How PE Firms Are Flipping Drugs in Price-Gouging Scheme that Cannibalizes the Entire US Economy

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They don’t care. And they’re not required to care.

The ravenous price increases that pharmaceutical companies slap on their medicines are part of the reason the US health care system is eating an ever larger slice of consumer, corporate, and government spending, and why the rest of the economy has trouble moving forward. Some of the price increases have turned into scandals with plenty of mouth-wagging by politicians.

Mylan got raked over the coals in Congress for raising the price of its autoinjector EpiPen seven-fold since buying it in 2007. Last year, Turing Pharmaceuticals, under Martin Shkreli, got into hot water over raising the price of just-acquired Daraprim 50-fold.

Private equity firms have figured this out. You can make a ton of money with a basic formula: Fund a newly created outfit that buys the rights to a prescription drug with little or no competition and with stagnant or declining sales, jack up the price of the drug, then flip the company at an enormous profit.

This has become the latest way of wringing out the American economy without contributing anything to it, and at the expense of everyone else. So Bloomberg dug into the role private equity firms play in these schemes.

For example, Genentech developed immune-disorder drug Actimmune decades ago. Eventually, sales began sagging. In 2012, it sold the rights to Vidara Therapeutics for $55 million. Vidara had been formed for this purpose and was funded by private equity firm DFW Capital Partners.

Over the next two years, they jacked up the price of Actimmune by 434%, thus making it a very profitable drug despite declining sales. In September 2014, they flipped Vidara to Horizon Pharma for $660 million, pocketing a huge low-risk gain in just 27 months.

Then Horizon jacked up the list price another 81% to $538,000 for a year’s worth of treatment. Since 2012, the list price has soared 866%!

At that time, Vidara’s co-founder and majority shareholder, Balaji Venkataraman, was involved in another highly profitable pharma flip, according to Bloomberg. He helped start up and fund Sebela Pharmaceuticals in 2013. In August 2014, Sebela bought Miacalcin, which treats high calcium levels, from Novartis. Over the next eight months, the price was jacked up from $68 a vial to $1,987 a vial.

Then the highly profitable exit. Bloomberg: “About a year later, Sebela sold Miacalcin ‘for a substantial gain,’ resulting in a special distribution to shareholders, according to an annual report from one of DFW’s investors.”

The buyer? Mylan of EpiPen fame. Which has since jacked up the price to $2,283 a vial. This brings the total price increase since August 2014 to 3,257%!

But it’s not just old drugs that get flipped. New drugs can get the same treatment, so to speak. Savient Pharmaceuticals developed Krystexxa for chronic gout. It started marketing the drug in 2011. But things didn’t work out. In October 2013, Savient filed for bankruptcy. In January 2014, Crealta Pharmaceuticals, which had no drugs but was backed by PE firm GTCR, acquired the assets of Savient for $120 million. It then jacked up the price of Krystexxa by $8,610 per vial, pushing it from $5,390 per vial to $14,000.



In January 2016, Crealta, with Krystexxa as the main asset, was sold to Horizon – the same company that had bought Vidara – for $510 million. Horizon continued the scheme, raising the price of Krystexxa to $16,909 per vial. Since January 2014, the price has soared by $11,519 per vial.

Covis, based in Switzerland and majority owned by PE firm Cerberus Capital, acquired 14 licensing rights for $345 million over three years, from Sanofi, GlaxoSmithKline, and others. According to Bloomberg, Covis jacked up prices on six of them by over 200%. In April last year, it sold 12 of the brands and some generics to Concordia for $1.2 billion. And… “Price rises continued.”

Two of these drugs, Nilandron and Dutoprol, are up 989% and 1,057%, respectively, since 2013.

They’re among dozens of drugs bought with private financing in the past six years, according to an analysis of products in a database kept by the software company Connecture Inc. The price often rises, and the drug’s often resold.

There are other examples: The price of the old Novartis cold-sore cream Denavir was jacked up 372% “as it changed hands twice with private equity help,” according to Bloomberg. The price of Dutoprol soared 1,057% after a flip.

Between 2011 and 2015, about 650 branded prescription drugs have doubled in price, according to data from Connecture, cited by Bloomberg. And for about 100 of these drugs, prices were jacked up by over 500%.

Insurance companies and pharmacy-benefit managers, which have been focusing on top sellers to contain costs, are now starting to home in on flipped drugs that had been flying under the radar. For example, benefits manager CVS Health said in August that due to these “hyperinflationary” price increases, it would stop covering Nilandron and Dutoprol.

Senator Bernie Sanders has lambasted the greed of this industry repeatedly. Over the past couple of days, he added some stinging tweets:

9 of 10 Americans blame the pharmaceutical industry for the high cost of health care. It’s time to end their greed and lower drug prices.

The business model of the drug industry is fraud. Glaxo put patients at risk to increase their profits

It makes no sense that the same drug that costs $70 in France costs $450 in the US. We should reduce barriers to importation of drugs.

Eli Lilly and Novo Nordisk clearly care more about their profits than their patients. It’s time to end their greed.

What you have is an incredibly powerful and greedy industry charging whatever price they want.

Companies will do whatever they can to build, use, and abuse monopolies, dysfunctional markets, patent laws, and other government protections in order to maximize profits while cannibalizing the entire economy.

They don’t care. And they’re not required to care.

The fault lies with Congress and regulators that have been “captured” by the industry. They’ve allowed and encouraged this form of price gouging. They’ve recklessly and willfully shuffled off the responsibility of keeping prices under control to market forces and competition, knowing perfectly well that there are no market forces and competition for many drugs, and nothing else to keep prices in check.

The dog-and-pony shows during the periodic congressional hearings with all their professionally faked outrage are simply brushed aside by these one-drug outfits, the PE firms behind them, and Big Pharma, all of them in search of maximum profit in the shortest amount of time, at the lowest risk, and at the expense of everyone else.

Health insurers just can’t stand competition. Read…  Are Big Health Insurers Screwing with Consumers and Businesses?



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  109 comments for “How PE Firms Are Flipping Drugs in Price-Gouging Scheme that Cannibalizes the Entire US Economy

  1. November 3, 2016 at 7:30 pm

    The fault lies with all of us.. We have the power to change Congress and the power to rein in or nationalize these drug companies but they have no fear of that ever happening. The mere mention of that will send their propagandists into overtime and an army of the gullible will come to their defense even when they can’t pay for their own medicines.. Even when their own families suffer..

    • bead
      November 3, 2016 at 8:05 pm

      The epic failure of civic education in the U.S. How can anyone vote for a Republican senator? Vermin. We can’t regulate drug prices because we have tied our own hands. Want to know why Trump, why Sanders? It really is a swamp. Trump won’t help it in the off chance he’s elected. We must vote out Congress to have any chance.

      • cmnsnse
        November 3, 2016 at 9:21 pm

        You had me with the first sentence then totally lost me with the second. You think a Democratic Senator is any better than a Republican one. Slightly redeemed yourself with ‘it really is a swamp’. Term limits, banning lobbyists, and a Supreme Court that understands and supports our Constitution would be a start.

