Healthcare & rationing

[gblaze42]

The government will be making decisions based on THEIR profit and loss calculations. i.e. young people will get treatment old people will be figuratively set out on ice floes. Why spend money on keeping alive a non-producer? Or an enemy of the state?

Yeah, that is really funny, because it is actually the private insurers that deny health insurance to the elderly.
Old people here get the same treatment young people do. I can only speak for Austria here. Maybe it is different in other countries. But if it works here, why wouldnt it in the US?

No! Canada does exactly that. As I had stated before, the experience of having my mother die from cancer at age of 82 because they estimated that she did not have many years ahead of her anyway.
And I doubt the elderly get the same treatment as the young, about 80% all medical costs are due to age related and end of life illnesses. Social medicine will have to determine who gets treated and who doesn't to make sure costs don't escalate out of control.

[Skipjack]

Well, while medical doctors here dont earn as much as they do in the US (the government insurance does not pay as much), they do make a rather good living. One also needs to factor in the losses US doctors make when they simply do not get paid (because the person in question cant pay it), or because they get sued, which also results in higher legal insurance costs for them. As I said, the US has a lack of MDs because of that. We here dont, we almost have to many. If it was such a bad business noone would want to become an MD. Pharmacies also make really good money here. Their owners belong to the richer people. I do find our system and regulations for pharmacies rather questionable though (only so and so many per area/number of people, regulations on opening times, etc). That is something the pharmazists themselves had introduced and it has been kept up by tradition. I guess it also guarantees that there are enough close by pharmazies and since their opening times are regulated (they alternate on which one is open at night and on the weekends), they make sure that there is always one open in an area (we unfortunately have regulations that limit the opening hours of stores, etc, they are valid for everyone in my country other than turks for some reason, gggg).
Still these regulations are rather strange and I am not a big fan of interventions like this. Anyway, pharamacies and doctors here are not poor here. The hospitals are not poor here either. Radiologists make a good living too.

If the government decides hip replacement is not cost effective for 80 year olds you have no recourse.

As I said, that might happen in other countries, it does not happen here.
Here you do also have the option to get an additional, private insurance for additonal treatments and better hospital rooms. Well, you do if you have not had a heart attack, then you are out of luck of course.

No! Canada does exactly that. As I had stated before, the experience of having my mother die from cancer at age of 82 because they estimated that she did not have many years ahead of her anyway.

That is sad, but as I said before, Canada is not the best example maybe. It got rather poor ratings in comparison. Austria rated much better.

My Grandmother is 90 now and does have lung cancer. She had the option to take chemo therapy. The doctors recommended (!) not to do it though, because she is to weak and would simply die during chemo therapy, which is hard on the system of a young person already.
Anyway she would die with more pain and more problems than she will like this. At this age cancer also spreads slower so she might actually have quite a few more months ahead of her.
I have two doctors in my family that want the best for my grandmother (and not for the governments pocket) and they say the same thing.
They are also not going to send my grandmother home just like that. She gets a home help payed by the government and if things still dont work out for her, she can request to get a permanent bed in a hospital.
My grandfather died at the age of 92 and had all the treatments he needed until the day he died. Again two doctors in my family made sure he did. Not a single problem there.
A friend of mine died at the age of 96. He too had never been denied a treatment for anything.

I guess Canada is just a really crappy example for a public healthcare system and that might be why so many of you are having problems with seeing the benefits that such a system can have.

Caring for the elderly does cost our government the most, yes, but luckily there are many younger people that need much less than they pay for and so the whole system is still kinda stable.

I also want to point out that pharmaceutical companies are doing very well worldwide. I dont think any of them are loosing profits because of the evil countries with public healthcare. My dad knows plenty of people that work at one or the other company. They are not hurting, at least not here.

[gblaze42]

I guess Canada is just a really crappy example for a public healthcare system and that might be why so many of you are having problems with seeing the benefits that such a system can have.

Caring for the elderly does cost our government the most, yes, but luckily there are many younger people that need much less than they pay for and so the whole system is still kinda stable.

Here's the big problem, Obama keeps using Canada as the example for health care reform.

[vankirkc]

Next, why would a public option strangle medical innovation? A better mousetrap is a better mousetrap no matter who buys it.

Are they buying at a price so the developer can make a good profit or are they paying just enough to cover the marginal cost?

Incentives make a difference.

So are you now claiming that the government doesn't finance innovation? Who is paying for Polywell research at the moment, my friend?

