Dean Kamen: Healthcare Debate "Backward Looking"(popularmechanics.com)
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Dean Kamen: Healthcare Debate "Backward Looking"
http://www.popularmechanics.com/science/health_medicine/4327012.html
6 comments
What makes you believe that there's anyone in America that does not have access to a doctor?
Hospital emergency rooms are required to take and treat all comers (at least if they want to participate in the system), and the Medicaid system reimburses those expenses.
A poor, uninsured person might not be able to get a kidney transplant, but they'll get some level of basic care. And what Mr. Kamen argues is that the income generated by those expensive procedures -- not to mention a segment of the population that is willing to pay for it -- is what will lead to the breakthroughs in the future that will make (say) kidney transplants unnecessary in another generation.
What really concerns me is that I know, because I have Crohn's Disease, that I have a much higher risk of colon cancer. Even at forty years old, I'm trying to put myself into a position where I'll be able to deal with that should it happen.
But in the ultimate socialized/rationed model, I'm not allowed to buy myself additional treatment beyond the lowest common denominator. Canada recently fought (and lost, thank %deity%) to prevent citizens from getting better health insurance than the socialist plan. In England and other places you're allowed to get better care, but only if you pay for every bit of it -- you can't take the baseline and then pay for the overage. So that's definitely the direction that "progress" is moving in.
My biggest objection is that this prevents people from having their own values. I'm not to be allowed to make decisions that balance for or against my lifespan. I can only get the mix that the regulators have deemed appropriate for every person, one size fits all.
Hospital emergency rooms are required to take and treat all comers (at least if they want to participate in the system), and the Medicaid system reimburses those expenses.
A poor, uninsured person might not be able to get a kidney transplant, but they'll get some level of basic care. And what Mr. Kamen argues is that the income generated by those expensive procedures -- not to mention a segment of the population that is willing to pay for it -- is what will lead to the breakthroughs in the future that will make (say) kidney transplants unnecessary in another generation.
What really concerns me is that I know, because I have Crohn's Disease, that I have a much higher risk of colon cancer. Even at forty years old, I'm trying to put myself into a position where I'll be able to deal with that should it happen.
But in the ultimate socialized/rationed model, I'm not allowed to buy myself additional treatment beyond the lowest common denominator. Canada recently fought (and lost, thank %deity%) to prevent citizens from getting better health insurance than the socialist plan. In England and other places you're allowed to get better care, but only if you pay for every bit of it -- you can't take the baseline and then pay for the overage. So that's definitely the direction that "progress" is moving in.
My biggest objection is that this prevents people from having their own values. I'm not to be allowed to make decisions that balance for or against my lifespan. I can only get the mix that the regulators have deemed appropriate for every person, one size fits all.
Canada recently fought
No, the province of Quebec did... Canada's system is not national, it's provincial. BC for instance allows for several areas of private care.
I'm not to be allowed to make decisions that balance for or against my lifespan.
You just gave examples in both Canada and the UK that showed that you most certainly can. You're argument is bullshit and comes from a place of ignorance - assuming that somehow the rest of the world has some sort of inferior system simply because we have single payers.
It isn't true. Every health statistic shows that the US is actually lagging behind. You're fighting each other for a dwindling and ever more expensive piece of the pie, and the solution is staring you right in the face.
No, the province of Quebec did... Canada's system is not national, it's provincial. BC for instance allows for several areas of private care.
I'm not to be allowed to make decisions that balance for or against my lifespan.
You just gave examples in both Canada and the UK that showed that you most certainly can. You're argument is bullshit and comes from a place of ignorance - assuming that somehow the rest of the world has some sort of inferior system simply because we have single payers.
It isn't true. Every health statistic shows that the US is actually lagging behind. You're fighting each other for a dwindling and ever more expensive piece of the pie, and the solution is staring you right in the face.
You're argument is bullshit and comes from a place of ignorance
You need to learn to argue civilly. Then you might not get down-voted.
No, the province of Quebec did...
Fine, that doesn't affect my argument.
You just gave examples in both Canada and the UK that showed that you most certainly can.
No. There's a difference. The UK system says "we'll give you $X for treatment A; if you want the more-expensive ($Y) B you get 0". What I'm arguing is "we're willing to invest $X; if you want B, you'll have to kick in Y-X".
In concrete terms, suppose that my hypothetical colon cancer can be treated for $50,000 but there's also a $60,000 treatment that's better but the government doesn't cover. The UK says that I have to "take it or leave it"; they won't let me get the alternative by kicking in the extra $10,000. I'd have to pay the full $60,000. For practical purposes, that's all but a prohibition.
You're fighting each other for a dwindling and ever more expensive piece of the pie
This is wrong. The pie is enlarging; everyone has access to better healthcare than anyone could get 60-70 years ago. The increasing expense is due to the availability of additional treatments. As Mr. Kamen said, there are treatments (e.g., polio) that were in effect infinitely expensive two generations ago that are now within the reach of literally everyone. The stuff that's outrageously expensive will be available for our kids.
But not if nobody develops them. If those researching new treatments can't sell those treatments because the gov't puts a wet blanket on the industry, then the treatments will never be sought.
