Kamala’s take on the Economy

[crazed_hoosier2]

Consumers can only price discriminate when they have both the knowledge of the market and an options to exercise that knowledge. I can easily choose at the grocery between Oreos and Kroger brand chocolate chips. Or skip both if they are priced more than I value them.

You can price shop with reasonable knowledge for say dental work or eyeglasses... But not for more complicated medical procedures, testing or many pharma purchases, often needed under severe physical duress.

That's why insurers exist (both public and private). They have the institutionalized buying knowledge of what is and isn't a fair price to pay providers.

There’s a reason that elective procedures such as LASIK have become much more affordable than other healthcare goods and services.

That reason? They’re paid for out of pocket.

And people don’t have to be experts to do it.

 

[Spartans9312]

There’s a reason that elective procedures such as LASIK have become much more affordable than other healthcare goods and services.

That reason? They’re paid for out of pocket.

And people don’t have to be experts to do it.

This has been my point about prescription drug prices.

The fact that everyone has “insurance” has artificially increased the cost to the consumer. AWP -17% + $1 is not a good reimbursement rate for pharmacies. Eliminating PBMs is the the way to properly bring down prescription prices to consumers

 

[JamieDimonsBalls]

What do you do in construction? Sit in a lawn chair at your job site giving occasional directions while reading history books? How th F do you remember so much

Don’t be a dick rider. Crazed was here long before you came around.

 

[crazed_hoosier2]

This has been my point about prescription drug prices.

The fact that everyone has “insurance” has artificially increased the cost to the consumer. AWP -17% + $1 is not a good reimbursement rate for pharmacies. Eliminating PBMs is the the way to properly bring down prescription prices to consumers

Maybe. I will say that I don’t think consumer information is the issue here. A doctor writing a script to a pharmacist doesn’t require the patient to know anything…other than where his pharmacy is and how to follow their instructions.

But considering that patents, R&D, etc. are such a big deal in the pharm world, there’s more going on here than with other aspects of the healthcare industry.

I do definitely agree with Chris Murphy that Americans are subsidizing foreign drug consumers. And we need to figure out how to put more of the pricing burden on them.

 

[JamieDimonsBalls]

There’s a reason that elective procedures such as LASIK have become much more affordable than other healthcare goods and services.

That reason? They’re paid for out of pocket.

And people don’t have to be experts to do it.

While true and I’m certainly not a proponent of medical insurers, the industry (led by Medicare) is dramatically pushing the change in surgical landscape, where ASCs, OBLs, and other models now account for a significant and growing percentage of procedures. That will reduce inflationary pressures.

Additionally, minimal invasive technological innovation will also curb costs and improve outcomes.

Now we need to find more one time solutions instead of long term medication subscriptions presented by pharma.

 

[Spartans9312]

Maybe. I will say that I don’t think consumer information is the issue here. A doctor writing a script to a pharmacist doesn’t require the patient to know anything…other than where his pharmacy is and how to follow their instructions.

But considering that patents, R&D, etc. are such a big deal in the pharm world, there’s more going on here than with other aspects of the healthcare industry.

I do definitely agree with Chris Murphy that Americans are subsidizing foreign drug consumers. And we need to figure out how to put more of the pricing burden on them.

If the patient pays for their prescription up front and then submits to insurance for reimbursement….the price of prescriptions will come down.

We know this because we once had that arrangement. Eliminate PBMs and watch the cost plummet.

 

[stollcpa]

Heh. I mostly just sign outgoing checks these days -- and hope that the incoming ones total more than they do.

I've been a longtime critic of Nixon's wage/price controls. A number of them didn't last very long, thankfully. But some of them did and they were among the biggest reasons we had fuel shortages, gas lines, etc. throughout the 70s. They also coincided with a policy that effectively shut down the Bretton Woods system and moved us off the gold standard.

But with inflation and unemployment up, Nixon decided to seek the counsel of esteemed economist Arthur Burns (Fed Chair), esteemed economist Paul Volcker (future Fed Chair), and lawyer/politician John Connally (then Treasury Sec, former Texas Gov).

