Thursday, November 07, 2013

deep defects in medical industrial economics...,

technologyreview | Because of medical insurance, co-pay reductions, and expanded access programs for the uninsured, relatively few Americans pay more than a few thousand dollars per year for even the most expensive drugs. The primary customers in the United States are not patients or even individual physicians, although physicians can drive demand for a drug; rather, the customers are the government (through Medicare and Medicaid) and private insurance companies. And since the insurer or government is picking up the check, companies can and do set prices that few individuals could pay. In the jargon of economics, the demand for therapeutic drugs is “price inelastic”: increasing the price doesn’t reduce how much the drugs are used. Prices are set and raised according to what the market will bear, and the parties who actually pay the drug companies will meet whatever price is charged for an effective drug to which there is no alternative. And so in determining the price for a drug, companies ask themselves questions that have next to nothing to do with the drugs’ costs. “It is not a science,” the veteran drug maker and former Genzyme CEO Henri Termeer told me. “It is a feel.”

There are inherent problems with a system where the government is one of the biggest payers, and where doctors, hospitals, insurers, pharmacy benefit managers, drug companies, and investors all expect to profit handsomely from treating sick people, no matter how little real value they add to patients’ lives or to society. Drug companies insist that they need to make billions of dollars on their medicines because their failure rate is so high and because they need to convince investors it is wise to sink money into research. That’s true, but it’s also true that the United States, with less than 5 percent of the world’s population, buys more than 50 percent of its prescription drugs. And it buys them at prices designed to subsidize the rest of the industrial world, where the same drugs cost much less, although most poor governments can’t afford them at even those lower prices.

Still, we have to ask: When is the high price of a drug acceptable? Perhaps it is one thing when Vertex charges $841 for two pills a day—every day of a patient’s life—for medicine that will save that life, and quite another when Sanofi offers a cancer drug that is twice as expensive as its alternative but offers no obvious advantages.


Vic78 said...

We can focus on fuel because that's where 90% of the oil goes. So if we can cut down on our need for gasoline by a significant amount, we'll make quite a bit of progress. Whoever wrote that article acts as if he doesn't know about our alternatives to drilling. Don't tell that guy about algae.

CNu said...

Gail Tverburg (the actuary/she) has forgotten more about this topic than any dozen mainstream experts combined. In terms of energy returned on energy invested in extraction, it is an objectively true fact that there are no alternatives to petroleum. Algae and other hypothetical biofuel sources are complete non-starters.

The ONLY identified but as yet unexploitable "petroleum" alternative is the methane locked up in ocean floor clathrate slush, but as of this writing, no one knows how to get at this methane source on an industrial scale.

Vic78 said...

You don't think algae could be produced efficiently within a 30 year timeframe?

CNu said...

It's a question of energy density brah, that, and, the fact that in order to transition to some more renewable energy source arrangement, we'd have to bet a significant percentage of the proven-reserves hydrocarbon-ranch on making that collective species "jump" to the new regime. That would require planetary level coordination and cooperation.

Sandwiched as we are between our species-hegemonic addiction to status-seeking conspicuous consumption, and our species-hegemonic inability to mattershare and powershare and to cooperate on a species-wide level - personally - I suspect our VERY best case prospect is for intra-species megadeath and reboot at around 100 Million.

Hopefully the war that brings about megadeath within our species doesn't escalate to planetary megadeath, but then, we're bringing about the latter outcome merely by our status quo conversion of irreplaceable natural material resources into shit..., without even having to set the whole damn thing on fire as we've systematically stockpiled the means to do.

CNu said...

It's been years since I trotted out the Wizards at War series and the concept of minimal regret population

In their entirety

makheru bradley said...

Reposted as requested.

{{But Wall Street has reached record highs under Obama. Record highs which are totally disconnected to the economic realities on main street. Obama has been a boon for the oligarchs and that may be understating the magnitude of his benefits to them.

[A recent analysis by UC Berkeley’s Emmanuel Saez and Thomas Piketty of the Paris School of Economics, revealed that 95 percent of the economic gains since the recession began have been captured by the top one percent.]-- St. Clair

Witness Virginia for proof of this argument.

[More likely, though, the Democratic Party will just become stronger. Their grip on the White House and their control over less benighted regions of the country will be enhanced. Barack Obama, more than any other factor, has brought this situation about ... Obama has brought the GOP to ruin and perhaps even to extinction just by being there.

Whatever happens, the Democratic Party has already inched closer to becoming the favored political instrument of the economic elites it yearns to serve.]

Speaking of elites, did Obama campaign bundler, Texas software billionaire Joe Liemandt, fund the Libertarian candidate in Va. to steal votes from Cuccinelli?}}

I totally disagree with the thesis of this NYT article: "the populists, the wilder the better, are taking over." The plutocratic candidate just won the race for governor in Va.

"The centrists are losing out in more genteel political battles on the left." Why, just because the new mayor of NYC is married to a Black woman who happens to be a former lesbian? I don't see it. The oligarchic psychopathocracy is poised for huge win with the Trans-Pacific Partnership. Putin, not the left prevented a US attack on Syria. Apparently, I'm missing something.

CNu said...

The money shot from the article speaks to the decline of small "d" democratic politics in the U.S., something I'd noted to Vic wrt the decline of organized labor a week or so agoIn the postwar era, civic engagement was built through a network of community organizations with thousands of monthly-dues-paying members and through the often unseemly patronage networks of old-fashioned party machines, sometimes serving only particular ethnic communities or groups of workers.

The age of plutocracy made it possible to liberate public policy from all of that, and to professionalize it. Instead of going to work as community organizers, or simply taking part in the civic life of their own communities, smart, publicly minded technocrats go to work for
plutocratsNothing beats that door-to-door mind-to-mind engagement around ideas, interests, and efforts.

CNu said...

Making an educated guess here, the reason that teatardism is so closely bound up with authoritarian theoconservatism, is because these little jack leg evangelical churches are the petri dishes in which person-to-person, grassroots organizing can be carried out with a minimum of effort. The Koch brothers don't give a rat's tired little tooter about dominionist, old-line calvinist superstition, what caught their political and organizational attention 40 years ago was the fact that these evangelical collective security clubs make for a very fertile breeding into which you can carefully inject political and ideological seed and have it yield a bumper crop with scant intellectual or critical resistance.

Interestingly, while they were able to gain some traction in some midwestern roman catholic parishes, and, for example, Sam Brownback is an intentional convert to catholicism, they haven't managed anything remotely approaching the wholesale highjacking of the RC church that would've been their ultimate fantasy. The catholic church, as exemplified under Pope Francis, has shown itself too strong in the head to fall for the Randian okey-doke.

Vic78 said...

Howard Dean was trying to get his party back to doing the hard work. Rahm Emmanuel didn't like him so they chose some status quo guy to head the DNC. They not only sent Dean packing; they scrapped his blueprints for moving forward. For doing that we have what's going on today. Everyone running things upstairs are scarred by ass whuppings they took in the 90s. They have no vision and very little creativity. You can tell by how quickly they jumped back on the Clinton wagon.

There's Still A Civil War Bubbling For Control Of The Israeli Government

mondoweiss |    Any Palestinian following the developments in the Israeli protest movement against “the judicial coup” will require nerves...