It's so bad you have to pay people to move to Vermont

[thetrailboss]

"Vermont is projected to exceed targets for health care spending in 2020, indicating the state’s reform efforts may not be working as planned.
...
According to Lindberg, much of the projected 2020 increase for care across the health system comes from Medicare, publicly funded insurance for disabled patients and people over age 65. That portion of the population, which is often the sickest and requires costly end of life care, is the most expensive."

-- VTDigger, 13 December 2019

This is problematic with the aging demographics of the state, and younger workers choosing elsewhere.

Exactly. The huge problem is the demographics. You can't offer very large public benefits to a needy population WITHOUT a sustainable way to pay for it. In other words, you need a LARGER number of people paying into the system than drawing it down. 10 years ago I was telling people that the ONLY way to keep these programs was to have MORE younger working people come into the state. That advice was ignored and now they are feeling the repercussions. It is way easier to just kick the can down the road and to just nudge up the tax rate every year. And just like the last 10 or 15 years the legislature is off to the races talking about stuff that DOES NOT address this problem.

 

[1dog]

I would like to point out an aspect of the healthcare system I have not seen addressed here yet (appologies if I missed it)

Our ERs are inundated with people who do not have enough sense to call their physicians for there stomach aches that they have had for two months. Drunks coming in daily because they are drunk, again,band leave before they can be offered help with their drinking problems. COPDers coming in weekly short of breath and in distress after smoking their 10th cigarette of the day, heart failure patients in with 10 pound weight gains because the won't stop eating TV dinners and fast foods. We see about 5-6 people who come in for STD testing or pregnancy tests.

People who have been given every opportunity to make changes in their lives time and time again continually choose not to. Social welfare comes with unlimited access to these services at the cost of taxes to the Commonwealth. And the state reimbursements to our little facility and all local facilities are on a steep downward trajectory. Despite the cuts in funding all these frevelous services need to be seen and largely go unfunded. How long do people expect healthcare facilities to stay solvent? Small local hospitals will start to shutter and push the burden onto larger urban facilities to absourb the patient flow and cost burden.

Bingo PRS - its 'free' and if they had to pay SOMETHING for access, it might not be so overcrowded. We all know it is mandated by the government to allow anyone to have access to emergency rooms. Used as office visits by a lot of people.

The free market responds by building these walk in all in one service centers for medical care. Thats where more and more 'customers' are going to avoid the ER. Hospitals and having to consolidate to use ecomonies of scale to afford the expense, and crazy prices to insurance companies to get 40,50, 60% of it to afford to still come out ahead. Insurance companies pass it on to us.

A lot of insurance executives were behind universal care because of political pressure, short term gain ( everyone forced to pay in something) and thoise executives - like the GM executives in the 80's to predicted great things for their pensions as long as the company grew at 7-8% a year. . . . . - would all be retired and gone before the proverbial crap it the fan.

Consolidation from a larger number of insurers in 2005 to a lot less in 2016 meant buy outs and large gains for the few who ran the smaller less profitable ones.



As far as the health of the average American - we all can visibly see the results of the WHO announcement last year that ' The worlds number one health problem - starvation - has been replaced by a new one - everyone is FAT! ( i'm paraphrasing of course) but thats what I read. Amazing.

https://ourworldindata.org/obesity 39% of adults are overweight.



Cost of medical services with regards to equipment was explained to me by a health care executive this way - and it made some sense:

He helped run an MRI businiess - one at one time using the Patriots as a 'customer'. Any given outfit ( hospital, outpatient place, etc. purchases an MRI from say GE - it costs $3M say. If that thing isn't paid for in 2 or 3 years, the newere ones come out that are better and the outfit is stuck with an outdated machine and no way to pay for it because patients and their docs send them to the place with the newer more advanced results.


Made sense to me. Great points by a lot of very sharp snow lovers here. I'm learning a lot. Thx all.

 

[mister moose]

Yes and no. In the spirit of this thread, I'm going to assume VT is getting very few takers on the 10k stipend to move there. Remove access to healthcare and that sell becomes even more challenging.

Clarification: It isn't a 10k stipend, it's up to 10k in reimbursed moving costs.

"Grants can be used for relocation, computer software and hardware, broadband internet and access to a co-working space." ​

Nothing goes into your pocket directly.

