Nine hundred dollar cure for Hepatitus C

[Cicada]

Take a certain pill for 84 days and You are cured. But here each pill costs one thousand dollars. But the pill only costs $900 for 84 pills in India. So go to India, stay 84 days. Why doesn't Medicaid send Hepatitus C patients on all expenses paid vacations to India? Medicaid could save many many billions of dollars doing that. And India also has vastly cheaper surgeries in high quality "tourist" facilities with western trained doctors with results exceeding those in many American facilities. Why don't US insurers contract with such foreign medical centers for patients who are willing to be paid a piece of the cost savings?

Or alternatively why don't we impose an excess profits tax on US doctor wages? We draft doctors to go to war zones and pay them very low salaries. Why not draft them and make them treat US civilians at military pay rates? We have a health care cost crisis at least as threatening to us as the risks we face in middle eastern war zones.

US doctors get paid more than twice as much as doctors elsewhere. Taxpayers spend about a million dollars on the training each receives (taxpayers fund teaching hospitals, fund medical research, etc) so it seems fair to make them each limit what they charge. Once their reduced wages hit the million dollars we spend on their training, then they can go back to their "money or your life" extortion.

[SwissTony]

1. Got a link to prove that it works?

Respectable medical journals only, thanks.

[The Polack MSgt]

4. I suppose that chemical compounds can have geographically specific properties

well, it kills Hep C Virus in North America but it causes webbed toes in Southern Asia. Weird.

I don't think it works that way.

[Cicada]

11. See Wikipedia ledipasvir

At the 20th conference on retroviruses and opportunistic diseases in March 2013 a 3 drug combo was 100 % effective over 12 weeks or something. I am not a medical professional but you can google to find what I have seen many times. Also notice that the Drug Company Gilead is richer than Vladimir Putin because it has the patent. They charge one thousand dollars per pill because in America it is legal to say "your money or your life."

This is a wonderful drug. It is worth $1000 per pill. Indeed that is a bargain. But California Medi-Cal, the CA Medicaid, will not buy it in general because the cost to provide it for all patients would be more than the cost of all other drugs combined.

[chowder66]

14. My brother was put on two drugs and he has been clear of the virus for a year

Harvoni and another maybe the one mentioned in this webMD article;

http://www.webmd.com/hepatitis/news/20141010/hepatitis-c-combo-pill#1

He has liver failure and is on a list for a transplant but they had to treat the hep c first.
The monitored him closely and told him he could have to be on it longer than recommended but he didn't have to.
The treatment made him extremely tired but he is battling other ailments and was on a cocktail of drugs.

Luckily he was able to get this treatment at nearly no cost. It was through some program.


He is considered cured (but my take on that is that it might be like cancer in remission, time will tell).

[dembotoz]

2. temptation to be a drug smuggler

fly to india, see a doc, get a script, fill the script for full coarse of pills...fly back to us with full script. unload script when here...rinse and repeat and rinse and repeat.

imagine the frequent flyer miles

l love this business plan!!!!

don't have hep c so getting the script sorta prevents this...but damn

[mitch96]

6. "temptation to be a drug smuggler"

Like sending people from Kentucky to Florida pill mills...
If it works...
Big Pharma is prolly blocking the inexpensive drug that would help people in this country. Lots of drugs mfg in this country are less money over seas... I know here in So Fla people go to the bahamas to get low cost drugs and bring them home...

m

[The Polack MSgt]

3. It's a rip off to be sure, but the military doesn't pay it's doctors starvation wages

Pay and allowances are public information here is a link:

https://www.dfas.mil/militarymembers/payentitlements/military-pay-charts.html

Let's say you're a single board certified vascular surgeon who joins the Army - here is how it would break out.

After you attend "Salute School" you will appointed at the Rank of Captain (O-3)

Right off the bat you will get a sign on bonus of $400K

Your pay will consist of Base pay, plus allowances for maintaining board certification, food and lodging. Only the Base pay is taxable income. That breaks out like this.

All amounts are monthly.

