US Politics

[berbatrick]

Well, the quote was made in a time of really mind-boggling ratios.

By the time of Baker's lawsuit, the population had shifted such that his district in Shelby County had about ten times as many residents as some of the rural districts.

And the court decisions were really narrow, with judges believing that voters should decide to have redistricting, not seeing that even if the majority wanted it, they could never show that, because their representatives were from these disproportionate districts.
Cart before horse, and the case deserved the common-sense approach that's visible in that quote.
I don't think he was criticisng FPTP and region-based representation, just that districts should be equal and the outcome should reflect the majority vote. Today, the same principle applied to politically-drawn lines.

Edit:

Voters from Jefferson County, Alabama, home to the state’s largest city of Birmingham, had challenged the apportionment of the Alabama Legislature. The Alabama Constitution provided that there be only one state senator per county. Ratio variances as great as 41 to 1 from one senatorial district to another existed in the Alabama Senate (i.e., the number of eligible voters voting for one senator was in one case 41 times the number of voters in another).

Among the more extreme pre-Reynolds disparities[8] claimed by Morris K. Udall:

• In the Connecticut General Assembly, one House district had 191 people.
• In the New Hampshire General Court, one township with three people had a Representative in the lower house; this was the same representation given another district with a population of 3,244.
• In the Utah State Legislature, the smallest district had 165 people, the largest 32,380.
• In the Vermont General Assembly, the smallest district had 36 people, the largest 35,000.
• Los Angeles County, California, then with six million people, had one member in the California State Senate, as did the 14,000 people of one rural county.
• In the Idaho Senate, the smallest district had 951 people; the largest, 93,400.
• In the Nevada Senate, seventeen members represented as many as 127,000 or as few as 568 people.

 

[PedroMendez]

American health care is basically anything but. Neither healthy nor caring.

Literally putting a number on the worth of people's lives scares the hell out of me, it's sociopathic.

we are putting a number on the worth on people's lives all the time. The number, that the US health-care system puts on people might not follow your assessment, is still fairly generous considering how we evaluate the lives of others in different contexts. So if that makes anyone a sociopath, you are one as well. Wilful ignorance is no excuse.

 

[PedroMendez]

That is probably the last time when anybody talks about health-care, so I try to shine some light at one of the problems of the ACA. It creates a race to the bottom (quality of coverage) for some of the sickest people.

That’s how it roughly works:

1) Insurance companies have to offer everybody insurance to a price that might not reflect their value as customer (community rating)
2) Companies lose money by insuring people with certain disease; that is particularly severe, when we discuss some of the sickest people in the country (e.g. with chronic and extremely expensive diseases)
3) The competition is not allowed to be driven by prices (due to community rating).
4) Sick people will buy insurance from the company that offers the best coverage for their disease.
5) The consequences is that companies, that offer the best quality are making the biggest financial loss.
6) That triggers a vicious cycle, where insurances start to lower the quality of their coverage for these people to discourage them from signing up. The only alternative would be to make financial losses.


http://www.nber.org/papers/w22832.pdf

ABSTRACT

By steering patients to cost-effective substitutes, the tiered design of prescription drug formulariescan improve the efficiency of healthcare consumption in the presence of moral hazard. However, along theoretical literature describes how contract design can also be used to screen consumers by profitability. In this paper, we study this type of screening in the ACA Health Insurance Exchanges. We first show that despite large regulatory transfers that neutralize selection incentives for most consumer types,some consumers are unprofitable in a way that is predictable by their prescription drug demand. Then,using a difference-in-differences strategy that compares Exchange formularies where these selectionincentives exist to employer plan formularies where they do not, we show that Exchange insurers designformularies as screening devices that are differentially unattractive to unprofitable consumer types.This results in inefficiently low levels of coverage for the corresponding drugs in equilibrium. Although this type of contract distortion has been highlighted in the prior theoretical literature, until now empirical evidence has been rare. The impact on out-of-pocket costs for consumers affected by the distortion is substantial—potentially thousands of dollars per year—and the distortion creates an equilibrium in which contracts that efficiently trade off moral hazard and risk protection cannot exist.

