Reply
 
Thread Tools Display Modes
  #101  
Old 09-11-2018, 01:26 PM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
puddleglum, the one thing you have right is that making the government pay for our current system is dead stupid. Our system is a ridiculous, overpriced, overcomplicated mess. The SYSTEM is what needs to be changed, not just who pays for it. The SYSTEM is why other countries pay half what we do for health care.

There are 50 systems out there that provide high quality health care far cheaper than ours, we need to understand why and apply those concepts to our own country.
  #102  
Old 09-11-2018, 01:58 PM
Chisquirrel Chisquirrel is offline
Member
 
Join Date: Mar 2016
Posts: 2,185
Quote:
Originally Posted by puddleglum View Post
The first way is better than the second way because having the government bankrupt itself trying to pay for everyone's healthcare has consequences that are much worse than rising insurance premiums.
So you're happy paying more for your healthcare than you have to? How Democratic of you!
  #103  
Old 09-11-2018, 02:03 PM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
Quote:
Originally Posted by Chisquirrel View Post
So you're happy paying more for your healthcare than you have to? How Democratic of you!
Hey, someone has to subsidize the French system by paying for all the health care R&D. How else can they get the same drugs we get for 1/3rd the cost?
  #104  
Old 09-11-2018, 02:05 PM
Dewey Finn Dewey Finn is offline
Charter Member
 
Join Date: Apr 2003
Posts: 26,711
The pharmaceutical companies in France (and virtually every other country) aren't spending billions on marketing and advertising prescription medicines to consumers. That's one way they get the same drugs for one third the cost.
  #105  
Old 09-11-2018, 02:33 PM
senoy senoy is offline
Guest
 
Join Date: Feb 2018
Posts: 1,400
Quote:
Originally Posted by Dewey Finn View Post
The pharmaceutical companies in France (and virtually every other country) aren't spending billions on marketing and advertising prescription medicines to consumers. That's one way they get the same drugs for one third the cost.
Fifty percent of Roche's revenue comes from the US compared to only 22% coming from all of Europe. Sanofi's revenues are closer, but US revenues were 12 billion last year compared to 9 billion for Europe and 10 billion for the rest of the world. 57% of all new pharmaceuticals between 2000 and 2010 came from American pharmaceutical companies. It's clear that American dollars are what is funding the pharmaceutical industry and I don't think many people would argue with that.
  #106  
Old 09-11-2018, 02:34 PM
elbows elbows is offline
Charter Member
 
Join Date: Jan 2000
Location: London, Ontario
Posts: 13,890
The other way is, they negotiate as a large group. It ain’t rocket science, the bigger the amount you’re purchasing the better price you’re going to get. America has millions of separate, much, much smaller groups. Not by accident either, it insures much, much higher profits.

The two things combined, negotiating as a large group and no advertising costs, create a truly substantial savings.

Isn’t blaming countries who negotiate smarter something y’all should admire? Maybe America just needs a better deal maker?

Yeah, more of the profit comes from the US, that’s where they get to freely exploit a system they constructed to purposely maximize their take! Blaming people who built a smarter system is kinda silly.

Last edited by elbows; 09-11-2018 at 02:36 PM.
  #107  
Old 09-11-2018, 02:43 PM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
I don't think it's so much negotiating as a large group as negotiating as a sovereign country. Guaranteed, we have insurers with far more customers than live in Iceland, but they don't get the prices Iceland gets.
  #108  
Old 09-11-2018, 02:52 PM
Nava Nava is offline
Guest
 
Join Date: Nov 2004
Location: Hey! I'm located! WOOOOW!
Posts: 39,948
Quote:
Originally Posted by senoy View Post
Fifty percent of Roche's revenue comes from the US compared to only 22% coming from all of Europe. Sanofi's revenues are closer, but US revenues were 12 billion last year compared to 9 billion for Europe and 10 billion for the rest of the world. 57% of all new pharmaceuticals between 2000 and 2010 came from American pharmaceutical companies. It's clear that American dollars are what is funding the pharmaceutical industry and I don't think many people would argue with that.
Part of it is because Americans are much more medicated; well, those who can afford it. Also, there are companies which make some medications available only in specific markets and if they can, one will be the US; I remember one instance where Novartis made one such med, specifically one which had to be taken for a week every year for the rest of the patient's life, available only in India (1) and in the US (2).

And did Mylan's research on epinephrine take place in the US? The US is where they came up with a price hike that would have gotten the racks taken out of museums and put back into service in pretty much any other country...




1: where the price was less than $500/year, and pretty much anybody could get it for nothing; one of the patients which they used in their publicity was a member of the Olympic Sailing Team who'd been diagnosed in India, traveled to the US for a second opinion and was getting it for free as he qualified based on his income.
3: where the price was 30K/year, period.
__________________
Evidence gathered through the use of science is easily dismissed through the use of idiocy. - Czarcasm.

Last edited by Nava; 09-11-2018 at 02:56 PM.
  #109  
Old 09-11-2018, 04:07 PM
Lemur866's Avatar
Lemur866 Lemur866 is offline
Charter Member
 
Join Date: Jul 2000
Location: The Middle of Puget Sound
Posts: 22,238
Also, he's acting as if people in the United States are paying for their health care out of pocket, and if suddenly a third party started paying for it, everyone would start going to the doctor more often and getting more medical care, because now it's free.

Except, dude, few people in the United States pays for medical care out of pocket, except for cosmetic surgery. Most people have health insurance, either through their job, or their spouse's job, or their parent's job, or from a government program. Or, they go to the emergency room with an injury, get treated, and then walk away because they have no money and no insurance and the emergency room can't legally toss bleeding people into the gutter to die.

You already subsidize the disabled and the elderly through medicare and medicaid. You already subsidize former military through the VA. You already subsidize the destitute and the homeless and the judgement-proof through emergency room treatment.

YOU ALREADY PAY FOR THIS. The advantage to a systematic system is that we can replace the giant roulette wheel that's spun every time you visit the doctor to see how much you're going to pay--is it free? Is it a $10 co-pay? Is it $50,000?

We're not talking about the government taking over health care. Private health care providers will still exist. We're talking about the government taking over health insurance, not health care.

And if you're upset because a government death panel is then going to refuse to pay for grandma's toe fungus, why aren't you upset when a private insurance death panel refuses to pay for grandma's toe fungus?

The bottom line is that you'd rather pay more for worse coverage, if that means that certain people who don't deserve it will get nothing. You're like the Russian peasant who finds a genie's lamp, and is upset to find that whatever he wishes for his neighbor will get twice as much, until he wishes to be beaten half to death.
  #110  
Old 09-11-2018, 04:21 PM
wolfpup's Avatar
wolfpup wolfpup is offline
Guest
 
Join Date: Jan 2014
Posts: 9,461
Quote:
Originally Posted by puddleglum View Post
What progressives are actually saying is not to make the system more efficient, but to change to a Medicare for all model. That is not because it is the best possible system but it is one of the few possible ways to get to single payer. We could get costs down to Canada's if the government agreed to cut provider benefits 25-40% and limit access to specialists and expensive technology. Neither is politically possible or even close to it. We could get to Canada's present level of spending if we started from Canada's level of spending in the 1960s and 70s. However, we can only start from the present system.
As discussed in the other thread, "Medicare for all" is a nebulous term with a lot of different possible implementations, but it should be obvious that if the US achieved substantially the same health care system as Canada, that costs would be roughly the same. So the obstacles are political and should be recognized as such.