Guess whose advice he took.

Many of my construction clients are starting to worry. They’re busy but their backlog has shrunk.

 

[mcmurtry66]

Don’t be a dick rider. Crazed was here long before you came around.

I go back to 2001

 

[crazed_hoosier2]

If the patient pays for their prescription up front and then submits to insurance for reimbursement….the price of prescriptions will come down.

We know this because we once had that arrangement. Eliminate PBMs and watch the cost plummet.

I don’t disagree. Giving people even some exposure to cost is a big deal. This is reminiscent of income taxes and withholding. If people had to write checks every year for their taxes…

 

[twenty02]

There’s a reason that elective procedures such as LASIK have become much more affordable than other healthcare goods and services.

That reason? They’re paid for out of pocket.

And people don’t have to be experts to do it.

That's a perfect example of what I referred to. LASIK is something you plan for, can shop for and is basically a commodity offering today. It's also completely elective.... Not something medically necessary.

If you have some illness that you are hospitalized for you aren't shopping around.

 

[crazed_hoosier2]

That's a perfect example of what I referred to. LASIK is something you plan for, can shop for and is basically a commodity offering today. It's also completely elective.... Not something medically necessary.

If you have some illness that you are hospitalized for you aren't shopping around.

Because you have no incentive to do so. Given the incentive to do so, you would.

Very few healthcare transactions are of an urgent nature where we don’t have any time to seek and consider options. Obviously, those would fall under the type you’re describing.

We need to figure out ways to get the consumer in the position he typically occupies, which has the effect of forcing everybody in the supply chain to be competitive and cost-conscious.

This is why, as far as national universal healthcare plans go, I think Singapore provides the best model to explore. They’ve done a better job balancing cost with quality and access. People there have direct incentive to act the way consumers are supposed to act.

 

[twenty02]

Because you have no incentive to do so. Given the incentive to do so, you would.

Very few healthcare transactions are of an urgent nature where we don’t have any time to seek and consider options. Obviously, those would fall under the type you’re describing.

We need to figure out ways to get the consumer in the position he typically occupies, which has the effect of forcing everybody in the supply chain to be competitive and cost-conscious.

This is why, as far as national universal healthcare plans go, I think Singapore provides the best model to explore. They’ve done a better job balancing cost with quality and access. People there have direct incentive to act the way consumers are supposed to act.

There are plenty of non urgent medical situations where it simply isn't practical, as well. Last year I was in the dermo office for a skin check. There was one spot I was concerned about... Dr didn't like it either and recommended a biopsy, which they did right there on the spot. It came back squamous cell, superficial only....I setup another appointment to have it removed, which took all of about 15 mins.

Was I supposed to go shop around and ask pricing for the biopsy? Was I supposed to shop around on pricing for the removal procedure when the current doctor did the biopsy, has the report on hand and knew clearly how much to remove? I had no clue what a reasonable rate is for either procedure or lab biopsy.

What you are describing just isn't practical for many even routine procedures. Nobody wants to hop around and substitute providers like they are deciding between Kellogg's and Post cereal in the grocery aisle. I have carried a HDHP with HSA for years, so I certainly have the economic incentive in place to not overpay. But nobody can be expected to know what overpaying is for a procedure that varies based upon patient. And you have zero experience ever purchasing.

 

[Spartans9312]

There are plenty of non urgent medical situations where it simply isn't practical, as well. Last year I was in the dermo office for a skin check. There was one spot I was concerned about... Dr didn't like it either and recommended a biopsy, which they did right there on the spot. It came back squamous cell, superficial only....I setup another appointment to have it removed, which took all of about 15 mins.

Was I supposed to go shop around and ask pricing for the biopsy? Was I supposed to shop around on pricing for the removal procedure when the current doctor did the biopsy, has the report on hand and knew clearly how much to remove? I had no clue what a reasonable rate is for either procedure or lab biopsy.

What you are describing just isn't practical for many even routine procedures. Nobody wants to hop around and substitute providers like they are deciding between Kellogg's and Post cereal in the grocery aisle.

