Self explanatory . . .
http://www.youtube.com/shorts/TTzIsrHyEXE

You are posting to TER P&R where a bunch of MAGA cult members DO need an explanation.
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Let's say a prescription costs $100.
50% of $100 is $50. Reducing the cost of that drug by 50% brings the cost down to (100 - 50) = $50.
A 100% cost reduction is (100 - 100) = $0 = FREE!
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A 500% cost reduction is (100 - 250) = --$150 means that the pharmacy or drug company will pay you $150 when you receive that Rx.
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1000% of $100 is $1000. That drug will now cost (100 - 1000) = --$900. You will get $900 from the pharmacy or drug company when you receive that Rx.
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I wonder how Trump will get drug makers and vendors to agree to that.  
I expect the MAGAs will continue to believe Trump's lies and that "Mexico Will Pay!"

It is just more proof that Trump is not just ignorant but stupid.

…anything and everything Trump barfs out of his mouth.

 
If the price of drugs are reduced by 100%, they would be free.  If they’re reduced 1000%, the drug companies would owe YOU money, lol.  

 
Trump knows as much about math as he does about anything else - NOTHING!

END OF MESSAGE

If you have been paying attention.   WHICH I KNOW YOU HAVENT.

What Trump is actually wanting to do is something that Mark Cuban has been trying to push.  It is cutting out the middle man and the mark up that pharmacies do.  Which was made into law under the ACA.

NOW you will see take 1000% or 1500% credit for it... and not give any credit to Cuban or his concept he is and has been implementing.   Cuban is only having a base 15% mark up on all drugs.  Trump wants same thing..... but then to go FURTHER by getting more generics, not allowing the strangle hold big pharma has on things, etc.  Which is dealing with trade and what not....IE: meds produced in other countries type thing.    Go look at what certain meds cost in Mexico, UK, Canada, etc.  Compared to USA.

But you are correct and the criticism is needed.  HIS MATH AINT MATHING.   Some drugs are marked up 500%.... like if a pill only costs $1 to produce they sell it for $500.  That is a 500% mark up.  Same goes for $1000 drug/treatments.   GET IT.  But it is typical Trump.  Like I have stated in another post.  He has his Ego and needs to exaggerate everything.

Actually you are  wrong on what he is talking about.   He is talking about what the cost of the drug is to make and the MARK UPS.

If a pill costs $1 to make and they sell it for $100.  That is 100% mark up.  Now you reduce that by 100% it costs $1... it isn't FREE... it is $1.

Now where Trump is talking out his ass is when he is saying he will REDUCE PRICES by anything over 100%.  You are correct on your math on that.  His math ain't mathing.

If the DUMB ASS would have just said his plan is to REDUCE MARK UPS OF DRUGS.  People wouldn't be calling him an idiot.   Because there are those 1000% mark ups.  There are pills that cost $1 to produce and selling for $1000 type shit.  Where insurance picks up 90% copay or what every and the consumer is stuck with $100 bill.

It is kind of what Mark Cuban is trying to do with his Cost Plus Drugs.  Cut out middleman where many mark ups happen.

Going off on a bit of a tangent, but an important tangent. The cost of a pill may be less than $1.00. The cost of DISCOVERING what goes into that pill and getting it APPROVED by the FDA can cost $400M to over $1 B.  Clinical trials aren't cheap and frequently fail.  
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Prior to a drug company spending $400 M or more on R&D, there might have been many more $millions spent by the NIH and NIH funded researchers and philanthropies (e.g., Wellcome Trust) to generate a huge body of information to jump start the R&D on a marketable drug.
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A patent is in force for 20 years. It can take YEARS after getting a patent issued to get FDA approval to sell the drug. Patent protection might be reduced to 5 years to 8 years during which time a company wants to cover its expenses and make a profit. During those 5-8 patent years, a competitor might get a similar or better drug approved. More income and profits disappear.  
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A generic pill mill in India or China can knock off a proven drug for pennies per pill. But they didn't spend anything on R&D.
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The US citizens deserve a return on their tax investment in NIH research. The drug companies (usually) deserve a return on their $400+ M investment to get the drug approved. But prices do have to be kept *reasonable.*  
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Getting people to agree on "reasonable" (or affordable) is the rub. One argument is to change the law to extend patent protection on drugs to spread out the years available to recover costs and make a profit at a lower cost per pill.  (Recoup $500 M over 5 years = $20X per pill. Recoup the same $500 M over 10 or 20 years = $10X per pill or $5X per pill.) And there are many other plans that have been proposed.  
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We probably agree on cases like Daraprim and the Epipen.
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Daraprim: http://en.wikipedia.org/wiki/Pyrimethamine#Economics Turing Pharm bought the rights to Daraprim and then jacked up the US price from $13.50 to $750 per PILL!!! In non-US countries, Daraprim costs from 2 cents to $1 per pill.
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Epipen: http://en.wikipedia.org/wiki/Epinephrine_autoinjector#United_States Mylan Pharm bought the rights to Epipen. Heather Bresch, Senator Joe Manchin's daughter, was a low-life CEO who lied about her MBA. Mylan is not an R&D drug company. They just sell existing products obtained from others. Mylan jacked up the price of Epipens by 500%.  
http://en.wikipedia.org/wiki/Heather_Bresch
"... The Intercept reported that during an ongoing racketeering case involving Mylan and Bresch, "newly released court documents show [Bresch] discussing a deal with Pfizer to eliminate a chief competitor to EpiPen, clearing the way for major price hikes." The 2010 and 2011 email discussions, unsealed by the judge, showed Bresch's assistant discussing divesting from Adrenaclick after the closure of the Pfizer/King deal. They "also show Bresch approving a scheme to force customers, captured by the company’s monopoly, to purchase two EpiPens at once, regardless of medical need."
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And there are other examples of such GREED, without even a sham interest in needed cash flow for R&D on new drugs. (The Epipen price gouging enriched Bresch and the other company officers. Bresch was one of the highest paid CEOs in her company category.)  

-- Modified on 7/25/2025 3:27:08 PM

..,but they’re only recovering their R&D costs from Americans.  There’s a brand-name drug that costs $800. for a 30 day supply in the U.S. (not genetic yet).  I talked to a friend overseas who told me that the exact same American brand-name drug costs $60/month there.  

 
That’s bullshit to only stick Americans for the R&D costs.

If that's true then why has he been grifting away even when back in office. Viz. his whole bitcoin thing and there's all this...

Compared to what he grifts. $400K is nothing to him. And his crypto deal alone has made him $2.9 Billion since he became Prez.
He is the biggest grifter and con man of all time. And Wanker and the other righty fools here are lapping it all up.

Flying Bravo

eat unlimited platters of Trump turds.
Gawd, what a dupe you are. No wonder you hang out here because there are enough of your fellow idiots to, in your excuse for a brain, validate your most absurd ideas.

