Specifically, What is it you'd like to change?

PeeTex wrote

mattchuck2 wrote

Do Trump supporters even know what to believe anymore?

Matt,
I use to have to have to work a little to refute your crazy statements - lately you have been making it easy.
This was the first hit I got on googling Clintons flip flops - So tell me again what her positions are?
http://imgur.com/gallery/yZ0LZDP

You can say this about any politician. The one thing (and possibly only thing) I like about Trump is he freely admits that he is flexible on most issues. You have to take what he says as "going in" positions. That does not mean he will give up on any issue, but he is likely not to freely disclose the position from which he won't back off of any further.

The hard part about being a liberal is that you arrive at positions early and you have to wait for public opinion to catch up. We all know liberal policy ideas like Civil Rights, Gay Marriage, and Weed Legalization will be the law eventually. We just need to wait for the public to finally be convinced.

This creates problems for liberal politicians because they still need to get elected. And it especially creates problems for centrist, defensive, self-interested politicians like Hillary, because she has to spend most of her time spitting vague policy pronouncements while hanging around the exact middle of public opinion.

As opposed to someone like Trump, who can drive the narrative so much that the Muslim Ban (which once polled around 40%) is now favored by 61% of people. That's the danger. He's making the country more radical, more racist, and more dangerous for people that aren't white.

I say harder to be conservative, lots of what you believe will be tossed someday

Thacheronix wrote

I say harder to be conservative, lots of what you believe will be tossed someday

Yeah, it seems like a sad existence. Short term victories, but constantly losing the long game. The leaders constantly letting you down. I guess I can see why they're frustrated.

But instead of blaming Mexicans and Muslims, maybe they should look at who is benefitting while they're getting fucked over. It's not people in the lower income brackets.

PeeTex wrote

Coach Z wrote

I work with medical device firms on developing all kinds of new stuff.  You should see what they are doing with orthopedic surgery techniques that will likely have a positive impact on every one of our forum readers aging knees and hips at some point.  All that will stop.

We'll you calibrated yourself - definitely a bias.

The reality is that NIH provides a pile of funding to medical device companies and big Pharma to fund R&D.
That won't stop. Z just wants to protect his gravy train.

You hit the nail on the head.  BigPharm always uses the excuse of R&D $ but those bucks are mostly spent on promotion (dinners, merch , "CE" trips, etc..) that is aimed at prescribers and disguised as education dissemination but it's mostly payola for prescribing.  I've had hundreds of high end dinners at the most expensive restarants and could quite easily have had a Lugar's quality steak every night had I so chosen.  I've never taken trips or anything more than a meal but have been offered them and know that it's a regular transaction in the business.  It's not quite as bad as it was 15-20 yrs ago.  Before the days of corporate compliance, hospitals used to actually host drug rep days each week and encourage this bacchanal of payola.

I clearly recall sitting in on an "educational" inservice hosted by PurduePharma complete with an absurd spread of food with books, promo merch, vacation offers and a super super hard sell of how we should be promoting the use of their wonderful new product, OxyContin, for all sorts of acute and chronic pain.  The jist was that we grossly underprecribe opioids for chronic pain (back pain, arthritis, hip pain etc...) and how their product , because of the wonderful time release formulation, would not lead to abuse problems for that patient population.  This hard sell continues to wreck thousands of lives.
Pfizer got sued and lost but the damage was done and their profits were barely dented.  It was the most egregious, evil, greed-induced sin I've ever witnessed.

R&D = promotion

OK if it is bribery (I believe it) how do you get the fair prices in the US? In your opinion would single payer work?

mattchuck2 wrote

The hard part about being a liberal is that you arrive at positions early and you have to wait for public opinion to catch up. We all know liberal policy ideas like Civil Rights, Gay Marriage, and Weed Legalization will be the law eventually. We just need to wait for the public to finally be convinced.

Matt, That is the liberal elitist stance, "where smarter than every body else". It's total BS. Conservatives are not smarter either - so don't get your nickers in a bunch. The reality is, the collective wisdom of all of us is smarter than any one of us. Being an asshole elitists I can tell you that it is the truth. Once you give up the position that you know more than the collective wisdom you free your mind.

