Tales of Big Pharma: Synagis™ (Palivizumab)

You might recall that in my last episode of “Who’s Paying for Health Advances?” I made brief mention of a drug used to treat respiratory syncytial virus (RSV) in children with chronic lung disease.

RSV is a seasonal disorder that causes significant disease (what doctors call “morbidity”) in children, especially premature infants who have grown into children with congenital heart disease and chronic lung disease. (“Congenital” means “occurring at birth” and “chronic” means “happening all the time”.)

RSV is around all the time. In healthy individuals, it causes nothing more severe than a common cold. However, in unhealthy people (like children with lung disease), it can cause the lungs to fill with mucus and fluid (severe pneumonia), even death.

Remember from the earlier article that the immune system uses two strategies to fight invaders. One strategy is to spit out a specialized protein called an antibody which binds to the invader and tags it for destruction (if it’s a bacteria) or simply gums up its ability to cause disease (if it’s a virus).

Antibodies made by pharmaceutical companies are in a new class of drugs called “biologicals” or “biologics”. It’s easy to spot the ones that are antibody molecules: the abbreviation for antibodies is “Ab” and so these drug names end in “-ab”. For example, antibodies against RSV are called palivizumab and are sold under the brand name Synagis™ by the drug company MedImmune, now part of the giant pharmaceutical company AstraZeneca.

Synagis

Synagis™ (palivizumab)

Palivizumab has been shown to be remarkably safe (causing almost no side effects or adverse reactions) and reasonably effective (reducing the incidence of RSV infections in susceptible persons to about half of what would be expected without use of the drug during a typical winter season). It sounds like a win-win situation. What’s the problem?

Synagis™ must be given monthly during the season; the length of the RSV season varies by location but is typically four to six months. Each monthly treatment has a cost of $1500 to $2000 for an annual cost of about $9000 per patient. The wholesale price of Synagis™ is $1416.48 for a single-dose 100 mg vial that will treat a 15-pound child. No one knows what it costs MedImmune/AstraZeneca to make that 100 mg, or how much of their research and development costs are being recovered with this drug. That’s of course a trade secret.

If I were an insurance company, I would make sure that I removed any parents with premature infants from my policyholder list, because my business would be to maximize profits, and laying out close to $100K for Synagis™ treatments will break the bank if I have too many of those patients on my rolls. At present, insurance companies will typically reject any claims for Synagis™ treatments, despite their proven effectiveness. This is just good business practice. It’s good parenting to resist this good business practice, so my Twit-friend Dr. Jen Gunter has a website designed to give advice on how to write an appeal letter to your insurance company.

Cases like these are the root problem of health care reform legislation. Somehow, the pool of patients needs to be large enough to spread a financial risk as broadly as possible. For example, imagine working for a company with 10 employees, one of whom has two children who are susceptible to RSV infection. A well-run insurance company will either drop this employer, or raise rates to the point where the employer can no longer afford to pay the premiums.

Roughly a half-million babies per year in the US alone are born prematurely, and virtually all of these will benefit from RSV prophylaxis.

What is to be done for this? Do we ration healthcare by forcing parents to write appeal letters? What about parents who are not covered by insurance? (It should go without saying that most parents of premature infants are young adults and tend to be healthy and uninsured.) Does this abrogate the rights of parents (and their children) who may not be as good at writing letters as others? Do we remove the ability of AstraZeneca to make a profit, or regulate the amount of profit they are able to make? How can we (or an insurance company) decide who is to receive treatment, and who does not?

Update: Dr. Jen Gunter, in the Comments section below, correctly points out that I’ve made a mistake in my assumptions about mothers of premature infants with health insurance. The linked article here has the statistics: 79% of mothers of premature infants have private-pay health insurance; 21% have Medicaid. As the paper notes, premature babies born to Medicaid-covered mothers tend to have lower Apgar scores, implying that they are less healthy than premature babies born to mothers who are privately insured.


About Monotreme

Monotreme is an unabashedly liberal dog lover, writer, and former scientist who now teaches at a University in an almost-square state out West somewhere. http://www.logarchism.com | http://www.sevendeadlysynapses.com
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62 Responses to Tales of Big Pharma: Synagis™ (Palivizumab)

  1. drjengunter says:

    Thanks for the post. One correction, most parents of premature babies are not uninsured. About 20% of adult women in the US are uninsured; however, many of these women qualify for Medicaid once pregnant. The actual rate of being uninsured during pregnancy is probably 5-10% at most. And lack of insurance is the biggest risk factor for premature delivery. Women who enter high-quality prenatal care in the first trimester are far less likely to have a premature delivery.

    Good post and thanks for the mention!

  2. Bart DePalma says:

    A well-run insurance company will…raise rates to the point where the employer can no longer afford to pay the premiums.

    Don’t worry, our outlaw socialist government is on the case. Despite the fact that the 2000 pages of Obamacare legislation nowhere grants HHS the power to set premiums, HHS simply assumed the power through regulation this week during the holidays hoping no one would notice.

    http://online.wsj.com/article/SB10001424052748703581204576033591200257356.html?mod=WSJ_Opinion_LEADTop

    This will assure that there are no well run insurance companies, only those in the process of being put out of business by the Obama regime.

