Capitalism Works Both Ways
Don't Let the Scarecrows Get You Down - Fight Back
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| Dr. Crane (AKA The Scarecrow) planned to hold Gotham for ransom by possessing the only drug to counter the 'Fear Gas' |
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| The resemblance is uncanny... |
This is a follow-on to two previous posts that together seek a balanced approach:
Complaints about the High Price of Miracles
Capitalism is Still in Effect, Right?
One Buyer, One Low Price
- Medicare nationwide buys medical devices and drugs. Currently, by law, only the smaller commercial insurers can negotiate their slices. Medicare is one massive buyer, and it should get the bulk discount it is entitled to. Additionally, that price will be public knowledge for all to compare against.
Oh Canada! - Oh, Why Not?
- If it's an advanced nation and it has a reliable regulatory system, why shouldn't U.S. customers be able to buy (drugs, especially,) from other countries? The FDA can lay out some international minimums and list countries when they qualify.
- Steady Canadian resupply trips by retirees, etc. are currently tacitly accepted by all but the drug companies, much like illegal immigrants come and pick our crops now.
- The only real reason this isn't happening now is the opposition of the drug companies and the politicians in the grips of their lobbies.
Fix the Patent System
When patents run out; generics can take over - stop wasteful legal fights and obvious extensions.
The USPTO makes the DMV look positively speedy.
> Partly due to how overburdened the underfunded department is in general
> The key decision makers are spread too thin
> And some reviewers/managers there are dumber than rocks. As cushy as government pay AND benefits have become, talented people leave to easily exceed this elsewhere, and, let's face it, most of the remaining government drones willing to put up with this probably gave up caring long ago.
Most companies would love to have a clear set of rules that would keep the patent trolls at bay and cut legal costs, even if it allows generics and copycats to get in the game earlier.
- Set the rules and have good refs/reviewers
> Stop patent trolls - they stop patients from actually getting the drugs (a company may decide not to pursue a drug due to the legal cost to prove it's theirs), and they're parasites of a slow-moving system
> Kill obvious extensions - reviewers should be quick to recognize that, in most cases, adding one drug to another, or tweaking a formula is NOT patent-worthy
> Four effin' years to do the first review on a patent??!! A review needs to be done in a timely manner to give the company a "fish or cut bait" decision point, AND not let them add on and craft this patent into a monopoly play.
- Lowers litigious waste of time and money overall that we all pay (the lawyers) for
Fund it and staff it: It will pay for itself immediately.
Hospitals are generally the most inefficient businesses around, because they are in the business of saving lives, not money - spoon feed them.
- Like the procedures themselves, let's have evidence-based equipment choices on all the standard stuff
- There are a couple companies that provide a fee-based subscription service in some key fields, but there is room for a more comprehensive view of medical devices and drugs
- Leave a cut-out for doctor's experimental use ('cuz that's what it really is and always has been), and provide collected, collated, impartially reviewed information on new technologies/devices/drugs
Compare Costs
In the Dark: For decades the medical device companies and, I would presume, the drug companies have been keeping each company in the dark on actual prices just like a car dealer, always negotiating to see just how much money they can extract from each customer, and then demanding their silence as part of the deal.
- Shed Some Light: If big GPO's band together to reveal what they're paying, or all Catholic hospitals do, the companies can't afford to cut them off. It's o'kay that different places get charged different prices for volume of use or state-by-state regulation costs, for example.
- Try to Simplify: There's Tier I-IV type pricing, List, the 40% off list starting point for negotiations, and any number of legal and shady use-related (that product or some other) or exclusivity-related prices. Companies will find a way around this to some degree, but it shouldn't become like shopping for a bed where each store has a custom bed that can't be compared easily - patents, FDA clearances and CR will likely preserve the unique identities.
Make the End User (You and Me! The Patients) have Some Financial Skin in the Game
- Give the people knowledge
> Doctor comparisons - some are good, some are bad; we should be able to know this
- Costs up front
> Which means simplify the systems so doctors actually know what the costs are
> Don't let hospitals, clinics and offices keep patients in the dark; audit and punish violations
- Craft the healthcare plans so NOBODY gets a completely free ride
> We have bemoaned the plight of the poor and uninsured, but where they were a huge financial burden on the hospitals using Emergency Room services before, they are now getting medical coverage WITHOUT CO-PAYS that leads to unnecessary procedures and expenditures.
> Hold firm on that "Cadillac Plan" tax, even if all the unions are the biggest recipients (not just the rich, who the Democrats were targeting). Eventually there may be an improvement of this plan, but we don't need to scrap it before that better version comes along.
Promote/Support Less Profitable Generic Drugs (Government and/or Charity)
Generic makers will likely ignore drugs for rare conditions or those that affect primarily third world countries. These drugs are still useful and sometimes absolutely necessary - a program is in order. This is where the 62-year-old anti-parasite drug that Turing Pharma (above) bought a monopoly on, would remain an affordable $13 (or less) pill, versus $750.
- Create a center for testing of generic versions, perhaps as a part of NIH
- Work on preferred path approvals (low or no fees, priority based on impact)
- Contract out the work; philanthropies can aid on the business savvy side
No vultures, no crows...no Scarecrows.
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