Universal Healthcare and Research and Development

[JoeEllison]

Remember, folks, the purpose of life is to make profit... and if you cannot provide profit to some millionaire, you're better off dead anyway, aren't you?

 

[luchog]

Medicare is run more efficiently than private insurance companies - an overhead of 3.6% compared to 11.7%.

First, Medicare is strictly for seniors, and is not comperable to general medical assistance. The federal medical assistance program is Medicaid.

As someone who spent time on public assistance due to disability, whose wife is currently on public assistance for the same reason, and therefore has first-hand knowledge of Medicaid, my own state's "Basic Health" system, and numerous versions of private insurance, I can tell you right now that those numbers are highly misleading. It's an apples to oranges comparison.

Medicaid is "more efficient" simply because they don't offer the same range of coverage as even the least effective private insurance company. There are far too many things they don't cover and won't provide, or cover only in extreme circumstances, and their system is heavily regimented to eliminate a lot of the complexities that private insurance companies are forced to deal with. They don't need the armies of administrators, since they're dealing with far fewer regulations, and far fewer complexities of care, than private agencies. The burden of paperwork is much greater on private companies, not least because they have to deal with regulations and restrictions not only on a federal level, but also for numerous different states whose laws can vary widely, requiring a greater number of administrators and managers to coordinate. Government programs only have to deal with, at most, federal regulations, and the regulations of the single state they operate in. They also have to administer multiple different treatment plans, investigate potential fraud, coordinate and maintain contracts with multiple other agencies, perform billing and collections functions, and multiple other activities that government-run agencies simply don't have to deal with.

On top of that, the low remuneration paid by government-funded programs is often well below average market value for services; which means that the majority of the doctors who accept government benefits (not all will) are not what one would call the "best and brightest". They are often those who simply weren't able to cut it in private practice; and treat medicine as an assembly-line process, sticking to cursory observation, with pat diagnoses and treatments that may or may not be relevant to the patient. Thus indirectly reducing the complexity of patient care. Treatments are also very limited, particularly with regard to pharmeceuticals. New, patented drugs are rarely covered, and patients are stuck with older, and often outdated treatments. If a new, more effective drug is covered, it will only be available after extended trials of every single less expensive generic alternative are performed, which can take from several months to well over a year. What's worse is that if you've already performed these trials through a private insurance program, and end up on Medicare for whatever reason, your previous medical history is often ignored, and you have to begin all over.

Many more expensive tests and treatments are available, but have huge waiting lists ranging from several months to several years. A lot of even basic procedures aren't even covered. The worst example is dental care. Only the most rudimentary dental care is offered. Restorative work, such as crowns for broken teeth, wasn't available at all until very recently. They were classed as "cosmetic" rather than necessary care. Even now, crowns are only available for visible front teeth, and only in the cheapest, most brittle material (i forget what it's called); and typically only one single treatment per tooth during your entire lifetime, regardless of future damage. No restorative care is available for molars and pre-molars, and extraction/dentures is the only option. This is even worse when you realize that the only reason that even this level of restorative care is available for front teeth is that the results of a government study showed that people with visibly missing teeth had a harder time gaining employment (and therefore getting off of Medicaid). Most private insurance only covers a fraction of the cost of restorative care, but at least they cover some. If you want crowns for your molars and are on Medicaid, you have to pay for it all out of pocket, since you can't get any assistance from any other program (with the exception of one-time charity assistance, IIRC), or you lose your eligibility for Medicaid, and may even come under investigation for fraud.

On the other hand, many states' taxpayer-funded Medicaid programs will cover medical woo like chiropractic and naturopathic "treatment", acupuncture, and even homeopathy. They won't cover real medicine, but they will cover quackery.

And all that is completely aside from the travesty that is the current VA medical program; which I won't even go into.

Again, having experienced two different government programs, as well as 5 different private insurance offerings, as bad as private insurance is currently, it's still preferable to government medical programs.

