Couple of things before I log. I think your assumptions are based on price (demand-side); I’m looking at cost (supply-side).
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However, you’ve probably noticed I don’t have a great answer. I’m thinking, even admitting I may need to concede the point. :smack: (Not yet throwing in the towel.)
One point I think we’re agreeing on (asking…): lack of profits in foreign countries is diminishing R&D potential.
Well, my train of thought may have been derailed on specifics of how price fixing has effected us, but I still stand by my assertion (and will be back tomorrow with more brain cells to back up) that price fixing reduces the ability of companies to invest more in R&D.
I don’t think anyone’s denied this. I certainly haven’t. What we’ve been denying is that price controls in Country A result in higher prices in Country B. And drug companies set prices with an eye to recovering research investments, rather than maximizing profits.
The problem is no country comes close to paying what we in the US pay for healthcare. We spend about 16% of GDP on healthcare, most other developed countries spend about 9-11%.
However you are referring to just tacking universal healthcare onto our pre-existing system instead of scrapping it and getting a single payer system. The quotes I’ve seen show its closer to $100 billion a year, not $300 billion to provide universal coverage. Considering that there are only about 50 million uninsursed people in the US if it was $339 billion that’d come to about $6800 per uninsured person, which is pretty excessive considering that we spend about $5400 per person on average, and that is for (I think) everything, not just insurance. Insurance for the poor would probably be deductible insurance, it wouldn’t be near $338 billion.
ALso the Cato institute is a very libertarian organization, I can’t take what they say at face value. IMO they probably cherry picked statistics to come to their conclusion(s).
I am sorry that no one finds the links to the Natiional Coalition for Healthcare Reform all that interesting, but if the conversation is to be about Pharma now, then I’ll throw my bit in there too.
Profit has been a poor incentive for meaningful R and D. The current model is blockbuster focused and blockbusters are lifestyle drugs. Nothing wrong with them, I’m on Lipitor myself and have family members on Concerta and Celexa. Useful products and very profitable; you take them everyday, perhaps for the rest of your life. But little relatively research is being done on new antibiotics, vaccines, etc. Meds that might make a bigger difference to the world’s health are getting short shrift because they won’t knock the ball oout of the park for shareholders.
The current model poorly serves the goal of motivating the best research for the world’s health. Precisely because it is driven by the American cash cow bonanza.
I have no easy fix to offer here. Our regulations are onerous and they are that way for good reasons. The drug pipeline is a long pipe with lots of leaks and dead end routes. Drug discovery is a tough business and when you have a winner you really want it to win big. It is a very high stakes game.
Removing the American jackpots might decrease some R&D, or it might just redistribute which R&D gets done. I’m not sure.
Actually, I think you’re probably right, but I was keeping it simple.
In fact, you’d also have to consider the reverse - the possibility that Canadian consumers would then try getting the drug in the USA, driving up demand in the U.S. market and pressuring prices to rise higher still.
Justanothergeek, it is probably true that price fixing “reduces the ability to companies to invest in R&D.”
In fact, it’s obviously true. If price fixing means they make less money then obviously they don’t have as much ability to invest in R&D. They don’t have as much money to do anything. My only point was that government price fixing a la Canada does not raise the price of the drug in the USA.
However, you’d have trouble showing that this effect substantially reduces the acceleration of scientific advances in pharmaceuticals. As has been pointed out, countries like Canada don’t get the drugs that much cheaper, really… if I didn’t have a drug plan thru my employer, I’d have gotten absolutely raped over prescription drugs. It’s doubtful the big drug companies are going to turn down a golden opportunity over losing a tiny percentage of their profits.
Drug companies only spend about 13% of their budget on R&D. Not a gigantic amount, and their profit margin is close to 20%. I don’t see why the elderly don’t just buy their drugs from europe & Canada though.
In the US if you can’t afford the drugs or treatment or your insurer doesn’t want to cover them then they are withheld too. What is the difference between your insurance company withholding treatment and the government doing it, or not affording it in the first place? I support a two tier system where if people don’t want the public service they can opt for private service, but we don’t have that in the US. We lack a public service available to everyone, the only people covered are the elderly and the poor with children.
Besides in the UK they spend about half what we spend on healthcare, so things like that are expected. But the end result is the same, some people ahve treatment withheld in the UK & US the only difference is in the US we spend twice as much money for it to happen.
