And R&D is needed to have a product to sell. So if drug prices come down, why do you leap to the assertion that R&D is the the thing that will suffer the most? Also, aren’t you bothered by the fact that we are subsidizing the cheap drug prices around the rest of the world by paying so much more for the same stuff? Imagine if a Ford F-150 cost $50,000 here, but the exact same truck in Canada cost $15,000. Wouldn’t you be a liiiiiiiiittle pissed at Ford for giving you a raw deal?
The risk is pooled, in the same way that women pay for the risk of developing erectile dysfunction, and you pay for coverage of, say, genetic diseases that you will never contract.
Man, it’s really weird to hear men talk about women needing to plan children like oil changes. Jesus Christ, dude. Jesus Fucking Christ.
So there is no system in the world that you can say is better than the U.S. public education system, which you assert is terrible?
You can think anything you want. It’s a free country. But there’s no reason to think what you say is true.
You can’t remove government regulation from something that doesn’t have any government regulation. The AMA isn’t some government agency. It’s a private organization set up by doctors. And doctors know that by working together they can set high prices and they’ll all make more money. They’ve been doing this for years and it’s working well for them. I don’t why you imagine they would choose to stop doing it.
You can look it up. The full name is the Specialty Society Relative Value Scale Update Committee. But it’s commonly called just the Relative Value Update Committee or the RUC. You can find it on the AMA website, although obviously they’re going to put a positive spin on it.
We have a government run by representatives that we elect. That government enacts programs and then pays for them by taxing people. Paying taxes is compulsory.
Do you feel that #3 is the equivalent of #1 or #2? Do you think taxation is theft?
To be fair about this, I’ll go on record and say I do not.
And we have a million industries in the United States that operate under free market principles that are vastly superior that government owned or paid for ones. Why is health care so different that it cannot operate under free market principles?
Who cares that providers make “huge profits”? Jeff Bezos makes huge profits from Amazon yet he provides a magnificent service which has greatly benefitted many people. Microsoft makes “huge profits” yet provides quality operating systems and software for millions of businesses and individuals. Grocery stores make huge profits. The housing industry makes huge profits. Why only in health care are profits something that needs to be eliminated?
Every other industry that flourishes in a free market
It’s simple economics. If I can make $10 million on something, I might spend $1 million to do it. If I can make $1 million on something, I might only spend $100k to do it. And it doesn’t matter if I am so pissed off that I am beating holes in my wall. The fact is that drugs will not be developed if a company does not invest in research to discover them.
It is a poor pool because the risks are not similar. You are overcharging one group to subsidize another. But, this is peanuts and it probably a wash for most families so I will drop it.
Come on now. That’s just a cheap shot. You know very goddamn well I wasn’t saying that children are like oil changes. You perfectly understood the point I was making that it is ridiculous to “insure” against known occurrences. Women will need to use contraception. You will need oil changes in your car. You will need to visit your doctor. You will need to change a light bulb. You don’t insure against things that definitely will happen. That is not what insurance is for.
This is getting into hijack territory, but I will just say that because something is at level X doesn’t mean that it couldn’t be at X+Y.
Again, this is getting into hijack territory, but people in West Virginia don’t seem to have a problem getting opiates regardless of the law. I know because I represent them. But regardless of drug policy, it introduces an inefficiency in providing health care.
If I have chronic back pain, it is an external cost to make me take time off of work, sit in a doctor’s waiting room, walk back and get my weight and blood pressure taken, and sit on that paper covered examination chair so that the doctor can come in and write another script for the same opioids I have taken for the past ten years. Then I get to pay a $20 copay which the insurance (or under UHC, the government) pays an additional $65 on top of, to tell me something I already knew.
I do not believe taxation is theft. As I said before, if the democratically elected government decides to use tax dollars for social programs, then that is what democracy is about.
When it changes, and keeping with the OP, and becomes a “right” of an individual citizen to have healthcare, then it is indeed theft. We have then created a society where we can no longer choose to provide charity; we must take from one and give to the other. That will be a foundational principle like free speech or freedom from unreasonable searches and seizures. It is outside the democratic process.
It is theft as a matter of foundational origin. It is a declaration by society that your money is not yours but for the benefit of the community. Or, socialism.
See, this is a great demonstration of the vast amount of ignorance on both sides. Or, if not ignorance, than deliberate misinformation designed to trick or hide. I’ll go with the former. There is no free market for healthcare in the US. There never has been, and never will be. So, the free market isn’t failing to deliver anything wrt healthcare in the US. I think the ‘why’ IS a very good question, to be honest, and your attempt to just brush that aside is interesting.
The ‘free market’ doesn’t ‘suck’, bad or otherwise. This isn’t a market issue wrt healthcare in the US. Our system is neither fish nor fowl…it’s not a free market system nor is it a government run system, it’s a kluged together mess that has aspects of a taxed based government run system and a series of regional monopolies run by quasi-private corporations using government mandates and good old boy networks along with a century of healthcare baggage, political changes in direction and out of date crap tossed in. Trying to say it’s a ‘free market’ system is about as accurate as calling what the Europeans, say, have for health care (as if THAT is some sort of unified thing either) ‘socialist’. It’s just wrong. And it’s misleading.