FTR, the health care systems in other countries -- and speaking of Canada specifically -- do not "limit access to specialists and expensive technology". A patient is free to see any specialist he wants, but because patients are typically not qualified to know what specialist is appropriate, a referral is typically required for the first appointment -- that isn't a restriction. Insurance company restrictions, out-of-pocket costs, and the limitations of provider networks are real restrictions, and those are inherent in the US system, not single-payer. Nor are there restrictions on "expensive technology". Everyone who needs an MRI or CT scan can get one in an appropriately timely fashion. What is absent is the profligate waste that exists in the US system, where provider fees are so outrageously inflated that these million-dollar machines and the staff to operate them can sit around idle.
Quote:
Originally Posted by puddleglum View Post
Discussion of which party made the cuts is the kind of stuff which would only interest a Canadian. It does not matter which party it is that enacts conservative policy, only that it gets enacted.
If the Canadian experience isn't relevant, why did you bring it up? But since you did bring it up, I thought it appropriate to point out the wonderful irony that it was liberal philosophy that led to this fiscal responsibility. This observation seems particularly relevant in a thread seeking to show that liberal policies would lead to the debacle of Venezuela.
Quote:
Originally Posted by puddleglum View Post
The first way is better than the second way because having the government bankrupt itself trying to pay for everyone's healthcare has consequences that are much worse than rising insurance premiums.
I fail to see how it would bankrupt the government to take the money it is already spending on health care and use it more efficiently to provide health care for all. Even if one assumed a system so grossly inefficient that taxes had to be raised, I don't see the problem with getting the same or better health care for half the cost but paying it in taxes instead of insurance premiums.
Quote:
Originally Posted by puddleglum View Post
One of the reasons that Medicare is able to pay less to doctors is the difference between marginal cost and average cost. Medicare is able to pay closer to the marginal cost because private insurers pay the average cost. When Medicare pays everything that will no longer be the case and providers will have to swallow the loss.
No. The gigantic fallacy here is assuming that Medicare for all or some type of single-payer UHC will pay for everything but nothing else will change. This is absolutely false. The simple facts are that the present health care system has more forms, paperwork, and bureaucracy to deal with it all than I've ever seen in my life, whereas in the single-payer system I'm familiar with I've never even seen a single form. The costs of this bureaucracy are estimated to be on the order of $500 billion a year. Providers not only have to pay for this overhead, they also have to endure losses from insurers and patients who don't pay them. Under a reasonably implemented UHC system, providers won't be swallowing losses -- they'll be enjoying unprecedented efficiency and be relieved of one of the most frustrating aspects of their profession. One of the complaints frequently heard from American doctors is that they didn't go to medical school to learn how to argue with insurance bureaucrats.
Quote:
Originally Posted by puddleglum View Post
It makes a huge difference who pays. People react to taxes differently than they react to other expenses. Because no matter how much or little you pay in taxes you receive the same benefit. Thus there is no benefit or incentive to pay more in taxes.
They do? Not that I've noticed, unless this is another uniquely American phenomenon associated with aversion to government. What I've seen is that people don't necessarily object to higher taxes, but they want to know what they're getting for it. Better schools, better health care, safer and more pleasant communities, and sustainable fiscal policies with balanced budgets are all considered good reasons for paying taxes.

Last edited by wolfpup; 09-11-2018 at 04:25 PM.
  #111  
Old 09-11-2018, 06:51 PM
Sam Stone Sam Stone is offline
Member
 
Join Date: Jun 1999
Posts: 27,339
Quote:
Originally Posted by wolfpup View Post
As discussed in the other thread, "Medicare for all" is a nebulous term with a lot of different possible implementations, but it should be obvious that if the US achieved substantially the same health care system as Canada, that costs would be roughly the same. So the obstacles are political and should be recognized as such.
Nonsense. The costs won't be the same, because Canada and the U.S. are not the same. For one thing, Canada free-rides somewhat on U.S. healthcare spending. Drugs are typically more expensive in the U.S. than in Canada, because Americans are on average richer than Canadians.

For an example of how intrinsic differences matter, consider education. The U.S spends significantly more per student on K-12 education than does Canada ($12,700 in 2014, vs $10,300 for Canada), but our students on average score much better on standardized tests and in measures such as graduation rates and college attendance. The OECD rankings has Canada ranked 10th in Math, and the U.S. is 41st, below the OECD average. Canada is 3rd in reading, and the U.S. is 24th. Canada is 7trh in science, and the U.S. is 25th.

If the differences always just come down to universal coverage or how much we spend, how do you explain this? Perhaps things as complex as a national education system or a national health care system can not be boiled down to something as simple as single payer vs market?

Our costs of living are very different as well. Large percentages of the U.S. population live in very expensive cities like New York, San Francisco, Los Angeles, etc. This drives up the salaries of doctors. The U.S. also has a fatter, less healthy population, more violence, and is different from Canada in many other ways that affect health care costs.

In addition, although many people think that UHC is more efficient because of economies of scale, it's exactly the opposite. Economies of scale only apply to industries with high fixed costs but low marginal costs, such as manufacturing. Economies of scale happen because you can amortize the fixed costs over more sales. But service-based industries are not like that at all. Opening a new hospital also means adding bureaucracy at every level. Every new doctor requires just as much managerial expansion. In fact, centrally planned systems behave in the opposite fashion - the bigger they get, the more top-heavy and unwieldy they become, and the less responsive they are to regional or individual needs. This is why huge corporations eventually die - their bureaucracies can no longer manage the complexity and they make increasingly poor decisions.

Universal Health Care may on balance be better than the hodge-podge of legislation, subsidy, market and government that is the U.S. system, but making categorical statements about what will be cheaper are not warranted. It may turn out to be far more expensive. You won't know until you run the experiment.

Quote:
FTR, the health care systems in other countries -- and speaking of Canada specifically -- do not "limit access to specialists and expensive technology". A patient is free to see any specialist he wants, but because patients are typically not qualified to know what specialist is appropriate, a referral is typically required for the first appointment -- that isn't a restriction.
You do know that Canadians can't always find family doctors? This is especially true in rural regions, but even in the cities. And even if you have one, getting an appointment can take weeks sometimes, and a referral to a specialist can take months.

We have another problem in Canada that's not discussed much - the quality of our doctors is declining, especially in the rural areas. Because of our rigid fee schedules, it can be difficult to find doctors willing to work in rural areas for standard fees. The result is that Canada has gone fishing for doctors around the world, while not looking too closely at their history. We picked up quite a few from South Africa in the past decade. Some of these doctors are good, and some are terrible.

My mother died two years ago. About five years ago, she started feeling stomach pains. She went to her 80 year old small city doctor, who told her it was her gall bladder, and gave her some medicine. The medicine did nothing. She went back again, and told him she thought it was something else. He disagreed, and gave her a different medicine. This went on for two years, while her condition got worse.

Finally, she asked for a referral to a specialist. The closest one was in Edmonton, four and a half hours away. It took her four months to get an appointment. When she finally did, it took them a day to discover she had bowel cancer. They booked an appointment with a cancer specialist - a month away. Her condition continued to deteriorate. The Cancer specialist sent her to a radiologist - another month delay. By this time she was bedridden and had lost about 40 pounds and was very weak. The radiologist scheduled her for Chemo - in another three weeks. Finally the time came, she was checked into the hospital, and the attending doctor decided she was too weak for chemo or surgery. She was sent to a hospice to die, which she did about a month later.

My son plays violin, and was thinking of a career in music. Then he started getting numbness in his last two fingers, and we got him an appointment with a specialist. Because it was non-life threatening, he waited for three months to see someone - three months during which he could not practice either his violin or piano. We finally got in, and the doctor misdiagnosed him and told him it was just an RSI and he'd be fine if he just took it easy and rested his hand a bit more often. I was unhappy with that, because I worried that it was his Ulnar nerve (the symptoms matched exactly), and if untreated could result in permanent damage and end his music career. We asked for a referral to another doctor for a second opinion, and the first doctor blew his top. He finally agreed, but said it could take three or four months before the second doctor would contact us with an appointment.

We waited for four months. Nothing. So we called the original doctor's office, and the secretary said that the referral was still sitting on his desk - he didn't bother to send it, probably because he was mad that we dared question him. That's the kind of thing you can do when you can't be fired.

We eventually got my son in to the second specialist, where he quickly diagnosed him with an ulnar nerve issue, and it turned out that his ulnar nerve was now over 50% deteriorated. He was right on the line for needing surgery, but first the doctor decided to immobilize his arm, which eventually worked. But he had to give up the violin and stay only with piano. Had we just accepted the first doc's snap diagnosis, my son would likely have permanent nerve damage in his hand and be unable to play and do other things.

My grandmother had to walk with a cane and be in excruciating pain for YEARS while on a waiting list for a knee replacement. Non-essential surgeries like knee and hip replacements can have very long waiting lists.

This is how it can go in Canada. Sometimes it goes smoothly and great. If you are a pregnant woman, you'll generally get excellent care. If you are a smart, educated person who can work the system and who the doctor thinks is worth his time, you might get good care. But if you are poor and disadvantaged, or you look like a biker or some other low-life, you can expect indifferent care and sometimes outright rejection from the system.

I don't know how waiting lists compare to how long you wait in the states, but you might like to read this: Waiting your turn-wait times for health care in Canada 2017. From that document, here are some tidbits:

Quote:
From referral by a general practitioner to consultation with a specialist. The waiting time in this segment increased from 9.4 weeks in 2016 to 10.2 weeks this year. This wait time is 177% longer than in 1993, when it was 3.7 weeks. The shortest waits for specialist consultations are in Ontario (6.7 weeks) while the longest occur in New Brunswick (26.6 weeks).

From the consultation with a specialist to the point at which the patient receives treatment. The waiting time in this segment increased from 10.6 weeks in 2016 to 10.9 weeks this year. This wait time is 95% longer than in 1993 when it was 5.6 weeks, and more than three weeks longer than what physicians consider to be clinically “reasonable” (7.2 weeks). The shortest specialist-to-treatment waits are found in Ontario (8.6 weeks), while the longest are in Manitoba (16.3 weeks).
So on average, AFTER you have had a referral from your family doctor, the average wait time until you actually start receiving treatment is 21.2 weeks, or a little over five months. That's the average for the country. Some provinces are slightly better, some a lot worse. 2.9% of all Canadians are currently on a waiting list for medical treatment. How does that compare to the U.S.?

And notice that things are getting worse, not better. This is typical of government systems. When they first start out, everything is new and fresh. Everyone is trying hard. Politicians and the public are carefully watching.

