#311

Dude can’t argue for his position:

Obviously the problem is more complex, but I do not have space, and frankly I do not pretend to be the most qualified person to lay out the full argument.
Exclusive: Luigi's Manifesto - Ken Klippenstein

He used life expectancy as an example but probably has no clue what’s causing it. Obesity, drugs and alcohol, lack of preventative care, these play a massive role.

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#312

Why people hate the US Health Insurance Companies and are resorting to extreme measures; they pay their senior managers $ millions, and donate even more money to politicians (so they don’t change the system) and spend millions in PR (to make it seem like people are ok with everything), all to deny people treatment and maximize share price…

Its not much of an exaggeration to say that the US health insurance companies are trying to kill you, so they can save some money, to satisfy Wall Street, & maximize stock price. Its not a recipe for high customer satisfaction scores.

Decades ago, the health insurance business put in place a dike to hide and contain the public’s disdain for for-profit health insurers, and to keep reformers at bay. Now, that dike might collapse.

As the former VP of corporate communications at Cigna, I played a role in building and fortifying that dike. Every year, my colleagues and I across the industry devoted massive amounts of the money — money our customers paid us to cover their medical care — on lobbying, campaign contributions, deceptive PR campaigns, and even charitable donations to buy goodwill. All of that was spent for the sole purpose of maximizing shareholder return. Restricting patients’ access to needed care made UnitedHealth, Cigna and a handful of other big insurers Wall Street darlings, and made lots of people lots of money while doing little to enhance care.

The public’s dissatisfaction has never been higher. Recent polling data show the health care system is as unpopular now as it was before the Affordable Care Act went into effect 15 years ago — a time when insurers could decline to cover people if they had any number of pre-existing health conditions and nearly 49 million people lacked insurance. A survey from Gallup released Friday reveals that “Americans’ positive rating of the quality of health care in the U.S. is now at its lowest point” since 2001.

Several factors have contributed to that resentment. Roughly 25 million Americans remain uninsured. Tens of millions of others have health insurance but can’t afford their deductibles, coinsurance, or copays due to the high prices of tests, surgeries, and prescription drugs. Insurers have tried to root out unnecessary procedures, but that sometimes results in inappropriate care delays or denials and excessive paperwork. These barriers aren’t just a nuisance — they can have real effects on patients’ health.

After care is provided, patients are inundated with medical bills they don’t understand — perplexed why their insurer isn’t advocating on their behalf, and fearful that hospitals and other providers will send them to collections or sue them.

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#313

The neighbors in the north:

Why is Canada euthanising the poor?

…
Despite the Canadian government’s insistence that assisted suicide is all about individual autonomy, it has also kept an eye on its fiscal advantages. Even before Bill C-7 entered into force, the country’s Parliamentary Budget Officer published a report about the cost savings it would create: whereas the old MAID regime saved $86.9 million per year – a ‘net cost reduction’, in the sterile words of the report – Bill C-7 would create additional net savings of $62 million per year. Healthcare, particular for those suffering from chronic conditions, is expensive; but assisted suicide only costs the taxpayer $2,327 per ‘case’. And, of course, those who have to rely wholly on government-provided Medicare pose a far greater burden on the exchequer than those who have savings or private insurance.

And yet Canada’s lavishly subsidised media, with some honourable exceptions, has expressed remarkably little curiosity about the open social murder of citizens in one of the world’s wealthiest countries. Perhaps, like many doctors, journalists are afraid of being accused of being ‘unprogressive’ for questioning the new culture of death, a fatal accusation in polite circles. Canada’s public broadcaster, which in 2020 reassured Canadians that there was ‘no link between poverty, choosing medically assisted death’, has had little to say about any of the subsequent developments.

