Re: Republican Health Care Bill
« Reply #20 on: September 01, 2017, 12:37:42 PM »
We are at a point where the only reasonable way for the government to rein in the rampant corruption in the medical industry is to join most of the rest of the civilized world and give its people universal healthcare.

"But Roundy, governments are so more corrupt than private companies so we'd only have higher medical costs and less services!"

That's not what has been demonstrated in all of the other wealthy industrialized nations of the world (flat or round).  Their governments are able to outperform us in total life expectancy and infant mortality for significantly less per capita expenditures.

Thank you,

CriticalThinker
Eh, yes and no.  Most of those countries have very different laws and social norms.
Like lawsuits.  Super common in the US, less so elsewhere so malpractice insurance isn't as bad, if at all.


Also, the companies have deals with drug makers.
And they also usually have fewer doctors.


Finally: America is 'Me First' and does not like thinking every American is worth helping.

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Re: Republican Health Care Bill
« Reply #21 on: September 01, 2017, 02:28:16 PM »
We are at a point where the only reasonable way for the government to rein in the rampant corruption in the medical industry is to join most of the rest of the civilized world and give its people universal healthcare.

"But Roundy, governments are so more corrupt than private companies so we'd only have higher medical costs and less services!"

That's not what has been demonstrated in all of the other wealthy industrialized nations of the world (flat or round).  Their governments are able to outperform us in total life expectancy and infant mortality for significantly less per capita expenditures.

Thank you,

CriticalThinker
Eh, yes and no.  Most of those countries have very different laws and social norms.
Like lawsuits.  Super common in the US, less so elsewhere so malpractice insurance isn't as bad, if at all.


Also, the companies have deals with drug makers.
And they also usually have fewer doctors.


Finally: America is 'Me First' and does not like thinking every American is worth helping.

One of the benefits of having a single payer system is collective bargaining power with pharmaceutical manufacturers.  It's no great secret that Medicare gets a better deal than a small regional health insurance.  Many of the lifestyle factors associated with total healthy life expectancy can be directly influenced by access to routine primary care which lowers the effects of malpractice claims.  Most malpractice claims boil down to informed consent and whether communication between provider and patient was accurately recorded.  In most cases, gross negligence is too hard to prove and documentation errors are used in lieu as evidence of "not meeting the accepted standards of care."  Infant mortality is the real tell tale factor that we should look at.  For a nation that doesn't have any wars on our soil, you would think that we would perform better than this.  50% higher than Canada & UK, 2-3x higher than many other European countries and just barely better than Slovakia.

Thank you,

CriticalThinker
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Re: Republican Health Care Bill
« Reply #22 on: September 01, 2017, 02:48:01 PM »
We are at a point where the only reasonable way for the government to rein in the rampant corruption in the medical industry is to join most of the rest of the civilized world and give its people universal healthcare.

"But Roundy, governments are so more corrupt than private companies so we'd only have higher medical costs and less services!"

That's not what has been demonstrated in all of the other wealthy industrialized nations of the world (flat or round).  Their governments are able to outperform us in total life expectancy and infant mortality for significantly less per capita expenditures.

Thank you,

CriticalThinker
Eh, yes and no.  Most of those countries have very different laws and social norms.
Like lawsuits.  Super common in the US, less so elsewhere so malpractice insurance isn't as bad, if at all.


Also, the companies have deals with drug makers.
And they also usually have fewer doctors.


Finally: America is 'Me First' and does not like thinking every American is worth helping.

One of the benefits of having a single payer system is collective bargaining power with pharmaceutical manufacturers.  It's no great secret that Medicare gets a better deal than a small regional health insurance.  Many of the lifestyle factors associated with total healthy life expectancy can be directly influenced by access to routine primary care which lowers the effects of malpractice claims.  Most malpractice claims boil down to informed consent and whether communication between provider and patient was accurately recorded.  In most cases, gross negligence is too hard to prove and documentation errors are used in lieu as evidence of "not meeting the accepted standards of care."  Infant mortality is the real tell tale factor that we should look at.  For a nation that doesn't have any wars on our soil, you would think that we would perform better than this.  50% higher than Canada & UK, 2-3x higher than many other European countries and just barely better than Slovakia.

