Knights & Knaves Alehouse

AxeMental wrote:

Werral wrote: You are factually mistaken that all medical advances have come form the American system - many have come from work done in Europe and many medical advances were made in Communist regimes too (and with the fall o Communism many companies rushed in to buy them up).).

What I said was this: Thats why most of the commercial advancements in medicine start in free markets (like the USA). And without that free market workhorse the socialists nations that use (either copy or buy direct) that technology would have never gotten it to begin with.

Note I state "commercial advancements" (for sale and working rather then in theory only)" and "in free markets (like the USA)"

Hmmm ... I'd have to say that many major medical evidences did not happen as the result of private activity in the free market. Like jet engines, rockets, computers, satellites, mobile phones, nuclear power, the internet, and a great many other things, technological progress in medicine, as in other things, has often occurred at the behest of, and funded by, governments (many of them very unlikable forms of government!)

I agree, and that is my entire point of stating "commercial". Govt labs and universities invent/develop new ideas for war etc. and eventually hand over the technology to private companies who use the technology to make commercial products for a profit. An invention is most useful if it can be made into a marketable and profitable product.

The huge spending per capita in the U.S. is due in part to wide availability of "cutting edge" technologies that tend to be expensive. Match that supply with a demand dictated more by advertising than by medical prudence: "Ask your doctor for the blue pill." From a profit-driven perspective, wherein profit accrues to the care provider in proportion to cost to the care receiver (or his or her insurance company), it makes sense to amortize the million-dollar cost of a machine as quickly as possible whether or not its use is sensible as a form of diagnosis or treatment. All the incentives are to rack up billable procedures.

Insurance companies are on the opposing side, and naturally raise premiums to maximize profits that could easily be wiped out if things swing too far the other way. That the insurance model is being used increasingly in an expectation of assurance -- going from probabilistic spreads of payouts for individually unlikely events to paying thoroughly anticipated expenses -- seems to (admittedly inexpert) me an odd proposition.

When OD&D books were (legally) available only as costly collectors' items, many people could not afford them (at least in terms of perceived cost to benefit). We have a similar situation with medical care. Health insurance rates keep going up, driven by people (probably still a majority of Americans) who can afford them. For others, the game is just too rich to buy in. Their lack of preventive care makes it more so, contributing greatly to "pre-existing conditions."

The "working poor" are really screwed, having neither enough money to pay their own way nor little enough to get "the dole."

Dwayanu wrote:The huge spending per capita in the U.S. is due in part to wide availability of "cutting edge" technologies that tend to be expensive.

Partially ... but that cannot really account for such a massive total, or American patients would have better prognoses than their counterparts in the UK, Canada, France, etc. They actually have worse prognoses and lower life expectancy.

I think the reason for the massive amount of spending is primarily in the bureaucracy of the US health care system. You have dozens and dozens of HMOs instead of a single government insurance plan, so there's an awful lot of redundancy in terms of administration. Plus court costs - I bet there are hundreds, probably more like tens of thousands, of civil cases relating to health insurance issues every year.

That wide but indiscriminate employment of "cutting edge" stuff is not necessarily associated with better outcomes was one of my further points in that post. Also, I wonder to what degree the characterization of "worse prognoses" is based on comparisons of patients with the same access to treatment. There may be a difference, but I suspect that it's very little next to the difference in access ("haves" and "have nots") as reflected in life expectancy and so on across the whole national population. I'm pretty sure, for instance, that the overall high infant mortality rate in the U.S.A. disappears or even reverses when you get into a high enough socio-economic stratum.

Cutting down on nonproductive expenses is actually one of the arguments for a publicly funded plan -- call it the "non-profit" premise.

Insurance companies employ hosts of people whose mandate basically is to avoid making payments. Doctors in turn must keep staff whose mission is to try to get bills paid. None of them actually do anything to help keep patients healthy!

The usual counter-argument concerning government bureaucracies of course comes into play. I reckon it's still as valid as ever -- but in this case, private enterprise has pretty obviously erected perhaps an even greater edifice of inefficiency. It seems to me that MediCare has done a pretty good job.

This seems hard for some ideologues to grasp, but we probably should not have won the Revolution without the Continental Army, and the U.S. Navy and Marine Corps have in fact accomplished more than Bob's Zouave Rifle Tirailleur Guards (so long as ever Bob's remained a BYOB militia).

The ones who are able to accept that much reality resort to Pixie Dust in claiming that the only thing better than Big Government when it comes to shelling the hell out of The Enemy is Even Bigger Government ... but the same somehow does not apply in any actually productive endeavor.

With a government program, we're back at least in theory to more direct ownership as opposed to being mere "consumers." The way commercial corporations work makes real democracy (as opposed to effective plutocracy) even in theory a dead letter.

As the share-owners in government, we reckon profit based one what we get for our dollars. There is (these days) usually no "outside" source of dollars to count as revenue to us as a whole. That's a pretty significant difference from other arrangements.

