Socialised Healthcare

[Spock Jenkins]

First post here for me. I've been reading and enjoying this board for a while. I do consider myself far more open minded than I was ten years ago and I'm always willing to learn.

Regarding the O.P. Beyond the United States basic founding principals being a mental hurdle for most to embrace the government handling things - there is one particular hurdle that I see that makes me hesitate to embrace a form of public health care.

That item is population size. I know proponents of a single payer / public health care system often site Canada or various European nations as examples. If I'm note mistaken, Canada has roughly 1/10th the population of the United States. I'm inclined to think this makes implimentation easier. I believe most European nations have roughly 1/3rd the population at most.

I would suggest, based on the United States founding principals, that this is a matter best left to the individual States. I'll reference the 10th Ammendment to the U.S. Constitution as my justification for this:

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

In other words - if Michigan would like their own single payer plan and the citizenry support that - then let Michigan implement it. If people like it - it could serve to bolster the economy of that state by attracting new businesses that find providing health care to their employees to be cost prohibitive. If people don't like it - they are free to move to another state.

Seems reasonable to me. Based on my reading of the forum, I am confident those who disagree will tell me why it isn't.

 

[Rolfe]

.... socialized medicine "to remove the evil profit motive" ....

What is your evidence for stating that the motive for introducing "universal healthcare free at the point of need" (the actual definition of what the NHS at least tries to achieve) is specifically "to remove the evil profit motive"? And in quote marks, no less. Who are you quoting on that one? Where are you getting that misinformation?

There are many criticisms that can be levelled at the NHS, but that motivation is not one of them.

Is it quite so inconceivable that the motivation might be to bring healthcare to the segment of the population that can't afford the costs of treatment?

In fact the market still operates within this sort of healthcare system, just in rather different ways to a wholly private one.

Even a private healthcare system cannot function at a high level without insurance. While most people may be able to afford relatively minor procedures, and many people might run to some fairly expensive ones, the real high-grade efforts are prohibitive for almost everyone's individual pocket. Those high-grade interventions are only going to happen if there is some sort of insurance in place.

Now, aren't we just down to how universal this insurance has to be? The NHS is not free to residents of Britain - we pay for it in our National Insurance contributions (essentially, tax). Everyone pays according to what they can afford, and everybody benefits. In addition, if you're well enough off you can choose to take out sdditional insurance to allow you to go private if you want to, or you can pay up-front to go private if you want to.

Other countries have different systems, but in the end, everything has to be based either on the sick person paying out when they are ill, from their own pocket, or some sort of insurance. The former, as I said, leads to very restricted progress at the high end because so few people can afford your high-end product.

The latter, insurance, can be voluntary or compulsory. If it's voluntary, then it's likely that the cost will be based on the risk - just as the voluntary top-up insurance available in Britain is costed by the risk the individual is deemed to pose. However, this is likely to see many of the poorer members of society priced out of the market, as they cannot afford the premiums based purely on the risk they present to the insurers. This is what the proponents of universal healthcare find unacceptable, and is the reason for the introduction of universal healthcare systems - nothing to do with any prejudice against profits.

Compulsory insurance, on the other hand, virtually has to be cross-subsidised, with the better-off paying more and the poorest paying less - just like taxes to pay for items of common good. So really, the difference is mainly down to whether insurance is voluntary, with premiums based on risk, or compulsory, with premiums based on ability to pay.

I know which one I'd rather live under.

How these different funding concepts affect progress is an interesting topic, and one much less simplistic than Beerina portrays. We also have to consider the effect of insurance companies refising to pay for experimental or risky procedures, thus nagating the incentive for innovation in these areas. At the same time a universal system can look at cost-effectiveness as an overall concept, and encourage innovation in the most cost-effective areas.

I'm not saying this makes it perfect, far from it. However, I think we have to realise that the systems are not so different as all that, it is all insurance-funded one way or another, and market forces still operate.