Thank you,

CriticalThinker


Infant mortality has more than one cause.  Great medical care helps, lower drug use, post teen pregnancies, and medical insurance.

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Re: Republican Health Care Bill
« Reply #23 on: September 01, 2017, 03:55:09 PM »
We are at a point where the only reasonable way for the government to rein in the rampant corruption in the medical industry is to join most of the rest of the civilized world and give its people universal healthcare.

"But Roundy, governments are so more corrupt than private companies so we'd only have higher medical costs and less services!"

That's not what has been demonstrated in all of the other wealthy industrialized nations of the world (flat or round).  Their governments are able to outperform us in total life expectancy and infant mortality for significantly less per capita expenditures.

Thank you,

CriticalThinker
Eh, yes and no.  Most of those countries have very different laws and social norms.
Like lawsuits.  Super common in the US, less so elsewhere so malpractice insurance isn't as bad, if at all.


Also, the companies have deals with drug makers.
And they also usually have fewer doctors.


Finally: America is 'Me First' and does not like thinking every American is worth helping.

One of the benefits of having a single payer system is collective bargaining power with pharmaceutical manufacturers.  It's no great secret that Medicare gets a better deal than a small regional health insurance.  Many of the lifestyle factors associated with total healthy life expectancy can be directly influenced by access to routine primary care which lowers the effects of malpractice claims.  Most malpractice claims boil down to informed consent and whether communication between provider and patient was accurately recorded.  In most cases, gross negligence is too hard to prove and documentation errors are used in lieu as evidence of "not meeting the accepted standards of care."  Infant mortality is the real tell tale factor that we should look at.  For a nation that doesn't have any wars on our soil, you would think that we would perform better than this.  50% higher than Canada & UK, 2-3x higher than many other European countries and just barely better than Slovakia.

Thank you,

CriticalThinker


Infant mortality has more than one cause.  Great medical care helps, lower drug use, post teen pregnancies, and medical insurance.

3 of which are possible for a lower cost in a single payer system.  In a single payer system everyone has insurance and all providers accept that insurance which makes coverage and access to providers more attainable.  Better access to pediatricians and birth control counseling can lower teen pregnancy rates.  In the US the states with abstinence only sex ed programs or, even worse, no sex ed programs have the highest rates of teen pregnancy.  Teens when educated on the proper use of contraceptives and family planning are able to significantly reduce teen pregnancy rates across socioeconomic strata.

Infant mortality, substance abuse and untreated mental health diseases are much more prevalent among the working poor in the US.  Those that cannot afford commercial health insurance or can't afford to use it in our current system.

Instead of asking who should pay for the $300+ bag of salt water, we should ask why any hospital is able to charge $300+ for a bag of salt water that cost them $1.  They do it to cover the costs of providing health care services to the uninsured or under-insured.  If everyone is ensured with one insurance company, they again have greater collective bargaining and we could even start to change the profit incentive for our healthcare system as a whole.

Right now we reward more tests and procedures not better outcomes.  If physicians were instead graded on markers of healthy life expectancy, instead of how many prescriptions they write out and how many blood draws they order, maybe we could get some bang for our buck.

Thank you,

CriticalThinker
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Re: Republican Health Care Bill
« Reply #24 on: September 01, 2017, 04:38:09 PM »
3 of which are possible for a lower cost in a single payer system.  In a single payer system everyone has insurance and all providers accept that insurance which makes coverage and access to providers more attainable.  Better access to pediatricians and birth control counseling can lower teen pregnancy rates.  In the US the states with abstinence only sex ed programs or, even worse, no sex ed programs have the highest rates of teen pregnancy.  Teens when educated on the proper use of contraceptives and family planning are able to significantly reduce teen pregnancy rates across socioeconomic strata.