But once the system is in place, rot starts to set in. Public unions prevent necessary reforms, the people in the system start to burn out, etc. You can see that in education, you can see it in health care (look at the Veteran's administration in the States, for God's sake. You even see it in large corporations or anywhere else where rigid bureaucracies form. They rot from the inside. In the free market, such corporations eventually die and are replaced - a process of constant renewal. In government, such systems can persist indefinitely. So even if Canada's health care system is okay today, it was better five years ago, and it's likely to be worse five years from now.

Quote:
Nor are there restrictions on "expensive technology". Everyone who needs an MRI or CT scan can get one in an appropriately timely fashion.
From the document above, "This year, Canadians could expect to wait 4.1 weeks for a computed tomography (CT) scan, 10.8 weeks for a magnetic resonance imaging (MRI) scan, and 3.9 weeks for an ultrasound."

How does that compare to the U.S.? Do you on average have to wait two and a half months for an MRI? Maybe you do, but now you have the Canadian numbers to compare. And bear in mind that an MRI or CT scan has to be ordered by a specialist - who already took you 10-20 weeks to see.

So imagine: you feel a pain in your stomach. You decide to see your doctor. You wait two weeks for an appointment. Then your doctor refers you to a specialist. You go home and wait for a few months. Finally you get in to see the specialist, who orders an MRI. You go home and wait for two more months. Then you get the MRI, and it shows a problem. You go back to your specialist (maybe waiting another couple of weeks for a follow-up appointment), and he decides to book you in the hospital for surgery - in another two months. Is that comparable to what would happen in the U.S.? Because that seems like a pretty average outcome in Canada.

Another reason why Canada's health care costs are lower is that we do not pay for extreme life-saving measures and many optional surgeries. If you want an artificial heart, or you want surgery to transition from male to female or vice versa, you're traveling to the states to get it done. In fact, medical tourism from Canada to the U.S. is big business, because if you are wealthy and suspect you have cancer, you're likely to pay for fast diagnosis and treatment in the U.S. rather than wait for months in Canada. Or if you need a hip replacement or a knee replacement and you are in agonizing pain, spending your life savings on U.S. surgery might be better than waiting five years for your 'free' surgery in Canada.

This is not a small thing. Last year, [url=https://www.ctvnews.ca/health/63-000-canadians-left-the-country-for-medical-treatment-last-year-fraser-institute-1.3486635]63,000 Canadians went to the U.S. for medical treatment. If our system is so great, why did 63,000 Canadians choose to pay out of pocket for American health care rather than waiting for 'free' Canadian health care?

This brings me to my biggest worry about universal health care - early adopters. In every industry, the wealthy pay for the innovations that eventually trickle down to everyone. We wouldn't have airbags or stability control in cars today if Mercedes Benz couldn't charge a premium to develop them. We wouldn't have cheap personal computers if wealthy people in the 1980's weren't around to pay $5000 for an IBM PC with a hard drive. We might not have cell networks if there weren't Gordon Geckos around willing to pay $1000/mo for a car phone. If we one day get cheap artificial hearts, it will be in part because millionaires paid for the early ones. If we get cheap access to space, it will be because billionaires and millionaires paid for rocket development when it was expensive.

If you make something universal and the government pays for it, you can bet that no one is going to approve $20 million dollars for an experimental artificial heart that might keep you alive for another year. But in a free market, rich people can spend that money, and eventually the technology matures, costs come down, and we all benefit. There's a reason why the U.S. leads the world by far in medical research.

Oh, and one other thing - Canada's government health care costs are somewhat lower because there are a lot of treatments the Canadian government doesn't pay for. For example: prescription drugs, vaccinations, dentistry, optometry, podiatry, psychology, fertility treatments, gender assignment, cosmetic surgery, and a long list of other things. Many Canadians carry supplemental health insurance for these things - or go to the U.S. for them.

Quote:
No. The gigantic fallacy here is assuming that Medicare for all or some type of single-payer UHC will pay for everything but nothing else will change. This is absolutely false. The simple facts are that the present health care system has more forms, paperwork, and bureaucracy to deal with it all than I've ever seen in my life, whereas in the single-payer system I'm familiar with I've never even seen a single form.
That doesn't mean the forms aren't there. While I was sitting in the hospital with my mother, I developed a headache. The little hospital pharmacy was closed, so I went to the front counter and asked the nurse if they had any Tylenol. Just plain over-the-counter Tylenol. Well... they couldn't do it without a doctor ordering it, so they opened up a file on me. Then I had to get my heart checked, blood pressure, etc. Then the resident had to come and do the formal admission. Finally, after all that I was given a little manila envelope with four Tylenol tablets. I figure the cost to the system for those four tablets probably came to several hundred dollars. If their little hospital store had been open, I could have walked in and bought an entire bottle of the same thing for $5.

Look, you can organize a complex system like health care in two ways - one is to let the market order it. The other is to have a bureaucracy do it. There is no other way. And a national bureaucracy for health care is massive.. When you have to micro-manage everything, there will be paperwork galore. It's just that you don't see it in Canada because it's done behind the scenes. But as the husband of a health care professional, I can tell you that they spend one hell of a lot of time shuffling papers and justifying everything they do and every dollar they spend. There are no free lunches.

The problem with the U.S. is that they do neither - they pretend to have 'free market' health care, where in fact everything is still controlled by huge bureaucracies. A large chunk of health care (the elderly and the poor and veterans) already get single payer health care. Would you say that their outcomes are particularly good? if going to single payer will save so much money, how come Medicaid and Medicare cost so much? I believe the U.S. spends more per capita on Medicare alone than Canada spends to cover everyone. So why is your government health care so much worse?

Quote:
What I've seen is that people don't necessarily object to higher taxes, but they want to know what they're getting for it. Better schools, better health care, safer and more pleasant communities, and sustainable fiscal policies with balanced budgets are all considered good reasons for paying taxes.
Except that spending on health care, schools, and cities has been skyrocketing in the U.S., while the quality is decreasing. And when taxes are raised, governments tend to find a way to spend the money rather than paying down the deficit. People are starting to figure this out.

Last edited by Sam Stone; 09-11-2018 at 06:53 PM.
  #112  
Old 09-11-2018, 07:19 PM
Lemur866's Avatar
Lemur866 Lemur866 is offline
Charter Member
 
Join Date: Jul 2000
Location: The Middle of Puget Sound
Posts: 22,238
Sam, do you want to hear a long list of horror stories about medical care in the United States? Because I can guarantee you that for every horror story about Canadian health care, I could give you a hundred about American health care.

Like, you know, rather than having to wait for a month to see a doctor, lots of people just aren't allowed to see doctors, period. Doctors are not for them, because they don't have medical insurance.

Or the people who do have health insurance, and go get some routine treatment, and then get hit with bills for tens of thousands of dollars.

Or on and on.

Hey, you want better medical care in Canada? Doctors aren't getting paid enough? Then you're gonna have to pay more. But you don't wanna pay more? OK. You think you're going to pay less if you just pay for every medical treatment out of pocket?
  #113  
Old 09-11-2018, 07:35 PM
Sam Stone Sam Stone is offline
Member
 
Join Date: Jun 1999
Posts: 27,339
My point was not that Canada was worse than the U.S. My point is that simplistic comparisons of complex systems are stupid - and more specifically, I was giving the actual numbers regarding wait times to counter Wolfpup's assertions. My anecdotes were merely to point out the human cost of those long waits.

No health care system is going to be perfect. Because resources are scarce, any system you impose is going to have tradeoffs and costs. This is important to remind people of, because too many are running around claiming that socializing health care will result in lower costs and better care for all, with apparently no other tradeoffs. That's nonsense.
  #114  
Old 09-11-2018, 08:11 PM
Miller's Avatar
Miller Miller is offline
Sith Mod
Moderator
 
Join Date: Dec 2000
Location: Bear Flag Republic
Posts: 43,333
Quote:
Originally Posted by Sam Stone View Post
My point was not that Canada was worse than the U.S. My point is that simplistic comparisons of complex systems are stupid - and more specifically, I was giving the actual numbers regarding wait times to counter Wolfpup's assertions. My anecdotes were merely to point out the human cost of those long waits.

No health care system is going to be perfect. Because resources are scarce, any system you impose is going to have tradeoffs and costs. This is important to remind people of, because too many are running around claiming that socializing health care will result in lower costs and better care for all, with apparently no other tradeoffs. That's nonsense.
It may be nonsense, but you're going to need better anecdotes to prove it. Because what you just described is a fucking dream compared to US health care. Jesus, they gave you a free aspirin at the hospital! Do you have any idea how much that would cost someone in the US?
  #115  
Old 09-11-2018, 10:04 PM
wolfpup's Avatar
wolfpup wolfpup is offline
Guest
 
Join Date: Jan 2014
Posts: 9,461
Quote:
Originally Posted by Sam Stone View Post
Nonsense. The costs won't be the same, because Canada and the U.S. are not the same. For one thing, Canada free-rides somewhat on U.S. healthcare spending. Drugs are typically more expensive in the U.S. than in Canada, because Americans are on average richer than Canadians.

