There must be a pony in here somewhere.

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Re: There must be a pony in here somewhere.

Post by JasonL » 26 Sep 2019, 08:36

Ahh thanks. I was thinking you had to bump to private supplemental because NHS didn't cover it. Gotcha.

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Re: There must be a pony in here somewhere.

Post by Mo » 26 Sep 2019, 08:53

Nope. Always go through insurance first because that's how you get queue skipping powers.
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Re: There must be a pony in here somewhere.

Post by Ellie » 22 Oct 2019, 15:34

Drug company makes a "business decision" to stop manufacturing drug used to treat children's cancer. Outrage!!!! (Even I was outraged when I read about it! Fucking corporations!) But if you read the letter you see a major factor affecting the drug's ability to be profitable is the cap Medicare put on reimbursing for it and other IV drugs like it, and that Europe tends to have fewer problems with shortages of the same drugs than the US because of that. So. Not as straightforward as it seems.

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Re: There must be a pony in here somewhere.

Post by JasonL » 22 Oct 2019, 15:57

One element of the various single payer systems I’m not really clear on is how supply is maintained in a price capped environment.

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Re: There must be a pony in here somewhere.

Post by Warren » 22 Oct 2019, 19:15

JasonL wrote:
22 Oct 2019, 15:57
One element of the various single payer systems I’m not really clear on is how supply is maintained in a price capped environment.
Almost all drugs can be mass produced for pennies a dose. Nearly all the cost is in development and testing. Those costs are recouped in the US while the patent runs. Additional income can be had selling to single payer systems at generic prices. This model requires that re-importation remain criminal.
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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 22 Oct 2019, 19:49

I have no problem with a pharma company making a business decision not to continue manufacturing a drug, but I think that decision should constitute abandonment of the intellectual property. The real problem, which I do lay at the feet of rent-seeking Big Pharma, is getting new manufacturers through the near-endless FDA gauntlet.

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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 22 Oct 2019, 21:37

Warren wrote:
22 Oct 2019, 19:15
JasonL wrote:
22 Oct 2019, 15:57
One element of the various single payer systems I’m not really clear on is how supply is maintained in a price capped environment.
Almost all drugs can be mass produced for pennies a dose. Nearly all the cost is in development and testing.
Nope.
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Re: There must be a pony in here somewhere.

Post by Warren » 23 Oct 2019, 01:13

Pham Nuwen wrote:
22 Oct 2019, 21:37
Warren wrote:
22 Oct 2019, 19:15
JasonL wrote:
22 Oct 2019, 15:57
One element of the various single payer systems I’m not really clear on is how supply is maintained in a price capped environment.
Almost all drugs can be mass produced for pennies a dose. Nearly all the cost is in development and testing.
Nope.
Nope? You just gonna leave it at that?
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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 23 Oct 2019, 06:39

You made a blanket statement with no background information or experience. I did as well but I have actual background info and experience in that area. Are we gonna do this?

There are a lot of meds that can only be made with a high upfront production cost. Clotting factors, hormones, and anything with antibodies. It's the main reason antivenom is so damn expensive. Theres a lengthy supply chain with some serious time and education requirements.
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Re: There must be a pony in here somewhere.

Post by Warren » 23 Oct 2019, 10:49

Pham Nuwen wrote:
23 Oct 2019, 06:39
You made a blanket statement with no background information or experience. I did as well but I have actual background info and experience in that area. Are we gonna do this?

There are a lot of meds that can only be made with a high upfront production cost. Clotting factors, hormones, and anything with antibodies. It's the main reason antivenom is so damn expensive. Theres a lengthy supply chain with some serious time and education requirements.
I would not make any claims to being an expert, but drug costs are an issue I've been interested in for some time. I consider myself "well read" on the subject. When you mentioned antivenom I was like Oh Right. But I didn't know about clotting factors and I actually thought hormones were mass produced from South American cabbage flowers or some such.
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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 23 Oct 2019, 14:20

Warren wrote:
23 Oct 2019, 10:49
Pham Nuwen wrote:
23 Oct 2019, 06:39
You made a blanket statement with no background information or experience. I did as well but I have actual background info and experience in that area. Are we gonna do this?