(...)Enforcing a policy of non-discrimination against the chronically ill can generate improvements in both equity and efficiency (Handel, Hendel and Whinston,2015). But such reforms may also generate a relationship between non-contractible consumer characteristics and the underlying cost to the insurer of providing coverage. In such settings, two classes of distortions may arise. The first is a price distortion caused by adverse selection of consumers on price, as originally studied by Akerlof(1970) and more recently applied to the context of health insurance byEinav, Finkelstein and Cullen(2010),Handel, Hendel and Whinston(2015), and Hackmann, Kolstad and Kowalski(2015). In this case, welfare losses occur because feedback from costs into prices result in inefficiently low takeupof insurance. The second—the focus of this paper—is a distortion of insurance contract features like risk protection and multidimensional quality. This type of distortion was first studied by Rothschild and Stiglitz (1976) and more recently applied to the context of modern health insurance by Glazer and McGuire (2000), Frank, Glazer and McGuire (2000), Azevedo and Gottlieb (2016), and Veiga and Weyl (2016). Under this type of distortion, insurers recognize that non-price features of the contract can act as screening mechanisms, allowing them to design contracts that cause consumers to self-sort by profitability.(...)

(...)Across all of the various parameterizations, we find health plans are designing their drug formularies to offer differentially worse coverage for classes used by the most unprofitable individuals,consistent with the hypothesis that Exchange plan formularies are designed to deter enrollment of unprofitable individuals. Below in Section 6, we show that these results are robust to a variety of alternative specifications, and we rule out competing explanations related to within-class substitutionto less expensive alternatives and related to differential demand elasticity across classes and markets.(...)

 

[berbatrick]

Pugh to veto $15 minimum wage bill she said, as a candidate, she’d sign
“I don’t think they would make me swear on a Bible.” Since the election, she also said, the city’s fiscal situation changed.

https://www.baltimorebrew.com/2017/...-wage-bill-she-said-as-a-candidate-shed-sign/

At least Trump tries to keep some of his promises.

 

[Javi]

@PedroMendez so the conclusio is that in this setting the govt. should enact minimum standards for all health care plans.

 

[Akshay]

@PedroMendez so the conclusio is that in this setting the govt. should enact minimum standards for all health care plans.

The problem is two fold. Not only is the quality declining, but also the number of willing insurers. If you set minimum standards that enforce losses, you're just going to further drive out companies willing to offer insurance.

 

[PedroMendez]

@PedroMendez so the conclusio is that in this setting the govt. should enact minimum standards for all health care plans.

The government is already setting minimum standards (and Ryan's reform would have kept them), but it is boarderline impossible to do that in a way that prevents this form of vicious circle. It is too complicated. Additionally we see what Akshay describes: companies quit the markets. Thats actually a quite significant problem on its own and another part of the ACA that is deeply flawed.
What I described above is just one of many aspects, that is problematic.

 

[Red Dreams]

It is gratifying to see Republicans admit the ACA is here to stay.
Medicare For All/single payer will come into being sooner than we think.

 

[Red Dreams]

The way to reduce cost of health care is to remove Health Insurance companies from the equation.

 

[Adisa]

The way to reduce cost of health care is to remove Health Insurance companies from the equation.

This and that bizarre rule preventing cheaper drugs from being imported.

 

[PedroMendez]

The way to reduce cost of health care is to remove Health Insurance companies from the equation.

How would that reduce costs in your opinion and who would do the job, that insurance companies do?

This and that bizarre rule preventing cheaper drugs from being imported.

I agree, but it is also a pretty interesting suggestion, because they are not allowed to be imported due to regulation. e.g health/security concerns are usually cited. Are you in favour or abolishing the FDA?

 

[Red Dreams]

How would that reduce costs in your opinion and who would do the job, that insurance companies do?

Medicare works. People love it btw even if it is not perfect. So it will be simply Medicare For All.

Please enighten me about what Health Insurance companies provide as a service to patients.

I know they enrich themselves on the premiums paid to them by people who have no choice but to go through them so they can live.

 

[Red Dreams]

I agree, but it is also a pretty interesting suggestion, because they are not allowed to be imported due to regulation. e.g health/security concerns are usually cited. Are you in favour or abolishing the FDA?

Did he say we needed to abolish the FDA?

