Health insurers dramatically mark up prices of generics and pharmacies are in on the scheme. 
Generic Drugs Should Be Cheap But Sometimes They Aren’t
The Wall Street Journal reports Generic Drugs Should Be Cheap, but Insurers Are Charging Thousands of Dollars for Them
The cancer drug Gleevec went generic in 2016 and can be bought today for as little as $55 a month. But many patients’ insurance plans are paying more than 100 times that.
CVS Health and Cigna can charge $6,600 a month or more for Gleevec prescriptions, a Wall Street Journal analysis of pricing data found. They are able to do that because they set the prices with pharmacies, which they sometimes own.
Across a selection of these so-called specialty generic drugs, Cigna and CVS’s prices were at least 24 times higher on average than roughly what the medicines’ manufacturers charge, the Journal found.
The prices at UnitedHealth Group, which also owns a large health insurer, were 3.5 times as much, according to the analysis of data compiled by 46brooklyn Research, a nonprofit drug-pricing analytics group.
Price Gap
- Cigna’s prices were 27.4 times higher than Cuban’s on average for 19 generic drugs.
- CVS’s prices were 24.2 times higher on average for 17 generic drugs.
- UnitedHealth’s prices were 3.5 times higher than Cuban’s on average for 19 generic drugs.
- Cigna can charge roughly $6,610 a month for Gleevec, the Journal’s analysis found. CVS Health can charge more than $7,000 a month. United Health can charge $218.
- A prescription for generic Tecfidera, a multiple-sclerosis therapy, costs $54 a month through the Cuban pharmacy, compared with nearly $1,215 through UnitedHealth. (Cigna and CVS didn’t submit prices for the drug to Medicare.)
- A monthly prescription for prostate-cancer drug Zytiga costs about $118 on Cuban’s website, compared with $4,195 through Cigna, $2,056 through CVS and $205 through UnitedHealth.
Kudos to Mark Cuban for Increasing Competition
On August 22, I wrote Kudos to Mark Cuban for Lower Priced Drugs and Increasing Health Care Competition
Big Win For Consumers
Fortune called it a big win for Cuban. I suggest it’s a big win for everyone.
It also strikes at the heart of precisely what is wrong with Medicare for all and single payer setups. When government picks up the entire tab, there is no incentive for consumers to shop around for better deals.
Those without health care coverage and those on high deductible plans are the biggest winners.
Just a Start
We need to go far beyond drug pricing into health care services.
Each year, millions of US residents travel to another country for medical care because of cost. The practice is called medical tourism.
Congress Investigates How Pharma Middlemen Affect Drug Prices
The WSJ reports Congress Investigates How Pharma Middlemen Affect Drug Prices
House Republicans have launched an investigation into the companies that manage drug benefits, dialing up the scrutiny of the middlemen who play an important role in how much medicines cost.
The House Oversight and Accountability Committee said Wednesday that it has sent letters to CVS Health Corp.’s CVS Caremark, Cigna Group’s Express Scripts and UnitedHealth Group Inc.’s OptumRx—the largest pharmacy-benefit managers—seeking documents about the drug-price rebates they negotiate and fees they charge.
The committee also said it has sent requests to the Centers for Medicare and Medicaid Services and other federal agencies asking for their contracts with the PBMs.
Medicare for All Isn’t the Answer
Hello Bernie Sanders, socialists, and progressives, Medicare for all is not the answer.
Medicare, Medicaid, and Obamcare have fostered a system of collusion, graft and outright fraud.
Companies that are allegedly independent collude with each other to charge the most that they can. Everyone suffers but the companies in on the fraud.
No Skin in the Game
Customers who have already reached their max out of pocket deductibles have no skin in the game. And that’s a huge problem.
According to Medicare.Gov “No Medicare drug plan may have a deductible more than $505 in 2023. Some Medicare drug plans don’t have a deductible. In some plans that do have a deductible, drugs on some tiers are covered before the deductible.”
Once deductibles are reached, sometimes in one month, consumers have no incentive to shop around.
Other customers, unaware of cost differentials, fill prescriptions on the basis of convenience, that being the nearest pharmacy.
In my recent experience, a doctor warned me not to go to CVS or Walgreens but rather Costco to get a prescription filled. Not many doctors do that. The worst doctors are in bed with pharmacies or insurers to not use generics. Some receive illegal kickbacks and/or a steady flow of customers for their efforts.
As long as we are going to have Medicare, and no politician will ever get rid of it, It would behoove Medicare and insurers to require the cheapest cost alternative on all drugs. That would force competition and eliminate fraudulent collusion.
US consumers are subsidizing the rest of the world. I would put an end to that by allowing drug imports.
Composition of Outlays for Major Health Care
The nonpartisan Congressional Budget Office says “Spending on Medicare is projected to account for more than four-fifths of the increase in spending on the major health care programs over the next 30 years.”
