Med System (10/27/07)
Posted Oct 26, 2007
Last Updated Apr 12, 2008
I'm opening a series on our medical system. I'm not an economist or medical expert, but at age 81 I've had a fair amount of experience. So I'm launching into this, and inviting your thoughts, as a means of sorting out my thinking.
At present I have some observations that seem to me worth looking at. For example: The plans laid out by presidential candidates are based on private enterprise, because (1) private enterprise has experience in the field," (2) private enterprise is more efficient than government, and (3) the resulting competition will hold down costs.
Hmm. (1) private enterprise has experience in milking the system for profit. (2) Will a system as complex as they propose actually be efficient? And (3) the pharmaceutical industry has many competing firms, I suspect with large profit margins. As for competition — they all seem to work together — to avoid any regulations to huge greed, and to lobby lawmakers to quash proposals to bring down pharmaceutical costs.
Will the plans proposed by the candidates benefit the public as much as they will the medical industry?
I take a med called ADVAIR DISKUS (100/50), for chronic low-grade asthma. I started out with a one-month sample of a stronger version, 200/100 as I recall. The company said to use it twice a day. (The large sheet of tiny print on the possible side-effects was a little spooky, but when you start tinkering a highly intricate and not all that standardized biological system which still contains a lot of unknowns, side-effects shouldn't be all that surprising.)
Advair helped a lot. It really did. So when the sample was getting low, I stopped at the drugstore to see what it would cost to keep using it. Talk about sticker shock! I called the doctor and told her I was going to discontinue when the sample ran out. She said let's try the lower strength version. So I did. It was the 100/50 version, at a little more than half the cost. A 60-shot inhaler costs about $140; that's a month's worth. And it worked as well as the stronger version. After a month of that, it occurred to me to wonder how it would work if I used it once a day.
I told my doctor what I had in mind, and asked what he thought. ("He" because my previous doctor had moved farther away than I liked.) "Try it," he said, "and let me know how it goes."
I did. It still did the job, seemingly just as well. Since then it's cost me a little more than 1/4 as much per month as the first formulation and frequency.
The system. Efficient?
But let's say someone stayed with the first formulation and prescribed frequency. At what? I don't recall exactly, but it came to a bit less than $9 a day, so it would have been about $260 per month. Instead of the $70 a month I now pay. Now there is one doctor in the world who may mention the possibility that the patient might want to try the lesser formulation and frequency.
Meanwhile the company's write up with the last refill says twice a day.
At present I have some observations that seem to me worth looking at. For example: The plans laid out by presidential candidates are based on private enterprise, because (1) private enterprise has experience in the field," (2) private enterprise is more efficient than government, and (3) the resulting competition will hold down costs.
Hmm. (1) private enterprise has experience in milking the system for profit. (2) Will a system as complex as they propose actually be efficient? And (3) the pharmaceutical industry has many competing firms, I suspect with large profit margins. As for competition — they all seem to work together — to avoid any regulations to huge greed, and to lobby lawmakers to quash proposals to bring down pharmaceutical costs.
Will the plans proposed by the candidates benefit the public as much as they will the medical industry?
I take a med called ADVAIR DISKUS (100/50), for chronic low-grade asthma. I started out with a one-month sample of a stronger version, 200/100 as I recall. The company said to use it twice a day. (The large sheet of tiny print on the possible side-effects was a little spooky, but when you start tinkering a highly intricate and not all that standardized biological system which still contains a lot of unknowns, side-effects shouldn't be all that surprising.)
Advair helped a lot. It really did. So when the sample was getting low, I stopped at the drugstore to see what it would cost to keep using it. Talk about sticker shock! I called the doctor and told her I was going to discontinue when the sample ran out. She said let's try the lower strength version. So I did. It was the 100/50 version, at a little more than half the cost. A 60-shot inhaler costs about $140; that's a month's worth. And it worked as well as the stronger version. After a month of that, it occurred to me to wonder how it would work if I used it once a day.
I told my doctor what I had in mind, and asked what he thought. ("He" because my previous doctor had moved farther away than I liked.) "Try it," he said, "and let me know how it goes."
I did. It still did the job, seemingly just as well. Since then it's cost me a little more than 1/4 as much per month as the first formulation and frequency.
The system. Efficient?
But let's say someone stayed with the first formulation and prescribed frequency. At what? I don't recall exactly, but it came to a bit less than $9 a day, so it would have been about $260 per month. Instead of the $70 a month I now pay. Now there is one doctor in the world who may mention the possibility that the patient might want to try the lesser formulation and frequency.
Meanwhile the company's write up with the last refill says twice a day.
________
What do you get for $260 a month? A small inhaler — fits nicely in the palm of your hand — with a 60-dose supply of a fine powder. You push a lever which meters out a single dose that you inhale deeply. The powder does what it does, and you feel better for it. At least if the biochemical side-effects don't kick in.
But why does it cost $260 a month? Or in my case $70? How much powder do you get for $260, or $140 or $70? A tablespoon maybe? A teaspoon? What does that particular powder cost to make?
A pharmaceutical company has beaucoup operating expenses. Business expenses that include research, development, and testing. Those are unavoidable.
But how about the sales reps that visit doctors and push samples and pay for lunches and golf dates. Some of that probably is avoidable — the lunches maybe, and surely the golf dates.
And just how much does the research and development cost? It would be interesting to know some of those things. And how much do executive bonuses add? And sales bonuses for that matter.
And congressional lobbying?
And what does Advair cost in Canada? In the UK? In Sweden?
Is there a website that tracks those things?
Would the company stop making Advair if states — or the feds! — got down to serious bargaining to lower the prices of pharmaceuticals? Would they stop research and development?
The companies are riding a cash cow. They have a guaranteed market. The problem is, the way things are set up now, their only competition seems to lie in developing products with different features, and pushing their own particular brands.
And the goal is not to save lives or improve health and functionality. They might feel that those are good things to do, but the bottom line is (dare I say it?) profit. And really big executive salaries, and really big bonuses, and really big golden parachutes in case you ever get let go.
Lemme know how this seems to you.
What do you get for $260 a month? A small inhaler — fits nicely in the palm of your hand — with a 60-dose supply of a fine powder. You push a lever which meters out a single dose that you inhale deeply. The powder does what it does, and you feel better for it. At least if the biochemical side-effects don't kick in.
But why does it cost $260 a month? Or in my case $70? How much powder do you get for $260, or $140 or $70? A tablespoon maybe? A teaspoon? What does that particular powder cost to make?
A pharmaceutical company has beaucoup operating expenses. Business expenses that include research, development, and testing. Those are unavoidable.
But how about the sales reps that visit doctors and push samples and pay for lunches and golf dates. Some of that probably is avoidable — the lunches maybe, and surely the golf dates.
And just how much does the research and development cost? It would be interesting to know some of those things. And how much do executive bonuses add? And sales bonuses for that matter.
And congressional lobbying?
And what does Advair cost in Canada? In the UK? In Sweden?
Is there a website that tracks those things?
Would the company stop making Advair if states — or the feds! — got down to serious bargaining to lower the prices of pharmaceuticals? Would they stop research and development?
The companies are riding a cash cow. They have a guaranteed market. The problem is, the way things are set up now, their only competition seems to lie in developing products with different features, and pushing their own particular brands.
And the goal is not to save lives or improve health and functionality. They might feel that those are good things to do, but the bottom line is (dare I say it?) profit. And really big executive salaries, and really big bonuses, and really big golden parachutes in case you ever get let go.
Lemme know how this seems to you.
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