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Post 0

Sunday, March 30 - 2:31amSanction this postReply
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This question will sound socialist (brace yourself):

If a drug company can afford to sell a drug to Canada for one-sixth of the price it charges here (because selling it at one-sixth of its U.S. price still results in "net profit" for that drug company), couldn't you say -- instead of saying that we're importing price controls -- that we're getting gouged by a fascist, captive-audience, FDA-Drug Company swindle?

Ed



Post 1

Sunday, March 30 - 3:51amSanction this postReply
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It is 'net profit' only in that it is disregarding the investment cost in creating the drug, and instead just dealing with the present production costs....



Post 2

Sunday, March 30 - 6:06amSanction this postReply
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Another myth is the level of administrative costs of private health insurance. Many people believe it is a large part of the premium, e.g. 40%. It is that level for some policies sold in the individual policy market with small premiums, like Medicare supplement coverage ("Medigap"). However, it is more like 12-15% for the group policy market (employer is buyer) and comprehensive coverage.

Be very wary when administrative costs in private insurance are compared to those in a government-run program, e.g. by nationalized health care advocates. It is usually very misleading. When the government-run number is given, much of the overhead cost is typically omitted, but it isn't for private insurance.

The article says, "But many states require insurers to charge everyone the same rate." I believe the proper quantifier is "a few" or "several" (link).




Post 3

Sunday, March 30 - 6:51amSanction this postReply
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Ed:

"If a drug company can afford to sell a drug to Canada for one-sixth of the price it charges here (because selling it at one-sixth of its U.S. price still results in "net profit" for that drug company), couldn't you say -- instead of saying that we're importing price controls -- that we're getting gouged by a fascist, captive-audience, FDA-Drug Company swindle?"

No. This is a fundamental error. The marginal cost of producing another pill is very cheap. What is happening with Canada is that they are paying only for the cost of producing the drug after the initial cost of development, and so they can still profit even with the price controls — but the development costs are borne by the US consumers.

Sam.





Post 4

Sunday, March 30 - 8:24amSanction this postReply
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It wasn't clear to me what Ed meant by "FDA-Drug Company swindle", but Sam is correct.

Another myth is that drug companies make enormous profits. Yes and no. It depends on how profit is calculated, and the more rational way says 'no'.  I read a book recently that compared profits of Pfizer and Wal-Mart. Pfizer reported a 28.4% return on sales for 2002 and Wal-Mart 3.3%. The author concluded Pfizer is far more profitable.

They are very different kinds of businesses, with far different rates of inventory turnover, research and development, and capital expenditure. A much better comparison is return on equity. For the latest five years on this basis Wal-Mart was far more profitable than Pfizer (data from WSJ online).
                                       Wal-Mart                           Pfizer 
                            Year ended     5-year        Year ended     5-year
                             1/31/2008      average      12/31/2007    average
Profit Margin*          3.51%           3.63%        17.05%       16.60%         * return on sales
Return on Equity     20.42%         21.48%        12.06%       12.60%




Post 5

Sunday, March 30 - 9:52amSanction this postReply
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Sam,

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The marginal cost of producing another pill is very cheap. What is happening with Canada is that they are paying only for the cost of producing the drug ... but the development costs are borne by the US consumers.
=========

Thanks, Sam. That clears this up for me.

Basically, what you are saying is that -- because drug companies have invested SO MUCH, they actually don't get any kind of "net profit" (even if they get a gross profit) from selling drugs to Canada. They actually can't afford to sell to Canada if they don't sell to us.

A plain way to put this, for instance, is that if drug companies were forced, let's say by Comrade Clinton, to hold prices to Canadian levels -- then they would all go bankrupt within a year or 2 (because they'd never be able to recover investment costs).