There are a lot of meds that can only be made with a high upfront production cost. Clotting factors, hormones, and anything with antibodies. It's the main reason antivenom is so damn expensive. Theres a lengthy supply chain with some serious time and education requirements.
I would not make any claims to being an expert, but drug costs are an issue I've been interested in for some time. I consider myself "well read" on the subject. When you mentioned antivenom I was like Oh Right. But I didn't know about clotting factors and I actually thought hormones were mass produced from South American cabbage flowers or some such.
I'm not up on the cabbage thingie but there are a lot of synthesized meds these days. Demand isn't huge and you have s&p to maintain. Daptomycin is 500 a pop. Costs around 200 to make though as apparently the conditions for its production are something requiring a ton of education and production controls. Then you got things like vasopressin where you can arguably mass produce it cheaply but its half life is so short no one wants much of it. Its complicated once you get away from the top 200 most common drugs.
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Re: There must be a pony in here somewhere.

Post by Warren » 23 Oct 2019, 14:52

Pham Nuwen wrote:
23 Oct 2019, 14:20
Demand isn't huge and you have s&p to maintain.
I don't know what s&p means in this context.
The thing about demand though, is one of the reasons the pharma will sell wholesale to Europe, Canada, and others. Being able to mass produce brings per unit down and improves the profit on US retail sales.
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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 23 Oct 2019, 15:23

Pharma companies will argue that it's a mixed bag: that, yes, the marginal cost of production of many of their products approaches zero after recouping R&D and other expenses but that their profit margins go to research for new products and to help recover from R&D sunk costs for failed products. Variable pricing is hardly confined to the pharmaceutical industry but, yes, compared to the rest of the developed world, U.S. pharma customers bear an untoward percentage of those companies' profits.

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Re: There must be a pony in here somewhere.

Post by Dangerman » 24 Oct 2019, 11:46

Warren wrote:
23 Oct 2019, 14:52
Pham Nuwen wrote:
23 Oct 2019, 14:20
Demand isn't huge and you have s&p to maintain.
I don't know what s&p means in this context.
The thing about demand though, is one of the reasons the pharma will sell wholesale to Europe, Canada, and others. Being able to mass produce brings per unit down and improves the profit on US retail sales.
Standards and practices lol.

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Re: There must be a pony in here somewhere.

Post by lunchstealer » 01 Nov 2019, 16:11

So here's a comment I posted to someone's FB post about Warren's Medicare-for-All plan which includes, if I read it correctly, a 6% wealth tax on assets above $1B.
Wealth taxes strike me as deeply awful. It's not like that wealth is a big room full of gold coins that Scrooge McDuck can go swimming in. It's often the 'paper' value of their company and other investments that could quickly shift in price. If Bezos is worth $250B because of the super high Amazon stock price, and he has to sell 6% per year to pay the taxes on it, now huge amounts of that stock have to be liquidated. Liquidating too much of an asset pushes the value of that asset down. If there isn't demand for 6% of the AZN stock he has to liquidate, the price of that stock has to drop, and all of a sudden that 6% tax creates an on-paper loss for Bezos of maybe 15% or more. And everyone who already owns AZN stock also takes that price-cut loss. So the wealth tax ends up reducing the wealth of a lot of not-billionaires, including all our 401ks and Roth IRAs and mutual funds and anything else we've been doing to try and have a not-cat-food retirement.

I'm not an expert so someone could convince me that that wouldn't happen, but I'd want to see someone professional and not-Krugman/Rubin lay it out with some real numbers.
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Re: There must be a pony in here somewhere.

Post by Aresen » 01 Nov 2019, 16:29

I think you're right, but I'll leave it to Mo to confirm.

A bigger problem would be capital flight and the massive hit every pension fund would take. (Pension funds are generally exempt from such tax, but the hit to the market value of the pension fund holdings would make most of them technically insolvent.) There would also be a problem for anyone who wanted to go public as it would leave them open to a huge tax liability from the moment of the IPO.

6% is also the highest rate I've ever heard of for a wealth tax. It's more than 3 times the highest rate on the (former) French wealth tax.
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Re: There must be a pony in here somewhere.

