February 19, 2007
From the desk of Jane Galt:Tyler Cowen points out that Medicare was twenty years behind private industry in covering prescription drugs. Ezra responds that that's just because the insurers and drug companies wanted it that way. Which brings up one of my perennial peeves about people advocating national health insurance or any other big programme: they point out all the ways in which public choice problems make the current system suck, and then proceed to outline their future plans as if those problems will somehow magically fall away in their system. Companies won't lobby. Voters won't demand that every stupid alternative procedure they can complain about be covered, much less react to the lack of a price signal by using more of everything. People employed in that sector won't band together to keep wages high and productivity as low as possible. Bureaucrats won't shift priorities to minimizing their own political risk, rather than maximizing the level of service provided to the public. Because it's not as if those things have happened with every single other government programme ever proposed, so why on earth would we suspect they might happen in this case?
Posted by Jane Galt at February 19, 2007 7:14 PM | TrackBack | Technorati inbound links"); ?>I sometimes think that many left political arguments are like the magic sketch pads -- you lift the plastic sheet and the slate blanks. Back to nurture - or ideal participants in our future utopia.
Posted by: Michael Tinkler on February 19, 2007 7:33 PMWhy Jane, you know the answer. Because corporations are Bad, and government is Good. That is, people who gravitate to the private sector are greedy, while people who want to go into politics are caring and thoughtful. Except for Rethuglicans. And it doesn't matter if that statement doesn't stand up to the merest examination, because it feels good and reassuring to believe it, because (1) it holds out hope that unsatisfactory things in the world can be rememdied, (2) it gives a face to the reason things don't always work out (or are affordable), and (3) you, by believing this lovely fiction, are part of the solution, just like that.
You know, with the whole prescription drug thing, we could have said:
1. Prescription drugs are an ever widening part of health care.
2. For historical reasons, they are not covered by Government health plans.
3. This is increasingly incongruous.
4. In order to keep health care as affordable as possible, we might consider adding prescription drugs to Medicare.
5. So, let's decide if we want to do that, and if we can afford it.
But instead:
1. We let people act as if all those pills keeping grandma alive are some kind of extortionary ruse.
2. We completely ignore how much all those tests and hospital rooms cost, because we don't directly pay for them, so the 'skyrocketing' costs of drugs seem so awful.
3. We try to make 'Big Pharma' out to be Evil, because they dare to profit from the things they invent and produce.
This sort of nonsense can only come from a desire to exist within a framework that must have a relatively simple answer to a tough (costly) problem with the usual assortment of tradeoffs, and a villain in the way of said answer - because it can't just be that it really is a tough problem that's going to cost a lot of money.
Posted by: eriver on February 19, 2007 10:12 PMYes, bureaucrats are people and people are stupid, but don't blame bureaucrats for the health care mess. They're just trying to make sense of the rules that the politcians make for them.
You're half right. Experience shows that third party payers will come under very strong pressure from provider lobbyists, quacks promoting their favorite nostrum, health care unions, people who want to medicalize everything. This happens with government regulation of private health insurance. Politicians love mandating more expensive private health insurance coverage. It pleases their constituents immensely and it doen't cost a penny of taxpayer funds, except indirectly when paying for employee health benefits. And when it comes to employee health benefits it is easy to promise generous benefits to future retirees because the politician will have moved on to a higher office when the bill comes due.
When government starts paying for health care with tax dollars, however, it becomes extraordinarily stingy. It is popular now to expand Medicaid coverage to more and more people, but the rising costs of the program are checked a little by not paying realistic fees to providers with weak bargaining power, and by saddling them with onerous paperwork. Often the result is that people newly covered by Medicaid, or one of its clones like SCHIP, cannot find a doctor who will see them. Ask yourself, when a state spends more money on health care for poor people than it does on education for its children, whose interests are going to suffer in the long run?
I don't know whether or not I favor national health insurance, it depends on the model. The virtue of national health insurance, though, could be that we will all be in the same boat when it comes to benefits and finding the money to pay for them.
Posted by: Jim Linnane on February 20, 2007 8:01 AMThank you, Jane!
That is the kind of insight that I have grown to love from you.
