1. Big Pharma is a major part of what's wrong with US health care.

2. Big Pharma uses offshore tax shelters to shield profits.

3. Big Pharma is also highly corrupt.

4. Corrupt entities often use offshore tax shelters to hide their activities.

Conclusion. Maybe if we want to solve health care woes, we should look at the above issues, and not depend on JPMorgan and Amazon to solve the problem, considering they both:

1. Use offshore tax havens to shield profits, or promote the use of offshore tax havens to benefit their clients.

I mean, I could be wrong about all this. But I also understand this stuff on a far greater level than you. I mean, when I threw out the $16 trillion figure and you had no idea what I was talking about, that kind of showed you are operating on a somewhat basic level when it comes to discussing this stuff.

You have reading comprehension problems as well as problems forming coherent arguments. It's not a good look for you to lecture others.

Look, I know it sucks finding out that the crap industry you work in is way more crappy than you ever realized. But, don't attack the messenger (RNA).

That's a pharma joke.

So what are you calling the practices of Apple? Isn't that a exotic scheme or do you think that is totally standard business behaviour?

Apple is/was definitely involved in exotic tax schemes.

The goalposts in this thread are wider than a black hole.

On an unrelated topic, my wife and I were watching the Netflix documentary Dirty Money last night about Valeant, and how they used shell companies in Delaware to create fake pharmacies to defraud insurance companies.

And she tells me that the Cali Cartel did the exact same thing in Colombia to launder drug money.

Which is interesting - and somewhat sad - that an allegedly legit drug company in the US would follow the exact same business model as Colombian drug traffickers.

And, as far as Apple goes, drug traffickers use the exact same schemes to hide their profits as Apple does to avoid taxes.

Heh just recently watched a documentary on shell companies through Netflix as well. Focused quite a bit on Delaware.

I suggest The Naked Truth. It's a year older than Dirty Money but follows the same theme of a documentary series focusing mostly on less commonly spoken topics such as shell companies and the mug shot publishing industry

Slightly OT, I know. Just thought I'd mention it.

When the president of the ****ing country thinks that hospitals are literally attempting to hook people on painkillers when they genuinely need it... I mean, how long before the bodies start piling up due to shock for not being able to be treated for pain?

I dislocated my hip in 2010 and had to wait 7 hours in a bed for the lone orthopedic surgeon in the area to pop it back into place. I practically had to beg for a shot of morphine to take the edge off. Didn't get prescription pain pills to take home with me either. I guess I lucked out in the end because with my personality and lack of mobility/anything to do while recovering, I probably would have ended up getting addicted.

WTF? A hit of propofol, a little effort and 90%+ of the time the hip is back in. I haven't had a patient relocated by an ortho doc in 20 years.

Where was this? Some dinky hospital in bum**** nowhere?

MM MD

That's what sucked so much. Took him less than a minute to pop it back into place but he was in surgery for so long working with some other patient that I had to lay on a bed crossing my fingers hoping that he would finish soon and fix my hip. It hurt like a mother****er during those hours.

Yeah it was in a dinky hospital in bum**** nowhere.

Sorry to hear that.

Stuff that I take for granted that should be handled by pretty much any competent ER doc isn't, especially in small rurals. I've probably done one every 3-4 months, and since we have 50+ docs in my group it's a fair number. But some are better than others at it. I'm pretty good, but I'm 6'2 and 235, so I've got some mass going for me in what is a pretty strenuous procedure - a couple of my lighter female partners not so much. OTOH, if you really snow the patient with propofol, it's usually not much of a gruntfest......

And sometimes the hip just won't go back in - did they even try?

MM MD

It was a while ago (2011). So a bunch of it is a blur. But I just waited for the guy with a dislocated hip. I was given some stuff that knocked me out for a few minutes and when I woke up the hip was back in place.

Of course it would be another 4 months before I could walk without pain.

But yeah wasn't given painkillers on my way out. Knowing my personality, I'd probably end up addicted to them like the people you see on documentaries about the epidemic.

Just an update, because I find it amusing.

we're now out of IV diltiazam, which is pretty much the only safe drug to use for atrial fibrillation with rapid response, which is something I treat a couple of times a week. Other drugs bottom out peoples blood pressure - but it's all we have, so hey, what's a stroke here and there...

and we're out of ****ing sterile water. Yep, water.

MM MD

So I assume you're sending nurses to the grocery store for distilled water and boiling it.

You'd think so - but we use it for compounding meds. Some drugs can't be in saline, just water. And boiling our own would be viewed as like us farming moldy bread for penicillin. So we just have to do without, somehow.

MM MD

What's the cause of your hospital not having that drug, or sterile water?

Because there is a huge hospital drug shortage issue in the United States.

Baxter is still having problems with their Puerto Rico plant, getting it back up to full production. This is causing sterile fluid issues (sterile water, dextrose, normal saline)

Pfizer bought Hospira and shut down a lot of the old Hospira plants because they weren't up to Pfizer level snuff.

The other drug companies are having trouble keeping the supply chain going with Pfizer/Hospira and Baxter problems.

We've had issues lately getting Zosyn (most important antibiotic in the hospital), fentanyl (ICU narcotic), all electrolytes (magnesium and potassium).

It's rough. You use 2nd line agents. Make restrictions on the use of certain drugs. Beg, borrow and steal from your sister hospitals.

Not just us. It's everyone, pretty much. Plenty of Viagra for sale, though - so we have our priorities straight.

MM MD

I probably could have asked the question better, but why aren't hospitals keeping that drug and sterile water in stock? Is it a manufacturing issue or a purposeful decision by the hospitals?

As said above, it's a manufacturing issue. They can keep a 6 month supply, but it's been 6 minths since the hurricanes.

A slight problem with incentives in Obamacare. The harder a state works to keep Obamacare up and going, the more the poorest people on it pay.

http://peoplespolicyproject.org/2018...es-them-worse/

Would appreciate reading material on the medicine shortage issues, should be headlining all over the interwebs!

I think this is untrue.

The average monthly payment for people with subsidies (i.e., the poorest who pay for insurance) just went down to $89/month.

For states with expanded Medicaid the poorest of the poor pay nothing. Thats 15 million people.

Who gets hit hardest are those who don't qualify for subsidies. Especially in red states that are actively trying to sabotage Obamacare. Still even though they are paying something like $6,000/yr for a family of 4 they do get the benefits of:
- no lifetime cap
- no exclusion for pre-existing conditions
- limits on out of pocket expenses
- can't be kicked off insurance once they have been diagnosed with severe illness or condition

And ironically they can now choose not to have insurance at all.