What I find so frustrating about the health care debate is that it so frequently gets framed as it has in this thread: there are two options–the status quo or socialized medicine. And that’s simply not true.
I, for one, think that perhaps the most workable plan for the United States would be something like what Austria has. From this link: Austrian Health Care System
Not a perfect system. However, it has advantages over what the United States has now, in that:
Almost everyone is covered for most medical needs.
Coverage is relatively affordable.
The advantages over a single payer system are:
We don’t have an inefficient government administrating things, yet coverage is guaranteed.
It’s not socialized medicine, which means the plan is going to be easier for the American public to swallow.
Choice of physician remains approximately the same as it is now.
Government already pays for 50% of healthcare in the US, compared to places like Canada, Australia, the UK, etc where the gov pays about 80-90%.
When you count medicare, medicaid, veterans administration, gov. funding for R&D, all the gov. employees who get healthcare through work (teachers, police, postal employees), etc it comes to about $800 billion a year.
So its not like we aren’t already gov. sponsored with healthcare, or that the gov isn’t involved (they cover alot of R&D and healthcare for alot of people). We are just half assing it a bit.
Besides, in all honesty I trust the government more than a PPO or an HMO. Given the choice I’d prefer an accountable, transparent, democratic government over a PPO that only cares about profits that I have no say in, who was picked for me anyway (most peole don’t get their pick of provider in the US, their employer picks them for them).
I frequently hear some variant on this, and I find it baffling. Do you believe that we do not have the right to choose our own doctor? If so, allow me to disabuse you. We choose our own doctors.
I chose a gay male GP so I wouldn’t have to explain as much; I asked for a referral and got it. I could have chosen any GP in the city, provided they were accepting new patients at that time. We are not assigned a doctor by the government, or anything of the kind.
I know you have some choice, but I’m not sure how broad a choice it is. Are you able to go to absolutely anyone? Or are you limited by geographic range or other factors?
I don’t really know why I put that pro under the single payer thing. I mostly meant it as a general “we’re not losing anything re: choice,” not as a slam on single payer in particular. Mostly just to address fears re: choice. I don’t know. It’s late. My brain is numb.
If I wanted to and felt like driving the distance, I could start seeing a doctor in Rimouski and the government would do nothing to stop me. I’ve been to CLSCs (public clinics) and walk-in clinics in various parts of the city, as well as a variety of hospitals. I have never received any indication that I am restricted to a particular set of doctors in Quebec.
I don’t know about doctors outside the province but my supposition is that the only restriction would be the practical matter of getting the two insurance regimes (which are provincial) to talk to each other, the details of which I’m unfamiliar with.
…Just to say that it can’t be that difficult, as people who move from province to province routinely stay under their original coverage until they are eligible for the new province’s health coverage.
This is correct. As an example drawn from ancient history, as a student in Manitoba but a resident of Saskatchewan, I show up at the clinic in Winnipeg, display my Saskatchewan health card. A form is filled out, and I see a doctor. The only thing that really comes into play is that the province you’re from doesn’t really want to pay if you’re actually residing in the province where you’re seeing the doctor. So they want some sort of evidence that you’re there temporarily, i.e., a student, on vacation, etc. Said evidence consists of writing down your reason for being in the province on the form. This may mean that it’s not feasible to see a doctor from another province on a regular basis. I don’t know offhand that we have any Dopers from Ottawa/Hull, or Lloydminster, or any other border town who might know more about such a situation.
Please read that National Healthcare Reform link I previously posted. There are indeed several scenerios for reform put forth, all of which include universal coverage and rate increase caps and none of which is socialized medicine.
Mandated coverage with some means of assuring affordability (sliding scale tax credits, etc.) is key. I would merely add a mandate that insurance companies must charge the same price to all comers to their proposals.
BTW, most Americans are not free to choose whatever doc they want. HMO’s PPOs and plain ole lack of any coverage at all limit choices for most.