Rolfe.

 

[CaptainManacles]

I saw that sentiment repeated quite often when I first came to the US from Canada - often from doctors familiar only with the US system. I couldn't figure out what they were talking about and eventually realized that they had some sort of misperception about what a single-payer system involves. What I found particularly interesting, was that I experienced far more interference in health care decisions in the US than I ever did in Canada. Apparently interference from some nameless/faceless bureaucrat a thousand miles away is acceptable if the motive is to make a profit on your back?

Linda

Only if you're incapable of thinking more then a few steps ahead, which I find is a common problem with people who support socialized medicine. The point is I can choose if and how much I deal with that nameless/faceless bureaucrat, and if dealing with that bureaucrat is truely unnecisary for the system to function, then someone will open up a business where I don't have to, to attract my business. The only difference in socialized medicine is that I'm *forced* to deal with that bureaucrat, and that bureaucrat has no modivation to be efficient/rational or to better his system.

It's not that we misunderstand what a single payer system involves, it's that we see it for what it truely is, instead of the minor aesthetic changes that you focus on.

 

[kev]

I would say one reason is that the government has a pretty solid history of taking things over, and then screwing them up. Most of our subsidized wellfare programs (like social security and medicare) are going broke as it is now. I for one am not real optimistic about the government taking over an even larger tax drain - medicine - when the things they are currently in charge of are on their way to failure.

One area of health care that seems to be problematic - in my opinion - is the belief many people have that they are entitled to spend no money on their own personal health. I know insurance costs a lot, but when I hear people in my workplace talking about "going to the doctor so they can 'get their money's worth'" out of their insurance, I want to bang my head against the wall. I would like to see some sort of system that required every man woman and child (physically and mentally capable) of covering the first $500 or $1000 of their medical expenses - then insurance kicks in. This is what insurance is for - to prevent a catostrophic medical situation that could bankrupt you. It is not in place so you never have to pay for anything except the insurance itself.

However, we have many people who care nothing about their costs because "insurance is paying for it." People do not "shop around, question or research" their medical expenses. We would never dream of shoping for a car or buying a house this way. If we treated our car insurance the same way we did our health insurance, we would turn in claims for oil changes, new tires and minor scratches. If we did that, auto insurance would be unaffordable too. What is wrong with investing $1000 of your own money in your own health each year? If everyone was writing their own checks for the first $1000, there would be much more vigilance on the part of the consumer, and in turn, more competition for reasonable prices, and less unnecessary testing among providers. Just my thoughts.

 

[Spock Jenkins]

People seem to forget that in the US, most states have some form of "Medicaid" program (goes under various names in different states) available to those who are below certain income levels. I know of one individual who works part time, has health insurance available through their employer, but due to income - they do not pay for their employer coverage since they qualify for Medicaid. This is seperate from Medicare, which is the federal program for retired individuals and the disabled. Many states also have another program that covers basic check-ups and required immunizations for the children of parents who don't have health insurance.

In some ways - I do wonder if a single payer system would serve to reduce much of the redundancy in the current United States government provided health care. Seems we already pay as much per capita as many other nations for our government health care programs that are thought not to exist. Not to mention the costs of overseeing the private health care industry.

It's almost as if we're paying 15 different ways to avoid paying one way a sum that would be roughly the same or less than what we currently pay (if that makes any sense).

Currently I pay close to $400 per month just to have insurance.

This does not include the amount my employer pays my insurance provider (which is far inexcess of my out of pocket expense), nor my co-pays, nor my deductable, nor my dental premiums (plus deductable), nor the portion of my state taxes that cover Medicaid, nor my Medicare payroll withholding, etc...

 

[ravdin]

I'm libertarian on most issues, but on health care I agree that we should be able to provide for all. I don't think this should be a particularly controversial issue- nobody is kicking up a fuss over our "socialized" fire departments, police departments, and highway builders (well, nobody who isn't crazy.) I think this is a similar case where libertarians can let go of the dogma.