Yes, BP. You are correct. As I am in the US, I also think that the drug companies need to spread the costs around A LOT more. (If I was in the EU, I might favor the status quo: cheap drugs for the EU and let the stupid Americans pay!)  
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And someone else posted about the "middle men" in the US prescription drug supply chain. There are MANY! It isn't just big drug company to (CVS, Walgreens, ...) to patient. There are middle men and wholesalers that jack up prices at every step of the way and who also provide opportunities to steal drugs for the black market or insert illegal cheaper hence more profitable knockoffs with sophisticated (even hologram) counterfeit labeling into the supply chain.  
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Other developed nations (UK, EU, etc.) provide universal health care for their residents. Their health agencies do not always agree with the USA FDA on drug approvals or allowed uses. And they are often MUCH more budget conscious and less prone to cave in to special interests. E.g., once a drug goes off-patent and there are generics available, they will only pay for the cheaper options, not all options.  
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Some drug approvals in the US have been very controversial, especially for rare diseases. Treatments that have shown limited effectiveness in clinical trials can still get approved under pressure from patient advocacy groups, Special Interest Disease Org., their Congressmen, and others. Insurance companies are then forced, by law, to pay for some of these million dollar treatments. Some of the EU health agencies have decided not to pay for some of the questionable treatments (but still allow patients get the treatments by other means: out of their own pocket, charities, 1-on-1 negotiation with the drug companies, etc.).

I agree.

You haven't addressed the BASE PRICE which is set by the Drug Co.. I.e., a 15% mark-up on what base price?

 

I don't know where Cuban is getting his drugs: direct from the Drug Co or from one of the numerous "middle men" wholesalers / shippers / warehousers.  
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We could also go into the economics of scale and markups. Suppose Cuban (or anyone) only sells cheap-o drugs at a base price of $100 per Rx-year and charges $115 for it. That could be a lot of staff, overhead, warehousing, processing, shipping, billing. 100,000 Rxs x $15 markup = $1.5 M markup.  
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Suppose Cuban (or anyone) sells Wonder Drug at a base price of $100,000 per Rx-year and charges $115,000 for each. He only needs to process, ship, ... 100 Rxs to reap $1.5 M in profit (markup). He only needs to pay for 1/1000 the staff, warehouse space, bottles and caps, FedEx envelopes, ... to process 1/1000 the number of pills to make the same $1.5 M in "markup" = more PROFIT on that markup.  
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Cuban knows math. I think he knows which is more PROFITABLE to sell.
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I've heard about Cuban's pharmacy company but haven't read a lot of detail. Personally, I want to keep my neighborhood pharmacists close by. In the past 10 years, I've had two "emergency" issues that required me to take some Rx drugs (an strong anti-inflammatory to treat a wound and an specific antibiotic to treat an infected wound). I did NOT want to wait until I got home to order on-line and then wait one or two days to receive some emergency meds that I needed "immediately" and I might not even get from my mailbox until returning home from work in the evening (almost 3 days delay to start treatment).

Trump provided only PARTIAL PROOF of giving away some portions of his salary in 2017-2019. Some Fed agencies acknowledged receiving payments from Trump (~$78 k per quarter = $100k after tax) and receiving an additional $22k from an anonymous donor to bring it up to $100k. In total, the acknowledged (PROVEN) donations amounted to less than $300,000 of the $400,000 salary for three years.
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http://www.usatoday.com/story/news/factcheck/2023/02/02/fact-check-partly-false-claim-trump-tax-returns-salary-donation/11132712002/
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"Trump reported nearly $2 million  in charitable donations in 2017 and a little over $500,000 in charitable donations in both 2018 and 2019, according to his tax returns and the report. He didn't report any charitable contributions in 2020."  
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ZERO charitable donations reported by Trump in 2020 and there were no agencies reporting the receipt of Trump largess in 2020.
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In 2025, Trump is STRIPPING agencies of their funding so I don't expect him to donate to any of them ... except maybe ICE.

Oh... i do know about all the R&D and what not.

It used to be something like to bring a drug to market was about $20M.... now I think it is about $100M... after all the R&D, trials, etc.

But also one thing sucks about US is that lets say during the trials for a dick pill.  They find out it can cure another thing.... say migraines.   GUESS WHAT.   They have to start back at day 1.  They can't start from that point and move forward.  That is what SUCKS.   So more money needs to go into everything.

But then like you mentioned how Phara is becoming a monopoly and what not.

It is also sad that Hospitals are now more FOR PROFIT than anything.  Hospitals will charge people MORE if they have insurance.   Make that make sense.  Shouldn't it be all the same???   Correct?  

I am not sure where Cuban is getting his 15% baseline either.

What I am think is Cuban is only offering it for generics type thing or drugs that past the 10 year patent stranglehold.  So the ones that have competition out there.  I mean think about it.  Viagra was the only dick pill for years... then came Cialis and others.   Now you got the China knock offs you can get with a phone call or online type things... your blew chews, red rx, hims, etc.  

I was just giving examples of what I think Trump is talking about.... But he is going to do it on a nationwide level.   Like make sure Big Pharma splits costs of R&D globally, maybe cut down on the 10 year patent strangle hold for competition, etc.  Type things.

I'm replying to some of crsm's points above (the cost of getting a drug approved) and here (recouping the cost of R&D).
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Crsm's estimate of $20M to $100M is way too low according to almost every analyst, including the most skeptical ones. On the other hand, only the most fervent Drug Co. supporters believe the Tufts numbers:
http://en.wikipedia.org/wiki/Tufts_Center_for_the_Study_of_Drug_Development
Tufts Center for the Study of Drug Development
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"The center has published numerous studies estimating the cost of developing new pharmaceutical drugs. In 2001, researchers from the Center estimated that the cost of doing so was $802 million, and in 2014, they released a study estimating that this amount had risen to nearly $2.6 billion. The 2014 study was criticized by Medecins Sans Frontieres, which said it was unreliable because the industry's research and development spending is not made public. Aaron Carroll of the New York Times also criticized the study, saying it "contains a lot of assumptions that tend to favor the pharmaceutical industry." The center's 2016 estimate, published in the Journal of Health Economics, found the cost to have averaged $2.87 billion (in 2013 dollars)." I haven't found their 2024 numbers yet.  
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The patent system is supposed to allow for exclusive rights for a period during which to recover costs (and make a profit and do more R&D for the next new idea).  Drugs aren't like a new screwdriver ("RatchetBall") or Apple Watch case (beveled edges versus squared edges - ooooOOOOHHhhhh! What a brilliant and risky idea!!!) You patent a screwdriver on Day 1 and it's being sold in stores in less than a year, exclusively by you for 19 more years.  There is little or no safety testing to slow down sales.
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You patent a drug on Day 1 (to protect the drug itself (the property) so no one else can make it and sell it). It can take 5 or 7 or 10 or 15 years to do all of the testing and clinical trials to satisfy the FDA and get it approved for sale and use. You now have only 5 years (at most) of exclusivity to recoup your costs. (There are rules that allow some extended coverage time.) One argument is to allow a LONGER period of exclusivity to keep the price lower for longer.  
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Other countries allow their Health Care systems to negotiate with the Drug Cos. In the US, Medicare / Medicaid IS NOT ALLOWED AND WAS PREVENTED BY LAW from negotiating lower prices. (Those laws were bought and paid for by the Drug Co. Lobby.)  Biden was able to get the Drug Cos. to lower prices on ~30 important drugs.  
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The system needs to be fixed.  

