The government would not tell the drug companies what they could make. It would merely decide what they would buy. Your economics seem to imply that the manufacturer is the one who decides what we buy. I say the customer chooses. If you want me too drugs go ahead and buy them. But not on our dime.
You decline to address the question regarding how you would ration health care. Most of us do not see the Public Health Plan as being a gold plated plan, but rather basic proven health care. If you want more, go ahead and buy it. As a tax payer, along with most of the rest of you, I am not all that in favor of paying for Gold. Good basic coverage provides almost all the benefit modern medicine has to offer. It is that extra benefit (or even useless medical care), profit, and waste that ups our medical costs from 8-12% of GNP to upwards of the 18% they are projecting.
Last edited by RobLL : 06-17-2009 at 01:35 PM.
Reason: expand answer
I agree with you on the drug development issue and stifling of new drug discovery... but there has to be something to do to control costs of this stuff. As it is, it seems the US is footing the entire bill for R&D; how else is it that other countries pay pennies on the dollar for the same medications we pay hundreds or thousands for here?
Seems to me that the fundamental structure of big pharma needs to be scrutinized, and not necessarily by the government. THere should be a shared cost in drug development, period. Raping only or primarily the US health care consumer is not an acceptable method to finance this--IMO.
I agree that it would be nice for the rest of the world to pay their share for the drugs that get developed here in the US. Even when US companies give huge discounts for drugs they still catch hell because they are not giving them out for free. It's a tough problem because a lot of the world is much much poorer than the US so anything the drug companies charge is going to seem like a lot.
Quote:
Originally Posted by RobLL
The government would not tell the drug companies what they could make. It would merely decide what they would buy. Your economics seem to imply that the manufacturer is the one who decides what we buy. I say the customer chooses. If you want me too drugs go ahead and buy them. But not on our dime.
Sigh, the government controls things by using the money carrot. That's how it works. They don't need to tell the drug companies what to work on, all they need to say is what they will pay for. For example, look at how the government controls states today. Basically we won't give you any of your tax money back unless you do x, y, and z.
Quote:
Originally Posted by RobLL
You decline to address the question regarding how you would ration health care. Most of us do not see the Public Health Plan as being a gold plated plan, but rather basic proven health care. If you want more, go ahead and buy it. As a tax payer, along with most of the rest of you, I am not all that in favor of paying for Gold. Good basic coverage provides almost all the benefit modern medicine has to offer. It is that extra benefit (or even useless medical care), profit, and waste that ups our medical costs from 8-12% of GNP to upwards of the 18% they are projecting.
I can't even begin to talk about rationing until I know what is getting rationed. First you need to define 'basic proven health care' and 'almost all the benefits modern medicine has to offer.'
As an aside, I could argue that we already have beyond basic healthcare for most/all. In CA for example they have a law on the books that says anyone and everyone must receive healthcare if they need it. Illegal aliens with no money or insurance are getting organ transplants in CA. If that isn't beyond basic proven healthcare I don't know what is.
__________________
"Only those who will risk going too far can possibly find out how far one can go." -- T.S. Eliot
"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
....................I can't even begin to talk about rationing until I know what is getting rationed. First you need to define 'basic proven health care' and 'almost all the benefits modern medicine has to offer.' ...
.
If you believe, as many of us do, that this is a crisis which is capable of bankrupting not only major businesses, but also states and the federal government, then addressing the economics which seem to be driving the crisis is essential. And there is evidence that it needs to be done fairly quickly. The current system has not been able to control costs (note: trends that cannot continue, won't), nor provide insurance for an increasingly large percentage of Americans.
How about some links to articles on a system you support, or I suppose, even a defense of the current system.
The insurance crisis affects hospitals. For example, DC General had to close their emergency room because too many of their patients lacked insurance. The emergency room lost too much money to stay open.
If you believe, as many of us do, that this is a crisis which is capable of bankrupting not only major businesses, but also states and the federal government,...
