Useless Conversation

[Johny Cee]

Okay, serious question here.

1. The medication is expensive primarily because the development of it was somewhere between $600-800M and they want to make that back before it can go generic.

2. It's probable that the pharma company negotiated a price with your insurance company and has some agreement with Walmart.  That's why the price became more affordable.

I get why it's expensive (although that's generally bullshit, since most of the expensive research is built on government funded research. NIH grants are the bread and butter of research. Drug companies pay more for advertising than research).

The NIH does alot of the general science research while alot of the pharma R&D is clinical trials, FDA approval, and figuring out how to manufacture the drug in large quantities.  The NIH does great work, but by and large it doesn't produce drugs ready to go out to consumers.  Just the cost of figuring out how to scale up production to industrial quantities can be huge.

More advertising than R&D?  No.  All marketing costs?  Maybe.  But marketing usually covers everything in the distribution chain, from sales reps/samples to advertising to discount and rebate programs.

And I can see it used wholesale -- it's primary use is for type-2 diabetics. So that's a big ass market, although I'm sure a big chunk of that is or will be on Medicaid/Medicare. (Older boomers, you know).

All I can think of is that maybe the rate my insurance company paid was, say, 400 and the 360 was my quote, and so they really got 40 bucks a month in actual pay. That I got rebated my insanely high copay for this stupid ass drug.

I know that if you jack the price of something up and then slash it back down and mark it as "on sale" or "discount" or otherwise make people think they're getting a deal, they'll want it more than if it wasn't discounted. (In fact, you see places that mark stuff up, discount it back but not all the way, and end up selling more at a higher price because it's got 'sale' on it).

Discounts and rebates often get included in marketing.  As to the why?  Rebating a drug in the early days of its profitable lifespan, to increase the speed of adoption can get it covered under insurance plans, then you stop the rebates once consumers are using the drugs and they are now mostly covered under existing plans.  That would be my guess.

Medical billing is a giant mess though.  Its also fairly common for large plans/Medicare to reimburse below cost on procedures, which causes medical practioners to overcharge in other areas to make up for, rinse and repeat year to year.  This last I experienced directly with physician practice client....   the most egregious was a Medicare underreimbursing below the cost of the per patient equipment lease on a very expensive imaging test.  Counting physician and nurse time, and almost $100 in supplies and dyes, the practice had a significant loss margin on every one of those procedures that year.  The owners response when I queried them was "will make it up somewhere else", as otherwise they would have to stop accepting medicare.  One of the common reasons to read stories about "the bandaids at hospitals cost $50" or whatever....   When the nurse/doctor time is capped at something low they push the costs into other areas.

I wouldn't be surprised if some of these rebates are the result costing shenanigans where the price you would accept is different from the negotiating prices/acceptable prices with various insurers/government programs.

[Yegolev]

The worst part about medical billing and insurance is when you use it for the first time and your wife flips her shit.  Looks like I picked the one wrong option!

[Paelos]

Going to an airport now rates higher for me in annoyance than going to the dentist

[Engels]

Totally. I try to get the sexy stews to look at my back molars but then there's this whole rigmarole with the air marshal and the escorting off the plane and the questioning...total drag.

[KallDrexx]

I wish train travel wasn't so terrible.  I'd tolerate double the trip time to not have to deal with airports and airlines, but when they turn a 2-3 hour flight into a 24 hour train ride for the same price it makes it unfeasible.

[schild]

I think it's weird that Spike TV has a half hour of entertainment I'm willing to watch and it's a spinoff of a skit from the Tonight Show (Lip Sync Battles).

There's isn't much better than watching Common lip-sync Lionel Richie in the full getup.

[pxib]

I wish train travel wasn't so terrible.  I'd tolerate double the trip time to not have to deal with airports and airlines, but when they turn a 2-3 hour flight into a 24 hour train ride for the same price it makes it unfeasible.

Yeah, the only trains I can heartily recommend are the Acela from Boston to D.C (stops in many major cities in between) and the San Joaquin from Bay Area/Sacramento to Bakersfield/LA. And the latter requires bus trips at the south end because there's only one grade-possible pass through the mountains at the end of the central valley... which happens to be the busiest rail freight corridor west of the Mississippi. Amtrak can't compete financially there.

