Universal Healthcare and Research and Development

[ponderingturtle]

More to the point, if you don't like how one health insurance company is treating you; and if you think you can get a better deal from a different company; then in a free market, you are free to take your business elsewhere. As inefficient and as otherwise bad as health insurance companies may be, they do have to compete with one another to get your business, so they are subject to normal market forces that compel them to offer some level of value for the money that you pay into them.

And this is totaly untrue for the majority of people. They have the insurance that their employier wants to offer.

It is my opinion that the biggest problem with the health care industry as it currently exists in the United States is that the participation of insurance companies creates a sort of a quasi-socialist environment, that tends to insulate consumers and health care providers from normal market forces. Patients aren't sufficiently compelled to seek the best value in their health care treatment, because they take it for granted that whatever their treatment costs, their insurance will cover it. Health care providers aren't as compelled as they should be to keep their costs in check, for the same reason.

Well normal market forces are not good for the consumer. Take supply and demand. Now take emergency medicine. If you are dying and I have a drug that I paid $5 for that will save you, and I am the only one with a supply of the drug that could save your life, then market forces dictate that I should take you to the cleaners for all you are worth.

That is the market as applied to health care.

 

[ponderingturtle]

I imagine government run health care would be much like going to the DMV. And I cannot think of a single program that the government runs efficeintly and cost effectivley.

That is except for any programs where there are medical insurance companies inbetween you and goverment. BUt really 40% of the funding should be expect to be used by the company and not go to actualy pay for health care right?

 

[Jaggy Bunnet]

I only have new ideas if someone pays me.

I only read books and learn new skills so I can earn more money.

There is no point doing anything that helps everyone unless there is a financial reward as well.

Thanks for clearing that up. I guess that explains why the drug companies are spending their R&D budgets on developing treatments for the diseases that kill millions of poor people every year rather than focussing on less serious diseases that mainly affect the rich?

Or maybe we don't live in Utopia?

 

[Ivor the Engineer]

Thanks for clearing that up. I guess that explains why the drug companies are spending their R&D budgets on developing treatments for the diseases that kill millions of poor people every year rather than focussing on less serious diseases that mainly affect the rich?

Yes, ardent capitalists are very short sighted.

Or maybe we don't live in Utopia?

I never said we did.

 

[balrog666]

We are not talking about FDA approval; that is something different.

If you wish to use a substance or device in human medicine in the USA, it must be pre-approved by the FDA.

If you want to treat, say idiopathic pulmonary fibrosis (or the common cold), with something more than aspirin, you need to get it approved first.

You are incorrect about whether or not a doctor will write a prescription for a drug not on the 'allowed' list. If the doctor thinks it's the best choice and the patient indicates they are willing to pay, the prescription will be written. The actual target of the marketing will be the doctors first, patients second.

If the doctor works for an HMO, he may be legally constrained against writing off-list prescriptions. And if he works for a bureaucratically bloated government, he will do whatever he is told if he wishes to keep his job - just like all the other drones.

Why do you think pharmaceutical companies' marketing budget outstrips their R&D budget?

That would be the need to recoup their investment. And then to make a profit.
I too employ salesmen and I pay them quite well for obvious reasons. Do you think that is somehow wrong?

I appreciate the concerns demonstrated by the links provided earlier. However, the normal course of events for these expensive drugs that are truly useful (rather than just over-hyped) seems to be that once a reasonable amount of evidence accumulates and the issue is made public, they make their way onto the lists. It could improve the quality of R&D, as the incentive will be to develop novel treatments, rather than me-too drugs.

Um, no, that is not how economic incentives work and without such incentives no such research will be conducted on an industrial scale.

And me-too drugs are researched because there is a well established market and a better, cheaper, or even alternative drug is very likely to make a profit for the company. And without profits, the company will go under.

 

[cafink]

And this is totaly untrue for the majority of people. They have the insurance that their employier wants to offer.