The politicians are promising to cover more people with more benefits for less money. These are the same people who pay $300 for a toilet seat and I'm suppose to think that they will be able to lower health care costs?
Why the hell people don't see this for the scam that it is, is beyond me.
Come on, you know the answer: because now the right people will be running things!
Posted by: Creech on February 20, 2007 10:45 AMmuch less react to the lack of a price signal by using more of everything.
You're claiming there are folks who enjoy going to the doctor and having medical procedures, but only aren't doing it because of the cost?
Studies have shown that raising the prices does make people consume less medical services - it makes them consume less of the cheap, preventative services that actually keep costs down by avoiding much more costly services later.
As with education, the profit motive has no place in healthcare. This is a service that people NEED, not want.
For-profit insurance is by its' very nature going to prevent people from getting the care that they need. It will block out the people who need coverage and attempt to get those who will not use the services. It is BAD for society. That's why every other industrialized country has universal health care.
You pathetic strawman about bureacracies is just that. The VA has the best healthcare in the country, Medicare is right behind.
Posted by: fasteddie on February 20, 2007 11:22 AMJim - the beauty of private insurance is that we're not "all in the same boat." Nobody in their right mind would rationally decide to pool his or her own risk of loss with that of a professional football player or race car driver. No non-smoker would willingly pool their risk of loss with smokers, and so on. Putting us all in the same boat is a euphemism for communism - it penalizes prudent behavior and subsidizes harmful behavior, allowing massive transfers from the prudent to the unwise.
Posted by: David Z on February 20, 2007 11:31 AMFastEddie - "You're claiming there are folks who enjoy going to the doctor and having medical procedures, but only aren't doing it because of the cost?"
Well yes, certainly these people do exist. But that's not what's on the table here. The basic economic argument is that when you don't have to pay for something (or when you have to pay less for something), you will inevitably use more of it. This is the same argument that you would use to make externality claims about pollution: the polluter doesn't bear the cost of his decisions, and consequently he pollutes more than he otherwise would. This logic is pretty much bulletproof.
Posted by: David Z on February 20, 2007 11:35 AMfasteddie,
Your argument is as much as a strawman as you accuse others of being.
There is no such thing in the world as a government health car program as I know it because virtually all of them rely on the for-profit US medical industry to a large degree. Unless you're going to tell me that sweden has discovered and manufactured every drug and piece of medical equipment they use there.
So the problem that some are afraid of eventually happening is government mandating certain things like they always do, and then the innovation gradually going away as peope realize whatever wonderful advances they make will be regulated, controled, stolen, reproduced, or whatever by the government as they see necessary. Or that the government insurance which all new expenses must go through won't cover it because a handful of bureacrats don't see or agree with the use/value of it.
You seem to thing that because something is good and beneficial it should be guarenteed to everyone. Sorry. Life is not a rose garden, and anyone trying to sell it as such is someone I'm very skeptical of.
Certainly if you tell someone they can get free car washes courtesy of the government you'll wash your car more. Certainly if you tell someone you can get free health care you'll go to the doctor more often than when it costs you more out of pocket. And to assume that every visit to the doctor makes you better shows a profound lack of understanding of how the human body works. I'd guess for the vast majority of daily sickness that we encounter our body fights it off on its own.
So what you'll end up with is a % of people who now go to the doctor everytime they get a sniffle. Ultimately society will say, "this costs too much" and then we'll swing the other way and limit the number of times you can go to thd doctor and start forced rationing. Great. Thanks. How about, if I want something, I'll pay for it. If I can't afford it, society will help me pay for it SO LONG AS I MEET CERTAIN CONDITIONS:
You don't spend your income on addictive substances
You don't pay for cable tv
You don't have a cell phone
And a variety of other services and or product that so many "poor" people getting governement services seem to be able to afford, yet that can't afford doctors visits for their kids or put food on the table.
Is it too much to ask that if your life is in such shambles that you need to collect governement assistance that your life is truly in shambles?
I have no problem helping people out. But I don't think we should help people out who are making everyday financial decisions not to help themselves and then expecting someone else to pick up the slack for them.
Posted by: cdub on February 20, 2007 11:39 AMFasteddie: If the VA has "the best healthcare in the country" then I'd hate to see the worst.
