Broomstick, have you even tried thoughts or prayers?
Do you know any elderly people? How many of them do you think could navigate that? Particularly if it really is a circle (you know that those have no end point, right?).
My wife’s spinster aunt would have died long before she did if her various nieces and nephews hadn’t kept an eye on her. And to my knowledge she never suffered from any form of dementia/diminished capacity, beyond not being terribly bright to start with.
Yeah, I do. My dad. And guess what he did? Called the Medicare number and asked questions.
About how old do you think people need to be before you add them to poor people in the group of “Can’t possibly figure anything out or get answers to anything”?
My dad did also, just last week. He even got the answers he needed.
That’s great! It’s almost as if they set up a number for people to call with questions.
Took me several months to get a clear answer to such a question.
Luckily, I wasn’t sick at the time. If I had been, I could easily have been dead by then.
Perhaps your method of asking questions and getting answers was faulty?
Perhaps your attitude towards other people’s difficulties is faulty?
Perhaps, but attitude is irrelevant. What a person does is relevant.
What the people on the other end of those phone calls, emails, and snail mail letters did (or, in a number of cases, didn’t do) is also relevant. As is the way the system as a whole is set up.
I’m also puzzled by the insulin market in the US. I understand that newer versions of the drug, which are patented, and whose prices have been jacked up in the US, are better than old-fashioned pork insulin or humulin. But surely humulin is off-patent by now? And surely it would be better to have enough of that than to ration “newer” forumations and not take as much as you need?
Is humulin still available? Is it affordable? What is the barrier to using it?
Needless complexity and expense in a system that’s supposedly designed to serve the public is also relevant. Exhorting people who are complaining, with reason, about serious systemic problems to just take some initiative and bootstrap their way through their difficulties comes across as kinda threadshitty.
Yes, “there are telephone numbers you can call”. And some of those calls do successfully answer the questions that people have about this needlessly complex and expensive system. Good!
Does that mean that the people complaining about the needless complexity and expense of the system don’t have a valid point? No. So, you know, “fuck a bunch of ‘what a person does is relevant’ personal-responsibility pep talk” is not an unreasonable reaction.
I once called la migra, explained that my work permit was about to expire and my employer’s legal department was refusing to provide me with a Proof of Employment letter and asked if one from my manager along with my W-2 and last paystub would suffice.
The lady on the other end of the phone called me a “stupid fucking Hispanic whore”.
Maybe there was something I could have done, but apparently I was too stupid to know what and that lady’s attitude can’t be called “helpful”.
Maybe that’s just a term of art ?
So instead of the Federal government, it’s a corporation (Wal-Mart) that’s negotiating cheaper prices with drug companies.
So… in order to get a halfway affordable price we will have to buy each different drug we need from separate corporations (i.e. Wal-Mart) that negotiated (separately) with separate pharmaceutical companies?
Wouldn’t it be better to have just one organization do the price negotiations for all the drugs used by all the people? Seems more efficient that way. Like it’d be cheaper, yo.
“There can be no doubt but that the statutes and provisions in question, involving the financing of Medicare and Medicaid, are among the most completely impenetrable texts within human experience. Indeed, one approaches them at the level of specificity herein demanded with dread, because not only are they dense reading of the most tortuous kind, but Congress also revisits the area frequently, generously cutting and pruning in the process and making any solid grasp of the matters addressed merely a passing phase.”
Rehabilitation Association of Virginia vs Kowolski
It’s a mistake to be dismissive of the complexity of Medicare and Medicaid benefits. And it’s ridiculous to think that anything but the most basic questions can be answered correctly by whoever is on the other end of some 800 number.
The stakes can be incredibly high when applying for benefits. My brother was recently given a Medicaid application by an administrative employee of my mother’s nursing home, who basically told him just to fill it out and send it to a particular address. Luckily for us, my brother forgot. If we had filled out and submitted that form without further investigation, we would’ve lost our house upon her death. Plus we would have been liable for several thousand in nursing home expenses out of pocket.
This would have happened because we didn’t fully understand the complex rules around Medicaid eligibility. So, a word of warning, be careful when applying for a benefit based on phone advice.
Yep, it’s the labyrinthine, patchwork healthcare system in the US that screws us. Shit, even when you buy insurance, you don’t know what it does and does not cover.
“Well your ambulance that took you to the hospital while you were in a coma is technically out of network now, so we can’t cover that 35,000 bill. So-reee.”
