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Thread: Millennials and younger, what's your retirement

  1. #41
    Senior Member Sinny's Avatar
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    Quote Originally Posted by starla View Post
    Oh, that must've been in your video then? I never click on videos.

    I've thought a lot about the price of pharmaceuticals lately. I'm on a drug that very few people take and it retails at $16k/month. It used to be $14k/month, but another drug was released that ate into their market and the price went up. My insurance pays ~$9k/month (was paying $16k last year), I myself will pay $20 this month and nothing after that; the drug company's patient assistance program will pick up the rest of my share, which this year would have totaled I think about $3600. I had a lot of misgivings about paying that much, even if it wasn't my money, for a drug of questionable benefit. The drug company is public and according to their financials, they are not profitable and never have been, and don't expect to be any time soon. Getting this shit to market is expensive as fuck. So as individualized medicine catches on and drugs get more targeted, and potential patient populations get smaller, drugs are going to get super expensive because it costs almost as much to develop a drug for 1000 people to take a year as one that 10 million take each year. That has been one train of thought.

    As for drug prices in the US vs. the UK, private insurance companies can negotiate prices with pharmaceutical companies, so I have no idea why Americans are paying so much more, or if that only applies to medicare patients and our insurance companies are paying prices similar to foreign governments. I do know that the UK and a lot of other countries approve drugs for their citizens based on cost per QOL (quality of life) year. So if a drug is too expensive and can't prove survival benefit, or the benefit isn't that great, or the side effects are detrimental to quality of life, the NHS doesn't provide the drug. (Patients in the UK cannot get the drug I'm on.) The FDA approves drugs based entirely on efficacy, which can be defined many different ways, and doesn't look at cost at all. Once a drug is approved for a patient population by the FDA, almost every insurance plan will cover it. So while they can technically negotiate cost, just not supplying the therapy to qualified patients is not really an option over here, so how much leverage do they really have? I don't think we'll be able to effectively negotiate with drug companies until just not buying their product at all becomes an option, and over here people think they should be able to get any treatment they want, proven or not, and their insurance should pay for it.

    For a long time I thought insurance companies were the reason why our healthcare was so expensive, but I learned recently that my and many people's insurance companies are just administrators. For any company of decent size (maybe a few hundred employees), it is cheaper for the company to self-insure and just use the insurance company to negotiate networks and formularies. No wonder my insurance company hasn't denied anything; they have no skin in the game. I do still think the insurance model adds a lot of cost in terms of administration, all of which is overhead. We would not have this kind of overhead with a single payer model.

    I think our biggest problem over here though is lack of access and poor lifestyle choices - basically our system favors treatment over prevention. It is quite obvious that prevention is cheaper than treatment. It is cheaper to change your oil every 5000 miles than to replace your engine when it locks up. And yet, even medicare pays more to specialists for procedures and significantly less to primary care providers to manage conditions, not to mention the literal nothing they pay for lifestyle interventions; this is why doctors rarely educate patients on nutrition or the benefits of exercise. Medicaid patients can't get any medical care unless they turn up in the emergency room because no doctors accept medicaid. Everyone else doesn't want to cough up the $500 deductible that they have to pay to see the doctor, so they wait until their minor problem becomes a huge deal before they do anything about it. And everyone's eating crap and sitting at desks all day, then driving home and everywhere else they go instead of walking.

    Anyway, maybe I'm biased because I'm in the industry and I'm profiting off the inefficiencies (and I could go on a long tangent about the FDA and how the barriers to entry they put up stifles innovation and competition in the market, and how companies like mine aren't incentivized to reduce costs - quite the opposite in fact) but I think overhead costs due to the private insurance model and poor preventive measures, both in terms of lifestyle choices and lack of access to basic care, are driving costs here more than expensive drugs. I think profiteering is maybe fifth or sixth on the list of things that drives up cost, but it also drives innovation.


    You know he was a millionaire who launched and sold a successful company before he did that, right?
    No, that particular bit wasn't in the videos, I was bouncing off Jyng's statement, who's medical system reflects the British NHS.

    You are right about lifestyle choices and treatment rather than prevention. I only recently learned about "food deserts" in the US. My god.

    I also recently watched a couple of documenaries on Medicare/Medicade also being used to rip off the tax payer, apparently quite a lot of hospitals/doctors just took advantage of the government funding and hugely inflated their prices whilst the tax payer was paying.

    One of my favourite alternative historians (conspiracy theorist) penned a book called Murder by Injection, and it foretold back in 1988 how the monopoly & profiteering on healthcare would work out in America.

    The key in all this is the patents and who controls them.
    Our opposition Government just lost over here, but one of the first policies they were going to implement was the seizing of parents for the common good and the nationalisation of production.

    I get that you're not finding the system too hard to navigate yourself, but I can't help but think of all those poor Americanswho are doomed to death & disease over things that are easily fixable, all in the name of profit.

    From the outside looking in, America seems to be decaying from the inside out. Ya'll don't need any more wars, your country is literally consuming it's self.
    All truth passes through three stages:

    First, it is ridiculed.
    Second, it is violently opposed.
    Third, it is accepted as self-evident.