Another thread in this page claimed that government funding would prevent this. There's a little truth in that, but it all revolves around the politicization of disease. We can already see the effects of that: government subsidizes AIDS/HIV research at something like 10x the rate of breast cancer, normalized to the number of people suffering from each. It winds that we help those with the best lobbyists, not those with the most need. And that's certainly no better than the Adam Smith's invisible hand could do.
You need to learn to argue civilly. Then you might not get down-voted.
No, the province of Quebec did...
Fine, that doesn't affect my argument.
You just gave examples in both Canada and the UK that showed that you most certainly can.
No. There's a difference. The UK system says "we'll give you $X for treatment A; if you want the more-expensive ($Y) B you get 0". What I'm arguing is "we're willing to invest $X; if you want B, you'll have to kick in Y-X".
In concrete terms, suppose that my hypothetical colon cancer can be treated for $50,000 but there's also a $60,000 treatment that's better but the government doesn't cover. The UK says that I have to "take it or leave it"; they won't let me get the alternative by kicking in the extra $10,000. I'd have to pay the full $60,000. For practical purposes, that's all but a prohibition.
You're fighting each other for a dwindling and ever more expensive piece of the pie
This is wrong. The pie is enlarging; everyone has access to better healthcare than anyone could get 60-70 years ago. The increasing expense is due to the availability of additional treatments. As Mr. Kamen said, there are treatments (e.g., polio) that were in effect infinitely expensive two generations ago that are now within the reach of literally everyone. The stuff that's outrageously expensive will be available for our kids.
But not if nobody develops them. If those researching new treatments can't sell those treatments because the gov't puts a wet blanket on the industry, then the treatments will never be sought.
Another thread in this page claimed that government funding would prevent this. There's a little truth in that, but it all revolves around the politicization of disease. We can already see the effects of that: government subsidizes AIDS/HIV research at something like 10x the rate of breast cancer, normalized to the number of people suffering from each. It winds that we help those with the best lobbyists, not those with the most need. And that's certainly no better than the Adam Smith's invisible hand could do.
Fine, that doesn't affect my argument.
It does, actually. It shows that the specifics of one particular system aren't even true across the same country.
For practical purposes, that's all but a prohibition.
No, it's a feature of that particular system. You're discounting the entire idea of single payer health care because one particular version has a component that you don't agree with. You're being intentionally deceptive in your argument.
everyone has access to better healthcare than anyone could get 60-70 years ago
...including those of us in government run systems, moot point.
If those researching new treatments can't sell those treatments because the gov't puts a wet blanket on the industry, then the treatments will never be sought.
By this logic, there should be effectively no medical research occurring anywhere else in the world save the US. This isn't the case.
And that's certainly no better than the Adam Smith's invisible hand could do.
Except of course for the however many millions that can't actually access any of this medical treatment. That's the whole crux of things: For those able, the trade-offs between a government run system and the US system are trivial overall. The major downsides in the US system have no equivalent in other systems.
It does, actually. It shows that the specifics of one particular system aren't even true across the same country.
For practical purposes, that's all but a prohibition.
No, it's a feature of that particular system. You're discounting the entire idea of single payer health care because one particular version has a component that you don't agree with. You're being intentionally deceptive in your argument.
everyone has access to better healthcare than anyone could get 60-70 years ago
...including those of us in government run systems, moot point.
If those researching new treatments can't sell those treatments because the gov't puts a wet blanket on the industry, then the treatments will never be sought.
By this logic, there should be effectively no medical research occurring anywhere else in the world save the US. This isn't the case.
And that's certainly no better than the Adam Smith's invisible hand could do.
Except of course for the however many millions that can't actually access any of this medical treatment. That's the whole crux of things: For those able, the trade-offs between a government run system and the US system are trivial overall. The major downsides in the US system have no equivalent in other systems.
No, it's a feature of that particular system. You're discounting the entire idea of single payer health care because one particular version
You're misunderstanding. I'm not saying that all are bad because (at least) a few have a particular feature. I'm citing two examples to show that the "progressive" movement in healthcare shows a trend toward that bad feature. This should be a warning to us about a) the motivations of those pushing this; and b) should we really decide that "reform" is necessary, we ought to guard against this.
Except of course for the however many millions that can't actually access any of this medical treatment. That's the whole crux of things
If that's the crux of this, then you've lost the argument. The premise that you're working from is simply erroneous. It is untrue that many millions cannot access any of these treatments. In the USA, anyone can walk into the emergency room and get treated. While it's true that esoteric treatments having sky-high prices (say, heart transplant) won't be provided, all of the basic services will be provided even to those unable to pay on their own.
FWIW, my wife is the Manager of Budget and Reimbursement at a largish urban hospital. She spends a fair amount of her time coordinating with Medicaid to get the hospital reimbursed for the cost of treating charity and bad debt cases. You seem to be saying that this is all a figment of her imagination, that the hospital is actually turning away all of these people. That ain't so: even the homeless get treatment in America, with the system we have today.