What are we going to do about that?
The Right to Die
It’s an uncomfortable topic, where demagoguery about “death squads” abounds, but we need to have a talk about the right to die and how much money we spend prolonging a terminal patient’s life, in massive pain, for a few weeks or months.
I have made my wishes known. I do not want to be kept alive by heroic means if the quality of my life is expected to be grim. That’s a personal decision.
At the national level we must face this very uncomfortable question: Should we spend hundreds of thousands of dollars keeping someone alive whose life expectancy is 3 months? 6 months? a year?
A review of US demographics, debt, and deficits puts a spotlight on those questions.
Debt to GDP Alarm Bells Ring, Neither Party Will Solve This
The CBO projects net interest will rise from 10 percent to 23 percent of total outlays.
Major Health Care programs, of which Medicare will comprise about 80 percent, will increase from 27 percent to 38 percent.
The total of Major Health Care and Interest is 23 percent + (38 percent * .77) = 52 percent.
Social Security is another 28 percent * .77 = 22 percent.
That makes the total of Major Health Care + Interest + Social Security 74 percent of total outlays, leaving 26 percent for everything else. Good luck with that.
For discussion, please see Debt to GDP Alarm Bells Ring, Neither Party Will Solve This
The solution to this mess is not politicians and certainly not Medicare for all.
Free market competition coupled with meaningful “skin in the game” individual actions is the only hope.
Biden has put a band-aid on the problem by limiting a patients total Medicare drug payments. Except the total is prohibitively expensive if the patient only requires one or two prescriptions. The legislation should limit maximum out of pocket for each medication based on prices pharma charges in Europe and Canada.
Costco Pharmacy often has reasonable prices compared to others and they don’t require a membership to take advantage.
You need to read The Healing of America. It changed my view of things. We have the same employer based healthcare as France, except, France’s system is way cheaper than ours. Why? Everything is negotiated in France – drug costs, doctor’s visits, procedures. And, the healthcare companies are non-profit. No multi-million dollar CEO salaries. Their system is rated one of the best in the world. Single payer is a joke. Good luck with the waitlists. Our system is a joke too. I really don’t understand why we continue to put up with it. We tend to view government as the problem – it’s actually the solution. It needs to be a referee. Instead, the medical lobbyists lobby the government to keep the current mess of a system in place.
Joe wrote “Our system is a joke too. I really don’t understand why we continue to put up with it.”
——-
What are you going to do to not put up with it? Refuse to get treated for a medical issue?
They’ve got everyone by the cojones!
Nothing prevents a non-profit from paying multi-million dollar salaries.
They are even allowed some amount of “retained earnings” to fund future projects.
“Your money or your life”
great book
How Do We Fix This?
We don’t! Our Healthcare System is very much like our Government System. By that I mean corrupted beyond repair or “Saving As Is” Much like our Government needs a complete and massive “House Cleaning” Companies like Pfizer for an example, or Obamacare as the “Primary Example” of how Government and Healthcare Team Up for Power & Control, NEEDS a Massive Cleanup.
If Our Government and Healthcare Systems were businesses, they would both have went “Out of Business” a long, long time ago. As in Belly Up, Broke, No Assets, No Money, No Long Term Plans, and to top it off, the People that have to utilize both of these “Useless Services” absolutely cannot stand them both!!! They get straight “F”s and Deserve Each and Every “F” They Get!
Clean-Up on Pennsylvania Avenue!!!
How do we fix this? Shop at Mark Cuban’s site.
We have insurance with a high deductible plan. It’s cheaper to get a 6 month or 1 year Prescription at Costco without insurance for 2 drugs for my husband. Mark Cuban phamacy will only give 3 month supplies. Costo is cheaper. People need to shop around.
Mish wrote
“The Right to Die
It’s an uncomfortable topic, where demagoguery about “death squads” abounds, but we need to have a talk about the right to die and how much money we spend prolonging a terminal patient’s life, in massive pain, for a few weeks or months.
I have made my wishes known. I do not want to be kept alive by heroic means if the quality of my life is expected to be grim. That’s a personal decision.
At the national level we must face this very uncomfortable question: Should we spend hundreds of thousands of dollars keeping someone alive whose life expectancy is 3 months? 6 months? a year?”
———
Your request may be ignored. Make sure full, notarized paperwork is available at all times in the event of an emergency. There was a story circulating of a guy who had “DO NOT RESUSITATE” tattooed on his chest. They still tried causing him much pain because they didn’t have an actual legal document in front of them stating this wish. A tattoo was considered insufficient of current wishes. And of course, they make much more money calling the calvary in for a resuscitation.
Spot on!
So long as we have the right to guns, we have the right to die.
Just put a trash bag on first so you don’t make a mess.
Just obtain a tank of N2 and a sealed breathing mask. Very clean!