I get what you are saying….but don’t we already “shop” around for these things? Just not from the financial end of it?

 

[twenty02]

I get what you are saying….but don’t we already “shop” around for these things? Just not from the financial end of it?

Maybe to some extent.... But financially we rely upon the insurance company to offset the pricing power of the providers. I'm looking for a provider in my insurance network, the insurance company is trying to negotiate the lowest reimbursement rates to provider groups, and thereby offer the most competitive premiums in the market.

The lack of consumer choice and pricing power via consumer is really tied to the lack of insurance choices for many. Which is the result of the horrible employer based insurance system. I have to take one of maybe two or three options that my employer offers. Often all with the same insurance company.

 

[crazed_hoosier2]

There are plenty of non urgent medical situations where it simply isn't practical, as well. Last year I was in the dermo office for a skin check. There was one spot I was concerned about... Dr didn't like it either and recommended a biopsy, which they did right there on the spot. It came back squamous cell, superficial only....I setup another appointment to have it removed, which took all of about 15 mins.

Was I supposed to go shop around and ask pricing for the biopsy? Was I supposed to shop around on pricing for the removal procedure when the current doctor did the biopsy, has the report on hand and knew clearly how much to remove? I had no clue what a reasonable rate is for either procedure or lab biopsy.

What you are describing just isn't practical for many even routine procedures. Nobody wants to hop around and substitute providers like they are deciding between Kellogg's and Post cereal in the grocery aisle. I have carried a HDHP with HSA for years, so I certainly have the economic incentive in place to not overpay. But nobody can be expected to know what overpaying is for a procedure that varies based upon patient. And you have zero experience ever purchasing.

In today’s world of instantly accessible comparative information, yes.

We have an unprecedented ability to acquire information and evaluate options - and to do so quickly and with confidence. For instance, I never eat somewhere out of town without first checking Google, Yelp, etc for reviews, menus, location, prices, etc. This simply wasn’t possible in the past. As such, I virtually never have a bad meal when I’m traveling.

When’s the last time you got lost driving in a strange place?

We can and should use this relatively new capability to improve healthcare, just as it’s been used to improve other things. We just have to be open to thinking differently.

Have you seen what Mark Cuban (and now Amazon) have done with pharmaceuticals?

 

[crazed_hoosier2]

The lack of consumer choice and pricing power via consumer is really tied to the lack of insurance choices for many. Which is the result of the horrible employer based insurance system. I have to take one of maybe two or three options that my employer offers. Often all with the same insurance company.

I disagree. I think the problem is trying to use an insurance model to buy things that insurance really isn’t a great model for.

We’ll always need insurance in medical care, of course. I’m not advocating getting rid of it. But I am advocating using it less in our more normal and routine healthcare consumption.

 

[JamieDimonsBalls]

I go back to 2001

Under what handles?

 

[mcmurtry66]

Under what handles?

McMurtry

 

[hoot1]

I disagree. I think the problem is trying to use an insurance model to buy things that insurance really isn’t a great model for.

We’ll always need insurance in medical care, of course. I’m not advocating getting rid of it. But I am advocating using it less in our more normal and routine healthcare consumption.

Craze, share your concerns about our "insurance model" as it relates to paying for health care.

The bottom line for me when it comes to health care is simply why is our care so expensive and why does such a high percentage of our total GDP go to health care.

Finally, what can be done to lower costs.

 

[BradStevens]

Because you have no incentive to do so. Given the incentive to do so, you would.

Very few healthcare transactions are of an urgent nature where we don’t have any time to seek and consider options. Obviously, those would fall under the type you’re describing.

We need to figure out ways to get the consumer in the position he typically occupies, which has the effect of forcing everybody in the supply chain to be competitive and cost-conscious.

This is why, as far as national universal healthcare plans go, I think Singapore provides the best model to explore. They’ve done a better job balancing cost with quality and access. People there have direct incentive to act the way consumers are supposed to act.

Don't you want to have a relationship with your doctor?

Do you think this type of model works with car mechanics?

