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Topic: Cost
May 4, 2015 | Posted By Bruce White, DO, JD

With the recent success of the blockbuster drug Sovaldi© (Gilead Sciences, Inc.), the manufacturer’s stock price has quintupled in the last four years. This supports the views of some that pharmaceutical prices in America should be subject to greater government scrutiny and controls like other industrialized countries.

High profits within the pharmaceutical industry are nothing new. “Historically [before the recent recession], the drug industry in America has been the top performing [sector] in terms of return on revenues (average 18.6%) and return on assets (average 17.7%) compared to 4.9% and 3.9% respectively for median companies in the Fortune 500 industries.” 

The extremely high costs of drug research and development (R&D) are often cited as the principal rationale for allowing an above average return and minimizing government price controls. However, studies have shown that “[as t]o the question of whether pharmaceutical drugs costs are justified by R&D, the answer is no. Pharmaceutical firms do indeed invest money in R&D, as do other production and service firms, but this investment does not account for their large ongoing profit, which ranges from 2.5 to 37 times the non-pharmaceutical industry average over time.”

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

March 13, 2015 | Posted By Wayne Shelton, PhD

Those of us who aspire to eventually having an affordable, quality, accessible healthcare system for all citizens, or even for most citizens, must first face an obvious but under-discussed challenge that uniquely American: The major players in the US healthcare system—including private insurance companies, pharmaceutical companies, medical device and equipment makers, medical specialties and sub-specialties, healthcare organizations and their executives and shareholders, and all of their lobbyists—are motivated by their own economic self-interests first and foremost. Which means our aspirations must be viewed as a long-term struggle.

Healthcare in American is simply unfettered capitalism at work. Let me hasten to add, this is not to say that all of these entities don’t do some remarkable work—I owe my life to the U.S. healthcare system as do millions more. But the fact remains that much of the extravagantly high costs of medical care in the U.S. healthcare system has nothing to do with improving or adding quality care for patients and producing good outcomes. Rather it’s a reflection of how these key players pursue their own entrenched financial interests, while creating narratives to the public that the services they provide is essential for quality healthcare. Interestingly, over time, this bloated, inefficient system has been generally accepted by the public and therefore gained a façade of legitimacy that makes it virtually intractable to reform.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

March 4, 2015 | Posted By Bruce White, DO, JD

Probably not. It’s just not the American way.

And, it is true that Americans pay more out-of-pocket for prescription drugs than citizens in other developed countries. Other nations use government cost controls and aggressive cost containment strategies to regulate prescription drug costs. Historically, the US Congress has deliberately and consistently refused to regulate prescription drug pricing directly.

The American pharmaceutical industry often has been accused of gouging consumers and profiteering. Its investor return on equity is usually much higher than other industries. And prescription drug pricing differentials have always been difficult to understand, whether at the local pharmacy or within similar hospitals in the same locale.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

January 19, 2015 | Posted By Wayne Shelton, PhD

Let’s say you are looking to buy a car. You think you might want to buy a Volvo so you go down to the Volvo dealer and check out the new models. But you are shocked by what you see. You realize that you really don’t need to spend $35 to $40,000, or more, on a new car, so you decide to visit the Subaru dealer. There you find very nice alternative models for thousands of dollars less. You are delighted to have a new Outback for about $27,000.

The above story is how private markets and market choices work for the vast majority of items that we purchase to meet most of our needs as human beings. However, it has become painfully obvious that healthcare is an area where the normal model of markets and market choices do not apply. I’ll use a personal example.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

September 16, 2014 | Posted By Wayne Shelton, PhD

Ok, I realize I am being somewhat provocative. But there is a real and very serious issue, which I am groping to address in a more precise manner.

In my last blog I described the contemporary moral setting from a philosophical perspective as one in which no single substantive normative moral perspective can resolve moral questions, such as the boundaries of human life and the scope of individual rights, with final moral authority. This is just to say, more simply and obviously when we reflect upon it, that in democratic, secular America, ethics, both philosophically and practically, becomes inextricably linked to public discourse in politics and public policy.

When bioethicists ask questions and make arguments about abortion, physician assisted suicide, stem cell research and cloning, and many other similar issues that pertain to questions about the value of human life in relation to both individual rights and societal goals, we have no privileged moral authority from which to draw. As bioethicists we engage in procedural, persuasive discourse, based on conventional moral principles that most often conflict, which is why there is moral dilemma or problem requiring analysis and prioritization. Our purpose in defending a particular moral position is to win assent from others. In short, for a bioethicist to promote a moral position, it is implicitly an attempt to build a consensus among readers and listeners that will hopefully impact public opinion about a particular moral problem or question. Moreover, to the extent these questions have public policy ramifications, and practically all do, it means that moral discourse is also oriented to effect change and function as a medium in which bioethicists often speak as advocates about how moral options should be framed as public policy positions in a democratic society. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