You're misunderstanding. I'm not saying that all are bad because (at least) a few have a particular feature. I'm citing two examples to show that the "progressive" movement in healthcare shows a trend toward that bad feature. This should be a warning to us about a) the motivations of those pushing this; and b) should we really decide that "reform" is necessary, we ought to guard against this.
Except of course for the however many millions that can't actually access any of this medical treatment. That's the whole crux of things
If that's the crux of this, then you've lost the argument. The premise that you're working from is simply erroneous. It is untrue that many millions cannot access any of these treatments. In the USA, anyone can walk into the emergency room and get treated. While it's true that esoteric treatments having sky-high prices (say, heart transplant) won't be provided, all of the basic services will be provided even to those unable to pay on their own.
FWIW, my wife is the Manager of Budget and Reimbursement at a largish urban hospital. She spends a fair amount of her time coordinating with Medicaid to get the hospital reimbursed for the cost of treating charity and bad debt cases. You seem to be saying that this is all a figment of her imagination, that the hospital is actually turning away all of these people. That ain't so: even the homeless get treatment in America, with the system we have today.
Sorry, every health statistic doesn't show the US is lagging behind. Look at cancer detection and treatment and survival rates from heart attacks. I think that you can get a system that works with a single payer system - but it's tough to find one that also innovates and is sustainable - there's a good case to be made here that the US actually subsidizes the rest of the world with developments in drugs and medical technologies/techniques.
Please point me to these stats, they seem interesting but I can't locate them.
Here's a start:
On cancer: http://www.ncpa.org/pub/ba596 and http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080716...
On heart attacks: http://www.circ.ahajournals.org/cgi/content/abstract/01.CIR....
On access to medical technologies: http://content.healthaffairs.org/cgi/reprint/13/4/113.pdf
On cancer: http://www.ncpa.org/pub/ba596 and http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080716...
On heart attacks: http://www.circ.ahajournals.org/cgi/content/abstract/01.CIR....
On access to medical technologies: http://content.healthaffairs.org/cgi/reprint/13/4/113.pdf
The United States is subsidizing the medical expenses of the rest of the planet.
Who do you think pays for medical research and why?
Who do you think pays for medical research and why?
Prove this.
This is nothing more than conjecture and PR taken to laughing stock levels (outside of the US at least).
Even in the US, the largest research funder is in fact the US government, just like every other country.
This is nothing more than conjecture and PR taken to laughing stock levels (outside of the US at least).
Even in the US, the largest research funder is in fact the US government, just like every other country.
This is common knowledge to anybody that works in medical research.
I don't know of a way to prove other than telling you to go to a medical research laboratory and ask some of the people that work there.
Most of them are going to chuckle a bit at your suggestion that I'm wrong.
I would also suggest looking at the Mayo Clinic and Johns Hopkins, which are the premier medical research institutions in the world. (I'm sorry, this is also common knowledge...I can't offer you any 'proof' of it other than...look).
I don't know of a way to prove other than telling you to go to a medical research laboratory and ask some of the people that work there.
Most of them are going to chuckle a bit at your suggestion that I'm wrong.
I would also suggest looking at the Mayo Clinic and Johns Hopkins, which are the premier medical research institutions in the world. (I'm sorry, this is also common knowledge...I can't offer you any 'proof' of it other than...look).
This is common knowledge to anybody that works in medical research.
Then it should be easy to support. Let's talk fact here, common knowledge is often wrong.
For reference, the largest medical research funder in the world is actually NIH; an arm of the US government.
Then it should be easy to support. Let's talk fact here, common knowledge is often wrong.
For reference, the largest medical research funder in the world is actually NIH; an arm of the US government.
Then it should be easy to support. Let's talk fact here, common knowledge is often wrong.
Sure! In 2003 the United States spent about $94 Billion Dollars on medical reseearch. About 28% of this came from the National Institute of health. Yes, you are technically correct, this makes them the largest "single" contributor. (http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/...)
In 2002/2003 the UK (the largest EU contributor to health research) spent about $480 Million (400 Million Euro) on cancer research. (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15...)
In this same period, the United States spent about $1.9 Billion. (http://www.cancer.gov/cancertopics/factsheet/NCI/research-fu...)
I understand that these sorts of things are inconvenient, and I apologize for not citing sources earlier. Like I said, this is pretty much common knowledge to anybody even remotely familiar with medical research.
In the future, I suggest using this website: http://www.google.com .. it is really great for helping you find things that support "common" knowledge.
Sure! In 2003 the United States spent about $94 Billion Dollars on medical reseearch. About 28% of this came from the National Institute of health. Yes, you are technically correct, this makes them the largest "single" contributor. (http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/...)
In 2002/2003 the UK (the largest EU contributor to health research) spent about $480 Million (400 Million Euro) on cancer research. (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15...)
In this same period, the United States spent about $1.9 Billion. (http://www.cancer.gov/cancertopics/factsheet/NCI/research-fu...)
I understand that these sorts of things are inconvenient, and I apologize for not citing sources earlier. Like I said, this is pretty much common knowledge to anybody even remotely familiar with medical research.
In the future, I suggest using this website: http://www.google.com .. it is really great for helping you find things that support "common" knowledge.