Post by Mo » 01 Nov 2019, 17:04

Amazon’s average daily volume is 3.2 million shares a day. At its current price, that means over 5.7 billion dollar of Amazon is changing hands every day. Bezos selling 6% of his wealth annually ain’t going to scratch the surface of that. The bigger issue is private, illiquid companies like Koch. 1st how do you value them, second, how do you pay taxes on it. Also, 6% is way to high. You can make a defensible case for 1-2% tops, but 6% is bonkers.
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Re: There must be a pony in here somewhere.

Post by Warren » 01 Nov 2019, 17:09

Like all Eat The Rich tax plans, it stupidly assumes the rich will just roll over and take it up the ass so the rest of us can feast on their carcass. Uh, sorry for that image. What was I saying? Oh yeah, nobody is going to pay that tax because they're going to arrange their finances in some way to avoid it. One of the results being that, as you say, they don't hoard their precious in a Scrooge McDuck vault, a lot of it is invested in stocks. Which is how companies raise capital to grow their business. Which means once the tax goes in place, investment in the economy will shrink (and ironically, hoarding wealth in the form of gold will actually grow), fewer people will be employed, and we'll all have to roll over and take it.

It's fundamentally stupid to think that you can change the rules to make rich people pay for everything. Rich people didn't get rich by writing a bunch of checks. And when you go after their wealth they're going make the less well off pay for it one way or the other.
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Re: There must be a pony in here somewhere.

Post by Mo » 01 Nov 2019, 17:12

The most realistic part is increasing IRS enforcement budget.
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Re: There must be a pony in here somewhere.

Post by Eric the .5b » 01 Nov 2019, 22:34

I think my favorite individual item on the list was people will get more take-home, so we'll get more income tax revenue.

So many trillions of dollars raised to cover the plan by the plan itself working fantastically and fixing all our problems. So much, "Oh! and that'll give us this many trillions..." that I wonder how many people really read it with a straight face*.




* People who read it with their mouths moving don't count.
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Re: There must be a pony in here somewhere.

Post by lunchstealer » 02 Nov 2019, 02:58

Mo wrote:
01 Nov 2019, 17:12
The most realistic part is increasing IRS enforcement budget.
This was my thought as well. Increasing enforcement budgets on Medicare and Medicaid would also be a good plan.
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Re: There must be a pony in here somewhere.

Post by JasonL » 02 Nov 2019, 10:59

The wealth tax is cosmetic. You can’t raise real money for forever programs with a wealth tax and further you don’t want to make your entire national health plan collapse if 1,200 or so households change their behavior. Or if assets swing in valuation. You get flight of the targeted groups. Ok so she does the exit tax thing. What if any people take her up on it? Any at all? It’s 1,200 households total. She’s doing no exemptions for artwork and diamonds and such. Ok. The government valuation service needs to get ramped up. Administration costs are very high. All this and these things don’t raise actual material revenue. They never have anywhere they’ve been tried. It’s aesthetics.

The other component of her plan is that employer Medicare contribution. That’s a tax per head, it falls on employees in large part sorry that’s just how it works. This part will raise money but will function like payroll taxes in calculations of total labor cost.

The biggest hurdle to me is the presumption she’s using for savings by way of price caps. I agree that US providers make way more than comparable providers in other countries. Realistic would be holding increases down or slight decreases in payments. She’s taking a chainsaw to total provider compensation so she can say this isn’t a $30 trillion nut. How are providers going to react? Basically this.


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Re: There must be a pony in here somewhere.

Post by Mo » 02 Nov 2019, 19:40

You can pull off a wealth tax at 2% for HNWs. 6%? NFW
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Re: There must be a pony in here somewhere.

Post by Eric the .5b » 02 Nov 2019, 20:47

I kinda think this proposal is just an Overton window thing, since she's got a "transition plan" in the works that supposed to be more palatable to the non-fully-automatic-Communism crowd.
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Re: There must be a pony in here somewhere.

Post by JasonL » 02 Nov 2019, 21:24

Mo wrote:
02 Nov 2019, 19:40
You can pull off a wealth tax at 2% for HNWs. 6%? NFW
You can, but even the 2% versions don't have any record of actually raising money net of administrative costs. It's either just cosmetic or full 'tard and cosmetic.

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