When my father was dying in an ICU I asked one of his physicians: “If I had ‘Do not resuscitate. No insurance.’ tattooed under my left breast would it stop the ER team?” He said no it would make no difference, they would proceed to save me at all costs.
Hi Mish. This question is a little off topic but it still concerns medical care. Do you have any thoughts about for-profit hospitals vs. non-profit hospitals? It seems to me this is a very important question as cost pressures on all hospitals continue to grow and will only get worse as our population of elderly citizens continues to increase.
A non-profit hospital is a hospital where the funding is spent on executive perks.
Try to replace hip in Poland. For that price you will wait 15 years.
… but in Soviet Russia, hip replace you!
But … you can have really delicious pierogi while you wait!
Nothing can be done. If something is done they lose their donors. If they lose their donors they lose their election. If they lose the election the donors will get new candidates to make sure nothing can be done again. It’s not just drugs either. It’s EVERYTHING.
yup. learned it as a young buck in teen and early 20s, working for politicians helping them gerrymander districts and get funds from lobbyists. the amount of naive middlebrows on this site is jaw dropping. glad they are in the markets. dumb money is needed for proper hunting and gathering of beaver pelts……..
If we want to reduce undue corporate influence of Congress, there is only one solution – REMOVE MONEY FROM POLITICS!
The only way to do this to completely and totally fund political campaigns from public funds. Due to the finite limit of such funds (which would likely have to be collected via a new tax assessment on everyone), political campaigns would have to be reduced in time to perhaps no longer than 8-12 weeks with hard spending limits imposed.
Corporate and PAC contributions to politicians or on behalf of them would have to be completely banned and individual contributions would need to be capped at a low level (less than $500/person?).
This would throw a big wrench into the current politician election horse race business model and would, of course, be strongly resisted by all those who profit from the current arrangement – from corporations to politicians to the media.
But doing this would solve the problem of corporate ownership of our politicians and allow politicians to make decisions based on the merits, rather than who gave them the most money.
Exactlly, I would add one more restriction. One term only that way they won’t for free stuff so they can get reelected.
… or make lying while campaigning for or occupying a public office a capital offense.
Lying is not ok… let alone something to make a career of.
1) I’m a physician with substantial midlevel administrative experience… take this disclaimer for what you will.
2) US healthcare is a complex regulatory system involving federal, state, and poorly regulated ‘not for profit’ entities given power by either market forces, tradition or government entities like CMS (they are the part of HHS that administers medicare).
3) This complexity results in market participants exploiting regulatory arbitrage. The more complex, the more perfectly legal arbitrage opportunities exist. Don’t believe me? Look at the situation Mish noted. In likelihood what is occurring is perfectly legal though perhaps immoral.
4) The complexity and regulations from ‘not for profit’ regulatory entities increases each year as do their fees while other ‘not for profits’ exist in the form of hospitals, which are really ran like for profits except that the private equity one actually treated their employees the best and cared more about patient experience than the not for profits.
5) The only feasible path to fix (as opposed to blow up) the US healthcare system is a combination of restricting or regulating certain parts more adroitly (hospital mergers, noncompetes, not-for-profit definitions,) while at the same time deregulating other parts of the healthcare system which are patient facing (why can’t pharmacists prescribe drugs, they can in other countries?). Doing this successfully would address regulatory arbitrage.
I like the blow it up idea better. Then start from scratch using the Japanese reverse enginerring process where you look at every system and construct one using the best points from each.
You also like spending the rest of your life shuffling among the rubble? This will take decades.
Thank you for that.
Pharmacists in other countries may prescribe, but they are not trained to diagnose.
It’s left to the patients to “diagnose” themselves.
Not always a wise choice, but always cheaper.
Right to die-what about the right to life, the right to live? We’ve got all kinds of drugs and procedures that have killed over 60 million pre-born babies the past 50 years because there is absolutely no respect for innocent, defenseless, pre-born human life. We have to dispose of inconvenient stray kids same as stray cats. Years ago my wife did volunteer work in a Crisis Pregnancy Center where they would do all they could to care for these girls emotional problems while trying to convince them to give birth and parent their babies or put them up for adoption. In the film-The Silent Scream-ultrasound shows the fetus-the child-recoiling in a silent scream as the instrument of destruction enters the uterus and begins to tear apart defenseless human life. Nowadays many babies who survive abortion attempts or left alone to die….
don’t forget to send your money to proper totalitarian government causes. dopes like you want the government small enough to fit a camera in every bedroom, medicine cabinet, doctors office and bar and club. screw you. i’m for freedumb. freedom from nit wits who want to control what people smoke, drink, fornicate, abort, get guns………..stay away from sex drugs and rock and roll you totalitarian scold.
… and the minute those babies pop out, you’ll dub them welfare cheats.
As Jesus taught.