Unless they are being forced to work for that particular employer, this is a non-issue. In a free market, one can work for any employer he can convince to hire him. One of the factors that is likely to strongly influence his decision is a job's rate of pay, be that pay monetary or in the form of benefits such as health insurance.

Well normal market forces are not good for the consumer. Take supply and demand. Now take emergency medicine. If you are dying and I have a drug that I paid $5 for that will save you, and I am the only one with a supply of the drug that could save your life, then market forces dictate that I should take you to the cleaners for all you are worth.

You just described a monopoly, which is generally not considered a "normal" market force, and for which we have special legal provisions.

 

[JoeEllison]

I imagine government run health care would be much like going to the DMV. And I cannot think of a single program that the government runs efficeintly and cost effectivley.

Medicare and Social Security... efficient and wildly successful. It isn't hard. Government is pretty good for some things. And I've never had a problem at the DMV.

 

[Jaggy Bunnet]

Yes, ardent capitalists are very short sighted.

As are those who jump to conclusions without evidence. I think that introducing a nationalised health service MAY reduce the incentives to carry out R&D. However that does not mean it should not be done, but it does mean that it would be sensible in designing the scheme to consider whether this is likely to be a problem and if so, to design the scheme to minimise that negative aspect.

If you want to imply that drug companies will do R&D out of the goodness of their hearts (e.g. in your comment that "I only have new ideas if someone pays me") then I think you are denying the realities of the world we live in.

 

[CaptainManacles]

Well normal market forces are not good for the consumer. Take supply and demand. Now take emergency medicine. If you are dying and I have a drug that I paid $5 for that will save you, and I am the only one with a supply of the drug that could save your life, then market forces dictate that I should take you to the cleaners for all you are worth.

If there is that much profit in it then other people will be looking to produce a solution until the price comes down due to competition. It does end up being very good for the consumer. You continue down this line of thinking and eventually you won't have the option to pay out the ass and save your life. And shouldn't you pay out the ass? Isn't that how much your life is worth? Should you be paying less then what it's worth?

 

[JoeEllison]

Look what government has done to our educational system. If you are wealthy enough, you can still send your kids to a private school, which will provide a better quality of education, at a lower cost per student, than government-provided education does; but you still have to pay the same taxes to support the inferior government-based education that you aren't even using, on top of the tuition to the private school. Do you really want to let this happen to the health care industry as well?

You're kidding, right?

 

[Jaggy Bunnet]

http://www.commonwealthfund.org/usr...hltsysdata2006_chartbook_972.pdf?section=4039

Table II-7.

Thanks for this. I remain surprised about the tax element - I knew overall spend was way higher I just didn't realise that you already had the public spending to pay for a nationalised system if it was spent as efficiently as in other countries.

How is this different in the US when an insurance company refuses to cover the costs of a treatment?

Other insurance companies may cover it. Customers can then choose if they want to be covered for it (and pay higher premiums) or not. Market forces can then act to determine what should be paid for.

Note that I am not opposed to an NHS type system, I just believe that one potentially negative impact could be on R&D incentives - i.e. that this is a legitimate concern, but far from a knockout argument.

 

[balrog666]

Medicare and Social Security... efficient and wildly successful. [snip]

And both are technically insolvent.

Do you think that is good stewardship?

 

[ponderingturtle]

You just described a monopoly, which is generally not considered a "normal" market force, and for which we have special legal provisions.

Nonsense it is normal market forces. You could have chosen to live near a different ER, or be transported to one father away, wait for a different ambulance.

These are ordinary market effects.

 

[ponderingturtle]

If there is that much profit in it then other people will be looking to produce a solution until the price comes down due to competition. It does end up being very good for the consumer. You continue down this line of thinking and eventually you won't have the option to pay out the ass and save your life. And shouldn't you pay out the ass? Isn't that how much your life is worth? Should you be paying less then what it's worth?

Nope. You see if you get that many hospitals you will get a lot of surpluss capacity and they will need to charge more to preserve the competition.

 

[Rufo]

You can choose which insurence company you want to have. A cheaper one that will do less or an expensive one that will do more. I don't see why I would want 51% of the population telling me how I should spend my money on health, or if I want to spend it, and why they should be able to force me to spend it on people I don't want to spend it on.