Infant mortality, substance abuse and untreated mental health diseases are much more prevalent among the working poor in the US.  Those that cannot afford commercial health insurance or can't afford to use it in our current system.

Instead of asking who should pay for the $300+ bag of salt water, we should ask why any hospital is able to charge $300+ for a bag of salt water that cost them $1.  They do it to cover the costs of providing health care services to the uninsured or under-insured.  If everyone is ensured with one insurance company, they again have greater collective bargaining and we could even start to change the profit incentive for our healthcare system as a whole.

Right now we reward more tests and procedures not better outcomes.  If physicians were instead graded on markers of healthy life expectancy, instead of how many prescriptions they write out and how many blood draws they order, maybe we could get some bang for our buck.

Thank you,

CriticalThinker
But America doesn't WANT that.  They WANT "those people" to suffer or figure it out themselves.  It really isn't about what's better.  I mean, you always have trade-offs.  For profit system means faster services (usually).  But some are excluded.  Single payer means everyone gets health care but it's usually slower because they can't afford literally everyone to have great care at quick times.

And in America, a New Yorker would rather have care himself and NOT pay for some guy in Texas whose probably a Republican anyway.
And in Texas, those ranchers don't want their hard earned money going to free loading liberals in California who are just mooching anyway.

And we do not reward more tests and procedures.  We reward less tests and procedures and more paperwork.  Insurance companies want just enough tests to say "Yes, this is what's wrong, we don't have to pay for anything else" but not so many that they pay more than they need to.  It's a balancing game with paperwork at the focal point.  Justify why you need this test and we'll pay for it.... eventually.  Probably.

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Re: Republican Health Care Bill
« Reply #25 on: September 01, 2017, 06:13:19 PM »
3 of which are possible for a lower cost in a single payer system.  In a single payer system everyone has insurance and all providers accept that insurance which makes coverage and access to providers more attainable.  Better access to pediatricians and birth control counseling can lower teen pregnancy rates.  In the US the states with abstinence only sex ed programs or, even worse, no sex ed programs have the highest rates of teen pregnancy.  Teens when educated on the proper use of contraceptives and family planning are able to significantly reduce teen pregnancy rates across socioeconomic strata.

Infant mortality, substance abuse and untreated mental health diseases are much more prevalent among the working poor in the US.  Those that cannot afford commercial health insurance or can't afford to use it in our current system.

Instead of asking who should pay for the $300+ bag of salt water, we should ask why any hospital is able to charge $300+ for a bag of salt water that cost them $1.  They do it to cover the costs of providing health care services to the uninsured or under-insured.  If everyone is ensured with one insurance company, they again have greater collective bargaining and we could even start to change the profit incentive for our healthcare system as a whole.

Right now we reward more tests and procedures not better outcomes.  If physicians were instead graded on markers of healthy life expectancy, instead of how many prescriptions they write out and how many blood draws they order, maybe we could get some bang for our buck.

Thank you,

CriticalThinker
But America doesn't WANT that.  They WANT "those people" to suffer or figure it out themselves.  It really isn't about what's better.  I mean, you always have trade-offs.  For profit system means faster services (usually).  But some are excluded.  Single payer means everyone gets health care but it's usually slower because they can't afford literally everyone to have great care at quick times.

And in America, a New Yorker would rather have care himself and NOT pay for some guy in Texas whose probably a Republican anyway.
And in Texas, those ranchers don't want their hard earned money going to free loading liberals in California who are just mooching anyway.

And we do not reward more tests and procedures.  We reward less tests and procedures and more paperwork.  Insurance companies want just enough tests to say "Yes, this is what's wrong, we don't have to pay for anything else" but not so many that they pay more than they need to.  It's a balancing game with paperwork at the focal point.  Justify why you need this test and we'll pay for it.... eventually.  Probably.