    I used to think that the Limbaugh rant that Obama intended to drive private insurance out of business in order to clear to the way for government owned health insurance was just a red meat. However, as I plow through socialist books from the 70s and 80s doing research for my book, I have discovered that socialists were suggesting just such programs under the guise of “reforming capitalism” as a transition period to full socialism.

    Looks like Obama and his people were reading the same stuff I am.

  3. shortchain says:

    Bart gives us: “Obama and his people were reading the same stuff I am.”

    The critical difference? The other people actually understand what they read.

  4. fopplssiegeparty says:

    I wish Obama (or anyone else) would put insurance companies out of business. Private insurance is a scam. They are leeches that are second only to the banks.

    Bart, anyone who says Obama is a socialist is a fucking idiot.

  5. mclever says:

    Thank you, drjengunter, for your contribution to this interesting topic.

    While most mothers aren’t uninsured, I find it compelling that “lack of insurance is the biggest risk factor for premature delivery.” Because premature deliveries are so much more expensive (and not only because they might want the particular drug mentioned in this article), it seems in the best interest of all involved to make sure that all mothers are covered and getting the appropriate prenatal care. It will cost less for the hospital and other providers, it will cost less for the patient, and it will vastly improve the health outcomes of both mother and child. AND having universal coverage means spreading those cost savings to everyone else as well.

    If we have true 100% healthcare coverage, the only loser is the drug manufacturer who finds the need for his drug drastically reduced as more mothers get proper care and more babies are carried to full term rather than born premature.

  6. drfunguy says:

    @fopplssiegeparty
    “Bart, anyone who says Obama is a socialist is a fucking idiot.”
    True, but he’s _our_ fucking idiot.

  7. shiloh says:

    Bartles ~ Don’t worry, our outlaw socialist government is on the case.

    Give it a rest, eh … or not!

    Bart, are you totally (((consumed))) by Barack Hussein Obama ?!? ~ rhetorical question.

    Spock: You must learn to govern your passions, they will be your undoing.

    >

    McCoy: Where are we going?

    Kirk: Where they went.

    McCoy: Suppose “they went” nowhere.

    Kirk: Then, this will be your big chance to get away from it all.

  8. Bart DePalma says:

    fopplssiegeparty says: I wish Obama (or anyone else) would put insurance companies out of business. Private insurance is a scam. They are leeches that are second only to the banks. Bart, anyone who says Obama is a socialist is a fucking idiot.

    You really should get that dissociative disorder checked out.

    First you offer a socialist rant typical of Hugo Chavez and then call me an idiot for suggesting that Obama is a socialists for doing what you demanded.

  9. Mule Rider says:

    “anyone who says Obama is a socialist is a fucking idiot.”

    And anyone who says that generalizes private insurance as a scam and wishes for the President to deliberately run private health insurers out of business has a dangerously anti-market and anti-freedom (dare I say totalitarian?) mindset.

    (Some of you) guys never cease to amaze me and with a worldview that is so completely antithetical to my own, I find it increasingly difficult to call you fellow Americans.

    The dissolution of the United States as we know it and emergence of regional, like-minded governance (South, West Coast, Northeast, Midwest, etc.) can’t come soon enough. For all of you who want to ban Happy Meals and run private health insurance out of town, I want you to have a place you can call home that’s all your own.

  10. filistro says:

    @doc… True, but he’s _our_ fucking idiot.

    Ah yes. So true. In our forum Bart serves an invaluable purpose. … and here it is.

    Hey Bart… what do you think of your president now? “Whiny crying baby,” eh?

    Let’s count the ways the GOP has been pantsed, noogied, swirlied, given atomic wedgies and generally humiliated in the past few weeks.

    *DADT repealed
    *START ratified
    *Tax deal passed, massive increase in UI benefits and middle class tax cuts, millionaire tax cuts only temporary
    *First responders bill passed
    *Food safety bill passed

    What am I missing? The only “defeat” was on DREAM.. .and tricking the dumb-as-rocks Republicans into voting down that sensible, compassionate, harmless initiative is going to move the Latinos solidly (like +90% solidly) into the Dem camp for generations.

    In keeping with the general intent of the thread… I am now REALLY looking forward to the coming GOP effort to repeal HCR.

    Boy, will that be entertaining. LOL…

  11. Bart DePalma says:

    Fili:

    Humiliated? :::smile:::

    There were only two important items before Congress during the lame duck session: (1) maintaining the current tax rates and (2) stopping the Dems from raising the spending baseline and funding the Obama initiatives through next fall.

    The GOP won both.

    The tax issue is now off the table and the GOP House will be setting the budget starting March 2011. Every bit of lame duck spending can be offset at that time and Obamacare zeroed out.

    DADT repeal and START passed with GOP votes.

  12. filistro says:

    LOL Bart… you’re just so cute :-)

    And you always tease ME about looking at the world through rose-colored glasses!

    I guess the recent stunning success of the GOP is why Obama’s approval hit 50% at Rasmussen yesterday… up a good 6 points since the beginning of the month.

    Once again, I would just like to politely point out…

    LAME DUCK KICKS ELEPHANT BUTT!!!.

  13. shiloh says:

    I am now REALLY looking forward to the coming GOP effort to repeal HCR.

