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Old 04-26-2018, 06:01 AM   #101 (permalink)
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Oh it's not a panacea by any means. When you need a freaking doctor because your heart is having conniptions you aren't in any position to comparison shop, and complicated procedures are more like the electrical work you get a quote for and you absolutely don't have time for that BECAUSE DYING RITE, but so long as it's supposed to be a "marketplace" which is the whole argument for the whole patchwork of insurance companies mess we have it needs at a minimum the same kind of transparency you get from, you know, an actual marketplace.
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Old 04-26-2018, 06:56 AM   #102 (permalink)
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That said, as a former retail employee, I can really emphasize how much doctors and hospitals must dread having to explain to patients why their open heart surgery costs more than that low number they saw online for a bypass.
Growing up in a state without a sales tax I was completely befuddled on moving to a state with one. This was as a college student, so of course I was counting every penny at first. I wound up deciding the actual price was the posted price and a bit more.

Going to a restaurant and learning about tipping at about the same time (before that I was usually with my parents at a sit-down restaurant so tipping was something I knew existed but had never experienced much) was another huh moment until I got used to it.
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Old 07-09-2018, 01:33 PM   #103 (permalink)
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Old 07-09-2018, 02:47 PM   #104 (permalink)
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Sure, there's cost-control in publicly funded health care systems, and it works. You know why it works? Because the docs are not piece-workers. They, the nurses and other health-care professionals, the clinics and the hospitals are not paid on a fee-for-service basis.


"This patient needs that treatment" - medical decision made by doctors not bean-counters. No insurance company in the loop trying to avoid paying for it. If the clinic or hospital cannot provide that treatment for any reason whatsoever - and yes, one of them may be budget-related - they immediately transfer you to a place where you can get it. Because there aint no such thing as out of network.



If a new treatment or medication is available for your condition, you don't get denied it because some insurance company decides it's too expensive. Sure, you may get told "no" sometimes but that decision not to include it in the formulary is a medical decision again, made by doctors - and it's not absolute. With clinical grounds to use it, it's covered.


You also don't get folks seeing ads on TV saying "talk to your doctor about ${EXPENSIVE_NEW_THING}" - instead people talk to their doctor about their health issues and if a cheap generic is available to treat that condition the doctor uses it. Drug companies hate that.


THAT is how publicly funded health care keeps the costs down, not by arbitrarily denying care or by fleecing its patients.
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Old 07-09-2018, 03:22 PM   #105 (permalink)
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Bet this governor supported the tax cuts for billionaires and corporations.
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Old 07-09-2018, 04:01 PM   #106 (permalink)
But it refused. <3

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Old 07-09-2018, 04:31 PM   #107 (permalink)
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I couldn't help it - I've just seen so much complete BS spewed about publicly funded healthcare by folks who simply don't know.

My dad was a family doctor in a small shipbuilding town. Until us kids came along my mother worked as a radiographer. I spent several years working for the NHS, around the time that Thatcher had a pretty good try at wrecking it by importing principles from the US system (it still hasn't recovered). My daughter is a doc, in the early stages of the journey to a specialty as an anaesthetist. In the USA the folks I worked for included a major medical equipment manufacturer and a company that supplied billing solutions to healthcare organizations.



So I've seen "under the hood" of both systems, warts and all, and I know which one I'd rather be treated by even before we start thinking about how much that treatment might cost me.
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Old 07-09-2018, 05:08 PM   #108 (permalink)
But it refused. <3

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Old 07-09-2018, 05:40 PM   #109 (permalink)
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A local progressive grassroots organization I've become involved with and volunteer with is holding our first "Healthcare Forum" here in my town on Sunday. We're having a panel of doctors and healthcare professionals to cover 3 different topics with whoever shows up. We've accepted questions in advance to help save time as we only have a 2 hour period for the space.

We're discussing the current situation with protections for pre-existing conditions being in danger, what changes are happening with the ACA and the affect they'll have and Medicare4All, what it is and what it would mean.

