Why is medicine so expensive?

Over on FaceBook an image posted a Senator’s facebook page asked the question “why are prescription drugs so expensive in the US? It also claimed to answer it: “We are the only major country without a national healthcare program and the pharmaceutical industry can charge whatever it wants.”

Well, let’s leave aside that latter part which ignores things like competition and supply/demand curves. (What?  You’ve never price shopped among different treatments?  Asked if there was a lower cost alternative to some expensive medication?  Whyever not?  I have.)  Instead, let’s look at what effect a “national healthcare program” really has.

The production of new medicines and passing the extensive testing required to get them approved is extremely expensive. That cost, and the cost of those medicines that do not get final approval has to be recouped somewhere. Now, all these places with “national healthcare” are a monopsony (that’s “single buyer” in the same way that “monopoly” is “single seller”) and, thus, can dictate the price they will pay. This means the cost of development cannot be recouped there. But it has to be recouped somewhere.
And that means that we’re subsidizing medical research for the rest of the world. Even if something is developed overseas–One of the medicines I used to take (a beta blocker–not allowed while I’m on allergy shots) was developed in Great Britain and only just “aged out” to having generics available–guess who pays to recoup the development costs? Yep. We do.

We not only subsidize our own research into new medicines and treatments, we subsidize the research of the entire rest of the world.

The problem is, if we stopped doing that–by whatever means, national health care, some “fair price” law, whatever–then research into new medicines would also stop. We could “enjoy” the same level of medical progress as, say, Yugoslavia.

Don’t think so?  Get a copy of an insurance formulary (many of them are available).  These list the various approved medicines at various copay price points.  Go through and list the ones that were developed in the Soviet Union, Communist China, Cuba, or similar highly “socialist” society where it’s all “good of the State” rather than profit motive.

Did you even have to turn the paper over to continue the list on the reverse side?  I didn’t think so.

So, take away “recouping costs” and “making money” from the equation and go instead to  top-down government funded and dictated research and medical progress essentially goes away.  You may reduce the costs of what you have now, but what you have now is all you will ever have.

So why, you may ask, do the pharmaceutical manufacturers sell to these other countries if they can’t recoup their development costs?  The answer lies in a concept called “marginal cost.”  Marginal cost is the added cost of producing one more of something.  If you’re making 10,000 pills, the marginal cost is how much more you have to spend to produce 10,001 instead.  Now, so long as you have some way, some how, to make back the fixed costs you can make money selling more so long as the price is higher than the marginal cost.  Sell 100,000 pills in the US priced to recoup costs and make a profit.  Sell 100,000 pills in the US at the same price and also sell 10,000 in France just a bit more than the marginal cost and make a somewhat bigger profit.  But without that 100,000 selling in the US at a price that recoups cost, the 10,000 to France won’t exist.

As I said, we’re subsidizing the world.

The bright side is that once that cost is recouped, prices do come down. Half the medicines I take every day are “$4 generics” (that’s not a co-pay. That’s what the pharmacy charges). And the ones that aren’t are mostly in the $10-20 range. But all of them were expensive during that limited window the developer had to recoup costs.

The Senator in question, of course, knows all this. At the very least, someone on his staff could explain it to him if he asked. But it’s much more useful for him to use the cost as a means to grab even more government power.

And that’s what this is really about–a power grab. The more dependent you are on government, the more they own you.

We’re subsidizing the world.  But if that’s the price for continued development of new prescription drugs and other treatments, I can live with it.  End that, however, and you end medical progress, which means my daughter, when she gets older, won’t have anything better than I have today.

And that I will never forgive.


Surgery results

I don’t recall if I mentioned the nose surgery I would be having:  septoplasty and some trimming of the “turbinates” in the nose.  They were causing restricted air passages which is why the least little bit of congestion (and I’ve got a lot of allergies) would shut down breathing.

That surgery was this morning.

I’ve been up and down with short naps since returning home. My wife went out to the store to pick up the pain meds. Have completely saturated through two gauze pad (“sterile eye pad” held across the nostrils with an elastic band), now working on a third.   My nose hurts (of course).  My head hurts (probably at least partly caffeine withdrawal since I couldn’t drink anything pre-surgery).  My throat hurts (breathing tube during surgery).

I always respond to general anesthetic with severe nausea on waking. I told the anesthesiologist and he provided a scopolamine patch pre surgery (to stay in place three days) and said he would include some anti-nausea meds in the IV before I woke. I think that may have helped some but not nearly enough.

Was a bit concerned when I vomited up blood, but the nurse who was attending me then explained that was from the surgery and probably a part of the nausea issue. Oh. I was flat on my back while the doctor was cutting inside my nose. Where did I think the blood would end up?

Phone call to the doctor’s nurse said the amount of bleeding is normal.  No driving until after I have the gauze removed. (Appointment tomorrow at 10:10).