    I’m looking forward to the GOP trying to defund/eliminate SS and Medicare as they will then piss off their (1) remaining demo ie old folk!

    Geniuses I tell ‘ya, geniuses!

    ok, they will always have one demo ~ old, white, yahoo segregationists er Bart’s teabaggers. :)

    After Shiloh er Pittsburg Landing, the South never smiled!

    Again, Bart longs for those glorious bygone days when women, African/Americans couldn’t vote, had no equal protection under the law and Indians were being slaughtered …

  14. filistro says:

    Muley, I know you’re not blocked, and I don’t see anything of yours in any of the filters.

    Must be gremlins. Sorry.

    I hate it when I type a long response and it gets lost. You can never recapture the essence of it, somehow.

  15. shiloh says:

    Muley, I know you’re not blocked, and I don’t see anything of yours in any of the filters.

    Karma!

  16. Bart DePalma says:

    filistro says: I guess the recent stunning success of the GOP is why Obama’s approval hit 50% at Rasmussen yesterday… up a good 6 points since the beginning of the month.

    Obama earned it by adopting conservative tax positions. If Obama pulls a Clinton and adopts a general conservative agenda over the next two years, the man will win reelection in the only poll that counts.

    Get past the “my team right or wrong” mindset. Politicians in either party who govern as conservatives earn votes from a center-right electorate.

  17. Max aka Birdpilot says:

    Bart said: “DADT repeal and START passed with GOP votes.”

    Yeppers, and you’ve already started your whining about how you Teabaggers are going to teach them a lesson about going off the reservation in 2012!

    And, please, no more about old, white segregationists!

    I am 60, Caucasian and FIRMLY believe that silly foolish irrational neo-conservatives should be separated from the rest of polite society.

  18. filistro says:

    @Bart… Get past the “my team right or wrong” mindset.

    ::chuckle::

    Politicians in either party who govern as conservatives earn votes from a center-right electorate.

    Bart… you’ve still never told me what you mean by “center-right”.. and I keep asking.

    Do you visualize the electorate as slightly right of center… or in the center of the right-hand side of the spectrum?

  19. Must be gremlins. Sorry.

    Guilty as charged.

  20. Mule Rider says:

    Thanks for checking into that, filistro.

    Hope you have a wonderful Christmas/holiday season!

  21. Max aka Birdpilot says:

    Mule Ears said: “The dissolution of the United States as we know it and emergence of regional, like-minded governance (South, West Coast, Northeast, Midwest, etc.) can’t come soon enough.

    So we have definitively and on the record that Mule Rider is UnAmerican!

    Just a couple of days past the sesquicentennial of the passage of the Ordinance of Succession, we have Muley singing from the same hymnal.

    Mule Rider, pay attention now.

    THAT MATTER HAS BEEN LITIGATED!!!!!!!!!!!! It was washed away in the blood of 600,000 Americans. The concept was DEFEATED!!!

    If you don’t like it in America, GET THE FUCK OUT and don’t let the doorknob hit your sorry ass on the way out!

    Stand on ideas. Try to convince others to join you. VOTE for those ideas. And, should you win, congratulations. But should you lose, salute and thank you lucky stars you live in a country where the loser doesn’t have to worry about being hunted down and shot because of those ideas.

    But you do it in AMERICA! Or use your liberty to leave.

  22. filistro says:

    You too, Muley :-)

  23. Bart DePalma says:

    Fili:

    There is an electoral majority consensus for the general propositions of social insurance against old age and unemployment (center), limited taxes and spending for everything else, the freedom to make money and a strong national defense; and against almost all forms of redistribution (right).

    Nearly everything from political rhetoric to votes and vetoes can be explained by keeping this fact of life in mind.

  24. Max aka Birdpilot says:

    Bart said: “The tax issue is now off the table and the GOP House will be setting the budget starting March 2011. Every bit of lame duck spending can be offset at that time and Obamacare zeroed out.

    Stupid, stupid, stupid. Bart, you just make it TOO easy. Didn’t you take even a single government or civics class. And you’re REALLY a lawyer?

    The House is the only place that spending bills may START, IT IS NOT WHERE SPENDING BILLS BECOME LAW!!!!! Anything the GOP controlled House might pass, MUST then be also passed by the Senate and signed by the President.

    Wanna bet as to whether or not that same civics lesson will be taught to the GOP over the next two years?

  25. Bart DePalma says:

    Max aka Birdpilot says: The House is the only place that spending bills may START, IT IS NOT WHERE SPENDING BILLS BECOME LAW!!!!! Anything the GOP controlled House might pass, MUST then be also passed by the Senate and signed by the President. Wanna bet as to whether or not that same civics lesson will be taught to the GOP over the next two years?

    Actually, if the GOP keeps its discipline, we are about to see a return to the basic constitutional principle of the power of the purse. One of the checks inherent in the separation of powers is that you cannot force the House or Senate to spend more than it wants, thus the result should be the lowest common spending level.

    The left has bypassed that constitutional check in the past with the legal fiction of mandatory spending on entitlements and by lumping everything into an omnibus spending bill bundles with hidden bribes to buy votes and with the implicit threat of closing vital government functions if it is voted down on the eve of running out of money.