I have never had a good train experience in the middle of the country. Even in Chicago, which prides itself on being the midwestern hub, has a terrible time even staying on schedule.

[KallDrexx]

The best part is how a train from Orlando to Atlanta has to go through Washington DC

[Maven]

A one-way ticket on Amtrak costs the same as a round-trip flight from Los Angeles to Seattle.

[Chimpy]

The reason Amtrak has such problems with ontime performance is that there is no dedicated passenger rail lines (except a couple in the NE corridor) and freight trains have the right of way. Since Chicago is the largest container freight hub in North America and all of those containers get there via rail, getting trains in and out of Union Station is a royal pain.

[Bunk]

Random note: just paid off my credit card balance completely last night for the first time in nine years. Still have some other debts, but that felt really good. Was at $4k at the start of the year.

[IainC]

Wargaming offered me a job at the end of my week here in Kiev. It;s not the job I was fishing for but it's still a nice role on a cool project. I'm going to have to think hard about it when I get the written offer with all the details.

[WayAbvPar]

Random note: just paid off my credit card balance completely last night for the first time in nine years. Still have some other debts, but that felt really good. Was at $4k at the start of the year.

I've got a balance ready for you to start chipping away at. PM me for details.

Wargaming offered me a job at the end of my week here in Kiev. It;s not the job I was fishing for but it's still a nice role on a cool project. I'm going to have to think hard about it when I get the written offer with all the details.

What project?

[IainC]

It's an unannounced one and I signed a 10 page NDA so that's all you're getting. If I take the job, I'll be sure to shill the shit out of it when it is revealed to the world though.

[Paelos]

Well if it's cool as long as you get us some good access we'll play it

[Merusk]

Grats, Ian. Have an escape plan and continue feigning ignorance about bribery attempts.

[Engels]

Interesting that WG has offices in Kiev when if I recall correctly they are Belorussian and had HQs in Moscow. Aren't like, Russia and the Urkraine at war atm?

[Morat20]

Random note: just paid off my credit card balance completely last night for the first time in nine years. Still have some other debts, but that felt really good. Was at $4k at the start of the year.

Congrats. You can bet when I finally wipe away my wife's student loans for her Master's, I will be shouting it in the streets. 6.8 fucking percent.

[Furiously]

It's an unannounced one and I signed a 10 page NDA so that's all you're getting. If I take the job, I'll be sure to shill the shit out of it when it is revealed to the world though.

Ahhh World of Pimps.

[IainC]

Interesting that WG has offices in Kiev when if I recall correctly they are Belorussian and had HQs in Moscow. Aren't like, Russia and the Urkraine at war atm?

They have a lot of offices. Their HQ is in Cyprus but the company is originally from Minsk in Belarus. The Kiev office was originally an outsource studio and it still provides art for almost all WG titles.

[WayAbvPar]

It's an unannounced one and I signed a 10 page NDA so that's all you're getting. If I take the job, I'll be sure to shill the shit out of it when it is revealed to the world though.

I am going to assume it is World of War with a combination of all three war games played out in the European and Pacific theaters. And that they bought the remains of Cornered Rats so they could relaunch it as WWIIOLII.

[Engels]

Interesting that WG has offices in Kiev when if I recall correctly they are Belorussian and had HQs in Moscow. Aren't like, Russia and the Urkraine at war atm?

They have a lot of offices. Their HQ is in Cyprus but the company is originally from Minsk in Belarus. The Kiev office was originally an outsource studio and it still provides art for almost all WG titles.

Cyprus? Must be a tax haven thing.

[HaemishM]

The reason Amtrak has such problems with ontime performance is that there is no dedicated passenger rail lines (except a couple in the NE corridor) and freight trains have the right of way. Since Chicago is the largest container freight hub in North America and all of those containers get there via rail, getting trains in and out of Union Station is a royal pain.

I looked this up a few months back because my wife kept getting delayed trying to get from Wisconsin to Chicago by train, always because the freight trains were blocking up the lines. This is because of a recent (within the last 5 years) Supreme Court decision that basically said business freight is more important than passenger traffic. Thank you, Roberts court.

[Samwise]

Freight has taken priority over passenger trains for much longer than that.  Maybe it was just recently made law of the land, but that's been the practice for as long as I've been taking Amtrak.