There's distinct financial incentives for the hospitals, medical associations and physicians to make excessive testing the standard of care.  Ever wonder why you had to have an X-ray before an MRI even when the issue in question would never show up on X-ray? Insurance companies in the US are still regulated by state and federal agencies which include the responsibility to pay for "medically necessary" tests and interventions. Medical necessity is established by peer reviewed research the funding of which is regulated most heavily by the federal government. All of the for profit interest groups representing the pharmaceutical manufacturers, hospitals, DME suppliers etc all spend heavily to ensure that the fed declares their incentivized testing and treatment procedures as "medically necessary" then double down and sponsor researchers and medical school textbooks that essentially teach new physicians the same thing.

Ever wonder why it's ok for a physician to prescribe a medication off label (for a non FDA approved symptom or diagnosis) and not have it labeled as experimental procedure even though that's exactly what it is?

I never said America wanted universal healthcare, merely that as a whole it would be healthier at a lower annual cost.

As to where our collective tax dollars are spent, perhaps we should ask politicians to justify unnecessary expenditures in much larger budgets before issuing a blanket statement that we can't afford a universal healthcare system.

Thank you,

CriticalThinker
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Re: Republican Health Care Bill
« Reply #26 on: September 02, 2017, 04:15:18 AM »

There's distinct financial incentives for the hospitals, medical associations and physicians to make excessive testing the standard of care.  Ever wonder why you had to have an X-ray before an MRI even when the issue in question would never show up on X-ray? Insurance companies in the US are still regulated by state and federal agencies which include the responsibility to pay for "medically necessary" tests and interventions. Medical necessity is established by peer reviewed research the funding of which is regulated most heavily by the federal government. All of the for profit interest groups representing the pharmaceutical manufacturers, hospitals, DME suppliers etc all spend heavily to ensure that the fed declares their incentivized testing and treatment procedures as "medically necessary" then double down and sponsor researchers and medical school textbooks that essentially teach new physicians the same thing.

Ever wonder why it's ok for a physician to prescribe a medication off label (for a non FDA approved symptom or diagnosis) and not have it labeled as experimental procedure even though that's exactly what it is?
I have never wondered or experienced anything of what you described.


Quote
I never said America wanted universal healthcare, merely that as a whole it would be healthier at a lower annual cost.
Nope.
It would cost more. Know why?  Because right now some people get no medical care.  When you add them in, costs go up.  Some negotiating will happen but largely, it'll be unchanged for a while.  Only after a generation, when most of the lingering medical problems are treated or being dealt with will the prices go down as people get treated sooner (and this avoid more expensive treatments later)


But the end cost is still gonna be higher.  Maybe not for individual services but overall.

Quote
As to where our collective tax dollars are spent, perhaps we should ask politicians to justify unnecessary expenditures in much larger budgets before issuing a blanket statement that we can't afford a universal healthcare system.

Thank you,

CriticalThinker

Vet health care takes a big chunk of that defense budget.  Just fyi.

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Re: Republican Health Care Bill
« Reply #27 on: September 09, 2017, 04:01:45 PM »

There's distinct financial incentives for the hospitals, medical associations and physicians to make excessive testing the standard of care.  Ever wonder why you had to have an X-ray before an MRI even when the issue in question would never show up on X-ray? Insurance companies in the US are still regulated by state and federal agencies which include the responsibility to pay for "medically necessary" tests and interventions. Medical necessity is established by peer reviewed research the funding of which is regulated most heavily by the federal government. All of the for profit interest groups representing the pharmaceutical manufacturers, hospitals, DME suppliers etc all spend heavily to ensure that the fed declares their incentivized testing and treatment procedures as "medically necessary" then double down and sponsor researchers and medical school textbooks that essentially teach new physicians the same thing.

Ever wonder why it's ok for a physician to prescribe a medication off label (for a non FDA approved symptom or diagnosis) and not have it labeled as experimental procedure even though that's exactly what it is?
I have never wondered or experienced anything of what you described.


Quote
I never said America wanted universal healthcare, merely that as a whole it would be healthier at a lower annual cost.
Nope.
It would cost more. Know why?  Because right now some people get no medical care.  When you add them in, costs go up.  Some negotiating will happen but largely, it'll be unchanged for a while.  Only after a generation, when most of the lingering medical problems are treated or being dealt with will the prices go down as people get treated sooner (and this avoid more expensive treatments later)


But the end cost is still gonna be higher.  Maybe not for individual services but overall.