    Here is how the GOP House gets back to basics if it stays disciplined:

    1) Vote on the debt level before any funding bill. If the GOP sets a debt ceiling below last year’s spending levels, this forces spending cuts. Politically, addressing the debt first isolates the issue from any particular spending proposal. The Dems cannot use kids and old folks as human shields because there is no particular spending proposals attached to the debt. The voters made it very clear that they want the borrowing stopped so the GOP wins any battle when this issue is decided in isolation. You can also use the threat of “crazy Tea Party” members threatening to vote against any increase to compel the lowest possible increase. The debt ceiling can then be used as a club to reduce spending in the funding bills.

    2) Enact individual bills for each department and regulatory agency. No more omnibus blackmail. Instead, the GOP House can give the Dem Senate and President take it or leave it bills to fund agencies like EPA which no one will miss if they shut down for awhile. For example, the GOP House can cut EPA spending by a third with a mandate that nothing shall be spent on regulating GHGs. If the Senate or President blocks the bill, EPA shuts down – so much the better.

    In the case of Obamcare, enact separate funding bills for any entitlements run by HHS, then propose a funding bill for the operation of the rest of the HHS bureaucracy with cuts in spending and a mandate that that nothing shall be spent on Obamacare. Who will care if the rest of the bureaucracies shut down?

    3) Make all spending requests go through public committee hearings. No more earmarks (spending inserted outside the hearing process) to buy off votes. This will take some real discipline and where the new Tea Party members need to hold the feet of the party elders to the fire.

    The GOP has already indicated that it is well on the way to adopting these principles. If they carry through, times may indeed be changing for at least awhile.

  26. Mule Rider says:

    “So we have definitively and on the record that Mule Rider is UnAmerican!”

    Riiiiiiiight….because wishing for a peaceful realignment (nobody said it has to be bloody or a repeat of 1861-1865…you’re the one invoking bloodshed…no wonder history occasionally refers to the Civil War as the War of Northern Aggression) of like-minded regions on the continent into autonomous governing bodies is “UnAmerican” but wishing for the President to exercise totalitarian control to vanquish elements of the free market isn’t?

    The rest of your obscenity-laced invective doesn’t dignify a response…

  27. Mule Rider says:

    It may not dignify I response, but I can still try to make lemonade from lemons…

    “THAT MATTER HAS BEEN LITIGATED!!!!!!!!!!!! It was washed away in the blood of 600,000 Americans. The concept was DEFEATED!!!”

    Different time, different era, different situation. The Left is always yelling at conservatives about the need to get with the 21st century. Much of the basis for and foundation of their “progressive ideals” is that the world doesn’t work the way it used to….wouldn’t it be reasonable, then, that the current geopolitical alignment across the North American continent just isn’t working anymore? What’s so wrong with a peaceful dissolution of the United States as we know it?

    “If you don’t like it in America, GET THE FUCK OUT and don’t let the doorknob hit your sorry ass on the way out!”

    I simply don’t understand the invective when something like this is mentioned. Some of you on The Left make it very clear you burn white hot with hate over conservative ideals and are incensed at having to share this section of the world with us? So why the angst over some of us suggesting we might just set up shop on our own and actually leave you guys alone? What’s the problem there, really? I would think you would be ecstatic about not having to put up with conservative ideals being part of the mainstream in your own country? For you to seem so indignant at the thought of a peaceful secession and separation of geographic regions on ideology doesn’t quite square with the idea that you are just some staunch defender of progressive ideals but that you want totalitarian control of other people’s lives and want to force your ideals onto them so as to make them share your own. So why don’t you just own up to that? Why don’t you just own up to the fact that it is about control for you and some others like you on The Left?

  28. Max aka Birdpilot says:

    No Mule Headed, YOU are the one advocating for the Balkanization of the United States. You are simply the descendant of the Compact Theorists of the first quarter of this country’s history. You are simply “wishing” for the same pipe dream that they wished for. “Since this country refuses to do things MY way, I want to destroy it.”

    That ideology LOST!!! You are trying to bring a losing ideology to life again. I repeat, since you hate the United States so badly, LEAVE. GO! You will not be missed.

    As did Lincoln, NO RESPONSIBLE American President will willingly oversee a breakup of this country, so your “wish” that the United States will Balkanize “peacefully” is as much propagandizing as was that of the secessionists of 150 years ago.

  29. Mainer says:

    You know Bart it is reaching the point where seeing one of your diatribes pop up here has about as much appeal as getting a note from ones doctor telling them they are scheduled for a hemorrhoid transplant.

    Your ideas that the House will now dismantle the Federal Government and vanquish Democrats is bullshit. Will they screw with suff the Democrats have done? Most assuredly. Will it be an accross the board dismantling to salve the egos of lunatics such as yourself? Probably not if for no other reason then as much as they piss me off most days they are smarter than that and realize that actions have consequences, you know like who votes for you next time.

    Barthole, you remember your concept that only counting likely voters matters for determining the will of the people? You do remember that right? I hope to god your side does just that and to go you one better I hope the only damned thing they give two shits about is making sure that the Bart DePalmers of this planet go to sleep happy for the next two years. You know why that is Barthole? Because while they are tucking your worthless ass in every night more and more and more of those Americans that to you aren’t worth counting are going to decide they are going to vote next time around and you and yours will become as extinct as I predicted two years ago on here only sooner than I ever expected.

