"Public Plan" will decimate R&D for New Medical Technology(online.wsj.com)
online.wsj.com
"Public Plan" will decimate R&D for New Medical Technology
http://online.wsj.com/article/SB124597297859757163.html
6 comments
Well, yes, this is a particularly poor comment article, by someone who is probably quite heavily lobbied by special interests.
However, I'm not certain Obama will be able to force through a nice health bill. It could turn into a very disappointing failure, like the cap-and-trade bill did, which would be very sad.
I don't think medical R&D is actually under any kind of threat. Nationalised healthcare does work, like it (basically) does here in the UK, but you need the political will and the correct architecture (ours is ok, but not that good).
However, I'm not certain Obama will be able to force through a nice health bill. It could turn into a very disappointing failure, like the cap-and-trade bill did, which would be very sad.
I don't think medical R&D is actually under any kind of threat. Nationalised healthcare does work, like it (basically) does here in the UK, but you need the political will and the correct architecture (ours is ok, but not that good).
Would a public plan have lower administrative costs? Well, how often are public enterprises run more efficiently than private ones? Why did practically all economically advanced nations dismantle their public airlines, phone companies, and so on, invariably obtaining lower administrative costs and consumer prices?
Funnily enough, a number of these advanced nations did not dismantle their public health plans.
Funnily enough, a number of these advanced nations did not dismantle their public health plans.
I find that impossible to believe. It would mean that these alleged nations made some kind of judgement between services that are useful for the state to provide and those that are essential.
The article doesn't do a good job of "proving" its points. The derived catch which makes it HN content is that R&D gets bit hard.
My personal opinion, you need a two step plan:
1 - outlaw preexisting condition exclusion. Its probably necessary to achieve the rest of the plan.
2 - force all policies to publish per person cost. The current private market segments by negotiating separate deals per company. This has to end in order to have transparent choice amongst providers. Also allows employers to get out of the way. A person, not an employee makes their choice and pays for it.
You do the above and you get efficient and open competition. End of story. Well, except: if you choose the policy with less bells and whistles and then when you get cancer switch to the better coverage when you actually do get cancer, it screws things up. Anyone got a solution to this part?
My personal opinion, you need a two step plan:
1 - outlaw preexisting condition exclusion. Its probably necessary to achieve the rest of the plan.
2 - force all policies to publish per person cost. The current private market segments by negotiating separate deals per company. This has to end in order to have transparent choice amongst providers. Also allows employers to get out of the way. A person, not an employee makes their choice and pays for it.
You do the above and you get efficient and open competition. End of story. Well, except: if you choose the policy with less bells and whistles and then when you get cancer switch to the better coverage when you actually do get cancer, it screws things up. Anyone got a solution to this part?
> Anyone got a solution to this part?
A single, government run, national health service, paid for by taxation?
Works OK for the rest of the world, and I don't quite buy the "US is subsidising the rest of the world's socialised health services" argument in the article. I read that pharmaceutical marketing spending is more than R&D spending (but still need to find a good source).
http://www.google.com/search?&q=pharmaceutical+r%26d+mar...
A single, government run, national health service, paid for by taxation?
Works OK for the rest of the world, and I don't quite buy the "US is subsidising the rest of the world's socialised health services" argument in the article. I read that pharmaceutical marketing spending is more than R&D spending (but still need to find a good source).
http://www.google.com/search?&q=pharmaceutical+r%26d+mar...
Works OK for the rest of the world isn't a good answer -- the rest of the world doesn't have free speech, and the us constitution which does not provide for the federal government to do anything even remotely close to health care.
I know the UK has had some pretty bad attacks on civil liberties in the last few years, but I reckon we still have free speech.
Quite frankly, as someone who has access to the NHS, I cannot believe how unethically the US handles health care. Surely even a single case of someone being financially ruined as a result of an illness is unacceptable, whether through being "uninsured" or the investigation department of your insurance company denying a claim?
As for efficiency of public vs private, here are some costs we don't incur: Marketing of drugs to patients. Claim management staff. Billing to patients. "Investigation departments" of insurance companies. (I'm sure there are more.)
Also, it sounds very time consuming to be caught up in the US health system. While we may have delays for non-acute procedures, acute health care is excellent and timely, and all you have to do is turn up at the appointed time.