Are you seriously suggesting that the drugs from Canada for example...the same very drugs btw are going to kill Americans?

Fact is Big Pharma and Health Insurance companies own these politicians from both sides.

These politicians do not represent people they represent their masters...corporations who pay them.

It was interesting to listen to a 'moderate' Republican. He pretty much admitted the ACA is the law of land and we need to help people...Voters. He wants to stay in power you see.

EDIT: btw every little trick the Republicans do to weaken the ACA only makes people turn to the government to fill the gaps left by Insurance companies not fulfilling their obligations.

They are in fact helping hasten Medicare For All coming.

Today is a good day for All Americans.

 

[PedroMendez]

Medicare works. People love it btw even if it is not perfect. So it will be simply Medicare For All.

Please enighten me about what Health Insurance companies provide as a service to patients.

I know they enrich themselves on the premiums paid to them by people who have no choice but to go through them so they can live.

Well even if I'd grand you, that Medicare works (which I don't), it is certainly not going to reduce the cost. Nobody, not even the biggest medicare defender would suggest something like that. Your analysis why the costs are completely out of control is simply not holding up. The insurance companies are not the problem.

I don't have a problem with a medical system, that strongly redistributes and offers are fairly high common standard for everybody.

 

[Red Dreams]

Well even if I'd grand you, that Medicare works (which I don't), it is certainly not going to reduce the cost. Nobody, not even the biggest medicare defender would suggest something like that. Your analysis why the costs are completely out of control is simply not holding up. The insurance companies are not the problem.

I don't have a problem with a medical system, that strongly redistributes and offers are fairly high common standard for everybody.

you are simply factually wrong.
Through payroll taxes which will be a fraction of premiums and deductables everyone will be covered. Can you show me Facts that payroll taxes are greater than premiums and deductables?

It is a lie to say that Health Insurance companies provide better standard of care.
The ACA stipulated CEOs should not be paid more than $500,000 for the 'work' they do. Ryan wanted to remove that cap.
btw the work they do is find ways to deny coverage to people who bought coverage so they can maximise profits.

It is a lie to say that there are lines of people waiting to see doctors in countries that have socialised health care. We Know. I see now some of these Republican congressmen are fnally being called out by journalists. Finally.
And wait for the anecdotal examples of people from Canada coming to get health care in the US

Yeah. I was in Mayo Clinic and saw Arabs and one or two other Well to dos coming to get treatment. All that says is people who have money can afford some of these treatments that many are denied in the US.

Seeing Ryan with his power point explaining the 'merits' of his bill....was sobering.
To do the bidding of his masters he was willing to have millions denied health care...to have them die.

One day that same pain and death will come to him through the ones he loves. Along with that will come wisdom to fill his emptiness...and he may find his redemption.

 

[berbatrick]

I agree, but it is also a pretty interesting suggestion, because they are not allowed to be imported due to regulation. e.g health/security concerns are usually cited. Are you in favour or abolishing the FDA?

There are drugs made in the US, in the same factories as drugs made for the US market, approved by the Canadian and EU FDAs, which are rejected by the US.

 

[PedroMendez]

There are drugs made in the US, in the same factories as drugs made for the US market, approved by the Canadian and EU FDAs, which are rejected by the US.

Yes. Thats what happens when every country has gigantic regulatory agencies. (I am not for abolishing the FDA; just to make this clear)
I totally agree with your sentiment. It would be one of the first things I'd do, but I am not sure how big its impact would be.. Additionally, following the debate in various EU countries, the people clearly don't trust USA regulators and probably wouldn't be comfortable with such an arrangement on their side of the Atlantic (not that this could stop the USA to do it unilaterally). TTIP would have tried to address that and people run riot.

 

[berbatrick]

Yes. Thats what happens when every country has gigantic regulatory agencies. (I am not for abolishing the FDA; just to make this clear)
I totally agree with your sentiment. It would be one of the first things I'd do, but I am not sure how big its impact would be.. Additionally, following the debate in various EU countries, the people clearly don't trust USA regulators and probably wouldn't be comfortable with such an arrangement on their side of the Atlantic (not that this could stop the USA to do it unilaterally). TTIP would have tried to address that and people run riot.

