Canadian Heathcare system sucks!!

[Rolfe]

Look, the economics of devoting such a high percentage of citizens' income to healthcare provision. The rationality (or otherwise) of compelling businesses to provide goods and services to people who cannot possibly pay for them.

The lies the Cushing's woman is telling, and why huge amounts of money which people have paid in health insurance premiums are being spent on propagating these lies, and why such flagrant misrepresentation is being permitted.

I spent quite some time on my posts which addressed these issues. Nobody has commented on a single word as far as I can see.

Rolfe.

 

[volatile]

But the power of bulk purchase agreements aren't based upon economies of scale. It's an issue of negotiating power, which is why a bulk purchasers can get better prices than small-volume purchasers, even though they both benefit from the same economies of scale. And you can't get negotiating power unless you're willing to forgo purchasing. In the case of generics, that's all well and good, because you can forgo purchasing from one vendor in favor of another. But for new drugs, that's not an option.

I know what you meant, and even addressed this exact argument.

Even for novel drugs (and what percentage of healthcare spending is truly novel), a bulk purchaser will get a lower price. This is simple stuff, Ziggurat.

You tell me whether or not you want to ever forgo buying new drugs, but if you don't, you won't get any price advantage.

Even bulk purchasers of monopoly goods get discounts. I'm sure Wal-Mart can buy Levis jeans cheaper than Bob's Jeans can, even though both must buy the same product from the same seller. And why? Because Wal-Mart buy more.

Calling me a "useful idiot" isn't an ad hominem? That's rich.

No. You might find it insulting - but it isn't an ad-hominem.

Not willing to give any reasons why you think the USA, alone, can't provide a UHC system? Or whether you think the complete privatisation of the British NHS would make it cheaper?

 

[volatile]

I spent quite some time on my posts which addressed these issues. Nobody has commented on a single word as far as I can see.

Rolfe.

Because they'd rather stick their fingers in their ears. It's ideologically preferable than actually confronting the truth that proves their free-market, quasi-libertarian evangelism false.

 

[volatile]

I've decided there are no realistic options which can dramatically reduce our total healthcare spending. That does not mean improvements cannot be made, in terms of efficiency, distribution, or quality.

But you haven't explained why. What is fundamentally different about the USA compared to Canada, or Europe? Why can't what works elsewhere work in America? What makes you guys so uniquely incompetent?

 

[Rolfe]

OK, here's my post about the effects of high healthcare costs on the economy.

http://www.internationalskeptics.com/forums/showthread.php?postid=4928559#post4928559

And here's my post about the irrationality of compelling businesses to provide goods and services to people with no hope of ever being able to pay for them.

http://www.internationalskeptics.com/forums/showthread.php?postid=4928580#post4928580

And here's my post about the lying bitch and her taradiddles about her "brain tumour".

http://www.internationalskeptics.com/forums/showthread.php?postid=4929210#post4929210

Is there nothing there equally worthy of discussion alongside exactly how the ambulance service is organised, and why comfortable middle-class people will prevent the introduction of universal healthcare by demanding that it supplies them with twice the medical services they actually require?

Just asking.

Rolfe.

 

[Rolfe]

But you haven't explained why. What is fundamentally different about the USA compared to Canada, or Europe? Why can't what works elsewhere work in America? What makes you guys so uniquely incompetent?

I think he's saying that they've boxed themselves into a corner. That they literally can't get there from here.

I agree, change is path-dependent, and the problems of moving from the present system will inevitably dictate the form of any future system. In some respects I can see why, if I was going there, I wouldn't really want to start from here.

But at the same time being such a late starter, the USA has the huge advantage of being able to look at the experiences of other countries, reject what doesn't work, improve on what does, avoid mistakes, and tailor a system to the USA's particular national circumstances.

Zig, have you watched this documentary (accessed by link from the home page)?

Sick Around the World.

This is the country that put a man on the moon. I can't believe they can't manage what every other developed country (and quite a few we'd not necessarily agree are developed) have managed pretty well.

Rolfe.

 

[Ziggurat]

Even for novel drugs (and what percentage of healthcare spending is truly novel), a bulk purchaser will get a lower price.

But you can't negotiate savings unless you're willing to walk away, which is what's at issue here. Without the ability and willingness to forgo a purchase, you have zero negotiating power. Can the government have such power in regards to new drugs? Yes, it can: if it's willing to walk away, and demonstrate that willingness to drug companies.

This is simple stuff, Ziggurat.

And yet...

No. You might find it insulting - but it isn't an ad-hominem.

Not willing to give any reasons why you think the USA, alone, can't provide a UHC system?

No I'm not, because that is not something I ever claimed. Care to try again with a little less straw?

 

[volatile]

But you can't negotiate savings unless you're willing to walk away, which is what's at issue here.

Even assuming bulk-purchasing and guaranteed order volumes don't get discounts, all this means is that a Universal System will get some novel drugs at the same price as private suppliers can get them currently. What percentage of drugs are novel? Is the fact that, on some drugs, the price will not significantly decrease a good reason not to switch - especially as other universal systems also purchase these same drugs and still manage to be cheaper than the American system?

