4 ms·

You're totally right, this is a hugely complex matter. However, it's not so simple to just relabel the drug, after all to a first approximation a drug is prima

by entee 10y ago

You're totally right, this is a hugely complex matter. However, it's not so simple to just relabel the drug, after all to a first approximation a drug is primarily an active ingredient and secondarily a delivery mechanism. You can patent one, the other or both together. There's definitely remixing, reformulation etc. for patent purposes, but it's not always that trivial to do. Re. regulatory capture, I don't know if the FDA or regulatory capture thereof is that huge an issue. The chief advantage other countries have is the ability to say, "No." Medicare doesn't have that ability, and even if we were to allow CMS (the agency that administers Medicare/Medicaid) to negotiate for drug prices, it's not much of a negotiation if CMS can't say, "we're not buying it." Can you imagine the outrage in congress from people calling in and saying, "I need this drug and Medicare isn't paying for it."? I guess that's regulatory capture in some way, but damn is it more complicated than cozy agency-industry relations. A really great and sober take on drug pricing from someone who's been in the industry forever can be found here: http://blogs.sciencemag.org/pipeline/archives/2015/12/02/a-look-at-drug-pricing http://blogs.sciencemag.org/pipeline/archives/2015/12/02/a-l... EDIT: Typo s/companies/countries/

maxerickson 10y ago
Medicare drug plans do say no. There's even tools to find one that works best for a given patient. https://q1medicare.com/PartD-SearchPDPMedicarePartDDrugFinder.php https://q1medicare.com/PartD-SearchPDPMedicarePartDDrugFinde...
- entee 10y ago
  Those aren't quite the same. Medicare part D plans are actually private insurance plans whose costs are subsidized by the government. It's not the same as the government itself negotiating for drugs, which is essentially what the NHS in England and many other systems in the developed world do.
  - maxerickson 10y ago
    Right. Part D is what people are talking about when they talk about Medicare not being able to negotiate prices. edit: That's one of the advantages of the privatized system, companies take the heat for having a formulary.
    - entee 10y ago
      Yes and no, a detailed article covering the terms of the debate is here: http://healthaffairs.org/blog/2016/09/19/the-politics-of-medicare-and-drug-price-negotiation/ http://healthaffairs.org/blog/2016/09/19/the-politics-of-med... Most relevant quote: "One bargaining chip to attract market-oriented Republican votes was the so-called “noninterference clause”—a provision drug manufacturers had a major role in writing and getting through Congress—which banned negotiations between Medicare and pharmaceutical companies on drug prices and prevented the government from developing its own formulary or pricing structure. Instead of CMS negotiating on Part D plans’ behalf, prescription drug plans compete for enrollees and negotiate directly with manufacturers." Part D (and presumably Part C plans that offer prescription coverage) negotiate with the drug companies individually. CMS cannot negotiate en-bloc for all the Part D plans. Therefore Part D plans have the same leverage as traditional insurers, which is to say some, but not nearly as much as All-Of-Medicare has. The VA and Medicaid do regulate/negotiate drug prices, but those are much smaller populations. I think something like the VA system might work, but you'd have to have politicians willing to take some political risk or find a way of isolating drug price negotiations from political pressure. I think in this political climate, that's a really tall order. Remember when "If you want to talk to your doc about end of life plans we'll reimburse you for the visit" turned into Death Panels? I suspect we'd see something similar... EDIT: and yes, private companies with a formulary are a great way to isolate yourself from the political heat, but you then lose the negotiating power government has ;)
joe_the_user 10y ago
"Re. regulatory capture, I don't know if the FDA or regulatory capture thereof is that huge an issue. The chief advantage other countries have is the ability to say, "No." Medicare doesn't have that ability..." Clearly, the influence of private interests is critical for the situation where those interests can set their terms and prices without fetters. Objecting that this isn't regulatory capture but something else seems like a quibble. Broadly, piecemeal reform is something like black list security. The supposed free market is left to set health care prices and process for a public that is clearly unequipped to bargain like an "informed consumer" (no matter how blithe pamphlet announce this need). Once one particular method of exploitation get a lot of press, regulation or legislation goes after this method, leaving the industry to work out it's next "zero day" against the health care consumer.
- entee 10y ago
  I'm not saying there's no regulatory capture, I am saying that an angry citizen calling their congressman is a very different kind of problem then cozy relations between industries and the agencies that regulate them. Both exist, but they have quite different political and policy ramifications, and I would suggest that citizens calling congressman is more fraught than agency/lobbying reform (already difficult in its own right). You can already see people calling the FDA saying, "let this drug through, it helped me, though it failed its clinical trial." Right now, the FDA has some insulation from political meddling, but that's not a guarantee, and I think that problem gets 10x worse if the government gets involved in direct negotiations and price setting. For example what happens when if/when Medicare says, "we're not paying more for name brand than generic."? You'll get tons of people calling their congressman saying, "I need NameBrandSuperDrug because GenericSuperDrug doesn't work." Despite the science being quite clear that the generic is virtually always fine.
  - joe_the_user 10y ago
    "I'm not saying there's no regulatory capture, I am saying that an angry citizen calling their congressman is a very different kind of problem then cozy relations between industries and the agencies that regulate them." - What I would say has roughly similar results is a cozy relationship between regulated industry and regulator versus a cozy relationship between regulated industry and congressmen they finance - and even patient groups they finance, advertising strategies they follow, etc.,etc. I mean "Cui bono" comes up strongly here. Your argument seems like an elaborate summary of the tree of the forest of health care corruption-in-a-broad-sense. I'm sure you can find a few more "trees" I didn't know about in this discussion but it seems like your approach still follows the path of ignoring this metaphorical forest for its trees.

