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. 

    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.

mark leigh

Dec 26, 2007

try reasearching the cost for the typical aids three drug cocktail. $1000 (yes one thousand)per month minimum

David Palter

Dec 19, 2007

Have you seen Michael Moore's latest documentary, Sicko? It is devoted to this subject, the high cost of health care and what we can do about it. Moore is known to sometimes over-state his case and is more of a propagandist than an objective journalist, however, he is extremely eloquent, and his movies are worth seeing provided that one takes them with the proverbial grain of salt.

By far the largest cost in the introduction of any new drug is the clinical trials, which in most cases are conducted for years and involve thousands of patients (and in most cases, all these patients are paid to participate in the study). Ever since the big thalidomide fiasco, drug companies are legally required to err on the side of caution, and caution is expensive.

I have had considerable experience with both the US private enterprise form of health care and the Canadian form of public health care, and I have no doubt that the latter is more efficient. Governments can be very efficient when they want to be. I might point out that there are also some state governments which offer life insurance, which also turns out to be more efficient (that is, you get more coverage for a given cost) than life insurance from a private insurer. Life insurance companies pay incredibly large amounts of money in the form of sales commissions to agents, an expense which government based life insurance doesn't have.

In the US, Health Maintenance Organizations have made obscene profits by selling health insurance and then doing everything possible to hold down their costs by finding ways to deny people the health care that they have paid for. This is a huge national scandal. But even aside from the particulary pernicious HMOs, private health care coverage will never be as effective as public health insurance. Only public health insurance can guarantee that all citizens are covered. (Of course, then we'll have have huge problems with illegal immigrants trying to claim health care to which they are not legally entitled. But illiegal immigration is a separate problem which has to be dealt with anyway, with or without the issue of public health care.)

There is also the problem that the US is spending so much money on the war in Iraq, and so much on social security, and is so deeply in debt, that it seems inconceivable that the government could take on another major expense. But logically it must. The US has got to find ways to provide its citizens with the services that they really need, without going bankrupt doing it. This will require a lot more intelligence than George W, Bush has shown, but perhaps the next President can do better.

Shawn Olson

Nov 8, 2007

John... I have gotten caught up in work this last week... so we'll have to reschedule our lunch. In the meantime... I read the post about meds. I feel the same skepticism about the system and everyone's proposed solutions. In my opinion, the culprits are a triumvirate that consists of Pharmaceutical companies, block-headed politicians and, perhaps most of all, the insurance industry. I personally think that the current culture, political powers and big money will make it impossible to "fix" the system in my lifetime. I hope I am wrong... but pessimism grows on me whenever I contemplate these things.