Aren’t you getting tired of that schtick? We get it…business pure evil and government completely benign.
Why do you think the government would NOT have the same incentive to deny care. What is the difference between a company and the government except the 3% profit margin? In theory government still has to pay the bills. There is still a bottom line to meet. So, just like a business, the government has the exact same perverse incentive to deny care or make you wait so long that you die. And, as opposed to insurance companies, the government can take a portion of your estate after you die.
Have you considered that the reason they have no incentive is because we, as insured consumers, don’t have to think about consequences? My cost for the MRI has no relation to the true cost, so there is no incentive to shop around.
There are non-profit insurance companies and they deny care just like the private ones. Canada’s Medicare and Britain’s NHS also deny care. There is not enough money in the world to give people all the health care they need or want, so decisions have to be made. Should they be made between patient and doctor based on what is cost effective for the patient, or should they be made by a panel of experts in Washington DC? Or worse, made by political appointees?
The US has the advantage of taking the best examples of competition from around the developed world, if the idea really is to create what is effectively an internal (UHC) market.
You think differently and innovate, it’s a huge challenge - Germany has been in the game almost 100 years, the UK 60 years, and so it goes on. Shop around.
**The left would rather we all get substandard care than let there be any gradient in health care access or outcome. **
I don’t think that’s really fair. I think the Left’s actual problem is insufficient faith in individuals to make rational choices and too much faith in the government to do so.
You think differently and innovate, it’s a huge challenge - Germany has been in the game almost 100 years, the UK 60 years, and so it goes on. Shop around.
I agree completely. I think the single payer model has proven itself to be deficient. The best systems tend to be a mix of public and private. The Netherlands and Switzerland stand out for me as the way to go.
The current reform is actually closer to the Swiss system than anything else, but it’s still deficient, too deficient to pass.
Many of our issues are asymptomatic, and sometimes the doctor gets inside of us better than we do. In any case, the panel of experts is not going to be looking at individual cases, but at data which lets us know the efficacy of certain treatments, which is just like the FDA does today. This will be very helpful.
Do you think that if the Fed didn’t intervene and we were in the midst of a second depression as opposed to coming out of a recession we wouldn’t be worse off? Yes, they and the panel of experts work on the macro level, but the macro level affects all of us at the micro level. And plenty more things make a difference at the patient level. The treatments the doctor has available for one, and the information he has available. If the panel of experts says that treatment A works far better than treatment B, you getting treatment A instead of treatment B will improve you outcome in most cases.
No, expensive and useless treatments will be denied. The panel, as I understand it, is going to evaluate the evidence for outcomes.
I hope you realize that drug company marketing costs far exceed R & D costs. If, like in some countries, there is no advertising to build demand for prescription medicine, they could cut costs and increase R&D.
What they do is find ways to make things cheaper and faster. R & D will go up if they have to compete. Competition is the key. If you can shop around you will force them to be innovative. There is no pressure to get better if you have free money.
You should read some behavioral economics. It will open your eyes. The Right and Greenspan’s faith in people making rational choices led to the subprime mortgage crisis and Wall Street execs doing things for short term gains that were going in inevitably destroy their companies. Even Greenspan admitted he was wrong about this - maybe it is time for you to look at the evidence.
You’ve completely disregarded the governments role via quasi-government organizations in the subprime mess. Thanks to all those government backed mortgages it was completely rational for the bankers to do what they did. Who would be left holding the bag? Remove the government threat about redlining, and prevent fannie and freddie from buying all those mortgages and bankers would have required some kind of down payment.
Many of our issues are asymptomatic, and sometimes the doctor gets inside of us better than we do. In any case, the panel of experts is not going to be looking at individual cases, but at data which lets us know the efficacy of certain treatments, which is just like the FDA does today. This will be very helpful.
Helpful as information, but if coverage decisions are based on it, it will be no different from what insurance companies do. Sometimes doctors prescribe the drug that’s effective only 10% of the time because a certain patient might be one of those cases where it would be most effective. Plus doctors prescribe a lot of drugs for off label uses.
I hope you realize that drug company marketing costs far exceed R & D costs. If, like in some countries, there is no advertising to build demand for prescription medicine, they could cut costs and increase R&D.
I do know that. I also know that marketing yields more money for drug companies than R&D, and it’s more of a sure thing, so in tough times R&D gets cut and marketing does not. and in some coutnries, the lack of advertising means that consumers aren’t even aware of a drug’s existence. Makes it much easier for the government to deny coverage, since voters won’t know what they aren’t getting. That’s why I don’t like government making these choices. The incentives are extremely pernicious.