        • c smith
          November 4, 2016 at 7:12 am

          Joe Manchin – who is Mylan CEO’s Heather Bresch’s father – is a Democrat.

      • wkevinw
        November 4, 2016 at 12:14 am

        The impulse to “regulate prices” when they are “too high” is a big problem today. Whenever prices are too high, there is an absence of private competition. Regulators in such industries need to facilitate private competitions in such cases.

        Believe me, the regulators highly regulated the Epipen product market. The big companies win the “price regulation” game, not the customers.

        I can explain in more detail very clearly, having been involved in patenting technology, but a blog post is not a good venue for such a complex subject.

        The judicial system/lawyer industry is corrupt. This is especially true in the patent law area.

        • OutLookingIn
          November 4, 2016 at 1:21 am

          “The judicial system/lawyer industry is corrupt”.

          NEWS FLASH

          The ENTIRE filthy, corrupt, criminally infested, crony controlled, federal, state, and local governmental levels of leaches, have held the country hostage for years.
          They see this as maybe their last chance, to steal every last single bit of wealth they possibly can, before there is a highly probable change of leadership and a call to account.

          The country desperately needs a Trump presidency to make a start to “drain the swamp” or forever more be totally lost in an ever growing lawless land.

        • Spongy Bob
          November 4, 2016 at 5:40 pm

          Drug prices are effectively regulated in all industrialized countries except the US. Those countries don’t experience any of the drug pricing problems the US is. This problem is distinctly American.

      • sheila chambers
        November 4, 2016 at 6:49 pm

        How can you “vote” the bums out if the “elections” are RIGGED?
        I find it hard to believe that people would keep “voting” in these criminals again & again then they turn around & gripe about how they are being “represented” by them, don’t they have a “brain”? If so, why don’t they use it?
        I stopped “voting” for the dems as POTUS decades ago, now I choose them according to their record, not their party.
        I haven’t “voted” for a repug since Nixon!

    • Mary
      November 3, 2016 at 8:09 pm

      A few days away from a presidential election, we are solely focused on the great email brouhaha. Health care costs, the true crisis of homelessness, climate change, none of it being debated.

      • Edward E
        November 3, 2016 at 8:50 pm

        Bernie Sanders would be right now winning in a landslide if it hadn’t been stolen from him.

        • Kam
          November 4, 2016 at 9:45 am

          “Bernie Sanders would be right now winning in a landslide if it hadn’t been stolen from him.”

          The stalking horse that had the cheek to think he could win.
          As soon as Bernie bleated out, “I’m sick and tired of talking about the damn e-mails” and criminal Hillary grinned like a banshee, it was over for Bernie.

        • sheila chambers
          November 4, 2016 at 6:54 pm

          I was a Bernie supporter & I was livid when I saw all the disenfranchisement, vote rigging, vote switching etc.
          I hope the “Killery” LOSES the “election” & that the electoral “collage” doesn’t select her as POTUS.
          Let the dam dems go down in flames!

          The people dumb enough to “vote” for either of those two corporate criminal candidates deserves what they will be getting!
          At least Trump won’t go to war with Russia or Iran like “Killery” plans to.

      • Petunia
        November 3, 2016 at 9:39 pm

        Trump has addressed all these issues which is why he is the nominee. And that email brouhaha is worse than Watergate. Not what you wanted to hear. So I leave you with my favorite campaign slogan of the political season….

        “Love is the answer. But you should own a handgun just in case.”
        — Senate candidate John Kennedy running in Louisiana

        • nick kelly
          November 3, 2016 at 10:19 pm

          You accidentally used the word ‘brouhaha’ meaning an overblown
          tempest in a tea cup.
          But many great discoveries are made accidentally.
          BTW: Trial for fraud re: Trump U- begins Nov.28

        • wkevinw
          November 4, 2016 at 2:24 am

          Pretty well agree.

          People don’t know that the pharma companies are part of the swamp. Lawyer, executive and lobbying jobs in that industry are very lucrative and are controlled by the insiders with the revolving door to the government.

          The Clintons (i.e. the “email brouhaha”) are deeply involved in this. Look at the donors to their charity and jobs that their cronies get in these companies: Goldman Sachs, Pfizer, Microsoft, etc.

          The Clinton corruption directly contributes to high consumer prices, misallocation of capital, lower wages by off-shoring, uncontrolled immigration, etc. People don’t understand this, evidently.

          I work for one of the corps that fed at the Clinton trough, and know exactly what went down. The US taxpayer got hosed. I personally benefited a bit (just by being in the right place at the right time), but I know it was not good for the country, slimed the morale of many government employees (e.g. law enforcement), and the common taxpayer paid. I am not a Clinton fan.

          I am just one of the useful mandarins…

        • Edward E
          November 4, 2016 at 8:28 am

          Could a President Trump issue the order to have Hillary arrested for her criminality during his fraud trial or his rape trial? This isn’t an election, it’s a crime scene…

      • c smith
        November 4, 2016 at 7:19 am

        The “great email brouhaha” (as you call it) demonstrates the immense corruption of HRC. She hid her communications from others because she wanted to hide the self dealing and other nefarious activities involved in creating the giant Clinton Foundation slush fund. She had motive.

        • Petunia
          November 4, 2016 at 8:44 am

          I would like to use the reply to your comment to address a political reality which is the unspoken truth, that which cannot be named. What is politely referred to as the revolving door between business and politics in America, is called another another name in Europe, it is called fascism. What we now have here in America is fascism. Goldman Sachs has its tentacles everywhere and they are only one example.

        • night-train
          November 5, 2016 at 1:49 am

          Trump was right. The election is rigged and his campaign did the rigging with the help of the FBI. So, I guess now neither side will accept the election results. However it comes out, we will be in unchartered territory. And it could be fun. It will definitely be interesting.

    • NotSoSure
      November 3, 2016 at 8:36 pm

      Not just congress. The entire generation has to be voted out because they are all benefiting at the expense of the later generation. Congress, bankers, CEOs, are just easy targets.

    • alexaisback
      November 4, 2016 at 10:29 am

      .
      You promise half the morons in America a free phone

      and they vote for a idiot that lies to America to get healthcare

      but does not put anything in it to bargain with drug companies, IN FACT INTENTIONALLY REMOVES LANGUAGE that permitted bargaining and control.
      .
      .
      Ya got what you paid for. idiots.
      .
      .
      There is zero control over congress when you can give out free phones, or fly around the country on the US TAXPAYERS dime to campaign.
      .
      .
      When Ever when the term was up, did the President of the US get to spend 100’s of millions campaigning and flying all over the country ?
      .
      .
      .
      Yup ya got what you paid for – corruption known
      corruption shown.
      .
      .

      • Smingles
        November 4, 2016 at 2:16 pm

        SafeLink Wireless– the program you are referring to– offers a free cellphone with approximately 60 minutes of talk per month to households near or under the poverty line.

