CBO: Obamacare costs revised downward, again. Finds lower than expected premiums.

[wareyin]

Evidence?

I think it's a tautological sort of evidence. Since US consumers are paying the lion's share of everything, they are also paying the lion's share of R&D. US consumers are also, by this metric, paying the lion's share of profit after R&D.

 

[Wudang]

I think it's a tautological sort of evidence. Since US consumers are paying the lion's share of everything, they are also paying the lion's share of R&D. US consumers are also, by this metric, paying the lion's share of profit after R&D.

Hmm, and the Wellcome Trust, UK Medical Research Council, Bill and Melinda Gates Foundation, various charities etc?

 

[thaiboxerken]

Hmm, and the Wellcome Trust, UK Medical Research Council, Bill and Melinda Gates Foundation, various charities etc?

They get money from consumers as well. See how that works? Almost all money is from consumers, therefore it can be claimed that all R&D is funded by consumers.

Of course, this ignores the fact that major advances in science and technology has been funded by government.

 

[Wudang]

The numbers I can find are either national or else too broad - eg wikipedia seems to just have numbers for "biomedical" research. Other numbers don't distinguish between developing new drugs and re-purposing which may or may not be important. And of course product development may cover such things as "new special back pain targeting " ibuprofen which is just standard ibuprofen with a new box and marketing.

 

[wareyin]

Hmm, and the Wellcome Trust, UK Medical Research Council, Bill and Melinda Gates Foundation, various charities etc?

I don't know what the percentage of income various drug labs get from charities vs from the drug companies themselves.

I don't agree with sunmaster14's apparent stance that the 25-30% profits drug companies reap after R&D is accounted for should be increased by overcharging the rest of the world as they are allowed to overcharge US consumers.

 

[Spock Jenkins]

But not a single thing in that bill addresses actual cost.

This.

I remember a campaign slogan at one time that said, "It's the economy, stupid!" I'm waiting for one on healthcare that finally says, "It's the cost, stupid!"

All this stuff about single payer, and HSA, and HMO, etc. doesn't matter if the costs don't stop escalating so dramatically. We had a new children's hospital built here that had this huge lit up wall of rising bubbles. I mean, a couple stories tall in big fancy lobby. Sure it looked great, but it was a lobby. A lobby that the patient only passes through. It has nothing to do with their actual care, and yet - the room costs all have to absorb that. Even if it was funded by donation, those donations could have been used far more efficiently for more impactful needs. Even the walkway from the parking lot. No run of the mill pedestrian bridge would due. It had to be an all glass architectural decorative thing.

I've spent 6 days in the hospital on more than one occasion for two open heart surgeries as well as a several other stays lasting a couple of days. A clean room, adequate staff, and a comfortable bed were my only concerns. I spent maybe 5 minute total passing through the main lobby.

Someone I know well who was interning at a hospital was making rounds with the hospitalist. The Dr's running joke was, "I can't bill them if I don't see them" and with that - he would randomly check on patients that had no pressing needs and weren't necessarily under his care.

The part of requiring health insurance for all that I do agree with (selfishly) is that it gets more good healthy people who don't make claims paying in to the system to help defray the cost of people like me. But it never seems to work out to any actual consumer savings in the end.

 

[Wudang]

I don't agree with sunmaster14's apparent stance that the 25-30% profits drug companies reap after R&D is accounted for should be increased by overcharging the rest of the world as they are allowed to overcharge US consumers.

Have I been drinking or do we have Americans defending the governments right to interfere in the free market by stopping medics negotiating for price and Europeans defending the right to a free market?

 

[KwamiFabu]

I remember a campaign slogan at one time that said, "It's the economy, stupid!" I'm waiting for one on healthcare that finally says, "It's the cost, stupid!"

In fact the costs were known ahead of time, but depended on "the stupidity of the American people" (in Dr. Gruber's words) to ignore or dismiss them as unimportant. Costs can only be constrained by connecting them directly to services rendered. Obamacare does exactly the opposite, introducing whole new layers of bureaucracy, inefficiency and incompetence.

The part of requiring health insurance for all that I do agree with (selfishly) is that it gets more good healthy people who don't make claims paying in to the system to help defray the cost of people like me. But it never seems to work out to any actual consumer savings in the end.

The problem -- and again this was known ahead of time -- is that healthy people are younger and poorer than your cohort, which can fall back on Medicare and Medicaid. There was never any way Obamacare was self-financing. The penalty for non-compliance (aka. Obamacare tax) is nearly $400. A lot of money for a demographic that's graduating college deeply in debt and working part-time (thanks in part to the employer mandate).

 

[Emily's Cat]

And this reading is supposed to tell me how ethics is relevant to situations where you have no choice and can do nothing?

Actually, that's exactly the point. It cannot be unethical for a comet to hit the planet. It IS unethical to enslave other people. The loss of life due to something completely 100% outside the control of any human cannot be ethically inferior to slavery. Only slavery can be considered unethical.

Insisting that it is ethically superior for half the people to die or suffer through the direct and conscious actions of other humans is absurd.

 

[Ziggurat]

Actually, that's exactly the point. It cannot be unethical for a comet to hit the planet. It IS unethical to enslave other people.

But a comparison between them is irrelevant unless we can choose between them.

Insisting that it is ethically superior for half the people to die or suffer through the direct and conscious actions of other humans is absurd.

It's absurd to prefer more people dying. The rest is semantics.

