with capitalism. When the Gov tells a business to send them the bill things go off the rails cost wise. The intent was to make healthcare and education more accessible but instead the private businesses raised there prices to make higher profits. 

I guess maybe this post is too political, I hope not. I'm nonpartisan and dont care which party is in power, I just want the government to work for the good of the people and for normal people to be able to afford a decent quality of life.

I also know this is completely off the topic of the original post, so sorry about that.

03Panther said:

As noted above, they are absolutely NOT the happiest countries. People that think socialism works, tell you they are. But the folks that have to live with that, do not like it. And for good reason. 
Saying it with authority, despite making it up, doesn't make it true. 
 

According to The World Happiness Report 2019-2021, the happiest three nations are Finland, Denmark, and Iceland. Then Switzerland, Netherlands, Luxembourg, Sweden, Norway, Israel, New Zealand...

The U.S. is #16, just behind Canada and ahead of the UK.

In the metrics measured in that report, the U.S. ranks worse for "Healthy Life Expectancy" than all the nations above it, and worse for "Freedom to make life choices" than all nations above it except Israel. It has higher "GDP Per Capita" than all nations above it except for Luxembourg, Switzerland, Ireland, and Norway. The U.S. is also brought down significantly by "Perceptions of corruption".

In reply to Beer Baron :

Don't waste your time.

In reply to gearheadmb :

People on here would not believe it, 'cause I'm not as well spoken, and have a problem with being reactive to absolutes... so end up sounds like I believe absolutes. 
But I agree with every word you just said. 
As you said, I couldn't care less about party, and the little political in your post is really economics, but that's a fine line - by keeping it mello, it makes for pleasant conversation. 

Peabody said:

In reply to Beer Baron :

Don't waste your time.

True.
But reference the post that I referenced that explained why such studies are skewed. 

gearheadmb said:The government can do a good job of supplying services. The police, fire departments, roads and bridges, public schools, while usually not perfect all do work and I have no problem with my taxes paying for them.

Back when I was a single man, and still living in a city in VA, I went on a few dates with the Commissioner of Revenue of that town. We became good friends. 
In discussions of this , she asked if I wanted the fire department, and other services, that very high city and state taxes in va paid for. 
After I began trace for work, and had an address in TN, I finally had a rebuttal for her good statement: TN has no state taxes, MUCH less individual taxes on a personal level, and the places in TN I've been have MUCH better services. So, the math doesn't add up. 
Where I am in AL, is on between on tax cost, but has poor services... unlike VA they leave us completely alone though, so it's a trade off. 

gearheadmb said:

I think the problem with healthcare is the same problem with higher education, and that is mixing socialism with capitalism. When the Gov tells a business to send them the bill things go off the rails cost wise.

If that is true, then why do European nations with systems like you are describing have a lower per-capita cost for health care and education?

The best argument I have heard similar to what you appear to be making is that one of the U.S.'s big problems is that where other nations have this style system or that style system, the U.S. has a patchwork of at least three major systems for providing healthcare. It's not that we have a system that is a "blend of socialism and capitalism" but that we have one system that is far more capitalist than most other developed nations and another system that is far more socialist, both are broken on their own and the issues each has compound upon each other rather than fill in the gaps.

In reply to Beer Baron :

Unfortunately, statistics can say whatever the agenda wants them to. Refer to earlier post by a gentleman with personal input from experience in Danmark, in particular. 
Corruption in government? Say it isn't so!

Still, it seems to be that a huge amount of people that are SO much happier, are still trying to get to te US so they can make their lives so much more unhappy. 

unlike peabody's thoughts, I can have a reasonable discussion , with anyone being reasonable. 

Yes people from more corrupt countries than the US are lining up to get into America.  While migration from Scandinavian countries is pretty rare.  
In fact we recently had a president who said something to that exact same point. 

Beer Baron said:

gearheadmb said:

I think the problem with healthcare is the same problem with higher education, and that is mixing socialism with capitalism. When the Gov tells a business to send them the bill things go off the rails cost wise.

If that is true, then why do European nations with systems like you are describing have a lower per-capita cost for health care and education?

The best argument I have heard similar to what you appear to be making is that one of the U.S.'s big problems is that where other nations have this style system or that style system, the U.S. has a patchwork of at least three major systems for providing healthcare. It's not that we have a system that is a "blend of socialism and capitalism" but that we have one system that is far more capitalist than most other developed nations and another system that is far more socialist, both are broken on their own and the issues each has compound upon each other rather than fill in the gaps.

I've heard that statement from several people in the past.  The government spends money recklessly. 
      Except Medicare, with all its flaws and mistakes. Has massively less administration costs than HMO's and private insurance companies.  
   It's administration cost is 2%. Compared to government mandated 35%. 
   Want to understand why costs for private insurance are so high?   35%  of $100 aspirin is $35  but 35% of a $2 aspirin is 70 cents.  

#1:  18% of our economy is healthcare and our current system of not charging taxes on employer provided benefits is causing big distortions.  IMHO, any proposal that doesn't include the decoupling of benefits from employers is going to be marginally effective at best.

#2.  It's to be expected that healthcare costs will increase faster than the rate of inflation..."we can keep you alive but it's going to be pricey - do it"...we can give you better picture quality, faster internet speed, etc. but it's going to be pricey - I'll think about it"

#3.  Medicare for all means Medicare for nobody as 85% of Medicare transactions are preformed at a loss (i.e. they're being subsidized by private health insurance programs).