by entee 10y ago

maxerickson 10y ago

Medicare drug plans do say no. There's even tools to find one that works best for a given patient. https://q1medicare.com/PartD-SearchPDPMedicarePartDDrugFinder.php https://q1medicare.com/PartD-SearchPDPMedicarePartDDrugFinde...

entee 10y ago
Those aren't quite the same. Medicare part D plans are actually private insurance plans whose costs are subsidized by the government. It's not the same as the government itself negotiating for drugs, which is essentially what the NHS in England and many other systems in the developed world do.
- maxerickson 10y ago
  Right. Part D is what people are talking about when they talk about Medicare not being able to negotiate prices. edit: That's one of the advantages of the privatized system, companies take the heat for having a formulary.
  - entee 10y ago
    Yes and no, a detailed article covering the terms of the debate is here: http://healthaffairs.org/blog/2016/09/19/the-politics-of-medicare-and-drug-price-negotiation/ http://healthaffairs.org/blog/2016/09/19/the-politics-of-med... Most relevant quote: "One bargaining chip to attract market-oriented Republican votes was the so-called “noninterference clause”—a provision drug manufacturers had a major role in writing and getting through Congress—which banned negotiations between Medicare and pharmaceutical companies on drug prices and prevented the government from developing its own formulary or pricing structure. Instead of CMS negotiating on Part D plans’ behalf, prescription drug plans compete for enrollees and negotiate directly with manufacturers." Part D (and presumably Part C plans that offer prescription coverage) negotiate with the drug companies individually. CMS cannot negotiate en-bloc for all the Part D plans. Therefore Part D plans have the same leverage as traditional insurers, which is to say some, but not nearly as much as All-Of-Medicare has. The VA and Medicaid do regulate/negotiate drug prices, but those are much smaller populations. I think something like the VA system might work, but you'd have to have politicians willing to take some political risk or find a way of isolating drug price negotiations from political pressure. I think in this political climate, that's a really tall order. Remember when "If you want to talk to your doc about end of life plans we'll reimburse you for the visit" turned into Death Panels? I suspect we'd see something similar... EDIT: and yes, private companies with a formulary are a great way to isolate yourself from the political heat, but you then lose the negotiating power government has ;)

joe_the_user 10y ago

"Re. regulatory capture, I don't know if the FDA or regulatory capture thereof is that huge an issue. The chief advantage other countries have is the ability to say, "No." Medicare doesn't have that ability..." Clearly, the influence of private interests is critical for the situation where those interests can set their terms and prices without fetters. Objecting that this isn't regulatory capture but something else seems like a quibble. Broadly, piecemeal reform is something like black list security. The supposed free market is left to set health care prices and process for a public that is clearly unequipped to bargain like an "informed consumer" (no matter how blithe pamphlet announce this need). Once one particular method of exploitation get a lot of press, regulation or legislation goes after this method, leaving the industry to work out it's next "zero day" against the health care consumer.

entee 10y ago
I'm not saying there's no regulatory capture, I am saying that an angry citizen calling their congressman is a very different kind of problem then cozy relations between industries and the agencies that regulate them. Both exist, but they have quite different political and policy ramifications, and I would suggest that citizens calling congressman is more fraught than agency/lobbying reform (already difficult in its own right). You can already see people calling the FDA saying, "let this drug through, it helped me, though it failed its clinical trial." Right now, the FDA has some insulation from political meddling, but that's not a guarantee, and I think that problem gets 10x worse if the government gets involved in direct negotiations and price setting. For example what happens when if/when Medicare says, "we're not paying more for name brand than generic."? You'll get tons of people calling their congressman saying, "I need NameBrandSuperDrug because GenericSuperDrug doesn't work." Despite the science being quite clear that the generic is virtually always fine.
- joe_the_user 10y ago
  "I'm not saying there's no regulatory capture, I am saying that an angry citizen calling their congressman is a very different kind of problem then cozy relations between industries and the agencies that regulate them." - What I would say has roughly similar results is a cozy relationship between regulated industry and regulator versus a cozy relationship between regulated industry and congressmen they finance - and even patient groups they finance, advertising strategies they follow, etc.,etc. I mean "Cui bono" comes up strongly here. Your argument seems like an elaborate summary of the tree of the forest of health care corruption-in-a-broad-sense. I'm sure you can find a few more "trees" I didn't know about in this discussion but it seems like your approach still follows the path of ignoring this metaphorical forest for its trees.