For an example of how intrinsic differences matter, consider education. The U.S spends significantly more per student on K-12 education than does Canada ($12,700 in 2014, vs $10,300 for Canada), but our students on average score much better on standardized tests and in measures such as graduation rates and college attendance. The OECD rankings has Canada ranked 10th in Math, and the U.S. is 41st, below the OECD average. Canada is 3rd in reading, and the U.S. is 24th. Canada is 7trh in science, and the U.S. is 25th.

If the differences always just come down to universal coverage or how much we spend, how do you explain this? Perhaps things as complex as a national education system or a national health care system can not be boiled down to something as simple as single payer vs market?
I didn't say the costs would be identical. I said that if the US achieved substantially the same system as the Canadian provinces, one could expect costs to be roughly similar. The interesting thing about the education analogy is that despite some significant differences in how the systems are run, their fundamental structural similarity (taxpayer-funded public schools) results in costs that are remarkably similar, whereas US health care costs are a complete outlier, pretty much off the chart compared to Canada or any other country in the world.

And incidentally, touching more directly on the OP and the original subject of this thread, the reason Canadian students do so much better than American ones is the (socialistic) emphasis on equality across schools and equality of opportunity within them, including for immigrants, minorities, and the poor -- and particularly with respect to equality of opportunity for the underprivileged, so that students' test scores are not dragged down by a long tail of underachievers.
Quote:
Originally Posted by Sam Stone View Post
In addition, although many people think that UHC is more efficient because of economies of scale, it's exactly the opposite.
I don't. Where did I try to make that point? Sounds like an irrelevant straw man.

In fact the point I've made several times, though not in this thread, is that for optimum flexibility UHC systems should be managed by the individual states under general federal guidelines, as they are in Canada by the provinces.
Quote:
Originally Posted by Sam Stone View Post
Universal Health Care may on balance be better than the hodge-podge of legislation, subsidy, market and government that is the U.S. system, but making categorical statements about what will be cheaper are not warranted. It may turn out to be far more expensive. You won't know until you run the experiment.
No, we know already. We know because UHC is far less costly than the US system in every single country in the world, without exception, and we know why. Because the staggering bureaucratic overhead has been eliminated, and because there is generally a central authority to regulate provider fees and services.
Quote:
Originally Posted by Sam Stone View Post
You do know that Canadians can't always find family doctors? This is especially true in rural regions, but even in the cities. And even if you have one, getting an appointment can take weeks sometimes, and a referral to a specialist can take months.

We have another problem in Canada that's not discussed much - the quality of our doctors is declining, especially in the rural areas. Because of our rigid fee schedules, it can be difficult to find doctors willing to work in rural areas for standard fees ...
Everything that you've said here about availability of doctors, quality, etc. applies to the US, too, and in many cases the issues are worse. At least Canada doesn't need to have charities like this one providing free medical care to its own poor citizens, something that should be considered a travesty in the richest country in the world.

I'm very sorry to hear about the health care issues you've described. But on the matter of misdiagnosis, you surely are not trying to imply that doctors made mistakes because they're not paid enough, or because they're paid by a public health care plan? If the argument is that the system discourages doctors from spending adequate time with their patients, I acknowledge that that can sometimes be the case, although fortunately that has not typically been my experience -- but these stresses happen regardless of the system of health care coverage, and indeed may be even worse with private insurance. This is why in the US some practices have been moving to so-called concierge services, high-end medical clinics where the payment of high annual enrollment fees gets you access to a doctor who can give his wealthy patients much more personalized attention and referrals to the best specialists. This sort of exclusivity in my view takes health care in the wrong direction, making it even more money-focused and weakening the system for everybody else. But such is the mercenary nature of US health care. And it wouldn't be necessary if people didn't perceive problems with mainstream medical care.

This business of wait times is a tired old canard that is constantly being over-hyped and exaggerated. Medical need in my experience has always been competently triaged and (again, in my experience) when there are significant wait times it's always been because it just doesn't matter. For instance, you mention your grandmother being "in excruciating pain for YEARS while on a waiting list for a knee replacement". I'm very sorry to hear that, but I simply don't understand, again from own experiences, how that can happen. Joint problems due to age don't typically arise suddenly, and if they arise due to some accident then they're triaged as emergencies. A friend had a gradually developing knee problem, his doctor scheduled elective knee-replacement surgery which was done a month or two later (actually, sooner than he would have liked, as he wasn't looking forward to it), and that was the end of it. He saw a slowly developing problem and had it dealt with in plenty of time. Had he fallen and broken something it would have been handled as an emergency. The system working as it should.

My experiences include acting as health care advocate for several elderly individuals, and I've never had issues with the timeliness or quality of their care. I'm not claiming the system is perfect, but I can't think of any major issues, and I can think of some surprisingly positive ones, like the quality of home care that one of them received. One also needs to keep in mind with these horror stories about long waits for MRI or CT imaging that not only are waits bypassed for time-critical situations, but they only apply to outpatients. Once you're in hospital all these resources are essentially instantly accessible.
Quote:
Originally Posted by Sam Stone View Post
Another reason why Canada's health care costs are lower is that we do not pay for extreme life-saving measures and many optional surgeries. If you want an artificial heart, or you want surgery to transition from male to female or vice versa, you're traveling to the states to get it done. In fact, medical tourism from Canada to the U.S. is big business, because if you are wealthy and suspect you have cancer, you're likely to pay for fast diagnosis and treatment in the U.S. rather than wait for months in Canada. Or if you need a hip replacement or a knee replacement and you are in agonizing pain, spending your life savings on U.S. surgery might be better than waiting five years for your 'free' surgery in Canada ...

... If you make something universal and the government pays for it, you can bet that no one is going to approve $20 million dollars for an experimental artificial heart that might keep you alive for another year. But in a free market, rich people can spend that money, and eventually the technology matures, costs come down, and we all benefit. There's a reason why the U.S. leads the world by far in medical research.
In addition to what I said just above, I disagree with many of those assessments. The main reason that a lot of medical innovation comes from the US is that a lot of technical innovation in general comes from the US, and there is a lot of public and private research money around. Outside of sci-fi movies, it's rarely because some billionaire funds an invention to let him live an extra month or year. The innovative technologies that Canada's health care systems fund vary by province but the general requirement (at least in Ontario) is proven efficacy. If there is some procedure that is not available here, it's probably still experimental or at least leading-edge and not yet mainstream, and available only in one or two places, perhaps research centers where it was developed. The few cases I've read about Canadian patients going to the US for medical treatment have involved such technology. In most cases the public health system will pay for it.

Moreover, as I've mentioned here and in the Medicare thread, a great deal of medical innovation comes from countries other than the US -- the bulk of advanced diagnostic imaging technology, for instance. As cited there, only two out of the 10 top companies providing this technology are US based.

In any case, while I'm sorry that you had these bad experiences, if one were to extrapolate from them and assume they are typical, then one would assume that Canada's health care system is dysfunctional and systemically broken. You are surely not trying to imply that this is the case, and it certainly disagrees with all of my extensive direct experiences over many years.

Quote:
Originally Posted by Sam Stone View Post
Oh, and one other thing - Canada's government health care costs are somewhat lower because there are a lot of treatments the Canadian government doesn't pay for. For example: prescription drugs, vaccinations, dentistry, optometry, podiatry, psychology, fertility treatments, gender assignment, cosmetic surgery, and a long list of other things. Many Canadians carry supplemental health insurance for these things - or go to the U.S. for them.
Much of this is wrong or misleading. Cosmetic surgery is covered if it's medically necessary (for instance, due to an accident). It's not covered if you're getting it done for reasons of vanity. In Ontario where I live, vaccinations are covered. As of December, 2015, fertility treatments are covered under the Ontario Fertility Program. Gender assignment surgery is covered as of March, 2016.

Certain forms of dental surgery are covered, though not most routine dentistry. Psychology is not covered, but psychiatry is. Prescription drugs are covered for seniors over 65, for the poor, for everyone while in hospital, and in cases of certain rare specialized drugs. Generally speaking the things that are not covered are common minor items like prescription drugs and optometry (eyeglasses) for those of working age which have minimal costs and are usually covered by routine employer supplemental insurance. The public health plan likes to nickel-and-dime on trivia like that while paying unconditionally and in full for major procedures like major surgeries. Those are priorities that I can get on side with.
Quote:
Originally Posted by Sam Stone View Post
That doesn't mean the forms aren't there ...
The first thing you're describing there is the hospital internal bureaucracy involved in dispensing drugs. That's completely irrelevant and has nothing to do with the bureaucracy involved in health care funding which is what I'm talking about.