 

[twenty02]

I disagree. I think the problem is trying to use an insurance model to buy things that insurance really isn’t a great model for.

We’ll always need insurance in medical care, of course. I’m not advocating getting rid of it. But I am advocating using it less in our more normal and routine healthcare consumption.

That's already happened/happening. The majority of those with private insurance now have a high deductible plan where the first $4-7k of annual expenses are paid out of pocket, not via insurance.

 

[mcmurtry66]

That's already happened/happening. The majority of those with private insurance now have a high deductible plan where the first $4-7k of annual expenses are paid out of pocket, not via insurance.

Some considerably higher. Tantamount to catastrophic insurance where you’re basically just hedging for a stroke or cancer. Everything else you’re effectively self pay

 

[twenty02]

Because you have no incentive to do so. Given the incentive to do so, you would.

Very few healthcare transactions are of an urgent nature where we don’t have any time to seek and consider options. Obviously, those would fall under the type you’re describing.

We need to figure out ways to get the consumer in the position he typically occupies, which has the effect of forcing everybody in the supply chain to be competitive and cost-conscious.

This is why, as far as national universal healthcare plans go, I think Singapore provides the best model to explore. They’ve done a better job balancing cost with quality and access. People there have direct incentive to act the way consumers are supposed to act.

Singapore is a worthless comparison. It's the population of Alabama in a nation that is half the size of Rhode Island. You can squeeze a lot of efficiency out of systems when all the population is tightly packed together.

 

[Spartans9312]

Maybe to some extent.... But financially we rely upon the insurance company to offset the pricing power of the providers. I'm looking for a provider in my insurance network, the insurance company is trying to negotiate the lowest reimbursement rates to provider groups, and thereby offer the most competitive premiums in the market.

The lack of consumer choice and pricing power via consumer is really tied to the lack of insurance choices for many. Which is the result of the horrible employer based insurance system. I have to take one of maybe two or three options that my employer offers. Often all with the same insurance company.

Yep…I’m in the same boat

 

[Spartans9312]

That's already happened/happening. The majority of those with private insurance now have a high deductible plan where the first $4-7k of annual expenses are paid out of pocket, not via insurance.

And the premiums are outlandish….pre-ACA I had employer provided coverage with a $750 deductible and the premium paid 100% by my employer.

 

[mcmurtry66]

That's already happened/happening. The majority of those with private insurance now have a high deductible plan where the first $4-7k of annual expenses are paid out of pocket, not via insurance.

Oh and I’ll add perhaps self pay that in reality is higher. If I show up at the Er with a busted leg they take my insurance then bc of the deductible I basically pay out of pocket. But if I actually just paid out of pocket having reviewed thousands of med bills it would actually be cheaper to have pretended I had no insurance and was true self pay. F’d up

 

[UncleMark]

Oh and I’ll add perhaps self pay that in reality is higher. If I show up at the Er with a busted leg they take my insurance then bc of the deductible I basically pay out of pocket. But if I actually just paid out of pocket having reviewed thousands of med bills it would actually be cheaper to have pretended I had no insurance and was true self pay. F’d up

Sure, the whole system is a mess. Hell, even a relatively bright and well read freeloader like me gets bit. I was prescribed Trelegy last winter after a bought of pneumonia. It's good stuff, but what it really is is nothing more than a delivery system for three different generic medicines all in one package. One hit and you get the proper doses of all three. Shit is stupidly expensive -- they bill Humana/Medicare $500 and they pay all but my $47 copay. Until... I went to get my monthly script last week and my copay now is $171. I pitched a fit, and the pharmacist looked and it appears I've hit my "donut hole". What a stupid contrivance.

I have a doctor's appointment in a couple weeks. I'll be asking her ahead of time to give me options on an alternative. Hell, set me up with the three generics separately and I'll figure out a way to take them all at once. Can't be hard.

 

[VanPastorMan]

View embedded media

She plans on fixing prices to bring down costs. That is f#cking stupid. The opposite happens. She’s beyond dumb.

Will she say colleges are price gouging because education costs have sky rocketed? No, because the Dems need educational contributions.

