24 July 2015

Pay Me Now and Pay Me Later

It bears repeating: given enough time and further concentration, even the 1% will need ObamaCare in order to afford decent health. In the course of musing on said subject, I coined (so far as I know) the phrase "the tyranny of average cost" to immortalize the issue. If a given widget, which has either high capital production cost, or high fixed capital cost (get it?), there result in two alternatives: shift widgets to as many users as possible, or gouge a tiny number of users. Either way covers the capital cost.

It also bears repeating: data is the result of motive and incentive, so in predicting the future one has the best chance by following the water downstream than by looking back at where it came from. And so it is.

Pharma has been under some pressure to justify the increasingly high price tag of recent drugs; many in oncology. Today's news brings some more facts to the discussion. Not everyone, including humble self, buys the notion that it takes billions of dollars of direct R&D to make a drug. But that has been the standard excuse from pharma.
The past R&D cost is really kind of a red herring," said Len Nichols, a health care economist at George Mason University, referring to research and development. "The current revenue doesn't pay for past R&D; it pays for current R&D."

It should be noted that GMU is the token right-wing seat of academe in the Capitol area. What's telling, and not mentioned, about the observation is that this is exactly the funding model used by Social Security. I guess it's premitted for big business, but not public business. (Aside: today also brings a piece on American socialism, as it actually exists; yes it does exist and you've read much of it here before.)

Another point ignored in the piece is Pharma's hard on for orphan drugs. FDA's acceptance of an ODD means that the company can pretty much charge whatever it wants pretty much forever. Here's a piece from a normally right-wing organ questioning orphan drugs.
Leonard Nimoy now rests in peace, dying of complications from Chronic Obstructive Pulmonary Disease, a condition he shared with 10 million other U.S. citizens. Too bad drug developers and investors haven't been busy pursuing drugs for debilitating conditions affecting millions of Americans, instead of pseudo-orphan drugs.

One of the benefits of procrastination (this missive was to be posted yesterday) is that new information can be included. And so it is. Today's news relates to specifics of Pharma, the HepC fiasco now ongoing. Two points that gain confirmation here.

First, a "cure" for HepC infection that's quick, easy, and painless just encourages drug shooters to keep shooting with dirty needles, as predicted in these musings. Many (most? all?) HepC patients are drug shooters. 1992 is the cutoff date for innocent infection, from transfusion.
Zach Wayman says he first contracted hepatitis C several years ago by sharing needles with other heroin addicts. He went into rehab and was successfully treated for the virus. But he relapsed into addiction and reinfected himself, testing positive for hepatitis C again this spring.

And, of course, HepC is centered in Red States, God's country, gun country, keep the Damn Gummint out of my life country. Of course, many (most? all?) of those getting HepC treatment are Medicaid folks. Poor folks. The 47%. And Right Wing, still.
In May, the Centers for Disease Control and Prevention reported a sharp increase in reported cases of hepatitis C among young adults in Kentucky, Tennessee, Virginia and West Virginia. While rates of acute hepatitis C, which is very costly to treat, have risen around the country, Kentucky's rate was more than seven times the national average.

Second, so, who pays? If one follows the money, those Blue State Damn Liberals, of course. Just as they send all kinds of other money to Red states.
The cost of the new hepatitis drugs is so high that state Medicaid programs and many private insurers say that even treating a fraction of the infected population is breaking the bank.

Medicaid, funded nationally in effect, picks up the cost. Not that the Right Wingnuts would ever admit it. Of course.

The real irony, for those who like it:
Karen Ruschman, a nurse practitioner at a private gastroenterology practice here, said many young adults with hepatitis C have not been able to quit heroin because treatment programs, especially those using Suboxone, a medication that suppresses opiate cravings, are expensive and hard to get into. Addicts typically "can buy heroin cheaper than they can get into a Suboxone clinic," Ms. Ruschman said.
[my emphasis]

Perhaps we should just pay the drug dealers to develop drugs?

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