Category Archives: Health Care

The health of our citizens

Insane Drug Prices

How Prices for the First 10 Drugs Up for U.S. Medicare Price Negotiations Compare Internationally

Image, view of pharmacy with people outside

View of a Paris drugstore on June 29, 2019. Americans pay more for brand-name prescription medications than do residents of most other countries, with per capita spending on pharmaceuticals nearly three times the average of the other member nations of the Organisation for Economic Co-operation and Development (OECD). Photo: Edward Berthelot/Getty ImagesToplines

  • Prices for 10 drugs commonly prescribed for millions of older Americans are, on average, three times higher than prices in other high-income countries
  • Even after price rebates and discounts, Americans pay significantly more for brand-name drugs than people in most other countries — leaving room for further reductions in upcoming Medicare drug price negotiations

Authors

Evan D. GumasPaige HuffmanIrene PapanicolasReginald D. Williams IIDownloads

  • Americans pay more for brand-name prescription medications than do residents of most other countries, with per capita spending on pharmaceuticals nearly three times the average of other member nations of the Organisation for Economic Co-operation and Development (OECD). In 2022, high costs forced one of five U.S. adults age 65 and older to skip or delay filling a prescription, miss or reduce doses, or use someone else’s medication. More than half of patients resort to cost-coping strategies like coupons or free samples so they can get the medications they need but cannot afford. Such stopgap measures can have particularly serious consequences for older people who rely on medications to control chronic health conditions.

The 2022 Inflation Reduction Act (IRA) has empowered the Centers for Medicare and Medicaid Services (CMS), for the first time, to negotiate prices on behalf of Medicare for a small group of prescription drugs. Negotiations for the first 10 drugs will begin in February 2024, with price changes taking effect in 2026. This will increase to 15 additional Medicare Part D drugs in 2027, up to 15 Parts B and D drugs in 2028, and up to 20 drugs in subsequent years. These price negotiations are projected to save the government $100 billion through 2031, savings that will go in part toward funding an important but costly provision of the IRA that caps Medicare beneficiary spending for Part D drugs at $2,000 per year, starting in 2025.

The first 10 drugs to be negotiated by Medicare — used to treat conditions like blood clots, diabetes, and autoimmune disorders — were selected because they account for a significant portion of Medicare Part D spending. They meet key criteria set by the IRA for negotiable drugs: 1) no generic versions available, and 2) they are either small-molecule drugs that have been on the market for at least seven years or biologics that have been on the market for at least 11 years.

Understanding drug pricing and policy in peer countries — where drug use is similar but costs are lower — is important for benchmarking drug affordability going into the negotiation process. In the following charts, we look at list retail prices, which are prices charged by pharmacists to patients or insurers before any discounts, rebates, or other price reductions. List prices are a standard in international drug-pricing comparisons because of the lack of reliable data on net drug prices, which are prices that include rebates and discounts. Because of the exclusion of discounts or rebates, list prices likely overstate the prices paid by patients and insurers. But because list prices are set before country-specific discounts or rebates are applied, they are some of the only data points that can be systematically compared between countries. They are also the basis for discount negotiations. For drug prices in the United States, we also estimate net prices based on publicly available, therapeutic, classwide rebate estimates.

See link below for the entire article. It is long but very informative and frightening. This is another example of a “hidden tax” for Citizens of the USA.

https://www.commonwealthfund.org/publications/2024/jan/how-prices-first-10-drugs-medicare-negotiations-compare-internationally

What Voters want

What Voters want but Congress will never approve:

 Almost 100% of voters want lower health care costs. Per Capita Healthcare costs are the highest in the world, despite not being even close to the best. In the USA about 1/3 of the costs are paid by the Government (Medicare & Medicaid), 1/3 by companies via benefits, and 1/3 by patients in the form of deductibles, premiums, and co-pays.

The issue that we have failed to address is the COST of Healthcare which is more than double the EU average. As of 2023, our per capita cost stands at over $13K. Compare this to many other “developed” countries, chart below:

Location20182019202020212022
 United States10,44710,85311,91612,19712,555
 Canada5,3375,2235,8796,2786,319
 Denmark5,3075,3605,6976,3726,280
 New Zealand3,9134,2504,4694,9216,061
 Ireland4,8774,9765,3785,8616,047
 Finland4,3304,3844,6155,2525,676
 United Kingdom4,1884,3894,9985,4675,493
 Iceland4,2364,3184,6325,1075,314
 Japan4,5544,6114,6204,8995,251
 South Korea3,0673,2913,5904,1894,570
 Czech Republic3,1293,2723,8044,3034,499
 Spain3,4273,5283,7164,0874,462
 Italy3,4963,5653,7534,0434,291
 Portugal3,1343,2243,3553,8304,162

Numerous political contributors have their hands in the bountiful healthcare pie: The Drug Industry, the Legal industry, physicians, hospitals and the Insurance Industry. In addition, the structure of the system is inefficient and broken. Solutions are available but they would significantly reduce political contributions.