Quote
As to where our collective tax dollars are spent, perhaps we should ask politicians to justify unnecessary expenditures in much larger budgets before issuing a blanket statement that we can't afford a universal healthcare system.

Thank you,

CriticalThinker

Vet health care takes a big chunk of that defense budget.  Just fyi.

Vet health care wouldn't be so expensive if we stopped invading other countries or occupying them indefinitely.  Just FYI.  Probability dictates that the longer you are placed at higher risk of severe injury, the more likely you are to experience it.

You are right that some people don't get medical care and they die untreated.  Other people get medical care and don't pay for it because they are medically indigent.  Those people significantly drive up healthcare costs for those that do have health insurance because they only receive emergency medical care when a small problem has progressed into a larger and more expensive problem.  Those high costs are passed on to the insured populations by jacking up the charges for incidental items like saline.  An IV bag of salt water shouldn't cost over $300, but it does because, if you have insurance, you pay for healthcare expenses of the uninsured that didn't die.

In the end costs should not be higher per person or as a whole as is shown in all the available data we currently have to pull from.  No other country in the world pays more per capita on healthcare than the US.  Single payer systems pay less per capita per year and achieve better results.  Collective bargaining is a powerful check on costs.  Compare the price in USD for a simple MRI in the US vs any other single payer first world nation.  Good luck even finding out the cost of an MRI in the US without having it done and billed first.  That's not regularly shared information.  In other countries, the costs for the procedure are much lower because it's not cutting edge technology.  The equipment has already paid for itself and no longer needs to command a high price per procedure.  As a result, hospitals are not allowed to dramatically inflate the costs to cover losses elsewhere.

You may not have ever been given an off label prescription, but there's a good chance that you have and didn't know it ever happened because doctor's don't have to tell you when they do it, why they are doing it and you'll never see a difference in price when you pick it up at the pharmacy.  That's the power of one large company (pharmaceutical manufacturer) negotiating against several smaller companies (insurance carriers) instead of 2 large companies negotiating.  The power of collective bargaining.

Largely the healthcare argument boils down to Americans not really liking other Americans that they don't personally know.  It's a general attitude of greed or selfishness.  It's no great surprise that the UK single payer system was formed immediately after WWII when the whole country was united in solidarity to rebuild their communities and country.  That's when a concept like universal healthcare makes sense because the overwhelming majority of the country was united.  The US is anything but united right now which makes our name rather ironic.  The US didn't feel the same after WWII either because, by and large, there was almost nothing to rebuild after the war.  Other than Pearl Harbor, there were no attacks or bombings on American soil during WWII so there wasn't a feeling of solidarity after the war was won.

Thank you,

CriticalThinker
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Re: Republican Health Care Bill
« Reply #28 on: September 09, 2017, 04:15:14 PM »
You also need to factor in things like supply and demand.
IV saline solution is expensive because alot of companies said "Yeah... let's not sell this cause it's not making enough money" so there is a shortage of those.  Not to mention all the requirements for producing it. (sterilization and such)

Plus medical school.  Alot of these other nations have better student loan programs.  Also, lawsuits.  The USA is lawsuit city.  If a doctor makes a mistake, even if it's minor and not permanent, people have sued.  Some are frivolous and thrown out, others are not.  Either way, an insurance company covers the legal fees.  This is unheard of in other nations.  Also, other nations also subsidize procedures so it helps.

In the end, the problem, when it gets right down to it, is that people are dicks.

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Re: Republican Health Care Bill
« Reply #29 on: September 10, 2017, 06:40:08 AM »
You also need to factor in things like supply and demand.
IV saline solution is expensive because alot of companies said "Yeah... let's not sell this cause it's not making enough money" so there is a shortage of those.  Not to mention all the requirements for producing it. (sterilization and such)

Plus medical school.  Alot of these other nations have better student loan programs.  Also, lawsuits.  The USA is lawsuit city.  If a doctor makes a mistake, even if it's minor and not permanent, people have sued.  Some are frivolous and thrown out, others are not.  Either way, an insurance company covers the legal fees.  This is unheard of in other nations.  Also, other nations also subsidize procedures so it helps.