 

[wareyin]

But a comparison between them is irrelevant unless we can choose between them.



It's absurd to prefer more people dying. The rest is semantics.

I think it is more absurd to claim that hypothetical people using a hypothetical cure are more important than real people using an existing cure.

 

[Ziggurat]

I think it is more absurd to claim that hypothetical people using a hypothetical cure are more important than real people using an existing cure.

I'm not the one who created the comparison of an exclusive cure with a completely unavailable cure. If you think that's the wrong things to compare, take it up with twinstead.

 

[jimbob]

I'm not the one who created the comparison of an exclusive cure with a completely unavailable cure. If you think that's the wrong things to compare, take it up with twinstead.

Developing an ongoing treatment for male-pattern baldness would probably be more profitable than a one-off vaccine against malaria.

Developing a me-too drug that can get some of Viagra's profits without violating the patents would also be a rational use of R&D resources.

I see no reason to accept your assertion that allowing massive overspending and bloated administration somehow improves lives saved by accelerating research into lifesaving treatments.

 

[Emily's Cat]

The problem -- and again this was known ahead of time -- is that healthy people are younger and poorer than your cohort, which can fall back on Medicare and Medicaid. There was never any way Obamacare was self-financing. The penalty for non-compliance (aka. Obamacare tax) is nearly $400. A lot of money for a demographic that's graduating college deeply in debt and working part-time (thanks in part to the employer mandate).

The penalty is still in its toothless phase. It increases year over year. Right now it's around $400 per year... but that's not really all that much of a penalty compared to health plans that cost $200 per month.

 

[Emily's Cat]

But a comparison between them is irrelevant unless we can choose between them.

It's absurd to prefer more people dying. The rest is semantics.

Nobody prefers more people dying. That's not what's going on.

You're comparing something that is known and current and includes volitional acts by actual humans that directly lead to the death of other humans... to something that doesn't exist and hasn't been invented but has the potential to maybe result in fewer deaths overall if it actually occurs at some undefined future point in time.

And you're choosing the unknown piece as being ETHICALLY superior to removing the volitional acts that directly lead to death now.

 

[Emily's Cat]

I think it is more absurd to claim that hypothetical people using a hypothetical cure are more important than real people using an existing cure.

See - that was much more concise and to the point than my color-coded response!

 

[sunmaster14]

Not true - the NHS negotiate bulk discounts as a large customer, but private medical care is available here.

When the government negotiates prices, it's called price-setting by economists. That's because it is a monopsony. I can't find any data on drug prices under private insurance in the UK, but it would be completely distorted anyway. Since the NHS remains a backstop for everybody, there is no reason for a private insurer to have a formulary that overlaps with NHS if their drug prices would be higher. It may be the case that UK private insurers offer drugs that NHS does not offer, but in that case, I would expect them to be in the same boat as US private insurers (who of course do negotiate drug prices, but have to compete with each other for customers, and those customers care about what and how much is covered on the plan's formulary).

Are private healthcare providers getting a free ride when they negotiate bulk discounts?

No, that's called a free market. The government in the US does not interfere in the market for prescription drugs directly. That's the point of not letting Medicare or Medicaid negotiate directly. It wouldn't be negotiation so much as dictation. The government only demands "most favored nation" status, meaning that it pays no more than the lowest cost offered to a private insurer.

Now, it's true that the US government interferes with the free market indirectly, but mostly in a way which increases demand for prescription drugs and other medical technologies, which boosts expected profits for health care companies, which boosts expected returns on health care investment, which then boosts health care investment. The US consumer and taxpayer pay a lot, but the rest of the world benefits from an implicit subsidy by seeing faster medical advances than they would otherwise.

All the NHS (and the healthcare providers in other rich countries are doing) is using the fact that they are large customers to negotiate a good deal.

No, they're using government monopsony power to free ride off the US consumer. The US government could put a stop to it, either by demanding "most favored nation" status for Medicare and Medicaid globally, or by allowing Medicare and Medicaid to negotiate down prices. Medical progress would slow however.

Here's a paper detailing some of the US inefficiencies:

http://www.ncbi.nlm.nih.gov/pubmed/15088673

Meh, seems like a small part of the problem. Regardless, most of the problem is caused by having 50 different regulatory agencies, one for each state. Also, because private insurers in the US don't insure people over the age of 65 (that's what Medicare is for), they end up insuring a group of people with lower average claims than the population as a whole. That makes administrative overhead look worse, since the denominator in the calculation is lower. Medicare's overhead is 2-3% I think, but the greater efficiency implied by the headline number is mostly an illusion.

 

[sunmaster14]

Evidence?

Take a look here in the other Obamacare thread. After I presented that evidence, all of my interlocutors skedaddled out of the thread, except for one particularly clueless one.

 

[sunmaster14]

I don't know what the percentage of income various drug labs get from charities vs from the drug companies themselves.

I don't agree with sunmaster14's apparent stance that the 25-30% profits drug companies reap after R&D is accounted for should be increased by overcharging the rest of the world as they are allowed to overcharge US consumers.

That's a bit of a strawman. I didn't opine on what should be done. I only claimed that the rest of the world is getting a free ride off of us. Hence, the alleged cost savings in their health care systems should be taken with a grain of salt. If we try to capture those savings, we will see slower medical progress.

 

[sunmaster14]

I think it is more absurd to claim that hypothetical people using a hypothetical cure are more important than real people using an existing cure.

Hmmm. I gather you're against doing anything drastic about global warming then?