Next year, the floodgates will open even further when those suffering from mental illness – another disproportionately poor group – become eligible for assisted suicide, although enthusiastic doctors and nurses have already pre-empted the law. There is already talk of allowing ‘mature minors’ access to euthanasia too – just think of the lifetime savings. But remember, slippery slopes are always a fallacy.

https://archive.ph/TI4bQ

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#314

Hmmm, I cite a Healthcare biotech news source, and you cite:

“The Spectator was founded in 1828 and has published continuously since then – making it the world’s oldest surviving magazine. It has always been considered the “house journal” of the Conservative Party, with its editorship often used as a stepping stone to political prominence (most recently by Boris Johnson).” Source: What the Spectator takeover means for the UK’s right-wing media and politics

Allsides.com Bias Review: https://www.allsides.com/news-source/spectator-world-media-bias

I can’t say I know much about the Canadian MAID program, but if I was interested, I’d look at academic reviews, not opinion articles in Convervative magazine… just saying, have you looked at the hierarchy of evidence recently?

But if additional safeguards are needed in a country’s euthanasia program, and more focus needs to be done on treatment - I’m all for it.

And if someone is getting paid $ Millions for encouraging a euthanasia program, paying politicians for implementing it, and paying the press to promote it, please identify the details.

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#315

Hierarchy of evidence doesn’t apply to this, that’s for medical and health claims, not broader journalistic work. Here’s from 大西洋 bringing up many similar examples as in the previous article:

The state is saving money. The Canadian press is partly funded by the state. There’s some warped incentives there. The examples show it, and that’s just how it is now. I’m not saying the U.S system is better, just that a socialized pay system like in Canada can cause some weird incentives.

#316

Cremieux gives Luigi’s manifesto an F.

Grading the World’s Shortest Manifesto - Cremieux Recueil

Cremieux notes, among other things:

" the U.S. does not spend all that anomalously much on healthcare. It is just vastly wealthier than its peer countries"

" America’s poor life expectancy has little to do with its healthcare system, and what amount it does have to with the healthcare system likely favors America ."

“America is ahead when it comes to mortality from conditions the healthcare system can actually affect”

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#317

Sure, I agree - at some level.

But, there are, I believe, many independent press outlets in Canada just as in other Western countries. Some may get some funding from the Canadian govt at some level.

More importantly there is a vast difference between some a CEO being paid directly $10 Million to $45 million per year to deny coverage/maximize profits, and PR people and politicians being paid (or “donated”) hundreds of thousands of dollars to do what a corporation wants in support of this aim, and some lowly Canadian journalist paid $45,000 a year to cover news generally (and who might write a story or two about euthanasia), and who’s parent corporation may get some federal funding. Its so indirect an incentive as to be insignificant (would you not agree).

One think you may want to note, in the USA there are 6 PR people (i.e. Public Relations / People paid to spin a positive narrative to the Press) for every journalist (and you get paid a lot more for working for corporate PR than you do as a journalist) so if you ever wonder why the mainstream press of all political persuasions is frequently bad, this is likely a big contributor:
https://muckrack.com/blog/2018/09/06/there-are-now-more-than-6-pr-pros-for-every-journalist

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#318

I don’t know if it’s insignificant or not. That’s a possibility why there hasn’t been a lot of journalistic work there (if true), when Canadian bureaucrats gets to decide and provide life or death for vulnerable people. There are also social contagions with passivity where no one speaks up and it just ramps up until it reaches a tipping point where the downsides of some past legislation is too hard to deny after rolling down the slippery slope crashing into the ground. I don’t know which one it is.

#319

Keep writing things like this. :+1: It adds a dimension to your personality that I was not aware of.

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#320

Which is why a rapamycin human clinical trial will never happen through our health insurance and pharmaceutical monopoly on health.

And rapamycin will continue to be identified as a black drug… a dangerous drug… with severe side effects.

My 3 month pharmaceutical grade zydus arrived today. Yes.

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#322

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#323

Recent research - Garmany A, Terzic A. Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States. JAMA Netw Open. 2024;7(12):e2450241. doi:10.1001/jamanetworkopen.2024.50241

Apparently (demographically speaking) one can’t have their cake (health) and and eat it too (longevity).