Not to nitpick, but the argument method that many believe something must mean it's true is not a very good technique. At one time in history many believed the sun circled the earth, the plague could be stopped by surrounding yourself with fire, and that black people were not real people. All those ended up being wrong.
Quote:
Originally Posted by RobLL
...then addressing the economics which seem to be driving the crisis is essential.
And there is evidence that it needs to be done fairly quickly. The current system has not been able to control costs (note: trends that cannot continue, won't), nor provide insurance for an increasingly large percentage of Americans.
How about some links to articles on a system you support, or I suppose, even a defense of the current system.
CA is probably the most progressive state in the nation with healthcare and every other social program they offer and they are bankrupt. Is that the model we want the entire US to follow? I'm would hope not.
Has anyone even found what is driving the costs higher? Tort reform could maybe help (this says no though). We could put in place good samaritan type laws for doctors and hospitals, although Obama has said he doesn't want to do that.
Have we ruled out the current government laws, mandates, and programs as a reason for the high costs? Maybe it's insurance (and I'm using the term loosely) that has driven higher costs? If we didn't have medicare or other health insurance would anyone go see a doctor? When something is 'free' people tend to use it even if they don't need it. An interesting article from a few years ago.
Quote:
There, she found that hospital spending soared after the federal Medicare program began in 1966.
But on the flip side, all the money flowing in pushed companies to develop newer and more expensive technologies. Do we want to stop research on new healthcare tech even if it is going to be expensive? It would be interesting to see how many of the US drugs and healthcare technologies are exported to the rest of the world and vice versa. Are we supporting the rest of the world through our high costs healthcare/research?
Finally, is the government plan really going to be cheaper? The CBO came out the other day and seemed to say no, although there is a lot of spin going on from both sides.
The current system does have problems, but I'm not willing to throw it out without knowing exactly what those problems are and how the new system plans to fix it.
__________________
"Only those who will risk going too far can possibly find out how far one can go." -- T.S. Eliot
"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
Not to nitpick, but the argument method that many believe something must mean it's true is not a very good technique. At one time in history many believed the sun circled the earth, the plague could be stopped by surrounding yourself with fire, and that black people were not real people. All those ended up being wrong.
CA is probably the most progressive state in the nation with healthcare and every other social program they offer and they are bankrupt. Is that the model we want the entire US to follow? I'm would hope not.
Has anyone even found what is driving the costs higher? Tort reform could maybe help (this says no though). We could put in place good samaritan type laws for doctors and hospitals, although Obama has said he doesn't want to do that.
Have we ruled out the current government laws, mandates, and programs as a reason for the high costs? Maybe it's insurance (and I'm using the term loosely) that has driven higher costs? If we didn't have medicare or other health insurance would anyone go see a doctor? When something is 'free' people tend to use it even if they don't need it. An interesting article from a few years ago.
But on the flip side, all the money flowing in pushed companies to develop newer and more expensive technologies. Do we want to stop research on new healthcare tech even if it is going to be expensive? It would be interesting to see how many of the US drugs and healthcare technologies are exported to the rest of the world and vice versa. Are we supporting the rest of the world through our high costs healthcare/research?
Finally, is the government plan really going to be cheaper? The CBO came out the other day and seemed to say no, although there is a lot of spin going on from both sides.
The current system does have problems, but I'm not willing to throw it out without knowing exactly what those problems are and how the new system plans to fix it.
The CBO "brief" actually didn't include the public option in the numbers. It was incomplete when published. See Ezra Klein here.
Quote:
The CBO's findings . . . are for an incomplete piece of legislation, making the cost-per-coverage estimates much worse than they will ultimately be. Republicans on the committee knew this, according to Democrats. But they pushed for the bill to be studied by the CBO now. And when poor results came back, they ran with them.
"The reality is there are still some outstanding issues, including employer responsibility and a public insurance option," said a Democratic aide to a committee member. "Those are two outstanding issues. So what we did in a good faith effort to find bipartisan consensus, we did not include those elements because we are trying to find common ground. But Republicans wanted there to be a score even though, the reality is, if there is an incomplete bill you will have an incomplete statement."