    Hell Mule man you make more sense with your regionalization of the US concept. That has been around for some time and there is even some pretty good books about it. Heck there has been a group here in Maine that has advocated for our leaving and joining Canada. To be honest it would not even be much of a lift to do. Some of the other groupings would be really hard. It is an interesting concept though except when Gov Perry uses it to agrandize Texas.

  30. Mule Rider says:

    “Since this country refuses to do things MY way, I want to destroy it.”

    You’re putting words in my mouth. I’m not wanting to “destroy” anything; however, I sincerely don’t believe it’s in the best interest of Georgia, the Carolinas, Tennessee, Alabama, Mississippi, etc. to be so heavily influenced by the politics and ideology of Oregon, Washington, and California, nor do I believe it behooves those states to have so much Southern influence on their political landscape.

    “That ideology LOST!!! You are trying to bring a losing ideology to life again.”

    It only “lost” because war was declared and blood was shed. In other words, it “lost” on the battlefield but not in the court of opinion or practicality.

    “I repeat, since you hate the United States so badly, LEAVE. GO! You will not be missed.”

    I don’t hate the United States, or at least the ideas of liberty and justice it was founded on…my problem is that I don’t believe every corner of this country still embraces those ideals…the evidence lies in comments above that express the wishes of one individual for the President to vanquish a segment of the private sector, an idea I know for a fact is shared by many other people. I don’t want to live under the kind of totalitarian control that a mindset like that prefers. That’s all I’m saying.

    “so your “wish” that the United States will Balkanize “peacefully” is as much propagandizing as was that of the secessionists of 150 years ago.”

    Sorry, the only “propagandizing” that has been done over the past 150 years has been from the people on your “side,” the “victors” from that war. The fact is that the Confederate States of America had no intention of going to war with the remaining Union of States. They wanted to depart peacefully. Don’t let the fact that the first shot was fired from the South obscure the truth….that being that the North was the aggressor….even Britain and France acknowledged this and acknowledged the right of the CSofA to exist as an independent state. While you may try to rewrite history, it tells us very clearly who the bloodthirsty control freaks were in this country, and it wasn’t those of us with a Southern persuasion.

  31. Mule Rider says:

    Thanks, Mainer, for your thoughtful response….and for not having a knee-jerk accusatory reaction of unAmericanism…

    I totally agree that secession (or separation, realignment, etc.) should not be talked about lightly or used for aggrandizement but can and should be talked about seriously when two regions under one governing body appear as if they may no longer be able to thrive under that same structure of governance.

    I’d rather have a peaceful realignment of governing regions on this continent than continue down the path we’re on….which is increasing friction and hate….

  32. Mainer says:

    Max it took me so long to get my last typed in that I missed your post. As I just posted such a regional restructuring of the US has been looked at in depth. And I too would not wish to see a Balkanization occur. But most of those that have considered the concept have not done so for narrow political ideology reasons but for reasons centered around economics, transportation, energy and resources such as water.

    In most of the more interesting ones Canada and parts of Mexico are involved too. None of us would live long enough to see such a thing but from certain aspects it can make sense but any one wanting to see it because their world view consists of looking through a Barthole is heading down the wrong road for all the wrong reasons.

  33. Max aka Birdpilot says:

    Mule, you could not appear more ignorant (optimistic) or stupid (pessimistic, take your choice) if you had rehearsed for months before the curtain lifted.

    “I’m not wanting to “destroy” anything”, but I want to Balkanize the United States of America.

    “the Confederate States of America had no intention of going to war with the remaining Union of States. They wanted to depart peacefully. Don’t let the fact that the first shot was fired from the South obscure the truth” is as inane and idiotic and self-contradictory a statement as I have EVER heard, and I’ve heard some doozies! So, by your (lack) of logic, if I wish to peacefully leave an argument with you but before I walk away I bust your freakin’ nose without the expectation of retaliation, then I had no intention of a physical confrontation (going to war).

    “the people on your “side,” the “victors” from that war” further demonstrates either your ignorance or lack of attention. As I have stated MULTIPLE times on this blog and its predecessor, I am a proud son of the South, I lost relatives in that War, I respect their memory and final sacrifice by displaying the First National Flag of the Confederacy alongside the United States flag at appropriate times during the year. I know the costs of that War, my family suffered as a result of that War. I doubt you can say the same.

    But I don’t want ignorant, foolish ideologues as yourself, with the thought that you and your cohorts alone are gnostic in what is best for the United States repeating the same mistakes that your ideological predecessors did 150 years ago. Those who do not understand history are bound to repeat it.

    It’s why we call this country a democratic republic. But again, if you don’t like that, get the hell out!

  34. Max aka Birdpilot says:

    Mainer,

    Let’s just play MR’s little game and just use Texas, as my governor has already put his mouth in motion prior to engaging his brain on the subject. Let’s pretend Texas would be allowed to peaceably depart the United States. Further, let’s just talk about taxes and military.

