Unsubstantiated Drug Price Increases

angrybearblog |  The ICER (Institute for Clinical and Economic Review)

Is an independent and non-partisan research organization. Its purpose is to evaluate the clinical and economic value of prescription drugs, medical tests, and health care and health care delivery innovations. ICER conducts rigorous analyses of all clinical data with key stakeholders to include patients, doctors, life science companies, private insurers, and the government and translate the evidence into policy decisions that lead to a more effective, efficient, and just health care system.

As explained by their site information, ICER is known as the nation’s independent watchdog on drug pricing. It’s drug assessment reports include a full analysis of how well each new drug works and the resulting “clinical value, quality of life, benefit to the health-care system and society” used to establish a price. Using the drug assessment report, a “value-based price benchmark” is established  reflecting how each drug should be priced addressing all four factors. Reports also evaluate the potential short-term budget impact of new drugs to alert policymakers to situations when short-term costs may strain health system budgets and lead to restrictions on patient access. Ensuring objectivity in its work, all ICER reports are produced with funding from non-profit foundations and other sources that are free of conflicts of interest from the life science industry or insurers.

What I have seen in the past is the ICER establishing pricing for new drugs taking into consideration these factors; “the patient’s quality of life, and the resulting benefits to the health-care system, and society.” This is the first time I am seeing the ICER looking at price increases and determining whether the value delivered substantiates a price increase. By the numbers: Here are the drugs (and manufacturers) highlighted in a recent ICER’s report, with the increase in net spending attributable to each drug’s price increase, and citing the increases could not be justified by the value delivered.

America's Healthcare Rip-off

nakedcapitalism |  Yves here. Reader Christopher J sent a contribution from Down Under, with a long note about his treatment for his first major medical treatment. I thought I would run it as a long-form example of how health care works in other advanced economies. Admittedly, my personal data points are stale, but when I was in Sydney (2002-2004), the caliber of health care was on a par with the US, and even with my paying out of pocket, the charges were about a third of what they would have been in the US. A couple I knew who had the option of the wife giving childbirth in New York City or Sydney chose Sydney because they deemed the care to be better. 

One of the big things that allows for America’s health care looting to go well beyond what ought to have been its sell by date is our provincialism. 

You can read about the Australian scheme here; the short version is citizens and permanent residents pay 2% of their annual income over a threshold for Medicare; they can then either buy private insurance or pay a surcharge for the balance of their coverage.

Christopher J lives in Cairns, which is a remote city of 150,000 near the Great Barrier Reef. 

By Christopher J

I follow your blog most days and have been a part time commenter for well over 10 years now, since I worked for the Bureau of Transport Economics in Canberra. 

Here is a story about my first medical emergency. I was born in the UK in 1961 and now live in Cairns after working in the public sector for 30 plus years in the finance and treasury sectors. I currently work for self as handyman and have a partner who also works.

Last September 2018, I gave up smoking cigarettes due to the expense. Heavily taxed to ‘discourage use’, a 20 pack of Marlboros now costs around A$30 – $20 US. And, I reckon my habit was costing around $750 a month, or the cost of an annual river cruise in Europe! I’d given up several times for months or even years, but this was the first time I’d given up arising from anger at how the Federal Government was tackling the problem with a huge tax on, mostly, working people.

After that first month, I withdrew the money I’d saved in cash and bought myself a flash wallet to put it in. Smug I was at the pub around my smoking friends. I found huge improvements in my health. For many years sleeping on my side led to my arms going to sleep as my circulation was constricted by all that smoke residue. After a month or so of not smoking, my blood circulation improved and I found I could sleep again on my side. I told partner we were going to extend all our run circuits by about 800 m and we started to hike up Mount Whitfield, and jog down, about an 8km round trip with an up and down of around 350m, with the trail along the ridge line. I was feeling very fit for my age and was feeling generally positive about my health and well being.

At the end of May, or so, and out of the blue, I found a lump as I was sitting on the bed one morning. This was a Monday about 4 months ago. At the top of my right thigh and groiu area was a lump, not painful, about the size of a small egg.’