No I'm not, because that is not something I ever claimed. Care to try again with a little less straw?

So it was a different poster who said "We're different" in response to the question "What makes the USA system different?" then?

Insults aren't ad-hominems; things you actually said aren't strawmen.

 

[Delscottio]

But you can't negotiate savings unless you're willing to walk away, which is what's at issue here. Without the ability and willingness to forgo a purchase, you have zero negotiating power. Can the government have such power in regards to new drugs? Yes, it can: if it's willing to walk away, and demonstrate that willingness to drug companies.

Drug companies don't tend to make just the one drug.... not saying it goes on but it in no way helps a drug company to be particularly difficult with one of their biggest single customers.

The bulk that the NHS buys at companies fall over themselves to be approved for use within the NHS, its guaranteed income and profit.

 

[Rolfe]

In my experience in healthcare purchasing, bulk discounts happen pretty automatically, even from a monopoly supplier. You might not think it's logical, but that's what happens.

I think the thing to remember is that the monopoly drug isn't the only drug that retailer is selling. They have a whole catalogue. Holding out for a ridiculous price on the monopoly drug isn't good business if you want to keep a nice fat account with the client.

Drug companies love universal healthcare systems. Instead of only the percentage of the population who can afford their wares being able to buy, everyone who requires their product is "buying" it. And when you have a bulk-buying client like that, you keep them sweet.

Rolfe.

ETA: Huge customers cost less per unit sale - an invoice costs the same for £5 or £50,000, sales reps get a lot more sold for less mileage, and it's all just so much less hassle than a dozen small customers. We love these big customers, and we give them our best deal - for now, and to keep them loyal.

ETA again: What he said. ^^^

 

[Ziggurat]

Even assuming bulk-purchasing and guaranteed order volumes don't get discounts

I'm not assuming that. But any such discounts should already apply to Medicare. What's being discussed are negotiated discounts on top of any generic bulk discounts.

What percentage of drugs are novel?

Tylenol isn't what people are talking about when they talk about the high price of drugs. It's the drugs under patent. That's what the entire drug price discussion is really about. There isn't a significant price problem on drugs no longer under patent.

Is the fact that, on some drugs, the price will not significantly decrease a good reason not to switch - especially as other universal systems also purchase these same drugs and still manage to be cheaper than the American system?

Drug companies are willing to sell cheaply to secondary markets because it's better than not selling at all there, and they make enough money on their primary market: the US. We won't be able to take advantage of the same dynamic, not unless we're willing to drive drug development away. And I never said this was a reason not to switch to a UHC. But it is a reason to expect that we won't get much cost savings on drugs by doing so.

Insults aren't ad-hominems

They are when they're used to try to discredit the argument, which is exactly what you were trying to do by labeling me as a "useful idiot" stooge of the insurance industr, and a cause of the healthcare problem.

things you actually said aren't strawmen.

Let me spell it out for you, since you missed the point so completely: I have never said that the US could not provide a UHC system.

You just aren't that bright, are you?

 

[Architect]

I suspect you're right, and I suspect there may be private provision, or possibly charity provision. However, as it's not within my experience, I don't actually know.

Okay, I've done a bit of research (and of very limited scope) but it appears that inter-hospital transfers are done using normal Scottish Ambulance Service "emergency" ambulances. Same system in Englandshire. There are also supplementary private and third sector services but I'm not clear as to the extent of their use; it seems relatively minor. In either cases there are concerns about being able to provide ICU level services in the back of a moving vehicle and generally doctors seem to think it a good argument against the downgrading of local hospitals.


[/derail]

 

[volatile]

I'm not assuming that. But any such discounts should already apply to Medicare. What's being discussed are negotiated discounts on top of any generic bulk discounts.

Because Medicare covers about 45 million, a universal system would cover about 300 million.

Drug companies are willing to sell cheaply to secondary markets because it's better than not selling at all there, and they make enough money on their primary market: the US. We won't be able to take advantage of the same dynamic, not unless we're willing to drive drug development away. And I never said this was a reason not to switch to a UHC. But it is a reason to expect that we won't get much cost savings on drugs by doing so.

Are you happy that the USA is disproportionately - if your figures are correct and it is not simply the case that companies are increasing their prices in the USA because they can get away from it - funding drug development?

They are when they're used to try to discredit the argument, which is exactly what you were trying to do by labeling me as a "useful idiot" stooge of the insurance industr, and a cause of the healthcare problem.

You're a useful idiot, but you're not wrong BECAUSE you're a useful idiot. In fact, it's the other way around. You're a useful idiot because you're wrong (and that's not an ad-hom either).

Let me spell it out for you, since you missed the point so completely: I have never said that the US could not provide a UHC system.

OK. Good. Excuse me for having read "We're different" in response to the question ""What makes the USA system different?" lead me to assume that you did, actually, think that the USA was different.

