Knights & Knaves Alehouse

Dwayanu wrote:What the @#$, Axe???

If a doctor wanted to order an MRI and the Baseball Commissioner "said no (in effect second guessing the docto)," would I be outraged? No! I just wouldn't give a flying fig!

The National Coordinator of Health Information Technology is there to help implement data sharing so the doctor can look at the MRI that's already been done, so it doesn't need to be done again. For which wasted effort a decent physician has too little time to spare. For which needless expense a private insurer would doubtless refuse to pay. For which I would have more money in my own pocket to pay, if we cut down costs as has been done elsewhere ...

What the @#$, Axe???

So thats an I don't give a flying fig for you. Got it.

Dw, I'm all for a system that allows sharing of info between docs (assuming it could really be kept confidential, unlikely), but am against setting up a system that can be used to manipulate doctors to cost cut (and that was the stipulation of my question to you, if in reality that is what was intended, I have no idea).

Werral, I don't think socialist health care is a sure thing. It would actually be much cheaper to bring the costs down (tort reform, FDA reform etc.) while protecting the private sector; and cover those outside of the insurance system pro-bono (as the lawyers put it) the way its done today infact (if your sick go to the emergency room etc.). I do think that that needs to be a policy made more clear to those that need that service (at the moment only the hobos and gangbangers seem to understand how that works). At some point, people have to understand there is a limit to what they (and the system) can afford in health costs. Even the very rich will run out of coverage and money eventually (infact I've heard of people going threw all their insurance and millions ultimately dieing to cancer). But, I'd like to keep that as an option.

It's just that your question is irrelevant to reality, man.

I hope your right...man.

As far as the particular points included in the stimulus bill, he is. Fully nationalized healthcare with government-mandated rationing, is not already a fait accompli. All this bill did was provide additional funding to the effort to modernize and standardize record-keeping (a project started under GWB), which will at least theoretically increase efficiency and lead to savings. Now, such having such a standardized record-keeping system in place would make it easier at some later date to set up a rationing board, and that may well be the ultimate intent of at least some, but that's a subject for future legislation, not something that's already happened.

The scare-mongering in the linked article was all about scoring political points -- minimizing Republican support for the stimulus bill and attempting to erode public support for it, so that when it passed (which it was always going to -- that's what a majority in the house and near-super-majority in the senate means) it could still be spun as a net political loss for Obama in his first legislative initiative -- that he rammed an "unpopular" bill through with no bipartisan support and used up all his political capital. The "no bipartisan support" part is somewhat true (though, given the circumstances, he got exactly as much as he actually needed -- 3 votes in the Senate -- and has the public support of at least two big-state Republican governors (yours and mine)), but the "unpopular bill" part didn't really pan out -- even despite the scare tactics, more people supported the bill than opposed it at the time of its passage.

Foster: "Now, such having such a standardized record-keeping system in place would make it easier at some later date to set up a rationing board, and that may well be the ultimate intent of at least some, but that's a subject for future legislation, not something that's already happened."

And that was my reading of the Bloomberg article in question as well (the inference was made clear that Daschel's book (which I haven't read) suggests such a system be used in this way). Considering Daschel's prominant position in the Senat, I think her worries are totally founded (and the inferences taken from his book logically made). This is step 1 (and I think that was what this article was trying to say), lets hope we never get to step 2 (the further legislation, not that anyone could stop it).

As for the meaning and vaugness of the actual text, I still have to read it (and I don't think its available save for small bits and pieces cut from the document). Anyway, one can never be too cautious.

Foster, I don't think your entirely correct about this being purely a political stunt to get Republicans to vote against this bill and score politically with the public. The spectre of health care control for even those insured is reason for alarm (hitting on a personal level), even if its not what was intended, better safe then sorry. Remember, we do have some within our party that actually believe what they say, that are idealists, as does yours). The fact that Bush 2 started this doesn't surprise me a bit (he's among the Republicans referred to as RHINOS, so basically on your team but pretending to be on ours (both our goveners fall in that catagory as well). Whats wierd is how much damage he really did. Short of another Reagan like figure, I think the Republicans are doomed for a good long time (becoming a moderate left to your socialist-Democrat or possibly morphing into a single party, differing only in name.

AxeMental wrote:The more profit potential you take from these companies, the less they'll be able to invest and risk loosing in going after new medications. Remember, many of those attempts fail before they hit pay dirt.

On what planet does the National Health Service remove profit potential from these companies? It adds millions of customers who wouldn't be able to afford Glaxo products from their own income.

AxeMental wrote:If the USA went with Alg's Canadian socialist model (the govt. determing what they'll pay for the American drugs) I wonder how that would cut into Glaxo Smiths profits (I suspect massively America is undoubtedly their biggest single market)?

If we're talking at Union level, then I suspect the European Union is "massively undoubtedly their biggest single market".

If we're talking at state level, I imagine it goes Japan - Germany - United Kingdom - France - Italy - California.