For the first 6 months:

"So far, the application for the Remote Worker Grant Program

has been downloaded thousands of times, but no completed applications have been submitted."
https://www.cnbc.com/2019/01/10/vermont-will-pay-you-10000-to-move-there-and-work-remotely---.html

​

 

[abc]

Oh, lord, THIS.

People are completely clueless about how much it costs to bring a new medication to market. And clueless is the polite word. You also have the real morons of society out there who think cancer would be cured, but if pharma cured cancer then it couldn't profit from it. Those people are so stupid they shouldn't be allowed to slice a bagel unsupervised.

Less clueless than you think.

People DON'T WANT TO KNOW the true cost of development of their life saving drugs. They know it's costly to develop it. So they'd rather not know the true cost. "The truth is too painful to know". They want the drugs, no matter the cost. They just want to get out of paying for it!

We do cure some cancer. At huge costs. Who pays? We all do.

I'm not a selfless person. I want to have access to all the potential life saving drugs, in case *I* need it. So, any form of rationing by some government that restrict the pipeline for new drugs, I will not be in favor of. Not in theory at least.

That said, I'm not rich. I can't realistically "afford" the true cost of the new drugs without others help paying for it. So when push comes to shove, I WILL support some form of universal care scheme.

 

[abc]

As for surgery centers? Sure, great lower cost option and a good business to be in....in high population density areas. Timely that you brought it up in a thread about VT. Know how many Ambulatory Surgery Centers exist in VT? 1! I helped open it last year. I don't anticipate seeing a major influx of them up there though. They simply lack the population density for it to make business sense for most docs to open a practice.

The other factor there is in rural areas, surgical services are literally the only reason hospitals can keep their doors open. They lose money in every other department. Do you think communities are going to want to give up a close ED and Extended Care option when Gramma gets the flu just so little Jimmy can get a cheaper fix for a broken arm?

Not sure hospitals can stop the opening of surgical centers though.

I don't know how VT compares with western PA. But I work as an occasional consultant for an enterprising doctor, who some years ago opened a few surgical center in the sparsely populated western PA successfully (financially successful).

Of course the hospitals don't want to lose their surgeons to the surgical centers. But they can't exactly stop those centers opening. Surgeons can just move their surgeries to those centers, at a fraction of the cost. Some hospital though, responded, I might say correctly, by lowering their charges and operating more efficiently, JUST LIKE THE STANDALONE SURGICAL CENTERS!

The said doctor had since gotten out of the surgical center business, due to competition. But that sounds like free market work at its best to me.

 

[deadheadskier]

Not sure hospitals can stop the opening of surgical centers though.

I don't know how VT compares with western PA. But I work as an occasional consultant for an enterprising doctor, who some years ago opened a few surgical center in the sparsely populated western PA successfully (financially successful).

Of course the hospitals don't want to lose their surgeons to the surgical centers. But they can't exactly stop those centers opening. Surgeons can just move their surgeries to those centers, at a fraction of the cost. Some hospital though, responded, I might say correctly, by lowering their charges and operating more efficiently, JUST LIKE THE STANDALONE SURGICAL CENTERS!

The said doctor had since gotten out of the surgical center business, due to competition. But that sounds like free market work at its best to me.

They do via the state. Hospital Associations have a lot of power and it's not uncommon to see moratoriums on new centers being built. Massachusetts just ended a 40 year moratorium two years ago. Any surgery center built in that timeframe had to be hospital owned.

The other thing you frequently see is the docs open an independent practice, operate it for several years and then sell the center to a hospital when they want to cash out and retire. With that reality, it's always good for patients to shop around.

Sent from my XT1635-01 using AlpineZone mobile app

 

[thetrailboss]

Clarification: It isn't a 10k stipend, it's up to 10k in reimbursed moving costs.

"Grants can be used for relocation, computer software and hardware, broadband internet and access to a co-working space." ​

Nothing goes into your pocket directly.

For the first 6 months:

"So far, the application for the Remote Worker Grant Program

has been downloaded thousands of times, but no completed applications have been submitted."
https://www.cnbc.com/2019/01/10/vermont-will-pay-you-10000-to-move-there-and-work-remotely---.html

​

Good point. Stipends of UP TO $10,000.00. I imagine that there will be many who don't get the full amount.