        The program is sustained by contributions from the telecom industry.

        The program for cellphones was started in 2008 by President George W. Bush (Barack Obama was elected in November 2008, and inaugurated in January 2009). Subsidies for telephones for low income people date back to 1984 under President Ronald Reagan, which were expanded in 1995 by President Bill Clinton.

        Another “low information voter” who can only point fingers when they should really be staring in the mirror.

        • kitten lopez
          November 4, 2016 at 4:30 pm

          (daaamn… talk about DROPPING THE MIC)

          i thought you were just a crabby troll guy before but that was impressive how hard it hit the motherfuckin’ FLOOR.

        • Chicken
          November 5, 2016 at 12:13 pm

          Thus the telecom industry needs presidential decree to accommodate their desire to provide free service.

    • Gregg Armstrong
      November 4, 2016 at 3:17 pm

      No the fault does not lie with us. It doesn’t matter who we vote for. The political parasites are all liars who do only what their puppet masters who bribe them tell them to do. 95% of the American People are disenfranchised. It doesn’t matter who we vote for or whether we vote at all. The United States of America is an Oligarchy-controlled Imperial Police State.

      • Passenger_Pidgin
        November 4, 2016 at 11:16 pm

        A less doomful way of saying it is that money buys political influence. The loss of money is the loss of political power. I hate saying this, but the Patriot Act was probably more appropriate to wealth distribution than national security.

    • Beans
      November 4, 2016 at 3:58 pm

      The problem with healthcare costs, drugs included, is that healthcare is as much a giant jobs program as a means to provide for the nations’s health. The army of ancillary healthcare workers that really provide no true service other than shifting paper around is massive. But cutting those jobs to bring down prices through better efficiency would have the same effect as offshoring manufacturing – massive job losses. So yes, the fault lies with all of us but no, we do not have the power to change, but for on the margins.

      What we don’t need are PE groups making gigantic profits and churning businesses without adding value. Propagandists are having a hard time justifying that practice. Continuing the pressure from stories like this is important.

  2. M.C.
    November 3, 2016 at 7:51 pm

    Interesting article, but misleading. Pharmas are partly to blame for the higher prices, and these so called generic companies and PE firms are even worse, but you completely ignored one of the leading problems in this byzantine industry, the middleman. Between the actual drug maker and the consumer lies a full load of middleman, each of whom takes a huge cut in the process. Really, just look up pharmaceutical supply chain and you’ll see how convoluted this mess really is. (this isn’t like a phone going from Apple or Samsung to the consumer)

    The comment “Insurance companies and pharmacy-benefit managers, which have been focusing on top sellers to contain costs” is a bit laughable. Since the leading pharmacy benefit managers (PBMs) are some of the biggest reasons for price increases seen in drugs. The PBMs reason for existence is supposedly to help negotiate better prices, but in reality, they are nothing more than a middle man that ensures the pricing is high and their own pockets are stuffed. All you need to do is to take a look at the income statements of the leading PBMs for the last few years, and you can see the benefit they derive as the middle layer.

    Not excusing the pharmas/biotechs by any stretch of the imagination, but realistically, there is a need to understand this bizzaro health care management complex before pointing fingers. This seem to be one of the leading problems with politicians and the peanut gallery.

    • November 3, 2016 at 11:34 pm

      To see how insidious the pharma industry is, see my response to James R. Chaillet, Jr., MD below. This was published today after I published my own article.

  3. James R. Chaillet, Jr., MD
    November 3, 2016 at 8:06 pm

    Thank you for the post and the examples. As a family physician with a modicum of economics knowledge and a libertarian bent let me make a few observations. First, most of the drugs are not truly unique and the only thing between you and death or severe disability. There are alternatives or should be. Even Epi-pen had competition. Second, a large part of the problem is third party reimbursement – aka the insurance companies. If patients had to pay these prices (or if they just knew about them), they would say “go to hell and stay there”. Third, too many physicians don’t give a sh__ or they are just sloppy. For example, I’ve seen an Epi-pen prescribed to someone with just a local reaction to a bee or wasp sting, which is not an allergic reaction. And then the prescription has to be refilled every year because of the nature of epinephrine. I goes bad.

    Part of the solution is for patients and physicians to just say no and find alternative medications, doable in a lot of cases but not always. Also, insurance companies will start to exclude these drugs from formularies or make doctors jump through so many hoops that they’re be too bruised and bloodied to prescribe anything

    I fear that the government alternative of price controls and fines will create more problems than solutions; such an another bureaucracy and more paperwork for physiciansl

    Keep up the good and entertaining work

    • Chicken
      November 3, 2016 at 9:58 pm

      “Part of the solution is for patients and physicians to just say no and find alternative medications”

      Wouldn’t avoiding ACA entirely involve breaking Federal law?

      • TheUncle
        November 4, 2016 at 7:10 am

        “Wouldn’t avoiding ACA entirely involve breaking Federal law?”

        I don’t think so, as Uncle Sam instituted a “shared responsibility payment” (aka, extortion) for your yearly taxes – so if you avoid ACA you still have to pay Uncle money (approximately the amount that would have been collected by taxing your money as it went into heath plans). As long as you pay Uncle, you are okay and they are golden.

    • November 3, 2016 at 11:29 pm

      Just happened this afternoon: This is one of the many reasons why your theory won’t work. The pharmaceutical industry is insidious, and an individual on his or her own is completely helpless, and totally exposed:

      U.S. Charges in Generic-Drug Probe to Be Filed by Year-End
      http://www.bloomberg.com/news/articles/2016-11-03/u-s-charges-in-generic-drug-probe-said-to-be-filed-by-year-end

      U.S. prosecutors are bearing down on generic pharmaceutical companies in a sweeping criminal investigation into suspected price collusion, a fresh challenge for an industry that’s already reeling from public outrage over the spiraling costs of some medicines.

      The antitrust investigation by the Justice Department, begun about two years ago, now spans more than a dozen companies and about two dozen drugs, according to people familiar with the matter. The grand jury probe is examining whether some executives agreed with one another to raise prices, and the first charges could emerge by the end of the year, they said.

      • M.C.
        November 4, 2016 at 12:11 am

        Yep, saw that particular article. The problem is that healthcare as an industry is so interconnected that it is impossible to pull apart. PBMs like CVS and Express Scripts have been around for years, so have the pharmaceutical distributors, three of them control most of the industry in the U.S. The entire complex is built around these middleman. The consumer really has no say in any of this.

        It’s not like an average consumer could go to Pfizer and buy his Lipitor or Viagara direct. The complex of middle man will easily double the pricing of a drug. I was looking at Gilead’s latest quarterly statement. Their HCV miracle cure lists at a range between $72K and $94K. But then you do the math on their US customer base for the quarter, 53K patients treated in the quarter, and revenue of about $2B in the US. The per patient cost is just under $40K. (not exactly cheap, but not too bad for a 95% effective cure, which is pretty rare for a drug) The rest of it is just sucked up by the middle man. I bet the out of pocket cost is probably significantly less for the consumer, but with all the money changing hands between the insurers, the PBMs, the distributors, that’s just a ton of money that is going into third parties.

