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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Peter Dierks who wrote (6721)	5/1/2009 12:01:46 PM
From: skinowski	1 Recommendation Read Replies (2) \| Respond to of 42652

Soon America may be employing third world doctors How does one define third world? Is India third world? Huge numbers of Indian trained MD's are working in this country, many of them excellent docs. Many FMG's are specialists, of course. At the root of many dislocations is the price control regime, imposed by the government as early as in the mid 80's. If a doc charges a medicare patient one cent above the allowed rates, he breaks a ton of laws. One of the results is that nowadays only 2% of 4th year medical students intend to choose primary care as a career. So, increasing the number of med schools will not change much - unless we flood the nation with those new schools. There seems to be a strong trend towards using PA's and nurse practitioners in place of MD's. This trend, obviously, will continue. I doubt, however, that costs will be much lower as a result - and I can't see how quality could be better.

To: Peter Dierks who wrote (6721)	5/4/2009 10:37:36 AM
From: Glenn Petersen	Respond to of 42652

Soon America may be employing third world doctors... Bring on the Cubans. Wal-Mart continues to lower drug costs without a government mandate: Wal-Mart Expands Drug Program Retailer Steps Up the Competition Over Managing Benefits for Employers By ANN ZIMMERMAN and AMY MERRICK Wall Street Journal MAY 4, 2009 Wal-Mart Stores Inc. is expanding a pilot prescription-drug program for companies, heating up the race among pharmacy retailers to transform the way drugs are priced and sold. The discount retailer is offering businesses low-priced drugs if they sign up to buy directly from Wal-Mart's network of in-store pharmacies, rather than contracting to buy drugs through third parties known as pharmacy-benefit managers. Wal-Mart's program follows other recent initiatives by big pharmacy retailers to grab market share by offering companies a less-expensive and simpler way to manage their drug plans. The competition among Wal-Mart, Walgreen Co. and others to create more-efficient business plans for pricing and selling prescription drugs has the potential to spur change across the pharmacy industry. And it poses a direct challenge to the dominant role pharmacy-benefit managers have played in the drug chain. When Wal-Mart introduced its $4 generic-drug program a few years ago, it shook up the drugstore business and prompted rivals to introduce their own discount plans, broadly lowering costs for consumers. But at least one PBM sees more benefit to Wal-Mart than to consumers in the retailer's newest drug program. "While our business model focuses on improving health outcomes while reducing wasteful spending, Wal-Mart's program appears to be designed to build store traffic," said Maria C. Palumbo, spokeswoman for Express Scripts Inc., one of the country's largest PBMs. Wal-Mart began a trial of its program in September with heavy-equipment maker Caterpillar Co., which provides prescription coverage for 70,000 employees and their dependents. Wal-Mart negotiated a fixed markup over its cost for the drugs it sells to Caterpillar's employees under the heavy-equipment maker's in-house insurance. Though Wal-Mart doesn't reveal the costs to Caterpillar, they are verified by a third party. The markup guarantees a profit for Wal-Mart, while reducing the cost to Caterpillar. Todd Bisping, who manages Caterpillar's drug-benefits program, said the company was able to reduce its drug costs enough that it waived copayments on generic prescriptions bought from Wal-Mart. Wal-Mart deemed the trial successful enough to expand the program to other companies last month, though it declined to say whether it has signed up new clients. Walgreen's strategy, meanwhile, has been to create an extensive health-care program, including checkups at a network of Walgreen's-operated health-care centers, for big employers such as Walt Disney Co. and Toyota Motor Corp. Walgreen's chief rival, CVS Caremark Corp., is betting on the PBM industry, purchasing the big PBM Caremark for $27 billion in 2007. CVS Caremark executives said owning more parts of the drug-supply chain would make the combined company more profitable and efficient, driving down costs for employers. Typically, employers and federal and state governments contract with PBMs to administer their drug coverage, which includes choosing which drugs will be covered and how much they will cost the employers and patients. The PBMs promise customers they're getting lower prices because drug makers and retail pharmacies give them discounts for buying in large quantities or sending patients their way. But it's often unclear how much of that discount is passed on to customers. The new competition from drug retailers aims to provide more certainty -- and better prices -- to companies. Wal-Mart says it, too, can negotiate lower prices because it buys large quantities. It says it passes more of that savings on to its clients than PBMs do. PBM representatives declined to discuss their pricing policies. Wal-Mart records a profit for each drug sale and benefits by drawing customers to its stores, who may make other purchases, from groceries to hardware. "This is a game changer," said Adam Fein, president of Pembroke Consulting Inc. and author of a blog called Drug Channels. "Right now there is no incentive for an employee to choose the lowest-price pharmacy, because the copays are all equivalent." Walgreen hopes to appeal to employers by offering a clearer pricing structure than PBMs, which base their prices on costs that aren't easily verified by clients. Walgreen executives say its clients will know in advance how much they are paying for each drug or service. Walgreen has a growing relationship with Toyota, operating about a half dozen pharmacies at the auto maker's U.S. work sites. The car maker is discussing with Walgreen the possibility of setting up a program similar to Wal-Mart's project with Caterpillar, in which Walgreen would expand its drug program for Toyota employees. — Kelly Nolan and David Armstrong contributed to this article. Write to Ann Zimmerman at ann.zimmerman@wsj.com and Amy Merrick at amy.merrick@wsj.com Printed in The Wall Street Journal, page B5 Story link