 

[fls]

First, Medicare is strictly for seniors, and is not comperable to general medical assistance. The federal medical assistance program is Medicaid.

I don't think either are really comparable. What would be reasonably comparable is the health administration costs in another country, such as Canada. But then the difference is even greater. However, I simply wished to point to a US government program (that was at least somewhat relevant) that did manage to operate more efficiently than private businesses. And in some ways Medicare is at a disadvantage as its members are much more likely to need expensive services than the general population.

I will add the caveat that I don't think the general population would be well-served by a simple expansion of either Medicare or Medicaid.

As someone who spent time on public assistance due to disability, whose wife is currently on public assistance for the same reason, and therefore has first-hand knowledge of Medicaid, my own state's "Basic Health" system, and numerous versions of private insurance, I can tell you right now that those numbers are highly misleading. It's an apples to oranges comparison.

Medicaid is "more efficient" simply because they don't offer the same range of coverage as even the least effective private insurance company. There are far too many things they don't cover and won't provide, or cover only in extreme circumstances, and their system is heavily regimented to eliminate a lot of the complexities that private insurance companies are forced to deal with. They don't need the armies of administrators, since they're dealing with far fewer regulations, and far fewer complexities of care, than private agencies. The burden of paperwork is much greater on private companies, not least because they have to deal with regulations and restrictions not only on a federal level, but also for numerous different states whose laws can vary widely, requiring a greater number of administrators and managers to coordinate. Government programs only have to deal with, at most, federal regulations, and the regulations of the single state they operate in. They also have to administer multiple different treatment plans, investigate potential fraud, coordinate and maintain contracts with multiple other agencies, perform billing and collections functions, and multiple other activities that government-run agencies simply don't have to deal with.

But this is really an explanation of why government programs can be run more efficiently and supports my point. Not the part about providing fewer services (which is not a necessary component of a universal system), but the part about the administrative burden.

On top of that, the low remuneration paid by government-funded programs is often well below average market value for services; which means that the majority of the doctors who accept government benefits (not all will) are not what one would call the "best and brightest". They are often those who simply weren't able to cut it in private practice; and treat medicine as an assembly-line process, sticking to cursory observation, with pat diagnoses and treatments that may or may not be relevant to the patient. Thus indirectly reducing the complexity of patient care.

My husband (and to a lesser extent myself) is associated with one of the elite, internationally renown, medical centres in the US, and he (through the institution) provides services to Medicaid patients (as have I), so I beg to differ. Surely what's good enough for kings and presidents is good enough for you?

Treatments are also very limited, particularly with regard to pharmeceuticals. New, patented drugs are rarely covered, and patients are stuck with older, and often outdated treatments. If a new, more effective drug is covered, it will only be available after extended trials of every single less expensive generic alternative are performed, which can take from several months to well over a year. What's worse is that if you've already performed these trials through a private insurance program, and end up on Medicare for whatever reason, your previous medical history is often ignored, and you have to begin all over.

Many more expensive tests and treatments are available, but have huge waiting lists ranging from several months to several years. A lot of even basic procedures aren't even covered. The worst example is dental care. Only the most rudimentary dental care is offered. Restorative work, such as crowns for broken teeth, wasn't available at all until very recently. They were classed as "cosmetic" rather than necessary care. Even now, crowns are only available for visible front teeth, and only in the cheapest, most brittle material (i forget what it's called); and typically only one single treatment per tooth during your entire lifetime, regardless of future damage. No restorative care is available for molars and pre-molars, and extraction/dentures is the only option. This is even worse when you realize that the only reason that even this level of restorative care is available for front teeth is that the results of a government study showed that people with visibly missing teeth had a harder time gaining employment (and therefore getting off of Medicaid). Most private insurance only covers a fraction of the cost of restorative care, but at least they cover some. If you want crowns for your molars and are on Medicaid, you have to pay for it all out of pocket, since you can't get any assistance from any other program (with the exception of one-time charity assistance, IIRC), or you lose your eligibility for Medicaid, and may even come under investigation for fraud.