Posted by: Jason Bontrager on February 20, 2007 11:59 AM"the profit motive has no place..."
Profit motive is non-negotiable in anything resembling a free society. It exists whether you or the government or a large portion of the public want it or not. The only two alternatives I'm aware of are 1) high altruism throughout most of society and 2) violence. Was the former a possibility there wouldn't be any problems in the first place.
Any person in the medical field that thinks he or she can get a better deal doing something else will do so regardless of whether he or she works for a public or private system.
In fact, I'd submit that the widespread idea that profit is a negotiable in education and medicine is one of the major reasons why both of these fields are a mess. You can ignore it, but it always kicks back.
Posted by: Bill on February 20, 2007 3:15 PMYou pathetic strawman about bureacracies is just that. The VA has the best healthcare in the country, Medicare is right behind.
It was a pretty convincing troll until you let that one slip. Either you weren't attempting serious dialogue, or you are confident in your ignorance, neither of which is worth raising to the level of debate.
Posted by: anony-mouse on February 20, 2007 11:12 PMI'd just like to say that Australia has an excellent Medicare system. So good that it is no longer a political issue.
It pays doctors a fixed amount for specific services and encourages doctors to accept that as full fee. Most doctors charge the pationt a bit more and the patient claims the amount back from their government direct or from their Health Insurance company. Poorer people find a doctor who does only charge the fixed fee - they bulk bill the government direct. I use doctors a lot but don't even bother with medical insurance.
Public hospitals have public and private patients while private hospitals only have private patients. I do pay private hospital insurance because I may need to use a private hospital. Its's not a big deal.
The whole scheme is run by bureaucrats and funded by taxpayers via a flat 1.5% surcharge on our progressive tax.
There is also a Pharmceutical Benefits Scheme with a safety net of about $1200pa. After that prescriptions are heavily subsidised. I use the safety net from about September each year - but I'm a small minority.
The other health related service is dental care. Free dental care for the poor is political issue. Less than 5% of the population need it and the political issue is training enough dentists.
If USA needs an effective medical/hospital system it could do worse than copy ours.
Posted by: Erik Lim on February 20, 2007 11:52 PMJane does seem to be getting religion (the right answer anyway). On a side note, I think the existence of the VA does lead to better overall healthcare delivery. The VA has a mission of patient care, research and education (now I know you feel better NOT). Care is given in the VA, on a physician level, on a physician to physician hierarchical supervised basis which is not done in private practice. And typically there is injection of resources and formal education from medical school and VA people who have proved capable of knowing the medical literature and research techniques well enough to win research funding; thus must be up on advancing medical knowledge. Analogously, I don't believe we should just use ideas/technology created by private individuals. Aren't you reading this on Defense Research Projects (DARPA) initiated system, for instance?
Posted by: Michael on February 21, 2007 12:00 AMfasteddie,
I have foot problems that require me to wear prescription orthotics. Without them I cannot walk in shoes for any length of time without agonizing pain. They are $400 a pair and my insurance does not cover them. I could have gotten extra sets made from the same mold for $200 a pair but I elected not to due to the cost. You had better believe that if someone else was picking up the tab I would have gotten 3 sets.
Believe it or not there are medical treatments foregone due to cost that do not fall into your "cheap, preventive care" bucket. Were we to proceed down the path of insan... single-payer care, we would discover more of them than we could ever imagine.
Posted by: Noah Yetter on February 21, 2007 12:52 AMJason, do you actually read the articles you link to? Please highlight where in that WAPO piece there is any reference to the VA? And anony-mouse, please enlighten us with your ability to raise the level of debate....what about the VA do you have a problem with? Just asking........
Posted by: KDV on February 21, 2007 1:39 AMJim: "Yes, bureaucrats are people and people are stupid, but don't blame bureaucrats for the health care mess. They're just trying to make sense of the rules that the politcians make for them." And politicians are people too and... No, that's far too charitable an explanation for the behavior of politicians. Most of them are 50 IQ points higher than they act. They're also acting according to perverse incentives - it's easier to use interest-group "campaign donations" to spread BS across the airwaves than to actually do the right thing on a complex issue and explain that to their constituents.