How will Trump get Big Pharma to split the costs globally? (There have been some bills that would require Big Pharma to charge the Medicare / Medicaid no more than some price (average price? highest price paid by a private insurance plan?). But if Big Pharma sells just one pill to one private company for a HUGE price, that sets the highest price as high as they want it!  
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More to discuss but I've got other stuff to do now.

-- Modified on 7/28/2025 4:01:46 PM

Agree on much of what you stated.... and my numbers were off.    I just remember hearing these things from a friend of mine who was in the Pharma sales 20 years ago.... so yeah my numbers are LOW AS FUCK.

Also I totally understand about Capitalism and they deserve to get money back for R&D.

But lots of the fuck up about regulations is the fact like I mentioned about if they are studying or developing a drug for one thing.  But then find out it can help in another area.  They have to start from scratch in that other area.  They can't start from that point in the R&D.  Even though they already did the early bullshit.  It is a waste of time, money, etc.  Which again boosts costs on that "new" discovery.  It is Gov regulations getting in the way of innovation.  

Also on the comments about negotiation of drug prices.  That is a huge fuck up of the system.  Which also pushes the burden of that "public" type of medical care negotiation (Medicaid/Medicare) on drugs onto private insurance companies.  Which will inflate premiums for people on those plans.

YOu are 100% correct it is the lobby game that is fucking everyone over when it comes to Big pharma and medical supply/device industry.  Even the hospital lobby.  Trust me hospitals are not innocent in all of this either when it comes to pricing and fucking over insurance companies and people.   Insurance companies are not always the bad guys.  They are not always innocent either.  But that is a different subject/topic.  

But back to what I believe Trump and Cuban are trying to do is the whole mark up on drugs.  They are trying to some how kill that or cut that down.   I have no clue how.  But that is what they are talking about.   Does that have something to do with these trade deals?  Who knows?    I do know last time Trump was in office he made deals with the new "NAFTA" that allowed certain generics into the US market earlier and what not.  So now is this something over seas markets.... Who knows?  Time will tell.

I think that we are going to agree A LOT on some things and disagree A LOT on some other things.

I disagree. That is, there is a big "It depends." "Drug Repurposing" (or repositioning) is a big deal.  
http://en.wikipedia.org/wiki/Drug_repositioning  Depending on the drug and disease, it is NOT as easy as writing an Rx for the new application. (See wiki.)
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The Gov regulations are NOT there to stifle innovation, they are there to protect THE PUBLIC from harm. See my post about the roots of the FDA in 1906:  
http://www.theeroticreview.com/discussion-boards/politics-and-religion-39/food-and-cosmetics-463707
(Scroll down to ...) "Upton Sinclair wrote The Jungle about the meatpacking industry in 1906. It helped lead to reforms and gov regulations to protect the public. http://en.wikipedia.org/wiki/The_Jungle#Federal_response "After reading The Jungle, [Theodore] Roosevelt agreed with some of Sinclair's conclusions. The president wrote "radical action must be taken to do away with the efforts of arrogant and selfish greed on the part of the capitalist." MANY additional efforts have been made since then and there is always industry resistance to regulations.  Some things never change."
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I would add the regulations can SPUR innovation into high gear! "No more toxic ethylene glycol in cough syrup." means that innovators had to come up with new ingredients and new formulations. (Not drugs, but) "No more gas guzzlers!" got the automobile industry to innovate and get fuel efficiency up from 8 MPG to 40+ MPG.  
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Back to drugs ... Several drugs for diabetes have been repurposed WITH FDA APPROVAL for weight loss. I think that happened fairly quickly.  
http://en.wikipedia.org/wiki/Anti-obesity_medication
Look at the list for drugs that were once Approved but were subsequently Withdrawn because the FDA determined that they were UNSAFE for that purpose or totally unsafe.And we agree. But private insurers often get better prices from the Drug Cos. than Medicare / Medicaid. The BIG insurers have a big say in what they will approve / pay for so Big Pharma has to negotiate to get drugs onto the approved list. There is a lot of discussion of problems with the "US Health Care System."  But almost EVERYTHING is about the "US Health INSURANCE System."  
  We have different recollections of the new NAFTA = NAFTA Version 2 = USMCA (the updated version of NAFTA). I don't recall anything that was supposed to lower the price of drugs. In fact,  
http://en.wikipedia.org/wiki/United_States–Mexico–Canada_Agreement#Provisions
"USMCA provides for a patent term extension where there is an "unreasonable curtailment" of a pharmaceutical's patent term stemming from delays in the regulatory or marketing approval process.  
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"USMCA accounts for data exclusivity of new pharmaceutical products. New pharmaceutical products are those that do not contain a chemical entity that has been previously approved by that party.[1] Generic manufacturers are prohibited from relying on the innovator's previously undisclosed safety/efficacy testing for at least five years from the date marketing approval was first granted. Mexico agreed to extend its data protection of new pharmaceutical products.[67] Canada's data protection regime already offered an eight-year exclusivity period for innovative drugs and thus was not required to make changes. ..."
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Trump makes many false claims about, well, everything, including drug pricing:
http://www.cnn.com/2024/06/14/politics/fact-check-trump-biden-insulin-costs
Fact check: Trump falsely claims Biden didn’t lower Americans’ insulin costs.
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If you've got some specific references (links) to the USMCA and lower drug prices, please post them.

NAFTA 2.0 with drug prices was with Canada and some generics or something.  IT was what we are talking about with the length of the patent and what not.  Can't remember but it cut down on the years or what ever.  It did something.... not a whole hell of a lot... but did do it.

Like I have mentioned... right about then you noticed the "over the counter" type dick pills.  The blue chews, hims, etc. type stuff popping up.  Before you couldn't do that stuff.... via phone, online, etc.

Now with the whole rebranding/redirection of drugs and R&D.  You bring up the weight loss with diabetic meds.  Those things were not "quickly" brought to market.  They did take years to do it.   I also understand about safety and what not.

But what I am getting at that even though lets say a drug went thru basic testing for XYZ and gets to a point and they find it has other benefits.  Now that they want to possibly go in that direction for those new benefits.... they have to start back over... with the same formula and test again for XYZ because they decided to take it in the new direction for those new benefits.  EVEN THOUGH they just did those tests.   It is REPEATING when they dont need to.  That is what I am getting at.  They didn't change the formula.  They didn't change a damn thing.  But they are made to RESTART the process all over again with the basic starter tests.