Related - I happen to be a pinko hippie pseudopacifist. (I don't live in the US, but we can assume I do if it makes any difference.) I don't want to spend one cent of my money on military funding, even if my democratically elected government has decided that the nation needs a military. If they also happen to be so unbelievably atrocious as to have a war going on, you can bet I don't want any part in funding that meaningless bloodshed.

Question - Is this a good reason to get rid of the army which our socialist nanny-state controls and replace it with privately funded mercenary forces? These mercenary forces could then take action against the percieved or entirely imaginary enemies of our nation financed by those who support such actions, while I can spend my money on, oh, I don't know... healthcare? Flowers? Fluid catalytic cracking units making shoes for orphans? I won't think of anyone as much more unreasonable if they think it is. I'm just curious.

 

[cafink]

Nonsense it is normal market forces. You could have chosen to live near a different ER, or be transported to one father away, wait for a different ambulance.

These are ordinary market effects.

You said in your example that you were "the only one with a supply of the drug." I don't know what dictionary you're using, but such a situation is indeed a monopoly.

 

[Bob Blaylock]

More to the point, if you don't like how one health insurance company is treating you; and if you think you can get a better deal from a different company; then in a free market, you are free to take your business elsewhere. As inefficient and as otherwise bad as health insurance companies may be, they do have to compete with one another to get your business, so they are subject to normal market forces that compel them to offer some level of value for the money that you pay into them.

And this is totaly untrue for the majority of people. They have the insurance that their employier (sic) wants to offer.

That would be an example of another point that I have made (and which you quoted) about insurance having the effect of insulating consumers from normal market forces. In this instance, while the end consumer may have little or no direct choice as to which insurance coverage he will have, the employer does have this choice. But the employer is going to be influenced by market forces; and select a plan that is perceived as giving good value to the employees relative to the money that the employer is paying for the plan. Employers, in general, are less inclined to waste their money than most employees. Is an employer going to waste money on a health care plan that gives poor value, when another plan is available that gives better value?

And of course, if the employees are dissatisfied with the current plan, they can always try to convince the employer to switch to a plan that is perceived as being a better value.

So there is some choice involved, and some market forces at work; without which the situation would be much worse than it is. What would make things better would be giving the end consumer more choice. Government-based socialized medicine, of course, is exactly the opposite of that; it eliminates choice entirely.

Well normal market forces are not good for the consumer. Take supply and demand. Now take emergency medicine. If you are dying and I have a drug that I paid $5 for that will save you, and I am the only one with a supply of the drug that could save your life, then market forces dictate that I should take you to the cleaners for all you are worth.

That is the market as applied to health care.

So what's your solution to that situation. You own the drug. It's your property. Should Big Brother simply take it away from you and give it to me, because I am perceived as being in greater need of it? Should Big Brother dictate how much you are allowed to sell it for?

And if it can just be taken away from you and given to someone deemed to be in need of it, then what was the point in your acquiring it in the first place?

 

[JoeEllison]

Just a note... "market forces" are inherently inhumane. If you are yourself an inhumane sociopath, feel free to post as though "market forces" are somehow acceptable to human beings.

As far as I'm concerned, anyone who cites "market forces" when talking about the lives of fellow human beings is a lousy example of a human being.

 

[Jaggy Bunnet]

As far as I'm concerned, anyone who cites "market forces" when talking about the lives of fellow human beings is a lousy example of a human being.

Of course they do happen to be the best system we have ever found of incentivising people to innovate and be efficient. As far as I am concerned anyone who is willing to ignore the reality of what actually helps their fellow humans because it does not fit their political ideology is a far better example of a lousy human being.

 

[Architect]

I imagine government run health care would be much like going to the DMV. And I cannot think of a single program that the government runs efficeintly and cost effectivley.

Your goverment, perhaps. The NHS costs us less and has comparable standards of treatment to your private system. And we have the option of going private if we want.