"The virtue of national health insurance, though, could be that we will all be in the same boat when it comes to benefits and finding the money to pay for them." Why would anyone but a communist consider that a virtue? Jim, I'n not calling you a commie, but inviting you to re-think your position.
Posted by: markm on February 21, 2007 5:55 AMNoah: Those foot pains sound awful. Some of the other commenters on this thread have implied that problems like yours are caused by your lifestyle, and that the rest of us shouldn't pool our money to help you out with the effects of your bad choices. Do you think it's right that you should have to pay so much to avoid unbearable pain? If you're avoiding needed equipment because of the cost, it sounds like you're Exhibit A for single-payer advocates like me.
Posted by: DK on February 21, 2007 11:38 AMDo you think it's right that you should have to pay so much to avoid unbearable pain?
This question encapsulates the difference between right and left neatly. Paying $400 to avoid unbearable pain is darn cheap if you ask me. I just paid far more than that to accompany my wife across the country, then fly back home, for the sole purpose of saving her the inconvenience (but not the "unbearable" inconvenience) of traveling with our toddler alone. I do not consider it a grand social wrong that society did not pool its resources to save me that money.
Back during the anthrax scare, when people were complaining about $5/pill Cipro, I really wanted to ask them: what's your life worth? Would you pay $100 to avoid dying? If your life isn't worth $100 to you, why should it be worth $100 to the rest of us?
Setting aside the truly indigent, who can't support themselves and so become wards of the state, what is it about medical care--as opposed to, say, food and water, or shelter from the elements--that makes paying out a few days' wages on relatively durable goods that put an end to "unbearable pain" some kind of moral issue demanding government intervention?
Posted by: Rob Lyman on February 21, 2007 12:01 PMRob,
Good point. I hope everyone complaining that their med. bills should be cheaper doesn't have a 2000 flat screen tv...
Posted by: good point on February 21, 2007 2:13 PM"..people advocating national health insurance or any other big programme.."
A conservative calling the kettle black.
OK, let us talk about big government programs, the ones that run up a 7 trillion dollar debt over 20 years of conservative rule.
We spent a half trillion on National Missle Defense, then bribe the Nuklureans for 250 million to disarmn.
Talk about stupid people.
"I'd just like to say that Australia has an excellent Medicare system. So good that it is no longer a political issue."
Y'know, I've been watching this debate for a long time.
We appear to be in a cycle:
1: USA advocates for socialized medicine point to a particular country as a shining example
2: A few years later the shortcomings of medical care in that country become evident to the general public
3: USA advocates for socialized medicine move on to another country
So far, it's been Great Britan, then Canada, and now it's Australia.
-dk
Well Matt, that's because paying for a military to protect the nation is not something we can each do individually. Paying for the vast majority of routine medical expenses we get is something the vast majority of all of us can do.
And then you go on to talk about why we shouldn't protect ourselves from nations that would like to build nuclear missiles and then use the presence of those missiles as a get out of jail free card. How about this...if a country has nuke missiles, they can do just about whatever they want because will we really risk New York for Taiwan. But if we can swat down every missile they send up in the air those countries don't really have much leverage on us anymore do they.
Now you might say Taiwan is not worth defending, but nevertheless I'd like to be able to knock down a few missiles if some crazed dictator decides he wants to take on the US.
So why did we bribe NK? Because wonderful people like yourself opposed the President when he took a hard line stance against them. Now that he is doing exactly the kind of thing that people like yourself were suggesting a few months ago, he's just a bumbling fool giving into aggression.
Posted by: uh... on February 21, 2007 3:33 PMUh?? Are you a Bolton nut, you know, Bolton who said if we have to bribe the North Koreans, then why didn't we do it 6 years ago? Why did Bolton and Bush wait until the nukes were built?
"But if we can swat down every missile they send up in the air those countries don't really have much leverage on us anymore do they."
This is actually the opposite. For every million spent on decoys, the National Missile Defense must spend 10 billion to re-engineer the defense. You have spent a half trillion on the boondogle, how has that dettered the North Koreans?
Here is a test on this big government conservative communist boondogle.