Since I can’t breathe with my mouth closed, eating is a bit of a problem.  Fortunately, my appetite seems to be down.  My wife made a sugar-free cheesecake pudding thing that I can take in small bites without having to chew.  That seems to be adequate for now.

What fun.

Edit:  Update 7/15/14
Got the packing out of my nose.  Man, those packs were _huge_.  I can breathe now, although my nose is a bit tender (more than a bit, to be honest) and there’s a “burning” sensation when I breathe through my nose.  I am told that this is normal.

The procedure was first to suction out the area at the bottom of my nose, then remove the packs, then stuff cotton balls soaked with a numbing medicine up in my nose.  After the numbing medicine takes effect (about a 10 minute wait) the doctor used a vacuum tube to suck out any gunk left behind. He stuck that tube far enough back that I actually felt him poke the back of my throat.

No strenuous exercise for two weeks (anything that might elevate blood pressure).  Saline spray hourly and saline nasal rinse daily.

One of my two prescription nasal sprays is “gone for good”.  The other it’s a matter of seeing how things go.

A possible downside, with more airflow through my nose, air bringing in allergens, my allergy symptoms may worsen.  But that’s what the allergy shots are supposed to be for.

Feeding the Active Writer

I experienced a lot of frustration with the coming of the first major holiday after I was diagnosed with diabetes.  I was used to preparing a big feast with all the trimmings.  Turkey, Dressing, Mashed Potatoes and Gravy, other stuff.

Most of that stuff was not on my new diet.  I’d already gone through a period of severe “carb cravings” after cutting back, way back, way way back, on the carbs.  Didn’t want to do it again even if “just one time won’t hurt you.”

So, I had to come up with alternatives.  And one of them was a replacement for mashed potatoes and gravy.  Gravy, as I knew it from childhood, was basically fat and a meat broth thickened with flour or cornstarch.  As folk who’ve been reading “feeding the active writer” know I’ve come up with an alternate thickener in xanthum gum.  The problem was the “gravy delivery system.” Potatoes are seriously high in carbs with a ridiculously high glycemic index. The solution is cauliflower.

The trick to good mashed cauliflower is to overcook it.  Ordinarily, for best effect, cauliflower is lightly cooked, lightly steamed, or even eaten raw.  For mashed cauliflower you need to boil it until it breaks apart at little more than the touch of a fork.

So, here we are  This is a basic recipe.  It scales fine.

Cauliflower (1 lb)
1 tbsp butter or margarine, softened.

For the gravy:
1 cup beef broth
1 tsp Xanthum gum.

As described above, boil the cauliflower until it breaks apart with slight pressure from a fork. Drain in a large strainer or colander.  Let it sit in the strainer for several minutes to ensure that all the excess water drains away.
Break up the large pieces using either a pastry blender or potato masher or, if you must, a fork.
Add in the butter or margarine.
Use a hand mixer on high to beat smooth.  It may retain a bit of a soft granular texture.  That’s fine.

In a small saucepan bring the beef broth to a boil.  Whisk in the xanthum gum, stirring constantly until the gravy thickens.  If it is not thick enough you can add a bit more xanthum gum.  Note that it does not thicken much on cooling.  In fact, I’ve noticed in the past that flour and cornstarch thickened gravies tend to congeal into solid lumps when refrigerated for later consumption.  Xanthum gum doesn’t behave that way.

Serve out a good dollop of the mashed cauliflower.  Top with the gravy.  Enjoy.

"Earth to Echo" a brief review.

On seeing the previews I thought “Oh, ET remade and re-imagined.”

Pretty much.  A group of kids find an alien and help it to go home. In ET, they had to send a message to request pickup.  In Earth to Echo it’s they had to assemble the parts of a “key” to allow the alien to use a spaceship already here.  In both movies they have the nefarious government types attempting to block the return of the alien.

However, the rather ho-hum and derivative story was not the worst part of it.  The worst part of it was that a “conceit” of the movie was that the footage was filming done by the kids, via various cameras, phones, and the like, put together.

That means that “shaky cam” was turned up to 11.

I got motion sick about ten minutes into the movie and stayed that way through to the end.

Absolutely most unpleasant movie experience I have ever had.

Not recommended unless extreme shaky cam is something you like.

On this July 4th.

Bringing a tradition over from my older blog:

When in the Course of human events it becomes necessary for one people to dissolve the political bands which have connected them with another and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security. — Such has been the patient sufferance of these Colonies; and such is now the necessity which constrains them to alter their former Systems of Government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid world.

He has refused his Assent to Laws, the most wholesome and necessary for the public good.

He has forbidden his Governors to pass Laws of immediate and pressing importance, unless suspended in their operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other Laws for the accommodation of large districts of people, unless those people would relinquish the right of Representation in the Legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their Public Records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved Representative Houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected, whereby the Legislative Powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the dangers of invasion from without, and convulsions within.

He has endeavoured to prevent the population of these States; for that purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their migrations hither, and raising the conditions of new Appropriations of Lands.

He has obstructed the Administration of Justice by refusing his Assent to Laws for establishing Judiciary Powers.