[olivier]

I suggest a change of perspective for a while: I know of a country which has made the audacious move in the opposite direction, from a "socialist" to a "capitalist" health care system. Got a heck of a result (60% increase in male mortality, and so on).
This country is Russia.

[TallDave]

By 'marginal cases' I think you mean extremely uncommon and esoteric illnesses where research is a deciding factor in care.

No, I mean situations where care has a small marginal benefit, like giving an artificial hip to an 80-year-old or doing an MRI in a situation with a relatively small chance of benefit.

Next, why would a public option strangle medical innovation? A better mousetrap is a better mousetrap no matter who buys it.

Yes, but if the better mousetrap costs $1B to develop and the government has "negotiated" a price at which you can never make that money back, your mousetrap is losing money.

Did you see a lot of innovation in the Soviet Union? They did lots of gov't research, but little of it saw any practical use.

I'm not sure people understand the difference between basic research and productization.

For instance, gov't finances semiconductor research. Intel uses that information to make chips. Both are necessary. Few people would argue the government should set chip prices or make chips.

Polywell is basic research, as are the various genome-mapping and receptor-identifying projects. Bringing a drug to market using that info is a billon-dollar proposition. Something like 97% of attempts fail.

My personal interest in the public option is a) it's cheaper overall, and b) evidence suggests countries that have it live longer on average

I've already shown why this reasoning is flawed. LE does not correlate to medical care and much of the difference can be explained by varying reporting standards and the rest by lifestyles. They also benefit from being free riders.

This is only true if a) they are able to finance said care

Again, Medicaid.

and know from personal experience that many of the populist arguments against it are simply untrue (e.g. long waits for procedures and shutting down of private care).

This is very poorly reasoned. The wait times you claim don't exist are well-documented. The fact you haven't personally experienced them is one data point against millions.

Look, if the current system is so good why does it cost so much more and at the same time exclude so many people?

This has been explained about a dozen times. Almost no one is excluded. The rest of the world gets a free ride on the innovation we pay for and we do better care than anyone else. If we stop paying, there's no more innovation and worse care.

http://www.kaiseredu.org/topics_im.asp? ... =61&id=358
75% of costs are associated with chronic illness rather than emergency care

You're misunderstanding that statistic; there's no "rather" in there. If you have chronic heart disease, a heart attack is associated with it. In the same paper it says drugs and nursing home care are 16% of total expense.

Yeah, that is really funny, because it is actually the private insurers that deny health insurance to the elderly.

Again, this is obviously wrong if you think about it. A government can say "You're too old, we cannot invest $20,000 in your continued health." An insurance company cannot -- because you're paying them. You have a contract with an insurer. You don't have one with your gov't.

How do you think Obama's grandmother get a new hip despite having terminal cancer?

Who here thinks a socialist country would do that?

[TallDave]

Nope, that is not the case. They do deny you insurance, if you have a severe preexisting condition. That is my biggest gripe. It pushes those people out of the system.

First of all, government created this problem by creating a huge incentive for employers to provide insurance. You can buy a right of renewal in your policy, but few people buy their own insurance.

No sane market would create this outcome. Only gov't intervention puts us in that position. I don't think more gov't is the answer. A better solution would be to transfer the health care credit to individuals. Then everyone can have the insurance contract they want.

In some states, by law you cannot be denied insurance for pre-existing conditions (this is a dubious practice imo (of course no insurance company wants to sell you a money-losing contract; does Vegas let you bet on last week's football scores?), but there it is). For others, Medicaid fills in these gaps.

I'm not sure how many people even here in the U.S. realize how socialized the American system already is. Private insurance is only about a third of the market by some estimates, and even there, there are mandates galore.

[Skipjack]

For others, Medicaid fills in these gaps.

Not that I would know of. You have to have a lower income or be older than 65 for you to be entitled to medicaid. I fall into neither cathegory as an evil capitalist, at 34 years of age

Yes, but if the better mousetrap costs $1B to develop and the government has "negotiated" a price at which you can never make that money back, your mousetrap is losing money.

If that was the case, they would not bother selling their medication here. Noone can force them to do that. Most of the medication we get here is non generic, but the "real stuff". The government is trying to get doctors to prescribe more generic meds, but the doctors dont really comply and noone can really do anything about that. It is still in the hands of the doctor (and the doctor allone) here, what treatment is prescribed.

[TallDave]

Not that I would know of. You have to have a lower income or be older than 65 for you to be entitled to medicaid. I fall into neither cathegory as an evil capitalist, at 34 years of age

Not really. My mother was on Medicaid for several years despite us being a two-income household that also had insurance (my dad worked at the Federal Reserve).