From what I understand, meeting US FDA standards isn't very different from meeting EU FDA.
But this isn't the case in terms of regulations regarding, for example, Roundup herbicide. Privacy norms are orders of magnitudes apart. And then there is the super-national investor tribunals, which undermine sovereignty, and the power of local/state/national political action quite severely.

 

[PedroMendez]

you are simply factually wrong.
Through payroll taxes which will be a fraction of premiums and deductables everyone will be covered. Can you show me Facts that payroll taxes are greater than premiums and deductables?

It is a lie to say that Health Insurance companies provide better standard of care.
The ACA stipulated CEOs should not be paid more than $500,000 for the 'work' they do. Ryan wanted to remove that cap.
btw the work they do is find ways to deny coverage to people who bought coverage so they can maximise profits.

It is a lie to say that there are lines of people waiting to see doctors in countries that have socialised health care. We Know. I see now some of these Republican congressmen are fnally being called out by journalists. Finally.
And wait for the anecdotal examples of people from Canada coming to get health care in the US

Yeah. I was in Mayo Clinic and saw Arabs and one or two other Well to dos coming to get treatment. All that says is people who have money can afford some of these treatments that many are denied in the US.

Seeing Ryan with his power point explaining the 'merits' of his bill....was sobering.
To do the bidding of his masters he was willing to have millions denied health care...to have them die.

One day that same pain and death will come to him through the ones he loves. Along with that will come wisdom to fill his emptiness...and he may find his redemption.

Just to start with the elephant in the room: Do you realize that medicare is administrated through private insurance companies, that you hate so much?

 

[Red Dreams]

Just to start with the elephant in the room: Do you realize that medicare is administrated through private insurance companies, that you hate so much?

surely everyone knows it is heavily regulated...as it should.

cheaper to do that than setting up another bureaucracy.

Once again. people will pay a little extra into their payroll taxes and will pay a nominal amount to receive health care services.
Healthcare is a fundemental right. You should not even have to think about this. Like expecting clean water (Flint excluded. The Republican Governor thought it was alright to poison his people to save some money. Hey. Free market at work eh?)

 

[Crossie]

From what I understand, meeting US FDA standards isn't very different from meeting EU FDA.
But this isn't the case in terms of regulations regarding, for example, Roundup herbicide. Privacy norms are orders of magnitudes apart. And then there is the super-national investor tribunals, which undermine sovereignty, and the power of local/state/national political action quite severely.

Don't want to derail your health care discussion with boring details on this specific matter but confirm your understanding that for many subjects, at least in theory, requirements and guidelines for clinical trials, drug registration and maintenance (pharmacovigilance) are pretty similar. That's why there are ICH guidelines in which agencies and industry (mainly) from most regions of the world agree upon standards.

In real life though there can be amazing differences, and this can lead to very different legal and reimbursement issues if you were to just import a drug from another country based on their own agency's approval. For example, the submitted data package (pre-clinical, pharmcokinetics, clinical) for the same drug in country/region A can be quite different to what you submit in country/region B. Or the identical data package gets a very different assessment in terms of usage, dosage, contraindications, warnings/precautions, ... IIRC, you have a bio- or life science background? If so, I'm sure you know what I'm talking about too well.

Sometimes FDA reviewers are more conservative than EMA reviewers (which are still located in their national agencies but work for EMA), sometimes it's the other way round. It's absolutely baffling and can be quite unpredictable. As both agencies publish assessment reports / reviews and of course lots of it is reflected in a drug's product information / summary of product characteristics, health care professionals with respective knowledge (and time) can roughly follow the lines of assessment but it doesn't solve any legal or reimbursement problem.

 

[Red Dreams]

Don't want to derail your health care discussion with boring details on this specific matter but confirm your understanding that for many subjects, at least in theory, requirements and guidelines for clinical trials, drug registration and maintenance (pharmacovigilance) are pretty similar. That's why there are ICH guidelines in which agencies and industry (mainly) from most regions of the world agree upon standards.

In real life though there can be amazing differences, and this can lead to very different legal and reimbursement issues if you were to just import a drug from another country based on their own agency's approval. For example, the submitted data package (pre-clinical, pharmcokinetics, clinical) for the same drug in country/region A can be quite different to what you submit in country/region B. Or the identical data package gets a very different assessment in terms of usage, dosage, contraindications, warnings/precautions, ... IIRC, you have a bio- or life science background? If so, I'm sure you know what I'm talking about too well.