Now onto insurance.... Yes Insurance Industry has its issues.....ie denying claims and what not.  Also many don't understand about the whole experimental drug vs other things.  Which is sad when dealing with life or loss of life.   But two things people dont understand IF insurance companies were to do those things at any costs necessary.  Nobody could afford insurance... NOT EVEN THE US GOVERNMENT.   Under a "national" healthcare people wouldn't get those "experimental" type drugs they would get "comfort care" type situations until they passed.  It is the sad and cold truth.

You could bring up... WELL THE GOV COULD REGULATE IT.....there are still costs on top of costs.  Who will be paying those costs?

But remember insurance premiums are based on costs or what hospitals, pharma, etc charge.  So when people complain about PREMIUMS..... it is on hospitals, pharma, medical device, etc costs.   If you don't believe me... right now you are only a # to most hospitals.  That is it.  Hospital employs or are hiring more people who DONT SEE PATIENTS than people who do.  More number crunchers, paper pushers, HR personnel, etc.  Then Doctors, nurses, and even receptionists.  

If you want to get into CEO's HUGE bonus.  Well they get them because of negotiations.... with hospitals for pricings or like said negotiations with pharma to a certain extent.  Those CEO's and their teams will get the data and find out Mayo Clinic does 100K knee surgeries a year for an age group and charge X amount in 2023.  So in 2024 Mayo wanted to increase by 20%... the CEO's negotiate that increase (possibly a decrease).  Lets say it is only a 10% increase.  Now that insurance company raises the premium (by law they can) with in that age group accordingly for that increase.  Now the next year they do only 95K knee surgeries with Mayo.... A portion of that 5K less unused premium increase gets kicked back to insureds (VIA ACA regulations)..... and a portion of that gets a BONUS to the CEO.  That CEO does many of these negotiations with other hospitals.  That is how they get HUGE BONUSES.    Simple example with those knee surgeries... lets say they negotiated that Mayo could only raise it $2K instead of $3K... that is $1K savings... that is $100M savings for the insurance company if they do the full 100K surgeries.  With my example.

 Nevertheless.... it is a fucked up system.   A national system wont work.  We as a nation are too lazy, too unhealthy, and too self centered and greedy.   The system set up now isn't working because.... we as a nation are too lazy, unhealthy, self centered, and greedy.... yeah.

The US Government made hospitals PROFIT from Covid.

Yes they did.  They reimbursed hospitals for covid related things.  Why do you think so many "deaths" had "covid" attached to it.  NOT SAYING people didn't die from covid.  But many deaths were marked "DIED WITH COVID"... which gave hospitals extra funding from the Government.

They even came out and admitted to doing this.  The whole marking deaths WITH COVID and not FROM COVID.  So that death numbers were falsely reported.  

I am not saying COVID wasn't real or anything like that.  But our Government lied to us, didn't completely tell the truth on many things, could have handled it way better, etc.   Were they in the situation of Damned if you do/damned if you dont... YES.  Hindsight is always 20/20....but they did hold on way too long.

So you'd rather keep a private system that puts profits over patient health. Insurance companies' goal is a 15% ROE and paying huge bonuses to the CEO and other senior management.  How do you think they achieve that? By denying claims that's how. Also see what private equity/for-profit has done with hospitals and medical providers. Read up on the recent collapse of the Steward Health Care system and its corrupt, greedy leader Dr Ralph de la Torre.  

I am not saying that insurance companies don't deny claims... it does happen but most of the time it is because the person didn't buy the correct coverage, bought a cheap policy, didn't buy enough coverage. had shitty limits, didn't have the add ons, etc.   There is always more to the story that is never told.  But the outright straight DENIAL of a claim is few and far between and isn't as frequently as people and media want you to think it is.   It is more limits are met and coverage you paid for runs out.... Which again comes back into the costs of Pharma, Hospitals, etc.     I mean if your premium and coverage is for $200K in coverage for something and then it costs $500K.... you think out of the goodness of the companies heart they should just pay that extra $300K?  The contract and premium you paid was for $200K coverage.   Or to cover certain things and exclude certain things.

 
You don't think Pharma and Hospitals know it is better for business to keep you medicated than cured.  Then that works hand in hand with insurance to a certain extent....ie: they need insurance to pay for it or they will DIE... so don't cure them.  

 
Where the "profits" come in is negotiations.  Promoting healthy living.... paying for gym memberships... etc.   If a $300 gym membership for 10 years helps someone from not having to take cholesterol drugs for 5 extra years that costs $1200 a year.... IT IS A WIN.

 
If you want to know Insurance companies are rated A, B, C and D with + or ++ by the letter grade.  To get a C rating is every Dollar in a Dollar goes out.  So every dollar of premium comes in a dollar is spent in claims, expenses, investments, re-insurance (insurance for insurance companies), etc.   Now the higher the rating scale the better investments and re-insurance rating you have.... and then service gets into the ++ and what not.

 
You also know that those CEO's get bonus for INVESTMENTS as well.  You never hear "Why" they got bonus... just that they got the bonus.  People assume how they got it.

 
I have worked in the Insurance industry (more personal/commercial property than health).   I know the good, bad, and ugly of it all.  I will call out the bull shit.  I will call out how it gets blamed for shit that it shouldn't.  Even though I mainly focused on PC side of it i kept a pulse on all of it.  I would go to conferences, talk to industry leaders, talk to company leaders, even P/C companies know about the health side of things, etc.   They know the bullshit of it all.  The cycle of good and evil of the insurance industry.

 
The sad part is people want EVERYTHING... for the CHEAPEST (cake and eat it too)  which like I mentioned.... greed of the consumer.  Then you have the company..... which wants to provide a good product but have great profit.... Cake and eat it too....aka greed of company.

I'd be surprised if it wasn't a bigger problem. The hospital where I get care ALWAYS gets pre-approval from a person's insurance carrier before going forward. In my case, my insurer is just about the biggest there is.
My hospital duly got pre-approval for a procedure for me more than a year ago. When they put through the claim it was denied. Appealed. Denied.
Fortunately, they did not charge me. But it was disgraceful they were not paid.

From AI Overview:
"In 2023, approximately 216 million people in the US had private health insurance coverage. This includes individuals covered by:  
Employment-based insurance (180 million individuals, 54.7% of the US population): This is the most prevalent type of private health insurance.
Direct-purchase coverage (46 million individuals, 13.9% of the US population): This includes plans purchased directly from an insurer, both on and outside of the health insurance exchanges.  
This means that 65.4% of the population had private health insurance in 2023, according to the US Census Bureau. This compares to 36.3% of the population who had public coverage. Note that these categories are not mutually exclusive, as some people may have both private and public coverage.  
The number of people with private health insurance has been increasing, with an average annual growth rate of 0.8% from 2020 to 2025, according to IBISWorld. This growth is attributed to factors like declining unemployment, broader access to jobs, and population growth."

So let me get this straight....

 
The hospital sent in a "pre-approval" to the company for the procedure.  Got the go ahead.  But when it came time to pay for it they denied it?