Another Democratic aide to the HELP Committee member concurred, adding that Sen. Ted Kennedy's office, in an effort to "find bipartisan consensus with Republicans colleagues" filed the bill and allowed it to be scored by the CBO -- not expecting it to be used as partisan fodder.
I would expect the public option to drive the numbers higher, not lower. Spending will be higher than any taxes associated with it (without a doubt there will be tax increases).
__________________
"A government big enough to give you everything you want is a government big enough to take from you everything you have."
Well, I'll post more on that later with some data to back it up, Bob, but although somewhat counterintuitive, a public option SHOULD cost less. If run properly. Yeah, I know that's a stretch.
If the government plan is going to be so great why does there need to be supplemental insurance? By having supplemental at all it shows that the government plan is lacking. My guess is that the supplemental plans also will not have a tax break. So, at the end of the day companies will quit offering insurance and defer to the government plan. Individual supplemental insurance will most likely cost more than what I pay now. When all is said and done I'll end up paying more money for the same or less benefits. Brilliant healthcare reform!
Its not meant all encompassing insurance, at least not without paying more for it.
Quote:
Except drugs will not get developed. It's fun to think that drug companies come up with revolutionary new drugs out of thin air, but that is not how it works. Drugs (and science in general) come from small evolutionary steps. Those 'me too' drugs help pay the bills while they work on other science. They can also help invent new methods by solving solved problems in different ways. Those methods can then be applied on new problems.
Worst of all is you then put the government in charge of what drugs get developed. Look at what Bush did to stem cell research, do you really want the government in charge of telling the companies which drugs they can and can't develop?
Meh. The NIH is responsible for the bulk of drug research, which is then used openly by drug companies and then twisted around into a monopoly in the form of a patent (which can then be abused). Also, their is collusion in the market as evident in the case of Androgel, where the makers paid off a generic company that was going to produce it to postpone or kill the release. They got caught by the FDA and Im sure are going to pay a hefty fine.
The big pharm companies can cry me a river.
Quote:
Not to nitpick, but the argument method that many believe something must mean it's true is not a very good technique. At one time in history many believed the sun circled the earth, the plague could be stopped by surrounding yourself with fire, and that black people were not real people. All those ended up being wrong
Haha I know. Everyone is referring to this as a 'crisis.' Then theres the housing crisis, banking crisis, economic crisis, blah blah. Must be really shitty to always be living in a perceived crisis.
__________________
"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
The CBO report on health reform and the federal budget is currently at the top of the list of reports. Click the pdf file, some 40 pages long, but an easy quick read. Reading it will give you facts from which you can continue the discussion. It is even OK to disagree with some facts, but what is written in the report is pretty much what most people believe. If anyone has come across a GOOD condensation of the report a link or extended quote would be useful. But the report itself really is a condensation.
Well, I'll post more on that later with some data to back it up, Bob, but although somewhat counterintuitive, a public option SHOULD cost less. If run properly. Yeah, I know that's a stretch.
My problem right now is Obama's assertion that if health care reform is not enacted this year it will never be enacted. Why is that? Is he going to take his ball and go home? I fear there will be a rush to get legislation to please the President's promise that will be full of holes so it doesn't end up costing less. I would rather see them take a little more time and get it right to start with.
I also see the public option as cost shifting, not cost saving. The President says that the uninsured cost the insured about $1,000 in additional premiums (which may not be accurate). So the public plan may reduce those premiums but the increase in taxes (and possible cuts in services) may offset those gains.
__________________
"A government big enough to give you everything you want is a government big enough to take from you everything you have."
The CBO report on health reform and the federal budget is currently at the top of the list of reports. Click the pdf file, some 40 pages long, but an easy quick read. Reading it will give you facts from which you can continue the discussion. It is even OK to disagree with some facts, but what is written in the report is pretty much what most people believe. If anyone has come across a GOOD condensation of the report a link or extended quote would be useful. But the report itself really is a condensation.
Ive read it, along with the 88p financial report of the stupid Geitner plan.