I do oppose the notion of health insurance for all, which just helps the insurance companies make more money. I have no problem with large corporations making a profit (in fact, I'm strongly in favor of it)- so long as they do it without the government's help.

I would also oppose abolishing private healthcare. I like the post office model- it's cheap and efficient, but if you want to send your mail through a private carrier it's up to you.

A healthier population would be more productive, and have more money to spend, more leisure, and less debt. This would result in more freedom, not less. Which is exactly why it won't happen in the USA- it's not in the interests of the lobbyists who are running our country.

 

[CaptainManacles]

I would like to see some sort of system that required every man woman and child (physically and mentally capable) of covering the first $500 or $1000 of their medical expenses - then insurance kicks in. This is what insurance is for - to prevent a catostrophic medical situation that could bankrupt you. It is not in place so you never have to pay for anything except the insurance itself.

They have insurence that works just like this. Unfortunately, because of the breaks the government gives employers, private health insurence outside your employers is difficult to afford. But again, the solution is more free market, not less. The free market allows you to have this opinion, and spend your money accordingly. I may disagree and spend it on more traditional coverage.

http://www.google.com/search?hl=en&...cd=1&q=catastrophic+medical+insurance&spell=1

 

[fls]

Only if you're incapable of thinking more then a few steps ahead, which I find is a common problem with people who support socialized medicine. The point is I can choose if and how much I deal with that nameless/faceless bureaucrat, and if dealing with that bureaucrat is truely unnecisary for the system to function, then someone will open up a business where I don't have to, to attract my business. The only difference in socialized medicine is that I'm *forced* to deal with that bureaucrat, and that bureaucrat has no modivation to be efficient/rational or to better his system.

I admit I got carried away with the comparison, as in reality, I wasn't ever forced to deal with a bureaucrat interfering in medical decisions in Canada. It wasn't 'til I moved to the US that I suddenly had people interfering with the doctor-patient relationship.

Which carriers provide insurance with no restrictions? The time to change my plan has passed, but I could keep them in mind for next fall.

It's not that we misunderstand what a single payer system involves, it's that we see it for what it truely is, instead of the minor aesthetic changes that you focus on.

To be honest, I don't consider interference with medical decision making to be a minor aesthetic change.

Linda

 

[NoZed Avenger]

I can't tell which study you are talking about. Can you provide a reference?



Can you provide a reference for this claim?

I can take a look after I am home from work this evening, though my sources from my coursework in the nineties may be a bit problematic.

 

[YoPopa]

I would say one reason is that the government has a pretty solid history of taking things over, and then screwing them up. Most of our subsidized wellfare programs (like social security and medicare) are going broke as it is now. I for one am not real optimistic about the government taking over an even larger tax drain - medicine - when the things they are currently in charge of are on their way to failure.

You've expressed my main concern precisely. The potential for corruption and bureaucratic inefficiency with a government run monopoly is frightening. Rolfe allays some of those fears with the explanation that private insurance is an option but that seams to be an option only for the very wealthy. You still have to pay for everyone else's coverage in the UK even if you opt out correct?

One area of health care that seems to be problematic - in my opinion - is the belief many people have that they are entitled to spend no money on their own personal health. I know insurance costs a lot, but when I hear people in my workplace talking about "going to the doctor so they can 'get their money's worth'" out of their insurance, I want to bang my head against the wall.

Ditto that as well. As long as it seems that someone else is footing the tab or that the tab has already been paid then there will be overuse. A variation of the tragedy of the commons.

I would like to see some sort of system that required every man woman and child (physically and mentally capable) of covering the first $500 or $1000 of their medical expenses - then insurance kicks in. This is what insurance is for - to prevent a catostrophic medical situation that could bankrupt you. It is not in place so you never have to pay for anything except the insurance itself.