With the SCOTUS ruling large swaths of America can go back to trying a bent coathanger again. Sometimes it works. Sometimes you get hemorrhaging. Sometimes you can’t ever have another kid.
Progress. /s
Been on Imatinib for 2 years – When I started they wanted $28k per month, thankfully I can buy it directly from CostPlus for $44 per month including shipping. I don’t use insurance – I’ve been with 4 different companies at that time and they are ALL dramatically more expensive.
Thanks for commenting
This problem is not unique to the US, albeit worse there than elsewhere.
Imagine that everybody had compulsory hardware insurance.
Whenever you need a tool, the salesman recommends what you should get; the bill goes to the insurance. What do you think that would do to the price of hammers and saws? Would anybody ever take something of lesser quality? Would the manufacturer have any other incentive other than to get the retailer to push his product, even if subpar? And the insurance, of course the greater the revenue, the greater the profit. Matter of fact, tools that are inadequate and need constant replacement would be even better.
It is insane to institute a circular economy in which no party has incentive to cut cost.
Cross-sales, tie-in sales, retail channel monopolization, whatever you call it.
ALL illegal under black letter anti-trust law.
The trouble is that there is no rule of law, not that new law is required — existing law must be enforced. “There shall be no restraint of trade or restraint of competition”
If you get your car fixed, an estimate is required, and there is protocol to protect you.
Charging different prices for different people is a transgression against the 14th amendment. The medical industry is rife with illegal racketeering and other crimes, but gets a pass.
Because if you need emergency medical care you’re unable or don’t have time to approve costs. So, it only makes sense to assume you’re OK with being charged $50 for an aspirin.
A significant first step could be taken at the individual level, where one maintains a more nutritious diet and active lifestyle. This significantly reduces the need for prescriptions (and more prescriptions to cope with side effects from the first round).
The U.S. is hooked on pharma — from advertisers to politicians to the millions who pop pills daily. Add in that most of the ‘medicine’ is excreted as waste and imagine the consequences for the water supply and environment at large.
“Nearly 7 in 10 adults aged 40–79 used at least 1 prescription drug in the past 30 days in the United States (69.0%) and Canada (65.5%), and around 1 in 5 used at least 5 prescription drugs (22.4% in the United States and 18.8% in Canada).”
link to cdc.gov
fatten up the middlebrow kids on poison sugar etc…….then profit on them in adulthood. rinse and repeat. amerikans are twats. they’ll make money on brutality like that. we profit on homelessness and bankrupt the families of sick. twisted empire of debt. the boomers too dumb to get it.
In Maryland they just enacted a law that restaurants have to offer a healthy meal for kids. The meal has to contain whole grains and fruit juice. People think eating refined carbs and sugar water is a healthy alternative. It also has to contain meat that contains < 10% animal fat. They still think animal fat is bad for you. And anyway when you cook it, all the fat runs out, so it doesn't matter how much fat the raw meat contains.
The one thing that single payer system should enact is to give rebates to people that maintain a health lifestyle including weight. Penalizing the obese like bad drivers are with car insurance would not work, to much backlash. You could impose more taxes on unhealthy foods though. The financing of govt healthcare would most likely be a national VAT combined with a payroll tax.
Exactly.
Don’t ban foie gras, tax it.
I put most of the fat back in.
I cannot understand making good chili without sufficient fat.
Personal responsibility! The NERVE of this guy! You’ll pry my fudge rounds from my pudgy dead hands!
The pharma industry probably has a hit out on Mark Cuban.
amerikans are grifters and stupid sheep from bottom to top. from doctors to pharma to insurance and economists. glad i’m on the free shit army and pay zero for my healthcare.
hat tip papa dave for the energy stock ideas. the deflation calls mish has been making is silly. money printing and wars will always produce inflation. last i took out a benjamin, it did NOT buy much.
bombs away with pax dumbfuckistan.
Isn’t there an ‘all you can carry under $950 discount’?
If you can figure out how much each bottle costs. Sometimes it takes pharmacists several minutes to figure it out.
While I agree market competition is the key and perhaps deductibles limit the consumer incentive. But, to blame on liberals is absurd when all the looting is by private companies that lobby Republicans to oppose competition. So their pretending they are the saviors is preposterous. All this absurdity was in place before Obamacare, which had to give profiteering opportunities to get any Republican votes. This is similar to the Republican plan to cut taxes on the rich again, and cut Social Security and Medicare because there is no money available. Only the top of the pyramid has benefited from Reaganomics. When I saw the actual results, I could no longer support extreme capitalism when moderate capitalism works better for most of the people, who have far more retirement security, health care security, and much higher happiness levels than Americans stressed to the limit. Let’s get politics out of it and everybody work together to solve it and tell the lobbyists who determine policy to shove it.
