tstorm823 said:
Ultimately, my point is that terrorism is terrorism because it's done with a purpose. Someone acting at the behest of ISIS is doing so to destroy the west and advance the goal of a single Islamic world government. Even in a case as clear cut as neo-nazi attacks a synagogue, you can identify the ideology that led to the problem, but you don't know what the person was trying to accomplish.
Yes, we do know what they were trying to accomplish: cleansing "white" countries of what they regard as foreign racial and cultural pollution. The individual may be relatively muddled, but the same themes (such as fighting or kicking off a culture/race war that will result in destruction or expulsion of foreign-ness) go all the way through.
Many aren't that different from many Islamic terrorists. Lots of the ones killing in the West seem to have backhistories of crime and drug use, and they haven't met an ISIS recruiters. They're fucked up individuals who went further off the rails and self-radicalised via the internet. Sure, ISIS claims the kill, because that's ISIS PR[footnote]There's a 30-year old comedy fantasy novel by Tom Holt - I think it's "Expecting Someone Taller" - where there's some kind of explosion at an airport and half a dozen terrorist groups claim it was them - it's what terrorist groups have done for decades.[/footnote].
Thing is, rules of competition don't exist in this market. In many places, major healthcare providers have been allowed to buy out entire counties worth of doctors offices. 3 or 4 national chains control most of the entire retail drug industry. 3 pharmacy benefit managers own almost the entire market. Companies like CVS have vertical monopolies that manage every step from the doctor to the drug manufacturer to your personal pill bottle. The dodgy things you describe might be happening behind a thousand closed doors, but it's a largely coordinated effort. The web is woven so tightly, there's not competition, there's collusion.
A single manufacturer shouldn't be able to declare epipens massively more expensive on a whim. Insurers trying to act in their clients interests should reasonably say "look dude, we'd rather ask our patients to learn a different less expensive epinephrine injector than siphon thousands of dollars from them to you." That attempt was not made. Insurances paid specifically for epipens at price gouging levels. That's coordinated, and assuredly responsible for some amount of premium increase.
It seems obvious to me that pharmacy benefit managers are likely to be dodgy as hell. I understand the utility of a dedicated large corporation that can manage drug procurement and distribution where a host of smaller suppliers buying directly have far weaker economic leverage, but I suspect there's a great deal of inefficiency mixed in there too as the pharmacy benefit managers look to maximise their profits. However, there's no guarantee that insurers actually have the power to break this system: that pharmacy benefit managers have expanded their operations so pervasively and successfully in the first place suggests that's where the leverage currently is. Collusion may occur, but I don't think there needs to be any collusion at all: just a pattern of where economic power lies, deals and profit motive is quite enough to create sub-optimal outcomes for the end user.
In the case of your epipens, what's possibly going on is that they sign a package deal gets certain drugs (I don't know modafinil, citalopram, whatever) at a massive discount, but at the cost of also accepting other products at higher price. Overall, the cost is potentially lower for the insurance company and customers as a whole, but that some individuals really get it in the neck if they're unlucky enough to be on non-discounted medication. As for manufacturers massively increasing the price at a whim, they totally have that right under free market principles. As we know, this causes a great deal of unhappiness (consider the recent daraprim affair), but if they can they may as well do.
The UK I suppose has a de facto pharmacy benefit manager, except that it's an arm of the entire national health service. One might argue it's a monopsony, but it's absolutely amazing at getting drug prices down. When the USA is discussing trade deals with the UK and opening up the NHS, a lot of what they mean is breaking this system so Britons pay more for drugs, to the benefit of... well, not the British people, that's for sure.
If you want to break these sorts of problem, as the free market seems incapable of doing so, it seems you would need government to step in. But then you need a party willing to seriously interfere in business, which is to say not the Republicans.
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Schadrach said:
It certainly reduced my employer's health care costs. As the ACA went into effect we had 15-25% rate increases every year. They had to let a couple of people go late last year, which put them below the magic number and let them discontinue our health insurance entirely. Which means I'm now on the marketplace, which raised my insurance premium by another $50/month, after applying the estimated tax credit in full. For worse coverage.
On the upside, my fianc? starts her new job next week, and we're getting married around when her training is over. It's a state job, and public employee insurance for a couple is much less than what I'm paying for just me on the marketplace.
Sorry to hear that - but unfortunately some people get the dirty end of the stick in the great big merry-go-round of life. Some people get a tax increase, for which others get a useful bus service.
I don't think anyone believes the ACA is perfect, but on a gross utlitarian measure it's better than its predecessor.