We'll be holding another one in August since it's such a huge topic and through our Town Hall meetings we found that it's pretty much THE main topic for most voters.

I'm glad we're doing this. This is important and people need to be more aware. I'm really hoping for a good turnout with a lot of engagement.
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Old 07-10-2018, 08:08 AM   #110 (permalink)
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Sure, there's cost-control in publicly funded health care systems, and it works. You know why it works? Because the docs are not piece-workers. They, the nurses and other health-care professionals, the clinics and the hospitals are not paid on a fee-for-service basis
"This patient needs that treatment" - medical decision made by doctors not bean-counters. No insurance company in the loop trying to avoid paying for it. If the clinic or hospital cannot provide that treatment for any reason whatsoever - and yes, one of them may be budget-related - they immediately transfer you to a place where you can get it. Because there aint no such thing as out of network.
If a new treatment or medication is available for your condition, you don't get denied it because some insurance company decides it's too expensive. Sure, you may get told "no" sometimes but that decision not to include it in the formulary is a medical decision again, made by doctors - and it's not absolute. With clinical grounds to use it, it's covered.
You also don't get folks seeing ads on TV saying "talk to your doctor about ${EXPENSIVE_NEW_THING}" - instead people talk to their doctor about their health issues and if a cheap generic is available to treat that condition the doctor uses it. Drug companies hate that.
THAT is how publicly funded health care keeps the costs down, not by arbitrarily denying care or by fleecing its patients.
This is how my health care in Canada was. Also I had a GP that I could get into within less than two days. I had good "whole human" care.

Here in Florida, there are almost no GPs so getting into one's office in less than a month is next to impossible (that's why there are so many people in ER's). Now it's welcome to "doc in the box" or CVS or Walgreens for flu shots and things like that.

Don't even get me started on most hospital ERs here. You have to go through a cop before you can even get to a triage nurse. I waited six hours in the ER after a grand mal seizure, that would NEVER have happened in Canada.

Cleveland Clinic is better than most so that's where I go but our health insurance keeps getting worse (covers less/higher deductibles) every year with regard to coverage and I don't know how long they will allow Cleveland Clinic.

So yeah - I know which system I'd rather be under too. Health care for the average person is irretrievably broken in the US.

This is the state of hospitals in the US: https://www.cbsnews.com/news/rural-h...atee-regional/

Scam after scam after scam ....
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Old 07-10-2018, 01:05 PM   #111 (permalink)
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Old 07-10-2018, 04:10 PM   #112 (permalink)
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...

Here in Florida, there are almost no GPs so getting into one's office in less than a month is next to impossible
...
This is a part of the problem that I became aware of in the '70's but which I rarely hear discussed.

In the U.S. there aren't enough medical schools. There is a shortage of doctors. And the last thing the AMA wants is to flood the market with new MD's willing to work cheap.
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Old 07-11-2018, 07:41 AM   #113 (permalink)
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Sure, there's cost-control in publicly funded health care systems, and it works. You know why it works? Because the docs are not piece-workers. They, the nurses and other health-care professionals, the clinics and the hospitals are not paid on a fee-for-service basis.


"This patient needs that treatment" - medical decision made by doctors not bean-counters. No insurance company in the loop trying to avoid paying for it. If the clinic or hospital cannot provide that treatment for any reason whatsoever - and yes, one of them may be budget-related - they immediately transfer you to a place where you can get it. Because there aint no such thing as out of network.



If a new treatment or medication is available for your condition, you don't get denied it because some insurance company decides it's too expensive. Sure, you may get told "no" sometimes but that decision not to include it in the formulary is a medical decision again, made by doctors - and it's not absolute. With clinical grounds to use it, it's covered.


You also don't get folks seeing ads on TV saying "talk to your doctor about ${EXPENSIVE_NEW_THING}" - instead people talk to their doctor about their health issues and if a cheap generic is available to treat that condition the doctor uses it. Drug companies hate that.