Go to the party store. Buy a bag of mylar balloons, stuff these ballons into your SS-21, uninflated. You will defeat the system, a half trillion down the drain., I know, I worked the red team and we beat the system everytime using mylar balloons. The system has only been faked, all these years, and as soon as the oversight hearing take place, most of you will say: "Fooled by big government conservatives once again"
No, I'm not a commie. If I had my way, the government would provide health care only to those who need it. Libertarian purity is all well and good, but then you have to deal with reality. The reality is that a lot of people don't know or care what their health care costs and they are happy to oblige the provider who suggests more. No matter who pays for our health care we are all victims of enormous inflation in the health care sector. All I'm saying is that there is no political will, none, for the libertarian dream that you guys espouse. People in general see the numbers of uninsured climbing and are concerned. Of course, many of the uninsured are either unwilling or unable to pay the huge premiums required to get insurance in the individual or small business market where only the least healthy buy insurance. The public just sees the climbing number of those without insurance and wants government to do something. All I'm saying is that if you keep expanding Medicaid in that area by adding people you end up with cuts that drive good medical providers out of the program. The only way the public is going to see what they're get in return for what they spend is through the government budgeting and appropriation process. The current patchwork system just fosters a lot of buck-passing and rent-seeking behavior.
Posted by: jim linnane on February 21, 2007 4:22 PM"Do you think it's right that you should have to pay so much to avoid unbearable pain?"
How many people in history even had the option of paying 'so much' to avoid unbearable pain? Where did the means to avoid it come from? From a bunch of people sitting around a campfire, demonstrating how much they cared about everyone?And what does 'think it's right' even mean? That it would be nicer to get neat stuff for free? That some source of evil is pulling strings to make sure you pay 'so much,' disregarding what something costs to produce, or God forbid, what it's actually worth?
Unbelieveable.
Posted by: Mike W on February 21, 2007 4:43 PMSo much stupid here, no benevolent, all knowing, all loving pharma conglomerate could POSSIBLY begin to help...
The world does not RELY on the private US healthcare system. Most pharma research in the US is done with NIH or other public grants. Pharma research actually done by pharma is mostly of a tertiary (marketing) nature. Also, most pharma firms are multinationals based outside the US. They do much of their biz in the US because (wait for it...) market conditions allow for the greatest profit, even with a higher degree of government regulation.
The rest of the bullshit here has been debunked elsewhere. Healthcare is not a free-market commodity. It might become more like a commodity if access were more fluid.
A few more points for the half-wits here: $400 in medical bills to avoid unbearable is ALL THE FUCKING MONEY IN THE WORLD to the sick person who doesn't have $400.
But come on, for christ's sake, the real flaw in government involvement is not government, but oversight. Glibertarians, I guess, would rather complain than take responsibility.
Posted by: Jim on February 21, 2007 4:48 PMSo much stupid here, no benevolent, all knowing, all loving pharma conglomerate could POSSIBLY begin to help...
The world does not RELY on the private US healthcare system. Most pharma research in the US is done with NIH or other public grants. Pharma research actually done by pharma is mostly of a tertiary (marketing) nature. Also, most pharma firms are multinationals based outside the US. They do much of their biz in the US because (wait for it...) market conditions allow for the greatest profit, even with a higher degree of government regulation.
The rest of the bullshit here has been debunked elsewhere. Healthcare is not a free-market commodity. It might become more like a commodity if access were more fluid.
A few more points for the half-wits here: $400 in medical bills to avoid unbearable is ALL THE FUCKING MONEY IN THE WORLD to the sick person who doesn't have $400.
But come on, for christ's sake, the real flaw in government involvement is not government, but oversight. Glibertarians, I guess, would rather complain than take responsibility.
Posted by: Jim on February 21, 2007 4:48 PMA few more points for the half-wits here: $400 in medical bills to avoid unbearable is ALL THE FUCKING MONEY IN THE WORLD to the sick person who doesn't have $400.
Well, I suppose 99 cents for a hamburger is ALL THE FUCKING MONEY IN THE WORLD to the hungry person who doesn't have a dollar. Single-payer meal insurance to stop obscene profiteering by McD's and the rest of Big Food!
But, um, Jim, many posters, including me, are not opposed to offering medical assistance to people who are truly poor, and so long as we're trading insults, it's rather half-witted of you not to notice that.