Support for Term Limits is universal among voters and breaches political, geographic and demographic divides. Eight-in-ten voters, 80%, approve of placing term limits on members of Congress (House & Senate).

Campaign Spending ((70 – 85%) [depending on the party] of campaign financing comes from either a small number of large amount contributors or from Political Action Committees. PACs are controlled by special interest groups. Special interest groups have a very targeted agenda and often it is not one that benefits the common good.)    Most Americans favor spending limits for political campaigns. Roughly seven in ten U.S. adults (72%) say that there should be limits on how much money individuals and organizations can spend on political campaigns. Just 11% say individuals and organizations should be able to spend as much money as they want, 

  • Two in three Americans — 65% — say that they trust the government less because big donors to Super PACs have more influence than regular voters. More than two-thirds of all respondents — 68% — agreed that a company that spent $100,000 to help elect a member of Congress could successfully pressure him or her to change a vote on proposed legislation. Only one in five respondents disagreed.
  • More than three-quarters of all respondents — 77% — agreed that members of Congress are more likely to act in the interest of a group that spent millions to elect them than to act in the public interest. Only 10% disagreed.
  • Americans overwhelmingly say that the cost of political campaigns makes it hard for good people to run for office. More than eight in ten Americans (85%) say this is a good description of the U.S. political system today, including identical shares of Republicans and Democrats.

 The Majority (60%) of voters favor the popular vote over the Electoral College for Presidential Elections. The EC fails to provide “proportional” representation.

I could not find research on Congressional perks, but a vote around our “coffee club” table was unanimous. Members of Congress should receive the same vacation, healthcare, and all other benefits as the rest of Government workers.

Again, I was not able to find online research regarding Political Lobbyists, but If I was king, they would be outlawed.

One other issue I could find not polls on was the length of time allowed for campaigning for national elections. Again our coffee club was unanimous that campaign periods need to be restricted (shortened). My suggestion would be 3 months.

One final issue is the so-called “Flat Income Tax”. Not surprisingly, the consensus among voters has not been favorable. Democrats are less favorable than most on this because proposals have advanced a very “regressive” approach which places an increased burden on the lower and lower to middle Income earners. The solution to this is simple, initiate 3 to 5 flat tax brackets based on Gross Income with higher income earners paying a higher %. All itemized deductions would be eliminated. Only short-term capital gains would be taxed at the same rate as income. Long Term Capital Gains and Dividends would not be taxed.

An example of a married couple filing jointly (% are just suggestions):

Income range                      Flat Tax Rate

$40,000 – $99,999                  5%

$100,000 – $249,999         10%

$250,000 – $499,999         15%

$500,000 – $999,999         20%

Over $1,000,000                25%

The economic benefits of this approach are enormous. It would eliminate costs for activities that do nothing to advance productivity. The IRS could be reduced by more than 80%. About 90% of taxpayers would no longer be required to file a return as their tax would be paid automatically by payroll deduction.  Tax preparation costs would be almost eliminated.

One final comment. House members are elected for only two years which I propose is ridiculous. Staggered four-year terms (one-fourth of the positions each year) would be much more productive for our country and save millions of dollars.

Die Glocke and the Acorn

The Kecksburg incident, a Pennsylvania UFO mystery, has intrigued many. On December 9, 1965, thousands of people across six U.S. states and Ontario reported seeing a fireball streak across the afternoon sky. In Kecksburg, Pennsylvania, residents witnessed a crash in the nearby woods. U.S. military personnel swiftly arrived, sealed off the area, and allegedly removed a large object on a flatbed truck. Official statements attributed the fireball and crash to a mid-sized meteor, denying any recovery from the woods.

However, witnesses who arrived before the military described seeing a bronze-colored, acorn-shaped object roughly the size of a VW Beetle (14’ long and 6 ‘ wide)

. This mysterious object bore markings resembling Egyptian hieroglyphics. Spectators were forcefully turned away by armed military personnel when they tried to approach the site for a better look. Stories circulated about Men in Black-style officials warning Kecksburg residents to keep quiet about what they saw.

The Kecksburg mystery has spawned various theories, including:

  • Alien spacecraft: Some believe it was an extraterrestrial vehicle that landed in the woods.
  • Russian satellite debris: Others posit that it was a piece from the spacecraft Kosmos 96, which reentered Earth’s atmosphere that same day after a failed attempt to reach Venus.
  • Misfired missile or time-traveling Nazi aircraft: These theories add to the intrigue surrounding the incident.

A particularly sinister aspect involves reporter John Murphy, who arrived early and claimed to have taken photos of the object. His radio documentary, titled “Object in the Woods,” described what he saw and his subsequent investigation. However, government officials allegedly confiscated his photos, and

the edited version of the documentary omitted any mention of the mysterious object. Tragically, Murphy died in an apparent hit-and-run accident while vacationing in California.

It was reported that Die Glocke was bell-shaped, about 4 meters (13 ft) high and 3 meters (9.7 ft) in diameter, and incorporated “two high-speed, counter-rotating cylinders filled with a purplish, liquid metallic-looking substance that was supposed to be highly radioactive, code-named ‘Xerum 525.'”