A key to making it work well, I think, is not to fall back into the trap of seeing "our" joint enterprise as a way to make a special profit for "me" at "his" expense.

"Ask your doctor for the blue pill." From a profit-driven perspective, wherein profit accrues to the care provider in proportion to cost to the care receiver (or his or her insurance company), it makes sense to amortize the million-dollar cost of a machine as quickly as possible whether or not its use is sensible as a form of diagnosis or treatment.

Great, so your not only against patients being able to request treatments they might find in their best interest (however they get that information), but your against doctors investing in technology to help their patients and actually using it when they (the MD) feel it is warrented?

Lets take the MRI. The increased demand for MRIs by the health care profession (ie individual doctors, groups, HMOs competing hospitals etc.) has made them less expensive to buy as manufacturers compete with each other (to provide less expensive models that are superior to whats already out there) and extremely common (we have at least 20 in my area). Soon (maybe in the next decade) MRI will be as common as x-ray machines are (where every office has one) and the cost is low to have them ordered. That is the wonders of the capitalistic free market economy. Remember when a calculator costs over $100, and then 5 years later you could get them for less then $1? Or a microwave went from a luxury item to dirt cheap. Its the same thing....its called competition and creating then filling a market.

Always remember D, the Liberal democrats (and moderate republicans) 1. created this medical mess (over the last 3 decades) by making the system overly expensive (allowing, even encouraging capless lawsuites, govt. red tape, costs to develop new drugs, etc. etc.) to 2. step in and offer to socialize it. It would be like going in the kitchen of a restaurant and sneakingly dumping in all sorts of salt and spices creating a terrible mess. Then offering to take over as cook to make it better.

And the sad thing is they've gotten away with it.

IIRC the studies have shown that in areas with lawsuit caps that the costs of medical care have not decreased and in some areas have even increased. Also if you want to throw some blame around on the medical problems lets peg the conservative republicans and their empowering of the insurance companies to be able to deny coverage, services, etc. and have non-medical staff decide if treatments are required or not. Lets also look at the number of poorly tested drugs that the Republican era FDA allowed on to the market despite medical doctors and scientist tested and were shown to be unsafe, mostly due to the pressure of the Drug Company lobbiest.

Well, the US is the only developed, First World nation on the planet without a public health care system. The only other countries who don't have one are places like Zimbabwe and Indonesia. I think that pretty much speaks for itself ...

Edgewaters wrote:Well, the US is the only developed, First World nation on the planet without a public health care system. The only other countries who don't have one are places like Zimbabwe and Indonesia. I think that pretty much speaks for itself ...

Yes it does. That won't stop those in the "Blame the Democrats" party from thinking about the issue from only an ideological view, however. Never mind that our actual health care would be vastly improved by adopting any of the myriad systems from the free world countries - we can't do that because that's socialism and socialism is bad and especially bad when it's been shown to work. Perhaps one day, a US citizen's health will be considered as valuable as protecting a body from theft, from enemy forces, and from fires. Until then we'll have pharmaceutical companies spend more on advertising than on R&D while having one of the highest average profit margins of any industry. Hey, at least we have some great jokes based upon the profligacy of pills designed to make dicks hard.

[Colbert]But I understand why so many conservatives are against socialized medicine. They'd just hate to see people not able to make profit from the bad health of others because it would make a mockery of the sanctity of marriage. In sickness and in health isn't as important when sickness isn't a leading cause of bankruptcies. It would be too easy to stand by your man when he's sick and that corrupts the moral fiber of our nation.[/Colbert]

joe "the profit motive incentivises towards systemic treatments over cures" b.

Q: "we can't do that because that's socialism and socialism is bad and especially bad when it's been shown to work."

Where would the state of mediicne be Joe if we hadn't had a freemarket system working in the world. Lets say the communists (or socialists) won the war of public opinion back in the 30s and 40s, say we all supported a communist system, world wide. Would we have any of the medical treatements of today? Would we have vast numbers of treatments for things like heat disease, cancers, strokes, terrible childhood diseases etc.? Would we (the world community) have developed the medications tools and complex medical techniques to save lives?

Joe, if you think about it, the ONLY reason these socialist systems you are so proud of work is because they do so off the back of the free market systems that take the risk and spend the money to make the medicines and develop the treatments. Do univiersities in socialist nations create breakthrews. Sure, but what good are these inventions if they don't get made properly (or at all)? People used to say, "if you don't like America, move to the Soviet Union". Too bad that doesn't exist anymore...and I wonder why? The point is, if we suddenly now socialize medicine not only will be create immediate problems (of rationing and increased costs due to govt. beauraucracy) but we'll end up shooting ourselves in the foot for our future generations.

