Profit Motive in Health Care - Essential, Immoral, or ???

[Dirty Dog]

I am a certified Wilderness First Responder. Next time I'm on trail, if someone is in need of aid, should I demand that that they pay me first? Lets say I come across someone who is going to die unless I provide some kind of aid. Should I demand that this person enter into a contract with me to pay me before I help him? Should this be a demand at anytime during this process?

Give me a break. There is a HUGE difference between "cash up front" and "you're not allowed to make a profit".
People die without food, water and shelter. When will you be lobbying to force grocery stores to give away food? The city to stop billing for water? The landlord to stop collecting the rents?

Despite your dramatic post, the reality is that at least 75% of the people in the average ED do not need to be there. They have no emergency. If medical care for visits like these is an entitlement, then pony up the tax money to pay for it.

 

[Archangel M]

Except the cost and development of most new drugs is entirely on the shoulders of the "evil" pharma companies.

http://www.america.gov/st/econ-english/2008/April/20080429230904myleen0.5233981.html

In the United States and most other countries with pharmaceutical industries, private industry undertakes or funds virtually all discovery and development of new medicines, often building on basic medical hypotheses developed through university and publicly funded research. Industry scientists searching for a new drug typically must sort through 5,000 to 10,000 new chemical inventions that look promising, in order to identify a pool of 250 compounds that then enter into preclinical laboratory and animal testing. Of those 250 unique compounds, fewer than 10, on average, will show enough potential to qualify for Phase I human testing to establish basic safety.

So while the hypothesis may be pubicly funded. "Making it work" needs companies (with investors) to spend the cash to "make something" and bring it to market. The same goes for most tech. Theory is different from R&D and manufacture.

 

[Bruno@MT]

I think profit in healthcare is not bad. I jus think it should ONLY be made on medical materials and care though. Not to the gianormous administration of lawyers, accountants and executives the US healthcare system has in between.

Btw for full disclosure: I work for a big pharma company. Meds are ridiculously expensive to develop and make, following the long list of various international regulations and industry best practises.

 

[Makalakumu]

Give me a break. There is a HUGE difference between "cash up front" and "you're not allowed to make a profit".
People die without food, water and shelter. When will you be lobbying to force grocery stores to give away food? The city to stop billing for water? The landlord to stop collecting the rents?

If people need water, they can get it for free. If they need food, they can get that too, most of the time. Housing? That is something our country subsidizes and out right provides in many cases, but it something we could do better. At any rate, very few people starve to death or die of thirst in our country, under normal circumstances. The exception is on many Indian Reservations, of which I've lived, but at any rate, that's besides the point.

IMO, you haven't really argued against the moral point I made above. You say there is a huge difference between "cash up front" and "you are not allowed to make a profit" I don't really understand what that means.

My point is pretty simple. If I demanded that I enter into a contract with me before I saved their life, a contract that would bankrupt the individual that I would be saving, I would be performing an immoral action in the eyes of many people. Yet, this is something the health care industry in the US does all of the time and people seem to have no problem with it.

Imagine if our police and firemen began demanding that we enter into contracts that were exhorebintly expensive before they rendered services. Imagine if the law forced individuals into said contracts with these individuals after the service has been rendered. A LEO could take the bad guy who was robbing your house and then slap you with a bill that would take your house as payment.

If you've got cancer and are going to die AND you want to live, you've got very few options but to lose everything you own in order to do that. I don't see much difference between that and the other situations I wrote about above.

 

[Makalakumu]

Except the cost and development of most new drugs is entirely on the shoulders of the "evil" pharma companies.

http://www.america.gov/st/econ-english/2008/April/20080429230904myleen0.5233981.html


So while the hypothesis may be pubicly funded. "Making it work" needs companies (with investors) to spend the cash to "make something" and bring it to market. The same goes for most tech. Theory is different from R&D and manufacture.

America makes damn good weapon systems and the government pays for that. R&D is already being done on the public dime there and it works great. So, it can be done on a larger scale.

Also, we have places where good R&D is being done on drugs on the public dime. What about expanding those?

 

[Archangel M]

Paying for something and PRODUCING something are different things. The gvt pays private companies to R&D weapon systems..general dynamics, boeing, raytheon..they are all profit driven industries. The gvt. funding contracts is vastly different from thinking that the gvt can provide the quantity, quality and innovation that these companies can.

My father-in-law works FOR the military, on military bases, doing military R&D but he does it for a privately contracted company.

 

[Makalakumu]

Paying for something and PRODUCING something are different things. The gvt pays private companies to R&D weapon systems..general dynamics, boeing, raytheon..they are all profit driven industries. The gvt. funding contracts is vastly different from thinking that the gvt can provide the quantity, quality and innovation that these companies can.

My father-in-law works FOR the military, on military bases, doing military R&D but he does it for a privately contracted company.

Could a similar arrangement work for the health care industry? Do we need to rely in companies producing drugs that will make lots of money rather then drugs that would benefit society the most? Maybe a public health motive would reveals some solutions that may not be profitable, but they are highly valuable in terms of public health?