I think they set the bar pretty high on Medicaid (on the scale from Death, Disability, Disease, and Discomfort to Dissatisfaction) to cover only the first three. I will admit that I don't consider Medicaid the model to adopt for a general program.

On the other hand, many states' taxpayer-funded Medicaid programs will cover medical woo like chiropractic and naturopathic "treatment", acupuncture, and even homeopathy. They won't cover real medicine, but they will cover quackery.

This is disturbing. There are similar situations in Canada (many provinces cover Chiropractic but not Physiotherapy).

And all that is completely aside from the travesty that is the current VA medical program; which I won't even go into.

Again, having experienced two different government programs, as well as 5 different private insurance offerings, as bad as private insurance is currently, it's still preferable to government medical programs.

Has anyone proposed providing universal coverage by expanding Medicare and/or Medicaid?

Linda

 

[ponderingturtle]

Except that the vast majority of employers, even smaller ones, typically offer a range of choices as well. Sometimes they're simply different packages (HMO/EPO/PPO/etc.) from the same provider, and sometimes they're different packages from different providers. In my 20 years of employment, I have never encounterd a business large enough to provide insurance to its employees, who didn't offer at least two package choices (typically HMO/EPO vs. PPO).

Well I have about four choices from one company, that is very far from the free market that the poster that was a responce to was suggesting.

 

[cafink]

Just a note... "market forces" are inherently inhumane.

Do you have any justification for this assertion, or would your prefer simply to stick with your "inhumane sociopath" ad hominem attack?

Remember, folks, the purpose of life is to make profit... and if you cannot provide profit to some millionaire, you're better off dead anyway, aren't you?

Wow, a strawman, too. Impressive.

 

[cafink]

Wrong, I said only available supply of the drug that can be utilized in a timely fashion.

No--that is not, in fact, what you said. To refresh your memory, I shall quote the relevent portion of the post in question:

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.

 

[Architect]

This discussion seems to be moving into the efficiency or otherwise of the US Medicare/Medicaid system, and there is some dispute as to its effectiveness amongst posters, so let me just bring up some of the points made in the old “this is the government you want to run healthcare” thread back at the beginning of the year. In doing so I have quote numerous posters, so apologies for not having credited them.

In the UK, Canada, and mainland Western Europe we have universal healthcare systems such as the NHS. In the case of the NHS, it is entirely free at the point of delivery to all UK residents (whether foreign nationals or otherwise) regardless of whether said individuals might have paid taxes or national insurance contributions.

In the UK there is also private provision, but it is far smaller than the NHS and generally only used for elective surgery such as cosmetic work. Private sector consultants generally also work in the NHS, and all treatments are regulated in the same manner. In short, barring private rooms and getting to choose exactly when your surgery is, there’s not a lot of difference.

Now, in the US Medicaid costs a larger percentage of GDP than the NHS does the British taxpayer. (44.7% of 14.7%=6.6%) was public, as opposed to the UK's (83.4% of 7.7%=6.3%) of GDP (Source: OECD Health Data 2007 - Frequently Requested Data)

Another study indicated that the US spends $6,102 per person from government coffers and get 44% of healthcare costs paid. In the UK we pay a third of this, and get 86% of ours, double what you get.

(source: http://66.102.9.104/search?q=cache:O...ox-aHere's )

These figures don’t include items such as people's private medical insurance premiums in the US. This article (I have no idea of the provenance of the site) seems to break it down in a sensible manner: http://www.nchc.org/facts/cost.shtml

By several measures, health care spending continues to rise at the fastest rate in our history.

In 2007, total national health expenditures were expected to rise 6.9 percent — two times the rate of inflation.1 Total spending was $2.3 TRILLION in 2007, or $7600 per person.1 Total health care spending represented 16 percent of the gross domestic product (GDP).