    First, Texas receives more money from the Federal government than it sends in Federal taxes. It would lose that right off the top. Like most states, 48 is the number that I seem to remember, Texas is fighting its OWN deficit issues. The stimulus allowed Texas to keep the wolf from the door last budget cycle. (Texas is on a two-year cycle) Currently, we face a deficit over the next cycle of from $20 to $25 Billion! We are already paying 8.25% state sales tax (more than MOST areas of California) and have a property tax that is in the neighborhood of 2.25% of value (more than TWICE California’s) every year. These offset to a great degree the lack of an income tax. Texans will HAVE to accept either fewer services, worse roads, worse schools OR higher taxes! And this is BEFORE the development of an Armed Forces of Texas, from scratch, to help protect us from those hordes of illegals coming over the Rio Grande.

    And speaking of the Texas Armed Forces. In the dire budget straits Texas finds itself in, how is it going to compensate the United States for Forts Bliss, Hood, Sam Houston, and Red River Depot. And Dyess, Shepard, Goodfellow, Laughlin, Lackland and Randolph AFB’s? Plus, NAS Corpus, Kingsville and Ingleside. Not to mention Brooks Army Medical Center here. And we haven’t even mentioned the Federal hardware that sits in possession of the various Texas National Guard bases.

    That’s just two subjects. The complications and logistics are substantial, to say the least.

    Or does Muley believe in getting something for nothing?

  35. Mainer says:

    Max……..exactly. Perry is just shooting off his mouth for ideological reasons and doesn’t have a clue what the cost would be to the state. Oh by the way you forgot that Texas receives I think it is 31% of its budget from the Federal Gov. You also forgot all of the payrolls at all of the bases you mention. Oh and you forgot the Johnson Space center, agricultural subsidies, Army Corps of Engineers work, BLM money……..and on and on and on. Perry is going to be lucky if he makes it full term. He is in a budget mess and nothing he espouses will get the state out of it. The taxes wll go up or the state will default, and even with that the roads will get worse, the schools will get more crowded (watch for the first law suits as money is moved to more white schools as I am told is already happening) and social programs will be gutted. Yeah Perry should get out but I doubt he will be taking much with him.

    This Max is why I said some hot headed politician isn’t going to do this in this day and age. Our society is too complex and interwoven. Now could at some point there be a new construct of regions? Yeah maybe…….I don’t know. Some of these concepts go back to the 60′s and events have kind of eclipsed many of them. But informal regional and cross border efforts??????? You bet. Google Cascadia as an example. Here in the NE there are any number of agreemens between Canadian Proviences and various states on all sorts of matters so it could occur over time with out any one realizing how we are moving.

    My state is a classic example. My culture, economics, transportation and energy to name a few we have almost more connections with Canada than we do the rest of NE.

  36. Max aka Birdpilot says:

    Mainer, please note. For simplicity I only made a point of taxes and military. I didn’t forget those items you mentioned or any of the hundreds of other interconnections with Federally financed property within the borders as, say, the Interstate highways.

    I mean, we STILL haven’t got a single Texas Navy ship. And you KNOW the TAF (Texas Armed Forces will need strict border security to protect us from all them gawddammed librul gays trying to get in heah and seduce our fine, manly Sons of Texas!

  37. Max aka Birdpilot says:

    Hey, let’s play MR’s game of destroy the USA again. How are we going to decide who secedes?

    So arbitrarily let’s take the last Presidential election results. Now let’s say we use the two thirds majority rule (67%) to secede. Let’s also say EVERYBODY for McCain would vote secede and everybody voting for Obama was against.

    NOT ONE STATE would secede! ZERO! NADA! ZILCH! Damn!

    Well hell, lets reduce it to 3/5ths (61%) and see what happens.

    ONLY FIVE STATES, Alabama, Oklahoma, Wyoming, Idaho and Utah, would leave. Texas ain’t even there! And you see that only three of those are contiguous. So much for regionalism! Damn, again!

    Even if you reduce it to a bare 56% majority, you only add 7 more states (Texas STILL isn’t in there).

    Sorry Mule. Looks as though your idea SUCKS.

  38. Max aka Birdpilot says:

    UNFAIR! Muley cries! You picked a year when a Dem won!

    OK. Let’s go back to 2004 and do the same for Bush-Kerry.

    Muley, you lose AGAIN. Even WORSE this time!

    Only THREE states, down from five, with a 67% majority.

    And only NINE, down from twelve, with more than 60%.

    Sorry. Next contestant please.

  39. Mainer says:

    No Max I really doubted you forgot them. Now how is that TAF thing going? I am guessing that DADT is a no issue to start with, right. Texas is like Iran and just has none. Or you could always go the route of that dufus in Virginia and declare you are going to make sure there are none in the Virginia National Guard (good luck with that by the way as I can’t wait for the states top dog National Guardsman to sort his sorry ass out).

    I didn’t realize all those folks were sneakng across the border for issues of seduction. Wow all this time I thought they were coming to see the new Cowboys stadium……..hmmmmhow many taxpayer dollars are there in that edifice to grand illusions?

  40. filistro says:

    So a discussion on the cost of RSV treatment for premature newborns has degenerated into a vigorous examination of southern secession.

    And just belwo, a serious examination of skepticism and confirmation bias in UFOlogy has deteriorated into a lusty exchange about sex with beautiful aliens.

    Jeez, you guys ;-)

    (BTW.. I note that the unifying feature in both those discussions is… MAX!!!)

    LOL….