I suspect their biggest customer is the world's third-largest corporation, which is the British National Health Service. (It has 1.3 million employees, slightly behind Wal-Mart and the Indian railway service.)

Because a National Health Service does not preclude a free market. We do have a free market in healthcare in the UK and I'd be at liberty to go to a private healthcare provider for treatment if I so wished, which is true almost everywhere with a national health service: there are private corporations competing with them. It helps keep them honest.

The largest such alternative company in the UK is BUPA, and I'd invite you to read up about how it works.

Innovation is rewarded and a free market exists.

Also, if you persist in describing a National Health Service as "socialist", then I shall start describing the US government's healthcare policies as "fascist".

PapersAndPaychecks wrote:On what planet does the National Health Service remove profit potential from these companies? It adds millions of customers who wouldn't be able to afford Glaxo products from their own income.

I think Axe is conflating two different thing. 1) universal healthcare; and 2) government imposed profit caps on medical supplies and pharmaceuticals. Obviously, #2 is detrimental to profit and would likely inhibit R&D efforts. I think, in Axe's opinion, #1 will automatically lead to #2.

Yes, I think that would have to occur to make such a system viable (espl. in the USA). I can envision profit caps without National Health Care, but not National Health Care without caps (and rationing) (it would be far too expensive, espl. without massive tort reform (which would never happen given that the trial lawyer lobby is so powerful with the Democratic party, not to mention most in politics are themselves attorneys).

P&P I'll have to take your word for that, I have no information related to that topic. I do suspect however, that private healthcare is hurt by competing with the public sector (its difficult to compete price wise when the government only needs to raise taxes to drive down price, like a private baker having to compete with a public baker who can sell his bread at a loss. Oddly this can make the price of bread more expensive for the buyer of private bread (the private baker has to make his profit off unique bread and pass the inflated cost to his few customers (and making less of a living to boot), obviously he can't spread his overhead with basic bread (when the govt. sells it at a loss).

We actually have something similar with our public Postal Service vs. UPS and FEDEX private entities. The postal service has its own trackable quick mail service and its usually cheaper (even their next day delivery) but it operates as not profitable (as its subsidized by Tax and the sale of stamps). Some think the UPS and FED EX (and other players) shouldn't have to compete with the govt. subsidized system, and that prices would drastically drop for the private companies if the postal service wasn't allowed to compete in this market (as the cost could be spread with more market share).

Personally I'm skeptical of this because of the nature of that business (the expense is huge and because of that its a natural monopoly really, simiar to: fire, water, electric, police, courts, etc.) 3 or 4 companies (tempted to set pricing) would not be enough to drive down costs threw competition (and the implications could be massive (unlike any other buisness catagory), stalling commerce). However, as I've stated before, medicine isn't a natural monopoly (perhaps insurance is). The nature of business of healthcare is infact very competitive even on a mom and pop small town level (doctor vs. doctor, hospital vs. hospital, testing facility vs. testing facility) etc.

The weak link is the 1. insurance company (not paying out, pre-conditions etc.) and 2. the inflated expense of the system (due to malpractise and associated insurance, red tape/paper work, R&D testing costs required by FDA, and I'm sure there are more). I'd like to see congress address these costs and accountability of the insurance industry (on a massive scale) helping out the provider of medicine, rather then move toward more govt. control (which would likely result in substandard care for the most severe illnesses (compared to what we have today).

http://socglory.blogspot.com/2007/08/ca ... s-how.html

http://www.ctv.ca/servlet/ArticleNews/s ... 4/20070914



Check out comments by Canadians on second link, such as Flanagan and Joe.

Socialized healthcare leads to rationing of care and government deciding who will make what financially.

Canadians come to America every year when important health issues must be addressed or are serious in nature.

Sorry, do not have the time to scour the net for past articles read.

I am for a base level of care for trully needy (ie incapable of working due to illness) individuals. All I know is that socialized medicine will kill innovation, drive competent people out of medicine, lead to rationing to the non-elites (who can afford to fly to India for medical care) and provide all of the goodies and fun off a government run organization.

I fear that soon I too will feel what it might be like to be a Canadian citizen with a major health problem. Sad state of affairs for America.

P&P----I hope if America adopts a socialized medial industry that, at a minimum, some sort of free-market alternative will be available.

blackprinceofmuncie wrote:I think Axe is conflating two different thing. 1) universal healthcare; and 2) government imposed profit caps on medical supplies and pharmaceuticals. Obviously, #2 is detrimental to profit and would likely inhibit R&D efforts. I think, in Axe's opinion, #1 will automatically lead to #2.

Well, real life examples such as my own country tend to show that's not the case.

I'd also like to reassure Axe and Ska that there are private companies in the healthcare business in the UK, and they're doing as well as can be expected in the recession.

AxeMental wrote:Yes, I think that would have to occur to make such a system viable (espl. in the USA). I can envision profit caps without National Health Care, but not National Health Care without caps (and rationing) (it would be far too expensive, espl. without massive tort reform.