The fix of course is to have separate rails so one doesn't block the other, but that would not only require investing in public transportation infrastructure, it would not in any way benefit the almighty automobile, so good luck with that.

[Selby]

The fix of course is to have separate rails so one doesn't block the other, but that would not only require investing in public transportation infrastructure, it would not in any way benefit the almighty automobile, so good luck with that.

Forget the automobile benefits vs not, consider all the NIMBY folks who refuse to sell or give up any land to get an extra set of tracks built.  The Bay Area has been fighting the fight for decades over adding a second rail line or expanding what they have to accommodate more people and it always comes down to the dozens of land owners and activists who refuse to consider letting it happen.

[Abagadro]

I looked this up a few months back because my wife kept getting delayed trying to get from Wisconsin to Chicago by train, always because the freight trains were blocking up the lines. This is because of a recent (within the last 5 years) Supreme Court decision that basically said business freight is more important than passenger traffic. Thank you, Roberts court.

It's actually the opposite.  Reader's Digest version: Law in 2008 gave Amtrak the ability to work with the Federal Railroad Administration to create rules to make sure passenger traffic was given priority to maintain certain level of being on-time.  Freight rail companies sued to block it saying Amtrak was private company so Congress can't do that.  Appeals Court threw out the law on that basis. Supreme Court (9-0) last month remanded back to the Appeals Court saying they were wrong to base it on that distinction since Amtrak is a quasi-governmental entity. Still up in the air on the ultimately outcome.  

[Triax]

The reason Amtrak has such problems with ontime performance is that there is no dedicated passenger rail lines (except a couple in the NE corridor) and freight trains have the right of way. Since Chicago is the largest container freight hub in North America and all of those containers get there via rail, getting trains in and out of Union Station is a royal pain.

I looked this up a few months back because my wife kept getting delayed trying to get from Wisconsin to Chicago by train, always because the freight trains were blocking up the lines. This is because of a recent (within the last 5 years) Supreme Court decision that basically said business freight is more important than passenger traffic. Thank you, Roberts court.

I worked on Amtrak as a waiter during summers back in the late 80's, they've always had those problems.  Back then freight trains still had priority once we were outside a certain window as they owned the tracks.  I worked the #4 route, Southwest Chief for one summer from LA to Chicago, our worst arrival time once was 28 hours late.

From all the things I've seen during those summers, I do not take Amtrak for anything longer than 8 hours...oh, and NEVER drink the water on a train...EVER.      Weird times.

[Abagadro]

EDIT: Never mind (drunken rambling removed).

[HaemishM]

There may be some appeals court or recent stuff that changes what's happening, but as of November or so, my wife was still getting stuck for 8 hours in train stations in Wisconsin trying to get to Chicago because freight took priority. If the Roberts court is reversing the Court's earlier idiocy, good on them.

[Yegolev]

They say a job in the hand is worth two in the bush, but really you need to remember that you'll be in that job for two years at the least.

Sitting here in Watercolor on 30A, I am reminded how terrible 3G is.  Stupid Florida panhandle.  Beaches are the best, though.

[Yegolev]

EDIT: Never mind (drunken rambling removed).

/sadf

I have had between two and twelve Yuengling today.  Also a Stella because the pool bar didn't have Yuengling. Philistines.

[Merusk]

Black and Tans or the standard Lagers? I'm a fan of the B&T, myself.

[Maven]

I just saw this. Amusing, I guess? It's for a five-part documentary. I assume this was just published.

[Lucas]

I had this horrible idea about saying "yes" to cleaning bloatware from the laptop of someone I barely know. Luckily I don't do this for a living (well, yeah, there are definitely worse jobs, ok :P) ; three hours in, while this fuckin' thing is crawling on its knees (wasn't allowed to format) with the finish line definitely not in sight. Fuck people that want teh "shiny" without a fucking clue on how to perform some maintenance and uninstall stuff.

[Teleku]

Ok, so I'm heading to soviet Putinland for 2 years very soon.  I need to upgrade my jacket.  Please start giving me some recommendations on the best coat/jackets to wear during a Russian winter.  Not really for skiing or anything (though I might do some of that).  Primarily just for not freezing to death while walking around.