What About Spending It On Medicaid Instead?

counterpunch |  Something very unusual happened on Thursday, Oct. 17. The New York Times suddenly ran an article on its opinion page explaining how to cut $300 billion from the $1-trillion military budget — enough, the article explained, to fund Bernie Sanders’ proposed program for an expanded Medicare program to cover all Americans without raising a dime in new taxes.

The article, written by Lindsay Koshgarian, director of the Institute for Policy Studies’ National Priorities Project, explained that by shifting the US diplomatic and military strategy from one of confrontation, endless wars, expansive overseas basing, and unilateralism to one of diplomacy, a pull-back from foreign bases and global deployments, with a concomitant reduction in the nation’s 2.4 million-person military could be accomplished with no threat to US national security.

Koshgarian’s opinion article actually listed the cuts that could be made, attaching a dollar value to each one. Examples were:

* End the practice of supplemental appropriations for war funding, much of which is actually used for more spending on other unintended military programs and which have only led to unending wars that have done nothing to make the US safer, for example in Iraq and Afghanistan. Savings: $66 billion per year.

* End funding for other nations’ militaries. Savings $14 billion a year.

* Close foreign bases (Almost one-third of all uniformed US military personnel serve abroad, most of them in non-crisis-zone locations or combat zones). Savings: $90 billion

Why 2+ Million American Expats Live in Mexico

businessinmexico |  If you’ve ever considered a move across the southern border, you may wonder what healthcare in Mexico is like for expats. While in many ways, the Mexican system is much friendlier than the U.S. healthcare system — so much so that Americans cross the border to get healthcare — there are still a lot of things you need to know.

What kind of healthcare system does Mexico have? Can you get insurance there as a resident, or while doing business in Mexico? What is the IMSS, or Seguro Popular, and how do those apply to you as a non-citizen? When it comes to medical care, south of the border, understanding your options is essential.

When many Americans think of Mexico, they think of a poverty-stricken country that people are trying to escape. While that might be true in some cases, primarily because of corruption, Mexico is a cosmopolitan 21st-century country and its healthcare system reflects that.

There are thousands of healthcare facilities throughout the country, about one-third of which belong to the taxpayers. Most healthcare providers in Mexico received at least part of their education in the United States, Canada or Europe. Finding an English speaking doctor should not be a problem.

We Switched from Meth Labs to Mexican Cartels

kctv5 |  As the officer in charge of COMBAT, Jackson County’s Drug Trafficking Task Force Dan Cumming deals with a lot of dangerous people.

“About 100% of what we recover, if you follow it back far enough up the drug train so to speak, comes from Mexico and is cartel related,” Cummings said.

Just last week, COMBAT worked a case at the request of Independence police.

A tip led them to a Kansas City, Missouri street where a search warrant led to the seizure of tires filled with meth.

“My guess is that’s the way it was shipped from Mexico to Kansas City,” Cummings said.

Cartels get creative when smuggling drugs in customs and border protection has a few recent examples.

Fentanyl in a vehicle transmission, heroine in a gas tank, marijuana inside a car door and cocaine in clay figurines.

Cummings says he’s seeing more cartel related drug busts in Kansas City now than he has in his 35 plus years in law enforcement.

Los Chapitos Put the Lie to the Myth of Sovereign Force Monopoly

reuters |  The mug shot-style photo of Ovidio Guzman that appeared as he was apprehended oozed defiance. Chin jutting out, eyes trained on the camera, the handsome youth bore a strong resemblance to his infamous father, jailed drug lord Joaquin “El Chapo” Guzman. 

He had reason to be cocksure. In response to his capture in an upscale neighborhood, hundreds of heavily-armed Sinaloa Cartel henchmen, guns blazing, were pouring into Culiacan, briefly taking the modern city of about a million people near Mexico’s Pacific coast hostage. 

Within hours they had pried him loose from authorities. 

It was like nothing Mexico had seen before, a military-style operation that outfoxed and outnumbered security forces, leaving the city shocked and smoldering. The show of strength dashed hopes the cartel was seriously weakened by the life sentence the elder Guzman received in the United States this year. 