PeeTex wrote

mattchuck2 wrote

The hard part about being a liberal is that you arrive at positions early and you have to wait for public opinion to catch up. We all know liberal policy ideas like Civil Rights, Gay Marriage, and Weed Legalization will be the law eventually. We just need to wait for the public to finally be convinced.

Matt, That is the liberal elitist stance, "where smarter than every body else". It's total BS. Conservatives are not smarter either - so don't get your nickers in a bunch. The reality is, the collective wisdom of all of us is smarter than any one of us. Being an asshole elitists I can tell you that it is the truth. Once you give up the position that you know more than the collective wisdom you free your mind.

I'm not saying anyone is smarter than anyone. I'm just saying that the liberal progressive side is more likely to push into the realm of "what could be", and the conservative side is in the side trying to preserve things "as is". I make no judgements against anyone's intelligence... Except Trump supporters.

Harvey wrote

OK if it is bribery (I believe it) how do you get the fair prices in the US? In your opinion would single payer work?

I'm not an economist, so I'd honestly be guessing.  There would be so much opposition from self interested insiders with the $ to spend to oppose it so we'll probably never find out.  

One regulations that would benefit everyone:  Get rid of pharmaceutical ads on TV!  It plants subliminal ideas in patient's minds that they need medication for a whole host  of issues that they either don't suffer from or aren't worth treating.  It creates exssesive waste  from office visits for worthless or harmful over medication and eventually leads to med errors, interactions, adverse reactions and overall bad medicine.  It's a systemic problem that's driven by $$$$$$.

  In addition, Md's oftentimes get suckered into prescribing new expensive drugs for common problems where old, cheap, well studied, very predictable old stand by drugs are ignored.  I.e.- the gold standard for new onset hypertension is a diuretic that has been used for nearly 100 yrs and costs pennies but oftentimes an MD starts a new hypertensive patient on new less studied, more expensive agents that are aggressively marketed to them....... The individual patient and the health care economy suffer as a result of stuff like this that happens hundreds of times everyday in this country.

mattchuck2 wrote

I'm not saying anyone is smarter than anyone. I'm just saying that the liberal progressive side is more likely to push into the realm of "what could be", and the conservative side is in the side trying to preserve things "as is". I make no judgements against anyone's intelligence... Except Trump supporters.

Matt - that is exactly what you are saying. "We liberals think of it first and then we have to wait for all the dead heads to catch up".  The conservative side does the same thing, they don't want to leave things as they are, they want to tilt things to their advantage. Trump supporters just want to change things, they don't necessarily know what that change is but they know that the last 30 years of crap everyone has been fed needs to stop. That's what is different about this cycle, it's not really about issues - it's about breaking the status quo. The Dems really had a chance to take this in the right direction but the whole super delegate thing has shown what a sham the Dems run.

Am I biased against the ACA based on what I do for a living... Absolutely yes.

But I also know much more about the medical device industry than you all do.  The ACA aka Obamacare already targeted this industry with a tax on the industries revenues.  This was not applied to pharma which was pretty stupid but some liberals lobbiest that wrote the bill were taking cash from pharma.  The tax should have been on profits and not sales.  It unfairly punished smaller firms that are doing much of the innovation.  They had to reduce R&D or sell to the big guys.  I've seen this first hand.  You don't see all the crazy ads for medical devices but I can tell you these things are saving and changing lives for the better.

Good catch by Ptex calling out Matt.  Liberals always think they are smarter than everyone else which is part of thier justification for telling everyone how they have to think or live.

Coach put ACA aside. How would you deal with super high US drug prices?

PeeTex wrote

mattchuck2 wrote

I'm not saying anyone is smarter than anyone. I'm just saying that the liberal progressive side is more likely to push into the realm of "what could be", and the conservative side is in the side trying to preserve things "as is". I make no judgements against anyone's intelligence... Except Trump supporters.

Matt - that is exactly what you are saying. "We liberals think of it first and then we have to wait for all the dead heads to catch up".  The conservative side does the same thing, they don't want to leave things as they are, they want to tilt things to their advantage. Trump supporters just want to change things, they don't necessarily know what that change is but they know that the last 30 years of crap everyone has been fed needs to stop. That's what is different about this cycle, it's not really about issues - it's about breaking the status quo. The Dems really had a chance to take this in the right direction but the whole super delegate thing has shown what a sham the Dems run.