Instead of trying to misidentify our system as ‘free market’ and then making the silly claim that this proves markets suck, blah blah blah, why not attack the real issues with the system? I mean, I’m sure you are good with rolling your eyes when various conservative types try and label a single payer or universal health care system as ‘socialist’ and blast it based on that alone, right? There are a lot…and I mean a LOT…of real issues with our cobbled together mishmash of a health care system. But it’s not because markets suck, or some other trite anti-capitalist horseshit. It’s because the system evolved over time, has had so many cooks stirring the pot that we can’t even keep track of them all, has been jerked around by various political movements that themselves have changed over time, and ultimately wasn’t designed to do what we need it to do now in the first place, but instead designed to fix issues that were happening almost a hundred years ago. Focus on THAT, instead of this other bullshit. Just like conservative types (though, ironically, doesn’t seem limited to them) shouldn’t try and hand wave single payer systems simply because they are ‘socialist’.
Cite? Most of the patients where I work are on original Medicare-B. For the most part, the rates are solid. The AMA and specialty board has our back when negotiating rates through the RUC, that’s why we pay dues. Most of the no-name insurance startups forgo a fee schedule and pay a single-digit percentage over the Medicare rate. Even better, original Medicare doesn’t do authorizations. If it’s on the fee schedule, or if it has an NDC/LDC (national/local guidelines), it is safe to assume the procedure or treatment is covered. Very straightforward, easy to work with, so long as the rates are okay, which they usually are.
Medicaid rates are a joke, though. Accepting Medicaid is taking a loss for the betterment of society. We are the only office of our specialty with open panels that accepts all of the Medicaid plans in… well, an embarrassingly large chunk of Florida. We don’t even get the advantage of dealing with one insurer - Medicaid is privatized here in Florida and there are like, five different payors, each with different rules and different provider networks.
We run into problems when it comes to prescription drug coverage and Medicare advantage plans. These sorts of things often require “prior authorization” - we, the doctors, have to ask the insurer before we can provide treatment. Problem: we cannot bill the insurer for time spent asking them to approve doctor’s orders. So when it comes to things that the insurance company gives us a hassle about, sometimes we can lose money even though we are being paid at Medicare rates, because of the extra time and resources spent jumping through hoops.
We know the free market fails for health care – we have lots of history to show this (for most of our history we had a mostly-pure “free market” health care system). This is because some people’s health needs are not profitable to treat, period. Some folks can’t be made a profit on in terms of health care. As long as people like that exist, the free market can’t solve health care, at least unless you’re willing to cut such people loose and doom them to short and miserable lives.
There are folks out there with chronic conditions who go to the hospital multiple times per year, and have to see their doctor for non-trivial treatment multiple times per month. Unless they happen to be billionaires, there is no market incentive to treat such folks.
I thought I did. The last paragraph you quoted. It would “work” for a very modest definition of work. People would get health care. But for the reasons that other markets provide better goods and services, we should get better health care by allowing free markets to work. Why can’t free markets work in health care?
What you say is partly correct but IMHO is itself misleading. When conservatives criticize single-payer as “socialist”, the implication is that the government is vastly overreaching into an important aspect of our lives in a way that will be detrimental and excessively bureaucratic, which is the exact opposite of the truth, but they irrelevantly cite the failure of socialist economic systems as evidence. This is also often closely associated with the claim that if any aspect of health care is “socialized”, it’s a slippery slope that will lead to the socialization of many other things. The AMA stated that it was “a definite step toward either communism or totalitarianism” and in the early 60s Ronald Reagan was part of a Republican-driven campaign to stop the passage of Medicare, saying that if it was passed, “one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” Cite.
Whereas referring to the present health care system as “free market” is just a short-hand way of saying that a major part of health care coverage for medically necessary procedures in the US is provided by private for-profit corporations, as compared, say, with zero in Canada, and that most health care providers are for-profit individuals or enterprises. Most importantly, it implies that the quality of health care you get in the US is pretty closely aligned with your ability to pay, in the time-honored free-market tradition of a rich person having, say, a high-end new car while a poor person drives a beater or has no car at all. And irrespective of some of the irrational factors that you describe, basing health care coverage for most Americans on private corporations is both directly and indirectly responsible for most of America’s health care woes, because treating coverage of medically necessary procedures as a business is fundamentally incompatible with the purpose and ethics of health care.
In short, referring to single-payer (or often any form of UHC) as “socialist” is an old conservative scare tactic that goes back decades, whereas referring to it as a “free market” reflects a fundamental truth about how the model basically works, even if there are exceptions and many screwed-up policies. If you prefer, it could be said to be “modeled on basic free-market principles”, most importantly the great capitalist tradition that you only get what you pay for. Not only do millions of Americans not get the health care they need for just this reason, but according to Families USA, between 2000 to 2006 an estimated 162,700 Americans actually died because of lack of health insurance.
Ok, here’s the difference. When the state accuses you of a crime, they are attempting to take away your liberty. That is an affirmative action against you. In order to do that, it is only fair (if you are poor) that the same state, including the taxpayers in it, fund a reasonable defense so that you can rebut the charges.
It really isn’t 100% for the benefit of the defendant. It is not in the state’s interests to incarcerate innocent people, and without a public defender, the state may well do so due to the defendant’s ignorance or indigence.
If we contrast that with health care, the state is not responsible for making a person sick, so no corresponding duty arises.
If the market controls health care, there will always be the incentive to deny treatment to the needy, because such treatment costs the insurance companies money. And most needy folks won’t have the resources to go toe-to-toe with the insurance companies, or the resources to pay doctors directly. That’s what the profit motive does – it motivates the denial of treatment. Take the profit motive out of necessary medical care and there’s no more motive to deny treatment.
But regardless of drug policy, it introduces an inefficiency in providing health care.