 
If that is the case and the paper trail is there.  LAWSUIT..... and easily won by you and hospital.   Now before you think MILLIONS.  You were not put out.  You didn't have to pay and still got the procedure.  So you, yourself might not get paid.  But the hospital would get paid for the procedure.... like promised with the pre-approval.

 
Now this is pure speculation.... here me out....  did the hospital possibly FUCK UP on paper work and not admit to you?  Hence why they are eating the cost.   Which can and does happen.   Insurance contracts only are good for one year and then renew.   What I mean is this.... since it was over a year prior... did they possibly miss a time table to get the procedure done?  Or were they suppose to resubmit the preapproval to the insurance company for the "new" contract year.  What I mean is yes they got the preapproval from last year but missed that it needed to be done in that year type thing.  So did they need to resubmit for approval again?  They when they sent the claim it got denied because it wasn't "pre-approved".  It got denied for a stupid technicality.   Again pure speculation.

 
Remember your insurance is a YEARLY contract and resets every year.   Like I said.... pure speculation.  Also like I mentioned... the evil and bullshit of insurance.  It is how they can get out of things, change things, etc.  BUT the yearly rest can also help things as well... especially when you reach limits.  Then those limits reset.

analysis from the right-leaning guys here, Trump's using a version of hooker math on the numbers he is touting.  Prices can go up by 500% or 1000%, but they can't go down more than 100%, because at that point, you reach zero.  So, claiming they will go DOWN 1000% is at least negligently misleading to the public.  He was reading a speech written by a staffer, so there is no way to know if Trump saw this ahead of reading it out loud for the news media.  

 
Trump may be good at construction math, but he's not good as pharmaceutical math.  Lol

If the hospital sued or simply appealed again and finally got paid, I have no idea. All I know is I wasn't billed and I didn't follow up.

Just a few comments for now ...

I think it kept the CA patent protection the same as it was (up to an extra 8 years) and Mexico agreed to INCREASE their patent protection up to 8 years. The idea was to PREVENT the CA and Mexican generics companies from entering the market sooner and harming the bottom line of the Big US Pharmas.The approvals of the ORIGINAL diabetes drugs took almost 20 years. Quite a few diabetes drugs proved to be very dangerous and were ordered to be taken off the market AFTER they were approved.  
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After many man-years of people taking the drugs, the FDA knew a lot about side effects (weight loss!) and approvals for prescribing for weight loss only took from 4 (for the first ones) down to just one year. (And I think that one or more are now OTC for weight loss.)I repeat myself but IT DEPENDS. It depends on the drug, the conditions being treated, the requirements of the previous (original) clinical trials (no diabetics; no women of childbearing age; BMI between 22 and 27 only; age 22 - 27; ...), and now they want to be able to prescribe to EVERYONE for some other condition? There is too much that can go wrong. Measure twice, cut once.
  1. The Health CARE System needs to be improved but all the effort goes into Health INSURANCE Reform.  
2. What do you mean by "experimental"? Drugs that are not yet approved but are going thru clinical trials?
3. Most other developed countries set a BUDGET first, and then allocate that budget according to various considerations. The US passes laws that MANDATE certain kinds of care -- "Everyone has a right to a double lung transplant" -- and THEN tries to figure out how to budget for it.
4. "Under a national healthcare ... "experimental" type drugs": What are you talking about? There are rules and regs for Compassionate Use and other sorts of use of experimental drugs. It is NOT automatic. Drug companies are not allowed to charge for Compassionate Use. Drug companies may not cut off compassionate use and must continue to provide the patient with the drug even if the drug was not approved for general use. ("Drug failed in 398 patients. Worked in two patients, both continue to receive the drug under Compassionate Use.")  
5. And more Qs.I have posted several times on Health Care - Health Insurance costs, e.g., about AOC and single payer. She was asked "How will we pay for it?" and her reply, without explanation, was "We just pay for it!" I explained it several times, most recently here:  
http://www.theeroticreview.com/discussion-boards/politics-and-religion-39/re-we-have-the-worst-of-both-worlds-468575
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Simplified, our health care system takes in ~$5 T in payments: Medicare, Medicaid, Insurance Premiums, Co-pays, out of pocket expenses, We will continue to pay in ~$5 T by the usual means or minor variations thereof. Around $4 T goes to the delivery of actual health care (which includes hospital support staff: receptionists, janitors, etc. AND doctors, nurses, etc.) . $1 T is skimmed off the top to pay insurance companies, their C-Suite, their investors, etc.. GET RID of the middlemen and insurance companies and you will get $5 T of health care from $5 T paid in or you can lower premiums or expand services. Right. Health INSURANCE (paperwork) costs, not Health CARE costs.   A national system CAN work. And private insurers can continue to offer SUPPLEMENTAL coverages.  

-- Modified on 7/30/2025 12:12:37 PM

The down side you ascribe to a single-payer system like true Medicare is completely incorrect. Patients have choices and, where there are adequate medical resources in your area, acceptable wait times for specialists, procedures, and testing.  Of course with a single-payer system like Medicare Advantage, sadly, you are correct. Medicare Advantage is not Medicare and there's no advantage to it unless you are healthy and don't need medical care. Medicare Advantage plans are administered by private insurance companies and are subject to all the negatives that come with a for-profit insurance company. Unfortunately, the insurance companies' profit motive always comes first vs the need to provide payment for their policyholders' medical care. You can thank George W. and a Republican Congress for the scam that is Medicare Advantage.

Was my speculation correct or just the original clarification?

I can't say if your speculation was correct because I simply don't know and haven't bothered to ask. The bill simply went away.

With everyones response....

 
We do have worse of both worlds because of Gov regulations.  But we do need regulations.  But with that we get OVER regulation... if that makes sense.   Just like with everything.  Government tries to regulate for EVERY SINGLE SENERIO possible, but they can't.   Which fucks up other things in the process or makes things more difficult that it should be.  It is what causes the more red tape, more paper work, etc.  It is the whole double edge sword type thing.  The damned if you do, damned if you dont.

 
Now with nickys stats.... the issue (like stated) many of the people in private also have gov plans too.  Which throws a monkey wrench in it all.  It also makes the system fall apart and helps with fraud/double payments to happen.

 
If you don't think FRAUD.... look into MN right now.  Adult day care, Autistic Centers, Feed our Family, Housing Assistance, etc.... all funded by Medicaid/Medicare and even some private insurance... all FRAUD happening.  Estimated when all said and done about $3B could be found in fraud.    

 
Now Jazz.... the single payer.  There are wait times and having to travel distances.  Look at Canada.  People up there either love the system or hate it.  If you talk to people.  The main people who love it typically live in bigger cities because they are close to care facilities.  The ones who hate it are rural because they have to travel.   There are wait times.

 
The other issue with single payer is this..... PEOPLE.  Especially USA attitudes and behavior and lifestyles....What I mean is people want things and want them done NOW.  Think about it.  Look how people bitch now about wait times.  With a single payer those times will actually increase.  It is a proven fact.  By how much... who know.  But they will.   If you don't think so.  Look at the VA.  Since Trump changed that the VA can now go to other hospitals it has decreased waiting time.  Yes, that is even with the cuts they have made to personnel.   It is all there.  