        Those are all the insurance premiums we’re stuck paying; and in the end the drug manufacturers benefits some, but then there is a whole chain of hanger ons that gets a piece of that pie too. Talk about inefficient.

      • Humpty Dumpty
        November 4, 2016 at 9:15 am

        Wolf, this sort of pitchfork rhetoric will get you Nancy Pelosi re-elected but not get you low cost drugs – ever. Your article identifies a myriad of financial deals conducted by unscrupulous pirates. That is not the pharmaceutical industry that risks huge amounts to find a candidate substance that takes billions to get through the idiotic, corrupt FDA. The pirates succeed because the market is broken – the intervention of the government in the health care marketplace gave birth to these pirates. You have decided that the outcome of the government investigation of generic price fixing is a fate accompli. I will bet you the cost of your next prescription that NOTHING will come of this. NOTHING but a shakedown. You want more government? Are you nuts? The FDA is out of control in its mandate to “protect” the consumer – aspirin could not get through the FDA today. Look at hospitals run by pirates for another example of Obamacare side effects. You want more of this? There is NO marketplace – generics find their prices by what the HOSPITALS/INSURANCE/GOVERNMENT decide they are going to pay – and so the prices are the same – duh! Government like you implicitly argue for means you won’t be able to buy a drug for any price because no one will produce them. European pharma produces NOTHING. It distributes. That’s your model? The problem goes back to the marketplace and it would take very little in the way of regulatory action to discourage the pirates if a true marketplace existed as it used to be – the laws are on the books, but a grandstand play by politically motivated investigations with guys like Wolf Richter cheering them on? – the investigations themselves, complete with a PR packet are hideously corrupt and instigated by the very people who have put in place the monster of Obamacare, itself only the tip of the iceberg of government intrusion into everything in the healthcare fiasco of crony capitalists, clamors for investigations, and media too stupid and naive to know what is going on. We are in a society lurching toward civil war – I suspect that will bring back the marketplace, but not much else.

      • Maximus Minimus
        November 4, 2016 at 11:45 am

        I would also ban free seminars for doctors given by drug companies. As usual, organized in luxurious settings, supposedly to inform doctors about their new wonder drugs. It is yet another scam.

    • william
      November 4, 2016 at 7:47 am

      Exactly. Assumptions of the ‘life sustaining powers’ of these pharma products are not true. Yet, the entire industry is sworn to secrecy on reports and lab findings or the actual effectiveness of many pharma products.

  4. Merlin
    November 3, 2016 at 8:56 pm

    Would this greedy practice be solved by a single payer system with set prices for all pharmaceuticals?

    • M.C.
      November 3, 2016 at 10:17 pm

      Wait, is your solution to put all those people who work at the insurance industry, the PBM, essentially the entire health care supply chain (the middle man) out of business?

      Let me know how that works out. This is exactly what I mean about the lack of understanding on the healthcare supply chain. Someone would have to recreate an entire bureaucracy whole cloth to replace the existing system. Given how well that has worked with ACA, I am surprised more people aren’t running away screaming.

      Then there is the fact that the US is subsidizing the cost of advanced medicines all over the world. Take Gilead’s miracle $84k hepatitis C cure, it costs less than $800 for the whole treatment in Egypt. Now why couldn’t we get that in the US, simple, if it was at $800 per treatment at the US, no pharma or biotech would have any reason to do R&D to get that miracle drug on the market. Gilead spent $11B to acquire the molecule, another few Billion to bring it to market by going thru clinical trials. There is not enough HCV infected people in the world to justify finding a cure at that kind of prices ($800 a treatment)

      So, oddly enough, Trump might actually have the right idea when he says he wants to make other country pay their “fair share.” But the reality is they can’t.

      • November 3, 2016 at 11:43 pm

        Here’s a model how that works: Kaiser Permanente is a large healthcare provider AND its own health insurer. It changes the dynamics. We’ve been with them for years. Low premiums, great health care, and lots of freebies for wellness, such as flu shots and all kinds of other things. They really WANT people to stay healthy because if they get sick, Kaiser is going to have to pay for it!

        • M.C.
          November 4, 2016 at 12:16 am

          Kaiser is a predominantly west coast, although there might be some stuff on the east coast too. I remember using them as a kid, but honestly don’t know enough about them to say. But if they are truly that good, why aren’t they nationwide? (Not being sarcastic here, just asking a question about their overall business)

        • November 4, 2016 at 12:28 am

          Insurers are regulated by the state. Each insurer has to set up a legal entity in that state and follow that state’s regulations.

          For Kaiser it’s even more difficult: it needs to set up not only an insurer but also the entire health care system in every city, so in each city a big hospital or two, diagnostics facilities, etc., plus hire all the doctors and staff needed in each city. So this is a big thing.

          They’ve been expanding. But it takes a lot of resources to build that kind of system all over the US.

          IN 2015, they had $60 billion in operating revenues. Here’s a list of where they are. Clearly, they’re biggest in California.

          https://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/

        • Humpty Dumpty
          November 4, 2016 at 9:25 am

          Nice model, but it is failing. Kaiser now is getting whacked by government mandated ‘members’ from Obamacare and will implode unless this stops. No one seems to be talking about where all this feel good legislation will take us, but Kaiser execs know they will be absorbed and taken apart in the future given the current trajectory that shows no signs of altering.

      • Smingles
        November 4, 2016 at 2:28 pm

        “Then there is the fact that the US is subsidizing the cost of advanced medicines all over the world. Take Gilead’s miracle $84k hepatitis C cure, it costs less than $800 for the whole treatment in Egypt. Now why couldn’t we get that in the US, simple, if it was at $800 per treatment at the US, no pharma or biotech would have any reason to do R&D to get that miracle drug on the market. Gilead spent $11B to acquire the molecule, another few Billion to bring it to market by going thru clinical trials. There is not enough HCV infected people in the world to justify finding a cure at that kind of prices ($800 a treatment)”

        My understanding is that R&D costs reported by the pharmaceutical industry are way overstated– like, by a whole order of magnitude.

        The Federal Government also subsidizes the vast majority of basic pharmaceutical research but sees very little of the profit for fully developed and successful drugs.

    • wkevinw
      November 4, 2016 at 2:36 am

      In the short run, yes. This is one of the big problems with centrally planned and controlled economies. HOWEVER…

      Over time, the product and service quality would decline.

      Also, this disincentivizes innovation. As a person who does international business in a technology industry, I can tell you that the rest of the world has abdicated almost ALL innovation to the USA. Look at the number of significant drug or electronic innovations over the past 10 years. It’s probably 90% USA based.

      If you make a single payer system, everybody will get a lot of equality: equally mediocre care with no new cures for anything.