  2. #42
    Senior Member jyng1's Avatar
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    Quote Originally Posted by starla View Post
    As for drug prices in the US vs. the UK, private insurance companies can negotiate prices with pharmaceutical companies, so I have no idea why Americans are paying so much more, or if that only applies to medicare patients and our insurance companies are paying prices similar to foreign governments. I do know that the UK and a lot of other countries approve drugs for their citizens based on cost per QOL (quality of life) year. So if a drug is too expensive and can't prove survival benefit, or the benefit isn't that great, or the side effects are detrimental to quality of life, the NHS doesn't provide the drug. (Patients in the UK cannot get the drug I'm on.)
    If there's a choice you won't get the branded drug either. If the patent has expired, you'll get a generic. Trade talks with the US always includes extending drug patents. We're having a bit of an issue with an epilepsy drug at the moment where Pharmac says the generic is identical to the branded drug but the epileptics aren't buying it. Pharmac's 2018/19 budget was NZ$985 million (NZ223 per capita). Total Health budget was NZ$19.871 Billion (NZ$4,516 or US$2,990 per capita). It was US$10,224 per capita in the US in 2017.

    Here, everyone gets treated the same. If there's a financial barrier the Government attempts to remove it. We try (unsuccessfully) to have similar health outcomes for the whole population.

    I get the impression in the US, quality of treatment depends on how much money you have.

    Quote Originally Posted by starla View Post
    I think our biggest problem over here though is lack of access and poor lifestyle choices - basically our system favors treatment over prevention. It is quite obvious that prevention is cheaper than treatment. It is cheaper to change your oil every 5000 miles than to replace your engine when it locks up.
    It's the same in all English speaking countries. We walk an average of 8 minutes a day; there are fast food places lining the streets on peoples way home from work and we have the second highest rate of car ownership in the world. Lack of physical activity kills 2,500 people a year (compared to 9,000 smokers). 9 men die every day from heart attacks.

    There was an article in the Guardian last week which said that people who do the basics (30 minutes moderate exercise a day, no smoking, moderate drinking etc) will live on average a decade longer than those that don't.

    In the US alcohol related deaths have doubled in the last few years to ~73,000, still slightly ahead of opioid deaths. Apparently increasing minimum wage by a dollar reduces suicide rates quite a bit... There are quite a few things that can easily be done to promote public health but some people will fight those initiatives literally to the death (bike lanes for instance provoke a level of rage in a not insignificant portion the population).

  3. #43
    Senior Member Sinny's Avatar
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    I hate cyclists on the road... I don't get why they don't just use the footpath.

    Was stuck behind some dickhead the other day in his high vis & flashlights, taking up half the road. The path next to the road was totally clear and he could have just peddled on that. The speed people go on the roads could easily be matched on the pavement. So I don't see why they need to song & dance about it. Get out the fucking way! Lol.

    Rev pointed out that it's "illegal" to ride on the path, yeah well that may be the case, but who the fucks enforcing it? No one!
    All truth passes through three stages:

    First, it is ridiculed.
    Second, it is violently opposed.
    Third, it is accepted as self-evident.


  4. #44
    Senior Member jyng1's Avatar
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    Quote Originally Posted by Sinny View Post
    Rev pointed out that it's "illegal" to ride on the path, yeah well that may be the case, but who the fucks enforcing it? No one!
    And yet, here in 2013 there were 1,043 people fined for riding on the footpath (and 10,800 fined for no helmet).

    Not as hard to understand as the 223 pedestrians fined for walking on the motorway.

  5. #45
    Senior Member Sir Caveat's Avatar
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    Quote Originally Posted by Sinny View Post
    I hate cyclists on the road... I don't get why they don't just use the footpath.
    I empathize with you.

    It does tend to be quicker for bicyclists on motorways than on mixed used paths and sidewalks, but at the cost of slowing down motorists. Bicyclists need to slow down (at least intermittently) on mixed used paths and sidewalks to safely share the path with pedestrians.

    Except in a business section of DC where bikes aren't permitted on the sidewalks, they're permitted on motorways, mixed used paths, sidewalks and of course on bike lanes.
    You hide behind caveats and modifiers. - Lurker

  6. #46
    Senior Member jyng1's Avatar
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    Quote Originally Posted by Sir Caveat View Post
    they're permitted on motorways,
    A Motorway is the English term for a Freeway.

    Here you're not allowed to bike on a motorway... and you're not allowed to bike on the footpath...

    That leaves the road.

  7. #47
    Senior Member Sir Caveat's Avatar
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    Quote Originally Posted by jyng1 View Post
    A Motorway is the English term for a Freeway.
    Thanks for pointing that out. I meant motorway as in where motorized vehicles (such as cars, motorcycles and trucks) can travel.

    Here you're not allowed to bike on a motorway... and you're not allowed to bike on the footpath...

    That leaves the road.
    Here bicyclists are freer to choose where they ride. Helmets are also optional for adults.

    Though the DC law does have some prohibitions such as the limited area where you can't ride on the sidewalk. I also recall a prohibition against biking on limited access highways. I've never seen a bicyclist braving the lanes of the DC Beltway, 495.
    You hide behind caveats and modifiers. - Lurker

  8. #48
    Senior Member jyng1's Avatar
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    Quote Originally Posted by Sinny View Post
    Was stuck behind some dickhead the other day in his high vis & flashlights, taking up half the road. The path next to the road was totally clear and he could have just peddled on that. The speed people go on the roads could easily be matched on the pavement. So I don't see why they need to song & dance about it. Get out the fucking way! Lol.
    Sinny hating on cyclists as she tries to turn over the top of one...


  9. #49
    Senior Member Sinny's Avatar
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    Quote Originally Posted by jyng1 View Post
    Sinny hating on cyclists as she tries to turn over the top of one...

    Look at all that pavement he could be cycling on! Cunt!
    All truth passes through three stages:

    First, it is ridiculed.
    Second, it is violently opposed.
    Third, it is accepted as self-evident.


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