Medical knowledge advances at a certain rate. Is it reasonable to allow that rate to slow, in exchange for making sure that quality of medical care is distributed more evenly between people at different socioeconomic levels?
I am not sure what I think about this, so I am intereste in hearing what others think.
No, it is a safety valve. Stopping it would require suppressing medical technology. Preventing people from using private wealth to pursue personal medical goals would deny everyone else that medical knowledge and technology later. How would that in any way translate to equality of care, unless the goal was to prevent care.
I don’t think the OP was suggesting people be prevented from using private wealth to purchase medical care. Just that people who can’t afford basic access be assisted. Most countries with UHC (including the US in the near future) allow people to make whatever personal medical expenditures they want.
It’s unfeasible or impossible to accomplish this. So much non-governmental money is used to fund medical research (pharma companies, private grants, charities) that you couldn’t stop it. Even if you somehow convinced the charities to stop, I’m not sure how you could convince pharma companies’ R&D departments to shut down and… what? Donate all of their money to giving away their medications?
I have to challenge your premise that it would be slower. If everyone is getting care that means more eyes looking over more bodies noticing more things. That means better preventative care, catching things earlier, before they need heroic levels of medical care, freeing those resources for either research or better, more available heroic care for those who need it.
It also means more chances for medical knowledge to grow. Its a bit like the tropical rain forest. One of the reasons people say not to chop it down is because the diverse life there might have evolved things we could turn in to wondrous drugs. Well maybe that medical case that will teach us something amazing about the human body is going untreated, as its owner suffers, and maybe dies from it in poverty. Diversity of experience, and thought provides the seeds and growing room for knowledge.
I think you’ve hit upon a fundamental difficulty of universal medical care. There is a mathematical asymmetry between the amount of hi-tech-labor-intensive medical care that that can be created versus the amount that can be dispensed.
Society can injure their bodies infinitely more ways and at a faster pace than advances in medical care can respond to it. Even a 100% tax on citizens’ income of which 99% is dedicated to medical coverage will not fix this discrepancy.
It’s a necessary tradeoff. However, that doesn’t mean we can come close to what most would call a reasonable and “good” society.
I see no reason for it to slow down. Universal healthcare is more efficient, leaving more money to be spent on research. It only has to slow down if people really don’t care about it–something we can’t know when people are paying for the use of medicine but also financing other things.
And it’s not like you couldn’t also have a tax that was for research, too, if you’re worried people won’t give voluntarily. A more efficient system means less monetary loss.
This does require people to be on top of pork barrel spending, but that’s another issue.
It is a good question, although I think medical technology should advance how it may, and if only the rich can afford the latest and greatest technology, so be it. Eventually it will be available to all. That may sound harsh, but if you slow down medical advancement in the name of fairness and equality, you doom millions of our descendants to poorer health and earlier death. It’s not all about us right here right now.
This debate will really come to the fore once it’s possible to reverse aging. Any technology that is universally desired will be unlikely to be universally affordable at first.
I agree with others that it’s a false dichotomy. Though I’m generally in favor of free markets, it’s simply wrong to think that if companies with free reign to seek profits will automatically pursue medical advances. Consider, for example, this summary of one case written by Malcolm Gladwell:
Ten years ago, the multinational pharmaceutical company AstraZeneca launched what was known inside the company as the Shark Fin Project. The team for the project was composed of lawyers, marketers, and scientists, and its focus was a prescription drug known as Prilosec, a heartburn medication that, in one five-year stretch of its extraordinary history, earned AstraZeneca twenty-six billion dollars. The patent on the drug was due to expire in April of 2001. The name Shark Fin was a reference to what Prilosec sales—and AstraZeneca’s profits—would look like if nothing was done to fend off the ensuing low-priced generic competition.
The Shark Fin team drew up a list of fifty options. One idea was to devise a Prilosec 2.0—a version that worked faster or longer, or was more effective. Another idea was to combine it with a different heartburn remedy, or to change the formulation, so that it came in a liquid gel or in an extended-release form. In the end, AstraZeneca decided on a subtle piece of chemical reëngineering. Prilosec, like many drugs, is composed of two “isomers”—a left-hand and a right-hand version of the molecule. In some cases, removing one of the isomers can reduce side effects or make a drug work a little bit better, and in all cases the Patent Office recognizes something with one isomer as a separate invention from something with two. So AstraZeneca cut Prilosec in half.
AstraZeneca then had to prove that the single-isomer version of the drug was better than regular Prilosec. It chose as its target something called erosive esophagitis, a condition in which stomach acid begins to bubble up and harm the lining of the esophagus. In one study, half the patients took Prilosec, and half took Son of Prilosec. After one month, the two drugs were dead even. But after two months, to the delight of the Shark Fin team, the single-isomer version edged ahead—with a ninety-per-cent healing rate versus Prilosec’s eighty-seven per cent. The new drug was called Nexium. A patent was filed, the F.D.A. gave its blessing, and, in March of 2001, Nexium hit the pharmacy shelves priced at a hundred and twenty dollars for a month’s worth of pills. To keep cheaper generics at bay, and persuade patients and doctors to think of Nexium as state of the art, AstraZeneca spent half a billion dollars in marketing and advertising in the year following the launch. It is now one of the half-dozen top-selling drugs in America.
In the political uproar over prescription-drug costs, Nexium has become a symbol of everything that is wrong with the pharmaceutical industry. The big drug companies justify the high prices they charge—and the extraordinary profits they enjoy—by arguing that the search for innovative, life-saving medicines is risky and expensive. But Nexium is little more than a repackaged version of an old medicine. And the hundred and twenty dollars a month that AstraZeneca charges isn’t to recoup the costs of risky research and development; the costs were for a series of clinical trials that told us nothing we needed to know, and a half-billion-dollar marketing campaign selling the solution to a problem we’d already solved. “The Prilosec pattern, repeated across the pharmaceutical industry, goes a long way to explain why the nation’s prescription drug bill is rising an estimated 17 % a year even as general inflation is quiescent,” the Wall Street Journal concluded, in a front-page article that first revealed the Shark Fin Project.
In regards to that, that’s one reason people should really research and not just rely on their doctors. Doctors tend to prescribe the newest thing even though the older version works just as well. My wife has to take Prilosec. She was prescribed Nexium, but the heck with that. Prilosec works just as well. I myself got prescribed some weird drug to treat ringworm. Once I found out I had ringworm, I just bought some Tinactin. Cleared it up quickly. A dentist once tried to sell me Peridex. I bought Listerine instead.
People just need to be better consumers. The drug companies aren’t taking advantage of the system, they are taking advantage of consumer laziness, exacerbated by insurance companies paying for drugs that shouldn’t even be in their formularies. Any insurance company that covers Nexium is a dumb insurance company.
Funny thing is, governments aren’t any smarter. Britain’s NHS covers Nexium, or at least they did at first. There were calls to take it off the formulary to free up funds for drugs that were actually useful, but I can’t find out if anything came of those sensible calls.
So one could say that when markets don’t work, a lot of times that’s because governments don’t work.