And more things Medicare-for-All won't cure--yet.
Bibliography of Alligator Ed's medical essays, in order of publication:
Bad news for Medicare, good news for Big Pharma
Big Pharma lacks shame and guilt.
Mixing medicine and politics; the gender flap.
Mixing medicine and politics: conspiracy theories.
Hillary's health plan, annotated version.
Dr. Emmanuel's ACA emergency cure for ACA disease.
ACA's death by exsanguination.
Hippocrates and the Price of hypocrisy.
MJ: light up or leave me alone.
One of the things Medicare-for-All won't cure.
Letter to my CongressCritter on Healthcare.
Response from CongressCritter re MFA/SP.
Two more things MFA won't cure.
Another CA Dim against single payer.
Above are listed my medical-related essays, for those who like the complete bibliography of such matters. You will see listed several essays about things Medicare for All won't cure. And here is another one. The issue discussed in the first article about MFA weak points concerns administrative burdens imposed by all insurance entities, including Medicare.
The second article concerns several issues, of which two stand out: telemedicine plus/minus robotization and MOC (maintenance of certification).
This essay presents yet another issue which might be curable but the cure is doubtful, even with full implementation of MFA/SP. The example quote here is applicable to many conditions other than today's exemplar: sleep disturbances including obstructive sleep apnea (OSA) and narcolepsy. OSA is widely prevalent. Treatment is usually efficacious although compliance is a frequent problem. Compliance issues can be overcome with counseling and treatment modification. But at least 10% of OSA patients compliant with treatment will still have excessive daytime sleepiness (EDS). This 10% incidence doesn't count people with co-morbid narcolepsy or other problems with sleep besides OSA. Then there comes a very significant yet under-diagnosed condition caused narcolepsy. Narcolepsy is strongly determined genetically, becoming clinical depending upon environmental factors not yet understood. However, more patients have narcolepsy undiagnosed than diagnosed. Proper medication for narcolepsy can reduce or eliminate symptoms entirely, but here too are cases of EDS which often require pharmacologic treatment.
Catch 22:
Even under Medicare, the government, as well as private insurers require a treatment algorithm before a practitioner can utilize certain tests or certain treatments. These requirements are much more stringent for Medicaid rather than Medicare patients.
For many years, the standard of care for narcolepsy were stimulants such as amphetamine or methylphenidate. These drugs are no longer first line in treatment of narcolepsy or OSA-associated EDS. They have been replaced by more specific drugs with less adverse effects: modafanil and armodafanil. But here's the rub: while more efficacious and safer, armodafanil and modafanil are also costlier than the stimulants previously used.
So patient and doctor have to navigate hurdles. These hurdles are that modafanil/armodafanil will not be authorized unless the victim patient undergoes the cheaper treatments first. Cheaper is not better--it is just cheaper. And these cheaper treatments are fraught with serious side-effects, including hypertension, cardiac arrhythmias, stroke (ischemic and hemorrhagic), to name a few.
What about the FDA you ask? The FDA says only that modafanil/armodafanil are first-line drugs to treat the two conditions mentioned above: narcolepsy and OSA-EDS. Yet private AND government payers will not authorize the safe, more specific drugs without a trial of the cheaper drugs--even though the FDA does not recommend this and the risk factors exclude certain patients and pose risks to other patients.
If you think that only private insurers entertain this expense-cutting measure, you would be wrong. Government does this too--even at the possibility of causing more expensive-to-treat complications.
There may be a solution to this, requiring two steps (possibly more depending on non-medical considerations):
1. MFA/SP regulations must ensure that FDA-approved safer, more specific medications be prescribed even if more expensive. This sounds pretty simple in the conditions outlined above; but consider the more complex diseases such as treatment-resistant auto-immune disorders (BTW, narcolepsy has an auto-immune basis) or metastatic cancer.
2. Big Pharma must be strictly controlled. These rapaciously priced products must be brought down so as to assure a reasonable profit, say 10%. This will not eliminate the price differential in certain classes of drugs, particularly the biologics, but it will help.
Unless MFA/SP incorporates at least these two suggestions, such illogical and potentially dangerous devil's bargains will continue.
Comments
Here's a link you might find interesting Gator
https://www.sciencealert.com/more-than-30-000-scientific-studies-could-b...
I never knew that the term "Never Again" only pertained to
those born Jewish
"Antisemite used to be someone who didn't like Jews
now it's someone who Jews don't like"
Heard from Margaret Kimberley
Ouch!
This is absolutely dreadful. Who knows how many pharmacological candidates were inadvertently neglected because of insecure cell lines. And, equally as bad, how many drugs have been approved because they were developed on contaminated cells.
Obviously another meta-analysis is needed to determine the probable size of this potentially devastating effect.