Sean, I agree unsafe drugs shouldn't be allowed to reach the public. All that one can ask is that they be tested to the fullest extent and be as good as possible before release. That is a legitimate government responsibility (one of the few). One would expect a drug company to see the bright spots and ignore the dark (not always intentionally, its human nature to want to see the good in what you do and ignore the bad, we all do that in our jobs for instance, we are only human, we make mistakes). An objective testing is essential by a nuetral party. If a bad drug slips threw this extensive govt. testing, then the company that produced the drug should not be responsible (for the most part), rather the govt. organization that did the testing should be (afterall, they gave it the all clear) a legal cap on rewards would help here (we don't want to sue out of existance (or scare others from entering) the very companies that develop new drugs). Will bad drugs get threw, yes. But its better then companies not getting into the game out of fear of future law suites, or worse still, limiting the number of players by making the system so expensive smaller firms can't get involved. Ever see how long it takes or how much money it takes to get a new drug approved? Billions. And when it does get released people rightly want it for an affordable price (say less the $1 a pill rather then $30). The company would rather sell it for $1 as well (they aren't evil), but guess what, they have to cover the costs of private development and insurance.

Protect the medical community first (nurses, doctors, hospitals, drug companies etc) and get the hell out of their way as much as possible (ie remove govt. from the equation). then attack the insurance companies (make them prove why costs aren't going down if risks have been removed).

I too am against any group (conservative or liberal) that protects insurance companies because of lobbying (or any other reason).

If the insurance companies want to make money great. But as consumers we need transparancy (what they collect, what their risks are and what they pay out), and the government needs to make sure any decreases in the cost to the insurance company is passed on to the consumer. I stongly suspect competition is not taking place between these companies (that would be illegal).

As for pre-existing conditions? I'm with you 100%. The government needs to help this segment (but first allow the system to do so on its own. For instance, hospitals and doctors getting tax breaks for giving a % of free assistance to those who can't afford it). There are ways. The key is, don't dump the entire free market system because of problem cases. All in all the USA medical system is the best in the world (quality wise) par none.

Great, so your not only against patients being able to request treatments they might find in their best interest (however they get that information), but your against doctors investing in technology to help their patients and actually using it when they (the MD) feel it is warrented?

No to the first; I was simply offering a reason per capita spending is so high. Getting someone else to spend on your capita is another matter, though.

Double-straw-man No! to the second! My worry is about unwarranted expenses. That's part of how you get a remarkably costly health care system without getting remarkably good health. It's not driven by the patient-care goals of MDs. It's driven by the MBAs' goal of relieving patients of their money.

The company would rather sell it for $1 as well (they aren't evil), but guess what, they have to cover the costs of private development and insurance.

I'm afraid I don't have citations handy, but studies of the phenomenon have found no such correlation. There is a correlation between price and spending on advertising, which is often all out of proportion to a drug's effectiveness. Basically, prices are set to maximize profit (which is, after all, a modern corporation's over-riding mandate).

A significant amount of publicly funded research ends up providing the bases of commercial products, usually without fair compensation to the public. Inputs of funding from corporations to researchers at universities are often to the end of skewing or suppressing results unfavorable to the sponsors. Even government agencies get subverted, in fact quite routinely under Republican administrations.

D: "It's driven by the MBAs' goal of relieving patients of their money."

If that were the case every product would be extremely expensive, from your toothbrush to your microwave bag of popcorn.

Look elseware, the free market lowers prices at the same time as it increases quality.

Like I said, Remove govt. from the equation (along with their red tape, HMOs, testing expenses and the threat of lawsuites) revamp the insurance industry (make it translucent and competitive) and costs will plumet.

D: "Basically, prices are set to maximize profit"
Bingo. If a company can produce a product for less (say $1 vs. everyone elses $30) and still make a profit they keep out competition (growing market share), thats why prices go down in a competitve market despite each company wanting to maximize profit; its also why you don't want monopolies developing (for instance having only 1 company supply x drug). In the end the consumer wins in a free market, looses in a socialist.

Axe, the facts are what they are. You seem determined to dismiss them as often as they may disagree with your ideology.

We've got a system set up to maximize profits for some parties, and it does that quite well. What it does not do so well is deliver good health care (or any at all) to many people -- and the ones who do get that end up paying a remarkably high price for it. In some other nations, the notion of going bankrupt because of illness is regarded as preposterous. It's as barbaric a suggestion as (say) eating babies.

We want to go to Boston. There's a route known to lead there directly. But your ideology would force us instead to keep heading for Los Angeles in the hope that someday, somehow that course shall get us where we want to go.

That's either disingenuous or plain foolish. If you really share the goal of a majority of the American people -- keeping Americans healthy -- then what's rational is to look at efficient means specifically to that end. Whether they happen also to line the pockets of CEOs is not relevant, except as a factor in the measure of efficiency (cost in, results out). What's "profit" to a pharmaceutical company is COST to the public.

Big salaries and pensions for desk warmers don't get things done. What gets things done is getting things done. To build a house is a physical activity. So, ultimately, is every aspect of medical care. There's some cogitation involved, but thinking about a new car or a vacation in Bermuda does not contribute to the cause. Think instead about the length of board needed, or about the symptoms the patient presents.

That's common sense, the dearth of which is responsible for much of what ails the world.