Most people a few decades ago couldn't afford personal computers (and didn't see a need for them), but now many people carry them in their pockets in their smartphones. Often technology initially is only used by early adopters who see a need for things the general public doesn't yet think worth using (often with bugs that need to be worked out or features added before most people would go for them), just as even most people who can afford it still only get monofocal lenses with cataract surgery. Over time prices fall and the technology becomes more widespread, even if not as fast as some people wish.
re: "In the past 40 years medical science has made tremendous advancements in the field of cataract surgery. "
Most of those advancements are unrelated to the lens implant and *are* covered by government and insurance plans. A few decades ago cataract surgery involved hospital stays, with either no lens implant and the need for high powered "cataract glasses", or lens implants where there was a good chance the lens power would be off and people would need glasses even for distance.
Now micro-surgery that doesn't require stitches makes cataract surgery an outpatient treatment. Now they can predict lens power more accurately using modern scanners to measure the eye and most people without other vision issues won't need glasses for distance (or near if they prefer to wear glasses for distance).
Even the monofocal lenses that most patients get that are covered are greatly improved over the past. They are now tiny foldable lenses able to be inserted through small incisions, with aspheric optics and features that limit the risk of complications that most people used to get like PCO but which only a small minority get today.
The major advance that isn't covered is premium lenses that provide better near vision. Seniors (and middle aged people) who haven't had cataract issues cope with losing the ability to see near through using glasses or contacts, just as most of the younger population requires glasses or contacts to see well for certain tasks.
Insurers and the government don't pay for laser correction of vision for younger people, since it is considered elective surgery since they can instead cope using other methods of vision correction. They feel limited medical funding is better spent on required treatment rather than what they consider a convenience luxury treatment at the moment. Although laser correction has gotten extremely safe, it still has some risk, and in fact laser surgery can interfere with the later ability to use some types of premium lens implants during cataract surgery.
re: "one-lens-fits all surgery"
The reason for that is surgery with a monofocal lens solves the problem of a lens clouded by a cataract, which is the medical condition being treated. Correction of the ability to see closer in during surgery is viewed as not necessary since people can use other methods to correct their vision, glasses&contacts. So it is labeled an elective that people can choose to pay extra for if they wish it, just as laser surgery is an elective for younger people.
Even most people who could afford to get a premium lens during cataract surgery don't choose to do so, just as most younger people who could afford laser correction still don't choose to do so. Just as there are potential risks for laser correction, there are some risks and tradeoffs with premium lenses, no lens is perfect yet.
re: "which operation that a senior gets is important to the life and safety of seniors and everyone else on the roads"
Up until a year or two ago in the US, the safest lens for driving was unquestionably the monofocal lens that is covered since it provides the highest quality of vision at distance and the lowest risk of halo&glare artifacts at night that can interfere with driving. With some premium lenses there is a reduction in vision in low light compared to a monofocal lens (which can be a safety issue). There may be some argument that newer lenses might be safer overall, but there isn't yet enough data to convince government&insurers of that. (and its a statistical issue, they may be better for some.. but not as good for others). Some of the newer lenses may not work as well with people who develop other eye problems, which adds to the risk of everyone getting them.
It is true that premium lenses can help drivers see the dashboard more clearly in addition to distance but it hasn't been clear that is enough to consider it a provable safety improvement (monovision with monofocals can help with seeing the dashboard, but with the risk of reducing sterovision and reliance more on one eye for distance).
The FDA study for approval of a low add Tecnis multifocal IOL (intraocular lens) does show fewer patients reporting difficulty with night driving than with a monofocal, presumably due to the issue of seeing the dashboard better (and difficulty seeing the dashboard can lead to attention taken away from the road). However that was a subjective assessment, I don't know that there is enough data for government&insurers to agree there is a strong enough case for a demonstrated safety benefit for premium lenses. Even if there is in reality such a safety benefit, it takes time for studies to be done and for people to critique those studies to be sure they are correct.
There is a reduction in distance vision with some premium IOLs, which impacts driving safety, though it is minor with the newest lenses. One study suggests the Symfony IOL may be slightly better at distance than a good monofocal IOL, though that was a small study I haven't seen confirmed by others, it may be a statistical tie, or that study might be a statistical fluke. Its risk of halo&glare is comparable to monofocals overall, though the risk isn't as low as that of the best monofocals.