...snip...

In 2007, employer health insurance premiums increased by 6.1 percent - two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,100. The annual premium for single coverage averaged over $4,400.2

...snip...

So what we seem to have is:

1. The US spends 6.6% of GDP on state-funded heathcare. [/font]
2. That provision covers only 37 million people, or 12.3% of the population.
3. That leaves 87.7% of the population being covered by private health spending.
4. Total healthcare spending in the USA is significantly more than this, circa was 15% of GDP.

Does this not therefore suggest that 87.7% of the population, that is 263 million people, is being cared for privately by spending only 8.4% of GDP?

Taken at face value, this would suggest that per skull, state-funded care costs over five-and-a-half times as much as private care.

Okay, but perhaps this is because you get better healthcare than us. Let’s look beyond costs and scare headlines such as this (http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm) to life expectancy, which is generally accepted as a good measure of overall health.

US:

Infant mortality rate:
total: 6.37 deaths/1,000 live births
male: 7.02 deaths/1,000 live births
female: 5.68 deaths/1,000 live births (2007 est.)


Life expectancy at birth:
total population: 78 years
male: 75.15 years
female: 80.97 years (2007 est.)

Canada:

Infant mortality rate:
total: 4.63 deaths/1,000 live births
male: 5.08 deaths/1,000 live births
female: 4.17 deaths/1,000 live births (2007 est.)

Life expectancy at birth:
total population: 80.34 years
male: 76.98 years
female: 83.86 years (2007 est.)
[
UK:

Infant mortality rate:
total: 5.01 deaths/1,000 live births
male: 5.58 deaths/1,000 live births
female: 4.4 deaths/1,000 live births (2007 est.)

Life expectancy at birth:
total population: 78.7 years
[male: 76.23 years
female: 81.3 years (2007 est.)

I don't think anybody is claiming that the US provides inadequate healthcare for the wealthy, expensive maybe, but not inadequate. However you’re paying massively more for a service which does not cover everyone and does not appear to provide any better quality of treatment.

Now, of course, you might claim that this massive cost is subsidising development of new drugs – and my goodness, what a subsidy that would be – but, being sceptical, we’d need to see a breakdown which showed that the massive difference wasn’t simply due to (say) paying doctors obscene salaries, making profits for healthcare shareholders, and so on. What proportion, in fact, of US medical expenditure goes on drugs – and new drugs specifically – in contrast to (for example) the UK system?

 

[This is The End]

How many of the people who are against Universal health care believe those who are for it all just want something for free? Would these same people be against free education up to a reasonable year/grade/level as well?

 

[fls]

So what we seem to have is:

1. The US spends 6.6% of GDP on state-funded heathcare.
2. That provision covers only 37 million people, or 12.3% of the population.
3. That leaves 87.7% of the population being covered by private health spending.
4. Total healthcare spending in the USA is significantly more than this, circa was 15% of GDP.

Does this not therefore suggest that 87.7% of the population, that is 263 million people, is being cared for privately by spending only 8.4% of GDP?

Taken at face value, this would suggest that per skull, state-funded care costs over five-and-a-half times as much as private care.

Just a comment on this part (without addressing whether or not it is reasonable to break down the numbers in that way)...

Health is strongly (negatively) correlated with age and socioeconomic status - the criteria used for Medicare and Medicaid. You have effectively taken those people most likely to need health care services and compared the cost of that care to those people least likely to need health care services. When the differences in cost due to differences in need dominate the comparison, you can't really draw any conclusions about what else may contribute to those differences (such as efficiency).

Linda

 

[Architect]

If we factor in private health coverage costs, though, the US spends circa 15% of its GDP on healthcare across the entire population however the UK spends significantly less for universal coverage despite it being a public system with comparable standards of treatment. Why is this?