I live in a country that has National Health Care without profit caps.

The NHS buys drugs at a rational price. It has a duty to the taxpayer to minimise the cost of the drugs it buys, so that's what it does. That means it exercises its (very considerable) buying power to keep the tax bill down.

But it isn't the only buyer.

The situation's like a local farmer's situation when there's a major supermarket in town. The supermarket's likely to be the farmer's biggest, or even only, customer -- so in a way, you might think the supermarket is exercising profit-capping power over the farmer. If you cast Glaxo as the farmer and the NHS as the supermarket, you get the idea.

What balances the monopolistic possibilities there are the dual facts that other healthcare providers do exist, and the NHS is under a duty to purchase the most effective drug that's available.

Now, that duty could allow drug companies to hold the NHS to ransom, so since 2005 there's been an independent regulator called the National Institute for Health and Clinical Excellence (NICE) whose job it is to evaluate the cost-effectiveness of the drugs on offer.

NICE has (controversially) prevented or restricted the NHS from buying about half a dozen highly expensive drugs in the four years for which it's existed. And because it will not approve the purchase of a drug that's not been clinically shown to be effective, it's been criticised for being slow to react. Here's an example of the kind of controversy you get from the existence of regulators like NICE.

AxeMental wrote:As for the meaning and vaugness of the actual text, I still have to read it (and I don't think its available save for small bits and pieces cut from the document).

Again:http://www.rules.house.gov/111/LegText/111_hr1_text.pdf is the 647 pp. document from the House Committee on Rules.

PapersAndPaychecks wrote:[

Because a National Health Service does not preclude a free market. We do have a free market in healthcare in the UK and I'd be at liberty to go to a private healthcare provider for treatment if I so wished, which is true almost everywhere with a national health service: there are private corporations competing with them. It helps keep them honest.

The largest such alternative company in the UK is BUPA, and I'd invite you to read up about how it works.

Innovation is rewarded and a free market exists.

in addition to the NHS there are over 100 private health care providers (that I could find) operating in the UK inlcuding Bupa, AGI, Cigna, etc.. and over 400 private hospitals and clinics operated by Nuffield, Spire (Bupa) and BMI.

So the market is "free" and open and there is a wide choice of healthcare providers available. Both systems working in tandem

Should point out that electing for private health cover dosn't exclude you from using the NHS at any point, the choice is always there.

P&P: "The NHS buys drugs at a rational price. " And there's your profit cap, each government entity (not private like Walmart or the supermarket) that does this is defeating the free market system (as they have unfair advantage to the private sector). A free market system would have the individual private insurance companies or individual wholesalers, retailers, hospitals, Walmarts etc. buying at the best rate they can muster (who in turn sell to another entity or directly to the patient at a profit).

Imagine if every country went to this sort of system (or even blocks like the EU, the NA block the SA block, the Africa block, the Asia block (so you only have a dozen say, or perhaps those blocks combined in to 2 or 3 buyers) this would hardly be a free market. We don't do this with Dell computers, nor do we do it with food (we all have to eat, its not fare that rich countries get better food then poor), IPODS (outrageously expensive!) or French Wine or English tea. What makes medication any different then any other product made by a company, are they not produced in a similar manner as any other (going threw each stage of development, and then marketing? If you take away the emotional, moral element, don't these companies have a right to be rewarded for the risk they take with their time and money (not to mention their inovation)?

Of course I understand that you can't take away the moral element. If a company invents a pill that slows the advance of cancer (after spending 6 billion doing so) everyone on the planet with cancer will want access to that pill. What the "government as buyer" system does is reduce the amount that company can collect. The company will in effect make less then it otherwise would, and if its not enough to warrant the risk then it won't continue developing new medications (who knows, their next might actually reverse cancer). So, what is "enough"? A govt. can't figure that out, only the free market can (as investors determine this on their own).

Socialism P&P has many forms (our own economy has socialistic elements mixed in it as others have pointed out). It can be extreme (like communism) or less extreme (what the NHS is doing I consider extreme). The goal of the Free Market champion is to establish a system of economics that minimizes govt. control of the market. The limit of this would be the prevention of the monopoly (or anything like it) to ensure competition.

We are holding the drug companies to a double standard I fear, making them out to be evil greedy money hungry pigs exploiting illness to make huge profits. But, all of those wonderful cures that extend peoples lives (and youth) would never exist without them (and more importantly without the capitalistic system that made that development possible). In any event those labels are not accurate. Most of these scientist start with humble beginnings and enjoy helping others threw their innovations. That they also enjoy living well is not a crime.

So, we need to pay irrationally high prices, to inflate pharmaceutical companies' profits (Don't they have a right?) ... because that's what drives prices down??

Mmmm ... pretzels.

Tastes like entitlement.

It's not possible that when the people are footing the bill, when they are both the venture capital and the consumer, they might be allowed to get what they consider "profit."