I tend to think overall the newer generation of lenses may be safer on balance for driving, but it will require more data to convince the government&insurance world that the benefit outweights the risks enough to cover them. I know because I chose to take that risk to get a premium lens and needed to evaluate the risks. I chose to go for it, but I can understand why its still viewed as an elective procedure.
I'm not a senior, but for some unknown reason had problem cataracts decades earlier than average. So I do know the benefits of premium lenses, a couple of years ago I chose to go outside the US to get a newer premium lens, the Symfony, that wasn't yet approved by the FDA (it is now), since I'd be living with the results for another few decades hopefully. So I also know the lenses aren't perfect, there are tradeoffs, and there are rational reasons they aren't yet covered by government or private insurance.
There may also be a safety improvement potential for premium lenses also regarding the issue of accidental falls which can be harmful for the elderly, but again there isn't data yet to concretely demonstrate that for certain. A premium lens can provide good vision at the distance for where you are placing your feet when walking, including good depth perception. Monofocal lenses may have lower quality vision for that distance. Monofocal lenses used in monovision to get a bit better quality vision at that distance may have reduced depth perception, which increases the risk of a misplaced foot and a fall. Then again, some premium lenses reduce low light vision which could increase the risk of falls in dim light.
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megafauna005
7 years ago
But that doesn't apply to prescription drugs because in many cases their costs have skyrocketed! President Trump said he wants to enable us to buy cheaper drugs from Canada or another cost saving measure.
Jesus NEVER existed! He is Judeo Christian MYTH!
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reality42
7 years ago
Prescription drug prices are high in part because the FDA limits competition, and because they have driven up the cost to develop new drugs and get them approved over the last few decades. e.g. see the work from the Tufts University Center for the study of Drug Development
http://csdd.tufts.edu/index.php
Which says that:
http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014_cost_study
"Developing a new prescription medicine that gains marketing approval, a process often lasting longer than a decade, is estimated to cost $2,558 million, according to a new study by the Tufts Center for the Study of Drug Development."
(though I hadn't checked to see if that is their most recent figure).
The higher costs not only directly lead to new drugs needing to be priced higher to recoup development costs, it leads to to fewer new drugs being developed and less competition to restrain prices.
Unfortunately since the US is wealthier, it has in the past covered more of the cost of new drug development. That benefits other poor countries that get drugs at lower prices, because they wouldn't buy the drugs at higher prices. Unfortunately if US consumers pay lower prices, in the short term that benefits them, but in the long term that insures there will be less money invested in developing new treatments. Thinking short term can sometimes cause problems over the long term.
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therefdotcom
7 years ago
it still leaves them with a 400% (and upwards) profit rate.
so this part is bull:
"Unfortunately since the US is wealthier, it has in the past covered more of the cost of new drug development. That benefits other poor countries that get drugs at lower prices, because they wouldn't buy the drugs at higher prices. Unfortunately if US consumers pay lower prices, in the short term that benefits them, but in the long term that insures there will be less money invested in developing new treatments. Thinking short term can sometimes cause problems over the long term."
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reality42
7 years ago
It isn't clear what you think is "bull" about it. It isn't clear where you get a 400% profit rate. It seems likely you are merely looking at the production cost of a drug and completely ignoring the cost to develop it, or the cost involved in the dead end drugs they invest in that turn out not to work but are part of the experimentation required to find the ones that do work.
R&D isn't free, it costs $billions to create a new drug. Companies only invest in R&D if they think they can recoup their investment. If the potential prices they can charge for a product would be too low, they won't be able to recoup their investment.
Investing in developing a new drug, or a company developing a new drug in addition to its existing products, is a risk. Investors need to be rewarded with see a high enough potential profit to make it worth taking the risk, rather than investing in some venture that isn't as risky. The higher the risk, the more profit they need to see in order to get them to invest. If you reduce the level of profit too much then no one will invest in new drugs.
All businesses compete for investors, and internally companies need to decide whether to invest money in new products (rather than just sticking to existing products, or say buying some other investment with any excess capital, or returning it to investors).
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