Ed
(Edited by Ed Thompson on 3/30, 9:53am)




Post 6

Sunday, March 30 - 9:58amSanction this postReply
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That is exactly right Ed. My friend Michael Dickey works for Pfizers and they show posters around the company building offices how much money goes into research and development on experimental drugs that end up failing or do not get approved by the FDA as compared to the very few that do end up on the market. In essence even drugs that get onto the market in the U.S., their prices are subsidizing the rest of the drug research that resulted in a dead-end. Drug research is an enormous cost, and price controls would essentially end pharmaceutical research in this country.

Drugs are also responsible for lowering other health care costs, where once an expensive surgery was needed to cure an ailment, a drug has taken its place as a viable substitution which is far less evasive and far cheaper than the alternative of surgery.



Post 7

Sunday, March 30 - 10:04amSanction this postReply
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Merlin,

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It wasn't clear to me what Ed meant by "FDA-Drug Company swindle"
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There's evidence that US Health Care doesn't operate via Free Market mechanics -- at least not predominantly via Free Market mechanics. There's evidence that it's predominantly Fascist, but merely referred to as Free Market -- in order to keep things confused so that more money can change hands than otherwise would (if there had been more transparency).

p.s. Thanks for the link on insurance premiums

Ed



Post 8

Sunday, March 30 - 10:49amSanction this postReply
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Ed,

There is much government intervention in the health care market, and governments pay about about 60% (counting health insurance for government employees). Economic principles still apply. People choose and act, including politicians, those they favor, and those seeking their favor. Supply and demand. Observe the money flow.

There is some abnormality in the health care market. In most markets a supply increase lowers prices. Supplier and demander are two different parties. Not so in health care. The supplier and demander can be the same party, the health care provider. A supply increase can raise prices.





Post 9

Sunday, March 30 - 11:15amSanction this postReply
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Merlin,

Supplier and demander are two different parties. Not so in health care. The supplier and demander can be the same party, the health care provider. A supply increase can raise prices.



That's what I'm referring to when I say "captive audience." Just like movie theater snacks which are priced well above the snacks sold outside of the building, it's like we're all in a grand theater with regard to health care. Drug Company A makes Drug B, Drug Company A pays for the specific medical textbooks that would-be doctors use in medical school. Drug B is propounded in these textbooks to be the benchmark drug for relevant disorders.

If the medical school student plays along, they will not go looking for right or best ideas on a free market, but remain in orthodox party-line with those in control of their "education." I know a few doctors who are independent thinkers and told me they'd never join the American Medical Association, for instance. They see the hypocrisy of masquerading a corrupt system merely by putting 2 warm & fuzzy words together: Health Care.

The real hypocrits go a step further and put together 4 really cool words: Free Market Health Care. If US health care were actually predominantly a free market, then competing producers -- such as those tauting dietary supplements as equal to or superior to drugs -- could enter the health care field. Instead, we have "closed entry ... accomplished ... by an act of government intervention, in the form of special regulations, subsidies, or franchises."

One dissenting doctor, Jonathan Wright, M.D., had his office raided at gunpoint and all of his files confiscated by the government ... because he gave folks shots of B vitamins. The folks were pleased with his services and wanted to be able to continue paying him money for them. The government wasn't promoting this free market supply and demand -- but interfered with it.

When Jonathan Wright asked for his medical files back, even years later, the government said "no." I want you to sit there with a straight face and tell me whether this is an example of fascist bullshit or not. Would you agree to do that?

I don't think it's what you were referring to, but it still really matters when I say that I think that it's perniciously inaccurate to describe THIS type of thing as "some abnormality in the health care market." Would you agree to the noted limitation here, in your 7 descriptive words?

Ed

(Edited by Ed Thompson on 3/30, 11:23am)




Post 10

Sunday, March 30 - 12:16pmSanction this postReply
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Ed, by "abnormality" I only meant what followed about supply and price. The normal relationship doesn't hold.
Would you agree to do that?
It sounds fascist.




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Post 11

Sunday, March 30 - 2:20pmSanction this postReply
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Thanks, Merlin.