I have to laugh at the misplaced smugness of your reply.
With your own quoted figures:
$480 million / 60 million population = $8 per person in the UK
$1.9 billion / 300 million population = $6.33 per person in the US
Nice try!
With your own quoted figures:
$480 million / 60 million population = $8 per person in the UK
$1.9 billion / 300 million population = $6.33 per person in the US
Nice try!
How does any of this bantering disporve my statement that the United States is doing the overwhelming majority of the medical research in the world?
The United States is responsible for 4x as much medical research as the United Kingdom is. How can you in any way misunderstand this to mean something other than "The United States does more Research than anybody else. This is common knowledge".
Are you illiterate?
The United States is responsible for 4x as much medical research as the United Kingdom is. How can you in any way misunderstand this to mean something other than "The United States does more Research than anybody else. This is common knowledge".
Are you illiterate?
No, and I think you're retreating from your argument because you can't defend it.
You asked: "Who do you think pays for medical research and why?"
It appears everyone, including the US, pays for medical research via taxation and government directed research and this dwarfs private investment on a global scale (absolute or per capita), even in the only first world nation to avoid socialized medicine (i.e. the US).
You didn't challenge this interpretation when the other poster said:
"Even in the US, the largest research funder is in fact the US government, just like every other country."
Yet, you suddenly suggest that you meant:
"The US pays for a lot of medical research because it is a populous first world country" which is true but utterly facile.
Why don't you answer your own question? Who pays and why? Maybe then we'll be able to figure what you're actually trying to say and how it relates to the topic being discussed.
You asked: "Who do you think pays for medical research and why?"
It appears everyone, including the US, pays for medical research via taxation and government directed research and this dwarfs private investment on a global scale (absolute or per capita), even in the only first world nation to avoid socialized medicine (i.e. the US).
You didn't challenge this interpretation when the other poster said:
"Even in the US, the largest research funder is in fact the US government, just like every other country."
Yet, you suddenly suggest that you meant:
"The US pays for a lot of medical research because it is a populous first world country" which is true but utterly facile.
Why don't you answer your own question? Who pays and why? Maybe then we'll be able to figure what you're actually trying to say and how it relates to the topic being discussed.
Luckily, research isn't done per capita. Find a cure, it's applicable to (pretty much) everyone.
You might say that other, smaller governments spend at a comparable per-capita rate. But that doesn't change the fact that the USA is still spending much more and accomplishing more research.
You might say that other, smaller governments spend at a comparable per-capita rate. But that doesn't change the fact that the USA is still spending much more and accomplishing more research.
So we've gone from "The US not having socialised medicine makes it a reseach powerhouse that the rest of the world has to leech off because of their backwards programs" to "The US has more citizens than other 1st world countries".
Hardly a great argument, but at least the latter actually is "common knowledge".
Hardly a great argument, but at least the latter actually is "common knowledge".
The original claim was "The United States is subsidizing the medical expenses of the rest of the planet."
When some evidence was provided, you stated that per capita they're only doing 1/3 more than the UK.
The thing is, that original claim that others were arguing with had nothing to do with per capita. The proposition is based on absolute numbers.
And for the larger argument about what current proposals would do to innovation in medical treatments, what we're really talking about is the total amount of research, not per capita -- the latter is a red herring.
The fear is that, if the USA clamps down on healthcare spending, then much of the research that's done in the USA won't continue. And if that's the case, then the pace of improvements in healthcare will slow, and in the long run that's a very bad thing.
That proposition is certainly open to debate. But decomposing the facts into per capita data is a red herring that does nothing to resolve the question one way or another.
When some evidence was provided, you stated that per capita they're only doing 1/3 more than the UK.
The thing is, that original claim that others were arguing with had nothing to do with per capita. The proposition is based on absolute numbers.
And for the larger argument about what current proposals would do to innovation in medical treatments, what we're really talking about is the total amount of research, not per capita -- the latter is a red herring.
The fear is that, if the USA clamps down on healthcare spending, then much of the research that's done in the USA won't continue. And if that's the case, then the pace of improvements in healthcare will slow, and in the long run that's a very bad thing.
That proposition is certainly open to debate. But decomposing the facts into per capita data is a red herring that does nothing to resolve the question one way or another.
I don't know about other statistics off-hand, but there has been a debate about this off and on for months on Megan McArdle's blog - one thing that has been well established is that cancer survival rates are substantially higher in the US than any other country.
I would be interested to know if this takes in account people who die of cancer who cannot afford to see a Dr. in the US.
I live in a place with a very good public health care system. I always go private so I can choose my doctors and get the best care. I pay medical insurance for this privilege by choice.
I see your slippery slope argument of "the ultimate socialized/rationed model". But aren't you concerned that without any type of public option that no insurance company will insure you at any price given your current condition? It seems that an insurance company would lose money by insuring you. Unless they charge exorbitant prices. Ultimately, your insurance company is going to decide what care you get.
"you can't take the baseline and then pay for the overage"
If that was allowed, there'd be a fuckton of nickel-and-diming going on where it'd be very difficult to avoid being forced to pay overages.