From Discussions section:
This study reported life expectancy and health-adjusted life expectancy trends over the past 2 decades and found healthspan-lifespan gaps for each of the 183 WHO member states. Sex disparities in healthspan-lifespan gaps and association with longevity and disease burden are also reported. The US stands out with the largest healthspan-lifespan gap and the greatest noncommunicable disease burden. The risk to healthspan is found amplified by longevity and is here recognized to be more pronounced in women. The widening healthspan-lifespan gap is a global trend, as documented herein, and points to the need for an accelerated pivot to proactive wellness-centric care systems.

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#324

This is why people hate the “health insurance” companies in the US. You really have no option as an employee… you take what you’re given or you don’t get a job. And the health insurance companies cover whatever they want, given the limits of the loose regulation that says that they have to cover something…

Basically, it seems to me that for a significant portion of the population it seems that a bad healthcare system is shoved down people’s throats, the companies pay the politicians and PR people to promote it as “good healthcare” (so they can continue the charade). Many of the people know its shit and if you have to spend anytime at all dealing with the health insurance companies you hate them. And you have to spend hours of your time dealing with insurance companies…

" Consumers’ sense of powerlessness is often amplified when dealing with health insurance companies, which govern the care that patients receive. But navigating those huge and opaque companies can be maddening at best, and consumers rarely have much of a say; for about 154 million Americans, employers select and provide health insurance coverage."

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#325

Diatribe coming just to pile on…

As you said @RapAdmin, when you work for a company, you have almost no choice on your healthcare options. I always worked for huge companies and we would have perhaps 2-3 options. I don’t know if that has changed, but with a smaller company, you have one option.

Once I stopped working almost 20 years ago and we needed our own private insurance, we could barely find any due to my high cholesterol and my husband’s headaches. We finally found ONE company to insure us but they excluded my husband’s head… because of damned headaches!

Thank goodness for Obamacare (for those of you not in the US, that made denying you for preexisting conditions a thing of the past). Having said that, when I recently took the test to see if I had e4/e4 for an elevated chance of getting Alzheimer’s, I used a fake name incase Trump was elected and repealed the entire thing.

I was a rep for a drug company over 30 years ago, we sold an injectable directly to medical practices, so part of our job was to help make sure reimbursement to their offices went smoothly. In training, even waaaay back in the olden days, I was taught that the people processing claims are given bonus based on how much they deny. They said they almost deny everything at first and then on the third try, you’ll often have success.

Now that preexisting conditions are not a thing, there are almost no options to buy private insurance anyway, at least in my state. Meaning, you don’t get to pick amongst all the carriers because most won’t even deal with individuals. If one is able, many people start small companies ONLY to get reasonable health insurance.

Just typing this out makes me ill. And even though I know their game, I still find myself unable to understand my coverage and am too weak to fight it because I can either win and shorten my life from the stress, or pay more and not give myself a heart attack from fighting those monsters.

The other day when I was using Good RX to buy something for $40 instead of $300 because my insurance denied it even though I’m at my out of pocket max for the year, the pharmacist said wow, I’m surprised they were bold enough to do that now. They should be fearing for their lives. When the random pharmacist is saying this to a customer, you know the nerve of a society has been touched. (I imagine there is a reason they could justify the denial, but the point remains).

PS
Bless you @RapAdmin for introducing me to Good RX!!!

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#326

I’m trying to wrap my head around this idea that health insurance companies are refusing care, but we spend more money per capita than any other country?
Does refusing care just cause more testing and more lesser care until we spend more, or the insurance company gives in?

I’m also trying to figure out how GoodRx makes money?

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#327

I think we spend the most money when the patients are near terminal and medical need is overwhelmingly apparent. However, that’s also when dollars spent are least effective.

It seems insurance companies are penny wise but pound foolish. But it’s also a game of hot potato where a patient might not be with them in 5 years, so why treat something now that will be someone else’s problem later?

#328

Yes, most of the time the patient ends up on Medicare.

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#329

Yes - a common question…

How companies like GoodRx work

How are drug coupon companies able to offer those discounts in the first place? It’s a complicated, opaque process that’s part of an even more complicated, opaque health care system.

Kevin Schulman, a professor at the Stanford University School of Medicine, said that behind the scenes, the manufacturer offers a discount or rebate to an intermediary known as a pharmacy benefits manager, or PBM.