You should read some behavioral economics. It will open your eyes. The Right and Greenspan’s faith in people making rational choices led to the subprime mortgage crisis and Wall Street execs doing things for short term gains that were going in inevitably destroy their companies. Even Greenspan admitted he was wrong about this - maybe it is time for you to look at the evidence.
And likewise, you need to learn about Public Choice Theory. Governments are motivated by politics, not by what’s best for everyone, but what is most popular.
The so-called responsibility of government programs in this mess is a Big Lie, fostered by the right who refuse to admit that lack of regulation caused a disaster. That program ran for a long time with no issues. Plus, many of the mortgage lenders most responsible for the mess weren’t even under the program.
Plus, no government program required or even suggested the use of undocumented loans. No, the government didn’t back this shite, the unregulated mortgage backed securities market did. Mortgage lenders - with no government involvement - sold off the loans and thus didn’t give a crap whether they were good or not. In fact, since these riskier loans got higher interest rates and were thus considered more valuable, the Countrywides of the world incented their brokers to write subprimes. The risky loans magically became AAA when merged with better loans, and of course the unregulated raters called them AAA. The Fannies did start lowering quality, because they were semi-private and had to keep up, but they always had a better portfolio.
Now, the actions of the businesses is not what I was talking about. They were acting perfectly rationally under the rules of the game, even though their short term actions were guaranteed to lead to long term disaster. If one didn’t do this, their stock would suffer because they weren’t writing as profitable loans, and their CEOs bonuses would suffer also. That is exactly why we needed regulation - to tell these people that it was tough they were “less competitive” but their actions had to be reined in for the common good. Alas, our Randian Fed Chair at the time didn’t get it until after it was too late.
I was referring to the poor saps who took these loans. Either from innumeracy, or their strong desire to get a house and not miss out on this magic market, or from being told lies by the “expert” brokers, they did things not in their own best interests. Your economics assumes that these kind of people do not exist, but your economics is wrong.
If there is a subset of the patient population for which the drug is most effective, I suspect it will be approved for that subset. These are experts, after all, and know this. The interesting case is for a drug where there is an alternative that works 20% of the time, but where the drug company sent their cheerleader sales reps to the doctor so that the doctor, hearing about this drug last, prescribes it.
Horrors, that scourge of mankind, restless leg syndrome, might not be covered!
You think marketing pushes stuff that works, or does it push stuff that is equal to or less effective than the competition? Public marketing for prescription drugs tries to drive demand, obviously. Remember, drug sales people don’t sell anything, but they get rated on the increase in prescriptions written. They inform (but are obviously a biased source of information) and leave reminders of their product. My wife’s aunt was a nurse, and for years we wrote notes on pad shaped like pills. Does any of this really add to our common welfare - especially when considered against the cost.
Many people like to stress how much more effective small businesses are, and in the drug case, they are really right. More and more of the advances of big Pharma come from buying small innovative companies. So their unregulated R&D isn’t all that effective even today. Maybe they’d do better with less marketing, or maybe they’ll have more money for acquisitions which drives venture funding which really drives innovation.
So you admit that the model of the rational decision maker is faulty? As for your response, if an action were actually best for everyone, it would be popular, wouldn’t it? The politics comes in when an action is best for only some people. You have a better way of deciding this sort of thing? However, that doesn’t mean that politicians should be micromanaging the economy. If the proposal was that every treatment decision be made by politicians, I’d be against it also. But the proposal is that a panel of experts make the decisions. You think each individual doctor, pressed for time, is going to do better?
The so-called responsibility of government programs in this mess is a Big Lie, fostered by the right who refuse to admit that lack of regulation caused a disaster. That program ran for a long time with no issues. Plus, many of the mortgage lenders most responsible for the mess weren’t even under the program.
It’s not a Big Lie, but you’re right in that it wasn’t sufficient on its own to cause the subprime mess. However, the government did take on a lot of these mortgages, which led to the collapse of Fannie and Freddie, and still actively pressures lenders to make unsafe loans. The government didn’t create the crisis, but it’s actions were never very helpful, and if anything, the government has learned less from the crisis than the banks.