Not only were the new generation of Guzmans, collectively known as Los Chapitos, keeping alive their family’s near-mythical outlaw reputation, they were doing it with a brazenness akin to open warfare. 

“We’re facing a new generation of organized crime that doesn’t respect civilians,” Cristobal Castaneda, head of Sinaloa state security, told Reuters after the attacks. 

Four surviving sons of El Chapo were already regulars in Culiacan’s nightclubs and restaurants, despite U.S. indictments against them, before last Thursday’s dramatic act of armed insurrection.

Toothpick Hanging Out His Mouth - Ole Warren Put a Brick Through Overton's Window

NEW: “We got a QUEER running for President... the white man has very few rights.”

Watch @SevierCounty Commissioner Warren Hurst’s homophobic, bigoted outburst Monday, telling folks to “wake up”.

Mayor’s office: 865-453-6136
Hurst: 865-453-8513

WVLT: https://t.co/GFwJLqehUf pic.twitter.com/bfXrAACfPh

— The Tennessee Holler (@TheTNHoller) October 22, 2019

Now Let's You Jus Drop Em'Pants...,

sicsempertyrannis |  Any fair reporter with half a brain would see these events as pointing to a conspiracy. But not the liars at the New York Times. But the Times does tip us off to the upcoming mad scramble for life boats. It will it the FBI and DOJ against the DNI, the CIA and NSA. According to the Times:

It is not clear how many people Mr. Durham’s team has interviewed outside of the F.B.I. His investigators have questioned officials in the Office of the Director of National Intelligence but apparently have yet to interview C.I.A. personnel, people familiar with the review said. Mr. Durham would probably want to speak with Gina Haspel, the agency’s director, who ran its London station when the Australians passed along the explosive information about Russia’s offer of political dirt.

There is no abiding affection between the FBI and the CIA. They mix like oil and water. In theory the FBI only traffics in "evidence." The CIA deals primarily with well-sourced rumors. But the CIA will argue they were offering their best judgement, not a factual conclusion. Brennan and Clapper will insist they were not in a position to determine the "truth" of what they were reporting. It is "intel" not evidence.

The Horowitz report will not deal with the CIA and NSA directly. Horowitz can only point out that the FBI folks insisted that they were relying on the intel community and had no reason not to trust them. This is likely to get ugly and do not be surprised to see the intel folks try to throw the FBI under the bus and vice versa. Grab the popcorn.

Squeeze Clapper Hard Now

sicsempertyrannis |  U.S. officials had been concerned that Russian sources could be at risk of exposure as early as the fall of 2016, when the Obama administration first confirmed that Russia had stolen and publicly disclosed emails from the Democratic National Committee and the account of Hillary Clinton’s campaign chairman, John Podesta.

In October 2016, the Department of Homeland Security and the Office of the Director of National Intelligence said in a joint statement that intelligence agencies were “confident that the Russian Government directed” the hacking campaign. . . .

In January 2017, the Obama administration published a detailed assessment that unambiguously laid the blame on the Kremlin, concluding that “Putin ordered an influence campaign” and that Russia’s goal was to undermine faith in the U.S. democratic process and harm Clinton’s chances of winning.

“That’s a pretty remarkable intelligence community product — much more specific than what you normally see,” one U.S. official said. “It’s very expected that potential U.S. intelligence assets in Russia would be under a higher level of scrutiny by their own intelligence services.”

Sounds official. But there is no actual forensic or documentary evidence (by that I mean actual corroborating intelligence reports) to back up these claims by our oxymoronically christened intelligence community.

Vladimir Putin ordered the hack? Where is the report? It is either in a piece of intercepted electronics communication and/or in a report derived from information provided by Mr. Smolenkov. Where is it? Why has that not been shared in public? Don't have to worry about exposing the source now. He is already in the open. What did he report? Answer--no direct evidence.