In the end, the problem, when it gets right down to it, is that people are dicks.

There isn't a shortage of saline and current costs are under $1 per unit.  The same mechanism applies to otc meds,  crutches, bandages and anything else that can be unbundled to increase reimbursements.  Unbundled charges are a creative way of transferring costs, nothing more.

Sure lawsuits play a role, but that can't be factored into the cost per procedure because the risk ratios are too complicated to calculate.  That's why we don't have any comprehensive lists for any chronic disease risk factors either.

Perhaps if everyone in the US agreed that we are all in this together and that we are stronger United than divided, we could stop being dicks to each other so much.

Thank you,

CriticalThinker
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Re: Republican Health Care Bill
« Reply #30 on: September 10, 2017, 07:08:10 AM »
You also need to factor in things like supply and demand.
IV saline solution is expensive because alot of companies said "Yeah... let's not sell this cause it's not making enough money" so there is a shortage of those.  Not to mention all the requirements for producing it. (sterilization and such)

Plus medical school.  Alot of these other nations have better student loan programs.  Also, lawsuits.  The USA is lawsuit city.  If a doctor makes a mistake, even if it's minor and not permanent, people have sued.  Some are frivolous and thrown out, others are not.  Either way, an insurance company covers the legal fees.  This is unheard of in other nations.  Also, other nations also subsidize procedures so it helps.

In the end, the problem, when it gets right down to it, is that people are dicks.

There isn't a shortage of saline and current costs are under $1 per unit.  The same mechanism applies to otc meds,  crutches, bandages and anything else that can be unbundled to increase reimbursements.  Unbundled charges are a creative way of transferring costs, nothing more.

Sure lawsuits play a role, but that can't be factored into the cost per procedure because the risk ratios are too complicated to calculate.  That's why we don't have any comprehensive lists for any chronic disease risk factors either.

Perhaps if everyone in the US agreed that we are all in this together and that we are stronger United than divided, we could stop being dicks to each other so much.

Thank you,

CriticalThinker

http://www.chicagotribune.com/business/ct-baxter-saline-investigation-0415-biz-20170414-story.html
http://fortune.com/2015/02/05/theres-a-national-shortage-of-saline/

You were saying?

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Re: Republican Health Care Bill
« Reply #31 on: September 10, 2017, 07:21:49 AM »
http://www.chicagotribune.com/business/ct-baxter-saline-investigation-0415-biz-20170414-story.html

Artificial shortage to increase profit margins and potential violations of Federal antitrust laws.  It's cheap to make, easy to transport and can actually be made on site by any hospital with basic compounding equipment.  Creating an artificial shortage allows them to justify a 300% price hike.  There's a revolving door between the FDA and big business that would be less effective with collective bargaining.

Just cause it's published in a magazine doesn't mean it's acceptable at face value.  If you want to believe De Beers, diamonds are a rare and extremely valuable gemstone even though they weren't until De Beers bought up almost all of the mines to control the supply and launched the most successful advertising campaign of modern media.  Fake markets result in fake prices.

Thank you,

CriticalThinker
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Re: Republican Health Care Bill
« Reply #32 on: September 10, 2017, 10:22:23 AM »
http://www.chicagotribune.com/business/ct-baxter-saline-investigation-0415-biz-20170414-story.html

Artificial shortage to increase profit margins and potential violations of Federal antitrust laws.  It's cheap to make, easy to transport and can actually be made on site by any hospital with basic compounding equipment.  Creating an artificial shortage allows them to justify a 300% price hike.  There's a revolving door between the FDA and big business that would be less effective with collective bargaining.

Just cause it's published in a magazine doesn't mean it's acceptable at face value.  If you want to believe De Beers, diamonds are a rare and extremely valuable gemstone even though they weren't until De Beers bought up almost all of the mines to control the supply and launched the most successful advertising campaign of modern media.  Fake markets result in fake prices.