And a bigger question that shows how screwed up this idea is: why not simply REDUCE the cost of taxes and living by a proportional amount on the PEOPLE ALREADY THERE instead of just increasing the cost on everyone and hand out these stipends? I get that it is a decision to entice a certain demographic and all, but think about that. When the decision was made as to lowering costs or "adding a new program", they "added a new program." That is the knee-jerk reaction.

 

[deadheadskier]

Good point. Stipends of UP TO $10,000.00. I imagine that there will be many who don't get the full amount.

And a bigger question that shows how screwed up this idea is: why not simply REDUCE the cost of taxes and living by a proportional amount on the PEOPLE ALREADY THERE instead of just increasing the cost on everyone and hand out these stipends? I get that it is a decision to entice a certain demographic and all, but think about that. When the decision was made as to lowering costs or "adding a new program", they "added a new program." That is the knee-jerk reaction.

well, in theory it's just a micro version of the same strategy states use to lure corporations. Virginia has a $1B commitment to Amazon from winning the HQ2 bid. Part of that is the state will kick back $22k to Amazon for every $150k job they bring to the state.

Sent from my XT1635-01 using AlpineZone mobile app

 

[Orca]

And a bigger question that shows how screwed up this idea is: why not simply REDUCE the cost of taxes and living by a proportional amount on the PEOPLE ALREADY THERE instead of just increasing the cost on everyone and hand out these stipends?

And deny the left its proclivity to "fine tune" anything and everything through a cornucopia of special, targeted, and sometimes coercive programs? Heresy in Vermont! What would all those do-gooders in government do?

 

[thetrailboss]

well, in theory it's just a micro version of the same strategy states use to lure corporations. Virginia has a $1B commitment to Amazon from winning the HQ2 bid. Part of that is the state will kick back $22k to Amazon for every $150k job they bring to the state.

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Very true. I was offering the response from a lot of Vermonters as to this program.

 

[BenedictGomez]

And that single payer healthcare plan? Well Shumlin scrapped that literally days after he got the supporters to vote for him for his last term. Even he realized the cost was simply too ridiculously high and not sustainable. But hell, he played to the supporters to get their votes and then ditched them.

That's how it's done. Hell, lying to supporters is 100% what the Sanders & Warren campaigns are all about. Financially impossible promises layered on top of more literally financially impossible promises.

If you take over healthcare and don't change patent law, aren't we in the exact same place regarding pharma prices? Conversely, if we reform patent law on it's own, we'd see the benefits of lower drug pieces unless I'm missing something.

You keep saying this, but havent explained what you mean by it.

I have a feeling I know what you mean, and if so, it's a horrendous idea.

 

[BenedictGomez]

BG, Pharma certainly needs to recoup the monies spent for research and the approval process of new drugs. They also need to recoup moneys spent for drugs that do not get approved. The FDA is a total bitch I understand. But did you ever look at the earnings of these companies? Unless they totally F-up like Purdue Pharma they all do very well. Some of the most successful companies in america. They are inflation proof, recession proof and a very good investment in general. I guess what I am saying is how much is enough for those guys. Drugs are far less expensive in other country's so what is the difference here?

Considering that is literally what I do for a living, yes, I have looked at & been involved with the earnings of those companies. And no, not "all" are successful, some do go bankrupt and/or have lean or tough years depending on current portfolio performance, reimbursement changes, pipeline (i.e. new, but unapproved drugs in R&D) progress, and a host of other issues. But you should be HAPPY when they do well & make lots of money. It means people are benefiting from emergent & current therapies, more jobs are created, and there is new $$$ to invest in the pipeline for potential future lifesaving & quality-of-life improving therapies. This is a good thing. I'm always quite flabbergasted when I watch a Democrat debate or something, and the leftist on stage is angry that pharmaceutical & biotech companies are doing well.

 

[spring_mountain_high]

well, in theory it's just a micro version of the same strategy states use to lure corporations. Virginia has a $1B commitment to Amazon from winning the HQ2 bid. Part of that is the state will kick back $22k to Amazon for every $150k job they bring to the state.

Sent from my XT1635-01 using AlpineZone mobile app

ell oh fucking ell

nice 'free market' ...and yet nobody screams 'WHERE WILL WE GET THE MONEY???211/????' so taxpayers can pay to lure a for-profit enterprise to plunk a building in their particular shithole province. (not to mention all the new roads, firemen, cops needed for this new population) and what does that get you? a transient workforce that can and will be used as a bargaining chip forevermore and contributes nothing to your particular shithole province beyond buying burritos at the local chipotle et al.

