Fed Up with Drug Companies, Hospitals Decide to Start Their Own • Hacker News Board

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#121

Post by phillc73 » Fri, Jan 19, 2018, 5:41 AM UTC

Clubber wrote: post #72

indescions_2018 wrote: post #61

I always assumed it would be CVS that got into the game. There are are probably a dozen or so drugs that account for the majority of consumption. Flu vaccines, blood pressure, cholesterol, thyroid, insulin, asthma, progesterone, beta-blockers, gerd, etc. Providing these at minimum cost, as well as community public health services. Could be enormously cost effective. And extend general wellness and productivity many t…

I they seem to be explicitly targeting generics, so R&D doesn't come into play. It's really just find someone who can build a known compound and press it into a pill. This has the potential to be massively disruptive.

There is still a significant R&D element in that "press it into a pill" step. This is manufacturing and process R&D. For example, continuous (rather than batch) manufacturing is the big hotness at the moment. Also new techniques, such as 3D printed pharmaceuticals, involve plenty of R&D effort.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#122

Post by thaumaturgy » Fri, Jan 19, 2018, 5:42 AM UTC

siquick wrote: post #113

shykes wrote: post #86

This article makes it seem like drug companies alone are responsible for predatory pricing in US healthcare, with hospitals being somehow on the consumer's side of the issue. In reality US hospitals are just as guilty of predatory behavior. If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they?

> If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they? As a non-American (UK and Australia citizen) it bewilders me that this is considered a possibility. Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US?

> Are they for-profit in the US?

Yes, with few exceptions.

Here's how this goes: "But if they weren't for-profit, then it would be more like Canada's or England's health care, and I've heard you have to wait months for anything over there. Also it would mean they wouldn't have as much money for innovation, and, y'know, the US has the best health care technology in the world. Oh, sure, only the rich can afford it, but if you're poor you can still go to a hospital and they won't turn you away."

There, that's every single defense of our system, in one paragraph. I don't think I missed anything.

Now, pardon me, I need to go throw up.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#123

Post by telchar » Fri, Jan 19, 2018, 5:57 AM UTC

maxxxxx wrote: post #112

telchar wrote: post #108

Earlier quoted context omitted.

It's frustrating. Neither the hospital nor the insurer typically has sufficient information to give you an answer. It's even worse when your information like age or diagnosis history factors into it.

Somehow they can figure it out after the procedure. They could easily give you the cost for each billing code upfront but they choose to hide the information from the patient;

Last time I had a procedure done it took 9 months before a bill showed up. It's a many to many communication problem so they only bother to figure it out when they need to, and then it can take a while for the hospital and insurer to hash things out. I'm not saying 9 mos is typical, but I wouldn't wait anywhere near that long to get an answer on how long something will cost me. They just don't have the incentives to form all the necessary lines of communication among themselves prospectively.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#124

Post by notatoad » Fri, Jan 19, 2018, 5:57 AM UTC

mirimir wrote: post #102

notatoad wrote: post #52

Earlier quoted context omitted.

Blaming one specific part of a profit-centric health care system for being profit-centric seems a little silly

Well, some of us blame the whole thing. Why shouldn't healthcare be a government service? Why is that less appropriate than police and military? Or roads?

i'm not sure if you're trying to argue with me about this, but i couldn't agree more.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#125

Post by rtpg » Fri, Jan 19, 2018, 6:01 AM UTC

tacon wrote: post #103

For a fantastic discussion about the Byzantine process for generic drug approval, I recommend a recent episode of EconTalk[0]. The guest wrote a book called "Drug Wars: How Big Pharma Raises Prices and Keeps Generics off the Market"[1]. When up to half a billion dollars of revenue is at stake, the drug companies have incredible incentives to delay or prevent generics coming to market. Believe or not, they often simpl…

Is this a worldwide problem? Or is this really an American failing?

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#126

Post by dragonwriter » Fri, Jan 19, 2018, 6:14 AM UTC

siquick wrote: post #113

shykes wrote: post #86

This article makes it seem like drug companies alone are responsible for predatory pricing in US healthcare, with hospitals being somehow on the consumer's side of the issue. In reality US hospitals are just as guilty of predatory behavior. If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they?

> If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they? As a non-American (UK and Australia citizen) it bewilders me that this is considered a possibility. Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US?

> Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US?

Contrary to sibling comments, no, they generally are not. Most (58.5%) US hospitals are private nonprofits, and another 20.2% are public. Only 21.3% are private, for-profit. [0]

[0] https://www.beckershospitalreview.com/hospital-management-ad...

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#127

Post by mirimir » Fri, Jan 19, 2018, 6:29 AM UTC

notatoad wrote: post #124

mirimir wrote: post #102

Earlier quoted context omitted.

Well, some of us blame the whole thing. Why shouldn't healthcare be a government service? Why is that less appropriate than police and military? Or roads?

i'm not sure if you're trying to argue with me about this, but i couldn't agree more.