THAT is how publicly funded health care keeps the costs down, not by arbitrarily denying care or by fleecing its patients.
Patients and doctors just care about one thing: fixing whatever is the issue (whether that is acute treatment or maintenance). Instead both of them spend lots of time with insurance paperwork. Things like sudden preapprovals for medicines the patient has been taking for years because of a formulary change.

Oh, as to generics: they are wonderful for some things but not others. Have a headache? The generic aspirin is cheeper? Go for it. There are some conditions though (like epilepsy) where it can trigger the thing it is supposed to prevent. Switching someone to a generic should be the call of a doctor, not a bean counter who wants to minimize costs.
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Old 07-11-2018, 12:59 PM   #114 (permalink)
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Patients and doctors just care about one thing: fixing whatever is the issue (whether that is acute treatment or maintenance). Instead both of them spend lots of time with insurance paperwork. Things like sudden preapprovals for medicines the patient has been taking for years because of a formulary change.

Oh, as to generics: they are wonderful for some things but not others. Have a headache? The generic aspirin is cheeper? Go for it. There are some conditions though (like epilepsy) where it can trigger the thing it is supposed to prevent. Switching someone to a generic should be the call of a doctor, not a bean counter who wants to minimize costs.

Kindly point to any place, ANY PLACE WHATSOEVER where I argued otherwise? That clinical decisions should be anything other than clinical and made by medical professionals?



On purely bioscience grounds I would question your assertion re generics. The same amount of the same active compound, delivered by the same route to the same patient will have the same result. So many milligrams of oral phenytoin absorbed into the bloodstream will have the same effect whether its source was branded as dilantin or not. If it were otherwise, if the effect on a particular patient were not reproducible, the active compound (let alone any particular formulation) would not have even made it to clinical trials in the first place. That's just not how pharmacology (or even fundamental science) works. Please don't try and bullshit a biochemist otherwise.



Now, different patients will respond differently to different formulations of the same active ingredient - particularly in complex multi-factor conditions like epilepsy, where even things like a minor difference in the absorption rate from a time-release preparation can make a difference - That's one of the reasons why you will usually find several different preparations in a formulary for a single therapeutic agent. Saying a generic "can trigger the thing it's supposed to prevent" however, is pretty much rubbish but you can bet any anecdote to the contrary is instantly filed for PR purposes by the pharma companies who want to promote their "reformulated just enough to justify a patent extension" brand that makes then a hundred or a thousand times as much as a generic would. It's on the same level of "junk science" as antivax idiocy.
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Old 07-11-2018, 03:55 PM   #115 (permalink)
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Kindly point to any place, ANY PLACE WHATSOEVER where I argued otherwise? That clinical decisions should be anything other than clinical and made by medical professionals?



On purely bioscience grounds I would question your assertion re generics. The same amount of the same active compound, delivered by the same route to the same patient will have the same result. So many milligrams of oral phenytoin absorbed into the bloodstream will have the same effect whether its source was branded as dilantin or not. If it were otherwise, if the effect on a particular patient were not reproducible, the active compound (let alone any particular formulation) would not have even made it to clinical trials in the first place. That's just not how pharmacology (or even fundamental science) works. Please don't try and bullshit a biochemist otherwise.



Now, different patients will respond differently to different formulations of the same active ingredient - particularly in complex multi-factor conditions like epilepsy, where even things like a minor difference in the absorption rate from a time-release preparation can make a difference - That's one of the reasons why you will usually find several different preparations in a formulary for a single therapeutic agent. Saying a generic "can trigger the thing it's supposed to prevent" however, is pretty much rubbish but you can bet any anecdote to the contrary is instantly filed for PR purposes by the pharma companies who want to promote their "reformulated just enough to justify a patent extension" brand that makes then a hundred or a thousand times as much as a generic would. It's on the same level of "junk science" as antivax idiocy.
"instead people talk to their doctor about their health issues and if a cheap generic is available to treat that condition the doctor uses it"

Note the key word you used in the latest post .... active. You are forgetting the "inactive" ingredients, which vary widely. For many things they do not matter however for some issues they do as they impact things like absorption rates. When you are dealing with things like brain chemistry you do NOT want that variable in there.