Second, what you say about your health care professional spouse having to do paperwork doesn't change the fact that American doctors and hospitals have to maintain significant staff to deal with accounts receivable and specifically with insurance companies which constitutes an enormous bureaucratic burden because of its volume and complexity, costing, as I said, an estimated $500 billion a year. Conversely, I can tell you for a fact that my family doctor has on staff just a receptionist and a nurse/assistant who never seems very busy. If there is a lot of paperwork to be done, nobody is doing it.
Quote:
Originally Posted by Sam Stone View Post
A large chunk of health care (the elderly and the poor and veterans) already get single payer health care. Would you say that their outcomes are particularly good? if going to single payer will save so much money, how come Medicaid and Medicare cost so much? I believe the U.S. spends more per capita on Medicare alone than Canada spends to cover everyone. So why is your government health care so much worse?
Because it has to work within a structurally broken system, including the fact of high provider costs and high provider overhead that it can't do anything about. I am continually astounded by the staggering complexity of the Medicare system and its different "parts" and options compared to the simplicity of the single-payer system I'm accustomed to that simply pays for everything without question and no money changes hands between me and the health care provider.
  #116  
Old 09-11-2018, 10:07 PM
TimeWinder TimeWinder is offline
Charter Member
 
Join Date: Jan 2004
Location: Albany/Corvallis, OR
Posts: 4,526
Quote:
Originally Posted by Sam Stone View Post
This is important to remind people of, because too many are running around claiming that socializing health care will result in lower costs and better care for all, with apparently no other tradeoffs. That's nonsense.
I think you're mischaracterizing. Mostly what they're saying is "there are lots of other countries trying this, and every single one works out better than us in terms of medical outcomes, effectiveness of care and/or cost, so the evidence is pretty damn high those things would improve for us, too, if we just copied one."
  #117  
Old 09-12-2018, 06:37 AM
Grim Render Grim Render is online now
Guest
 
Join Date: Feb 2012
Posts: 1,060
Quote:
Originally Posted by senoy View Post
Fifty percent of Roche's revenue comes from the US compared to only 22% coming from all of Europe. Sanofi's revenues are closer, but US revenues were 12 billion last year compared to 9 billion for Europe and 10 billion for the rest of the world. 57% of all new pharmaceuticals between 2000 and 2010 came from American pharmaceutical companies. It's clear that American dollars are what is funding the pharmaceutical industry and I don't think many people would argue with that.
People who would argue with you, though, include those who have researched the issue.

US Pharmaceutical Innovation in an International Context

"Conclusions. Higher prescription drug spending in the United States does not disproportionately privilege domestic innovation, and many countries with drug price regulation were significant contributors to pharmaceutical innovation."

It is true that pharmaceutical innovation generally happens in large developed nations. Among them, however, the US does not innovate more than its share. The US does spend far more money on it, but that is the case for every area of health care. That does not produce better results for the US.
  #118  
Old 09-12-2018, 07:51 AM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
Quote:
Originally Posted by senoy View Post
It's clear that American dollars are what is funding the pharmaceutical industry
If this is true, we need to change how much we overspend so the world's pharma industry isn't funded on the backs of Americans. That responsibility should be shared.

If this is not true, we need to change how much we overspend because it just goes into the pockets of investors, and we don't even get the benefit of more research with our excess spending.
  #119  
Old 09-12-2018, 12:14 PM
puddleglum's Avatar
puddleglum puddleglum is offline
Guest
 
Join Date: Oct 2000
Location: a van down by the river
Posts: 6,073
Quote:
Originally Posted by Cheesesteak View Post
I don't think it's so much negotiating as a large group as negotiating as a sovereign country. Guaranteed, we have insurers with far more customers than live in Iceland, but they don't get the prices Iceland gets.
Medicare is already run by the government. It has more people as beneficiaries than the entire population of Canada.
A better explanation is the difference between average cost and marginal cost. Generally the American consumer pays the average cost of the medicine and foreigners pay closer to the marginal cost. Drugs cost about 2 billion dollars to come to market and many don't sell at all. In order for them to be developed someone has to pay the average cost.
  #120  
Old 09-12-2018, 12:34 PM
puddleglum's Avatar
puddleglum puddleglum is offline
Guest
 
Join Date: Oct 2000
Location: a van down by the river
Posts: 6,073
Quote:
Originally Posted by TimeWinder View Post
I think you're mischaracterizing. Mostly what they're saying is "there are lots of other countries trying this, and every single one works out better than us in terms of medical outcomes, effectiveness of care and/or cost, so the evidence is pretty damn high those things would improve for us, too, if we just copied one."
This is not true at all. Russia has government run health insurance, and infant mortality is higher, life expectancies are 10% shorter, there is more untreated mental illness, heart disease is worse, and cancer survival rates are much lower. The same is true for Mexico and Turkey. The cost is much less but the healthcare outcomes are much worse.
Five year survival rates for the 18 most common forms of cancer are highest in the US
  #121  
Old 09-12-2018, 12:39 PM
wolfpup's Avatar
wolfpup wolfpup is offline
Guest
 
Join Date: Jan 2014
Posts: 9,461
Quote:
Originally Posted by puddleglum View Post
Medicare is already run by the government. It has more people as beneficiaries than the entire population of Canada.
A better explanation is the difference between average cost and marginal cost. Generally the American consumer pays the average cost of the medicine and foreigners pay closer to the marginal cost. Drugs cost about 2 billion dollars to come to market and many don't sell at all. In order for them to be developed someone has to pay the average cost.
It's already been explained -- several times now, actually -- why this is completely false as an explanation for high health care costs. Medicare has no meaningful ability to control costs because it can't do anything about the incredible overhead inherent in the overall system, nor can it just arbitrarily decide to pay less because at some point providers will focus primarily or entirely on privately insured patients who pay more. It doesn't matter how big Medicare is when it's just one player in a fragmented and dysfunctional system that it can't control.

If you compare US costs with those in other countries, particularly those with a similar cost of living (e.g.- Canada) you find that equipment and supply costs are essentially the same, real estate costs are similar, and the big differences are the labor costs: the much higher costs of getting paid by a system whose staggering complexity never ceases to amaze me, and the fact that providers can basically charge what the market will bear. The root causes of US health care costs are so extreme and egregious that it's not usually the subject of contention.
  #122  
Old 09-12-2018, 12:40 PM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
Quote:
Originally Posted by puddleglum View Post
Medicare is already run by the government. It has more people as beneficiaries than the entire population of Canada.
But they don't negotiate like a government. At least, they don't negotiate with the extraordinary market power of Iceland.
Quote:
In order for them to be developed someone has to pay the average cost.
Why does that someone have to be Americans? Is there a reason our government, who supposedly is "for the people" is refusing to step in and change this dynamic? They are allowing this burden to fall on the backs of hard working Americans, while the lazy socialists across the pond get to pay next to nothing. No wonder they get 6 weeks of vacation, we're doing all this damn work for their benefit.

This dynamic really irritates me because the party that seems to want to maintain the status quo, also defends that status quo by pointing out that we are subsidizing the socialist health care systems of other countries. It's mind boggling.
  #123  
Old 09-12-2018, 12:53 PM
wolfpup's Avatar
wolfpup wolfpup is offline
Guest
 
Join Date: Jan 2014
Posts: 9,461
Quote:
Originally Posted by puddleglum View Post
This is not true at all. Russia has government run health insurance, and infant mortality is higher, life expectancies are 10% shorter, there is more untreated mental illness, heart disease is worse, and cancer survival rates are much lower. The same is true for Mexico and Turkey. The cost is much less but the healthcare outcomes are much worse.
Five year survival rates for the 18 most common forms of cancer are highest in the US
I see that in order to prove your point, you have to cite poorer countries with far less developed technology infrastructure. But more developed countries such as Canada and the UK spend half as much as the US and have lower infant mortality and higher life expectancies, and also better quality of life in old age. Survival rates for cancer are similar to the best of the US, better for some cancers and slightly worse for others, but basically similar. Your own cite refutes your claim about US cancer survival rates -- the article does not single out the US, but talks about "United States, Canada, Australia and New Zealand, followed by Finland, Iceland, Norway and Sweden". Moreover, the article cites many cancers with better survival rates in Asia, and for leukemia survival in children, Finland beats out the US, and for brain tumor survival, Sweden and Denmark beat out the US. This is not a winning line of argument for you.
  #124  
Old 09-12-2018, 03:24 PM
Lemur866's Avatar
Lemur866 Lemur866 is offline
Charter Member
 
Join Date: Jul 2000
Location: The Middle of Puget Sound
Posts: 22,238
I really can't understand how nationalist America-firsters are adamant that Americans are obligated to pay high drug costs so that people in France can get cheap new drugs.

Are we running a charity here?
  #125  
Old 09-12-2018, 06:25 PM
wolfpup's Avatar
wolfpup wolfpup is offline
Guest
 
Join Date: Jan 2014
Posts: 9,461
An interesting comment on the subject of drug prices from the founder and president of one of the US pharma companies, who recently raised the price of an essential antibiotic called nitrofurantoin from about $500 per bottle to more than $2,300. He claimed he had a "moral requirement" to make as much money as he possibly could and praised his kindred spirit Martin Shkreli for having been a fine exemplar of that moral principle. I'm not joking:
"I think it is a moral requirement to make money when you can," [Nirmal Mulye, founder and president of Nostrum Pharmaceuticals] told the Financial Times, "to sell the product for the highest price." ... According to the Financial Times, the executive defended "Pharma Bro" Martin Shkreli, who was once dubbed the "most hated man in America" after his company raised the price of an AIDS drug by more than 5,000% in 2015. Shkreli was recently sentenced to seven years in prison for fraud due to mismanaging money at his hedge funds.