And of course consumers aren’t perfectly rational. No one is. The government sure as heck isn’t. But more often than not at the macro level, money flows to where it can get the best return. that happened to be housing for awhile, and government incentives did create a lot of that demand. Why does the government subsidize homeownership? Because it’s popular. Homeownership is rewarding enough, the government doesn’t need to subsidize it. Why didn’t the government act to burst the bubble once it was clear it was building? Because again, homeownership is popular and it would have been a bad idea from a public choice standpoint for politicians to burst that bubble. They would have lost their jobs. Why are profits from selling your home exempt from capital gains taxes for the first $500,000? Because homeownership is popular. Public Choice Theory again. And what happened since you pay capital gains on other investments but not housing? money flowed to where it would make the best profits: housing. Houses got traded like stocks and bonds.
None of the ways that government enables housing bubbles has been dealt with. So we’ll have another one. If anything, the government is trying to reinflate the bubble as we speak. Rational from an economic standpoint? No. Rational from a Public Choice Theory standpoint? Yes.
If there is a subset of the patient population for which the drug is most effective, I suspect it will be approved for that subset. These are experts, after all, and know this. The interesting case is for a drug where there is an alternative that works 20% of the time, but where the drug company sent their cheerleader sales reps to the doctor so that the doctor, hearing about this drug last, prescribes it.
It doesn’t work as smoothly as you think, and cost effectiveness will be part of the analysis. Just like with an insurance company.
Horrors, that scourge of mankind, restless leg syndrome, might not be covered!
Or Remicade, an extremely effective drug for treating arthritis, which few national health systems cover. Herceptin, a breast cancer drug that few national systems cover. There is also a new drug for treating stomach cancer. But again, national regulators are faced with a horrible choice. The drug only helps people to live three more months at great cost. Worth it? The decisions are very difficult and it doesn’t help when shills for the government try to act as if only minor ailments aren’t covered.
But the proposal is that a panel of experts make the decisions. You think each individual doctor, pressed for time, is going to do better?
The panel of experts doesn’t see a patient. There’s a huge difference. I’m not opposed to comparative effectiveness, but it should be strictly advisory. Doctors who see actual patients should make the final decision. This is EXACTLY what we complain about with insurance companies. It does’t get better just because the government is doing it. Insurance companies also use “panels of experts”. It pisses people off the same.
The Fannie/Freddie portfolio was of much higher quality than the mortgage company portfolio. However, the privatization rush did make them a Frankenstein’s monster, stitched of private and government parts, which really gave them the pressure to compete against the unsafe lenders. If they had stayed out of the stock market, we would have been better off.
The reason for the exemption is simple - when people retired, and sold their houses to move to smaller, cheaper, places, they would othewise get socked with a gigantic tax penalty. Back when I bought my first house you got this once. (And if you bought a more expensive house, you also were exempt from capital gains on your old one.) I’m not aware that people flipping houses for profit are exempt - is that what you are implying. That is of course bad policy.
My reading of the Wiki entry on Public Choice Theory seems to indicate that it explains why unpopular laws get enacted. Mortgage subsidies are popular - while I’m sure that the housing lobby supported the law, I suspect that a majority of the public would also. Home ownership does have certain social benefits also, like involvement in the community. Both sides support this; remember Bush went on about the Ownership Society during the bubble.
You don’t seem to be supporting your initial contention that policy should assume all people make rational decisions. For the most part, chasing profit is good, of course. Regulators have to step in when short term profit is going to lead to long term disaster. A regulated free market beats either an unregulated one or socialism.
I wouldn’t call trying to stabilize the housing market reinflating the bubble. The economic benefits of halting the decline are great - putting lots of people to work, reducing foreclosures, and getting people’s mortgages down to market rates. Once the economy recovers, interest rates will have to rise to stop a repeat of the Greenspan induced bubble, and we’ll have to regulate the mortgage market to reduce unqualified demand, which should moderate prices. Let’s climb out of the hole before we worry about climbing too high on the ladder.
Nice sleight of hand! I was talking about drug marketing creating demand. Do you think that effective breast cancer drugs need a platoon of marketers?
What you are talking about is the rationing dilemma, which is a real problem, but totally different. As I said in some thread or other, the common right complaint about HCR a few years ago was that the Dems were going to give away the store - which they haven’t, so it has turned into the Dems are going to kill Granny. We’ve got two choices - ration randomly based on personal income, or ration somewhat rationally based on some degree of logic. Clearly people will disagree on any decision. But in our system those without good care are not going to get these drugs either (or get them and go bankrupt), plus they won’t get all sorts of care they would get in a UHC system. Is that really better?