 
I am not 100% knocking a single payer.  But our government would fuck it up.  Smaller countries in size and population single payer is a way to go 100%.   Bigger countries in population and size you can't.  Logistics alone is a nightmare.  With advancement in AI could help with some of that with the "paperwork" type logistics.  But the movement of people and shuffling appointments, seeing people, specialists needed across the country, supplies, machines, costs on government, etc.  Pure nightmare.

 
We all can agree things need to be done.  We all can agree out government has fucked it up and so has the private sector with lobbying and greed.  Now is the how can we right the ship or start to right the ship FOR THE PEOPLE.

 
I honestly think a revamping of the system we have could possibly work.  But the idiots in DC would rather squabble that do anything to help the citizens.  One side doesn't understand that cuts actually need to be made.  The other side doesn't understand that you can't just cut everything and kill all government programs.   Then there are very few that understand what needs to be done but they are being silenced by loud mouths.  

 
A good start was Doge find those "dead" SSN what I mean is that those numbers were not getting direct checks like MAGA idiots were thinking.  Those "dead" numbers were being used to gain access to funding.  What I mean is this...  Example... In MN the Adult Day Care program would get one of these "dead" numbers and use it as a "body".  They would report that SSN and person as someone who they would represent that would be using that Adult Day care and apply for funding.   So you sprinkle in 100 of these in with 400 actual "Live" people.  You have 500 people you are getting funding for.  But you can pocket 100 of that funding.  See what was happening.    

 
Now you might ask... what does this have to do with Health Insurance exactly.... this keeps money in the coffers to help fund what they got so less cuts are needed.   Same goes for them going thru the VA and cutting red tape, cutting the overhead of employees, etc.  All helps keep money in the system to actually go toward healthcare.  It is a small step in the right direction.

 
Then this is where Congress needs to step in and PUT ON BIG BOY PANTS AND GROW A PAIR..... they need to address the real issue.  Why does it cost so much to do healthcare?  Why do drugs costs so much?  Why do procedures costs so much?  Why does crutches at a hospital costs so much?  Why do wheelchairs costs $6K?..... get my point.  This is all the lobby industry and them saying NO FUCK YOU... to the money.  They will need to stop the monopoly that is happening with in PHARMA.... I think it is like what 3 or 4 major drug companies in the USA that control everything or something like that.  

 
I know I went on about 4 different tangents and opened up a whole different can of worms.   But honestly... would term limits possibly help on this or hurt this?  Would it kill Pharma lobbying or just open the door to new people they would bribe?   Sorry for the 5th tangent.

Trump's staffers cringe whenever he decides to go off script to "wing it". I'm sure Chief of Staff Susie Wiles pulls her hair out whenever it happens.

I should have been a little more clear when I meant with "experimental".

 
It is stuff that is approved.  I should have said "radical".   Or like a treatment that is "last resort" not typically done, Etc.

 
You talk about budget and  my  wording of "experimental"....

 
how do you "budget" or draw the line at things?   That is the issue and what happens in a national system or single payer.... and same goes for private insurance (unless paid for via premium and plan choice).   The difference is private insurance YOU CAN PAY for the coverage if you choose to.  LIke buy the supplement, pay for the extra coverage, higher limits, etc.   Single payer you can't.  You are stuck with what they tell you or set for you..... or what they budget for you.

 
What will happen and what does happen in a single payer.  Is they have a "check list" type or a game plan/budget they follow.  You get diagnosed with something.  You have step 1, 2, 3 for treatment or surgery... then if those don't work... well they will make you comfortable.    They can't BUDGET for every person in the country or the "what ifs".  The "radical" treatment or "last resort" wont be an option unless you want to pay out of pocket or go into a "study".... if they even give you that option.   With private if your plan or coverage allows it, you can keep going.  Some insurance companies do work with trials with PHARMA and get you in on them for "radical" treatments..... so do hospitals and they work with your insurance as well.  The reason why is because you already paid for it or they have "budgeted" for it with the paid in premiums or co-ops with Pharma... (that CEO's negotiate and get bonuses for if those drugs hit it big)

 
Now your mentioning of the combination of the single payer and private offering supplemental could work.  But the issue would be.... how do you divvy it up?  What is considered "basic"?   You brought double lung transplant... is that basic?  Are some elective surgeries "basic" or will be voted into becoming "basic"?  You know boob jobs, Lasik eye surgery, trans surgeries, etc....(think of political climate right now).  Will now every citizen be required to get a physical?  

 
I agree a combo would work.  A revamping of what we got could work.  The real issue is you can never cover for all situations and Congress would try to cover for every situation possible just to get votes.

 
In another response on this thread.  I mention single payers are great for smaller population countries and smaller in size geographical countries as well.  Where people are in close proximity to hospitals and what not.   Highly population density areas it would work.  Low population density is doesn't as well.  So people would lose care and resources.... is that fair if they get taxed the same?  Should they get penalized?

Trump has a proven track record of being TERRIBLE at construction math. BY HIS OWN ADMISSION, he overpays for real estate. (He admitted overpaying for the Park Plaza, Eastern Shuttle [that he "reconstructed" and never had a profitable month], and the DC Post Office Hotel lease ... that other hotel professionals said could never be profitable at that valuation AND THEY WERE RIGHT! Trump made possibly illegal transfers of money from Trump Org to the Post Office Hotel in order to HIDE the fact that the Post Office Hotel lost $70 M in the first three years of operation.)
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Then, Trump overspends on renovations and "improvements" (that are not improvements but add expense and decrease revenue and lower the value of the property). He has defaulted on numerous real estate loans (with more coming due very soon).  
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His employees and advisors (professional construction engineers) describe Trump as being unlearned and unteachable regarding his construction projects. He spends most of his time making important decisions about the color schemes for the furniture.
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He originally wanted to build a 2000 mile long Big, Beautiful border wall out of reinforced concrete or brick -- he kept changing the story.  

Trump is a construction moron.

-- Modified on 7/31/2025 5:48:06 AM

I just got an explanation of benefits, again denying the hospital's claim for an amount nicely into the six figures. We are talking about services performed almost two years ago that, as I said, were pre-approved. The explanation is simply that "The information that was previously received is not complete." I have heard nothing from the hospital and we'll see what happens.