Base Pay- $4046
Basic allowance for housing- $1086
Basic allowance for sustenance- $253
Board Certification Pay - $500

Total monthly pay - $5,885. Annual pay = $70,620. Gross taxable income = $48,552

And that's entry level, you will receive annual pay raises tied to the Consumer Price Index and every 2 years in grade you will get a seniority raise.

Keep you nose clean and you will be promoted in 6 years to Major - with a $2.4k increase in Pay and allowances.

Also, Military doctors cannot be sued and do not pay for malpractice insurance. The DoD pays all facility and equipment costs. It will pay for you to attend training in your specialty.

So, you won't get mega rich, but it's a good living - especially since the 400k lump sum wipes out a shit load of student loan debt

[Cicada]

8. My arthritis doctor gets about 400,000 per year

[fescuerescue]

15. Bonus is nice but thats pretty bad for yearly pay

To pay a surgeon $78k who dedicated his life to the profession and years and years of school is insulting.

By comparison, with a few years experience and without a degree, it's fairly easy to earn $100k+ in IT or project management.

[Cicada]

19. If he pays back USA subsidies he got - fine

Medicare pays teaching hospitals extra money as compensation for doctor education. If your brother pays back what taxpayers spent on him then there would not be as good a case to ask him to limit his fees for a couple years. Altogether taxpayers spend about a million dollars for training each doctor through the extra payments to teaching hospitals and other subsidies.

It is not an insult to your brother the to ask him to pay us back in some way.

[jmowreader]

25. Here's the flipside of that $78K

Army doctors do not have to:

pay malpractice insurance premiums, because they cannot be sued
keep an attorney on retainer, just in case
pay for nurses, medical assistants, transcriptionists or lab techs, because the Army pays for them
pay rent on their offices, because the Army already owns the building they're in
pay for billing and coding staff, because their patients do not pay for care
pay for their own Continuing Medical Education
pay the lion's share of their student loans, because the military gives them that $400K sign-on bonus
buy supplies
worry about whether their patients can afford a procedure or their meds
have to fight with an insurance company to try to convince them to cover something they're supposed to
have to deal with patients who know they need a medication they saw on TV, and have to tell them (1) they don't need it, (2) it probably won't work anyway and (3) it's $950 for one bottle of pills
keep up on the payments on a $75,000 Mercedes just because it's obvious that any doctor who doesn't drive a really expensive car must not be much of a doctor
have to buy advertising
make house payments because the Army will assign you a set of quarters

By the time you subtract all the things a $400K civilian physician has to spend just to be in business, he may take home less money than the Army captain.

[wishstar]

26. Military docs can retire after 20 years too and then go into private practice making megabucks

I know one who retired before age 50 as anesthesiologist, then made millions in private sector.

[The Polack MSgt]

27. That is also true.

And the pay doesn't stay @ $78k for long, at 2 years in service the Captain will get a bump to $84k and when he pins on Major, he would be making $107k per year.

I received great care in my career, and don't like the attitude many folks have regarding the Medical Corps - Namely that these must be crap Doctors or they'd be getting rich in the civilian world.

After 20 years, the now LTC Theoretical Doctor will be pulling in over $140k and will be about to get an annual pension of $54k and low cost high quality health insurance for himself and spouse - for life.

So, yeah

[AngryAmish]

5. I do not think enslaving doctors is viable.

On edit:. I think yours is the first pro-slavery post I have seen in all my years on DU. Just when you think you have seen it all...

[Cicada]

7. You oppose drafting doctors for war zones?

Hawkeye in MASH was a slave. He did not consent to being forced to work in Korea.

Also medical prices are fixed to not exceed certain amounts in most other countries. The doctors in Japan may not charge more than certain prices for various procedures, for instance. Are all those doctors slaves?

[AngryAmish]

9. There is quite a robust jurisprudence in the United States outlawing slavery.

I suggest you become familiar with it.

[Cicada]

12. You should email the draft board with your analysis

[BzaDem]

16. Funny thing about draft boards and drafts is that their existence requires something.

Think a bit on what that might be.

