b_b and I were just looking at the construction site of a large cancer center yesterday, and I joked that they better not cure cancer too soon. I can see how people care about money, it gives you shelter, security, and maybe yachts, but what a sad illusion that money is some sort of cardinal direction.
Preventative medicine creates a steady stream of people that need to see your doctors 1-2 times a year for simple visits that are fully covered by the ACA. Doctors would make more but hospitals and surgery centers may, MAY make less over time in facility fees. Interesting article.
Preventative medicine is also available in generic form and as such, is reimbursed at approximately 70 cents on the dollar for what it costs to administer. My shitty-ass insurance would cover one free physical every two years. Now that I've seen the ICD-9 codes and the reimbursement table, I can report that my shitty-ass insurance would have paid my wife under $7 for a half-hour physical. The system is so much worse than you imagine.
Honestly, I am glad that a financial institution like Goldman-Sachs is thinking about it this way. It's their job. To make money. So before they invest in something, they need to evaluate the money-making potential of it. Health care is not a sustainable for-profit business, and it shouldn't be. Health care is about the NATION. It's about helping everyone be healthy, so nobody is being an unnecessary drag on the system. It isn't a business, because a business has the wrong goals and metrics.
I agree that patient care is not incentivized to work properly as a traditional for-profit enterprise. Drug development is a different beast altogether. Drugs need to make a return, because they are really, really expensive to develop, and something like 95% of them fail, which means that a 20x return is the minimum sustainable number that investors have to meet to keep their business from folding. The number of drugs out there that are going to cure a serious, life threatening illness like HepC are really low. Even if they become more numerous with personalized medicine approaches, there will always be chronic disease. Anyway, it doesn't really matter if the disease is cured, because once you know that information, it's very easy to mathematically model how many people you should expect to treat per year (assuming you know the incidence rate, the cure rate, and the disease course--all really well defined for HepC), and you can base your pricing on those predictions. If investors at Goldman or anywhere else didn't do that modeling, then they should lose their jobs. Any mathematical biologist or epidemiologist worth their salt could do that calculation in a matter of minutes. I sort of disagree that healthcare is about the nation; it's about people as individuals. It's not really up to you or me to tell people how to live. Everyone already has limitless free access to the best medicine god has ever invented (walking regularly), but very few people use it. It's up to the private sector to make up the rest. Even if we do end up making the choice to have a more robust safety net, drug companies will still always be around to try to improve upon what's out there (where it gets muddy is in the definition of "improve"). If healthcare were about the nation, we'd outlaw smoking and make exercise mandatory, but then we'd be living in a place that none of us wants to live in.
If you weren't an officer of a biomedical company I wish to do well I'd let you continue down your merry libertarian path. As it is, if my taxes are in any way paying for your health, your health is an aspect of my social contract. The private sector is best at internalizing profit and externalizing loss and in a system as closed as a nation's citizenry that externality only leaves the private sector, not the system as a whole. Absolutely: walking is good medicine. but considering there's no profit motive to make people walk, it comes down to individual initiative. Meanwhile, there's a deep and wide profit motive to make people take an Uber, so in effect we're allowing internalized profit motives to damage externalized public health. We tax the shit out of it and require exercise of children, all the while doing our goddamnedest to instill healthy habits. This isn't an either/or problem, it's an optimizing problem and part of that optimization is recognizing that even if Cletus the slack-jawed couch potato doesn't want to walk to work, his poor health costs me tax dollars so fuckin' hell let's socialize whatever we can to optimize his health for the betterment of all our budgets.I sort of disagree that healthcare is about the nation; it's about people as individuals.
If healthcare were about the nation, we'd outlaw smoking and make exercise mandatory, but then we'd be living in a place that none of us wants to live in.
I've definitely never been accused of being a libertarian before! First time for everything, I guess. I am definitely highly sensitive to the various profit motives of big pharma (right now I'm small pharma, so I get a pass--still a do gooder). For example, my buddy used to be an exec at AstraZeneca at the time when Nexium came on the market (you may remember Nexium from such infographics as the one you posted a couple weeks ago about drugs that make the most money and how few people they actually help). At that time their previous antacid was about to go generic (prilosec or whatever it was), and they showed the FDA a bunch of data about how Nexium is so much better because it reduced esophageal ulcers or some shit, and the FDA bought it even though they intentionally had suppressed the exact same data for prilosec (or whatever) years prior just so they'd have it in their back pocket years later. Who says public companies don't plan for the future?! My point about walking is not to totally blame the individual, but when you see people every day who have had limbs amputated because of uncontrolled diabetes, you just want to get in some faces and start yelling "DON'T EAT THE FUCKIN' SUGAR, DUDE!!!" These horses have been led to water, but the social complexities make them indifferent to drinking it. It's not a simple problem, but it sure is frustrating. And in that situation it's really easy for pharma to say, fuck it, here's some insulin, and everyone's happy.
And that was exactly the move AstraZeneca needed to make in order to meet their quarterlies and uphold shareholder value and preserve the dividends for each of the millions of their shares. I don't hate the player, I hate the game. And that goes for Cletus. I'd love for him to not eat the fuckin' sugar. But I also know that even when he screws his face up as tight as he can to deny all the good we're trying to do for him and his lifestyle, I still benefit if he gets healthcare. Okay, fukkit I'm badging it: This is a system we're talking about, and it has more components than sick people, drug companies, insurance companies and doctors. They all need to interoperate cleanly and smoothly or we're all fucked.We know that neighborhoods that have more evictions have higher violent crime rates the following year. You can understand why — it rips apart the fabric of a community. We pay for that. The top 5 percent of hospital users consume 50 percent of the health care costs. Guess who those people are? They're the homeless and unstably housed. And so I think we can spend smart or we can spend stupid, and so I think addressing the affordable housing crisis is a win for families, for landlords and for the taxpayer.
There are legit reasons for high prices on some medicines, and then there's shit like this: https://wapo.st/2qEj2QC Every time these goddam pharma companies pull something like this, they wither the social contact just a bit more. I'm embarrassed to tell people I'm working on drugs at times for exactly this reason. The fucked up thing is that all the people I know in this industry genuinely want to make good medication that helps people. Wall Street is, let's say, unhelpful at times.
Why yes. Yes I would support a federal price-gouging statute. Thanks for asking.
Like francopoli said, preventative medicine should be able to generate revenue even with healthy people. Goldman Sachs sounds like their ideal business model would be to give everyone cancer and then jack up the price of chemo and immunotherapy. No such thing as a line they won't cross. For some comedic relief, here's Mitchell and Webb predicting conversations like this in 2010.