      • night-train
        November 4, 2016 at 2:53 am

        If your scenario plays out as you predict, the Feds could provide grants for researchers to continue innovations. Many things we have today were seeded with government money. DOE developed the technology used in shale fracking and coalbed methane production, among other things. Markets are so distorted at this point, many no longer work. A kickstart may be needed.

        Many rare medical conditions are not profitable for the private sector. In those cases, I have no problem with government providing drugs at a reasonable cost to save lives.

        • wkevinw
          November 4, 2016 at 3:59 am

          The erroneous argument for putting all innovation into government/public funding schemes is easily refuted.

          While government/state-based academics have certainly contributed, without the profit motive, believe me, the innovation doesn’t happen.

          There are lots of very smart academic and government researchers in Europe and Asia with plenty of government support to innovate. The true innovation doesn’t happen there. (Note- their science education/skills might be “better” than in the US in some areas).

  5. PrototypeGirl1
    November 3, 2016 at 9:09 pm

    We must vote with our feet, and stay away from pharmaceuticals if we ever hope to slay this beast. I’ve seen so many people completely loose control of their health, it usually starts with a flu shot, vaccination, or an insistence from their doctor that they need a statin of some kind. Within days or several months they have some major problem, like they can’t walk up a flight of stairs, or a major arthritis problem. The people never connect the dots. I had a friend from CA visit for a week, he has some weird health problems, I said let’s look up your meds and check for symptoms, well sure enough his symptoms were listed as possible side effects. I could go on for days but let me just say the medical world is a huge scam. Let the rock throwing begin.

    • william
      November 4, 2016 at 7:50 am

      “Every medicine has a side effect”….. When I mention this, people stare at me like I just swore. The doctor never mentions side effects.

      • Ivy
        November 4, 2016 at 4:34 pm

        Have a pharmacist review all of your meds together to see about any interactions. They are more qualified to assess potential problems and compounding side effects. Also ask them specifically about the dosages and whether any adjustment may be merited.

  6. Chicken
    November 3, 2016 at 9:52 pm

    I don’t know about you guys but I fully intend on voting for more of the same.

  7. Chicken
    November 3, 2016 at 10:02 pm

    “But they don’t care. And they’re not required to care.”

    When you have a system that rewards theft, that’s what you’ll get. But, there’s no debating, the decisions are already determined (We want more of the same).

    Hook line and sinker…….

  8. Flying Monkey
    November 4, 2016 at 1:57 am

    H.R.1207 – Prescription Drug Marketing Act of 1987 banned re-importation, which could used market forces to control price abuses such as these ….It passed both the House and senate on voice vote.. Now one sees the unforeseen consequences of such legislation meaning to do good.

    100th Congress 1987–1989 composition
    Senate Dem. 55 Rep. 45
    House Dem.258 Rep. 177

    https://www.congress.gov/bill/100th-congress/house-bill/1207/cosponsors?q=%7B%22party%22%3A%22Democratic%22%7D

  9. Lee
    November 4, 2016 at 2:48 am

    An interesting article and one that caused me to do a little checking.

    Here in Australia we have a Medicare system and what we call the PBS (Pharmaceutical Benefits Scheme)

    http://www.pbs.gov.au/pbs/home

    Prices vary for the type of medicine and range from A$5.20 to around a maximum of A$38.20 if the item is on the PBS list.

    Being a ‘lucky’ person I had come complications from a fall and have to take a nifty new drug.

    Here in Australia that costs me the maximum of A$38.20 per fill per month. I thought that was a lot compared to the minimum cost items……….

    However in the USA I checked to see what I would pay…………..

    Yep, around US$378 for the same item.

    Finally, an item where Australians are NOT getting ripped off.

    • william
      November 4, 2016 at 7:52 am

      A few of these stories trickle into the U.S. but most are squashed. Also, there’s buzz American doctors are moving to Australia, quite enthusiastically.

  10. Jas
    November 4, 2016 at 3:24 am

    Very interesting article. I agree with pretty much every conclusion made there.
    Drig manufacturers also deploy patent extenders on some of their more profitable medicine to prevent generic competitors. This can extend intellectual property rights for a very long time.
    I heard an interesting interview with a retired CEO of a major pharmaceutical company not long ago and he said he’s appalled at the greed in todays big pharmaceutical industries. Not long ago he main purpose of pharmaceutical companies was to improve patients lives, not make as much money as possible. Today’s CEO’s in general work for their shareholders and really don’t care about the company or employees.
    They make as much as possible and bail with their golden parachutes, moving on to the next victim.

  11. Jas
    November 4, 2016 at 3:39 am

    It also is interesting how Private equity has been moving into businesses that used to be publicly run. Such as prisons and local fire departments. Industries they know nothing about but can reap huge sums of money on the tax payers dime. Bernie Sanders has it 100% right and it’s a damn shame he wasn’t given a fair shot at becoming the democratic nominee. He has consistently been a strong advocate for the middle class and makes no qualms about pointing out greed and corruption when he see’s it. Just as Hillary said, she has a public position and a private position. We can all expect more wall street free money and unfettered global trade and capital with TTP, TTIP, TISA. She’s already acknowledged that she is foing to be Barack Obama, 2.0 Good luck folks.

    • night-train
      November 4, 2016 at 4:17 am

      Bernie was my first choice. But he isn’t a choice now. Hillary doesn’t inspire me, but she is qualified and less likely to blow it all up. While there is part of me that would like to see the system blown up, the realist in me knows that the suffering would be wide spread and weaken the country, perhaps beyond repair. For me, the better option is to give her 4 years while we watch the outcome of the Brexit vote. In a sense, the British have blown it up. If it works out for them, maybe we follow. If it goes badly, then we may benefit from their mistakes.

      • Lee
        November 4, 2016 at 7:00 am

        Clinton is Nixon on steriods times ten to the 10th power.

        A disgusting human being and ugly on the inside as well as on the outside.

        Qualified?

        Qualified to do what? Blow up the Middle East more than she and her buddy, obama, have done?

        Qualified to set up more foundations to take money from rich people and corporations?

        Qualified to set up personal communications systems that ignore the law?

        Qualified to advise on commodities? She did better at that than I ever did in such a short time period. Move on nothing there either folks.

        Qualified to become a real estate salesperson? Yeah, I hear that she and her husband did a bang up job with Whitewater.

        Qualified to become a personal counselor and rape crisis center advisor? I hear that she has some experience in the area.

        Qualified to be in the military? I heard that she has some kind of experience of being ‘under fire’ when she landed in Bosnia. Nah, another lie there folks.

        Qualified to become a travel agent? I see that she didn’t do to well with that Travelgate matter in the White House before.

        Qualified to tell the truth? She wouldn’t know what the meaning of the word is.

        Yeah, I guess that she has a variety of interesting experiences that make her perfectly qualified to do another stint in the corrupt US government to make the USA and the rest of the world a much worse place for everyone.

        Bernie?

        Another joke – ‘More free *hit”, was his slogan wasn’t it?