I am happy to blame both sides and I do. Republicans block drug imports.
amerikans are assholes. we profit off homelessness, people go bankrupt over sickness, not to mention bombing 40 million innocent humans out of their homes past 22 years since 9.11. and so much more ways we are willing to do anything for a lousy shekel. the idiots that don’t realize this get caught up in the D v R pro wrestling idiocracy.
The rantings of a true Zardoz endorsed, loon bat, kook.
Toot, Toot!
Where’s Zardoz when you need him?
“we are willing to do anything for a lousy shekel”
Sounds antisemitic. Are you a Jew hater, TT?
go phuck yourself
i love all primates, human and non human. only hate assholes.
Put down the kookwhistle and back away. You don’t know how to use it, and you’ll put your eye out.
100% agree TT
Absolutely. Blame everyone. Totally agreed. That’s why we named it the UniParty.
You are delusional if you believe the democrats aren’t bought and paid for by special interests. Both parties are the tools of the money masters and pharma companies are huge if not the largest contributors to the corrupt Aholes in DC.
They are and they give more money to democrats. Although both parties are well compensated.
Lobbying itself is an industry.
Hiring a top tier lobbying firm will cost you around $25,000 per month.
A one man attorney registered as a lobbyist costs around $5,000 per month.
In 2022 there were 12,644 registered lobbyists in D.C.
These are the costs for the lawyers.
Campaign contributions cost extra.
Let me tell you how a pal of mine “fixed it” >>>>> He had a kidney stones blasted in S.D. and simply refused to pay the Co-Pays and Deductibles and he was able to simply claim that he was living in a van, down by the River and never paid those bills.
Fortunately he doesn’t have the money to try to buy a home.
“How Do We Fix This?”
Well, to keep it broken and/or break it more, we keep increasing govt involvement.
The only question is whether we can reverse the damage by getting rid of govt involvement.
1) Somebody flew to Thailand to fix his heart, but something was not quite right. He
flew again to fix it.
2) To avoid the healthcare swamp eat starch food – rice, potatoes and sweet potatoes – plus veggies and fruits.
3) Covid is back in rd #2. The healthcare swamp salivates. Eat green leafy veggies with a few drops of balsamic vinegar – don’t overdose – to produce Nitric Oxide.
4) Dr Nathan Bryan, Dr Esselstyn and Dr McDougall are swamp killers.
What is rd #2.
Having a hard time decoding your post…
Perhaps you can spell it out if you’re not talking to yourself.
Eating starch seems the opposite of what Americans need for their diet.
Starch is almost as bad for you as sugar.
Sugar is a drug, not a sweetener.
In some european countries they have a better approach. The doctor gives the recipe, and the patient buys the drug where he likes. He pays 50% of the prize, so there is a strong incentive to seek the more competitive pharmacy.
You have the criminalized gov/med/edu/pharma/media/insuro cartels to thank for this.
“Medicare for all is not the answer,”… I beg the differ, yes it is. Just needs to be done correctly and not corrupted by the corrupt crony capitalist political alliance we have. Obamacare was a CF. Why are drug prices way lower in universal healthcare Canada? Why are per capita healthcare costs about 1/2 in univeral healthcare Canada. Why is per capita health care outcomes and longevity much greater in the countries with universal healthcare? We rank dead last in every category of health compared to countries witrh universal healthcare. A national debate needs to be done on this with actual facts not just the usual BS garbage talking points thrown around. With Obamcare my self paid private ins was reasonable with great coverage. When Obamacare was enacted my self pay insurance premiums doubled with essentially no coverage until after 15k deductibe. My only rx went from $70 for 3 months to 170 for 3 months. Got in Canada mailorder for 35 USD. Obamacare keeps people ouut of the workforce in order to retain free health insurance. Universal healthcare would eliminate this. An interesting book on the topic is “The healing of America” can’t remeber the author. Our current healthcare system if FUBB.
“Just needs to be done correctly and not corrupted by the corrupt crony capitalist political alliance we have.”
This is impossible until bribery is illegal, no politician in his right mind will give up his seat to do the right thing, he loses his job atop having no private sector prospects for having a reputation as a non-team player.
Justice Scalia’s infamous words, “Money is free speech”, was the end of Democracy.
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You confuse two different problems. First, Canada is not a system I would want to model something off of. If you are a reasonably healthy middle age person in Canada and completely tear your ACL, you end up waiting 9 months to get it fixed. Know how well it works then? The outcomes are often poor. Cancer? Same deal. Try looking at the Swiss system or even the Germany system. Both do far better for a more diverse mix of issues than Canada because they have a robust private option. In Switzerland, everyone gets a basic plan and if you have the money many can add on.
As for the ACA, it was fairly obvious it would not improve much of anytime when it passed. In fact, the composition of the provisions actually seemed to be intended to raise healthcare costs overall. It turns out it also increased wait times for care if you have commercial insurance, so you get less for more money. I actually wonder if it was intended to slowly worsen US healthcare so that we would foolishly try a pure single payor system.
