Damn pharmaceutical companies

The BBQ Pit
21

I’m jumping through hoops right now with my own insurance company.

They’ve FINALLY okayed my breast reduction (trust me, this is a major medical necessity), but some genius has decided that they don’t want to cover the type of nipple graft that the plastic surgeon needs to use.

See, the normal method for smaller breasts is to cut around the nipples and leave them attached to the stalk of blood vessels and nerves. That doesn’t work when you have to move the nipples more than 10 inches. You end up with the vessels knotting up, kinking, and the odds are high that you could end up losing a nipple entirely, or at least the sensation.

The other method is an actual graft, moving the nipple section and reattaching it where it needs to go. This is a higher risk proceedure in the first place, but the only one that gives me a good chance of actually retaining normal looking breasts after surgery.

Now I get to sit and wait again, and possibly have insurance turn the whole thing down all over again. They don’t seem to care that I’ve got a folder on my back troubles that’s over an inch thick. They don’t care about pulled muscles, or blisters, or pressure sores, or bruises. They don’t care that I’ve already had surgery on my ARM for cryin out loud because of having to spend so much time typing around a ridiculously large chest.

All of this is documented, yet the whole deal could be thrown because they don’t want to pay the extra money for part of the proceedure.

This is the same insurance company that didn’t want to cover my $400 a bottle antibiotics that I needed every two weeks while dealing with 7 freakin months of tonsilitis. Funny, they covered the first five doses of other antibiotics that didn’t work (including the one that put me in the ER in anaphylactic shock).

Techchick … seriously, check your policy. Falcon had a very good point. I know that one of the companies we were with when the hubby and I first got married had a 6 month clause on pre-existing conditions. Most do, I think.

Of course, this was also the insurance company that covered all of one surgery … but the anesthesia. They covered the surgeons, the hospital time, the meds, everything but the anesthesia. Their reason? “Pre-existing condition.”

Hell, the only thing we could see as the problem was that I’d been awake when they had to use it.

22

I hope I do not seem smug because I do not wish to but,
there is a thread in GD about socialism,

http://boards.straightdope.com/sdmb/showthread.php?threadid=23087
A good deal of this thread seems to have got lost in the doctrine of ‘isms’ which is why I have left it alone.

The point I am trying to make is that it is not all bad although some of it undoubtedly is.

In the UK if you need treatment you get it despite the cost of the drugs.This is what the National Health Service does well.
There are medical insurers for those who wish to pay for private treatment and they are in a tiny minority but it is taken as a basic right by all Britons that we are all entitled to good medical cover.

I know there are lots of issues about the fact that it has become expensive for a national budget and that this can mean some hard decisions do have to be made.

In the US if you can’t afford the long term drugs and the insurers will not touch you then a lifetime of poverty may well be the result.

You will often see ,in your media ,lots of criticism of our NHS but there are an awful lot of very wealthy people in the US who make sure that the potential threat to their revenue stream is not realised.
One way of ensuring this is to make certain that any negative facet of the NHS is reported upon, and yes, your drug companies and medical insurers do have media ‘consultancy’ departments.

What percentage of your nation has inadequate or no medical insurance cover?
If your free city hospitals are so good then why do people want to transfer to their privately run hospitals as soon as possible.
I do understand the concept of being able to choose your medical practitioner but I also think there is a lot of smoke and mirrors involved here
Do you really think we would allow any idiot to practice medicine ? Choice means that the wealthy can appoint themselves the very best medics to the detriment of those who cannot find the wherewithall, it almost looks as if you are saying that the lives and welfare of the poor are somehow less important than those of the rich when it comes to medical care.

BTW it really does not matter what your family history is or wether you have had any pre-existing condition in the UK the only criteria you must satisfy is-do you need medical assistance .
If you were to ask any Briton wether they would be prepared to pay higher taxes so long as it was spent on the NHS and not some crackpot government scheme you should not be surprised at all to get a major YES vote.

No President of the US is likely to be able to overcome the vested and sel-serving interests of the medical industry unless there is an absolute crescendo of demand for universal cover.That will not happen because so many of you will believe the flag-wavers many of whom are only interested in their own pockets.

Fire away!

23

Oh god! people wanting to keep their own money? Oh god no! not that! Pleeeease not that , ohhhhhhhhhh.

What you and other socialist nitwits are asking for is healthcare that delivers more than you pay for. In other words, you want to pay $100 for $1000 worth of services. Could you and your ilk please take a basic course in finance. Perhaps when you realize that the world has finite resources you will stop trying to legislate for magic fonts of resources.

In some cases, you want to pay nothing for these resources. Sure, the local government hospital is not quite as nice as a private hospital. But you can still get stitched up there. Of course, it would be a lot nicer is every irresponsible nit who would rather buy cable than take care of himself could get his STD taken care of at John’s Hopkins … at my expense. And it would be nice if you bought all of my groceries. But it is neither fair, just nor prudent.

Are you suggesting that one should receive not only basic healthcare, but top rate health care for nothing?

24

I wish I could remember where I saw this.

IIRC, a drug company came out with a new cancer treatment and charged $25.00 a dose for it. Fine until somebody noticed that it was the same drug as a veterinary medicine, for which this same company charged 25 cents a dose. The drug company explained the price difference as “recouping the cost of research”. Then somebody found out that the research had been federally funded.

With the cost shifting, upcoding, downcoding, PPO discounts, HMO discounts, bundling, unbundling, co-pays, co-insurance, etc. I am pretty sure at this point that the cost of any medical product or service is whatever the provider damn well feels like charging.

25

“I am pretty sure at this point that the cost of any medical product or service is whatever the provider damn well feels like charging.”