Or…
“We actually contract with an out-of-network anesthesia monitor to assist the anesthesiologist. So unfortunately, even though your hospital is in the network, that specialist was not. That’ll be $85,000 please. Would you like to set up a direct debit payment plan?”
p.s. Oh, wait, one more thing: Your premiums just went up by 15%
I’m always amazed that you guys stick with your bullshit. Even in the age of mass media, mass global comms and so on. I hit Twitter and about once a month I land upon some US person who had an accident or illness and is just flabbergasted at how it’s handled in Ireland, in German, hell even in Canada. Flummoxed that, yeah, no, they’ll take you in right away for tests without seven forms from three different organizations, and they’ll do the tests within the day and oh yeah they’re a little expensive at 25 kröner (or whatever) but don’t worry you’ll get most of it back at the end of the month.
And yet, while I suspect the majority of you guys actually know this, or suspect it at least, there are no guillotines anywhere. Worse, for every last one of these Twitter threads you’ll have a regular contingent of dudes trying to find faults in those other systems or praising US healthcare anyway.
Americans have insurance Stockholm syndrome. Ask your doctor about it.
I don’t know why you say “even” Canada. If you need an ambulance in Ontario the cost is a flat fee of $45 which is waived in many circumstances (I think it’s higher in other provinces). And for any medically necessary care there is no cost at all. In fact doctors’ offices are typically not set up to deal with any kind of monetary transactions, which can actually make it tricky in some unusual case where you do actually have to pay for something, like a missed appointment.
Anyway the point is, if you suddenly need an emergency trip to the hospital, in Ontario your maximum out-of-pocket cost will be $45 no matter what care you receive or how long you stay, unless you opt for extra amenities like a fully private room or cable TV.
My bolding added.
TLDR: being off-patent isn’t enough, there is also a period you have to wait before you can apply to market a copy product; and the FDA need to reclassify insulins from chemical drugs to biologicals before copy drugs can be authorised. They are doing this now.
Detail:
Upthread I linked to this FDA statement on attempts to bring competition into the insulin market. I’ll give the technical explanation of what I understand the situation to be. If this is unclear, tell me how and I’ll try to clarify. And of course I’m cutting corners with these explanations.
Back in the day, drugs were pretty much always chemicals. By which I mean they were simple molecular structures - link to show the chemical structure of simvastatin, as an example.
This was patent protected, of course (and typically molecules were also protected with further patents on synthetic processes used and so on). Once the patents all expire, you can make and sell the molecule - in principle. But (in principle) if you want a licence to market the drug, you should do all the preclinical testing and clinical trials that would be expected for a new drug - after all, you should know that it is safe and effective - right?
This is of course absurd and unacceptable for all manner of reasons - not least because doing needless clinical trials on humans for a chemical whose properties are well understood is pointless and unethical. Over the years rules for the licensing of generics were developed, based on the fact that the properties of the chemical were well understood. After a certain time has elapsed since the originator product - Zocor in the example of simvastatin - was first marketed (the period of “data exclusivity”), you are allowed to say to the FDA “Guys, this is our application for our simvastatin product - for all the preclinical tests and clinical studies, can you just refer to the stuff that was provided with the application for Zocor?”. So the Zocor data was used for the generic simvastatin applications - and it’s possible to do this because, y’know, a chemical is just a chemical, it doesn’t matter who makes it or even (with caveats) how it’s made. All you really have to show is that your generic is absorbed at the same speed and to the same extent as the originator in a bioequivalence test. No preclinical testing, no clinical trials.
HOWEVER - these days there are a lot of biological drugs (like EPO, for example). And because the folding of these complex molecules is critical to how they work, who makes them and how they are made is critically important to their properties. So you can’t just make a generic and support it with a bioequivalence test. Even after you have shown that it has the same “structure” in terms of chemical bonds, a (limited) clinical and pre-clinical package is required to show that it works in the same way as the originator. These are biosimilar producs - it’s more difficult and expensive than developing a chemical generic, but it’s the best way to get to cheap copy products for biologicals onto the market.
And here’s the complicating factor with insulins - they are* really old* biological drugs. So old that they were classified as chemical drugs because there wasn’t a classification for biological drugs at the time. And once you start classifying examples in a particular way, then it’s hard to change what you do with further examples as they arrive.
So insulins ended up in a class where a copy of the drug would have to be a generic; but with no mechanism for making a generic, because it isn’t a chemical drug. Hence the profound significance of the FDA announcement that they will solve this - by reclassifying all insulins as biologicals, thus making the development of biosimilar products possible:
So, to answer your question - being off-patent isn’t enough, there is also a period you have to wait before you can apply to market a copy product; and the FDA need to reclassify insulins from chemical drugs to biologicals before copy drugs can be authorised. They are doing this now.
OK, so that was long and complicated, but I hope it makes sense and helps. I’m sure there are bits that need further explanation - so treat this as a Mini-AMA: just ask and I’ll do my best to explain.
j
Disclaimer - there are many drugs - eg inhalers, ointments - which are outside the scope of this explanation.