Quite frankly, as someone who has access to the NHS, I cannot believe how unethically the US handles health care. Surely even a single case of someone being financially ruined as a result of an illness is unacceptable, whether through being "uninsured" or the investigation department of your insurance company denying a claim?
As for efficiency of public vs private, here are some costs we don't incur: Marketing of drugs to patients. Claim management staff. Billing to patients. "Investigation departments" of insurance companies. (I'm sure there are more.)
Also, it sounds very time consuming to be caught up in the US health system. While we may have delays for non-acute procedures, acute health care is excellent and timely, and all you have to do is turn up at the appointed time.
The UK is not even close to having free speech:
1. http://en.wikipedia.org/wiki/ASBO
2. http://en.wikipedia.org/wiki/Hate_speech#United_Kingdom
"the rest of the world doesn't have free speech"
Wow! Only Americans have Free Speech(TM)! </sarcasm>
you seem to be using the UK's Hate Speech Laws to prove that the UK doesn't have "free speech". Every country that allows "free speech" sets limits. For example, in the United States,
"There are exceptions to the general protection of speech, however, including the Miller test for obscenity, child pornography laws, and regulation of commercial speech such as advertising. Other limitations on free speech often balance rights to free speech and other rights, such as property rights for authors and inventors (copyright), interests in "fair" political campaigns (Campaign finance laws), protection from imminent or potential violence against particular persons (restrictions on Hate speech or fighting words), or the use of untruths to harm others (slander). Distinctions are often made between speech and other acts which may have symbolic significance"
reference:http://en.wikipedia.org/wiki/Freedom_of_speech_in_the_United...
so, a definition of "free speech" has to be looser than "anyone can say anything he wants in any context with full impunity". No country in the world, including the United States, makes such an absolute guarantee. Most democracies (the real ones, not sham ones like in Iran) have "free speech" with boundaries depending on local culture and history.
Wow! Only Americans have Free Speech(TM)! </sarcasm>
you seem to be using the UK's Hate Speech Laws to prove that the UK doesn't have "free speech". Every country that allows "free speech" sets limits. For example, in the United States,
"There are exceptions to the general protection of speech, however, including the Miller test for obscenity, child pornography laws, and regulation of commercial speech such as advertising. Other limitations on free speech often balance rights to free speech and other rights, such as property rights for authors and inventors (copyright), interests in "fair" political campaigns (Campaign finance laws), protection from imminent or potential violence against particular persons (restrictions on Hate speech or fighting words), or the use of untruths to harm others (slander). Distinctions are often made between speech and other acts which may have symbolic significance"
reference:http://en.wikipedia.org/wiki/Freedom_of_speech_in_the_United...
so, a definition of "free speech" has to be looser than "anyone can say anything he wants in any context with full impunity". No country in the world, including the United States, makes such an absolute guarantee. Most democracies (the real ones, not sham ones like in Iran) have "free speech" with boundaries depending on local culture and history.
In general when most people speak of free speech they are concerned with political speech, not libel/slander/ordering an execution/shouting fire in a theatre.
And I do agree that all campaign finance law is an act against free speech.
And I do agree that all campaign finance law is an act against free speech.
"In general when most people speak of free speech they are concerned with political speech,"
exactly so. And by that definition the UK does have free speech. As do a lot of countries. Most of the democracies do.
You brought up Hate Speech laws as some kind of free speech exception. I quote "the rest of the world doesn't have free speech".
as for,
"And I do agree that all campaign finance law is an act against free speech."
that wasn't what the article implied so you can't "agree" ;-). But sure you can have an opinion.
You are bringing in some custom vague definition of "free speech" (to claim the USA has some kind of monopoly on free speech) which doesn't stand up to logical scrutiny.
I am done with this thread. (I notice the article is dead too . reminder to self. Don't feed the troll)
exactly so. And by that definition the UK does have free speech. As do a lot of countries. Most of the democracies do.
You brought up Hate Speech laws as some kind of free speech exception. I quote "the rest of the world doesn't have free speech".
as for,
"And I do agree that all campaign finance law is an act against free speech."
that wasn't what the article implied so you can't "agree" ;-). But sure you can have an opinion.
You are bringing in some custom vague definition of "free speech" (to claim the USA has some kind of monopoly on free speech) which doesn't stand up to logical scrutiny.