As we're now on the same page, and you agree that a UHC is possible, what's stopping you? What are your objections, if possibility is out?
You just aren't that bright, are you?[/quote]

 

[BeAChooser]

Is there nothing there equally worthy of discussion alongside exactly how the ambulance service is organised, and why comfortable middle-class people will prevent the introduction of universal healthcare by demanding that it supplies them with twice the medical services they actually require?

Or how about a discussion of how dishonest those pushing UHC in this country have been in denying it will lead to a single payer system and in denying it will destroy the nation's private insurance market? Here's a post on that using their own words to prove that is exactly what they anticipate will happen:

http://www.internationalskeptics.com/forums/showpost.php?p=4928101&postcount=63

 

[volatile]

The invention of the car destroyed the bridle market too, BaC. Now, I'm sure you're not in favour of maintaining inefficient systems just to preserve jobs are you, you communist?

 

[Rolfe]

tl;dr

One more zealot refusing to face the issues, noted.

Rolfe.

 

[Rolfe]

The invention of the car destroyed the bridle market too, BaC. Now, I'm sure you're not in favour of maintaining inefficient systems just to preserve jobs are you, you communist?

Didn't destroy it. Simply caused a significant contraction. You can buy a bridle very easily in 2009, in a variety of sizes and styles. Saddlery-makers still make a very nice living. There are simply fewer of them than there were in 1909.

And there are many more automobile manufacturers. I suspect insurance providers will simply reposition themselves as healthcare executives. (Be afraid. Be very afraid....)

Is his argument merely protectionism? Oh dear.

Rolfe.

 

[Ziggurat]

Because Medicare covers about 45 million

And that's not bulk?

Are you happy that the USA is disproportionately - if your figures are correct and it is not simply the case that companies are increasing their prices in the USA because they can get away from it - funding drug development?

No. But my preferred solution is not to reduce our contribution to drug research and development funding.

You're a useful idiot, but you're not wrong BECAUSE you're a useful idiot. In fact, it's the other way around. You're a useful idiot because you're wrong (and that's not an ad-hom either).

So your position is that your insult was not part of your argument. Then why did you include it, volatile? Because you wanted to make a policy debate into a personal feud? Because you just like being a jerk? Inquiring minds want to know.

As we're now on the same page, and you agree that a UHC is possible, what's stopping you?

It's not enough that a UHC system be possible: it has to actually offer an improvement. None of the UHC systems being proposed for the US look like they will be.

 

[Rolfe]

And that's not bulk?

I think what you're forgetting is the advantage of getting all your supplies at the knock-down price, not just the Medicare component.

No. But my preferred solution is not to reduce our contribution to drug research and development funding.

So you're perfectly happy to pay inflated prices to drug companies because you believe this facilitates R&D? News flash - it's probably going on their advertising budget.

If this is another poster who believes that the disadvantaged of America just have to suffer to protect drug company profits (sorry, I forgot, R&D), I despair.

It's not enough that a UHC system be possible: it has to actually offer an improvement. None of the UHC systems being proposed for the US look like they will be.

Funny, I could have sworn you were arguing against universal healthcare as a general principle. Indeed, the devil is in the detail. Rejecting the entire concept because of deficiencies in current proposals seems a bit extreme to me.

Rolfe.

 

[volatile]

And that's not bulk?

300 million is more bulk than 45 million.

No. But my preferred solution is not to reduce our contribution to drug research and development funding.

OK. Fine. So what's your preferred solution?

So your position is that your insult was not part of your argument. Then why did you include it, volatile? Because you wanted to make a policy debate into a personal feud? Because you just like being a jerk? Inquiring minds want to know.

Because this thread includes examples of the type of propaganda that you seem to have based your ideas on, and another current thread includes information of where that propaganda comes from, who's paying for it, and who's repeating it uncritically.

You serve the expressed purposes of the insurance industry well. You are useful to them.

It's not enough that a UHC system be possible: it has to actually offer an improvement. None of the UHC systems being proposed for the US look like they will be.

Because no-one is proposing ones that actually will, because people like you oppose them on ideological grounds. It's a vicious circle, and precisely the reason that I accuse you, Ziggurat, of standing between America and the healthcare system it deserves.

Single-payer systems work everywhere else they're tried, but no-one dares realistically propose one in the USA because the vested interests in the insurance industry have been phenomenally successful in (mendaciously) convincing people like you that such a system would be detrimental, despite all the evidence to the contrary.

In any case, if we're talking about "improvements", what's your metric? Rolfe, in particular, has explained at length that not only are UHC systems better financially and in terms of coverage for those currently uncovered, it also offers considerable benefits even for those with decent insurance packages in the current system (cheaper premiums, for starters) at NO COST; that is to say, under a UHC neither you nor anyone else who currently has private insurance will be any worse off.

Honestly, what downsides do you perceive were the USA to switch to a UHC? And what would you count as an "improvement"?