If that was allowed, there'd be a fuckton of nickel-and-diming going on where it'd be very difficult to avoid being forced to pay overages.
I'm a Canadian as well - most of my friends in my town don't have access to a family doctor and are on waiting lists. And that's family doctors - try getting an appointment with a specialist.
This isn't Kamen's point though. If the US can continue to accelerate innovation, being the biggest medical innovator in the world, costs for older technologies will also fall improving access. Restrict what technology companies and healthcare firms who use these technologies can charge however, and you reduce the incentive to innovate. Improvements in technology in every other industry results in lower not higher costs. One thing he doesn't talk about as much which is a hurdle is the system of third party payers - but I think he at least discusses a more sustainable solution and the threats that the current and proposed regulations pose.
This isn't Kamen's point though. If the US can continue to accelerate innovation, being the biggest medical innovator in the world, costs for older technologies will also fall improving access. Restrict what technology companies and healthcare firms who use these technologies can charge however, and you reduce the incentive to innovate. Improvements in technology in every other industry results in lower not higher costs. One thing he doesn't talk about as much which is a hurdle is the system of third party payers - but I think he at least discusses a more sustainable solution and the threats that the current and proposed regulations pose.
Access to a family doctor has nothing to do with the fact that our system isn't private, it has to do with a well known shortage of doctors.
To the point though: I reject the notion that there is effectively a single country conducting health research that the rest of the world is leaching off of. It's preposterous and unsupported. Further, even in the USA a vast majority of medical research is government funded!
If the US moved to a single payer system, medical research will change, not end. That's the same thing that happens whenever there is a disruption in any industry.
To suggest that we will a reduction in medical innovation because the US suddenly collectively and not individually paying for medical coverage is to spout nothing more than PR that various corporate interests would love to pay for.
To the point though: I reject the notion that there is effectively a single country conducting health research that the rest of the world is leaching off of. It's preposterous and unsupported. Further, even in the USA a vast majority of medical research is government funded!
If the US moved to a single payer system, medical research will change, not end. That's the same thing that happens whenever there is a disruption in any industry.
To suggest that we will a reduction in medical innovation because the US suddenly collectively and not individually paying for medical coverage is to spout nothing more than PR that various corporate interests would love to pay for.
Can you provide any links re: "vast majority of medical research is government funded"? As to whether or not we would see less research, markets create greater demand for that research and most of it is developed in the US. I don't believe these are controversial points.
You're right though, the medical research wouldn't go away completely but my suspicion based on the output of countries with single payer systems, and how much less they pay for such things as pharmaceuticals that result in substantial healthcare savings (which is why I think that the US does subsidize much of the world), is that this would be the case. It would definitely change, but when it comes to the issue of innovation and making that technology usable, I doubt it would be for the better.
Also with respect to the doctor and specialist shortage - it has a great deal to do with incentives within a public system. When you restrict the pay that doctors can make, they work less and fewer of them stay in Canada. This is the case for my doctor who chooses to work 4 days a week and where she caps out and for a few of the specialists I know.
You're right though, the medical research wouldn't go away completely but my suspicion based on the output of countries with single payer systems, and how much less they pay for such things as pharmaceuticals that result in substantial healthcare savings (which is why I think that the US does subsidize much of the world), is that this would be the case. It would definitely change, but when it comes to the issue of innovation and making that technology usable, I doubt it would be for the better.
Also with respect to the doctor and specialist shortage - it has a great deal to do with incentives within a public system. When you restrict the pay that doctors can make, they work less and fewer of them stay in Canada. This is the case for my doctor who chooses to work 4 days a week and where she caps out and for a few of the specialists I know.
Two good links on this page:
http://wiki.idebate.org/index.php/Argument:_Most_investment_...
it has a great deal to do with incentives within a public system. When you restrict the pay that doctors can make, they work less and fewer of them stay in Canada.
Yes, but this is an administrative problem. It's simple math, if you only have x doctors, and their max patient load is y, you should be able to know exactly how many doctors you will need per population.
http://wiki.idebate.org/index.php/Argument:_Most_investment_...
it has a great deal to do with incentives within a public system. When you restrict the pay that doctors can make, they work less and fewer of them stay in Canada.
Yes, but this is an administrative problem. It's simple math, if you only have x doctors, and their max patient load is y, you should be able to know exactly how many doctors you will need per population.
There's something odd about some of the numbers cited: "The single biggest source of medical research funding, not just in the United States but in the entire world, is the National Institutes of Health (NIH): Last year [2006], it spent more than $28 billion on research, accounting for about one-third of the total dollars spent on medical research and development in this country (and half the money spent at universities)"
Pharmaceutical companies spent $39 billion in 2004 according to the CBO's report (which would ironically have been done by Peter Orszag): http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf That doesn't even include the billions spent on other medical technologies. Either way, it doesn't support your claim that "vast majority of medical research is government funded". Further, not all dollars are created equal. Private firms invest capital based on markets and demand and they have a significant incentive to do so whereas it's far easier to find frivolous government research studies.