"I agree with Martin Shkreli that when he raised the price of his drug he was within his rights because he had to reward his shareholders," Mulye was quoted as saying.
https://www.cnn.com/2018/09/11/healt...-bn/index.html
And that, ladies and gentlemen, is why Americans are gouged on drug prices, and not to "fund research", which is carried out in advanced countries all over the world and develops pharmaceuticals and health technologies for global markets. The difference is that other countries have necessary and responsible regulation of health care costs and drug prices; with respect to drugs, for instance, France has the Economic Committee for Health Products, the UK has the Pharmaceutical Price Regulation Scheme (PPRS), Canada has the Patent Medicine Prices Review Board, and so on. The US has Nirmal Mulye and Martin Shkreli.

Last edited by wolfpup; 09-12-2018 at 06:25 PM.
  #126  
Old 09-12-2018, 07:46 PM
elbows elbows is offline
Charter Member
 
Join Date: Jan 2000
Location: London, Ontario
Posts: 13,890
Americans are NOT subsidizing drug prices for other countries. They are just being gouged because they allowed the drug companies to construct a system that endlessly maximizes their profits.

If everyone else is getting a better price and you’re paying more it’s because you’re over paying. This isn’t complicated, sheesh!
  #127  
Old 09-13-2018, 01:03 AM
Budget Player Cadet's Avatar
Budget Player Cadet Budget Player Cadet is online now
Guest
 
Join Date: May 2011
Posts: 8,142
Quote:
Originally Posted by wolfpup View Post
An interesting comment on the subject of drug prices from the founder and president of one of the US pharma companies, who recently raised the price of an essential antibiotic called nitrofurantoin from about $500 per bottle to more than $2,300. He claimed he had a "moral requirement" to make as much money as he possibly could and praised his kindred spirit Martin Shkreli for having been a fine exemplar of that moral principle. I'm not joking:
"I think it is a moral requirement to make money when you can," [Nirmal Mulye, founder and president of Nostrum Pharmaceuticals] told the Financial Times, "to sell the product for the highest price." ... According to the Financial Times, the executive defended "Pharma Bro" Martin Shkreli, who was once dubbed the "most hated man in America" after his company raised the price of an AIDS drug by more than 5,000% in 2015. Shkreli was recently sentenced to seven years in prison for fraud due to mismanaging money at his hedge funds.

"I agree with Martin Shkreli that when he raised the price of his drug he was within his rights because he had to reward his shareholders," Mulye was quoted as saying.
https://www.cnn.com/2018/09/11/healt...-bn/index.html
And that, ladies and gentlemen, is why Americans are gouged on drug prices, and not to "fund research", which is carried out in advanced countries all over the world and develops pharmaceuticals and health technologies for global markets. The difference is that other countries have necessary and responsible regulation of health care costs and drug prices; with respect to drugs, for instance, France has the Economic Committee for Health Products, the UK has the Pharmaceutical Price Regulation Scheme (PPRS), Canada has the Patent Medicine Prices Review Board, and so on. The US has Nirmal Mulye and Martin Shkreli.
In a sane world, that fucker would be dragged from his house and thrown against the wall.
__________________
If you want to vote for people who will attack the rights of me and those close to me, we cannot be friends, and I will not accept that you're a good person.
  #128  
Old 09-13-2018, 03:59 AM
septimus's Avatar
septimus septimus is online now
Guest
 
Join Date: Dec 2009
Location: The Land of Smiles
Posts: 17,815
Quote:
Originally Posted by Lemur866 View Post
I really can't understand how nationalist America-firsters are adamant that Americans are obligated to pay high drug costs so that people in France can get cheap new drugs.

Are we running a charity here?
I am not an adamant Nationalist American-firster but I think "freeloader" would be part of their answer: "They short-change us on NATO, and they short-change us on drugs. These Marxists know nothing about the virtues of competition but, boy do they know how to J** us down on the price."
  #129  
Old 09-13-2018, 04:24 AM
Budget Player Cadet's Avatar
Budget Player Cadet Budget Player Cadet is online now
Guest
 
Join Date: May 2011
Posts: 8,142
Quote:
Originally Posted by Budget Player Cadet View Post
In a sane world, that fucker would be dragged from his house and thrown against the wall.
I'm sorry, I don't know what I was thinking. Temporary aggression robbed my sanity for a moment. I meant to say "dragged from his mansion" because no way in shit this parasite lives in a simple house.
__________________
If you want to vote for people who will attack the rights of me and those close to me, we cannot be friends, and I will not accept that you're a good person.
  #130  
Old 09-13-2018, 06:37 AM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
Quote:
Originally Posted by Lemur866 View Post
Are we running a charity here?
Yes, as long as it doesn't benefit poor Americans.

Those losers can go suck it!
  #131  
Old 09-13-2018, 07:39 AM
survinga survinga is offline
Guest
 
Join Date: Sep 2017
Location: In the Deep South
Posts: 237
This thread is starting to look familiar to me. I'm not gonna re-tread old arguments here. But I will point out that some states are trying to expand Medicaid, against the wishes of their Republican overlords. I hope they succeed, because the people want the Medicaid expansion. See the links.

https://www.omaha.com/livewellnebras...7f34cf67f.html

https://www.healthinsurance.org/idaho-medicaid/

http://nymag.com/daily/intelligencer...expansion.html

In particular, the guy in Maine is being obstinate. He just wants to end his term and say, "I never expanded Medicaid". His term ends this year, and he's breaking the law.

This is how dug in the Pubs are on Medicaid expansion in red states. I think over the next 5 or so years, popular support will chip away at it, and we'll get almost every state on the expansion, with the exception of some deep-red states in the South. Even there, it's possible that states like Georgia and Texas might change their view, as demographic trends are turning them closer to purple.
  #132  
Old 09-13-2018, 08:31 AM
Alessan's Avatar
Alessan Alessan is offline
Guest
 
Join Date: Jul 2000
Location: Tel Aviv
Posts: 23,613
Quote:
Originally Posted by Cheesesteak View Post
Yes, as long as it doesn't benefit poor Americans.

Those losers can go suck it!
That's the weird thing about the American version of nationalism. You guys are great with the "fuck everyone else" part of it, but you just can't seem to grasp the "we're all in this together!" part.
  #133  
Old 09-13-2018, 10:38 AM
puddleglum's Avatar
puddleglum puddleglum is offline
Guest
 
Join Date: Oct 2000
Location: a van down by the river
Posts: 6,073
Quote:
Originally Posted by Cheesesteak View Post
But they don't negotiate like a government. At least, they don't negotiate with the extraordinary market power of Iceland. Why does that someone have to be Americans? Is there a reason our government, who supposedly is "for the people" is refusing to step in and change this dynamic? They are allowing this burden to fall on the backs of hard working Americans, while the lazy socialists across the pond get to pay next to nothing. No wonder they get 6 weeks of vacation, we're doing all this damn work for their benefit.

This dynamic really irritates me because the party that seems to want to maintain the status quo, also defends that status quo by pointing out that we are subsidizing the socialist health care systems of other countries. It's mind boggling.
Why don't they negotiate like a government?
The claim is that government run healthcare is cheaper for these reasons. Yet our government run healthcare, which some people to expand to everyone does not take advantage of these ways to cut spending. This is because cutting spending is politically unpopular so no one wants to do it. This will not magically change.
I am old enough to remember when Democrats controlled the Presidency, and both houses of Congress by a large margin. They took that opportunity to impose their version of healthcare on America. Despite this huge amount they did not impose cost controls on Medicare drug purchases. Yet we are asked to believe that having failed to do it on a smaller level they will succeed in doing so when they control the entire system. The savings based on negotiation power is a mirage, if it actually existed we would have seen it already.
  #134  
Old 09-13-2018, 10:57 AM
puddleglum's Avatar
puddleglum puddleglum is offline
Guest
 
Join Date: Oct 2000
Location: a van down by the river
Posts: 6,073
Quote:
Originally Posted by wolfpup View Post
I see that in order to prove your point, you have to cite poorer countries with far less developed technology infrastructure. But more developed countries such as Canada and the UK spend half as much as the US and have lower infant mortality and higher life expectancies, and also better quality of life in old age. Survival rates for cancer are similar to the best of the US, better for some cancers and slightly worse for others, but basically similar. Your own cite refutes your claim about US cancer survival rates -- the article does not single out the US, but talks about "United States, Canada, Australia and New Zealand, followed by Finland, Iceland, Norway and Sweden". Moreover, the article cites many cancers with better survival rates in Asia, and for leukemia survival in children, Finland beats out the US, and for brain tumor survival, Sweden and Denmark beat out the US. This is not a winning line of argument for you.
The claim was that every country with universal healthcare has better outcomes. That claim is refuted.
It is very difficult to measure health outcomes, infant mortality is a bad metric because genetics is involved and different countries measure it differently. Life expectancy is a bad outcome because it is mostly genetic. For example, Hispanics in the US have a longer life expectancy than people in the UK does and Asians in America have a higher life expectancy than any country in the world and it is not because they have their own special healthcare system.
The study listed America first because overall the survival rates are the best, though not much better than Canada, Australia, or New Zealand.
  #135  
Old 09-13-2018, 11:35 AM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
Quote:
Originally Posted by puddleglum View Post
Why don't they negotiate like a government?
Our government doesn't let them.