I just used CA as the closet eg. Even dispite the many shortcomings of the CA system it still is better when you compare cost and healthcare outcomes. Most Canadians are happy with the system and wouldn’t switch to our system despite the many complaints. I always ask canadians about this when I meet one and living in MI I have encountered quite a few. One of my best freinds was a Canadian.
The system will never change because the American people do not get it. They continue to refuse the obvious answer which is a more mutualized system.
Americans are not subsidizing medications for the rest of the world, they are just the bigger suckers because the let corporations lobby and buy Congress and they still call it a free market. But any attempt to, say, let Medicare bargain wholesale discounts is considered anti-markets and potentially, ready for it?, socialist (brrrrr).
You get the system you vote for: a pseudo libertarian utopia that gives the illusion of choice while a few connected puppeteers run the show.
The SCOTUS pretty much sealed the deal with Citizens United.
A billionaire healthcare CEO sends his lobbyist into K st, whispers a number off the record into an ear in exchange for tax exemptions, deregulation or government subsidy, then “Patriots for Liberty” SuperPAC receives millions from an anonymous donor, all legal, at least what’s on paper.
“Money is free speech”
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I can’t figure this out.
The speech isn’t free.
It’s paid for.
How much did you pay to say that?
Just for starters I pay AT&T over $50/month.
It’s classic cartel behavior in restraint of trade, which has been black letter illegal for over 100 years. If our government weren’t completely dependent on the grift it might have a chance of being fixed. No executive will touch them with a 10 foot pole lest they lose next year’s election for “pushing granny down the stairs”.
The Sherman Anti-trust act only applies to non-campaign donors.
“CVS and Cigna Charge $6,000 for $55 Generics … ” The extra payment goes for R&D to find new drugs that saves lives — that is the Republican Mantra.
Repubs do not want Medicare to negotiate drug prices. In a competitive environment, Medicare will buy from Cuban at the lowest price, not from the big Pharma. No?
Democrats take in more money than republicans.
link to opensecrets.org
Both sides of the aisle are on the take.
This is the con the Uniparty has foisted on the public. Voters revert to defending their own party, even though both parties have protected this incredible fleecing of the public. Insurance companies own the pharmacies that pay 2 7 times the market price of a drug.
Consumers are being cheated and both parties have done nothing to stop the graft.
Healthcare is bankrupting America. That’s a fact.
The new players in pharma prescriptions have to be price setting to some extent.
What’s needed is tort reform to control egregious payouts. Then you’d have to fix prices to some extent. You need WAY more transparency across the entirety of healthcare. You need some way to reward healthcare that is efficient but doesn’t ration care. Imaging services is a great example. I got a CT Calcium scan that cost $100 at a facility that specializes in imaging, but the same service through a United HC porvider would have been 3-5X more expensive. Certainly, end of life savings by not going above & beyond to keep people alive would save money, but it’s not some huge amount.
Ultimately, it comes down to telling the healthcare industry they’ve got to take a pay cut. How that happens without turning things into socialized medicine is a hard nut to crack. But, again, pricing setting in some form would have to be part of the solution.
“What’s needed is tort reform to control egregious payouts. Then you’d have to fix prices to some extent. You need WAY more transparency across the entirety of healthcare.”
The problem with this, as highlighted with the Obamacare debates in 2009, is that it will hurt healthcare stocks, effectively lowering the bonuses of big campaign funders, thus causing more honest politicians to be elected.
Citizens United, where the SCOTUS concluded bribery is free speech.
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I’m not trying to split hairs over the pros / cons & unintended consequences. The main point is through some means, healthcare will have to take a haircut.
It’s that simple. To your point though, the entire healthcare industry will line up to ensure this doesn’t happen.
If / when it does, it will be part of some larger financial collapse that forces massive change, probably after a period of “the butt end of a gun” takes place. Or put another way, when hell freezes over.
Not going to happen. Too many stakeholders In the Medical Industrial Complex benefit financially.
End of life medical costs are a huge amount.
Years ago I read that over 50% of a persons lifetime medical costs occur in their last 30 days of life.
You could say if a fortune teller could predict the date everyone was due to die and you just shot them a month before that date it would cut the share of GDP in healthcare from 20% to 10%.
But as we have no soothsayers the only way to achieve that level of cut is to enforce laws on collusion and closed shops which would cut healthcare by more than 50%.
Except the majority know they only have 30 or so days in advance.
Yup.
A scan at a hospital costs 10x more than at a radiology center. Same equipment and operators. They can get away with it because people at hospitals can’t always travel to a radiology center or they need a scan urgently.
Here is another medical outrage. link to bloomberg.com
There are a lot of problems with our “healthcare system”. Prolonging life at the very end costs a tremendous amount of money and increases discomfort as Mish said. Patient education and a strict cost benefit (life extension) approvals may be necessary. Allowing imports of medicines would help along with requiring that health insurance pay for certain procedures done overseas (at the patient’s option with the patient receiving 25% of the savings as an incentive to go) would help keep costs down by increasing competition.