 

[Bill Mattocks]

Also, we have places where good R&D is being done on drugs on the public dime. What about expanding those?

I already said why.

When the public dime is spent on R&D for health, it goes to the maladies that the politicians who control the purse strings demand. That means companies who make big campaign contributions, companies that have a big presence in the home states of powerful chairmen of congressional committees. It also goes to maladies that the public clamors for by way of special interest groups.

There is also a downside to private money spent on R&D. Private companies will not invest research money on drugs that cannot be patented, or on maladies that not many people have. They want to do R&D on the diseases everyone has, and drugs that can be patented and a profit made from them for as long as possible.

A mix is what we have now. It does tend to level things out a bit. However, the big winners are still AIDS research and Diabetes (which I have) because of the aforementioned. Contract a disease that few get, and for which there are non-patentable treatments, and you'll discover that no one cares to do any research into that field.

 

[Bill Mattocks]

Could a similar arrangement work for the health care industry? Do we need to rely in companies producing drugs that will make lots of money rather then drugs that would benefit society the most? Maybe a public health motive would reveals some solutions that may not be profitable, but they are highly valuable in terms of public health?

Public R&D is not done for the public good but for the benefit of those who control the political committees that dispense the money. There is no such thing as altruism.

 

[Makalakumu]

There is no such thing as altruism.

A friend of mine back in MN works on MS drugs because he wants to help his father live longer. When it comes to health care, I think there are other motivations rather then pure profit. The desire the help others is not dead.

 

[Bill Mattocks]

A friend of mine back in MN works on MS drugs because he wants to help his father live longer. When it comes to health care, I think there are other motivations rather then pure profit. The desire the help others is not dead.

Your friend is noble. I am referring to those who control the purse-strings of R&D for medical research. In the public sector, that is the US Congress. They do not devote money to R&D for fields they feel personally strongly about.

 

[Makalakumu]

Your friend is noble. I am referring to those who control the purse-strings of R&D for medical research. In the public sector, that is the US Congress. They do not devote money to R&D for fields they feel personally strongly about.

I think we may be touching on two separate issues here. All of these points that you are bringing up aren't necessarily criticisms of public funding, but of Congress and of the process in which Congress operates. For the sake of discussion, lets say that Congress worked perfectly and that the will of the people was always served. Do you have any ideologic reasons for not supporting public funding of R&D? Health care in general?

 

[Knives]

immoral with the amount they price gouge

 

[Bill Mattocks]

For the sake of discussion, lets say that Congress worked perfectly and that the will of the people was always served. Do you have any ideologic reasons for not supporting public funding of R&D? Health care in general?

Ah, that's a different, and interesting, discussion.

Yes, I have an ideological reason to not support public funding of R&D for health care, and it is that it is not the proper role of the federal government. I am, after all, a Jeffersonian and not a Hamiltonian.

However, I have changed some of my positions with regard to the role of the federal government, and I admit (gasp) that there are some things that the federal government can either do better than private industry or that it can do because private industry will not. I get that. I am not anti-all-regulations, for example. So even though my fellow conservatives will skin me for it, I'm not a pure free-market capitalist any longer; I harbor some secret pro-regulation tendencies.

For the sake of argument, let's say that we could have a system of public funding for health care that was truly run for the benefit of the people and not for the contributors to some politician's reelection campaign or favorite PAC, or because their research facility happens to hire a lot of people in that Congressman's home state.

If that were the case, I would be a lot less opposed to the idea of publicly-funded health care R&D money, or even government-run R&D (universities and direct government labs, as the USDA does today).

I am sorry to say that I do not believe such a system is possible. I am not being partisan in my condemnation - I have pointed out that the private sector has different, but just as serious problems with R&D for health care.

 

[Bruno@MT]

The thing is, pharma companies already try to do that: find cures for the things that most benefit society, for the simple reason that that is where the most money is.

At the same time, it would be silly to suggest that we (pharma) have to abandon the meds we have and know how to make, just because they are not what the majority needs.

 

[Bill Mattocks]

The thing is, pharma companies already try to do that: find cures for the things that most benefit society, for the simple reason that that is where the most money is.

But that's not true. The profit motive says that they put their money in R&D where they are most likely to make a profit. That means researching drugs that are likely to be patentable (and thus expensive and not cheap) and researching maladies that are common and not unusual.

Thus, there is huge research money spent on developing new replacements for erection enhancing drugs and weight-loss pills, and very little spent on cures for diseases that few have.

At the same time, it would be silly to suggest that we (pharma) have to abandon the meds we have and know how to make, just because they are not what the majority needs.

Developing a new drug often costs billions of dollars and years of effort on the part of the labs. Like the movie industry, they find themselves only able to pursue the most promising drugs, so they put everything they have behind a few, quickly abandoning those that do not appear to be heading towards rapid success. They also put major effort into getting those drugs approved, since their success as a company is so tied to them.