Then there is the lie that the Russians hacked the DNC. They did not. Bill Binney, a former Technical Director of the NSA, and I have written on this subject previously (see here) and there is no truth to this claim. Let me put it simply--if the DNC had been hacked by the Russians using spearphising (this is claimed in the Robert Mueller report) then the NSA would have collected those messages and would be able to show they were transferred to the Russians. That did not happen.

This kind of chaotic leaking about an old intel op is symptomatic of panic. CIA is already officially denying key parts of the story. My money is on John Brennan and Jim Clapper as the likely impetus for these reports. They are hoping to paint Trump as a national security threat and distract from the upcoming revelations from the DOJ Inspector General report on the FISA warrants and, more threatening, the decisions that Prosecutor John Durham will take in deciding to indict those who attempted to launch a coup against Donald Trump, a legitimately elected President of the United States.

We Can Never Be China's Friend

asiatimes |  Trump’s real liability isn’t impeachment. It’s China and the economy. What the Trump administration has been doing so far, vis-à-vis China, is an own goal — ein Eigentor [“an owner”].

Why is it an eigentor?

Because the effect of the tariffs on the US economy is at least as bad as the effect of the tariffs on the Chinese economy. American export orders are collapsing. We have the weakest industrial reading since June of 2009. We are in a manufacturing recession, according to the Federal Reserve. Factory output is contracting. Trump won in 2016 by carrying key manufacturing states like Pennsylvania,

Ohio, Michigan, and Wisconsin. This blunder could lose him the election. This is much more dangerous than the impeachment masquerade. China’s also suffering, but appears to be suffering less.

And the big difference is Xi Jinping [China’s president] doesn’t have a presidential election in 2020 and Trump does.

In fact, President Xi will never face an election. He is elected for life.

That is true. But all that can change if he fails to succeed.

You have compared the situation that the US is facing toward China to the siege and conquest of Baghdad by the Mongols in 1258.

The Mongols, by themselves, did not have the capability to penetrate the twelve-foot-thick walls of the city of Baghdad. But they hired a thousand Chinese siege engineers. Within three weeks, the Chinese mercenaries breached the walls, at which point the Mongol horsemen went in and killed the entire population of Baghdad.

Who are today’s Chinese siege engineers who are breaching the American fortress?

Huawei very much is the spearhead, because in the Chinese model of economic expansion and the development of world economic power, broadband is the opener to everything else.

It’s a company with a lot of very talented people. Ten years ago – if you asked people, “What Chinese products do you buy?” – you wouldn’t mention a single brand name. But everyone now knows Huawei. They produce the world’s best smartphones. They certainly dominate 5G internet. But Huawei is not a Chinese company. It is an imperial company.

The Chinese empire is doing better than us because it’s absorbed the talent of a very large number of others.

As Important as Preference Falsification - The Overton Window

oftwominds |   If you're truly interested in finding solutions to humanity's pressing problems, then start helping us pry open the Overton Window. 

The Overton Window describes the spectrum of concepts, policies and approaches that can be publicly discussed without being ridiculed or marginalized as "too radical," "unworkable," "crazy," etc. The narrower the Overton Window, the greater the impoverishment of public dialog and the fewer the solutions available. Those holding power in a socio-economic-political system that's unraveling devote their remaining energy to closing the Overton Window so that only "approved" narratives and policies that support the status quo are "allowed" into the public sphere.

Everything outside this narrow band of status-quo-supportive narratives is immediately disparaged as "fake news," "Kremlin talking points," or other highly charged accusations designed to close the Overton Window--a process Noam Chomsky and Edward Herman called manufacturing consent: if no "outside" ideas are allowed, people accept the status quo as "all there is and all there can possibly be." 

This narrow Overton Window benefits those in power who are "legally looting" the system. There is another source of a narrow Overton Window: the cultural, social and political elites have no new ideas and so they cling to doing more of what's failed, relying on the past successes of now-failing strategies to cement their power. 