Like I said, I didn't think that you meant your statement to apply to this special case -- but I felt it appropriate to exand the scope of this discussion, nonetheless.

Ed




Post 12

Monday, March 31 - 6:22amSanction this postReply
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Why the hell are the drug companies agreeing to the loss in profit by selling under price controls?  I think they should establish a policy that the costs have to be the same everywhere, so they at least "average out" the costs to the US so we dont have to pay so much - however the costs may go down over time as the development costs are paid off - this is normal in most industries with a sunk investment cost.  I know in some cases they threaten to copy, but I think if they stuck to their guns and got OUR government behind it - which could benefit us too - they could hold them to not doing that.



Post 13

Monday, March 31 - 6:50amSanction this postReply
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Ed T. wrote:
That's what I'm referring to when I say "captive audience." Just like movie theater snacks which are priced well above the snacks sold outside of the building, it's like we're all in a grand theater with regard to health care.
You're too subtle. :-) What I described is a little different from the "captive audience" you descibe here. In the former the patient is not the (direct) payer. In the latter the customer pays. For drugs the patient often pays much less than the amount that goes to the drug manufacturer.

(Edited by Merlin Jetton on 3/31, 7:00am)




Post 14

Monday, March 31 - 7:16amSanction this postReply
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Merlin,
In post #4 you made the distinction between Profit Margin and Return on Equity.  I'm going to expose my ignorance of financial matters here and ask you to elaborate on this difference, in small words.  Specifically, my question is: doesn't Profit Margin take into account all of the costs, including R&D and capital expenditures?  I always thought that Profit Margin was what was left over after all costs were included.  If that were true, then Return on Equity would be redundant, wouldn't it?
Thanks,
Glenn




Post 15

Monday, March 31 - 9:07amSanction this postReply
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Glenn wrote:
Specifically, my question is: doesn't Profit Margin take into account all of the costs, including R&D and capital expenditures?  I always thought that Profit Margin was what was left over after all costs were included.  If that were true, then Return on Equity would be redundant, wouldn't it?
Yes to the first question. However, capital expenditures are "expensed" (an accounting term) over multiple years. For example, suppose a business buys machinery that is usable for 5 years. For the business' first year it would only expense, say, 1/5th of the cost of the machinery in arriving at its first year profit. It would take 5 years to take all costs into account.

I shall try to explain profit margin (return on sales) versus return on equity with a simple example. Suppose you could choose running either of two businesses, B1 and B2, over the next year starting with $100. With B1 you could buy what you need and sell your product for $103, and with B2 sell it for $120. Return on sales (%) is 3/103 = 2.91%  for B1 and 20/120 = 16.7% for B2. B2 appears much better. But hold on. Suppose with B1 you could repeat the process 11 more times over the next year, but with B2 it's not repeatable (long production cycle). Hence, with B1 your profit for the year is 12*$3 = $36, and with B2 it is $20. From this perspective B1 is more profitable, despite its much lower return on sales. Return on equity is 36% for B1 and 20% for B2.

Now I will complicate my B2 example. Suppose you could start with $50, borrow the other $50 and pay $5 interest. Then the net profit would be $20 - $5 = $15 for the year. The "profit margin" is somewhat less, but return on equity is 15/50 = 30%.




Post 16

Monday, March 31 - 9:20amSanction this postReply
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Out of curiosity, I sent this article off to a friend...... this was the response [and, I might add, an oft common one for the most part]---------



This author is obviously trying to sell her book - did u notice the title? She's taking these points of the overall healthcare issues and applying her specific statistics to slant each as a "myth". Shame on her.
In point 1, she debunks the census bureau stats but then uses them to prove a point in point 2. Of course the census stats capture data in a point in time...the reported year is 2007 - not for the entire year. She failed to mention that figure does not include data unreported and the number of lost benefits...overall, 47 million is fairly accurate. Point 3 - using the inflation rate to compare against the rise of drug costs is ridiculous. Many insurance carriers have hiked the prescription copays in order to keep RX plans...and more and more, people aren't getting the drugs they need because they cannot afford them. Her point 5 really has no point.
 