I'm not exactly clear though how you think that the shortage of doctors are an administrative problem when the problem is that they aren't willing to pay them more for the services they perform so there's a shortage. It's not that they don't hire more, there just aren't enough willing to practice in Canada - and that's directly related to the single payer system because governments here are unwilling to spend more.
Pharmaceutical companies spent $39 billion in 2004 according to the CBO's report (which would ironically have been done by Peter Orszag): http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf That doesn't even include the billions spent on other medical technologies. Either way, it doesn't support your claim that "vast majority of medical research is government funded". Further, not all dollars are created equal. Private firms invest capital based on markets and demand and they have a significant incentive to do so whereas it's far easier to find frivolous government research studies.
I'm not exactly clear though how you think that the shortage of doctors are an administrative problem when the problem is that they aren't willing to pay them more for the services they perform so there's a shortage. It's not that they don't hire more, there just aren't enough willing to practice in Canada - and that's directly related to the single payer system because governments here are unwilling to spend more.
The numbers add up if you consider all the other governments, not just the US, and compare that to the $39B for pretty much every pharma company.
As to the shortage of doctors: Doctors in Canada are limited to the amount of patients they can see, not so much by what they can charge. (Although the rates for services are set, the same way they are often set by HMO's in the US.)
The whole reason this is done is to prevent doctor "factories" - doctors that spend 10 minutes with patients and provide poor diagnosis' in order to see as many people as possible.
The shortage is exactly due to the fact that they don't hire more. The number of semi-qualified medical professionals driving cabs in this country is outlandish. The doctoral societies have been not bent in their admission guidelines, and hospitals simply don't have enough space for all the people needed a Canadian residency requirement.
There are tons of people willing to practice in Canada.
As to the shortage of doctors: Doctors in Canada are limited to the amount of patients they can see, not so much by what they can charge. (Although the rates for services are set, the same way they are often set by HMO's in the US.)
The whole reason this is done is to prevent doctor "factories" - doctors that spend 10 minutes with patients and provide poor diagnosis' in order to see as many people as possible.
The shortage is exactly due to the fact that they don't hire more. The number of semi-qualified medical professionals driving cabs in this country is outlandish. The doctoral societies have been not bent in their admission guidelines, and hospitals simply don't have enough space for all the people needed a Canadian residency requirement.
There are tons of people willing to practice in Canada.
re: numbers adding up - re: 39B (not including research in medical equipment and techniques) versus NIH: I'd be curious what you would find if you added it up all other governments as I think you assume erroneously here. All european governments spent 3.7B (2000, the most recent number I was able to find) in medical research. Further, the impact of the pharma industry in the US is disproportionate to other countries in output. And again, not all dollars are equal in efficacy. Again, the US is the dominant innovator in medical technologies and the way that they charge for pharmaceuticals in the US differs than what they charge to the rest of the world.
re: doctor shortages in Canada: When you maximize number of patients and maximize amount charged on a given procedure, it amounts to a pay cap. A direct result is that doctors go elsewhere. The regulatory system is also inefficient as you note in that those who are trained elsewhere encounter barriers here. Further, we don't empower nurses sufficiently instead of allowing patients to choose like in the US (Walmart / Walgreens). This says nothing about specialists who are even harder to find in Canada because incentives are even greater to move elsewhere (again a direct result of caps in the one payer system).
A related article from Macleans: http://www.thecanadianencyclopedia.com/index.cfm?PgNm=TCE... (also talks about the spending in attempt to integrate some of the foreign medical practitioners)
re: doctor shortages in Canada: When you maximize number of patients and maximize amount charged on a given procedure, it amounts to a pay cap. A direct result is that doctors go elsewhere. The regulatory system is also inefficient as you note in that those who are trained elsewhere encounter barriers here. Further, we don't empower nurses sufficiently instead of allowing patients to choose like in the US (Walmart / Walgreens). This says nothing about specialists who are even harder to find in Canada because incentives are even greater to move elsewhere (again a direct result of caps in the one payer system).
A related article from Macleans: http://www.thecanadianencyclopedia.com/index.cfm?PgNm=TCE... (also talks about the spending in attempt to integrate some of the foreign medical practitioners)
Take a look at the VC money invested just this week in US companies:
http://www.xconomy.com/tag/Life-Sciences/
If the huge pay-off for a blockbuster treatment is not out there all that research goes away
http://www.xconomy.com/tag/Life-Sciences/
If the huge pay-off for a blockbuster treatment is not out there all that research goes away
In the 1970's I lived in a small town in Oregon. You paid your fire protection fee and they stuck a little sign in your yard. If your house caught fire and you weren't a customer they would allegedly come and protect your neighbor's houses, but not risk anything to save yours.
You missed his whole point. Because the US has such high costs we can't afford to give it to everyone. These exorbitant costs also create incentives for innovation. No other countries produce the medical breakthroughs that the US does.
This quote sums-up his thinking: "Every drug that's made is a gift from one generation to the next because, while it may be expensive now, it goes off patent and your kids will have it essentially for free."