William F. Buckley described conservatism as "standing athwart history, yelling stop".

It has nothing to do with who is smarter than who. It's one side that wants to try things and find solutions, and another side that wants to stop that side (or turn back the clock on some progress that was made).

You see this represented in many ways. One side is interested in scientific observation, problem solving, and the scientific method, while the other side has people who insist the world is 6,000 years old, and even its Presidential Candidates aren't sure if they believe in evolution. One side believes in government and its power to get shit done, and the other side just doesn't.

Coach Z wrote

Am I biased against the ACA based on what I do for a living... Absolutely yes.

But I also know much more about the medical device industry than you all do.  The ACA aka Obamacare already targeted this industry with a tax on the industries revenues.  This was not applied to pharma which was pretty stupid but some liberals lobbiest that wrote the bill were taking cash from pharma.  The tax should have been on profits and not sales.  It unfairly punished smaller firms that are doing much of the innovation.  They had to reduce R&D or sell to the big guys.  I've seen this first hand.  You don't see all the crazy ads for medical devices but I can tell you these things are saving and changing lives for the better.

Not entirely true.  ACA does tax "Branded" Pharmaceuticals, https://www.irs.gov/Businesses/Corporations/Annual-Fee-on-Branded-Prescription-Drug-Manufacturers-and-Importers,  its not a simple flat tax as is imposed upon med devices- it's a complicated/convoluted formula.  It's highly disingenuous, naive & childish to state that the only politicians with greased hands from BigPharma are on the left.  

And a similar. Taxing fiasco on. HOSPITAL GROSS. RECEIPTS has been instituted in NYS , NOT by The ACA , BUT by our state government .

In NYS it is damn near impossible due to excessive regulation for the vast majority of hospitals to make apositive margin , .this is due to several factors , medicare , medicaid pay only a FRACTION of what is billed , many other insurers negotiate based on capitation AND there is charity care for some which is severely discounted .....and then mandates which come without money .....the result net revenues are substantially LESS than Billed YET the state takes its CUT on the GROSS figure .

THIS Anomaly coupled with the impact of ACA has forced mergers , acquisitions , consolidations and downside reorganization that results in some consequential impacts in small communities inn terms of distance one may have to trAvel for services that have been regionalized.rather than localized . This model is a bit easier where pop density and distance is not an issue , but. In rural NY it has impact .

Systemic change is occuring at geometric rates of speed in the entire spectrum of healthcare delivery and support services .Like it or not that genie ain''t going  back in the bottle regardless of who sits in 1600 Pennsylvania ave  . The insurance industry owns dc and is the straw that stirs the drink in this entire scope of endeavor . The medical field is having a great deal of churn as many are no longer interested in becoming physicians IN THIS environment . Most docs today are now EMPLOYEES , no mor Markus Welby's in private practice .


Tough business , getting tougher every day in NYS. Regional  states are not as Byzantine in the over regulation and stultifying bureaucracy .

https://en.m.wikipedia.org/wiki/340B_Drug_Pricing_Program#

This program which btw represent s ONLY. 2 per cent of big PHARMS's  325 billion market share is the critical difference that helps  qualified hospitals serving high medicaid populations in NYS  and who have substantial charity care to approach the possibility of making a RAZOR thin margin .

Lol:

Looks like it lasted for more than 4 hours.

Harvey wrote

Looks like it lasted for more than 4 hours.

 BWAHAHAHAHAHAHAHAA

Harvey wrote

Looks like it lasted for more than 4 hours.

LOL

Harvey wrote

Coach put ACA aside. How would you deal with super high US drug prices?

Negotiate better.  End all drug ads to the public.  Strictly limit how docs can be marketed to.  Don't cover lifestyle prescriptions such as the blue pill.  Allow insurance to cross state lines so the carriers have more purchasing power.

I take 3 different prescriptions daily.  My insurance company must be better than others in negotiating becuase my costs have been going down not up for these drugs.

If you end up with a rare disease the R&D costs get spread out over way fewer patients so if course that is going to cost more.  If you take away the profit motive to research these drugs they won't be created.