 

[fls]

If we factor in private health coverage costs, though, the US spends circa 15% of its GDP on healthcare across the entire population however the UK spends significantly less for universal coverage despite it being a public system with comparable standards of treatment. Why is this?

A chunk of that is excess administrative costs and defensive medicine. Otherwise it's that generally goods and services provided by the health care system are more expensive in the US.

And I forgot to mention profit.

Linda

 

[Architect]

Evidence? Source?


ETA: I'd mentioned profit already, and that also presumably comes under the "services" heading you meantioned.

 

[fls]

Evidence? Source?

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

ETA: I'd mentioned profit already, and that also presumably comes under the "services" heading you meantioned.

Services are things like physician visits and hospital care.

Linda

 

[Gord_in_Toronto]

To get back to the topic of this thread -- Universal Healthcare and Research and Development

Medical research results reported just this week from the centre of socialized medicine aka the Province of Ontario:

http://canadianpress.google.com/article/ALeqM5i7XhFSfrDzwsqtFdHV367Q0r0eUQ
Early detection of autism in babies -- McMaster University, Hamilton, Ontario.

Note that additionally this research absolutely destroys the "vaccination cause autism" idiocy!

http://canadianpress.google.com/article/ALeqM5jdB29IseRj3rw2d7eD5PyCtmeNhA
Women deficient in vitamin D when diagnosed with breast cancer may have a poorer prognosis compared to those with optimal amounts of the sunshine nutrient in their blood -- Mount Sinai Hospital, Toronto.

www.thestar.com/News/article/426684
Fortification of Salt with Iron -- potential to save millions of lives of people with iron deficiency -- University of Toronto.

Not one of them supported by a drug company as far as I can tell. It's not just drugs that saves lives. It's not just the profit motive that drives research.

 

[Architect]

http://assets.opencrs.com/rpts/RL34175_20070917.pdf

What does the United States get for the money it spends? Said slightly
differently, does the United States get corresponding value from the money it spends on health care? The available data often do not provide clear answers. For example, among OECD countries in 2004, the United States had shorter-than-average life expectancy and higher-than-average mortality rates. Does this mean that the U.S. system is inefficient in light of how much is spent on health care? Or does this reflect the greater prevalence of certain diseases in the United States (the United
States has the highest incidence of cancer and AIDS in the OECD) and less healthy lifestyles (the United States has the highest obesity rates in the OECD)? These are some of the issues that confound international comparisons.​

However, research comparing the quality of care has not found the United States to be superior overall. Nor does the U.S. population have substantially better access to health care resources, even putting aside the issue of the uninsured. Although the United States does not have long wait times for non-emergency surgeries, unlike some OECD countries, Americans found it more difficult to make same-day doctor’s appointments when sick and had the most difficulty getting care on nights and weekends. They were also most likely to delay or forgo treatment because of cost.​

However this is particularly interesting (my emphasis):

Prices. Although OECD data does not compare prices of medical care, other studies have found that the United States pays higher prices for medical care than countries such as Canada and Germany. Part of the reason for this may be that U.S. general practitioners and nurses are the highest paid in the OECD, and U.S. specialists are the third-highest paid in the OECD (Table 2). Health professionals in wealthier countries earn higher salaries than those in poorer countries (Figure 14), but even accounting for this, U.S. health professionals are paid significantly more than the U.S. GDP would predict (for example, specialists are paid approximately $50,000 more than would be expected). However, U.S. health care professionals also enter the careers with substantially more educational debt than in other OECD countries. For example, in 2006, 62% of new U.S. medical school graduates had educational debt exceeding $100,000.102​

and​

Health Administration and Insurance. Spending on health administration
and insurance cost $465 per person in the United States in 2004, which was seven times that of the OECD median (Figure 20).​

So, you pay your staff too much. Hmm. That's profit on services, btw.​

Anyway, the interesting thing is that no-where does the paper mention the cost of R&D! Or Drugs!​

 

[fls]

So, you pay your staff too much. Hmm. That's profit on services, btw.