Neurologists can go into more detail but it is a pretty well known fact that you can not use a generic for everything.

Many pharmacies, no matter how much they push generics, have a specific clause not to slam a generic in place of a seizure med. Not all have that policy though so I have to be careful every time. Unfortunately if they send me a generic I can not always do something right away as I may not have a supply built up that I can use. Yes, I have had seizures solely because I had to take a generic.
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Old 07-11-2018, 05:07 PM   #116 (permalink)
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"instead people talk to their doctor about their health issues and if a cheap generic is available to treat that condition the doctor uses it"

And in the context I said that, I was not suggesting the bean-counters made the decision I was highlighting the situation where TV ads talk folks into pestering their docs into trying new (and therefore more expensive) meds when it isn't clinically necessary. I presume you either missed the bit further up my post where I lauded "medical decisions made by doctors not bean-counters" or mistakenly conflated the two distinct contexts.


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Note the key word you used in the latest post .... active. You are forgetting the "inactive" ingredients, which vary widely. For many things they do not matter however for some issues they do as they impact things like absorption rates. When you are dealing with things like brain chemistry you do NOT want that variable in there.

Neurologists can go into more detail but it is a pretty well known fact that you can not use a generic for everything.

Many pharmacies, no matter how much they push generics, have a specific clause not to slam a generic in place of a seizure med. Not all have that policy though so I have to be careful every time. Unfortunately if they send me a generic I can not always do something right away as I may not have a supply built up that I can use. Yes, I have had seizures solely because I had to take a generic.

Your condition has been stabilized with one formulation. Obviously it is a bad idea to swap them out of the blue. That's particularly true of any neuroactive med that depends on steady-state conditions for its effectiveness. Changing formulations that you take should be something you do as gradually and as carefully as making significant dosage changes or substituting a different med regime.



Supplying a different formulation to the one on which your levels have been monitored and your condition stabilized is contra-indicated. That is not the same as saying "the generics caused the condition they were intended to treat"



You know (intimately) that settling on a proper dosage regime for epilepsy meds is a matter of tailoring it very finely to an individuals needs and to their physiology as that impacts the pharmacokinetics. If your initial stabilization had been achieved with the generic the precise dosage and timings would likely need to be different but it would, with these things being correct, be equally effective. You would then run the risk of seizures swapping to the branded product at the dosage regime developed for the generic. Similarly for substituting a different branded product with the same active component.
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Old 07-11-2018, 05:20 PM   #117 (permalink)
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Even in our screwed-up system, it was a far simpler world before pharmaceutical companies were allowed to advertise on TV.
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Old 07-11-2018, 09:57 PM   #118 (permalink)
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You know (intimately) that settling on a proper dosage regime for epilepsy meds is a matter of tailoring it very finely to an individuals needs and to their physiology as that impacts the pharmacokinetics. If your initial stabilization had been achieved with the generic the precise dosage and timings would likely need to be different but it would, with these things being correct, be equally effective. You would then run the risk of seizures swapping to the branded product at the dosage regime developed for the generic. Similarly for substituting a different branded product with the same active component.
Yes, likewise if you start on one generic and change neurologists often the new doctor will (or at least should) make an effort to have you stay on the same generic.