The fact is, $400 is not that much money for the average middle-class American. Many of them are probably spending more annually on coffee, and that can't be but a fraction of the average monthly mortgage payment. If the average person can afford it, then single-payer doesn't look so essential, does it? I'd have to say it's rather half-witted to confuse medicine for the indigent with medicine for everyone else.
Meanwhile, I'd love to see a cite to back up the (oft-repeated) claim that the NIH does "most" drug research. If that were really true, the NIH could be making billions selling drugs, or at least licensing patents to pill-makers. Government-owned patents are by no means unheard of. But the reality is, there's an enormous gulf between identifying a protein involved in cancer cells and creating a practical treatment--a gulf bridged by EEEEEVIL pharma companies and their billions of research dollars.
Just for kicks, I decided to try out this Internet thingy: The NIH asked for a grand total of $28 billion in FY2007. That's their total budget, as far as I can tell, from research grants on down to paperchips and copier toner.
http://www.nih.gov/about/director/budgetrequest/fy2007directorsbudgetrequest.htm
PhRMA claims its members spent 39.4 billion on R&D. Depending on their accounting conventions, that may or may not include lots of overhead costs like heating labs; naturally they don't say.
http://www.phrma.org/news_room/press_releases/r%26d_investments_by_america%92s_pharmaceutical_research_companies_nears_record_%2440_billion_in_2005/
I will certainly not deny that drug companies spend a lot on marketing, or that they do some sleazy rent-seeking things (they exist because of government granted monopolies, and behave as expected) but the notion that somehow you could cut that $40 billion out and rely on the NIH to generate the same number and quality of drugs for us is...how shall I put it? Half-witted.
(Sorry about the links, but I don't want to be trapped in moderation)
Posted by: Rob Lyman on February 21, 2007 5:43 PMI'm not a fan of single payer at all, but the current system is horrible. Here are the problems with the current medical system as I see it;
1. Inefficiency from arguing over price. There's a huge amount of time wasted dickering about the appropriate price for common procedures between doctors and insurers.
2. Lack of doctors. Insurance companies squeezed doctor's profits. Now we have fewer people going into medicine. We could bring in doctors from other countries, but the medical community opposes that. It looks like whatever can be farmed out to other countries (i.e. reading x-rays etc) will be done.
3. Lack of incentive for quality. The doctor's incentive isn't to do a good job, really. He gets paid whether he fixes the problem or not. There's a much stronger incentive for him to cover his cover his own butt from a legal standpoint. When I had what I think was mono, two doctors failed to properly diagnose it... but still demanded payment. There needs to be more feedback (public review of doctors by some Consumer Reports type of organization combined with user feedback?)
4. Lack of coverage for alternative medicine. I've known naturopathic doctors who were better with diagnosis than normal doctors, but they weren't covered by insurance. No way I'm going to pay for someone else's medical coverage and then have to pay for mine as well.
5. Insurance fraud. I've had several family members have insurance accidentally drop them, claim to fail to receive payment, etc. in response to pending use of services. When my uncle was having triplets, the company tried everything in the book to drop coverage. My uncle finally drove out there and personally handed him his payment. There should be massive civil suits to prevent this kind of thing. Similarly, when I was flooded from someone's washing machine upstairs, their insurance (metlife) refused to pay because it was an accident and not "deliberate negligence." Insurance doesn't have to pay if it's an accident? What the heck? And this was state law, apparently. Fortunately, my own insurance paid. But my insurance got canceled because of that, and noone else would insure me for a year because of the claim (it was the second flooding claim in two years, both caused by other tennants.)
Posted by: Ryan on February 21, 2007 6:14 PMOK, what is "health care"?
It seems likely that health care will, over time, increase as a portion of GNP, even if unit costs decrease, simply because the number of appealing things the health care system knows how to do increases. I prefer my contact lenses to glasses. Over time, options for people with bad knees or hips have progressed from asprin to replacement joints to cementless replacement joints and who knows, in the not-too-distant future, perhaps custom-grown cartilage. More money, much more functionality, much higher quality of life.
Meanwhile, the amount of classical "stuff" middle-class people might buy may not increase as fast.