June 10, 2014 | Posted By Jane Jankowski, DPS

No one seems to know what the answer is to keeping costs down in healthcare but grand efforts have been undertaken to find someone to blame. Some of the targets are patients, others are providers, and sometimes the insurers are dragged into the fray as well. The rhetoric is tired and worn on both ends.  Is it the folks with chronic diseases like diabetes? Is it the folks who need dialysis? The smokers? The patients who do not follow the doctors’ advice and stay sick and expensive? The people who want ‘everything done’ at the end of life? Is it the doctors who acquiesce to patient demands or the laws that obligate them to do so? Do doctors order too many expensive tests, bleeding insurance system? Is it the liability insurance that must cover them if they fail to order a test? Maybe it is the insurance companies paying high salaries to executives while handing down ever-shrinking reimbursements pressing institutions to find new ways to eek out enough income to sustain an operating budget. Newer to this menu are penalties for staying in the hospital too long and coming back too soon. This latest addition to the list is perhaps among the most absurd.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

April 29, 2014 | Posted By Marleen Eijkholt, PhD

Earlier this month, the New York Times (NYT) reported on individuals in a minimally conscious state (MCS). Although the article headed: ‘PET Scans offer clues on Vegetative States’, its contents addressed the technologies around MCS: a ‘newly’ diagnosed state of consciousness. The paper commented that PET scans would be more beneficial than functional Magnetic Resonance Imaging (functional M.R.I.) in diagnosing this state. Around the same time, the NYT published a paper that headed: ‘Cost of treatment may influence doctors’. This paper quoted a doc saying: “There should be forces in society who should be concerned about the budget, about how many M.R.I.s we do, but they shouldn’t be functioning simultaneously as doctors,”

In this blog post I want to focus on the cost and price of consciousness. I do not only want to focus on the economic costs, but also on costs in a more holistic sense, including the psychological and emotional costs. In the end, I want to ask you: how much is consciousness worth to you?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.bvg

April 14, 2014 | Posted By Jane Jankowski, LMSW, MS

A coach is defined as a person who is tasked with teaching or training others, usually in conjunction with athletic endeavors. When this term is applied to health, we often presume the coach is a personal trainer of sorts, focusing on optimizing fitness and nutrition for those who can afford the fee for this level of personal attention. Over the last few years, however, there has been a growing movement to provide a different kind of health coaching within the medical arena for patients who have difficulty adhering to health related regimens for medication, office visits, and management of chronic medical problems. This endeavor has been found to work for many reasons, but remains in the wings of the contemporary healthcare industry.

The first time I read about the concept of community based health coaching was via Atul Gwande’s article “The Hot Spotters” published in 2011 in The New Yorker magazine included here in its entirety for interested readers. What resonated for me was the comment from one recipient who stated that the coach was effective because of the way the advice and encouragement and nudging was delivered, “Because she talks like my mother” implying that there is understanding, concern, and discipline delivered as the underlying message between coach and patient. I think most good athletic coaching is the same. While success is not measured in trophies, medals, or college scholarships when it comes to medical coaching, the potential for life changing outcomes are very real. And the opportunities for cost savings are very real as well.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

November 25, 2013 | Posted By Wayne Shelton, PhD

The political right in the U.S. has mounted a formidable effort from the outset to mischaracterize the aims of the Affordable Care Act (ACA) and to mislead voters about the need for fundamental reform in healthcare. I take it as a given that the opposition to the ACA has never been about its efficacy to promote certain goals to expand coverage for more Americans; even if the ACA accomplished its goals perfectly, those on the extreme political right would still oppose it. That is, the opposition from the political right is not about whether or not the ACA will work effectively but about ideology—they oppose the ACA as a matter of principle. They are committed to the view that government should not be involved in healthcare and fear, perhaps rightly, that if the ACA proves workable it would lead to a single payer system of universal coverage for all citizens. They apparently see healthcare services being like any other market service provided in a capitalistic society. But upon even a superficial analysis, this position is flawed.

It is basic to free markets that the ability of an individual to use a certain service or product is a function his or her ability to purchase it. One of the few services that is an exception in our current capitalistic society is healthcare, albeit only at the level of requiring services at an acute level. For example no matter how desperately I need transportation to go back and forth to work, I will not get a free car as a function of someone else’s obligation to provide it. This is not true of healthcare: even if I cannot pay for healthcare or I lack healthcare insurance, if I get sick enough and show up at an Emergency Room, I’ll not only be stabilized, I’ll be hospitalized and be given all I need to improve, or more fittingly, to be rescued from dying.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

October 28, 2013 | Posted By Jane Jankowski, LMSW, MS

With contentious changes afoot in the US healthcare system these days, one old problem seems to be gaining important attention as the public reflects on what will change with the advent of the Affordable Care Act. The cost of prescription medications is often so high; patients are forced to make tough choices in order to maintain their health without going broke. This topic was front page news in the New York Times (New York Times October 2013 ) this month where the focus was on escalating costs of asthma drugs. Compared to other nations, the expense of many common – and even not so common – medications is dramatically higher for consumers in the US. This is hardly news, and studies have been done showing that senior citizens were historically the hardest hit by medication costs given the intersection of age related health problems and fixed incomes with no prescription benefits. Though somewhat ameliorated when Medicare D was added, not all of the medication problems are resolved, particularly when an individual requires skilled nursing care in a nursing home (Medicare D and Nursing Home Residents.)

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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