This proposal makes the most sense to me. I don't know why it is not discussed more. It almost seems like the third rail of medical politics to talk about using insurance only for catastrophic coverage and to use cash for basic and elective care. The logical way that the US could implement that would be to allow a tax deduction for medical savings accounts. We got into the current system of relying on private insurance shortly after WWII when the IRS decided that companies could offer health insurance to employees as a tax free benefit. A tax free medical savings account combined with catastrophic insurance coverage should at least be an option.

 

[fls]

First post here for me. I've been reading and enjoying this board for a while. I do consider myself far more open minded than I was ten years ago and I'm always willing to learn.

Regarding the O.P. Beyond the United States basic founding principals being a mental hurdle for most to embrace the government handling things - there is one particular hurdle that I see that makes me hesitate to embrace a form of public health care.

That item is population size. I know proponents of a single payer / public health care system often site Canada or various European nations as examples. If I'm note mistaken, Canada has roughly 1/10th the population of the United States. I'm inclined to think this makes implimentation easier. I believe most European nations have roughly 1/3rd the population at most.

I would suggest, based on the United States founding principals, that this is a matter best left to the individual States.

That's the way it is in Canada. The federal government does not have jurisdiction over health - that was given to the provinces. The federal government basically provides a grant (the history of how they figured out how to get around the constitution is interesting) to any provinces that institute a provincial health care plan that satisfies a set of conditions (universal, accessible, comprehensive, portable, publicly administered). Most health care provision in Canada is private, with the government acting as a single-payer. So the government is not running the health care system (that is still done privately) it is just financing it.

In other words - if Michigan would like their own single payer plan and the citizenry support that - then let Michigan implement it. If people like it - it could serve to bolster the economy of that state by attracting new businesses that find providing health care to their employees to be cost prohibitive. If people don't like it - they are free to move to another state.

Seems reasonable to me. Based on my reading of the forum, I am confident those who disagree will tell me why it isn't.

I think that in order for a publicly funded system to work, you need a population committed to the idea of fairness, and I don't really see that happening in the US - not at the expense of any sense of a restriction on individual choice, anyway.

Linda

 

[CaptainManacles]

I admit I got carried away with the comparison, as in reality, I wasn't ever forced to deal with a bureaucrat interfering in medical decisions in Canada. It wasn't 'til I moved to the US that I suddenly had people interfering with the doctor-patient relationship.

Which is again a problem of perception and reason, it has nothing to do with the reality of the situation. You are dealing with a bureaucrat, even if socialized medicine makes that easier to ignore. Someone other then you sets the rules that determine how your money is spent for medical treatement. The only way to avoid that is under a privatized health system.

Which carriers provide insurance with no restrictions?

Which nationalized medical systems do this? If I can find a doctor that says I need 17 million dollars for crystal treatments to reallign my lower chakra layers, the government will just dole that money out? Someone is going to have to set some restrictions somewhere, under private health care, I can choose who is going to make that decision, or I can just spend my own money, giving me the only option where there truely is no interference between the doctor patient relationship.

To be honest, I don't consider interference with medical decision making to be a minor aesthetic change.

Neither do I, but instead of focusing on the reality of what is actually being interfered with, and trying to see the big picture, trying to think more then a step or two ahead, you focus on the aesthetic immediates, acting like you're getting medical care from some magic fairy, instead of acknowledging the reality of what's really going on.

 

[fls]

You've expressed my main concern precisely. The potential for corruption and bureaucratic inefficiency with a government run monopoly is frightening. Rolfe allays some of those fears with the explanation that private insurance is an option but that seams to be an option only for the very wealthy. You still have to pay for everyone else's coverage in the UK even if you opt out correct?

I would have a similar concern, especially with what I've seen of the US government. There are many different types of national health care systems, and I think some sort of a privately run system with public funding would be a better idea for the US.