PBMs are companies that serve as middlemen between drug manufacturers, insurers, big employers and pharmacies, negotiating with drugmakers to get the lowest prescription price. PBMs are like real estate agents, an economist told Marketplace in 2018, handling complicated details.

Schulman said that behind the scenes, the manufacturer offers a rebate to the PBM, who then takes a cut of that rebate. In other words, instead of passing off the full discount, the PBM pockets some of the money. As critics have pointed out, it’s unclear how muchPBMs take from the pot.

If you have health insurance, the PBM then passes on the remaining rebate to your insurer.

GoodRx doesn’t negotiate its prices with pharmacies; it uses PBMs for that. So how does GoodRx make money?

By getting a cut of the price PBMs negotiate for them, similar to how PBMs make money, explained Reshma Ramachandran, an assistant professor at the Yale School of Medicine.

A flow chart on Drug Channels, an online site that covers the pharmaceutical industry, explains the different players in America’s drug distribution and reimbursement systemand another way PBMs make money. When you use a discount card, the PBM receives a fee from the pharmacy, and the PBM will then share some of this fee with the discount card vendor that steered you to that pharmacy.

But in this system, some players may end up missing out on revenue, like pharmacies or large chains, and leave the discount card networks, said Stacie Dusetzina, a professor at Vanderbilt University Medical Center.

For example, the Los Angeles Business Journal reported that in 2022, Kroger “stopped accepting GoodRx discounts.”

PBMs in particular have gotten backlash, with critics saying that they’re responsible for rising retail drug prices.

“The PBMs say the drug manufacturers set the list price of the drug, and so it’s the drug manufacturers’ fault,” said Schulman of Stanford University. “The drug manufacturers say the PBMs are demanding greater and greater rebates, and so they have to raise the list prices to pay the rebates.”

Three PBMs control a majority of the market: Express Scripts, CVS Caremark and Optum Rx. They have negotiating power because if manufacturers “want to sell their products, they need good formulary placement,” Schulman explained. (A formulary is a list of drugs, created by PBMs, that health insurance will cover.)

How are companies like GoodRx able to provide drug discounts? - Marketplace.

PROFITING FROM A CRAZY SYSTEM

The GoodRx team has built and scaled a robust platform for monetizing the three steps above.

Here’s their reward: In 2019, GoodRx collected an astounding $364 million in fees on $2.5 billion in consumer Rx spending.

In other words, GoodRx earned about 15% of the $2.5 billion that consumers spent at pharmacies with its programs.

Incredible.

Note that we don’t know the undiscounted cost of these prescriptions. Nor do we know how much PBMs earned—but we can assume it was more than they paid GoodRx.

Sales and marketing are GoodRx’s biggest expenses, and they absorb almost 50% of revenues. After other expenses, the company’s pre-tax profit margins are 40%. (See page 85 of the S-1.) Again, incredible.

It’s no surprise that pharmacies despise this model. Pharmacies lose in two ways. One, they lose the potential revenue from a cash-paying customer, who would have paid more than what the pharmacy received from a PBM. Two, the pharmacies must pay a fee for the privilege of dispensing to a patient who may have used their pharmacy anyway. However, pharmacies are effectively prevented from offering low cash prices, because they risk undercutting their third-party margins.

Think about it this way: GoodRx profits by helping consumers avoid the U.S. pharmacy industry’s historical cash pricing models.

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#330

The true disruptors are Indian pharmacies. :slight_smile:

Thank goodness for India!!!

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#331

At the A4M conference, on Saturday, the discussion with Peter Attia was enjoyable. He discussed this issue and suggested if we flipped the system and had Medicare for those under 65 and private insurance for over 65, the incentives to focus on maximizing health would be there in trying to minimizing health complications as Medicare would own those patients and their health needs for decades.

@RapAdmin The crazy system with all health services and the three tiered billing is a huge problem that consumers need to be apprised of. For drugs, medical services, labs and imaging for the same services at the same facility, billing can be more than 15 fold different. Being savvy and navigating this is something I help my patients with. It is a complete scam. There should be one price for the same thing.

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