They routinely put technical writers to work writing glowing reviews and studies that they then farm out as 'ghost written' technical papers that they pay respected doctors to sign on to as if they had written them. They lobby the government for approval intensely, and they send armies of salesmen into the field to convince doctors to prescribe on and off label with perks that would beggar the imagination and television commercials designed to get patients to beg their doctor for 'the purple pill' or whatever else they're selling.

http://www.nytimes.com/2009/09/11/business/11ghost.html?em

Ghostwriting Is Called Rife in Medical Journals

In the scientific literature, ghostwriting usually refers to medical writers, often sponsored by a drug or medical device company, who make major research or writing contributions to articles published under the names of academic authors.

http://www.ama-assn.org/amednews/2009/09/14/prl20914.htm

Pfizer pays record $2.3 billion in off-label drug marketing settlement
A drugmaker's subsidiary pleads guilty to misbranding Bextra.

A Pfizer subsidiary, Pharmacia & Upjohn Co., agreed to plead guilty in early September to a felony violation of the Food, Drug and Cosmetic Act for misbranding its COX-2 inhibitor, Bextra, for off-label uses. The company agreed to pay $1.3 billion in criminal fines for systematically promoting off-label Bextra use to physicians through marketing materials, drug rep talking points and more.

I do not blame the problems in the drug industry on 'greed' or whatever else. The free-market system itself just doesn't work well in this environment, when so much is at stake for each drug introduced - failure of more than one or two new drugs is liable to bankrupt a drug maker completely, just due to the extreme costs involved in making and marketing a new drug.

As I've also said, there are also huge problems on the other side of the coin - when government itself does the R&D. Then you have control over the purse strings held by politicians who have their own agendas, which seldom coincide with the 'public good'.

So the system is rotten to its core, and I do not know of a solution. But private and public are both very very bad right now.

 

[CanuckMA]

There are ways to reduce the immediate and future costs of drugs. The solution is obvious, but since it involves countries not protectting their turf, it will never happen.

To reduce the consumer cost, lower the time limit on patents so that generics will be available faster.

To offset loss of revenues to the drug companies, have as many countries as possible agree on a mutual approval process. Same standards everywhere. A good portion of costs is the clinical trials and mass of regulations that must be duplicated from country to country.

 

[Makalakumu]

For me, the moral issue trumps any government spending ideology I may harbor.

http://www.nytimes.com/2009/09/13/opinion/13kristof.html?_r=1

After Al Qaeda killed nearly 3,000 Americans, eight years ago on Friday, we went to war and spent hundreds of billions of dollars ensuring that this would not happen again. Yet every two months, that many people die because of our failure to provide universal insurance — and yet many members of Congress want us to do nothing?

Priorities?

Nikki was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.


In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, “The Healing of America.” Some 80 percent of lupus patients in the United States live a normal life span. Under a doctor’s care, lupus should be manageable. Indeed, if Nikki had been a felon, the problem could have been averted, because courts have ruled that prisoners are entitled to medical care.


As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition. She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.


Finally, Nikki collapsed at her home in Tennessee and was rushed to a hospital emergency room, which was then required to treat her without payment until her condition stabilized. Since money was no longer an issue, the hospital performed 25 emergency surgeries on Nikki, and she spent six months in critical care.


“When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” her step-father, Tony Deal, told me. “But that’s not when she needed the care.”

When you consider the amount of people who will be getting sick from our terrible industrial food system (diabetes cough cough), we may be reviving the Megadeath from the Cold War era. Reforming health care is a moral issue. It has to be done.

 

[Bill Mattocks]

For me, the moral issue trumps any government spending ideology I may harbor.

I am not sure I disagree with you. I'm getting there, slowly.

However, what I do not want is another patch. ObamaCare is a political hack job, a patch, and it just takes more money out of my pockets (and yours) to throw to administrative types and bureaucrats to waste.

If we're going to do it, let's face it head on and dismantle the whole stinking system and start from dot.

When you consider the amount of people who will be getting sick from our terrible industrial food system (diabetes cough cough), we may be reviving the Megadeath from the Cold War era. Reforming health care is a moral issue. It has to be done.

If I can get past the constitutional issue, then I'm on board with you.

I am planning to see the movie "King Corn."

http://www.kingcorn.net/

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There is room for this old conservative to learn a few things, my friend.

But I still have to wrestle with the better angels of my conscience about the whole constitutional thing.

 

[Makalakumu]

I think the good news is that there is room for solutions by both ideologies. For example, a driving cause of the mess of our food industry and the health care industries are the subsidies and regulations that actually FAVOR the most unhealthy options in terms of choices of both food and treatments for disease (In my mind, the issues of Food and Health Care are intimately twined because what we put into our bodies determines the ultimate shape they are in). Good old fashioned conservatives can craft a populist argument that basically states that we need to get rid of these subsidies and these regulations they are provably bad for the people of this country.

This isn't the only solution because some Liberal ideas also have merit. What we can't have is this one or the other approach. That doesn't work. Especially the idea drifted by our current crop of democrats that we can force everyone to have insurance and keep giving them stuff that will make them sick AND treating them with the same old inefficient mandated treatments. That is a recipe for bankruptcy right there. It's a measure of how strong these lobbyists are that not even Republicans are really serious about tackling the negative influence of government intervention in the system.