-- Modified on 7/31/2025 4:27:36 PM

Same thing happened to me (and others that I know of).  
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It took me almost two years to get the first pre-approval letter. It was a MEDICAL procedure for a MEDICAL condition. It was not cosmetic procedure. It was not a luxury procedure. it was a proven method to improve something that often happens with aging that would greatly improve my QoL. It was even on the list of covered procedures with pre-approval. I went for the procedure and had a couple of routine follow up appointments but it needed some tweaking to get the maximum benefit ... but we are now one year later and I needed another approval letter. I asked the doctors' for their letters to submit to my insurance company, one of the MAJOR and most highly rated in my area, to get the pre-approval. The docs then told me that they weren't paid for the previous treatment and I was flabbergasted (that is not a medical condition). I fought with the insurer for months to honor the pre-approval and get the docs paid and it went nowhere. I don't remember the exact wording in the letters of appeal denial but it was something like: "Screw you. Screw them. Too bad. Eat shit and die." In the meantime, I called every other major practice that does this procedure and they all said, "Sorry. That insurance only pays us for basic services 1, 2, and 3. They NEVER pay us for anything else. Even WITH a pre-approval letter, we don't get paid for anything but 1, 2, and 3."  
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(I've posted about knowing a multi-generation household where everyone has a different insurance plan. One person there probably averages 10 hours per week to try to straighten out mistakes and get providers (MEDICAL providers) paid. Even making appointments for routine care is frustrating. One person's doctor does not accept the insurance being used by a different person in the household. They have to search insurance company databases to "locate a doctor" ... and the lists are full of doctors who no longer (sometimes NEVER DID) accept that insurance. It is bonkers (not a medical condition).

So it actually sounds a paperwork type thing.  Was that on the hospital's end?  Possibly.

 
Kind of like what I explained in the speculation.  When things are in the six figures.... hospitals just don't "drop" it or let the patient walk away without paying.  Unless they are the ones who fucked up.... if you get my drift.   But they will battle with the insurance company for a while.

 
But again, it is pure speculation.

 
Just like I mentioned about the yearly contract and stipulations.  The pre-approval is all good.  But could have been a time frame when it needed to be completed.

 
Here is an example on most homeowners' policies (depending on state you live in) you have 24 months to fix a claim.  So here is the example.  You get hail damage on a roof.  Adjuster comes out and meets with the contractor and they come up with $10K in damage.  Most companies will cut a check for about 75-80% to get the process started and the balance once the job is finished type thing.   So they cut the homeowner a check for $8K.   The contractor says he will get to the job when he can.... he takes 27 months to get the job completed.  Guess what.... the homeowner isn't going to get that extra $2K.  Even though it was "pre-approved".... it was needed to be done with in a time frame.

 
Again.... just giving an example of what could have possibly happened.  It is pure speculation.  With medical all that could have been needed was possibly a resubmission which the hospital dropped the ball on.  Which is why they ate the cost.   But again, pure speculation.  It is why hospitals have huge legal departments.... not only for the doctor malpractice stuff.   It is also why they have HUGE Errors and Emission Insurance policies to pay for fuck ups.... if this was indeed the case.    Because your insurance company could have in the notes they told the hospital to just resubmit the "pre-approval" by a certain date and they would approve it again.... but the hospital missed that date.  So the E&O insurance is on the hook and will pay for it.   Anyways that is another tangent/explanation of what could possibly have happened.

I spoke to one of the schedulers and the pre-approval is always obtained before the procedure is done. I think this is just game-playing by the insurer to delay paying the hospital for as long as possible.

Canadians, in general, are more satisfied with their health care insurance than Americans. They pay half of the premiums that we pay in the US and everyone is covered.  True the care in rural Canada may be lacking as it is in rural America. There are longer waits for elective surgery and to see a specialist in Canada, but that's a result of lower premiums. Canada ranks highly in international comparisons of healthcare systems. Canada also has much better life expectancy than the US. The Canadian system is superior to the US.

This has been a huge issue especially since the ACA was passed.

 
Many insurance companies changed or were forced to change how they did business or coverages they provided.  What I mean is I am a man... my plan had to cover PREGNANCY... yes.  It had to cover pregnancy if I would happen to knock up a woman.  My plan would cover some of the care..... not all of it.  BUT some of it.  This is for private plans.   So what that did was make them take away coverages in other places.  Like mentioned they only cover 1,2,3 not 4,5.   So you were "pre-approved" for 1,2,3... but not 4,5.  They told you half truths.... which is bullshit.

 
Now..... I am not sticking up for the insurance.  But you did say your procedure needed "tweaking".... so you got 1,2,3... but the 4,5 was the tweaking I assume.  So the basic was paid for... the tweaking wasn't.   Again not sticking up for the insurance at all.  But showing you how it is FUCKED.   They are right and wrong at the same time.  They did follow thru with the 1,2,3 of the pre-approval... but the "tweaking" of the 4,5 that might not have been know wasn't approved.   That is the shitty part with medical insurance.  Things happen and need to be tweaked... then need to be paid for.   Which medical companies for some reason have an "out" for not paying.  Unless you pay for the coverage.  Again... not sticking up for the insurance companies at all.  This is where it is all FUCKED.   But people want to blame them.... but they did fulfill their part.... they did the pre-approval of the 1,2,3.... then when things needed to be "tweaked" with the 4,5 that was possibly unseen and couldn't have been known about.  Even though is normal.  But wasn't in the "pre-approval".   It gives them an "out" not to pay that portion.   It is dirty and low.... but "technically" not wrong.  It is bullshit....but it isn't wrong.

 
Kind of a side tangent or possibly something legislation could do... Insurance like home and auto they have "supplements" that came be added to a claim.   this is when extra "damage" is found while working on a car, home, etc.   The only issue is that with the human body is you can't "total" it.   Or how do you put a "limit"..... then the "million dollar" question.... how does the coverage get paid for?   But this is where things could or can possible be looked at.  Maybe it has.  I don't know.  

 
Then what BIG companies or MAJOR companies did was FORCE customers to use only certain hospitals otherwise out of pocket expenses increased or they wouldn't cover things at all.   So like you are talking about is you need to search certain hospitals to see if they would even take your insurance.  Blue Cross is a major one who did this.  They used to be accepted any hospital.... but then now only major medical ones now.  I actually LOST MY DOCTOR.  Remember that promise where you wouldn't.   BTW... this goes into the whole CEO bonuses as well... they got them because negotiate better deals with those big hospitals than the small ones.

It could be that as well.

It could be 1000 other things.   It could be the people handling the claim on the insurance companies end fucked up on paperwork.   It could be a form is floating out there somewhere.  It could be someone waiting on an invoice for one damn pill because it "wasn't" on the approved list.   It could be literally anything.... because we don't know all the paperwork.

 
I was just showing a scenario of how things can happen.   I was also pointing out that Hospitals typically don't "eat" bills unless they might be a little bit at fault.  Even when they are battling the insurance company.  They will let the E&O insurance fight it out and try to either recoup it or "sweep" it under the rug and blame "insurance".  It saves face for the hospital.   It is a great PR move.   Hell, it is what I would do.

 
Hospitals have numerous boogeymen to blame.... Insurance, Pharma, Government, etc.... "We are here to just save lives".... pay us whatever we charge without asking questions.

I don't believe that's how Errors and Omissions ( AKA professional liability ) insurance works. I think a more likely scenario is that the medical insurer is trying to 1) delay making a claim payment for as long as they can to help their bottom line, or 2) decided whoever preapproved the procedure made a "mistake" and is trying to keep from paying until they are sued. These are some of the many ills with "for-profit" medical insurance.  