Yes, but if the better mousetrap costs $1B to develop and the government has "negotiated" a price at which you can never make that money back, your mousetrap is losing money.

If that was the case, they would not bother selling their medication here.

Not so. R&D are sunk costs and you guys are free riders who take advantage of that fact. Allow me illustrate the cost acocounting (I'm a CPA).

Cost to produce product: $1
Cost of R&D amortized over number of units sold during expected patent life of product: $9
Profitable price: $12

Now, along comes Country X and says "Well, sorry, we're only paying you $5 for this product." As a business, you can either play along and make $4 gross profit (with a $5 net loss) at whatever qty they can use, or forego selling there (with a $9 net loss x qty). The first option is obviously better, since R&D costs are already sunk. It reduces your losses.

Now, if every country did this your company would obviously go out of business since you could never pay back the R&D costs, but fortunately the biggest market in the world allows you to charge $12 so you (probably) get to make a net profit on your drug.

Now here's the critical part that pro-socializers don't seem to understand: if no net-profit market exists, no one will develop this product. Why would they, if they're guaranteed to go bankrupt?

[MSimon]

I suggest a change of perspective for a while: I know of a country which has made the audacious move in the opposite direction, from a "socialist" to a "capitalist" health care system. Got a heck of a result (60% increase in male mortality, and so on).
This country is Russia.

I hear it is alcohol related. Perhaps they need to do what Portugal has done:

http://powerandcontrol.blogspot.com/200 ... igion.html

Because:

http://powerandcontrol.blogspot.com/200 ... ption.html

===

And then you have the problem that maybe the Soviets were cooking the books. My son who reads and writes Russian and has visited there (he has plans to go back) was talking to some relatives of mine (around two weeks ago) who do business with Russia. The relative said that Russia is Mafia run. My son said, "Only 60%. It used to be 100%."

So it may not be capitalism as Americans know it. Or even Europeans.

[Skipjack]

Now, if every country did this your company would obviously go out of business since you could never pay back the R&D costs

Reference please

[TallDave]

I suggest a change of perspective for a while: I know of a country which has made the audacious move in the opposite direction, from a "socialist" to a "capitalist" health care system. Got a heck of a result (60% increase in male mortality, and so on).
This country is Russia.

It was done very badly. There is very little private care in Russia.

http://en.wikipedia.org/wiki/Health_in_Russia

The OECD reported [18] that unfortunately, none of this has worked out as planned and the reforms have in many respects made the system worse. The population’s health has deteriorated on virtually every measure. Though this is by no means all due to the changes in health care structures, the reforms have proven to be woefully indequate at meeting the needs of the nation. Private health care delivery has not managed to make much inroads and public provision of health care still predominates. The resulting system is overly complex and very inefficient. It has little in common with the model envisaged by the reformers. Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers.

On Simon's point:

A study blamed alcohol for more than half the deaths (52%) among Russians aged 15 to 54 from 1990 to 2001. For the same demographic, this compares to 4% of deaths for the rest of the world

[TallDave]

Now, if every country did this your company would obviously go out of business since you could never pay back the R&D costs

Reference please

A refernce to what? That businesses need profit to survive?

http://en.wikipedia.org/wiki/Business

Which part of the math is confusing you? If your revenue is less than your expenses you go bankrupt.

[Skipjack]

Dont ridicule me please. As someone running a company myself, I am not completely stupid, OK?
I meant a reference stating that the pharmaceutical companies will go out of business if the US was paying less for their medication.
And a reference to the rest of the world being "free riders" and all the burden being on the poor US to save the rest of the world as you stated it. I somehow doubt that. You guys got a messiah complex.
Btw, not all meds are cheaper here. Aspirin, e.g. is more expensive. Some non prescription meds are more expensive. Vitamins are more expensive here too. That just to relativate things.
Still on average medication is cheaper here.
Also, not all pharmacy companies are from the US. The local pharmaceutical companies still live quite well though.

[MSimon]

Now, if every country did this your company would obviously go out of business since you could never pay back the R&D costs

Reference please

A refernce to what? That businesses need profit to survive?

http://en.wikipedia.org/wiki/Business

Which part of the math is confusing you? If your revenue is less than your expenses you go bankrupt.

T. Dave,

That was a hilarious come back.

Socialism can only survive in an innumerate population that prefers fuzzy thinking to running the numbers.

I thank my lucky stars that I grew up in a family run grocery store. I breathe profit and loss. Of course working in engineering helps too.