        You people in the States have been going downhill for years. Frogs being slowly boiled alive and too dumb to know what is going on.

        I really do feel sorry for you people over there and what has become of what was once a great nation and one to become worse if that woman ever becomes President.

        • Edward E
          November 4, 2016 at 8:43 am

          Lee, with all due respect, please go check out Asher Edelman and what he had to say in the spring and summer about Bernie, Hillary and the Donald. I am the one that sent the email, got him and his team aware of what Edelman was saying. We just couldn’t get him to join Jill.

          https://asheredelman.com

        • Chicken
          November 4, 2016 at 10:21 am

          You can’t simply redistribute wealth, that’s just nutso big government and is exactly what’s been going on.

          “Capitalism” doesn’t work due to self-conflicted interests inside the Beltway, it’s become bastardized capitalism where you win contracts worth billions, some high level appointment or some special protective clause via the pay to play.system.

        • night-train
          November 5, 2016 at 2:15 am

          Lee: I sense that you don’t like Hillary. You are an angry man. Maybe big pharma has something that will help you.

      • Petunia
        November 4, 2016 at 8:57 am

        Bernie was always running to make it look like Hillary had opposition. The problem is that she is such a terrible candidate that his campaign took off. If he was a serious candidate, he would have taken the Libertarian or Green party nominations, which were both offered to him. Even I might have voted for him. But I knew he was a fraud and would never give up his committee assignments(given to him by the dems) or his reelection to the senate(the dems guarantee that he will not be opposed by a dem).

        BTW, this was all talked and written about by Chris Hedges from the beginning of the campaign.

        • Edward E
          November 4, 2016 at 9:17 am

          Possibly, heard that before well anyway, if Hillaboo has to withdraw I’m sure Bernie will back whomever the DNC picks. This is the absolute last election I spend any money on!

          This has certainly been the most money grubbing election I’ve ever witnessed. Trump sent an email to invite me to be one of his founding doners. I replied that “No, I’ve spent all the money set aside for this dog & pony show and watched Bernie cave in to a woman who needs put in the big house instead of the Whitehouse.”

          Then I get a reply from Dr Ben Carson about be a foundation doner and asking what I do for a living.
          ‘I’m just a dumb twuck driver, don’t need to be spending that kind of money.’

          He says, “Hey if you give Trump all your money I can get you a brain transplant and then you won’t have to be a dumb trucker no more. Who do you work for?” “The pumpkin patch.” He says, “The pumpkin patch! Man if we can get one of those upper management executive brains, they’re priceless!”

          I replied, “Look I might be a dumb twuck dwiva but I’ve met most of them folks, they ain’t exactly rocket scientists! What is so special about their brains?”

          He says, “That’s just it, those are the freshest brains, they’ve never been used!”

        • kitten lopez
          November 4, 2016 at 4:40 pm

          YOU’RE RIGHT! Chris Hedges DID say that. i love that man’s work. talk about being beyond giving a fuck what anyone thinks…he’s got that LOOK in his eyes that he’s beyond the bullshit of anything anymore and all this is for his kids at this point.

  12. Sound of the Suburbs
    November 4, 2016 at 4:39 am

    We had small state, raw capitalism in the 18th and 19th Centuries.

    Adam Smith saw price gouging in the 18th Century:

    “The interest of the dealers, however, in any particular branch of trade or manufactures, is always in some respects different from, and even opposite to, that of the public. To widen the market and to narrow the competition, is always the interest of the dealers. To widen the market may frequently be agreeable enough to the interest of the public; but to narrow the competition must always be against it, and can serve only to enable the dealers, by raising their profits above what they naturally would be, to levy, for their own benefit, an absurd tax upon the rest of their fellow-citizens.”

    What’s new?

    Adam Smith saw how today’s Mergers and Acquisitions remove competition and work against the public.

    Capitalism gone wrong in an 18th Century sort of way, all the old problems are back.

    • Islander
      November 4, 2016 at 10:42 pm

      Wonderful quote, thank you!

  13. Gregg Armstrong
    November 4, 2016 at 4:45 am

    I used to be very pro capitalism. But, not any longer. Conporations are nothing more than criminal enterprises aided and abetted by their bought and paid for political parasites and there is no difference between the parties of political parasites. I can’t afford medicine any longer even though I’m covered by Medicare Part D.

    Conporate crime goes far, far beyond the criminal crony capitalist pharmaceutical conporations. There’s the banking gangsters and the Con Street Swindlers to reckon with as well as many others. A conporation’s greatest return on equity is in bribery where rates of return of 20,000% are common.

    I’m for burning the whole corrupt system down to the ground with ALL the criminals inside the building.

    • wkevinw
      November 4, 2016 at 8:19 am

      Yes, corporations are run by imperfect humans that are sometimes greedy, unethical and unlawful.

      The job of the government is to enforce the law against these people. The government is to blame for these problems because it does not properly enforce the law.

      Do you think the current administration sent any financial criminals/banksters to jail? No, they did not. That is all you need to know.

      The big fight now between Clinton, Inc and the FBI is yet another example. We’ll see if the government law enforcement people can get this one right.

      • walter map
        November 4, 2016 at 10:35 am

        “The government is to blame for these problems because it does not properly enforce the law.”

        Naturally, the perpetrators have nothing to do with it.

        The government doesn’t enforce the laws, where there are any laws, because you get suckered into voting for the candidates bankrolled by the perpetrators. And for that you have no one to blame but yourself.

        • wkevinw
          November 4, 2016 at 10:36 pm

          Of course the perps are to blame! But the government MUST enforce the law, or you have no civilization.

          It is a GIVEN/assumption that you will have law breakers. It should also be a GIVEN/assumption that you have effective law enforcement. We do not have effective law enforcement, which is always a government duty.

      • Kent
        November 4, 2016 at 12:34 pm

        I always find it intensely important to blame the government for everything. Otherwise, people might find out who the real perpetrators are.

    • nick kelly
      November 5, 2016 at 2:09 pm

      Who built the computer you are commenting with?

      • Gregg Armstrong
        November 6, 2016 at 3:20 am

        The Chinese built the computer (iPhone in this instance, but they also built my iPad and Apple MacBook) that I am commenting with. The integrated circuit chips were probably fabricated in Taiwan, Malaysia, Indonesia, Singapore and other Asian nations.

  14. c smith
    November 4, 2016 at 7:07 am

    Fascinating. Looks like VRX and MYL got in late to the “game”, took it to excess, and got caught, thus ruining it for everyone.