He has made Judges dependent on his Will alone for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of New Offices, and sent hither swarms of Officers to harass our people and eat out their substance.

He has kept among us, in times of peace, Standing Armies without the Consent of our legislatures.
He has affected to render the Military independent of and superior to the Civil Power.

He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his Assent to their Acts of pretended Legislation:

For quartering large bodies of armed troops among us:

For protecting them, by a mock Trial from punishment for any Murders which they should commit on the Inhabitants of these States:

For cutting off our Trade with all parts of the world:

For imposing Taxes on us without our Consent:

For depriving us in many cases, of the benefit of Trial by Jury:

For transporting us beyond Seas to be tried for pretended offences:

For abolishing the free System of English Laws in a neighbouring Province, establishing therein an Arbitrary government, and enlarging its Boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule into these Colonies

For taking away our Charters, abolishing our most valuable Laws and altering fundamentally the Forms of our Governments:

For suspending our own Legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.

He has abdicated Government here, by declaring us out of his Protection and waging War against us.

He has plundered our seas, ravaged our coasts, burnt our towns, and destroyed the lives of our people.

He is at this time transporting large Armies of foreign Mercenaries to compleat the works of death, desolation, and tyranny, already begun with circumstances of Cruelty & Perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the Head of a civilized nation.

He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the executioners of their friends and Brethren, or to fall themselves by their Hands.

He has excited domestic insurrections amongst us, and has endeavoured to bring on the inhabitants of our frontiers, the merciless Indian Savages whose known rule of warfare, is an undistinguished destruction of all ages, sexes and conditions.

In every stage of these Oppressions We have Petitioned for Redress in the most humble terms: Our repeated Petitions have been answered only by repeated injury. A Prince, whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people.

Nor have We been wanting in attentions to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our Separation, and hold them, as we hold the rest of mankind, Enemies in War, in Peace Friends.

We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these united Colonies are, and of Right ought to be Free and Independent States, that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. — And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

Christians are equivalent to ISIS or the Taliban?

I am not a Christian.  I describe as an "Asatru leaning agnostic" or maybe "a practitioner, if not a believer, in Asatru".  Still, I'd I have to say that Christians make far better neighbors than many another group.  Yeah, they have their bad apples but the comparison between Christians as a group, at least in the Western world, and Isis or the Taliban is beyond ridiculous.  Part of that is simply a matter of civilization.  People simply behave better in the civilized world than they do in the more barbaric regions.  However Christians in the civilized world try to spread civilization.  Groups like Isis and the Taliban try to spread barbarism.  Apples and dark matter they have so little in common.

I have yet to meet a Christian who believes I must die for being asatruar (well, leaning that way anyway). They may try to convince me of their belief. They may be concerned for my immortal soul. But they do not say I should be killed for not believing in "the god of the book." How have ISIS and the Taliban weighed in on that? Is, perhaps, the choice they offer Islam, Dhimmitude (for Christians and Jews--"people of the book"), or death?
The Crusades you say? Well, leave aside that the Crusades were quite a few centuries ago, you might want to look more deeply into the history behind them. It was a lot more complicated than simply wanting to kill the infidel in the name of Christianity.

As for folk like the abortion clinic murderers and the like that are often paraded about as examples of how "Christians are just as bad", you might want to consider the religious leanings of the people who investigated those crimes, the people who caught the culprits, the people who tried them, the people who convicted them, and the people who punished them. Simple statistics suggests that the majority of them were some flavor of Christian.
How about ISIS or the Taliban?  Same thing going on their?  Violence in the name of their religion being punished by their religious peers?  No?

Then would people stop with the false comparisons?

If it’s not one thing, it’s another.

Follow up with the podiatrist today.  While a part of me thinks it’s kind of silly to see the doctor over a sore toe (even one that’s been pretty persistent) I have also been told that with diabetes I have to pay special attention to my feet and this kind of thing is not to be ignored.

The problem is a puzzle.  The X-rays show a very slight increased separation in the first joint (the joint between the metatarsal and the first toe bone) but nothing that really explains the problem.

One thing, the new shoes I got–up from 9 1/2 EEEE to 11 EEEE–are still not wide enough.  There’s apparently a “turning” of the metatarsal bone on the little toe side that’s normal with age and that makes my foot wider than before.  He suggested going to the New Balance store and see if they have 6E in stock.  I can probably reduce a half size in length so long as they’re wide enough.  In the meantime he gave me a steroid shot in the joint, hoping to get the inflammation (the probable cause of that increased separation) under control.

If the wider shoes do not relieve the problem (since I still have the discomfort when going barefoot at home, this may well be an issue) and the cortisone doesn’t resolve it, then we may be looking at surgical intervention.  According to the doctor since I have a sedentary job, I might be able to go back to it about a week after the surgery, so long as I can stay off my feet with the “repaired” foot propped up.

We’re hoping to avoid that.

All that from a sore toe.