Perhaps health care will reach 40-50% of the GNP, especially if the concept is extended to include bodily improvements*. If the advocates of single payer succeed, and they outlaw paying extra to get procedures not covered by the health service [as the Canadian system does and the Hillary Plan of the 1990's would have done, with a few named exceptions such as cosmetic surgery] then they will have succeeded in backing the US into a socialist economy, where by earning more you can only improve your living standard in minor ways such as by buying toys, not by buying an OEM-like joint when you need one.
Maybe you want this. At least admit it.
-dk
* I've wanted to place a bet on longbets.org that the Olympic Committee would outlaw at least one artificial mechanical part by 2020, but I can't get the site to work.
Posted by: Dick King on February 21, 2007 6:19 PMIf USA needs an effective medical/hospital system it could do worse than copy ours.
Actually, many of the systems on the European continent are also structured along lines like those. The biggest hurdle to any sensible reworking of social medicine in the US is probably the fact that most of the sanctimonious lectures on the US system's inadequacies come from left-wing Canadians and Brittons (perhaps on account of the low language barrier and close social proximity) who, arguably, have the two WORST-RUN social healthcare systems in existence. No allowance for the problems of moral hazard, and such.
Blow away Medicare, Medicaid, the VA, and all other forms of social healthcare in the US, and then replace them with something more along the lines of Aussie or continental approach while still allowing private industry to function in parallel, and most of the debate would go away -- at a cost that could not possibly be higher than what we've got now, and with a very equitable distribution of basic healthcare service availability.
Posted by: anony-mouse on February 21, 2007 6:26 PMAnd anony-mouse, please enlighten us with your ability to raise the level of debate....what about the VA do you have a problem with? Just asking........
Sorry, you'll have to do your own homework, or else ask fasteddie to do his, since it was his unsupported assertion in the first place. Nobody with more than a passing familiarity of the VA and Medicare would call an argument about the problems of bureacracy a "pathetic strawman" and then cite those two institutions as counterexamples.
Posted by: anony-mouse on February 21, 2007 6:31 PMFrom Jim: "The world does not RELY on the private US healthcare system. Most pharma research in the US is done with NIH or other public grants. Pharma research actually done by pharma is mostly of a tertiary (marketing) nature. Also, most pharma firms are multinationals based outside the US. They do much of their biz in the US because (wait for it...) market conditions allow for the greatest profit, even with a higher degree of government regulation"
Most of the pharma research takes place in the United States. Practically very large foreign pharmaceutical company does a great deal to most of it research in the US. Indeed, I work for just such a firm.
On the issue of the NIH: yes, the NIH funds a lot of the work in university laboratories, and the laboratories do a lot of fundamental work in addition to training the next generation of scientists. However, pharmaceutical companies also do a lot of the fundamental stuff and they also directly fund a lot of the academic research, too.
However, drugs are almost never discovered and developed in academic labs. This process is labor and capital intensive and well beyond the scope and ability of an academic lab. Finding and optimizing the drug candidates takes a team comprised of hundreds of researchers from various fields working from 1 to 5 years.
It is a certainty that pharmaceutical companies spend far more than the NIH on research, and that this research that gives us new pharmaceutical treatments.
Posted by: Yancey Ward on February 22, 2007 7:42 AMah, yes! but you forget! the government paved the roads to the pharma research facilities! so therefore everything they've done is the result of all the government's effort! they certainly couldn't have made those drugs if they couldn't get to work!
oh ya, and since this nation and its wealth was built on the backs of slaves (reparations anyone?) we can attribute all the medical advances we've made to slavery! free medical care for all blacks!
Just because the government does somethings...doesn't mean it does all things.
Posted by: unhinged on February 22, 2007 10:49 AM
One thing we have to demand and get in ironclad form from these SOB Democrats:
If they end up foisting some crappy nationalized health care on us, make it ILLEGAL, under pain of imprisonment, for them to get any medical care better than they are shoving down our throats.
Posted by: Chester White on February 22, 2007 1:46 PMStatistically. the more socialized healthcare a nation has, the faster the population declines.
We have a strong movement to socialize medicine because the conservatives have been so busy expanding government, the progressives need to compete.
Posted by: Matt on February 23, 2007 5:22 PM