  15. Bob
    November 4, 2016 at 9:15 am

    I never paid too much mind to the healthcare crisis because I’ve never required care. Then my daughter broke her arm this year, and I woke up to how bad this system is. I paid about $8,000 for a about 4 hours of care. The real cost was all the back office work. I went to only two care facilities but received about 12 invoices because there are so many parties invovled. The hospital, the nurse, the radiologist, and many others all come from different practices. Then there is the insurance company. I spent 15 hours of my own time sifting through invoices and dealing with the insurance. Some providers were were sending bills to me rather than directly to my insurance. Some providers weren’t sending the right information to the insurance. It’s a darn snowball effect. One error leads to 10 others. I tell you – don’t ever get sick because this system will take advantage of you big time. I used to believe in free market for healthcare but it’s hard to see any benefits from that now. Single payer is now a legitimate option in my mind. Too much of cost in today’s system is related to billing, administration, and protecting the separate interests of the huge number of parties that get involved in a simple hospital visit.

    • Chicken
      November 4, 2016 at 9:58 am

      May as well call a veterinarian, I think they provide better care for anything short of brain or heart surgery.

      • walter map
        November 4, 2016 at 5:55 pm

        “May as well call a veterinarian”

        Of course, you’re a chicken. Humans have doctors.

        • kitten lopez
          November 5, 2016 at 1:48 pm

          !!!!!!!!

          —–“May as well call a veterinarian”

          ————-Of course, you’re a chicken. Humans have doctors.

    • Ivy
      November 4, 2016 at 10:31 am

      If you do have to go through the bills, that can be a real eye-opener. When a single dosage of a simple med is listed at $160, that cries out to be challenged. Hospitals in LA, for example, use local competition for price guidelines, which means that they support each other through effective price floors instead of facing any material incentives to become more efficient. They should just tell the patient that XYZ Hospital charges $$$ so we can too. There can be some flexibility in reducing invoices if you have the will to keep after them.

  16. walter map
    November 4, 2016 at 10:24 am

    It’s either a mugging or an extortion racket. Maybe both.

    “Your money or your life.”

    “Pay up or the kid gets it.”

    All perfectly legal. Americans consistently vote in favor of its kleptocracy – government by thieves.

    • walter map
      November 4, 2016 at 10:28 am

      The Germans have an expression for it:

      Ich kann nicht so viel fressen, als ich kotzen moechte.

      I can’t eat enough to puke as much as I would like to.

      • Ivy
        November 4, 2016 at 10:37 am

        Consumers may also feel the need to use another German word when dealing with bureaucrats, politicians, the media and countless other modern folk:

        Backpfeifengesicht – a face in need of a fist

        • nick kelly
          November 5, 2016 at 2:11 pm

          Die kack ist am dampfen

      • kitten lopez
        November 5, 2016 at 1:51 pm

        “I can’t eat enough to puke as much as I would like to.”

        “a face in need of a fist”

        …oh man this place is HIGH FUCKING LARIOUS…it needs its own tv show.

        i could spend my entire LIFE looking for opportunities just to say this line as much as possible but i’ll wait til i’m drawing my eyebrows back on crookedly and repeating life stories over and over again:

        “I can’t eat enough to puke as much as I would like to.”

  17. walter map
    November 4, 2016 at 10:38 am

    “This has become the latest way of wringing out the American economy without contributing anything to it, and at the expense of everyone else.”

    The U.S. does not actually have an ‘economy’. It’s more like a collection of racketeering operations.

    • kitten lopez
      November 5, 2016 at 1:54 pm

      you need a rim shot, Walter Map. i can’t even keep up here. so if you can’t get a partner to do the noise, you must make it your personal ring tone or become a ventriloquist.

  18. Betty King
    November 4, 2016 at 10:58 am

    something even more sinister is at work here…

    Did you know that all physicians who write prescriptions for Opioids are now requiring that their patients get a prescription for an Epi-pen? It is suppose to be used in cases of overdose which has become an “epi” demic among their patients.

    I cannot help but think that this was all part of someones scheme to make billions off of the sale of this 5 cents worth of product.

    • November 4, 2016 at 11:13 am

      Dr. Gorback, where are you? Can you weigh in?

      Any other MDs out there who want to weigh in?

      • Michael Gorback
        November 4, 2016 at 11:47 am

        Epi-pens inject epinephrine, which is used to treat anaphylaxis, a severe potentially life-threatening allergic reaction. For example, someone who has anaphylactic reactions to bee stings might carry an epi-pen.

        Epinephrine is useless for drug overdoses.

        There are numerous community based programs around the country that provide people with naloxone, which can reverse an opioid overdose. It can be administered by injection or as a nasal spray. These programs have been around for years. The success of naloxone kits depends upon someone having one and using it on the OD victim, unlike an Epi-pen, which can be self-administered.

        I don’t know anyone who requires their patients to obtain a naloxone kit. I don’t, and I don’t carry one.

        Check out the Harm Reduction Coalition.

        • November 4, 2016 at 11:50 am

          Thank you!!

        • kitten lopez
          November 4, 2016 at 4:46 pm

          that was funny Wolf calling out a doctor in the room –AND ONE APPEARED. man. i love this place…

          Petunia… Edward E…Walter Map… Mary… aaaaah… still here…

    • Chicken
      November 4, 2016 at 12:33 pm

      I haven’t heard of this, it makes no sense and I doubt it’s occurring (hopefully), unless perhaps the MD is getting kickbacks?

      I’m not a doctor or PhD, I’m a simple chicken pecking at the ground for crumbs.

  19. Chicken
    November 4, 2016 at 12:23 pm

    DC knows full well why a particular medication in the US costs $350 while that same product in Australia costs $35, they enable this b/c choose to reward theft.

    Vote for more of the same, guess what you get?.

  20. Kent
    November 4, 2016 at 12:42 pm

    Health care in the U.S. is not a market. Markets require price transparency, a common understanding of quality between buyer and seller, and competition.

    None of these things exist and therefore should be fully regulated by the government. However, the government has been fully coopted by industry groups including health.

    So nothing will be done to fix this until the level of outrage reaches an inflection point. No one knows when that point will be. But the results will be far worse for healthcare providers than they can imagine. And its a shame, if they could just stop now, they could live very well. But greed only grows when rewarded.

    • walter map
      November 4, 2016 at 3:23 pm

      “But greed only grows when rewarded.”

      It is always a mistake to feed the rich. It only makes them hungrier. Eventually one runs out of anything to feed them, and then you have nothing to feed yourself. Of course, the rich could ultimately ruin the markets that enrich them, but by that time they are already rich.

      Still, what they cannot do is destroy the economy or the ecosystem, because wealth has no value if there is no viable support for it. Their gold is worth nothing to them if there is nothing to buy with it, or if desperate hordes come to take it from them.

      But that is what they are doing. The rich are destroying the planet.

  21. Petunia
    November 4, 2016 at 3:25 pm

    I can’t wait for a single payer healthcare system.

    • kitten lopez
      November 4, 2016 at 4:48 pm

      why? what do you mean? i want to know!

      • Petunia
        November 4, 2016 at 9:10 pm

        Everybody is covered and everybody pays.

        • c smith
          November 5, 2016 at 7:24 am

          “Everybody is covered and everybody pays.”