  41. dcpetterson says:

    Mule, if you get your wish, and those states break off — can the rest of us get our money back?

  42. Max aka Birdpilot says:

    Well now, fantasizing about a purty fili like yourself in that strapless gown, feather boa and 6″ heels can only carry a man so far!

  43. Max aka Birdpilot says:

    shiloh

    5000/365 = 14 times a day or only about once per waking hour.

    Who the hell were they interviewing, eunuchs?

  44. filistro says:

    MAX.. I should never have bought you that Texas Ranger outfit. You’ve been out of control ever since ;-)

  45. Monotreme says:

    As a native Texan, when secession comes, I wonder if I will get dual citizenship or whether I have to choose.

    Can we get back to a discussion of how to pay for health care? I think there’s actually one vote for government-run medicine and one vote for rationing by financial status in the above thread, but tell me if I’m misrepresenting either.

  46. dcpetterson says:

    It always amuses me. The Right wingers go on and on about how patriotic they are, and how much they love America and the Constitution. Yet they keep coming up with ways to change the Constitution, and keep wanting to break off from America. And when an election goes some way they don’t like — which is, of course, something the Constitution was set up to allow to happen — they do their best to undermine and deny and defeat the Will of the People.

    I’m having a hard time understanding exactly what part of America these people claim to like. Not our freedoms, certainly — they object to all manner of speech and minority religions. Not our Constitution — they keep wanting to change it. Not our Union — they keep wanting to break away. Not our pluralism — they keep expressing fear, or even hatred, of anyone different form them, particularly anyone who dare expresses an idea they disagree with. Not even our embracing of immigrants, despite the fact that we are a nation of immigrants — they keep casting immigrants as scapegoats, and denying the sentiment and intent of the Statue of Liberty.

    They seem to have a view of America that exists only in their head, an Ayn Rand dystopia where arrogant elites live on some mountain and are fed peeled grapes by the unwashed masses of docile serfs. What is most amusing is that were the fascist totalitarian corporatocracy of their wet dreams actually put into place, 99.9% of the people who vote for Republicans would be relegated to the serf class, along with nearly everyone else. Perhaps they truly imagine themselves to be lart of that elite 0.1% — Bart certainly does. As he put it, “I know what’s best for you rabble.”

    Anyway, since they have this false image of America, they are constantly disillusioned — at least, those few who have a toe in reality. This, I think, is what distinguishes Mule from Bart. Mule realizes (current) America is not as he dreams, and so wishes to take his ball and go home to where his dreams can come true. Bart, on the other hand, sees nothing other than his self-portrait and interprets all sensory input through that (as we’ve frequently seen, the articles he links almost never say what he imagines they say — but he honestly can’t help it, he can’t see anything that doesn’t fit his worldview).

    Bart denies reality. Mule at least tries to find a way to flee it.

  47. Pingback: The Secession Thread | 538 Refugees

  48. dcpetterson says:

    @Monotreme
    Can we get back to a discussion of how to pay for health care?

    Eliminate employer-provided health insurance. Give the insurance companies what they want — the ability to sell across state lines. Hell, remove all regulations on the insurance industry. Then also offer Medicare for Everybody. Let people choose the insurance thieves or the proven system of Medicare.

    Also, on a related note — raise the exemption limit on Social Security to $500,000 and then means-test the payouts. This would allow us to actually lower the retirement age to 62, with full benefits.

    That’s how I’d do it.

  49. shiloh says:

    Bart denies reality. Mule at least tries to find a way to flee it.

    Again, damned w/faint praise lol

  50. Bart DePalma says:

    Looks like the GOP is moving toward my first step of reform discussed above:

    The draft rules would repeal the “Gephardt Rule” that allows the House to raise the debt limit automatically when a conference report on the budget is approved. If the rule is repealed, a separate vote on raising the debt ceiling must be held.

    http://thehill.com/homenews/house/134799-new-gop-rules-will-make-it-tougher-for-house-to-raise-debt-ceiling

  51. Monotreme says:

    Thanks for getting back to the problem at hand, DC.

    At the risk of redundancy, I would restate my discussion questions from the last paragraph of the post:

    What is to be done for this? Do we ration healthcare by forcing parents to write appeal letters? What about parents who are not covered by insurance? Does this abrogate the rights of parents (and their children) who may not be as good at writing letters as others? Do we remove the ability of AstraZeneca to make a profit, or regulate the amount of profit they are able to make? How can we (or an insurance company) decide who is to receive treatment, and who does not?

    If Congress is going to investigate something during the 112th, rather than the Issa-led investigation of AGW scientists, how about the Issa-led investigation of whether Big Pharma is price gouging? I honestly don’t know whether they’re charging a fair price for biologicals or not.

    I would ask Congress to investigate over the next few years, then use that careful, thorough investigation to introduce legislation that reforms how science is done.

    At one end of the pipeline (research), our government-sponsored R&D system, set up by Vannevar Bush after World War II, has done a really good job at basic research, but sucks at bringing products to market.

    At the other end of the pipeline (development & marketing), the military-industrial complex and Big Pharma have done a great job of maximizing profits but have very little regard (by design) for the public interest.

    I’d look into ways of strengthening both, but with the creation of incentives for innovation at one end of the pipeline and the creation of incentives for acting in the public interest at the other end of the pipeline.