Linda

 

[Abe_the_Man]

Reduction of profits is well-established to do this. Government can make up some of the difference, e.g. military or space, but in those cases there's not much direct "profit" to be made, so the government pours cash into it to force development. Such is not the case for medicine. It probably exceeds everything except food itself in driving its own innovation, by profit motive, precisely because everyone wants it so badly, and will pay for it.

I also find it cynical that I've seen some touters of socialist medicine suggesting that "relying on fame of developing a cure" is sufficient motive to keep things moving.

I think you may be confused about socialised medicine or universal healthcare as it's often refered to here in Canada. The government doesn't force the drug companies to lower their prices. It doesn't cut into their prophets and thus stifle productivity due to lack of funding. The government PAYS for the medicines and medical services for us.

I have experience with this as a member of my family was diagnosed with a brain tumor on July 25th 2007. She underwent brain surgery with one of the top neurosurgeons in the country 14 days later on August 8th (approximately $45,000). After that she went for daily radiation treatments (about $2000 per week due to frequency) for 6 weeks. She also recieved daily chemo treatments with a Timazolamide(spelling?), a prescription ($1500/week). Not to mention she has had 4 MRIs ($4000 each) and 4 CT scans ($300 each). She is now on a new trial drug as well as timazolamide and I have no idea the cost of it. Also I don't think the dozen or so appointments/consults she has had with neurosurgeons, radiologists and chemotherapy specialists as well as the regular doctors (saw weekly for the 6 weeks of treatment). I can't imagine all the doctors appointments would be cheap.

So lets add this up $45,000 + $12,000 + $9,000 + $16,000 + $1,200 = $83,200 (not including the price of her current treatment or the cost of all the doctor/specialist appointments as I have no idea what they cost)

This isn't $83,200 that the government magicked away. This is $83,200 they paid, in money, into the medical field. Without socialised medicine we would not have been able to afford the top treatment and she likely wouldnt be winning against the cancer.

And yes these are the actual costs, not what the government says they would cost. We had not filled out one of the pieces of paperwork and so she didn't qualify for coverage for the timazolamide for the first 3 weeks of treatment and so we were forced to pay the $1500 per week out of pocket. The ministry of health put a rush on our paperwork and they took over payments starting with the 4th week as well as reimbursing us for the first three.

Also I have heard people talking about the poor quality of care or delays in recieving care. Notice above that the only significant wait was between diagnoses and surgery. 14 days, and we chose to wait so we could have the neurosurgeon of our choice.

From my own experiences I can't understand the US fears of universal healthcare.

From wikipedia

The United States is the only wealthy, industrialized nation that does not have a universal health care system.

http://en.wikipedia.org/wiki/Universal_healthcare#United_States

 

[fls]

Which is again a problem of perception and reason, it has nothing to do with the reality of the situation. You are dealing with a bureaucrat, even if socialized medicine makes that easier to ignore. Someone other then you sets the rules that determine how your money is spent for medical treatement. The only way to avoid that is under a privatized health system.



Which nationalized medical systems do this? If I can find a doctor that says I need 17 million dollars for crystal treatments to reallign my lower chakra layers, the government will just dole that money out? Someone is going to have to set some restrictions somewhere, under private health care, I can choose who is going to make that decision, or I can just spend my own money, giving me the only option where there truely is no interference between the doctor patient relationship.



Neither do I, but instead of focusing on the reality of what is actually being interfered with, and trying to see the big picture, trying to think more then a step or two ahead, you focus on the aesthetic immediates, acting like you're getting medical care from some magic fairy, instead of acknowledging the reality of what's really going on.

The public funds are used to cover services that are medically necessary (as a group, not on an individual basis), so the magic crystals wouldn't fall under the plan. You are, of course, free to find insurance (or pay yourself) to cover the magic medical fairy. There is a competitive market in Canada for insurance to cover those services that are not medically necessary. This varies from province to province, but examples include physiotherapy, psychologists, optometrists.