 

[BradStevens]

Will she say colleges are price gouging because education costs have sky rocketed? No, because the Dems need educational contributions.

I’d be all for price controls on that.

 

[mcmurtry66]

Sure, the whole system is a mess. Hell, even a relative bright and well read freeloader like me gets bit. I was prescribed Trelegy last winter after a bought of pneumonia. It's good stuff, but what it really is is nothing more than a delivery system for three different generic medicines all in one package. One hit and you get the proper doses of all three. Shit is stupidly expensive -- they bill Humana/Medicare $500 and they pay all but my $47 copay. Until... I went to get my monthly script last week and my copay now is $171. I pitched a fit, and the pharmacist looked and it appears I've hit my "donut hole". What a stupid contrivance.

I have a doctor's appointment in a couple weeks. I'll be asking her ahead of time to give me options on an alternative. Hell, set me up with the three generics separately and I'll figure out a way to take them all at once. Can't be hard.

Sure, the whole system is a mess. Hell, even a relative bright and well read freeloader like me gets bit. I was prescribed Trelegy last winter after a bought of pneumonia. It's good stuff, but what it really is is nothing more than a delivery system for three different generic medicines all in one package. One hit and you get the proper doses of all three. Shit is stupidly expensive -- they bill Humana/Medicare $500 and they pay all but my $47 copay. Until... I went to get my monthly script last week and my copay now is $171. I pitched a fit, and the pharmacist looked and it appears I've hit my "donut hole". What a stupid contrivance.

I have a doctor's appointment in a couple weeks. I'll be asking her ahead of time to give me options on an alternative. Hell, set me up with the three generics separately and I'll figure out a way to take them all at once. Can't be hard.

Is this it?

https://www.needymeds.org/search-programs?initialSearchTab=coupons&initialSelectedDrugId=68d2816d-2bb7-9f4a-8f03-1aa52fde4621

 

[VanPastorMan]

You're confusing effective policy with effecting campaign messaging. She's merely saying what people want to hear. She's going to take on The Man on behalf of The Oppressed. People love that shit. You're simply not the audience she's pitching to.

If she promises to cut fast food prices in half I might be tempted to vote for her.

 

[mcmurtry66]

Sure, the whole system is a mess. Hell, even a relative bright and well read freeloader like me gets bit. I was prescribed Trelegy last winter after a bought of pneumonia. It's good stuff, but what it really is is nothing more than a delivery system for three different generic medicines all in one package. One hit and you get the proper doses of all three. Shit is stupidly expensive -- they bill Humana/Medicare $500 and they pay all but my $47 copay. Until... I went to get my monthly script last week and my copay now is $171. I pitched a fit, and the pharmacist looked and it appears I've hit my "donut hole". What a stupid contrivance.

I have a doctor's appointment in a couple weeks. I'll be asking her ahead of time to give me options on an alternative. Hell, set me up with the three generics separately and I'll figure out a way to take them all at once. Can't be hard.

Those online outfits will ship to your door. You can also call the manufacturer directly. They sometimes have some allocated for in kind type donations and special programs

 

[DANC]

Sure, the whole system is a mess. Hell, even a relative bright and well read freeloader like me gets bit. I was prescribed Trelegy last winter after a bought of pneumonia. It's good stuff, but what it really is is nothing more than a delivery system for three different generic medicines all in one package. One hit and you get the proper doses of all three. Shit is stupidly expensive -- they bill Humana/Medicare $500 and they pay all but my $47 copay. Until... I went to get my monthly script last week and my copay now is $171. I pitched a fit, and the pharmacist looked and it appears I've hit my "donut hole". What a stupid contrivance.

I have a doctor's appointment in a couple weeks. I'll be asking her ahead of time to give me options on an alternative. Hell, set me up with the three generics separately and I'll figure out a way to take them all at once. Can't be hard.

I'm getting hit like a MFer on that donut hole shit.