You could say the same thing about the US vis-a-vis the rest of the world. Every drug/treatment/device that is developed in the US is a gift to the rest of the world
This quote sums-up his thinking: "Every drug that's made is a gift from one generation to the next because, while it may be expensive now, it goes off patent and your kids will have it essentially for free."
You could say the same thing about the US vis-a-vis the rest of the world. Every drug/treatment/device that is developed in the US is a gift to the rest of the world
I'd just like to point out that the internet was government-funded innovation. As well as the massive amounts of R&D we do in the military space. Another area in which we lead the world. To assume that government-funded equates to lack of innovation is false.
The initial invention was gov't funded, but it wasn't until (decades) later when business began investing in it that it really took off. And became much more than an academic toy.
Companies weren't interested in the internet until they could make a profit. The same way they aren't interested in treatments/medicines/cures unless they can make a profit. What if these decisions were made altruistically based on how many people you can help, regardless of the profits...
Which is why we have 15 different types of erectile dysfunction pills and no HIV vaccine.
It's also why health care should be a government problem rather than a free market problem. They can focus on the right things rather than the profitable things, no business can survive doing that.
I agree. I wouldn't mind trading the private bureaucrat who determines if I get care (and gets rewarded for containing the medical loss ratio * ) for a government bureaucrat who determines if I get care.
The point I agree with is that the very high medical expenses in the US aren't just going up in smoke. Because of those high costs people are directing private investment dollars towards creating new treatments.
* medical loss ratio - the amount of my premium that actually gets handed over for medical care - typically 75%-80% vs. 95% with Medicare.
The point I agree with is that the very high medical expenses in the US aren't just going up in smoke. Because of those high costs people are directing private investment dollars towards creating new treatments.
* medical loss ratio - the amount of my premium that actually gets handed over for medical care - typically 75%-80% vs. 95% with Medicare.
Yes, but these companies determine what to invest in based on how much profit they presume to make. Should profit be the only motive to creating new treatments?
You have no idea, I recently got into a car accident (look at my history for the story of that). And for all of our "socialist policies" in the US that republicans owuld want you to believe, we're grossly libertarian.
Long story short: Accident happened, cop came out and wrote me a ticket based on the fact that he had to come out, and pretty much told me that. Then today I got a bill from the fire department/EMS for them having to come out. In total these bills/tickets are about 1K in cost. So you'd think there isn't a fire-fighters tax but there is....
Long story short: Accident happened, cop came out and wrote me a ticket based on the fact that he had to come out, and pretty much told me that. Then today I got a bill from the fire department/EMS for them having to come out. In total these bills/tickets are about 1K in cost. So you'd think there isn't a fire-fighters tax but there is....
Let's take your argument and apply it to other commodities.
"How is it that someone can argue in favor of people not having free groceries? Would you also argue that people shouldn't have access to computers unless they pay the computer tax? Entertainment? The protection of free homes?"
The problem with making everything free is that you create a system where no one wants to work, corrupt officials take more than their fair share, and scarcity becomes the norm.
"How is it that someone can argue in favor of people not having free groceries? Would you also argue that people shouldn't have access to computers unless they pay the computer tax? Entertainment? The protection of free homes?"
The problem with making everything free is that you create a system where no one wants to work, corrupt officials take more than their fair share, and scarcity becomes the norm.
He didn't say make everything free, and healthcare isn't like any other commodity. The world is not so black and white.
Why is health care so special then? Shouldn't food and water be just as free? Aren't they even more basic necessities?
Because food is predictable, available, and cheap. Healthcare is unpredictable; you don't know when you'll need it and you hope you never do, but if you do, it could completely bankrupt you and since your life could be on the line you'll do anything to get it.
Also unlike food, since we have a massive insurance industry involved to spread the risk of unpredictable and often massive expenses, we've actually created a system that incentivises people to hurt other people by denying claims. Not everyone believes the invisible hand of the market is the correct solution to every problem; I'm all for socialized healthcare.
Also unlike food, since we have a massive insurance industry involved to spread the risk of unpredictable and often massive expenses, we've actually created a system that incentivises people to hurt other people by denying claims. Not everyone believes the invisible hand of the market is the correct solution to every problem; I'm all for socialized healthcare.
The problem is that the same healthcare service costs a lot more in America than it does anywhere else in the world. It's understandable if the surgery that only 4 surgeons in the world can do costs a lot, but relatively routine/commoditized stuff shouldn't cost more than in other developed countries.
I've only ever seen statistics that compare the aggregate cost of health care relative to aggregate outcomes in the US vs other countries. Do you have more details on the delta between pricing for specific services?
It's generally very difficult to compare the cost of specific services in any meaningful way. For instance, many countries institute price controls on medication, cutting the cost of some prescriptions to 30% of what they'd cost in the US. However, some of these drugs were developed in the US based on US patent law and with the assumption of a certain amount of profit from US consumers. A price control in Canada is effectively subsidized by US consumers of a given drug, in lots of cases.
A great deal of the costs we pay come as a result of artificial scarcity of both drugs and medical services. The result of legislation, fears of malpractice, and prescription requirements mean that treating a simple sinus infection (which I can diagnose reasonably well myself) costs ~$150 or so after the doctor visit and trip to the pharmacy. There are a great many ways to attack that scarcity, but we're not really considering them (unfortunately).