Sorry, I just tend to get extremely touchy whenever it looks like there might be a statement that generics are always better. Unless it is over the counter you should really talk to your doctor before changing brands. Frustratingly pharmacies will often default to the cheapest option if your doctor slips up on specifying on even one refill that they should send you the brand version.
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Old 07-12-2018, 06:39 AM   #119 (permalink)
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Sorry, I just tend to get extremely touchy whenever it looks like there might be a statement that generics are always better. Unless it is over the counter you should really talk to your doctor before changing brands. Frustratingly pharmacies will often default to the cheapest option if your doctor slips up on specifying on even one refill that they should send you the brand version.

And I'm sorry to have kicked back so hard too. It's just fairly important that we're careful about avoiding feeding the "soundbite machine" by saying "the right thing the wrong way" when we're talking about science. Big pharma does love to play up fears of generics, portraying them as somehow "substandard" and lines like "generics cause...." are grist to that mill and incorrect. The outcome happened when a generic was used, but the cause was not that it was a generic, the cause was that it was the wrong formulation to use in this circumstance.
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And I'm sorry to have kicked back so hard too. It's just fairly important that we're careful about avoiding feeding the "soundbite machine" by saying "the right thing the wrong way" when we're talking about science. Big pharma does love to play up fears of generics, portraying them as somehow "substandard" and lines like "generics cause...." are grist to that mill and incorrect. The outcome happened when a generic was used, but the cause was not that it was a generic, the cause was that it was the wrong formulation to use in this circumstance.
The problem is dividing the chemicals used into active and inactive ingredients, it raises a false expectation that the inactives mean nothing. The fact that new companies are required to use a different inactive does not help.

For many things the inactive components do not significantly alter the result from the medication, anything over the counter usually fits into this. It is when you get into prescription drugs that they play more of a role, for most meds they do not significantly alter things because the theraputic dose is such a large range. For some meds they do. So if you are used to taking anything prescription from one manufacturer (generic or brand) you should not switch to drugs from another manufacturer (generic or brand) without talking to your doctor first.
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Old 07-12-2018, 05:27 PM   #121 (permalink)
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The problem is dividing the chemicals used into active and inactive ingredients, it raises a false expectation that the inactives mean nothing. The fact that new companies are required to use a different inactive does not help.

For many things the inactive components do not significantly alter the result from the medication, anything over the counter usually fits into this. It is when you get into prescription drugs that they play more of a role, for most meds they do not significantly alter things because the theraputic dose is such a large range. For some meds they do. So if you are used to taking anything prescription from one manufacturer (generic or brand) you should not switch to drugs from another manufacturer (generic or brand) without talking to your doctor first.

Absolutely correct. An "inactive" component in a medication is something that you can take in massive quantities and it won't do anything to you.



They assess its "activity" based on whether or not it has any effect alone, not on how it might interact with something that does have a therapeutic effect.



Mostly, they can get away with this, as you say. Even with prescription drugs if the primary action of those drugs is prompt, where they have an effect and are then eliminated from the body. Treating acute conditions. If that's what you're taking it for and how you're taking it then the doc mostly doesn't need to care about the rest of the formulation - it needs to get X milligrams of substance S into your bloodstream and that's pretty much it. (ETA: "Pretty much" isn't absolute even here though. Wonder how many ladies were diligently taking the pill and found themselves knocked up after a minor infection required a course of tetracycline? - tetracycline inhibits absorption of oral contraceptives and 'oops')



Where a steady state needs to be maintained, not so much. Diabetics changing their insulin formulation will find their calculations about how much to take based on a glucose level test changes if the formulation of their particular insulin prep changes. Anything depending on a steady state level that is used to manage chronic conditions rather than cure an acute one - the list is legion - you can't just specify the active ingredient in the Rx and expect it to behave the same. It's even worse for anything neurological. Antidepressants, antipsychotics, anticonvulsants...
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Old 07-12-2018, 09:51 PM   #122 (permalink)
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Exactly, I have to constantly be on guard not to vary my exertion and activity level too much for example. Of course, it is impossible to keep both that and when there are spikes from taking medicine completely flat all the time, especially when things like a heat wave can have the same result even if I do as little as possible during it.
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