I thought that I was, but I misunderstood your comment :)

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#128

Post by thaumaturgy » Fri, Jan 19, 2018, 6:45 AM UTC

dragonwriter wrote: post #126

siquick wrote: post #113

Earlier quoted context omitted.

> If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they? As a non-American (UK and Australia citizen) it bewilders me that this is considered a possibility. Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US?

> Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US? Contrary to sibling comments, no, they generally are not. Most (58.5%) US hospitals are private nonprofits, and another 20.2% are public. Only 21.3% are private, for-profit. [0] [0] https://www.beckershospitalreview.com/hospital-management-ad...

Contrary to your comment, yes, they generally are; they're just using Hollywood accounting and referring to their profits as "excess earnings".

"A study published in the May issue of Health Affairs revealed that in 2013, seven of the top ten most profitable hospitals in the United States were nonprofit hospitals, with each earning over $163 million in profits from patient care."

https://www.forbes.com/sites/brucelee/2016/05/08/very-profit...

(Forbes, yuck, I know. This Washington Post link covers the same story: https://www.washingtonpost.com/news/to-your-health/wp/2016/0...)

That article links to a CBS "investigation" into the University of Pittsburgh Medical Center, which claims to be a nonprofit but made $948 million from 2011 to 2012, pays its CEO $6 million a year, gets a private chef, chauffeur, and a jet for additional compensation, and has a dozen other administrators each making over a million dollars a year.

https://www.youtube.com/watch?v=zikgppxCFnA

Claiming themselves to be a nonprofit saves them about $200 million in state and federal taxes. So, they're just an "accidentally profitable" nonprofit.

But yeah, sure, let's just keep taking the health care industry at its word when it says it's not profitable.

edit: more, because why use a scalpel when a hammer will work just as well?

"Many nonprofit hospitals calculate their charitable care by using something known as “charge master” pricing; exorbitant, non-negotiated prices which are inflated many times higher than what private insurance or Medicare would pay. This allows facilities to overstate their provision of “charity care,” calculated as revenue loss by the hospital in exchange for their lucrative tax exemptions. In a patient evaluated with chest pain, the allowable for Medicare is $3600; however, in an uninsured patient, the hospital may “write-off” an inflated $25,600 in uncompensated costs, which is 8 times higher than actual cost of care provided."

http://thehealthcareblog.com/blog/2017/04/25/the-fairy-tale-...

"But even many hospitals that showed losses on patient care had positive margins overall. The study found that median net income per adjusted discharge from all activities—including investments, charitable contributions and space rental—was $353 for all hospitals and $178 for hospitals with 50 or fewer beds."

http://www.modernhealthcare.com/article/20160502/NEWS/160509...

"Non-profit is instead simply a tax status, and specifically, it exempts hospitals from paying real estate and other taxes in exchange for contributing a fixed portion of their revenues to ‘community benefit’ rather than paying dividends to shareholders. ... Cleveland Clinic, one of the largest health systems in the country, was held up as an example of a wildly profitable non-profit in a recent article in Politico."

https://www.acsh.org/news/2017/07/19/non-profit-hospitals-ca...

(read that one, it's a good breakdown of the accounting that hospitals use to maintain their nonprofit status while behaving in every other way like any other for-profit business.)

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#129

Post by otempomores » Fri, Jan 19, 2018, 6:55 AM UTC

thaumaturgy wrote: post #128

dragonwriter wrote: post #126

Earlier quoted context omitted.

> Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US? Contrary to sibling comments, no, they generally are not. Most (58.5%) US hospitals are private nonprofits, and another 20.2% are public. Only 21.3% are private, for-profit. [0] [0] https://www.beckershospitalreview.com/hospital-management-ad...

Contrary to your comment, yes, they generally are; they're just using Hollywood accounting and referring to their profits as "excess earnings". "A study published in the May issue of Health Affairs revealed that in 2013, seven of the top ten most profitable hospitals in the United States were nonprofit hospitals, with each earning over $163 million in profits from patient care." https://www.forbes.com/sites/brucelee/…

When in the wulf pit the worst one is the one on my side of the group

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#130

Post by selectodude » Fri, Jan 19, 2018, 6:56 AM UTC

thatcat wrote: post #110

toomanybeersies wrote: post #77

Earlier quoted context omitted.

In New Zealand, Pharmac [1] is a government run entity that bulk negotiates bulk contracts for supplying the entire country with prescription drugs. It's not quite the same as manufacturing it themselves, but the bulk buying does bring the price down quite substantially. [1] https://en.wikipedia.org/wiki/Pharmac

This is common, the US is alone in its legislation against negotiating as a group for prescription prices.

the government is not allowed to negotiate at all on drug prices (utterly insane, thank you W. Bush) but insurance companies can, and do, negotiate as a group.