Linda

 

[Darat]

You've expressed my main concern precisely. The potential for corruption and bureaucratic inefficiency with a government run monopoly is frightening. Rolfe allays some of those fears with the explanation that private insurance is an option but that seams to be an option only for the very wealthy. You still have to pay for everyone else's coverage in the UK even if you opt out correct?

...snip...

In the UK you can elect not to use the NHS but you will still be paying "contributions" i.e. taxes that help fund it if you have income above a certain level. An interesting point tidbit is that apparently (and this is only from listening to radio debates about it so I don't have any links I can provide so take it with a pinch of salt) UK private insurance premiums are lower than many other countries because they do not cover emergency procedures and the like because these are provided by the NHS.

(As a FYI most firms I have worked for from when I hit "management" grade have provided some private medical insurance.)

 

[qwert]

I think you may be confused about socialised medicine or universal healthcare as it's often refered to here in Canada. The government doesn't force the drug companies to lower their prices.

Actually, the Canadian government does set maximum prices for drug sales within Canada. The Patented Medicines Price Review Board (PMPRB) in Canada sets the maximum price that can be charged by drug companies for certain patented drugs. http://www.pmprb-cepmb.gc.ca/english/View.asp?x=175&mp=87)

That's one reason there was such a fuss a couple years back about online pharmacies in the US obtaining their drugs from Canada. Canadians didn't like it as they felt it could potentially lead to a shortage in availability. US drug companies didn't like it as their prices were being undercut.

 

[Rolfe]

I'm sorry there's bee so little comment on what I said. I was to some extent thinking aloud, and was hoping for comment.

The point is I can choose if and how much I deal with that nameless/faceless bureaucrat, and if dealing with that bureaucrat is truely unnecisary for the system to function, then someone will open up a business where I don't have to, to attract my business. The only difference in socialized medicine is that I'm *forced* to deal with that bureaucrat, and that bureaucrat has no modivation to be efficient/rational or to better his system.

I don't see your point here. You're saying that you can choose if and how much you deal with the bureaucracy of your health insurance provider? I suspect that's a bit optimistic, if you actually want them to pay your claim. If Suezoled was around, I'm sure she'd have some amusing tales (she worked in a health insurance call centre, and fielded calls from people wanting to claim on their insurance - a whole level of bureaucracy totally foreign to me).

You're then saying that if you don't like this, someone will set up an insurance provider where you don't have to deal with faceless bureaucrats? I doubt it. Claims consultancy and loss adjusting are pretty much universal truths of insurance.

Or you're saying that if you don't like the way your health insurance company treats you, you can change to another company? Maybe. But in the middle of a claim, or with a medical history that indicates you'll be claiming on them for some time to come? Good luck with that one.

You know what? I never have to deal with faceless bureaucrats regarding my own healthcare. I'm not even sure what you're talking about as regards the NHS system. I make an appointment with the doctor, I go along, tell her my woes, and she deals with it. End of story. Nobody mentions money, and the only "bureaucrat" I have to deal with is the receptionist who gives me my appointment time.

OK, but I'm fairly healthy. Yes, but I also look after my 91-year-old mother who has had four eye operations, and is on a number of prescription drugs. This morning I simply ticked the boxes on the prescription counterfoil to say which ones she was running out of, posted them in the box by the surgery on my way to work, then on my way home stopped outside the village pharmacy where I collected the package of medication which was ready and waiting. No fuss, no mess, no money, just one signature.

Her eye operations are an excellent example of how the system works. Her consultant suddenly decided she needed surgery for bilateral glaucoma, and she needed it now. It was all scheduled within a couple of weeks, couldn't have been easier. However, the next bit was trickier. Her eyesight began to deteriorate again. The consultant said that her cataracts were now becoming a problem and more surgery was needed. However, the delay on that was 13 months, because it wasn't seen as urgent (and there was a backlog because of a problem with instrument sterilisation).