The fastest way to remedy this is to look at which campaigns these two entities have been “contributing” to (money is free speech, folks) and then outbid them.
(link to opensecrets.org)
I could go on and on about the plethora of problems as a result of legalized bribery / Citizens United, not just in healthcare, but suffice to say until we reverse the SCOTUS’s Citizens United decision, we now live in a Corporatist form of Fascism, big money creates the rule of law.
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Is anyone working on reversing the SCOTUS’s Citizens United decision? Any challenges?
I doubt politicians would support a challenge, as this opened up much new campaign contributions to them, so who exactly might challenge the ruling?
The biggest campaign fund a politician has, is the tax payer. Legalized bribery: vote for me and i will work to create a new government program that will cost billions, but will be a benefit for you. Just don’t look at the tax increase on your pay stub.
People were worried about “death panels” with socialized medicine but the truth is there won’t be enough doctors, nurses, and other healthcare workers to take care of 80 million retired boomers in 2030. There will be long lines for any kind of specialty service and if you need surgery now, you’ll probably die waiting.
The smart thing to do RIGHT NOW is build your network of remote (foreign country) healthcare professionals that you can go visit when the time comes.
If your genetic ancestry says you are prone to heart problems or cancer or diabetes then start researching countries that offer those treatments very fast. I can tell you a whole lot of people I know have hip replacement issues, knee replacement issues, etc.
Waiting to do this research after you become sick will be a death sentence as you wait for doctors to be available. This is part of “invest in yourself” that everyone should be doing now because I guarantee congress or the next president won’t fix a damn thing.
“The smart thing to do RIGHT NOW is build your network of remote (foreign country) healthcare professionals that you can go visit when the time comes.”
This is a loophole used with many corporate H1-B workers, they opt to forgo the health insurance U.S. workers need, saves big on corporate payrolls, great for C-suite bonuses and shareholder value.
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Not at all, I was referring to YOU and ME finding a doctor(s) in places like Mexico, India, Thailand or wherever that you fly to in order to get treatment on site. You can’t import doctors and have them treat people here unless laws change in every state. It’s why foreigners with medical degrees end up driving taxis in the U.S.
I know what you meant, medical tourism.
Only worth pursuit for surgery or high cost procedures, then you’re on your own if there are complications after the fact.
Not to mention, the vast majority of Americans don’t have the financial resources or time to fly around the world for healthcare.
I think others will agree when I say it’s a ridiculous idea to promote that as a solution.
I say the problem itself needs to be fixed.
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next time i get chest pains i’ll book a flight to thailand. great plan.
Any ounce of prevention is worth a pound of cure. If you congenital heart problems you should book the flight to South Korea, have a full diagnostic done, get treatments then head back home.
Waiting till you have chest pains in 2030 will be an immediate death sentence as you are told to come back in 3 months to see a doctor.
Here is some interesting math from the BLS.gov released last week.
link to bls.gov
The slower birth rates of the 1970’s will cause the population ages 55 to 64 to decrease much faster than any other age group. Meanwhile, the 65 and older age group will experience fast growth as all baby boomers age into that category by 2032. This age group’s projected 14.4 million increase in population accounts for over three quarters of the overall projected population growth. Of that 14.4 million increase, about 10.6 million comes from the 75 and over age group, as most of the baby boomers age into that bracket.
–Slower projected growth in the population is expected to constrain growth in the civilian labor force over the projections period. The civilian labor force is expected to increase from 164.3 million in 2022 to 170.7 million in 2032, an increase of almost 6.5 million. This translates to a projected annual growth rate of 0.4 percent, slower than the 0.6-percent annual growth rate exhibited during the 2012-22 decade.
–The labor force participation rate is projected to fall from 62.2 percent in 2022 to 60.4 percent in 2032. The principal factor driving the projected decline in the labor force participation rate is a greater share of individuals over the age of 65.
That’s where AI’s come in to play. We will save huge $$ replacing most MD’s, which is why the medical industry will fight AI’s tooth and nail.
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The average doctor in the U.S. makes $350,000 a year. Why?
Analysis by Andrew Van Dam, Staff writer|
August 4, 2023
The average U.S. physician earns $350,000 a year. Top doctors pull in 10 times that.
When those simple data points were first presented in 2020, a small subset of physicians came unglued on the microblogging site formerly known as Twitter, slinging personal insults and at least one deeply unflattering photo illustration of an economist.
We couldn’t understand why. The figures are nigh-on unimpeachable. They come from a working paper, newly updated, that analyzes more than 10 million tax records from 965,000 physicians over 13 years. The talented economist-authors also went to extreme lengths to protect filers’ privacy, as is standard for this type of research.
