Q: If you cause the cost of drugs to plummet, pharma won't spend money on R&D, right?
"If you cause the cost of drugs to plummet, pharma won't spend money on R&D, right?" This was a question from another anonymous post, but at least they were friendly this time. Before I answer this question fully (since I think I've alluded to it in other blog posts), I want you to take a step back and ask yourself a question: Why do drug companies make drugs? The first and feel-good answer is because they want to help people. I think this is the case for bench research. Havi
Q: So I looked at your plan; why should providers be on salary?
"So I looked at your plan; why should providers be on salary?" This was a question posed by an anonymous person in a forum I chat on. They had really great manners (which seems more and more rare these days). When I thought about how to support and incentivize a provider to go into the field of medicine, I looked at my own behaviors. When I was fully salaried and making above 200K, I was perfectly fine with waste. Even though I was the most productive physician in my group, I
Q: But why make it state-dependent?
"But why make it state dependent if you're advocating for a single payor?" This question was submitted by a friend and accountant. A "citizen-owned" statewide nonprofit allows citizens in each state to set their health care goal. For instance, in Vermont, if the citizens there chose to pay more into their general health fund so that all preventative and all sick visits are covered, they could do so. As a Texan, with our ridiculously fierce independent streak, we would likely
Q: Is brand medically necessary?
"If people knew how much time we spent on stuff like this, it would blow their minds." This conversation was had between me and a fellow child psychiatrist. Here's the back story: Intuniv is a medication commonly used in the treatment for ADHD. It's a long-acting form of a medicine called guanfacine that costs four bucks at most pharmacies. The good folks at Shire pharmaceutical company worked out some great deals for Texas Medicaid and earned a place on the Medicaid formular
Q: Then who's going to pay for medicines?
"The costs of medications are so high. Who's going to pay for people to get their meds?" This question was posed to me by someone who currently works as a nurse in a psychiatric ER. One of the reasons medication and medical device costs are so high is because Big Pharma and Big Devices drive up the prices. We know from looking at other countries that the very same medications and technologies have huge markups here comparatively. Why is that? It's partly because we are requir