I insisted to her that she ask about having the operations privately. She was reluctant to be seen to be "jumping the queue", but I told her that she was simply allowing those behind her to move up a step. Living alone, with the cataracts worsening, waiting over a year was foolish. So she asked the nurse. She was immediately transferred to a different consultant, as her original guy didn't have a private practice, and surgery was arranged at a private hospital, again within a few weeks. She is a clergyman's widow on a small pension, but even so it didn't cost that much out of her savings, and she still managed to afford some smart home improvements the following year.

After the private surgery she simply went back into the NHS system, but this time stayed with her new consultant. She's still attending hospital as an outpatient twice a year, and everything is still free.

And this was without even having any health insurance at all. Of course she wouldn't have been able to go privately for a major intervention, but then she wouldn't have to - as this story shows, the thing which was considered urgent (the glaucoma surgery) was not subject to any waiting list.

And nobody had to deal with any faceless bureaucrats at all. Indeed, the only time that aspect impinges on my consciousness is when I visit a friend who is an NHS consultant, and he starts banging on ab out NHS managers. Hey, someone who has a gripe with his management! How unusual is that?

So CaptainManacles, I'm just at a loss to identify with what you're talking about.

And, YoPoppa, private health insurance in Britain isn't just an option for the very wealthy. It's not especially expensive. Quite a lot of people have it to make that decision to skip a waiting list for a non-urgent but inconvenient problem. But a lot of people just choose not to bother, because they know the NHS will look after them 99 times out of 100.

Rolfe.

 

[Abe_the_Man]

Actually, the Canadian government does set maximum prices for drug sales within Canada. The Patented Medicines Price Review Board (PMPRB) in Canada sets the maximum price that can be charged by drug companies for certain patented drugs. http://www.pmprb-cepmb.gc.ca/english/View.asp?x=175&mp=87)

That's one reason there was such a fuss a couple years back about online pharmacies in the US obtaining their drugs from Canada. Canadians didn't like it as they felt it could potentially lead to a shortage in availability. US drug companies didn't like it as their prices were being undercut.

Thanks for the link and I stand corrected. I was really trying to get across the point that socialised medicine isn't stifling progress through lack of funds. It's designed so that you won't be ruined financially if some kind of medical problem occurs. Drug companies are still extremely profitable in Canada.

A little info about how our drug regulation works

From a 2004 Article. http://www.motherjones.com/news/qa/2004/09/09_401.html

If you look at Canada, it’s a very mild form of regulation, really. They have a national board, and when a me-too drug comes on the market, they say it can’t be priced any higher than the highest-priced drug for that condition already on the market. Nor can it be priced any higher than the median in seven advanced countries, and these countries include the U.S. Then they say the prices cannot rise any faster than the inflation rate. So, that’s not too onerous. Drug companies make profits in Canada.

And a little info about what exactly a "me too" drug is. http://www.cmaj.ca/cgi/content/full/171/12/1451

The main output of the big drug companies is "me-too" drugs: minor variations of highly profitable pharmaceuticals already on the market.5 Some me-too drugs are gimmicks to extend monopoly rights on an older blockbuster. For example, the antacid Nexium was AstraZeneca's virtually identical replacement for Prilosec when its exclusive rights on the older drug expired. Others are attempts by competitors to cash in on lucrative markets. For example, the top-selling drug in the world, Pfizer's Lipitor, is the third of 3 me-too drugs to cash in on the success of the first statin, Merck's Mevacor. All of these drugs inhibit the same rate-limiting enzyme in cholesterol synthesis. There is generally no good reason to believe that one me-too drug is better than another, since they are seldom compared head-to-head at equivalent doses in clinical trials. Instead, they are tested against placebo, and so all we know is that they are better than nothing. In fact, it's conceivable that, within me-too families, each successive drug is actually worse than the one before. Without suitable comparative testing, we'll never know.

 

[Rolfe]

OK, been thinking about it, I'll try again.