Sometimes FDA reviewers are more conservative than EMA reviewers (which are still located in their national agencies but work for EMA), sometimes it's the other way round. It's absolutely baffling and can be quite unpredictable. As both agencies publish assessment reports / reviews and of course lots of it is reflected in a drug's product information / summary of product characteristics, health care professionals with respective knowledge (and time) can roughly follow the lines of assessment but it doesn't solve any legal or reimbursement problem.

http://www.huffingtonpost.com/entry...ght-on-big-pharma_us_5877edd4e4b0b3c7a7b05c29

As I said the scum are on both sides.

 

[PedroMendez]

surely everyone knows it is heavily regulated...as it should.

cheaper to do that than setting up another bureaucracy.

Once again. people will pay a little extra into their payroll taxes and will pay a nominal amount to receive health care services.
Healthcare is a fundemental right. You should not even have to think about this. Like expecting clean water (Flint excluded. The Republican Governor thought it was alright to poison his people to save some money. Hey. Free market at work eh?)

You make false claims ("The way to reduce cost of health care is to remove Health Insurance companies from the equation."), that you don't even try to substantiate to push your narrative of "oh some evil corporations are surely to blame". When the it clashes with your own argument ("cheaper to do that than setting up another bureaucracy"), you just move the goal-post and move to other nonsense. Pretty much ever single of your statements is ideological drivel and wrong. Bringing up the flint water crisis as an example against free markets is the cherry on top.

 

[Crossie]

http://www.huffingtonpost.com/entry...ght-on-big-pharma_us_5877edd4e4b0b3c7a7b05c29

As I said the scum are on both sides.

Totally disagree on the scum bit. It's the most normal thing of the world that scientists - drug regulators are scientists from different fields - interpret data and come to different conclusions.

 

[Red Dreams]

You make false claims ("The way to reduce cost of health care is to remove Health Insurance companies from the equation."), that you don't even try to substantiate to push your narrative of "oh some evil corporations are surely to blame". When the it clashes with your own argument ("cheaper to do that than setting up another bureaucracy"), you just move the goal-post and move to other nonsense. Pretty much ever single of your statements is ideological drivel and wrong. Bringing up the flint water crisis as an example against free markets is the cherry on top.

you have yet to prove that payroll taxes are greater than premiums and deductables.

prove that first.

then we will discuss your other nonsense.

 

[Red Dreams]

Totally disagree on the scum bit. It's the most normal thing of the world that scientists - drug regulators are scientists from different fields - interpret data and come to different conclusions.

did you read the entire article?

Our former governor (A Repulican) asked a simple question. So are people in Canada all dying from consuming the same drugs? Free market. If we can get the same drugs cheaper they should be allowed. simple.

Drug companies can charge whatever they want. That is a big issue.

 

[PedroMendez]

you have yet to prove that payroll taxes are greater than premiums and deductables.

prove that first.

then we will discuss your other nonsense.

In useful debates, the person who makes questionable claims should bring at least some evidence, that his claim might be true. Thats how it works. Additionally whats your argument again? Insurance companies are the reason for high costs in the health-care system and cutting them out would do the trick? You seem to have moved away from that.

 

[Red Dreams]

In useful debates, the person who makes questionable claims should bring at least some evidence, that his claim might be true. Thats how it works. Additionally whats your argument again? Insurance companies are the reason for high costs in the health-care system and cutting them out would do the trick? You seem to have moved away from that.

stop moving the goal post as you say.

You did not address my post #55 other make a general statement you agreed.

Rebutt it if you can.

you also made a false accusation that @Adisa wanted the FDA removed.

In useful debates you rebutt a claim with facts.

You simply either lie or pull out defences from the Libetarian playbook or conveniently do not address them.

Fact: Tricle down economics is not a Macro Economics Theory. In what uni did they teach you this?

You also do not seem to have a good grasp of the English language. I never moved away from my accusation that Insurance companies are the reason for high health care costs...so much so people cannot afford it.