          Yes, everybody is covered, including all the people who continuously make awful decisions in their lives – to smoke, drink and take other drugs to excess, refuse to exercise and do nothing but sit on the couch and eat themselves into obesity with all its (incredibly expensive) complications. And I pay for it. Ain’t it great!

        • kitten lopez
          November 5, 2016 at 1:56 pm

          okay, thank you— i was wondering if you were just being facetious and if so, i HAD to know what you knew.

          (smile)

  22. Julian the Apostate
    November 4, 2016 at 4:22 pm

    It is still ok to be pro-Capitalist. What we have today is NOT Capitalism. It is ok to blame government since all they have is a monopoly on force. Government is not a necessary evil. It’s just evil. Night Train my friend your mind is well ordered and I have admired on many occasions your observations. But you’re going to vote for HRC to save us from Trump? To quote my granddaughter “Omg! WTF??” Do you remember all those dire warnings about letting that cowboy Ronald Reagan get his finger on the nuclear trigger? Did the missiles fly? No. The Soviet Union collapsed instead. I didn’t vote for Reagan back then, as I was a blue collar democrat. I didn’t vote for Carter either. I was sick of his damned sweaters and driving 55 and freezing my butt of from setting the thermostat at 60 so I could pay the light bill. When Reagan stepped out of the limo at the Inauguration I thought well damn! The man at least looks like a President. Trump will do well, I think.

    • walter map
      November 4, 2016 at 5:37 pm

      “Government is not a necessary evil. It’s just evil.”

      Only because it’s holding back corporate totalitarianism. Which is actually a good thing.

      Americans typically lack any experience with benevolent government, and therefore presume none exists, even though there are many fine examples in Europe and elsewhere.

  23. Julian the Apostate
    November 4, 2016 at 4:29 pm

    P.S. To Wolf: I find it verily irritating that instead of jumping to the top of your article when I pull it up that I’m being sent to an ad for Hillary in the middle between the article and the comments. Just sayin’🚛

    • November 4, 2016 at 5:13 pm

      Yeah, these Google ads do this to you. I can’t wait for this election to be over. I’m tired of looking at all these dang political ads. And since I’m in San Francisco, I get our state and local political ads too. And ads about our pile of state and local propositions. You name it, we got it on the ballet. I can’t wait to see a Ford Super Duty ad again.

      • walter map
        November 4, 2016 at 5:40 pm

        Look at the bright side. Wolfstreet still gets credit for all the ads I never see, and page formatting is excellent.

        And to think some people insist there is no such thing as progress.

  24. Gregg Armstrong
    November 5, 2016 at 6:25 am

    Government is a huge part of the problem. I’ll cite just one personal example of many.

    In 2007 I made the transition from my employer’s health plan to Medicare. In Seattle I was accustomed to paying nothing, not even a co-pay for a certain recurring 15-minute procedure. My employer paid about $100 total for this procedure. The first time under Medicare, for the exact same procedure, I was presented a bill for the 20% co-pay of almost $300. The doctor billed Medicare $2400 and Medicare ‘allowed’ $1500 and payed them ~$1200 ($1500-$300). The very SAME exact procedure!!!

    My employer didn’t have the Feral Reserve System to print endless fiat for them. They had to control costs. The government is an irresponsible drunk with endless overflowing pockets throwing fiat toilet paper left and right to every grifter and conporate criminal in the nation.

    I can’t even afford medicine any more, even with Part D. Just one of which cost $550 for a month supply a year ago. Who knows what it costs now.

    • Chicken
      November 5, 2016 at 12:42 pm

      You see the spectacle of government money where I live now, not from from where I grew up inside the beltway. It’s really something to behold.

      Growing up inside the beltway was a very special enlightening opportunity that outsiders could never comprehend in a million years.

  25. Wade Riddick
    November 6, 2016 at 2:29 am

    In order for this private equity scheme to work, drug companies must maintain a monopoly on distribution or they can’t escape competitive pricing pressures. When there’s no patent on a generic, that means they have to control the distribution through a cartel.

    Domestically, there is one remaining way around that price-fixing kickback system of PBMs. Compounding pharmacies buy drugs directly from an FDA-inspected manufacturer, often customizing them for patients with allergies or to get around a drug shortage.

    Since the FDA recently acquired the regulatory authority, it has been drastically restricting the formulary for reasons no doctor or pharmacist has been able to understand. The FDA is trying to ban compounders from using chemicals readily available in over-the-counter drugs – and even in common foodstuffs.

    In the name of patient safety, the FDA has even enacted specific market-rigging provisions that limit the volume of business compounders can do with hospitals and doctors’ offices to a small percentage of their overall walk-in business. It’s like saying, “We think your car is unsafe so you can only sell 5% of your production line in California.” The market-rigging that blatant and irrational.

    Hospitals, though, are exempt from the in-office restrictions. Of course, the average hospital has the least capable compounding operations to begin with but this has the effect of pushing doctors who offer what’s now “specialty” care into larger regional monopoly hospital chains.

    Doctors have been prescribing drugs for use in their own offices and E.R.s for years. Think about that novocaine use by your dentist and how it landed in his hands. You just took that for granted that it would always be there – but, increasingly, it’s not.

    There are numerous instances of preparations used in chemotherapy, emergency medicine and gastroenterology that have no rival source in Pharma and they are now simply vanishing from the market. The FDA has eliminated entire treatment plans for these patients by limiting the volume of business compounders can do for “in office” use and absurdly requiring E.R. patients to get prescriptions *days in advance* before the E.R. can even stock these medicines. How many people know they’ll be burned days before arriving in the E.R.?

    Most patients don’t know enough medicine or economics to understand what’s happening to them. Doctors simply tell us we’re getting the “best available care.” We never ask, “What’s the best care, period?” Even when we do know the real score, we’re too sick and disorganized to fight back.

    Those doctors and pharmacists who complain are easily threatened by regulators holding a sword of Damocles over their licenses so it’s not a story you hear much about – but people do die from these shortages. And the press never covers them. (That would mean criticizing their true customers, the advertisers.)

    The FDA is on the verge of doing this to me with my chosen pain medication for my peripheral neuropathy – methylcobalamin shots. They’ve declared this vitamin derivative “demonstrably difficult to compound” – despite the fact that I’ve used them daily for the last decade – and they could pull it from the market any day now with a rule in the federal register. It’s a cheap anti-inflammatory and neuroprotectant useful in a broad variety of conditions from Alzheimer’s and Parkinson’s to multiple sclerosis and chronic pain.

    It’s almost like the government is angry I won’t use Gabapentin, Oxycontin or Lyrica – drugs made by campaign donors that have all paid out hundreds of millions of dollars in fines and penalties. Will there be anyone left I can do business with who isn’t a criminal drug cartel? I use a cheap, non-narcotic, non-addictive method of pain relief and the government is very, very irate about it for exactly that reason.

    Patients are not the customer in neoliberal medicine. We’re the product being sold. We’re traded among drug companies, insurers and hospital cartels – but at no point does anybody ever consider what’s cheapest, safest and most effective for our treatment.

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