In another thread I was taken to task for saying that it seemed that US objections to universal healthcare systems were based on not wanting to pay for someone else's heathcare costs. So, looking for other reasons to favour the US system in this thread, I've come up with a few.

More choice. No, as I mentioned above, this isn't so. You retain the right to choose to spend your own money on your own choice of healthcare if you want to. As my mother did with her cataract surgery. And that includes paying 17 million dollars for crystal treatments to realign your lower chakra layers if that's what you want and you can afford it. You also retain the right to buy your own private health insurance, with premiums based on your assessed risk, and in fact you will find this is surprisingly affordable, as Darat said, because the insurance companies know they will not be called on to pay for any emergency treatment you may need - the NHS will take care of that. Actually, considering how healthy my pay packet looks even with the tax element that covers my contribution to the NHS, I have to say this is the bargain of the century, and I in fact have more choice, not less.

More innovation. That was heavily promoted in an early post on this thread. Thinking about it, I don't accept the connection. Nigeria does not have universal healthcare (so far as I know), but there are no great innovations coming from there. I don't dispute the assertion that the US is a global leader in medical innovation, but I submit that this is related to affluence, not to payment ideology. A large population with a large affluent section is going to promote innovation, simply because this is the market for it. However, in less affluent circumstances it's arguable that universal healthcare may provide more incentive for innovation by widening the pool of patients likely to take advantage of such innovations. In no way is medical research stifled by the NHS. It pays for a fair bit. But more importantly, it pays the drug manufacturers for their products, and in fact gives them a bigger market than they might otherwise have had, by paying for those who could not have afforded it for themselves.

Better value for money. That doesn't seem to be the case either. I've often heard it said that US healthcare costs on a per capita basis are the highest in the world. Yes, there's some great stuff being done for that money. But at the same time, there a lot of people more or less excluded from the system. I see no evidence that the nation's health as a whole is better for this expenditure. Indeed, when one considers that the overheads, salaires and profits of the health insurance companies have to be factored in as well, maybe it's not surprising.

So. We can exclude the option of all healthcare being paid for out of the individual's own pocket when necessary. This would lead to a market for the very expensive procedures which was so small that nobody would invest in them. We must have insurance, to spread the cost.

If we insist that the premiums be based on assessed risk (like car or home insurance) then it cannot be compulsory, as many people will not be able to afford it. Then what do you do for the remainder? Rely on the charity of the better-off? Set up a basic, humiliating, cheap-as-chips safety net which only covers minor interventions? Or set up a more sophisticated system which comes closer to what the insured receive? Either way, this has to be paid for, and unless you go for a real soup kitchen pill-doling system, it's going to cost you.

Or we could be really innovative, and insist that the insurance be universal and compulsory, accepting that premiums in this case have to be set by ability to pay, rather than by assessed risk. This covers everyone to a good standard, and still leaves anyone the option of buying their own private treatment or private insurance if they want to.

You're going to get faceless bureaucrats either way. You're going to get wastage and overspending, and people not happy because they haven't been treated exactly as they wanted to be treated, either way. But I know which system I'm glad I'm living under.

Yes, those who choose to pay for private insurance are still also paying their NHS "tax". But as Darat said, it's not wasted money, because the insurance premiums are cheap, because BUPA et al know they don't have to pay for emergency treatment, which the NHS contribution covers.

I'm not saying the NHS is perfect. Too many politicians interfering, too many political targets, too many managers being paid way too much money, and while we're at it too much kow-towing to Jug-Ears and his integrated health foundation and pressure to pay for woo-woo placebos. But that's no reason even to consider radical changes.

Remember Morgan Spurlock's "30 days" film where he tries to live on the minimum wage? He would have managed it too, if it hadn't been for the healthcare costs (his back pain and his fiancee's cystitis), and finding that the socialised medicine wasn't actually available to them because of queues and waiting times and rationing. For all its faults, I'm deeply grateful that I'm covered by the NHS. I don't know what I'd do without it.

Rolfe.