I am done with this thread. (I notice the article is dead too . reminder to self. Don't feed the troll)
I know it is not how it is commonly used, but health insurance is supposed to be insurance. So a preexisting condition, already exists... it'd be like purchasing fire insurance after your house burned down -- it does not work.
How about this, remove all regulations relating to the medical industry. Let states step in if they feel there are any problems, remove all tax incentives for employer provided health care. Stop medicaid etc.
How about this, remove all regulations relating to the medical industry. Let states step in if they feel there are any problems, remove all tax incentives for employer provided health care. Stop medicaid etc.
Healthcare is not optional. Therefore leaving it to the markets is unwise.
Would you consider leaving policing to the private sector? Perhaps you could have a system where you have "civil protection" insurance policies, and the company protects you from crime? I'm sure that'd work really well.
Would you consider leaving policing to the private sector? Perhaps you could have a system where you have "civil protection" insurance policies, and the company protects you from crime? I'm sure that'd work really well.
Food is not optional, Housing is not optional, Clothing & Protection from the Elements is not optional... Would you leave that to the markets?
Most people define government as a monopolization of force, so policing must fall under that category.
Most people define government as a monopolization of force, so policing must fall under that category.
Most reasonably wealthy countries leave those things to the markets, with some guaranteed minimums for everyone, provided by the government.
I am right in thinking that even in the US, no-one will be left to starve or without basic accommodation?
If I'm right about that, what's so different about healthcare? In the UK, the government provides the basic healthcare, and then you're free to top it up with private health insurance should you want the bells and whistles.
Also, since the private health insurance is competing with good healthcare provided for free at point of delivery, they have a wonderful incentive to provide really good value for money.
If I'm right about that, what's so different about healthcare? In the UK, the government provides the basic healthcare, and then you're free to top it up with private health insurance should you want the bells and whistles.
Also, since the private health insurance is competing with good healthcare provided for free at point of delivery, they have a wonderful incentive to provide really good value for money.
Well, your proposals sound to me like a recipe for a nightmare, but you must feel differently. So what do you think would happen?
If a public plan is inserted into private insurance markets, the American health-care system could rapidly evolve into a single-payer system, which would have devastating effects on R&D for new medical technology.
The author underestimates the power of prestige in regards to medical R&D. I worked outside of Boston for a number of years as critical care nurse, and there's _tons_ of research that goes on because of Harvard Medical School, Boston University Med School and Tufts. And, a lot of those physicians compete with each other to publish research. Why? Not because they are financially reimbursed, but because they get prestige. Once prestige and published research gets to a certain point, the doctors can spend more time on the lecture circuit.
The author underestimates the power of prestige in regards to medical R&D. I worked outside of Boston for a number of years as critical care nurse, and there's _tons_ of research that goes on because of Harvard Medical School, Boston University Med School and Tufts. And, a lot of those physicians compete with each other to publish research. Why? Not because they are financially reimbursed, but because they get prestige. Once prestige and published research gets to a certain point, the doctors can spend more time on the lecture circuit.
Well, now that we got MJ out of our pants, can we go back to bitching about something being an obvious politics story? "Hi tc!"
Please don't post OPINION pieces!!!
I hate to say it, but Obama is right on about the idea that the current system needs competition to shake the parasites loose. There are a lot of middlemen and a lot of misaligned incentives in our current system that must be squeezed out.
Since the nation seems to be in a Keynesian mood at this point, here is my modest proposal for how to organize medical research for the next twenty years as a public/private partnership on a par with the moon race or the interstate freeway system.
The basic structure is a patent pool with a set of protocols for licensing advances from research shops and licensing assemblies for manufacturing. Define a small set of ideal medical technology goals; a universal medical imager, a universal portable pathology lab, a universal pharmacopia, and a universal medical expert system to tie it all together. Allow anyone to present model assemblies of technology that approach one of the defined goals. Have a fast track approval process for testing assemblies and licensing them for release to manufacturing. Every year, or every three months, pick the top 5 designs in each category and release them to manufacturing with a minimum guaranteed order for any manufacturer taking the product to market within a short time frame. Iterate, until we have a functionally complete autodoc that is as capable as the entire Mayo Clinic is today, and yet so affordable that middle class people can choose to have them in their homes.
Done properly it would be a self-funding effort after the first few years, and it would take health maintenance and medical surveillance out of the hands of the health insurance mafia.