[Cicada]

20. Yes, a grave threat to the nation's welfare

We draft doctors to save US lives at risk. Our absurdly high medical costs, such as doctor income twice as high as elsewhere, puts US lives at risk. I think MASH stands for mobile army surgical hospital. We can put MASHes in West Virginia, Louisiana etc and draft doctors to serve for 2 years in order to save the lives of those who are at risk of death.

Seems analogous to me.

[BzaDem]

22. No, no and no. The gravity of threat to the nation's welfare is irrelevant.

This isn't some game where you get to make up analogies. This is a settled legal question, with right answers and wrong answers. Your answers fall squarely into the "wrong" bucket.

The 13th amendment prohibits involuntary servitude. The only exceptions are duties of citizenship expressly articulated in the Constitution itself -- namely, conscription and jury duty.

Notice how there is no "gravity of threat" exception (and certainly no "draft doctors to save lives" exception). A military draft can be in effect even if the threat to the nation is precisely zero. Of course, a military draft involves drafting citizens into the military. A military has a well defined meaning. This includes support personnel (such as doctors to staff field hospitals). It does not involve general saving lives of civilians.

You may have different priorities, but your priorities are irrelevant to what the Constitution permits. And I for one am grateful that our government does not have the power to declare a national threat of any type, make some claim about the gravity of the threat, and then conscript whoever they want to deal with the threat. (Frankly, the original institution of chattel slavery that prompted the 13th amendment would likely be justified on those terms by some state governments after the civil war.)

[Cicada]

24. The Constitution does not mention conscription

The words conscription and draft are not in the Constitution. It permits the raising of an army but it also provides for many other tasks requiring labor.

But you are probably right given what raising an army meant when the constitution was written.

We can just pass a law requiring the military to provide medical care to the public and then raise an army of doctors and nurses.

But to be serious - we should fix medical prices including the prices doctors can charge just like virtually every other country on earth does. I think it was Ken Arrow who first clearly explained why medical care should not be subject only to the free market. Uncertainty and the welfare economics of medical care 1963.

[mythology]

10. It's really hard to take your post seriously with such absurd hyperbole

[Cicada]

13. Price controls are legal and wise in this case

The only way to get our medical costs comparable to all the other countries in the world is to do what they do: fix prices by law rather than by the free market. In Canada the govt sets the price at zero. In Japan each doctor has a list of all medical procedures and the maximum he can charge. In the Korean War Hawkeye was forced to work, and his pay was set far lower than he could have earned back home. This is just reality. Nothing else will work in the real world. Our "your money or your life" system leads to high prices.

[fescuerescue]

17. I think if I were a doctor and you got your way

I would just say screw it and take up another line of work.

[Cicada]

21. They have enough doctors in Japan, Germany etc despite lower pay

If doctor compensation fell by one fourth, same for nurses, we would still pay them much more than anywhere else. Some would become professional bowlers etc instead but other countries seem to deliver good medical care despite limiting such medical income. It is worth looking into.

[BzaDem]

18. In your system where all drugs have their price fixed at zero

Who spends billions of dollars on research to find the drugs in the first place? Just curious.

I don't support the current system, but the idea that you can just snap your fingers and legislate all prices to zero is absurd on its face.

[Cicada]

23. NIMH NIH NSF Hughes Medical Foundation etc does most research

The US govt has traditionally spent most of the money for research leading to new useful drugs. Most of the researchers working for drug firms got government funding for post graduate education. The NSF paid me to do medical research in graduate school, $200 per month in 1969 and 1970. US govt backed basic and applied science has been the primary source for medical advances. The greatest "drug" ever invented, the one which will transform us from the Stone Age to unimaginably improved health, crispr cas9, was paid for by USGovt and Hughes Medical, mostly. But I agree that we need to keep drug prices high despite my attention seeking comment about going to India. In return for somewhat shortened patent terms we can subsidize drug companies by banning drug ads to consumers and banning drug company payments to doctors. Those costs are just costs to get market share from competitors. They do little to raise industry profits overall.