I don’t know about Canada, but in France, you can see whoever you want, with two caveats :
Doctors can choose to apply the regulate rate (for instance, it’s 20€ for a visit to a GP, 30€ for a home call, more for a specialist) or to charge you more. You’re only reimbursed for the regulated rate. So, you might be unable to see a particular doctor who charges a lot if you can’t afford the difference (most GP charge the regulated price, most specialists charge more). Except if you have a mutual insurance (an insurer without shareholders and controlled by the insured, called “societaries” who elect the board of directors, etc…), or less frequently a private insurance, that will cover the difference (these insurers also cover medical care poorly reimbursed by the public system, like dental care, nice acccomodations in private hospitals, health related things like loss of income due to an illness, etc…)
-A new law just have been implemented last month. According to it, you have to register with a specified GP and in order to see a specialist, it must be recommanded by this GP (with some exceptions, like eye-doctors, for instance). I’m not sure what are the consequences if you don’t. I suppose you’ll be reimbursed less. Or maybe not reimbursed at all. However, you still choose whoever you want. But it becomes more complicated, since you’ll have to notify the social security services when you will switch to another doctor (at least if you want to beneit from the full reimbursement). This has been implemented in order to prevent “medical nomadism” (people visiting several doctors for the same issue until they find one willing to do/say whatever they want him to do/say) and to prevent people from seeing a specialist when it’s not necessary (I feel something weird in my chest, I surely need an appointment with a cardiologist and an EKG).
I’m very pro universal health care (it’s one of my favorite issues); one of the reasons I prefer a single-payer system is because it’s simpler. I’m really leary of simply throwing patches and bandaids at our current system: things like insurance pools for subsets of the currently uncovered, tax credits, subsidies, etc. seem like they’d make a system that’s already super-complicated and administratively top-heavy (medical billing is its own profession!) and make it more so–not to mention waisting resources on yet another administrative beuracracy.
I think some of the people most in need of health care are some of the people who are least able to navigate a complex stew of government programs, and I think one of the requirements for a universal health care system (and one that’s not addressed in the NCHC paper) should be that it’s simple for people to access. I think one of the things that’s the most broke about our current system is how complicated it is: A poor person in need of health care is going to have to navigate through Medicare (federal), Medicaid (state), any local charity programs, any programs available through the hospital. Each of those steps is gonna involve seperate agencies, and each could range from simply filling out a form to consulting a lawyer so you can shuffle your assets around so that you can qualify. The fact that “medicare lawyers” exist is a sign of a very broke system, IMO. Adding additional programs to it, instead of a revolutionary overhaul, would make it more broke, at least in this important aspect.
Can get a mandate that all health care providers have to charge the same price to all their customers? And publish their fee scales, so that people and organizations can shop around?
Sorry, didn’t notice that. I scanned parts of the thread, mostly looking to see if anything other than “free market” and “single payer” were discussed. I must have missed your post.
The point still stands, though–most people in here, and most people in the outside world, seem to discuss the problem as if those are the only two options.
I’ve had a lot of discussions about this with a lot of different people in my personal life because health care issues have become really important in my life in the last four years. I have a chronic health condition and I’m currently unemployed (with COBRA due to run out in two months). I generally find that no matter how smart the person is, they’re typically entrenched in one of two viewpoints:
We can’t trust corporations, private health insurance sucks, our current system leaves too many uninsured, the government needs to take over the whole thing.
We can’t trust the government, they’re too wasteful, a lot of people will lose quality of care, we need to stick with the status quo. Some people in this category say we need to plug the holes somehow; I’ve met some others who think the uninsured are just getting what they deserve (or more than they deserve, through federal, state, and local programs funded by taxes).
Most of the people I’ve discussed this with are Ph.Ds or hold some advanced professional degree. They’re not stupid. They’re just ignorant of the other options. And I’m disappointed to see that the argument here is similarly dichotomous and polarized, at least to a large extent.
As for a single payer system–I do not think that the American public will, at any time in the forseeable future, be willing to accept one. Republicans control Congress and the Presidency; socialism is anathema to their supporters. To continue to advocate for a single payer system in light of this reality seems pointless. It’s time to look for a compromise that both sides will be willing to accept. For the left to dig in and insist on pushing for a single payer system will only delay needed health care reform.
Indeed, I’ve looked at a lot of insurance plans. Few HMO permit non-plan, non-emergency room visits unless one is on an extended visit far from the service area. If the visit isn’t covered, neither are the tests. Magiver, I don’t know what kind of cable or cell phone service you get, but if you are paying even as much as the cost of a single uninsured medical test for either of them, I want to live at your place.