As opposed to the right way to decide the price of a product which is…what? Who should determine the price of your labor, other than you and the person you’re selling it to?

26

In most other situations, as I understood it, the pricing mechanism works as a sort of communication device. If seller X sets his prices too low, after everybody buys his stuff he resets the price so he can make more money. If his prices are too high, nobody buys it and he gets stuck with a bunch of stock so he cuts his price. This is possible because everybody is free to make different choices among sellers, or, not to buy at all.

In medical care, however, people usually come in when they are sick. They need their problem treated. The freedom to walk away is usually not there. This is almost a forced purchase.

I know that the drug companies are only “charging what the market will bear”. Does anybody else look around, see the scandalously high prices, the people who are forced to choose between medication and food and shelter, and not see just the normal operation of capitalism?

To you it may be a free market, but to a lot of people, it sure LOOKS like price gouging.

27

Mr .Zambezi

Oh god! people wanting to keep their own money? Oh god no! not that! Pleeeease not that , ohhhhhhhhhh.

Not even near to what I was saying.

I was pointing out that there are some people who have become rich in the US on the system of healthcare finance you have.Perhaps they would not be keen to see that system modified if it were to mean a loss of income.

Do medical insurance salesmen take a commission? I’ll bet they do.
Do hospitals, GP’s, drug companies, make a profit - of course.Do shareholders in these medical institutions want a return on their investment, you bet!
Who pays for all that? What if you can’t afford to - tough so your life is flushed down the toilet because, as a poor person, you are not worth bothering with. Fine if that is how you want society to be.

What you and other socialist nitwits are asking for is healthcare that delivers more than you pay for. In other words, you want to pay $100 for $1000 worth of services. Could you and your ilk please take a basic course in finance.

Who said I was a socialist? Does advocating an equitable health sevice make me that?
You may find that Socialism is a whole raft of princples and policies none of which I espoused.
So you think our health system comes free and I pay nothing toward it, how odd!
I think I mentioned that people were prepared to pay higher taxes than they do now to secure a better standard of care.
The taxes I pay for healthcare easily covers my needs and is enough to help pay for someone else, I have no objection to that.No-one in the UK expects healthcare to be free, what do you think we are parasites?
Do you think that if your system was funded in that way there would be less scope for the able to ‘forget’ about insurance and spend it on cable TV? I think so.

Once such a system was in place is it likely that people would deliberately make themselves ill just so they could spend your tax dollars.
So top line care is enjoyed by all Americans except for those who cannot be bothered to pay the insurance so the poor and lazy deserve all they get, interesting. Would the person who has to decide wether to buy luxuries such as food or insurance because of their low income agree? Doubtful.

The standards of care are lower here than in the US? prove it, don’t forget that the medical insurance business makes certain any negative facet if our healthcare system is amplified and distorted.

I can walk into a British hospital with lets say some form of leukeamia and expect to get treatment right the way through to bone marrow transplant and chemotherapy, and there would be no insurance company telling me that they would not meet my claim because I had not revealed some family history or pre-existing condition.The money for the treatment would be found, what percentage of US citizens could afford that?

In fact, I still have not seen anyone here provide any figure whatsoever about how many in the US have adequate medical cover or how many could actually afford the insurance.
So I get first aid in a local US hospital, nice and the standards are possibly excellent, but what if I needed dialysis or what if I needed insulin and I cannot afford it?
What happens to a family that has a disabled child and for one reason or another the insurance refuses to pay up?

BTW the drug companies over here are screaming because we have set up a commission to decide which treatments are the most effective for the money, odd how the price of some drugs has fallen, now isn’t it?

28

techchick68:

You spelled it right. I used to think like that about pharmaceutical companies until I went to work for one. The place started as a small group of researchers supported by a few technicians. They got some seed money and stretched pennies into copper wire until they could get some more. They found a drug that was effective and nearly starved while they pushed it through clinical trials and FDA approval. We spent a lot of time fixing old equipment and leaky roofs. Then because they thought that their money should be spent on more R&D instead of advertising, they lost a bunch of market share to a competitor who came out with a very similar drug a few months later. The revenue that was left barely covered the bills while the smart guys searched for another drug.

Six years ago we thought we stumbled onto a blockbuster drug. In this business it takes three to five years to get a manufacturing plant built, tested, and licensed, so management had to roll the dice and build the plant before final FDA approval. Out of a blue sky, the drug showed some weird side effect and washed out of late stage clinical trials. The specialized $75 million dollar plant sat vacant for the next three years, but of course the mortgage still had to be paid. The expense nearly broke the company. There was a long year of layoffs and attrition.

I worked in fantastically expensive R&D facility, at the end of a 10 year string of research and testing, with a large group of professionals, all paid for by venture capital. Three years ago we finally got a second drug approved for limited release. This time, lesson learned, they went with the glitzy ad campaign and it worked. Now they are over the hump and probably won’t go under. In spite of all that I understand that they have always had a program to give the drug away to needy people.

I’m sure that a lot of drug companies do all the price gouging they can. But the competition is real and there are lots of ways to get around a patent. Most outfits charge just about enough to cover costs and make a reasonable profit and then move on to the next discovery. And yes, you can thank the next lawyer you meet, legal costs are a significant part of the retail price. I’d be glad to help you thank him if you need a hand.

It’s a tough situation. You can bitch about the cost, but before a team of highly skilled people risked their life savings and a decade of work on a long shot you didn’t even have the choice. They brought something new into the world.
I don’t know what the answer is, but I do know I never see a ripple when a small pharmaceutical company goes under. That’s the other half of the story.