Quote:
cutting spending is politically unpopular so no one wants to do it.
Wow. I mean, just wow. We shell out $300 for something that you can buy in the UK for $60 (epi pens) because spending less is "politically unpopular".


Quote:
I am old enough to remember when Democrats controlled the Presidency, and both houses of Congress by a large margin. They took that opportunity to impose their version of healthcare on America.
I guess you're not old enough to remember when the Republicans proposed this plan as the alternative to HillaryCare. That's OK, I'm old enough to remember that for you.

Quote:
Yet we are asked to believe that having failed to do it on a smaller level they will succeed in doing so when they control the entire system. The savings based on negotiation power is a mirage, if it actually existed we would have seen it already.
The savings are not a mirage, they exist. They exist in spades. They exist in literally every industrialized nation besides ours. I am not asking for the impossible, I'm asking for what everyone else already does.

If you want to tell me that America can't accomplish what every other nation has been doing for decades, we should just give up on the idea that we deserve to be a world leader in anything. Take our place with the Turkeys and Mexicos of the world, at least we can do better than them, right?
  #136  
Old 09-13-2018, 12:06 PM
RickJay RickJay is offline
Charter Jays Fan
Moderator
 
Join Date: Jun 2000
Location: Oakville, Canada
Posts: 40,241
Quote:
Originally Posted by puddleglum
A better explanation is the difference between average cost and marginal cost. Generally the American consumer pays the average cost of the medicine and foreigners pay closer to the marginal cost. Drugs cost about 2 billion dollars to come to market and many don't sell at all. In order for them to be developed someone has to pay the average cost.
Nope. Totally wrong; completely, entirely at odds with rudimentary economics, arithmetic, and logic.

First of all, it is obviously silly to suggest "foreigners" aren't a profitable market for drug companies, for the simple reason that if they were not, drug companies would not be bothered to sell their products there. Why would Pfizer or Sanofi go to the trouble, risk, and legal peril of selling a drug in France they don't make a lot of money off? Wouldn't that be stupid?

Secondly, if the USA is where all the profit is, why are there huge pharma companies and CROs based ikn other countries? Novartis is Swiss. I think Roche is, too. Sanofi, who I randomly named just now, is French. (France is a big pharma country.) GSK is British. Of the major contract research orgs, Chiltern is in Britain, ICON is in Ireland, and so on. Funny how the foreigners seem to have made money off this stuff.

Finally, lower drug prices in pother countries have absolutely nothing to do with high drug prices in the USA. Nothing at all.

Allow me to explain. Drug prices in the USA are, to an extent that matters, a completely wide open free market. If Lilly comes up with a new drug, which I'll call Newdrugutin, and gets it through Phase 3 testing, it will be offered for sale in all the countries they can get approval for (which will be pretty much all of them.) In the USA, that price will be set at what they assume to be the profit maximizing price - the price point at which their net revenue will be maximized. While this won't be one price all the time (they may offer free samples, for instance, through physicians) it'll be pretty close to one price, and any variance from that price will mean they make less money. If they correctly set the market clearing price at, say, $50 a dose, then it's $50 a dose. If it were less, they'd lose money by not charging enough. If it were more, they'd lose money by making more per dose but selling far fewer doses. Over time the drug may have to be cheaper (due to reduced demand, more competitors, etc.) or go up (inflation, increased demand, etc.) but the price will always be set at the profit maximizing price. If it's not, the drug company appearently doesn't want to make money.

In, say, Canada, things are different. The price of the drug must be approved with the PMPRB - I'm not going to type it out because who cares - which is effectively a group that determined the price based on

- A variety of criteria to determine what price is fair and
- in truth, some unofficial negotiation with the drug maker so they don't just say "the hell with Canada."

This is a simplification - it is a complex process and the nature of it depends on whether we're talking about new drugs, new doses of existing drugs, ANDs, packaging changes, inflationary adjustments, etc. - but you get the idea. At the end of this process, let us suppose that the PMPRB determines that a dose of Newdrugutin should be sold in Canada for $30 a dose.

Tell me; how does that affect the price of the drug in the USA?

It doesn't. It would make no sense at all for it to. If Lilly, frustrated with only being able to sell Newdrugutin at $30 in Canada, were to raise the price in the USA, they will LOSE MONEY. The price of $50 in America is, as we have seen, the profit maximizing price; increasing it will not make more money. If an increase were to make more money, they would have already raised it no matter what Canadians paid for it; it would make sense to raise it simply for that reason alone, even if Canadians were paying the same amount. The price in the USA is determined by its market forces, nothing else. The price Canadians pay (or people in France, Australia, Germany...) isn't going to make any measurable difference to the American market.

You cannot get around this. A company cannot just arbitrarily raise the price of one product to make up for lose profit in another. If they could, why doesn't every drug in the USA literally cost a billion dollars a pill?
__________________
Providing useless posts since 1999!

Last edited by RickJay; 09-13-2018 at 12:34 PM.
  #137  
Old 09-13-2018, 12:37 PM
Lemur866's Avatar
Lemur866 Lemur866 is offline
Charter Member
 
Join Date: Jul 2000
Location: The Middle of Puget Sound
Posts: 22,238
Quote:
Originally Posted by puddleglum View Post
The claim was that every country with universal healthcare has better outcomes. That claim is refuted.
Seriously? No, that is not the claim. The claim is not "every country", the claim is "every first world country".

You could compare the United States with poor countries like Mexico and India and Chad, but it makes a lot more sense to compare us to rich countries like Canada, France, Japan, or Belgium. I don't want our health care system to be more like Uganda's, I want our system to be more like Australia's.
  #138  
Old 09-13-2018, 12:38 PM
Lemur866's Avatar
Lemur866 Lemur866 is offline
Charter Member
 
Join Date: Jul 2000
Location: The Middle of Puget Sound
Posts: 22,238
Quote:
Originally Posted by puddleglum View Post
Why don't they negotiate like a government?
Because the Republicans passed a law making it illegal for Medicare to negotiate drug prices.
  #139  
Old 09-13-2018, 01:23 PM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
RickJay, while I don't think it changes the essential wrongness of Americans paying a premium for drugs, there is a nugget of economic theory supporting the idea that the American Premium funds research into drugs. If you are preparing a business case to support investing in drug research, part of that case is going to be the deluge of cash from the US. Without Americans pouring their (apparently) excess cash into your coffers, the business case will look somewhat different. Whether it's different enough to tip over into "let's not bother" territory is going to be determined on a case by case basis, and depends on the scale of the American Premium vs. World prices (something I know little about).

I don't believe this circumstance warrants maintaining the American Premium, but it would suggest a potential resetting of negotiated prices around the world, with everyone chipping in a bit more so that drug research remains a profitable enterprise.
  #140  
Old 09-13-2018, 02:13 PM
RickJay RickJay is offline
Charter Jays Fan
Moderator
 
Join Date: Jun 2000
Location: Oakville, Canada
Posts: 40,241
The percentage of the price of drugs that go into research is surprisingly lower than I think most people would assume. It's less than a sixth of gross revenue, and much lower than marketing (in the case of large pharma companies; small speculative ones, usually called "biotech" in the language of the industry, are different, but they have little interest in such matters anyway - most seek to create a single drug and be bought out by the big players) and a huge, huge percentage of that is not, contrary to what I think people assume, paying brilliant scientists to devise new things in a lab. Most of it is the grind of clinical testing in Phases 1 through 4, which is generally just assembling information and studying the underlying statistics. Quite a lot of the expense is necessitated not by research goals but by the extraordinarily high requirements set by regulatory agencies, off whom the FDA, ironically, is the biggest and toughest.