Michael Grant described how this failure of imagination and devotion to the past leads inevitably to decline and collapse in his excellent account The Fall of the Roman Empire, a short book I have been recommending since 2009:

Round this Trash Up On Its Way Back Into the U.S...,

NYTimes |  Speaker Nancy Pelosi has traveled to Jordan to meet with the Jordanian king for “vital” discussions about the Turkish incursion into Syria and other regional challenges, amid uncertainty about whether an American-brokered cease-fire with Turkey in northern Syria was holding.

The visit by senior United States officials came as sporadic clashes continued on Sunday morning along the Turkish-Syrian border, where, according to the Turkish Defense Ministry, a Turkish soldier was killed by Kurdish fighters in the Syrian border town of Tel Abyad. 

Confusion and continued shelling have marred the cease-fire deal announced by Vice President Mike Pence last week, with both Turkey and Kurdish leaders accusing each other of violating the truce.

Ms. Pelosi, a California Democrat, led a nine-member bipartisan congressional delegation to Jordan that included Representatives Adam Schiff, Democrat of California; Eliot L. Engel, Democrat of New York; and Mac Thornberry, Republican of Texas. The group met with King Abdullah II of Jordan on Saturday evening.

Take Back Apokolips

Tulsi Schmacked the Stank Clean Out of Hitlery's Girdle

tomluongo |  Tulsi Gabbard has stones. She has the kind of stones born of a life dedicated to the cause of serving others. 

She is the direct opposite of Hillary Clinton, for whom all causes serve herself and her enormous narcissism and pathology.

So seeing Gabbard go directly after Hillary Clinton after her debate performance the other evening where she explicitly called out both the New York Times and CNN (the hosts of the debate) for the hit jobs on her puts to rest any idea she’s someone else’s stalking horse.

Two weeks ago I asked if five tweets from President Trump changed U.S. foreign policy for good, Gabbard does him two better with these three tweets of absolute, Oscar Wilde-like beauty.

Great! Thank you @HillaryClinton. You, the queen of warmongers, embodiment of corruption, and personification of the rot that has sickened the Democratic Party for so long, have finally come out from behind the curtain. From the day I announced my candidacy, there has been a ...

— Tulsi Gabbard (@TulsiGabbard) October 18, 2019

 

... powerful allies in the corporate media and war machine, afraid of the threat I pose.

It’s now clear that this primary is between you and me. Don’t cowardly hide behind your proxies. Join the race directly.

— Tulsi Gabbard (@TulsiGabbard) October 18, 2019

There is so much goodness to unpack in these tweets it is almost beyond my ability to do so.
 

Tulsi Gabbard Kicking Ass, Taking Names, and Looking Good....,

Tulsi Gabbard calls The New York Times and CNN — the hosts of the debate — "completely despicable" for alleging she is a Russian asset and Assad apologist. pic.twitter.com/0pzpA4nvRo

— Axios (@axios) October 16, 2019

But perhaps the highlight was her directly calling out the very sponsors of the debate, CNN and the New York Times, for their “despicable” and baseless attacks. 

“Just two days ago, the New York Times put out an article saying that I’m a Russian asset and an Assad apologist and all these different smears. This morning, a CNN commentator said on national television that I’m an asset of Russia. Completely despicable,” she said.

The CNN charge specifically referenced comments made by Bakari Sellers on New Day on the morning of the debate. He said Gabbard is the “antithesis” of what the Democratic Party and the other candidates stand for, adding, “There is no question that Tulsi Gabbard, of all the 12, is a puppet for the Russian government.”

Very Interested in These Lost Red-Headed Stepchildren....,

ineteconomics |  Under the shadow of a future darkened by climate crises, political instability, inequality, and super-human machines, how to best proceed? For some, the answer is more technology and scientific advancement; for others, better policies and political arrangements. Or some combination of these. 

Not enough, warns Jeremy Lent, author of The Patterning Instinct: A Cultural History of Humanity’s Search for Meaning. First we’ll need to confront something deep in our psyches that prods us toward destruction. 

To get at that something, Lent traces a “cognitive history” of the human species in a book delivering big, sweeping ideas and a discipline-hopping approach drawing from neuroscience, archaeology, linguistics, and systems theory, the study of complex living systems. 