Thanks for the link.
When I began my research career...
We were experimenting with no-till agriculture. Almost all the farmers tried to explain to us why it wouldn't work. The lead scientist had a great line...our job is to figure out how to make it work. I think it is the same thing with healthcare.
I like the nationalized approach in the UK...but they've undermined it with under-funding. Regardless of the system there will be those profit mongers who will do everything possible to crash the system. Like in my state (and yours?), we refused to take our free share of expanded medicaid money...absolutely insane. Purposely crashing the system and preventing poor folks from having access to care.
Perhaps we must first destroy capitalism (or at least take profit out of healthcare) before any sane system can be established.
“Until justice rolls down like water and righteousness like a mighty stream.”
Governor Moonbeam would never pass up the money.
Why not allow Medicare
to negotiate the cost of drugs with Big Pharma as they do in other countries?
Seems like a better system than the one we have now where Medicare cannot.
"You can't just leave those who created the problem in charge of the solution."---Tyree Scott
This was implicit in my statement
Why not make
drugs a public asset if it is funded by the taxpayers? Government fund so much drug research; I wonder how much of it goes to private firms.
dfarrah
This might new tricky to enforce
Lots of government funding goes to universities, medical schools, non-profit research institutions etc. This funding does not in most cases pay for all developmental costs. Of course Big Pharma pays the majority of drug research. Nationalizing pharmaceutical research would be a disaster. Government has never been good at honest creativity. This isn't as simple as nationalizing the railroads or oil companies.
Big pharma does not . . .
pay for the majority of research costs. The government does. Big pharma does pay for most of testing and development, which are expensive. But big pharma spends more on advertising than on development and testing.
All traditional Medicare D & Advantage programs prescription
drug use is controlled by insurance companies and PBMs (prescription drug managers). The only program not controlled by one of these these two groups is the VA (veterans administration) which has its own issues of treatment controls. Medicaid varies from state to state regarding the level of involvement of PBMs and insurance companies.
Part of the problem is the multi-level involvement of different parties trying to extract maximum profit. Creating fewer levels and regulations provide short term relief, until new loop holes are discovered. If is very frustrating to see individual have to jump through the hurdles to receive effective treatment, only to change insurance companies and have to jump through them again.
Somehow a fundamental shift in valuing patient outcomes and quality of life vs profit needs to occur.
A couple of Open Threads discussing prescription prices and drug usage.
How drug prices are kept high by delaying generics, expiration dates and PBMs.
Manipulation of drug use and price in the market place.
Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.
About expiration dates
In studies of 30 year old medicines found by chance in a forgotten drug closet, potency was tested for the various compounds. Some had lost 30% of potency in 30 years and others only 20% or less. The US Air Force performed a study about drug potency after an interval of 5 years plus and found the average loss of potency was 1% or less.
Shortening drug expiration dates artificially is an unsound economic move in my opinion. Another example of governmental hypocrisy at work here: FDA forbids the dispensation of "expired drugs" (which as mentioned above are still fully potent) by private practitioners and pharmacies to dispose of perfectly good pharmaceuticals. There are penalties for those entities not to do so. Yet the VA and other governmental agencies are allowed to dispense these so-called out-dated drugs.
Expiration dates are an artificial construct having no bearing in reality. They exist solely to churn pharmaceutical sales, hence profits, via the complicity of Big Pharma and Uncle Sham.
Ironically in my state
one of the few duties that may not be delegated to a technician is checking if a drug is expired. It takes a University degree in pharmacy and passing board test to understand if a drug container with an expiration date of 09-30-2017 is safe to dispense, use or needs to be removed from an emergency box or treatment tray.
Still yourself, deep water can absorb many disturbances with minimal reaction.
--When the opening appears release yourself.
This is the standard bureaucratic brushoff
It goes like this (pardon my paraphrasing but I cannot tell a lie!): "You [sir, madame, miz, whatever] are an uneducated oaf. You have not spent years in college with professional skills in this field; you have no degrees and are basically too effing stoopid to understand with your serf-mentality what we exalted beings are telling you. You think you can read that label? No you can't. It takes considerable knowledge, which you did not obtain in primary grades (e.g., reading) of schooling. Now piss off!"
On expiration dates...
I was part of a group of healthcare folks that went to El Salvador several years back as part of a health "mission". It was more of a social community exchange in the end. "I see you. I care about you. Let's share food. Oh, let's deal with your abscessed tooth too."
All drugs, vitamins included, that we took with us had to have an expiration date 6-12 months out (I don't remember which). It is understandable on the one hand, no one wants to feel like they are getting expired medicines dumped on them. But, chemically it made no sense. Probably a third of donated drugs couldn't be taken with us because of expiration dates.