Were the USA to bring drug prices under control, it's possible prices elsewhere might see some upwards pressure, but, honestly, probably not much, and the effect on human health would be negligible.
__________________
Providing useless posts since 1999!
  #141  
Old 09-13-2018, 03:36 PM
septimus's Avatar
septimus septimus is online now
Guest
 
Join Date: Dec 2009
Location: The Land of Smiles
Posts: 17,815
Quote:
Originally Posted by RickJay View Post
The percentage of the price of drugs that go into research is surprisingly lower than I think most people would assume.
It may even be somewhat less than official figures imply. Physicians are paid to prescribe to their patients as "research", though the payments are really just in lieu of other junkets that would show up under "marketing."
  #142  
Old 09-13-2018, 03:45 PM
survinga survinga is offline
Guest
 
Join Date: Sep 2017
Location: In the Deep South
Posts: 237
Quote:
Originally Posted by puddleglum View Post
I am old enough to remember when Democrats controlled the Presidency, and both houses of Congress by a large margin. They took that opportunity to impose their version of healthcare on America. Despite this huge amount they did not impose cost controls on Medicare drug purchases. Yet we are asked to believe that having failed to do it on a smaller level they will succeed in doing so when they control the entire system.
The funny thing with the "single-payer now" crowd is that these are the same people we dog-cuss our politicians all the time about this and that. And I agree with them that our congress and president are worthless. But somehow, I'm supposed to set that aside and believe that they'll do a great job turning everything into single-payer. These idiots who can't tie their shoe - many of whom despise average working Americans - are going to completely re-engineer healthcare and everything will be better. It boggles the mind.
  #143  
Old 09-13-2018, 04:25 PM
Grim Render Grim Render is online now
Guest
 
Join Date: Feb 2012
Posts: 1,060
Quote:
Originally Posted by survinga View Post
The funny thing with the "single-payer now" crowd is that these are the same people we dog-cuss our politicians all the time about this and that. And I agree with them that our congress and president are worthless. But somehow, I'm supposed to set that aside and believe that they'll do a great job turning everything into single-payer. These idiots who can't tie their shoe - many of whom despise average working Americans - are going to completely re-engineer healthcare and everything will be better. It boggles the mind.
Probably because its not a particularly difficult task, except politically. And politics is the one thing we expect politicians to be good at.

I mean, everyone else does it with no more whining than usual for officials trying to get their budget up. And much cheaper than the US, as in 2-3 military budgets cheaper. Berlusconis Italy did it. Portugal. Ireland, Iceland, Austria, Taiwan, etc. No-one else things it much more complicated than providing education.

The US would also have two huge, massive advantages over everyone else. Economics of scale and the ability to examine 50 plus years of UHC in 40ish developed nations. Lots of things have been tried, evaluated, rejected or improved. The US has no special immunity from economics.

Quote:
Originally Posted by puddleglum View Post
Life expectancy is a bad outcome because it is mostly genetic. For example, Hispanics in the US have a longer life expectancy than people in the UK does and Asians in America have a higher life expectancy than any country in the world and it is not because they have their own special healthcare system.
Haven't you tried that argument before?
  #144  
Old 09-13-2018, 04:37 PM
Cheesesteak Cheesesteak is online now
Charter Member
 
Join Date: Jan 2001
Location: Lovely Montclair, NJ
Posts: 12,835
Quote:
Originally Posted by Grim Render View Post
Probably because its not a particularly difficult task, except politically.
The trick is, the people in government actually have to want it to succeed. If something doesn't work right, the government needs to act to fix it, instead of acting to make it worse so they can try to dismantle it. the ACA, for all its faults, did not get anything resembling care and feeding from our government to make it function better. I'm amazed it hasn't crashed long before now.
  #145  
Old 09-13-2018, 04:43 PM
survinga survinga is offline
Guest
 
Join Date: Sep 2017
Location: In the Deep South
Posts: 237
Quote:
Originally Posted by Grim Render View Post
Probably because its not a particularly difficult task, except politically. And politics is the one thing we expect politicians to be good at.

...But re-engineering health-care is policy, not just politics. And policy is something that our congress is not good at, and that Trump doesn't understand. If giving a few good political rallies was enough to re-engineer healthcare and make it all better, then sign me up. But policy is something our congress is particularly and specifically bad at.

Most people on this board realize that. So, if I take their comments at face-value, then I can't square that with, "Oh, and when you're not busy destroying the world, please set up single-payer healthcare"....

Last edited by survinga; 09-13-2018 at 04:45 PM.
  #146  
Old 09-13-2018, 05:09 PM
Alessan's Avatar
Alessan Alessan is offline
Guest
 
Join Date: Jul 2000
Location: Tel Aviv
Posts: 23,613
Quote:
Originally Posted by survinga View Post
...But re-engineering health-care is policy, not just politics. And policy is something that our congress is not good at, and that Trump doesn't understand. If giving a few good political rallies was enough to re-engineer healthcare and make it all better, then sign me up. But policy is something our congress is particularly and specifically bad at.

Most people on this board realize that. So, if I take their comments at face-value, then I can't square that with, "Oh, and when you're not busy destroying the world, please set up single-payer healthcare"....
So, what, you're just suppose to shrug your shoulders and give up? No. You do your best with what you've got, even if what you've got is the U.S. Congress.
  #147  
Old 09-13-2018, 06:24 PM
wolfpup's Avatar
wolfpup wolfpup is offline
Guest
 
Join Date: Jan 2014
Posts: 9,461
Quote:
Originally Posted by survinga View Post
...But re-engineering health-care is policy, not just politics. And policy is something that our congress is not good at, and that Trump doesn't understand. If giving a few good political rallies was enough to re-engineer healthcare and make it all better, then sign me up. But policy is something our congress is particularly and specifically bad at.

Most people on this board realize that. So, if I take their comments at face-value, then I can't square that with, "Oh, and when you're not busy destroying the world, please set up single-payer healthcare"....
What a sad, defeatist attitude that ignores the great things this country has accomplished under inspired leadership! It may be bad at policy but it still enacted Social Security, Medicare, and -- not to overuse a tired old trope -- put men on the moon. And in each case, the enabler was an inspirational leader -- in these cases, Franklin D. Roosevelt, Lyndon Johnson, and John F. Kennedy, respectively. I'll leave it to the reader to decide if it was mere coincidence that all three great presidents were Democrats.
  #148  
Old 09-13-2018, 06:53 PM
survinga survinga is offline
Guest
 
Join Date: Sep 2017
Location: In the Deep South
Posts: 237
Quote:
Originally Posted by wolfpup View Post
What a sad, defeatist attitude that ignores the great things this country has accomplished under inspired leadership! It may be bad at policy but it still enacted Social Security, Medicare, and -- not to overuse a tired old trope -- put men on the moon. And in each case, the enabler was an inspirational leader -- in these cases, Franklin D. Roosevelt, Lyndon Johnson, and John F. Kennedy, respectively. I'll leave it to the reader to decide if it was mere coincidence that all three great presidents were Democrats.
We just elected a guy who tweets about women bleeding when they get facelifts. Let's take a break from "saving" the healthcare system, and focus on the task at hand, which is making Trump an ex-president. The last thing we need is anyone in the current administration or congress "fixing" healthcare.
  #149  
Old 09-13-2018, 09:11 PM
wolfpup's Avatar
wolfpup wolfpup is offline
Guest
 
Join Date: Jan 2014
Posts: 9,461
Quote:
Originally Posted by survinga View Post
We just elected a guy who tweets about women bleeding when they get facelifts. Let's take a break from "saving" the healthcare system, and focus on the task at hand, which is making Trump an ex-president. The last thing we need is anyone in the current administration or congress "fixing" healthcare.
Trump was democratically elected (sort of, never mind the Electoral College stuff). So it's hard to make any interpretation of your statement other than one that effectively says "we cannot have the kind of health care system -- or, indeed, the kind of society -- that the rest of the world enjoys, because we are a nation of morons who are fundamentally incapable of governing ourselves". That seems to be exactly what you're saying with respect to health care, and the OP appears to be saying it more broadly with regard to social solidarity as a whole. Is that really the sentiment that either of you want to express and truly believe?
  #150  
Old 09-13-2018, 10:15 PM
septimus's Avatar
septimus septimus is online now
Guest
 
Join Date: Dec 2009
Location: The Land of Smiles
Posts: 17,815
I'm trying to understand the debate between wolfpup and survinga since I largely agree with both.

Quote:
Originally Posted by survinga View Post
We just elected a guy who tweets about women bleeding when they get facelifts. Let's take a break from "saving" the healthcare system, and focus on the task at hand, which is making Trump an ex-president. The last thing we need is anyone in the current administration or congress "fixing" healthcare.
While the GOP is in control it's silly to hope for anything but to return control to non-criminals. Most of us would agree with that.

But this confuses me:
Quote:
Originally Posted by survinga View Post
The funny thing with the "single-payer now" crowd is that these are the same people we dog-cuss our politicians all the time about this and that. And I agree with them that our congress and president are worthless. But somehow, I'm supposed to set that aside and believe that they'll do a great job turning everything into single-payer. These idiots who can't tie their shoe - many of whom despise average working Americans - are going to completely re-engineer healthcare and everything will be better. It boggles the mind.
Some of the grammar in this post boggles my mind. Setting that aside,
Are you aware that the last time the Democrats had a filibuster-proof majority in the Senate was January, 1979?

In making this statement I am of course specifically excluding that heinous DINO, the Senior Senator from Insurance Companies Who-Must-Not-Be-Named outside BBQ Pit. He voted for ACA only after ensuring that instead of a public good it would be another boondoggle for his constituents, the insurance companies.

Last edited by septimus; 09-13-2018 at 10:17 PM.
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 07:22 AM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2018, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@straightdope.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Copyright 2018 STM Reader, LLC.

 
Copyright © 2017