__________________
"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
Its not meant all encompassing insurance, at least not without paying more for it.
Maybe not, but the first time someone is denied healthcare because it's not part of the their government plan we are in the same situation all over again. I can see it now, "40M Americans are without basic healthcare above what we defined last month as basic healthcare."
Quote:
Originally Posted by GqArtguy
Meh. The NIH is responsible for the bulk of drug research, which is then used openly by drug companies and then twisted around into a monopoly in the form of a patent (which can then be abused). Also, their is collusion in the market as evident in the case of Androgel, where the makers paid off a generic company that was going to produce it to postpone or kill the release. They got caught by the FDA and Im sure are going to pay a hefty fine.
The big pharm companies can cry me a river.
No one is saying big pharm needs handouts or help. I just like to point all of the possible unintended consequences of doing drastic and sudden changes to the current system. Those types of questions need to be researched and answered before any new plan is implemented.
Quote:
Originally Posted by GqArtguy
Haha I know. Everyone is referring to this as a 'crisis.' Then theres the housing crisis, banking crisis, economic crisis, blah blah. Must be really shitty to always be living in a perceived crisis.
One would think that from reading/watching the news that 99% of Americans are jobless and laying around on their couch, starving and near death. Anytime someone starts framing something as a crisis all my internal red flags go off. Chicken little FUD is a classic manipulation technique. Bush used it to take personal liberties for the fight against terror and now Obama is using it in an attempt to nationalize as much as possible. More of the same anyone?
__________________
"Only those who will risk going too far can possibly find out how far one can go." -- T.S. Eliot
"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
There are other compelling cases for a National Public Option, or at least national standards for health.
Many law suits relate to expensive medical care in the future. Most affected by this would be medical malpractice. Many of these claims occur when patients are facing lifelong injuries, and have little to do with malpractice
Another in the same vein is auto liability. If you face life long medical expenses you may have no practical option to a law suit.
Small companies would be far more competitive in hiring, were they not to have to come up with medical plans competitive with big companies and the government.
Workers would have a great deal more freedom to change jobs, were they and their families not dependent upon medical insurance by a particular employer
All of us would have a lot more freedom were we able to become self employed without losing medical insurance.
Labor and Industry (our state insurance for worker injured on the job) would become a lot simpler were they able to get out of the medical insurance business. This is not to say that hazzardous jobs and egregious safety violations could not result in penalties.
And finally as a matter of justice. Those in low paid essential jobs which do not provide medical insurance (nursing homes, school bus drivers now, agricultural workers etc) would not be at the mercy of emergency care and underfunded Medicaid insurance.
And as a PS, The last NBC/WSJ poll showed 70+% in favor of a Public Plan as an option, with only 20% opposed.
PPS - old man - I am fairly sure I am not up to a 852 page report!
The problem is that the 20% includes the current insurance providers who support so many of the current congressmen and senators. I thought there was a chance to get something done, but now I think this is going to end up like the bankruptcy legislation did.
Nice that Friedman and I think alike ;) I've long said that hiding the true cost of medical care and insurance through forced employer plans has driven up costs. HSAs should be available to everyone.
I've also said for a long time that health insurance is frequently misused. Insurance is for *unexpected* events. Most people today are over insured for the small stuff (checkups, etc...) and under insured for a serious event like cancer.
It is an older article that may have influenced me at some point and I just don't remember reading it ;)
__________________
"Only those who will risk going too far can possibly find out how far one can go." -- T.S. Eliot
"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
Friedman and his supporters all say sorts of nice things. But they NEVER are willing to put in the political muscle to turn their nice thoughts into action. That is why libertarian/AynRand sorts of thinking has been so unproductive. Republicans/Conservatives pick and choose what they like and ignore all the hard parts. Brad Delong has mentioned that for economists political affiliation almost always trumps theory.
His plan assumes government subsidies/insurance beyond a certain level, several thousand IIRC. That is totally impractical for any family making less than a few hundred thousand dollars a year. We have to get medical expenses down to the 8-12% other peer countries are spending. It may not happen, too many Democratic senators are already bought.
http://www.fivethirtyeight.com/ see comment posted at 5:45am (may be a time zone problem, title begins "Special interest money".)