 

[PedroMendez]

You made the claim, so you need to bring up some evidence. That’s how it works in rational debates (or science). I also didn’t accuse Adisa of anything. I asked a question. So stop dragging him into this. You just move all over the place. From flint, to trickle-down economics to people being “scum”, to anecdotes about Canada and Arabs and so on. You are just throwing these things out and attack me over it while I didn’t say anything about it at all. Straw man fallacy ftw. That's all just unnecessary distraction from the discussion.

So back to square one.

The way to reduce cost of health care is to remove Health Insurance companies from the equation.

Please enighten me about what Health Insurance companies provide as a service to patients.

I know they enrich themselves on the premiums paid to them by people who have no choice but to go through them so they can live.

Just to start with the elephant in the room: Do you realize that medicare is administrated through private insurance companies, that you hate so much?

surely everyone knows it is heavily regulated...as it should.

cheaper to do that than setting up another bureaucracy.

Your initial claim was that health insurance companies are the reason for high cost of healthcare, but afterwards you say that they are not a problem, when they offer medicare plans. These are contradicting statements. Are you trying to argue that the individual market for healthcare is the problem? Or the market, where employees get insurance from their employer? These would be at least understandable arguments, but I am not sure what you are trying to say, because you prefer to make random accusations.

 

[Crossie]

did you read the entire article?

Our former governor (A Repulican) asked a simple question. So are people in Canada all dying from consuming the same drugs? Free market. If we can get the same drugs cheaper they should be allowed. simple.

Drug companies can charge whatever they want. That is a big issue.

Did you read my entire initial post and more importantly understand the content and its implications? Obviously not. Implement some sort of price control in the US if you want to deal with high prices, don't meddle in other areas.

 

[PedroMendez]

Did you read my entire initial post and more importantly understand the content and its implications? Obviously not. Implement some sort of price control in the US if you want to deal with high prices, don't meddle in other areas.

Do you know if there is any dialogue between the big regulatory agencies? How do smaller/poorer countries do it? Do they have the same regulatory agencies or do they just accept drugs, that are approved in the USA/EU?

 

[Crossie]

Do you know if there is any dialogue between the big regulatory agencies? How do smaller/poorer countries do it? Do they have the same regulatory agencies or do they just accept drugs, that are approved in the USA/EU?

1. Yes, there is. There are numerous projects on specific topics, unrelated to specific drugs.
   Then there can be drug-specific dialogue. It is not uncommon, for example, that the clinical reviewer or the statistician at FDA who's working on the registration of a new drug, a new formulation of an already registered drug or a new indication (usage) of an already registered drug pick up the phone and call their counterpart in Europe to discuss, or vice versa. That's happening of course only when the specific registration application is submitted in both countries which is not always the case.
   Another occasion is that reviewers from FDA spend some time at he EMA or a European national agency, or reviewers from Europe spend some time at the FDA.
2. Define 'smaller/poorer' or name 2-3 countries you're interested in. Not that I would know the specifics from each and every country but chances are I can answer at leas a bit.

 

[PedroMendez]

1. Yes, there is. There are numerous projects on specific topics, unrelated to specific drugs.
   Then there can be drug-specific dialogue. It is not uncommon, for example, that the clinical reviewer or the statistician at FDA who's working on the registration of a new drug, a new formulation of an already registered drug or a new indication (usage) of an already registered drug pick up the phone and call their counterpart in Europe to discuss, or vice versa. That's happening of course only when the specific registration is submitted in both countries which is not always the case.
   Another occasion is that reviewers from FDA spend some time at he EMA or a European national agency, or reviewers from Europe spend some time at the FDA.
2. Define 'smaller/poorer' or name 2-3 countries you're interested in. Not that I would know the specifics from each and every country but chances are I can answer at leas a bit.

Thanks. Very interesting. I was wondering about nations like Liberia, Sierra Leone or Moldova, who might not have the infrastructure/ressources to do it (my assumption could be totally false). Additionally, do you know how Chile is handling this?

 

[berbatrick]

Don't want to derail your health care discussion with boring details on this specific matter but confirm your understanding that for many subjects, at least in theory, requirements and guidelines for clinical trials, drug registration and maintenance (pharmacovigilance) are pretty similar. That's why there are ICH guidelines in which agencies and industry (mainly) from most regions of the world agree upon standards.