I was trying to think of characteristics that were fairly unique (or at least specific) to the US system. Providers of goods and services generally enjoy a profit, regardless of the system. But enjoying a profit from administering healthcare is specific to the US system. I was thinking of the latter when I said "profits".

Anyway, the interesting thing is that no-where does the paper mention the cost of R&D! Or Drugs!

It does mention the cost of drugs starting on page 22.

I think that the reason R&D isn't mentioned is because medical advances aren't generally financed by the healthcare system.

The myth that excess drug prices finance R&D has yet to be supported by evidence. We are now on page 2 of this thread, and while the usual players have shown up to argue the usual rhetoric, they still haven't provided us with any information that confirms this idea. All I have is information that disconfirms it.

Linda

 

[Architect]

As far as I can see from the paper - and I think we agree on this - the only additional costs readily identified are administration, staff costs (i.e. in view of higher salaries), and profit for private sector providers.

But nothing usggesting that it's because of R&D into new drugs in comparison to other comparable countries.

 

[fls]

As far as I can see from the paper - and I think we agree on this - the only additional costs readily identified are administration, staff costs (i.e. in view of higher salaries), and profit for private sector providers.

I don't agree that those are the only readily identifiable additional costs. There is also the issue of defensive medicine (which depends more upon legal reforms) and early adoption of new technologies (early adopters tend to pay a higher price (just like the consumer who buys the first Blu-Ray players)).

But nothing usggesting that it's because of R&D into new drugs in comparison to other comparable countries.

I think the argument includes R&D for new drugs and for new technologies (I'm guessing, since it's not my argument). Novel drugs are just as likely (maybe even more likely) to come from government and foundation sponsored research, and non-US pharmaceutical sponsored research, as they are to come from US pharmaceutical companies. And profits and marketing both exceed the amount spent on R&D by pharmaceutical companies, which means that there is a large cushion before reduction in revenue would necessarily lead to reduction in spending on R&D.

When it comes to new technologies, the US is usually an early adopter, so a change in the system could lead to a change in how rapidly a new machine is taken up (and thereby influencing profits). However, new medical technologies tend to have a minuscule (if any) affect on health. Even if we concede that the supply may be affected by a change to a universal healthcare system, it's hard to see how that could influence outcomes in a way that was comparable to the influence from improving access.

Since it doesn't look like evidence is going to be forthcoming, I guess we'll just have to stick with discussing it amongst ourselves?

Linda

 

[Architect]

I don't agree that those are the only readily identifiable additional costs. There is also the issue of defensive medicine (which depends more upon legal reforms) and early adoption of new technologies (early adopters tend to pay a higher price (just like the consumer who buys the first Blu-Ray players)).

Perhaps, and almost certainly a significant cause of the discrepancy in expenditure between the US and some countries, however we're talking about the likes of the UK, France, Germany, and Canada - comparable countries with a universal, predominantly public-sector healthcare systems which are also early adopters of new technology.

Even if we concede that the supply may be affected by a change to a universal healthcare system,

...which doesn't seem to be the case in the aforementioned countries....

it's hard to see how that could influence outcomes in a way that was comparable to the influence from improving access.

Indeed. A society where a significant number of people are unable to access vital healthcare because of concerns about cost seems to me to have failed in its duty of care to its own citizens.

Since it doesn't look like evidence is going to be forthcoming, I guess we'll just have to stick with discussing it amongst ourselves?

I fear you may be correct. What happened to all the pro-private sector market-led healthcare supporters?

 

[Wildy]

As far as I can see there isn't very much evidence that supports the idea in question.

On a similar but different note, why do researchers go to the US or companies invest more in the US?

I've encountered a guy who is claiming that it is because of other countries having universal healthcare, but I think that there are other factors involved as well.

Would I be right in saying that the US is a more business friendly country?