    Drug companies like biologicals, at least in part, because of the patent protections they offer. They’ve resisted all efforts for generic drug manufacturers to enter the market using the legal protections offered them by Congress. It’s time to examine that system and see if it continues to make sense, in the light of the obvious abuses.

  52. Monotreme says:

    DC sez:

    Eliminate employer-provided health insurance. Give the insurance companies what they want — the ability to sell across state lines. Hell, remove all regulations on the insurance industry. Then also offer Medicare for Everybody. Let people choose the insurance thieves or the proven system of Medicare.

    The problem with that approach, DC, is that you necessarily push the sickest and poorest segment of the population into the “Medicare” pool. That drives the cost of the Medicare pool up.

    It’s exactly analogous to what created the mortgage crisis, with crappy loans being foisted on Fannie Mae and Freddie Mac. Here, instead of people who can’t repay their loans and shouldn’t be homeowners, we have people who are costing the system much, much more than anyone can put into it.

    Unlike bad mortgages, though, we can’t just offer these people the opportunity to rent rather than own. The alternative to drugs like Synagis is death to children of poor parents, and life to children of well-paid parents. I find that hard to swallow.

    What PPACA tries to do — and I’m not arguing whether or not it will be successful — is to spread that risk amongst all the private insurance companies by using economic disincentives to people who “choose” to remain uninsured.

  53. mostlyilurk says:

    Actually, Mono, this touches on one of the huge problems that I see in current system. Because of the way that the private insurance companies operate, the costliest care is often provided by the taxpayers. For example, there’s a woman who posts on a parenting website that I frequent. She has a teenage son who tried to commit suicide and has been admitted to a private facility for the intensive treatment that he obviously needs. Her health insurer has determined (in its infinte wisdom, lol) that long-term treatment for this boy is two (yes, I said, two) weeks. That’s obviously not enough time so here’s what will happen after the two weeks – the boy will be moved to another facility and the state (i.e., the taxpayers) will pay the costs. I don’t have any wish or desire for the insurance companies to go away but the manner in which they’ve handled this situation (and, many others like it, I believe) just doesn’t seem right and, as a result of their actions, its the taxpayers who end up paying for care that the insurance companies won’t, i.e., the most costly care. As a result, things becomes more expensive all around, i.e., people’s insurance premiums go up, the cost of medical care is goes up and revenue has to be found for the state to cover the medical costs that the insurance companies are able to walk away from. That revenue, of course, also must come from the taxpayers. I have (or had) hopes that the health care bill would at least begin to take steps to address these issues. At the very least, I thought there might be a reasonable discussion that had been sorely lacking over the years. However, instead of suggestions as to how the problems might be addressed, we got “Obama is a socialist who wants to take over all private industry and implement death panels.” I just don’t see how that moves us forward in addressing these complicated issues. Moreover, I think that when our elected leaders did make an attempt to try and address the problems with the passage of the health care bill, they got punished for it at the polls in November. That being the case, I truly wonder what the impetus will be for any elected representative to attempt to address these issues in the future.

  54. Monotreme says:

    @mostlyilurk,

    That’s why I’ve come to the considered opinion that single-payer is the only way to go.

    We can go single-provider, like the NHS in the UK, or single-payer government-run insurance with multiple independent providers, like the Canadian system, but it’s gotta be single payer, I believe.

    Still, I’m open to rational arguments from those who disagree. I want to hear them, really I do.

    For example, one modification of my “favorite” approach would be a state-by-state single-payer plan. I think that would get the pool large enough to be spread amongst enough taxpayers. However, I think such an approach would run into Constitutional issues, because the Federal government would have to regulate the content of those insurance plans to prevent a “begger thy neighbor” approach where (say) Texas does f***-all for their poor in the hopes that they’ll move to Oklahoma. And so forth.

  55. Monotreme,

    Still, I’m open to rational arguments from those who disagree. I want to hear them, really I do.

    I agree that a large, relatively randomly distributed, pool is necessary for a fiscally sound insurance policy. But that hardly requires single-payer.

    The biggest problems we have with medical insurance stem from the ways in which medical care differs from situations typically covered by insurance. Single-payer doesn’t address those problems.

  56. mostlyilurk says:

    Mono,
    I do sometimes wonder is single payor isn’t the best way to go. From what I can tell, Medicare seems to work very well for the most part. I just wonder how well that would translate to the population at large.

    Michael,
    I agree with you (I think) regarding the way medical insurance differs from other types of insurance coverage. It seems to me that when you need medical insurance the most (i.e., when you’re ill), you’re the least appealing customer to the provider of medical insurance (the insurance company).

  57. shortchain says:

    There’s an article in the MPLS Star-Tribune this morning about a socialist experiment in St. Paul, where a small family practice has been offering a one-price health care solution.

  58. mostlyilurk,
    I described at length the issues surrounding treating healthcare as insurable in this post and this one, too.

  59. Monotreme says:

    MW,

    True, there are (at least) two separate discussions to be had. One has to do with the “insurance” pool (using quotes because you’re right that it doesn’t follow the normal rules of insurance) and the other has to do with the rationing mechanism to be used.

  60. Pingback: Open Laboratory 2011 – submissions so far | A Blog Around The Clock

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