Here's one you'll love - I was given a new prescription last April. I got it filled and paid a high, but not that obscene, amount. OK, no problem. Next time I get a refill it's 3 times as much. I pitched a fit and the pharmicist told me to talk to my insurance. So, I did. Turns out the pharmacy had automatically given me the generic brand. WTF? Aren't generics supposed to be cheaper? No, because it hadn't been approve by the insurance..... So, I went back to the pharmacy and told them to give me the name brand. Nope, they can't do it - I have to have my doctor specifically request the name brand. AAARRRRGGGHHHHHH.

And now it's even more expensive because of the donut hole. Whoever thought that up must hate old people.

 

[Spartans9312]

Sure, the whole system is a mess. Hell, even a relatively bright and well read freeloader like me gets bit. I was prescribed Trelegy last winter after a bought of pneumonia. It's good stuff, but what it really is is nothing more than a delivery system for three different generic medicines all in one package. One hit and you get the proper doses of all three. Shit is stupidly expensive -- they bill Humana/Medicare $500 and they pay all but my $47 copay. Until... I went to get my monthly script last week and my copay now is $171. I pitched a fit, and the pharmacist looked and it appears I've hit my "donut hole". What a stupid contrivance.

I have a doctor's appointment in a couple weeks. I'll be asking her ahead of time to give me options on an alternative. Hell, set me up with the three generics separately and I'll figure out a way to take them all at once. Can't be hard.

Breo is now available generically (it’s not a whole lot cheaper than the brand name at this time)….but you would still have to buy Incruse. If your goal is to equal getting Trelegy.

I’m guessing that would increase your out of pocket cost

 

[Spartans9312]

I'm getting hit like a MFer on that donut hole shit.

Here's one you'll love - I was given a new prescription last April. I got it filled and paid a high, but not that obscene, amount. OK, no problem. Next time I get a refill it's 3 times as much. I pitched a fit and the pharmicist told me to talk to my insurance. So, I did. Turns out the pharmacy had automatically given me the generic brand. WTF? Aren't generics supposed to be cheaper? No, because it hadn't been approve by the insurance..... So, I went back to the pharmacy and told them to give me the name brand. Nope, they can't do it - I have to have my doctor specifically request the name brand. AAARRRRGGGHHHHHH.

And now it's even more expensive because of the donut hole. Whoever thought that up must hate old people.

Eliminate the PBMs….the brand name padded their pockets to stay preferred on the formulary. This is an easy fix….but, alas we suck

 

[hookyIU1990]

Don't you want to have a relationship with your doctor?

Do you think this type of model works with car mechanics?

That model absolutely works with car mechanics. I've got a mechanic that I go to for 80% of my needs. But I get tires from someone else, as well as oil changes. I do some stuff myself. When my maintenance interval service comes up, he does it, gives everything the once over and does anything he's found that makes sense for him to do. If it's transmission related he sends me to the transmission specialist.

I've had a 20+ year relationship with my mechanic.

 

[UncleMark]

That model absolutely works with car mechanics. I've got a mechanic that I go to for 80% of my needs. But I get tires from someone else, as well as oil changes. I do some stuff myself. When my maintenance interval service comes up, he does it, gives everything the once over and does anything he's found that makes sense for him to do. If it's transmission related he sends me to the transmission specialist.

I've had a 20+ year relationship with my mechanic.

Yes and no. What happens if he tears into it hunting that growling noise you mentioned and it turns out to be a differential bearing? Do you shop him around?

 

[hookyIU1990]

Yes and no. What happens if he tears into it hunting that growling noise you mentioned and it turns out to be a differential bearing? Do you shop him around?

No, of course not because I trust him and have a long standing relationship. He's not competitive on tires though, so I shop around for those. When it comes to an oil change, I use the one (of a few that I know to be reputable) that sent me a coupon last month.

 

[crazed_hoosier2]

That's already happened/happening. The majority of those with private insurance now have a high deductible plan where the first $4-7k of annual expenses are paid out of pocket, not via insurance.

You'd think that would be the case. Unfortunately, it's barely made a dent.

 

[UncleMark]

You'd think that would be the case. Unfortunately, it's barely made a dent.

None of this accounts for the new coverage that 20M people now have, who would have been without before the ACA.