By accounting for all streams of income, they revealed that doctors make more than anyone thought — and more than any other occupation we’ve measured. In the prime earning years of 40 to 55, the average physician made $405,000 in 2017 — almost all of it (94 percent) from wages. Doctors in the top 10 percent averaged $1.3 million. And those in the top 1 percent averaged an astounding $4 million, though most of that (85 percent) came from business income or capital gains.
…
link to washingtonpost.com
Lol. And AI engineers are raking in $900,000 per year……why?
link to nbcnews.com
There is usually a great difference between gross and net income.
Duh.
True but you only need to have that plan if you are currently sickly and below 65. Once you get on Medicare (i.e. STRAIGHT Medicare, not an “Advantage plan” and a supplement plan) all your medical worries go out the window.
I can get $5 million in surgery and it will cost me next to nothing (possibly nothing at all).
medicaide starts much younger and even picks up my aspirin. everything is free. i’m a flag officer in the free shit army. taxes are for the little people.
Straight Medicare only pays 80% of costs. That’s why supplemental insurances, like Advantage plans exist.
So, if you had a $5 million procedure done, with straight Medicare, your copay would be about $1 million.
The rich have always had better (state of the art) healthcare.
Only those with insurance are paying those huge prices. The insurance rate is much higher than what you would pay if you refused to pay. Thanks to Obamacare. Obamacare is setup to allow drug companies to charge whatever they want forcing insurance companies to pay for it. Insurance is expensive because health care is expensive. Not the other way around. The ACA, like the IRA, is sarcastically named. They both did the opposite of what the name implies.
Drug companies own both sides of the aisle, so Washington will never do anything about this.
You can bet CVS and McKisson will fight Cuban in court every step of the way. Every state has a myriad of laws that will take forever to get approval in every state.
Agree with everything except government has done plenty… for the benefit of pharma.
Health care is expensive due to lack of transparency and lack of competition and collusion. Here are some solutions link to market-ticker.org
There is no “solution” within the workings of capitalism. It isn’t universal medical care that creates the problem, it’s the bloodsuckers of profit, the fox guarding the healthcare henhouse of Medicare/Medicaid. Same thing with anything else the capitalist class can get its hands on—housing, military appropriations, political parties, etc.
oh please, how about, “allow foreign companies to mail legal drugs to Americans without proof of a local prescription.”
I’ll give you one clue. Who is stopping pharma in foreign countries from selling the same exact pharmaceuticals that we get here to us for pennies on the dollar? Hint: It starts with “G” and ends with “t”.
The truth is that there is no solution. Both free market and universal create problems. Every cycle has an up phase and a down phase. There is no avoiding that. Something seems to work until it doesn’t. If something actually worked on a permanent basis, we would have been practicing it for millennia by now.
Fix it ?
Its not broken! Somebody or company is making large margin.
The problem (as it always is that You Mish taught me) is market interference by govt/regulator/medical insurance scam….
Exactly, business in America is legalized stealing. Why does the insurance company want to cover beyond reasonable (if not extortion) prices ? Everyone in this medical ecosystem is a con. When I got ear wax removed it was called “surgery” by doctor. So Doctor office scams HMO which then has to charge absurd prices to cover that scam OR not cover it OR cover some part of it and then sticks that cost to patient. We used to have a government that at least pretended to care. Obamacare and the whole universalization of medical software, billing, tracking has just made it impossible to go to a doctor’s office in a reasonable amount of time. When you get there, it’s all doctors hacking on keyboards, using crappy EMR software that has all the charm of a smog test.
I don’t think that it has to do with Obama care/ Booboo care or anything else. what I find is that prices for health care should be publicly on display, similar to a mechanics shop. The people have allowed, as voters, the politicians to bamboozle them into the current system. We all can see the ridiculous pricing for healthcare before they swipe your insurance card, we would think twice to go to the expensive clowns.
Mish forgot his Microeconomics 101. He usually doesn’t do that.
Medical markets are not very amenable to pure market mechanisms alone. Remember the half dozen things a functioning efficient market needs? Medical markets have none of them. It’s a market the more or less needs some level of “interference”. It will never be able to function like the market for Wheaties.
It’s great red meat to hang in front of free marketeers/libertarians, but it makes horrible health care policy.
Even with interference from governments, they cannot allow 1000% markups like that? The free market would allow for drugs to be purchased from any country, maybe by manufacturer and open competition not interfered with by corrupted FDA
Lol. Ok, I’ll bite. Why do YOU think medical markets are not amenable to the free market?
What’s wrong with companies exercising their God-given liberty to collude and maximize profits? It’s good for shareholders! Nobody said life is fair!
Nothing. Except when government is involved to tilt the odds in their favor.
You’ve got it wrong. It is not the regulator. It is capture of the regulator by Big Pharma that is the problem