Thank you,

CriticalThinker
Even so, it wouldn't be solved with a single payer system.  Only an investigation will actually fix it and that's currently going on.
But it's not impossible that it's a reality.  I mean, if there IS a need for more but it's so cheap that it's not profitable to actually have a new factory, then there would be a shortage, especially given the cheapness of the product.

ex:
1 Bag is sold at $1.
The cost to make 1 bag is $0.50
Profit per bag: $0.50
The total cost of the factory per day to run:
$10,000 (utilities, labor, etc...)
So they need to sell 20,000 bags to break even.

If demand is 30,000 bags a day, then building a new factory would put them at a profit loss of $5,000 a day.

Yes there are ways around this and these are just made up numbers but my point is that they may have looked at the cost of increasing production to meet demand and found that it's just not profitable enough to justify the cost.

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Re: Republican Health Care Bill
« Reply #33 on: September 10, 2017, 02:32:36 PM »
That's the thing about volume that many seem to miss.  The unit cost of production goes down when you increase volume.  This means that overall profit margins increase.  It's the primary motivating force behind the standardization of almost all manufacturing methods.  From cars to tv's to medications.  Highest volume possible for the lowest amount of minimally skilled people you can squeak by with.  It's the Henry Ford model and it built industrialized America, then abandoned it for China and India because human costs are lower and environmental protections are almost nonexistent.  New factories are not needed for step production increases and saline can produced on demand on site with minimal equipment.  With nothing more than a high school chemistry set, oven, glass IV bottle, basic surgical tubing and needles you could create sterilized IV saline solutions in a home.  I wouldn't recommend it though.

You also are missing the point of collective bargaining and its impact on market forces.  Today, some large hospital networks have the bargaining power in the provider/insurance market.  This means that they have the ability to demand higher payments which ultimately come from the patients.  No difference in service compared to their smaller cousins, just better bargaining position.  In a single payer system, the insurer has the power in that bargaining process which means that hospitals can bill any amount they want to the insurance company, they just won't get it.  In a single payer system, there are no uninsured so there is no way to over bill patients and there are no uncovered losses to make up either.  As a whole, this places market pressure on the providers to become more efficient in delivering healthcare services.  You can charge $20 to hook up an IV or $2 million but you'll receive whatever payment the single insurance company is willing to pay and every one of your patients is covered by that insurance company.  Now it's on you as the service provider to figure out exactly what your unit service costs are determine the best way to provide that service within an acceptable profit margin.  That in turn places market pressure on pharmaceutical companies to keep manufacturing costs in check.

It's worth noting that during this supposed evaluation of how to provide saline in 2015, Baxter's financial performance was so good that it had a stock split.  It's fun for corporations in America to cry poor me to the press when they're posting record breaking profits.  It's all a theater to mask full on corporate greed.  That FDA labelling of saline as a national shortage was, I'm relatively sure, paid for in lobbying funds.  It's just a polite way to say bribes to federal officials.

Thank you,

CriticalThinker
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Re: Republican Health Care Bill
« Reply #34 on: September 10, 2017, 02:57:12 PM »
That's the thing about volume that many seem to miss.  The unit cost of production goes down when you increase volume.  This means that overall profit margins increase.  It's the primary motivating force behind the standardization of almost all manufacturing methods.  From cars to tv's to medications.  Highest volume possible for the lowest amount of minimally skilled people you can squeak by with.  It's the Henry Ford model and it built industrialized America, then abandoned it for China and India because human costs are lower and environmental protections are almost nonexistent.New factories are not needed for step production increases and saline can produced on demand on site with minimal equipment.  With nothing more than a high school chemistry set, oven, glass IV bottle, basic surgical tubing and needles you could create sterilized IV saline solutions in a home.  I wouldn't recommend it though.