We can do the easy thing and just pick winners and losers by shifting the cost burden around or we can do the hard thing and build a comprehensive model of the process, identify the inefficiencies, and intelligently reduce / eliminate them.

Beer Baron said:

gearheadmb said:

I think the problem with healthcare is the same problem with higher education, and that is mixing socialism with capitalism. When the Gov tells a business to send them the bill things go off the rails cost wise.

If that is true, then why do European nations with systems like you are describing have a lower per-capita cost for health care and education?

The best argument I have heard similar to what you appear to be making is that one of the U.S.'s big problems is that where other nations have this style system or that style system, the U.S. has a patchwork of at least three major systems for providing healthcare. It's not that we have a system that is a "blend of socialism and capitalism" but that we have one system that is far more capitalist than most other developed nations and another system that is far more socialist, both are broken on their own and the issues each has compound upon each other rather than fill in the gaps.

As someone who works in this- this is completely true. The simplest expression I can give of the USA's healthcare system, is that it's built and meant for the 70s running the worst of both capitalist and socialist ideologies. 

I am not a fan of Medicare for All because it has serious faults... but I'm not a fan of people dying more, and a lot of americans die needlessly.

We can do the easy thing and just pick winners and losers by shifting the cost burden around or we can do the hard thing and build a comprehensive model of the process, identify the inefficiencies, and intelligently reduce / eliminate them.

This is also true. I hate the trend of band-aiding onto the current system, because there's no control over insurance systems when it comes to the level of work they demand for proper bureaucracy. That in fact, is how insurance agencies fight against us- after the ACA passed they increased the amount of paperwork so much that it took an average of 3 minutes to over 20 for one doctor's visit, which is part of why NPs and PA-Cs are seeing such an expansion.

   Want to understand why costs for private insurance are so high?   35%  of $100 aspirin is $35  but 35% of a $2 aspirin is 70 cents.  

Ironically, Medicare/Medicaid can be one of the key reasons why prices on medications is so high in hospitals. The reason is because economically, since Medicare draws a line in the sand saying "We won't pay more than $X for a pill", in doing so these corporations are incentivized to only combat that number and not each other- and since it's daddy US government and the cash flow is guaranteed, why change? It's basically a check that hasn't been banked yet, and because of that there's also no impetuous to change.

From here corpos will eventually shove each other out, but that's more in a duopoly/tetarchy way, a partnership more than anything. They do this because it eventually makes more sense for one company to focus on X products and simply... agree to not step on each other's toes. They'll purchase and swap plants and lines and personnel until two or three companies make all of one product, and the price remains static. You see this in the modern telecom industry as well; here in the USA, we still only have Baxter producing all our saline for infusion out of Puerto Rico, and ... you get it. 

It is not uncommon for people WITH INSURANCE in the U.S. in need of major surgeries to take a month off work, fly to Europe, pay out of pocket for an operation, and sit around recovering on vacation for a couple weeks before flying back to the U.S. sooner and for lower out-of-pocket cost than using their insurance to cover the same procedure in the U.S.

E36 M3 dude, our insurance is starting to sponsor it even. It's called "Healthcare Tourism"  Spain is a major destination for hip and knee replacements now. 

I believe that the increase in pharmacy benefits with health insurance was a factor in the crazy increase in drug prices. Before the mid 70s, one went to the pharmacy, had their prescription filled, and paid whatever the charge was out of pocket. Pharmacist had to figure the price by calculating the wholesale price  and marking it up. It was uncommon for a prescription to cost as much as $20.  If the patient had prescription coverage through their insurance, they would file a paper claim & wait for reimbursement.

Then insurance started offering prescription co-pay cards through employer. The patient would present the prescription and the co-pay card and the pharmacy would charge the insurance company average wholesale cost (in reality a fictional, highly manipulated number) plus a dispensing fee and collect a small co-pay from the patient. 

The patient no longer cared about the cost of the drug, since they only paid the co-pay.  Drug manufacturers realised that if the consumer didn't care about the cost of the drug, they could arbitrarily increase the price with no push back from the consumer and did so in spades.   Meanwhile the insurance companies started squeezing the pharmacy to discount the AWP charged or decrease the dispensing fee. 

Things have gone downhill since then.

However, one can reasonably argue that drug therapy is a bargain even with out high prices.  If you can take a $200 antibiotic prescription & recover well at home in a few days and avoid a multithousand dollar hospital stay, you're ahead.  If you can take omeprazole, metronidazole, and pepto bismal & avoid surgery for a stomach ulcer, you're ahead.  

France and Canada don't have perfect health care systems, but I often think that things would be a lot better if Congress sent a postcard to France & Canada asking for full details of their health care system, flip a coin to decide which one to copy, and implement it.  

I don't think I've got politcal in the post.  Be aware that PHARMA  (and insurance industry pacs) give tons of money to politicians on both sides of the aisle.

In reply to M2Pilot :

Big Business does that.  They support whoever is favored to win but on the off chance the underdog  connects they support that person as well.   A few million to gain access  to law makers?  Cheap at twice the price.  
   That isn't political it's just the way things are done in this country. It's legal bribery.