No that is exactly how E&O insurance works.   If someone made a mistake, be it paperwork, lied, etc.  IT PAYS for that mistake.   Because it finds the company (hospital) liable for that mistake, error, or omission.   I worked in the insurance industry for YEARS.  I have been a part of E&O Claims, sold E&O insurance, sat in on E&O trials, and E&O boards.  It is why E&O insurance is expensive depending on the industry.  

 
You are correct.... it could be someone inside the insurance company that fucked and "pre-approved" something that shouldn't have been.  Which then they are on the hook to pay..... and they are delaying it.     Them just "delaying" the claim for bottom line... not for this long.  Also the hospital would still have a "bill" hanging over or out on inicky....with balance due.   It wouldn't be a "clean slate".   Even if they know they will win.... it would still show something.   Which if there is Nicky didn't say that.

 
Like I stated it could be 1000 different things.

I got a bill from the hospital over a year ago but they ultimately dropped it. It was far above my out-of-pocket maximum so there's no way I would have been responsible for it. I haven't heard from the hospital since then. I just received the Statement of Benefits regarding the procedure yesterday from the insurer, which is how I learned it is an ongoing situation.

Correct.... that is my point.  Hospitals don't just "drop" bills.  The hospital would still be sending you bills even when they fight with insurance or when insurance is paying.   They never just "drop" things..... unless they FUCK UP.

 
You got a statement of benefits from the insurance company..... so that show the hospital is still trying to go after them.  Which could be the E&O insurance company trying to get a small piece or all of it.   It could be in subrogation with the E&O insurance of the hospital.   It could be in some subrogation situation with the hospital via lawsuit.  Could be 100 other things.

END OF MESSAGE

have you actually talked with Canadians?   i have....

 
Like I said it is about 50/50.   I know many that come to the US for many procedures and pay out of pocket with CASH.  Especially when wait times are long.    The premiums are not "lower".  You are ignoring what they pay in for taxes that goes towards medical.   Also wait time and lack of "specialists" compared to US.   The system isn't SUPERIOR to the US system for the actual care you get.   Why do people fly to USA to get healthcare?   I am not saying it is bad at all.  But it isn't SUPERIOR.   You have wait times, you don't have lots of specialists, you don't have access like in USA (you might have to travel long distances ie: cross country/providences to get treatment), etc.   They do have lower costs in general, gov over head costs are about $2100 per person and in US it is $2700 per person.  

 
Now you bring up life expectancy.   THAT IS A HUGE ISSUE ON WHY SINGLE PAYER WONT WORK IN USA.   US Citizens are unhealthy as fuck.  Plain and simple.  FACTS that people don't want to admit.   I have been trying to allude to it with the whole impatient citizens are among other things.

 
Side note and which is good/bad for Canada is the fact that 70% of the doctors in Canada are GP and not specialists.  Which like mentioned is why long waits and people come to US but is also good because can help more people for "cheaper" type thing.   But many doctors leave Canada to pursue more $$$ in the US....just like others from around the globe.   They come to US to become specialists..... and make more $$$.   WHich again... is why our healthcare COSTS SO MUCH and is fucked.   It costs more to pay a "specialist" than a GP.

any McDonald's on an Interstate or take a cruise. It's mostly morbidly obese people waddling around, needing walkers or scooters, canes, crutches, etc. And stuffing themselves with sodium-laced burgers or giant portions of starchy food. They deserve what is happening to them. We don't deserve to pay for it but we have no choice.

I have spoken to Canadians and have read about the their healthcare system. Canadians may have complaints about their healthcare until they hear about the U.S. system.  Healthcare spending per capita in the U.S. is double what Canada spends. The Canadian healthcare system consistently ranks much higher than does the American system in impartial studies done. They wait longer up North for elective surgery and to see a specialist so theirs is not a perfect system. The fact that many Americans are unhealthy ( because of obesity, sedentary lifestyle, tobacco and alcohol, stress, don't have medical insurance, paucity of primary care physicians, etc ) is an argument for, not against, a single-payer system like Medicare for all citizens (and more primary care physicians).

“Lesnar backtracked slightly on his comments, clarifying that he wasn’t ‘bashing the Canadian healthcare at all,’ and that the issues were due to being in the ‘wrong facility’ and having broken equipment (the CT scan machine).”

The Canadian hospital told him the CT scan would be fixed the next day, but it remained broken after eight hours.  Lesnar‘s wife drove him to Bismarck, North Dakota, where the CT scan machine diagnosed him with diverticulitis.  

 
This occurred in 2009. From Ai overview: “Lesnar’s comments might have been influenced by American partisan politics and his opposition to healthcare reform in the United States. Lesnar admitted that his comments had a political motivation related to the healthcare reform debate in the U.S.”

 
See, willy, a computer is cold and unfeeling.  It doesn’t add heated rhetoric as humans do.  As Sgt. Joe Friday said: “Just the facts, ma’am.”

Willy (the troll), Medically assisted suicide is an end of life option available in several progressive countries and U.S. states for terminal patients who are suffering with zero chance of recovery. There are 20,000 medical malpractice lawsuits filed in the U.S. every year. Those patients (or their families) were dissatisfied enough with their health care outcome to sue their medical provider. 20,000 lawsuits every year. Year after year. In the U.S.

Another outrageous allegation by Willy the troll. Willy loves to troll and make up stories like this. It makes him feel like a provocateur, I guess. It certainly doesn't make him look intelligent as he likes to portray himself.  No, most depressed patients in Canada, or anywhere in the world, are able to commit suicide on their own. Any what about the 20,000 medical malpractice lawsuits filed in the U.S. every year? Willy conveniently ignores facts that disprove his fantasies. Mk

I was too vague. I'll have to give an example that happened to a younger colleague with a non-agve issue. His insurance covered podiatry:
Covered:
1 - one "routine" visit per year (check the tires, change the oil and filter; trim and polish)
2 - fungal infections covered
3 - three bunion treatments per year  
Covered with pre-approval:
4 - wart removal
5 - ingrown toenail surgery ----------------- his issue. COVERED WITH PRE-APPROVAL
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He had surgery to trim away and suture up an ingrown toenail. THEN, the insurance didn't pay (but he didn't know that yet). He went back with a sore toe and the diagnosis was that they need to trim away some more toenail and that should solve the problem. "OK, give me a letter and I'll get it pre-approved." They didn't pay us the last time. "WHAT?? I'll tell them to pay you!" ... ... ... As far as I know, the insurance never paid. I don't know what happened to his toe.
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MY situation was similar but different. I had a pre-approved procedure that worked / improved things, maybe 30%. "NOW, with a tweak, we can get that up to 80% or better." Give me a letter and I'll request the pre-approval! "They didn't pay us last year." WHAT??? I'll tell them to pay! "They PRE-APPROVE services but then they don't pay us. They don't pay anybody!"  
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I hope that's more clear what people WITH REAL PRIVATE INSURANCE have to go through.