Sure, to a point.  Machines cost money.  Training costs money.  Maintenance equipment, spare parts, and supplies all cost money.  And, of course, labor.  If you can have 3 lines, all using the same machines, producing the same product, without having to swap out production for another product (that does happen alot) then you can cut costs alot.  Make it as automated as possible so you need less skilled workers (or less workers at all) and you're great.  And of course, the more product you can produce without error and without increasing labor, machines, or what-not then you're gonna make more money. 

BUT there is a limit.  Eventually you get to the point where you can't make more of a product without more equipment and people. 

Quote
You also are missing the point of collective bargaining and its impact on market forces.  Today, some large hospital networks have the bargaining power in the provider/insurance market.  This means that they have the ability to demand higher payments which ultimately come from the patients.  No difference in service compared to their smaller cousins, just better bargaining position.  In a single payer system, the insurer has the power in that bargaining process which means that hospitals can bill any amount they want to the insurance company, they just won't get it.  In a single payer system, there are no uninsured so there is no way to over bill patients and there are no uncovered losses to make up either.  As a whole, this places market pressure on the providers to become more efficient in delivering healthcare services.  You can charge $20 to hook up an IV or $2 million but you'll receive whatever payment the single insurance company is willing to pay and every one of your patients is covered by that insurance company.  Now it's on you as the service provider to figure out exactly what your unit service costs are determine the best way to provide that service within an acceptable profit margin.  That in turn places market pressure on pharmaceutical companies to keep manufacturing costs in check.
Sure.  If you can guarantee supply, then they can happily sell it cheaper as they're ensured to not have product sitting in a warehouse doing nothing.  But if everyone buys your product anyway, then your power isn't very much.

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It's worth noting that during this supposed evaluation of how to provide saline in 2015, Baxter's financial performance was so good that it had a stock split.  It's fun for corporations in America to cry poor me to the press when they're posting record breaking profits.  It's all a theater to mask full on corporate greed.  That FDA labelling of saline as a national shortage was, I'm relatively sure, paid for in lobbying funds.  It's just a polite way to say bribes to federal officials.

Maybe.
We can only hope they figure it out.  Though if it's so cheap and easy to make, why don't you do it?  Start a business.  Supply saline solution.  Make money.

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Offline CriticalThinker

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Re: Republican Health Care Bill
« Reply #35 on: September 10, 2017, 05:35:39 PM »
Hospitals don't maintain warehouses nor do they produce any products.  The fact that they have the upper hand in bargaining with insurance companies has to do with service supply not product supply.  Essentially many regional hospital networks border on monopolies.  The official economics term is an oligopoly.  Services don't get stored nor do they expire.  As such step production limitations don't apply the same way.  To increase services, you must the increase variable costs of labor.  To increase products, you have incremental step upgrades to the existing manufacturing infrastructure.  Because the hospitals have the better bargaining position, they get to inflate the overall costs of healthcare through their power of collective bargaining.  In a single payer system, the roles are reversed.  You're conflating the two bargaining points in a 3 point delivery system.  1st bargaining step is pharmaceutical manufacturer/hospital, the second is hospital/insurance.  You're talking about the first one in a single payer world, I'm talking about the second one.  The second one is where hospitals charge insurance companies $300 per bag of IV saline after paying roughly $1 per bag in the first one.

Starting a small saline company in the US would not be easy.  There is a powerful lobby group that suppresses competition in the industry of pharmaceuticals.  It would be on the order of starting up a new cell phone carrier or cable company.  Starting a new pharmaceutical manufacturing entity could be done with a lot of financial backing, but you would need to have patents on medication formulas already in place and probably some already in 1st stage FDA approvals to even attempt to solicit investors.  There's a reason that pharmaceutical manufacturers don't ever make a single product.  They have to be manufacturing giants in order to compete within their own industry.  You're suggesting a business model that can't exist in the US.  You can't start a home saline business out of your garage.  You're not a licensed medical entity or pharmaceutical manufacturer.  I'm simply stating that the "shortage" is artificial, not real and it's expressly due to widespread corporate greed in both the manufacturers and hospitals.

Thank you,

CriticalThinker
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