The McKinsey Institute has a hundred page report on the US medical system and its financing. Registration is required. A lot of what they have to say (I've read about 20% so far) was not what I expected. Most of the excess we spend goes to doctors and hospitals, maybe 70%; admin and drugs, less than 30%.
His plan assumes government subsidies/insurance beyond a certain level, several thousand IIRC. That is totally impractical for any family making less than a few hundred thousand dollars a year. We have to get medical expenses down to the 8-12% other peer countries are spending. It may not happen, too many Democratic senators are already bought.
That's Friedmans point though. As soon as you remove the 3rd party pay system, health costs would plummet because no one would be able to afford it any other way. There would be a rough transition, but eventually prices would settle around where people could get their basic healthcare fairly cheap. Give everyone HSAs and it would effectively become even cheaper.
This is anecdotal, but I've already seen some Drs. offering great deals if you pay on the spot at the time of the service. I talked to one of the docs and he explained that being able to avoid insurance paperwork, price haggling with the insurance companies, and collections on what insurance didn't cover meant he could charge much much lower prices.
__________________
"Only those who will risk going too far can possibly find out how far one can go." -- T.S. Eliot
"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
Friedman and his supporters all say sorts of nice things. But they NEVER are willing to put in the political muscle to turn their nice thoughts into action. That is why libertarian/AynRand sorts of thinking has been so unproductive.
Seriously, what the fuck are you talking about? Ron Paul led a resurgence in such thought, and Friedman himself started a non-profit foundation dedicated to school choice and reform.
__________________
"The strongest steel goes through the hottest fires."-Anonymous
"When you begin to believe nothing is heavy, all weights become light." -Rossbow
"Just remember, somewhere there is a little Chinese girl warming up with your max."-Jim Convroy
"It's a round hole, dammit. Everyone fits."--Anonymous Mod at Strengthmill
I simply do not see any major moves by Friedman or Paul that have solved any major societal issues. Friedman's monetarism theory is discredited. Greenfield's reliance upon rational actors in the banking system is shown false (and he himself expressed it), and Ron Paul is a bit player. I do not doubt that all three of these men may have cogent criticisms in current affairs. But there is little evidence that they actually can come up with politically acceptable programs that function. At one time I thought the two economists might.
Actually I would be more interested in an actual medical plan from your perspective that would work. The second step is more difficult: Republican legislatures will attempt to destroy any plan that does not protect current medical and insurance profits, inefficiencies, and overuse.
So what would the problem be with changing the system to greatly increase the purchase of health insurance by persons rather than companies? Competition would drive down price, and likely increase efficiencies. Give a credit to those that cannot afford insurance and give a deduction for those who can. Above a certain amount gets taxed.
__________________
"So many of our dreams at first seem impossible, then they seem improbable, and then, when we summon the will, they soon become inevitable."
- Christopher Reeve
Column on the Times website running today on the economics of health care. The column will be changing throughout the day. I like the first guys take.
Quote:
Dana P. Goldman is chair and director of health economics, finance and organization at the RAND Corporation. He is also a professor at U.C.L.A.
One reason that health reform proposals always seem to fail is that proponents promise too much. Reformers declare they will improve quality, lower costs and increase access all at the same time. This mantra is repeated so often on both sides of the ideological divide that the public tends to believe it is possible, when really it isnt.
I want to suggest a new priority improve health, not the health care system.
This may sound like a parsing exercise, but it is not. Consider the evidence. Many of the greatest improvements in health during the last century had little to do with the health care system. Clean water, public sanitation and reduced smoking all reflect public health interventions that had dramatic benefits.
Cardiovascular disease is another good example. Between 1980 to 2000, the death rate for coronary heart disease was cut in half. But only about half of this reduction came from better medical therapies. The rest lower blood pressure, lower cholesterol, less smoking, and other factors came from better behavior and some drugs. And treatment of heart disease is one of our greatest success stories. Our accomplishments in diabetes, cancer, and lung disease are not nearly as impressive. So good health is only partially a story about excellent health care.