All points are valid arguments to be proved or disproved - anyone can do that by pulling out statistics to support his/her opinion but none are "myths" as the author suggests. Our healthcare system is in dire need of fixing and we should keep an open mind by looking at other countries way of doing things and the possibility of an open market. To say there is no problem would be a travesty.

.........................

What is your response to this?




Post 17

Monday, March 31 - 10:51amSanction this postReply
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Thanks, Merlin.  That was very helpful.
Glenn




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Post 18

Monday, March 31 - 12:54pmSanction this postReply
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The problem with American health care boils down to one essential: coercive state and federal government meddling that date back to the mid nineteenth century. The meddling started with state legislatures, which imposed liscensing restrictions on medical practitioners in response to lobbying by doctors. These medical practitioners sought political relief from competition, by imposing restrictions on homeopaths and other less orthodox, less politically aggressive competitors. Today, of course, the American Medical Association is a powerful state-sanctioned cartel, wielding the power to limit accredited medical schools for the purpose of holding down the number of MDs, thereby boosting their fee income way beyond what they could earn in a free market. The AMA also decrees which ideas will be included--or excluded--from the curriculum taught to medical students.

The FDA, which has unbridled powers to approve the "efficacious" drugs of its political clients, while prohibiting the "dangerous" drugs of companies that incur its displeasure, is the Star Chamber of Medical Inquisition. "Efficacious" drugs include AZT, patented by the politically influential "non-profit" British drug company Burroughs Welcome, which destroys the immune systems of naive and trusting patients. "Dangerous" drugs, include isoprinosine, a safe, inexpensive and effective immune booster sold in 83 foreign countries around the world, patented (as I recall) in the US by Newport Pharamceuticals, a company that some years ago incurred the displeasure of the FDA. Together with the AMA, the National Institutes of Health, and other coercive institutions, the FDA retards innovation, raises drug costs, and  serves as Chief Enforcer of Received Medical Wisdom, punishing dissenters and grooming sychophants.

Medicare and Medicaid socialize the costs of medical treatment for countless millions, thereby guaranteeing that countless millions will seek medical care for all manner of ailments, ranging from hangnails, colds, and depression, to cancer and heart disease. Meanwhile, doctors are burdened by incessant demands of forms and bureacratic fee formulas, and continually threatened by legal sharks looking for a piece of the action. Such disincentives encourage the brightest and most productive to seek employment with Wall Street hedge funds, or get law degrees. In the face of restricted supply and inexorably rising demand, medical costs soar to the heavens. 

The answer is to get rid of state and federal regulations that significantly hurt the productivity of the medical market place, while rewarding mindless conformity and obediance among medical scientists and practitioners. If we get Hillary-or-Obama-Care, or McCain's EZ Solution for Medical Pain, the results won't be pretty. The inevitable day when the speeding express train of out-of-control government spending hits the wall will arrive much sooner.




Post 19

Monday, March 31 - 3:45pmSanction this postReply
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From the article ...
The real price of prescription drugs is actually decreasing. In 2007, inflation rose more than 4 percent, while drug prices increased just 1 percent. So in real terms, drugs were 3 percent cheaper last year than in 2006, on average.
It's a little malicious to compare increasing drug prices to inflation -- but to pick the benchmark up at 2006. For the average of the dozen years before 2006, drug prices increased each year by about 10 times the 2006-2007 number (10% annual increases on average)!

What's more, drug spending is but a small slice of total health-care spending — less than 11 cents out of every health-care dollar goes to prescription meds.
I couldn't verify this, but I found Spain's proportionate spending. Spain spends 25% of their total health care dollars on prescription meds (25 cents out of every health-care dollar).

Why would they spend more than double what we do?

Ed




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