Lent argues that how we view the world arises out of language, specifically core metaphors that shape our values and culture, which in turn mold history in a reciprocal feedback loop. Cultural templates are often long lasting, but can also shift dramatically, sometimes in a generation or two. The process of cultural evolution, Lent observes, determines how well humans fare as much as the genes we inherit (there’s a feedback loop between culture and genes, too). 

As Lent sees it, you and I are in the midst one of history’s great transitions — a process which could lead to conditions far less hospitable for most, or even a total collapse of global civilization. To avoid these dire fates, we can train our brains to adopt alternative metaphors that allow us to live less destructively. 

So which metaphors are causing the trouble? For one, Lent faults a tendency to conceive a dualistic universe of binary categories, like mind and matter, reason and emotion, self and other. This framework, as the postmoderns observed, drives us to favor one category over the other and to build societies based on hierarchy and separation. 

The pattern is not universal: Lent presents evidence that early hunter-gatherers emphasized connectivity rather than separation, a mindset that engendered a more egalitarian social structure. (Unfortunately, they also lived by a metaphor of nature as an endlessly giving parent, resulting in problems like overhunting, which illustrates that even seemingly harmless metaphors can eventually lead to catastrophe).

To What Extent is Color a Physical Thing in the Physical World?

bbc | Depending on what language you speak, your eye perceives colours – and the world – differently than someone else. The human eye can physically perceive millions of colours. But we don’t all recognise these colours in the same way. 

Some people can’t see differences in colours – so called colour blindness – due to a defect or absence of the cells in the retina that are sensitive to high levels of light: the cones. But the distribution and density of these cells also varies across people with ‘normal vision’, causing us all to experience the same colour in slightly different ways. 

Besides our individual biological make up, colour perception is less about seeing what is actually out there and more about how our brain interprets colours to create something meaningful. The perception of colour mainly occurs inside our heads and so is subjective – and prone to personal experience.

Take for instance people with synaesthesia, who are able to experience the perception of colour with letters and numbers. Synaesthesia is often described as a joining of the senses – where a person can see sounds or hear colours. But the colours they hear also differ from case to case.

Another example is the classic Adelson’s checker-shadow illusion. Here, although two marked squares are exactly the same colour, our brains don’t perceive them this way.

Since the day we were born we have learnt to categorise objects, colours, emotions, and pretty much everything meaningful using language. And although our eyes can perceive thousands of colours, the way we communicate about colour – and the way we use colour in our everyday lives – means we have to carve this huge variety up into identifiable, meaningful categories.

Painters and fashion experts, for example, use colour terminology to refer to and discriminate hues and shades that to all intents and purposes may all be described with one term by a non-expert.

What Preference Falsification Hath Wrought

Preference Falsification

wikipedia |  Preference falsification is the act of communicating a preference that differs from one's true preference. Individuals frequently convey, especially to researchers or pollsters, preferences that differ from what they genuinely want, often because they believe the conveyed preference is more socially acceptable than their actual preference. The idea of preference falsification was put forth by the social scientist Timur Kuran in his book Private Truth, Public Lies as part of his theory of how people's stated preferences are responsive to social influences. It laid the foundation for his theory of why unanticipated revolutions can occur. It is related to ideas of social proof as well as choice blindness. 

Exemplars or Mutant Fakirs?

wikipedia |  David Goggins (born February 17, 1975) is an American ultramarathon runner, ultra-distance cyclist, triathlete, motivational speaker and author. He is a retired United States Navy SEAL and former United States Air Force Tactical Air Control Party member who served in the War in Afghanistan and the Iraq War. He is a former world record holder for the most pull-ups done in 24 hours. His self-help memoir, Can't Hurt Me, was released in 2018. 

wikipedia |  Dean Karnazes (English: /kɑːrˈnɛˈzɪs/ car-NEH-zis; born Constantine Karnazes; August 23, 1962), is an American ultramarathon runner, and author of Ultramarathon Man: Confessions of an All-Night Runner, which details ultra endurance running for the general public.^[3][4]