Advocates of universal coverage often get confused on this point. They equate good health with having health insurance, and cite myriad academic studies. The problem is that these studies dont account for all the other differences between the insured and uninsured what they eat, where they live, whether they smoke or drink, the amount of stress in their lives, and even their genetic predisposition to disease. No health care system is good enough to fully compensate for bad behavior and poor environmental factors.
With a growing elderly population and a larger baby boom generation approaching retirement the prevalence of chronic diseases will rise. If current trends continue, health care costs will consume an ever-increasing share of national income. The future liability of the Medicare program alone is estimated to be $24 trillion over the next 75 years, absent any policy changes.
So what can we do?
Well, the first step is to invest, not in the health care system, but in education. We should take the $120 billion it might cost for universal coverage, and use it to provide earlier education and to improve the quality of education. Better educated people live longer, are less likely to be disabled, and engage in healthier behavior. They also are better at self-managing their chronic disease. And, unlike universal coverage, more education has other valuable benefits to a person and society. Less crime, less divorce, and higher earnings can universal health insurance promise that?
The second place to invest is prevention. Primary prevention has the capacity to slow or reduce the rising prevalence of chronic disease, and simultaneously attenuate the downstream spending associated with it. Equally importantly, however, prevention leads to a life with less disability and more years of an active lifestyle. It just makes a lot of sense to avoid disease in the first place, rather than try to treat it later.
There are also sound economic arguments for a strong government role to prevent disease. Because the benefits of prevention often accrue decades later long after someone has switched employers or health plans private plans will skimp on prevention coverage. The government needs to step in to fill this void. Medicare could save itself money, for example, by paying for anti-hypertensive medication before people turn 65.
Perhaps most strikingly, my colleagues and I estimate that if we could roll back obesity to levels seen in the 1980s, we could save up to $1 trillion. We need to find a way to make this happen. One way may involve better medicine an obesity pill but it may mean other methods having little to do with health care. Maybe it is an extra hour of physical education at school, or subsidized treadmills in the workplace, or even pedometers for all Americans. Clearly there would be huge returns to a substantial investment to combat obesity.
It is time for us to put the priority on health, not health care.
I wonder what the ROI is for better education regarding health practices?
__________________
"A government big enough to give you everything you want is a government big enough to take from you everything you have."
Everyone is talking about throwing trillions of dollars at healthcare. Look, as a trauma surgeon, I am happy to make more money. You can throw as much money at me as you would like. What many people are talking about (many progressives, anyway), is universal healthcare. This means eliminating insurance costs from the equation, which frees up $700 billion. Somebody go get a calculator. We spend just over $7,000 per person in the United States. We have 46 million Americans who are currently not covered by any insurance. We can use this $700 billion and cover all 46 million Americans. ....
....
The McKinsey report (link above) does not feel that US all over health or demographics is a major factor in our excess over peer countries.
Your hero Obama doesn't even agree with you. From his latest speech on healthcare:
Quote:
It also means cutting down on all the junk food that's fueling an epidemic of obesity -- (applause) -- which puts far too many Americans, young and old, at greater risk of costly, chronic conditions. That's a lesson Michelle and I have tried to instill in our daughters. As some of you know, we started a White House vegetable garden. I say "we" generously, because Michelle has done most of the work. (Laughter.) That's a lesson that we should work with local school districts to incorporate into their school lunch programs.
Obviously the obesity problem is not the only driver, but it cannot be ignored how many other long term, chronic, and expensive problems are caused by the obesity epidemic.
__________________
"Only those who will risk going too far can possibly find out how far one can go." -- T.S. Eliot
"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
This is the testimoney of a form senior executive in the insurance industry. The villain as he sees it in for-profit insurance companies is that Wall Street wants quarterly increases in earnings. And it simply is not possible in medical insurance. This is only about 9 pages long, and an easy read.
Linear Mode