 

[BenedictGomez]

Drugs are far less expensive in other country's so what is the difference here?

You & I are subsidizing them. Yes, it's a problem.

And I dont know what the solution is, short of with-holding critical medications from XYZ country unless they "pay up", which is an instant PR nightmare, and a big part of the reason why phama just bows down & takes what they can get. That doesnt happen in America.

Also, what are going to do, tell a 3rd-world nation that none of their thousands (literally) of suffering patients can have literally life-saving HIV medications because they obviously cant afford to pay for it? Guess what, most HIV pills swallowed in Africa you're paying for here in America. That's something you'll never here the pharma-hating politicians tell you. Even the generic cost is more than many Africans will make in an entire year, and remember, there was a time when no generics existed. Imagine the cost 15 years ago!

 

[BenedictGomez]

And don't try to tell me a government can just tax its way out. There have been some big cities that have gone bankrupt in this country due to pensions among other financial failures.

This is going to be the next major political fight in America, and it will make Obamacare seem like patty-cake. Sometime in the next 10 years, a liberal state is going to try to declare bankruptcy. Democrats will be for it, Republicans will be against it.

Like Obamacare, the fight will take several years go all the way to the Supreme Court. If Democrats win, taxpayers in New Hampshire, Iowa, Florida, Montana, etc... will be paying the expenses of a financially irresponsible liberal state like New Jersey or Illinois.

You heard it here first.

 

[fbrissette]

I'm always quite flabbergasted when I watch a Democrat debate or something, and the leftist on stage is angry that pharmaceutical & biotech companies are doing well.

Don't always make everything about politics. The current republican President has been one the most vocal advocate against current pricing of drugs in the US.

Having a few friends in bio-pharma, I mostly agree with the rest of your post.

 

[BenedictGomez]

Only 5 of the top 100 most profitable companies in the world last year were Pharma companies (and the first wasn't until J&J at #25). Why is it ok for some companies to make profits but if a Pharma company does it, it is considered "greedy" and "evil"? Shouldn't their innovation and work be rewarded? Apple is the 2nd most profitable company in the world (with profits nearly 4x that of the highest ranking Pharma company). Yet I don't see anyone forcing or demanding that Apple lower their prices.

Because Apple gives a lot of money to the political party which calls Pharmaceutical companies "evil" & "greedy".

 

[BenedictGomez]

nice 'free market' ...and yet nobody screams 'WHERE WILL WE GET THE MONEY???211/????' so taxpayers can pay to lure a for-profit enterprise to plunk a building in their particular shithole province. (not to mention all the new roads, firemen, cops needed for this new population) and what does that get you? a transient workforce that can and will be used as a bargaining chip forevermore and contributes nothing to your particular shithole province beyond buying burritos at the local chipotle et al.

Your post is virtually fully incorrect.

Ever been to North Carolina or South Carolina (or numerous other town, city, and state examples I could provide)?

How do you think they've completely revitalized their economies from the sorrow of 30 years ago. By luring big companies to them, yes, (GASP) with tax advantages, usually coming to their locality from a liberal state.

And increasingly, some liberal states have paid attention, playing defense by keeping their jobs at home by providing those same tax breaks that those Democrat politicians claim dont help. State of New York is a perfect recent example of this. Bausch & Lomb is still in Rochester, New York, because Chuck Shumer gave them the tax breaks that he publicly tells his Democrat voters are wasteful, corrupt, and bad.

By the way, Chipotle is a $25 BILLION company, which employs over 80,000 people, and provides health insurance to its' workforce.

 

[NYDB]

Quick question for the experts here.

Why can't Medicare and Medicaid use the VA formulary for drug prices? VA pays 40% less. that seems wacky to me. Seems like an easy political fix. I wonder who would hold that up?

 

[BenedictGomez]

The current republican President has been one the most vocal advocate against current pricing of drugs in the US.

Yes, he does. And I'm no great fan of the "current Republican president", who by doing so is just (wisely unfortunately) playing to ignorant populism who knows nothing about the industry, which ABC already alluded to.

That said, in America, he is generally an exception in his party. It is our other party that typically demonizes pharma & biotech in a routine fashion.