In real life though there can be amazing differences, and this can lead to very different legal and reimbursement issues if you were to just import a drug from another country based on their own agency's approval. For example, the submitted data package (pre-clinical, pharmcokinetics, clinical) for the same drug in country/region A can be quite different to what you submit in country/region B. Or the identical data package gets a very different assessment in terms of usage, dosage, contraindications, warnings/precautions, ... IIRC, you have a bio- or life science background? If so, I'm sure you know what I'm talking about too well.

Sometimes FDA reviewers are more conservative than EMA reviewers (which are still located in their national agencies but work for EMA), sometimes it's the other way round. It's absolutely baffling and can be quite unpredictable. As both agencies publish assessment reports / reviews and of course lots of it is reflected in a drug's product information / summary of product characteristics, health care professionals with respective knowledge (and time) can roughly follow the lines of assessment but it doesn't solve any legal or reimbursement problem.

Thanks
I am in life sciences and was in chemistry, but right now my work is far far away from any medical applications - it is evolutionary bio/biochem in extremophiles.

My dad retired ~7 years ago, for his last few working years he was with some pharma companies who wanted to export to the west, advising about QC and certification. Maybe I can talk to him about it, I never asked.

 

[Red Dreams]

Did you read my entire initial post and more importantly understand the content and its implications? Obviously not. Implement some sort of price control in the US if you want to deal with high prices, don't meddle in other areas.

Did you understand the point I made? Obviously not.
Its obvious there are different standards.
The point was why these standards are so different for specific drugs that are widely used with no negative results and therefore not available in the US at much lower costs.

 

[Red Dreams]

You made the claim, so you need to bring up some evidence. That’s how it works in rational debates (or science). I also didn’t accuse Adisa of anything. I asked a question. So stop dragging him into this. You just move all over the place. From flint, to trickle-down economics to people being “scum”, to anecdotes about Canada and Arabs and so on. You are just throwing these things out and attack me over it while I didn’t say anything about it at all. Straw man fallacy ftw. That's all just unnecessary distraction from the discussion.

So back to square one.








Your initial claim was that health insurance companies are the reason for high cost of healthcare, but afterwards you say that they are not a problem, when they offer medicare plans. These are contradicting statements. Are you trying to argue that the individual market for healthcare is the problem? Or the market, where employees get insurance from their employer? These would be at least understandable arguments, but I am not sure what you are trying to say, because you prefer to make random accusations.

Back to square one indeed.
No contradiction. You obviously do not have a good grasp of the English language.
Support your false claim that health premium costs as offer in the open markets or through employers including deductibles are cheaper than a medicare tax through payroll.

 

[PedroMendez]

Back to square one indeed.
No contradiction. You obviously do not have a good grasp of the English language.
Support your false claim that health premium costs as offer in the open markets or through employers including deductibles are cheaper than a medicare tax through payroll.

From strawmans to ad-hominum. Your first statement was unambiguous.

The way to reduce cost of health care is to remove Health Insurance companies from the equation.

Once I asked you how this would work, you started to bring up unrelated issues and moved the goalpost. It is not my fault, that you changed your argument. Now you are coming with another straw-man.

“Support your false claim that health premium costs as offer in the open markets or through employers including deductibles are cheaper than a medicare tax through payroll.”

Why should I bring up support for an argument that I never made? Your way of arguing is really something else. I’ll just leave it here; you are unwilling to provide any evidence for your initial claim or engage in anything that I actually say. All you are doing is arguing with your own strawmans.

 

[Crossie]

Did you understand the point I made? Obviously not.
Its obvious there are different standards.
The point was why these standards are so different for specific drugs that are widely used with no negative results and therefore not available in the US at much lower costs.

Your point wasn't why there are different standards.

In your first response your point was that regulators on both sides of the Atlantic are scum which is not just wrong but totally unacceptable. Sadly though, it fits to your further posts.
In your second post your point was that cheaper drugs from another country (Canada) should be allowed to import as long as people in the exporting country do die from it.

My response is as above but paraphrased: The regulatory environment of the US isn't what's driving the costs in the US. Any sensible politician will work on fixing what is broken and not fighting or circumventing something that is entirely unrelated to the problem.

 

[Red Dreams]

Your point wasn't why there are different standards.

In your first response your point was that regulators on both sides of the Atlantic are scum which is not just wrong but totally unacceptable. Sadly though, it fits to your further posts.
In your second post your point was that cheaper drugs from another country (Canada) should be allowed to import as long as people in the exporting country do die from it.

My response is as above but paraphrased: The regulatory environment of the US isn't what's driving the costs in the US. Any sensible politician will work on fixing what is broken and not fighting or circumventing something that is entirely unrelated to the problem.

to clarify. My point was about costs being higher here in the US not on both sides of the Atlantic. And I meant we have corporate stooges among Democrats and republicans. The FDA is not universally trusted in the US btw.
Politicians who are funded by Big Pharma have no inclination to see how they can lower prescription drug prices.

 

[Crossie]

Thanks. Very interesting. I was wondering about nations like Liberia, Sierra Leone or Moldova, who might not have the infrastructure/ressources to do it (my assumption could be totally false). Additionally, do you know how Chile is handling this?

For the last 30 minutes, I have been typing a long post to address your general question - then Redcafe crashed before I could hit the post button, and only few paragraphs were saved. I'll do a short version below. Don't hesitate to ask if something isn't clear: Drug registration is more complex than even health care professionals, let alone patients assume.

• All countries have an independent agency that is legally responsible for drug registration and maintenance in that country; I mention maintenance because it is a publicly totally underestimated issue that requires a lot of staff both at agencies and companies.
• Generally, what reviewers do when assessing an application is to draw conclusions about the benefit / risk balance of that drug (or combination of drugs). The three main review areas are efficacy, safety and pharmaceutical quality of the formulation.
• Agencies have requirements for registration and do the assessment according to local guidelines that are designed for the specific population of their country in context of the medical landscape, climate and standard of living; in some countries also health care landscape.
• Most agencies do an independent full assessment, including Chile's. It's not uncommon though that an agency wants to see Q&As and / or assessment reports from registration procedures of that drug at the FDA and/or EMA.
• Some agencies refer to the assessment from bigger agencies (almost always FDA and/or EMA but possibly additional ones) - but only partially. That's what is happening i.e. in some African or Asian countries. Quality data are usually reviewed independently, sometimes combined with independent inspections of manufacturing sites of drug substance (pure pharmacologically active substance) and drug product (formulation = e.g. tablet, sterile solution, syrup, ointment). Most countries would also check if sufficient pharmacokinetics, pharmacodynamics, efficacy & safety data (PK = what's the body doing with the drug?; PD = what's the drug doing with the body?) are available to support the claimed indication and usage in the population of their country; there can be big differences between caucasians and non-caucasians, and the majority of data in pivotal trial (clinical trials designed to establish efficacy and safety) are still from caucasians.

Some background that IMO helps to get a better grasp of the complexity of the subject:

• A drug gets registered by an agency on very specific conditions. The vast majority of these conditions are outlined in what the FDA names product information(PI), the EMA summary of product characteristics (SPC or SmPC), Health Canada product monograph (PM). The agencies decide word by word, comma by comma what gets in. Practically any changes, including fixing typos, require approval.
  PIs/SmPCs/PMs are available on the agencies' websites so everybody can read them.
  Patient leaflets / package inserts reflect what patients need to know from the PI/SmPC/PM in layman's language (ideally at least). That's where a lot of the complexity, i.e. from the indication wording of a drug, is removed from the patient's eyes but it is still relevant for regulators, prescribers and reimbursement bodies.

• Most countries offer different types of licenses for drugs. That's a really complex world but as a rule of thumb, the main difference between them is that requirements differ in terms of robustness of evidence (and possibly obligations tied to a certain type of licence).
  Obviously, a company isn't entirely free to chose which type of licence it wants to obtain; it depends on the medical environment: A drug for a disease with no or only few insufficient treatment options in this country so far (e.g. limited efficacy, suboptimal safety profile) may qualify for a licence with fewer requirements but a drug that doesn't offer anything substantially new or better than existing treatment options qualifies only for a 'standard' licence.

Hope that helps.