Dean Kamen has a good point. The level of medical care we can provide to people is both insane and insanely expensive. High prices are rationing. What we need to do is attack the high prices that are artificially inflated.
It's generally very difficult to compare the cost of specific services in any meaningful way. For instance, many countries institute price controls on medication, cutting the cost of some prescriptions to 30% of what they'd cost in the US. However, some of these drugs were developed in the US based on US patent law and with the assumption of a certain amount of profit from US consumers. A price control in Canada is effectively subsidized by US consumers of a given drug, in lots of cases.
A great deal of the costs we pay come as a result of artificial scarcity of both drugs and medical services. The result of legislation, fears of malpractice, and prescription requirements mean that treating a simple sinus infection (which I can diagnose reasonably well myself) costs ~$150 or so after the doctor visit and trip to the pharmacy. There are a great many ways to attack that scarcity, but we're not really considering them (unfortunately).
Dean Kamen has a good point. The level of medical care we can provide to people is both insane and insanely expensive. High prices are rationing. What we need to do is attack the high prices that are artificially inflated.
"A price control in Canada is effectively subsidized by US consumers of a given drug" I think that is the crux of his point, if the US didn't have these crazy high prices - then the drug would not have been developed.
I liked this quote: "Every drug that's made is a gift from one generation to the next because, while it may be expensive now, it goes off patent and your kids will have it essentially for free."
The high cost in the US is paying for the R&D that makes the drug possible
I liked this quote: "Every drug that's made is a gift from one generation to the next because, while it may be expensive now, it goes off patent and your kids will have it essentially for free."
The high cost in the US is paying for the R&D that makes the drug possible
The drug companies spend almost nothing on R&D, not compared to what they spend on consumer advertising, marketing to doctors, regulatory compliance, lobbying, civil defense lawyering, and patent lawyering.
Typically 15-20% of their expenses are spent on R&D. The cost of marketing is also about 15-20%. This is roughly the same as any large tech company. Compare Merck and Johnson&Johnson to Google or Intel.
http://www.google.com/finance?q=NYSE:MRK&fstype=ii
http://www.google.com/finance?q=NYSE:JNJ&fstype=ii
http://www.google.com/finance?q=NASDAQ:INTC&fstype=ii
http://www.google.com/finance?q=NASDAQ:GOOG&fstype=ii
http://www.google.com/finance?q=NYSE:MRK&fstype=ii
http://www.google.com/finance?q=NYSE:JNJ&fstype=ii
http://www.google.com/finance?q=NASDAQ:INTC&fstype=ii
http://www.google.com/finance?q=NASDAQ:GOOG&fstype=ii
Marketing does not raise the cost of Healthcare and medicine, but those lawyers you mention sure do.
The other problem is that despite spending significantly more than any other nation, measures of health care (i.e preventable deaths, access to health care) rank the US well behind other first world nations.
The interview largely ignores that concern, and focuses instead on the strawman of absolute cost.
The interview largely ignores that concern, and focuses instead on the strawman of absolute cost.
Unfortunately the debate usually isn't as black and white all the time given that there are a number of metrics like survival rates following heart attacks or cancer detection/treatment where the US is very much ahead of other first world nations.
Absolute cost is far from a strawman in this issue given that the basic argument for reform (as they've proposed - since I think a lot of people are for reform including Dean Kamen), is that the US healthcare system as it is now is too expensive and ergo a significant barrier to access. Others like Kamen make the point that by restricting absolute costs, innovation will drop because the incentives for innovating drop.
Absolute cost is far from a strawman in this issue given that the basic argument for reform (as they've proposed - since I think a lot of people are for reform including Dean Kamen), is that the US healthcare system as it is now is too expensive and ergo a significant barrier to access. Others like Kamen make the point that by restricting absolute costs, innovation will drop because the incentives for innovating drop.
This seems intuitive and if its true that the cost is ONLY for that service and not ALSO for the superior research and development, then I would agree.
I don’t know for sure but my hope would be that at least some relatively routine/commoditized stuff is higher in America to pay for things that aren’t being done in other places.
In any case Dean Kamen makes some great points about moving beyond fear based legislation.
I don’t know for sure but my hope would be that at least some relatively routine/commoditized stuff is higher in America to pay for things that aren’t being done in other places.
In any case Dean Kamen makes some great points about moving beyond fear based legislation.
Health care is just like any other product or service. It will be sold at market prices.
Health care is not just like any other product or service.
It's impossible to predict when you'll need it, and how much of it you'll need. When you really need it, you'll pay any price for it, even if that means spending every penny you have and then going heavily into debt.
I can't think of a single other product or service that behaves quite like that.
It's impossible to predict when you'll need it, and how much of it you'll need. When you really need it, you'll pay any price for it, even if that means spending every penny you have and then going heavily into debt.
I can't think of a single other product or service that behaves quite like that.
Taking the rationing argument to the extreme, suppose we could take a painless treatment once a year that would stop all aging and disease but costs $1 million. Would we still innovate in cheaper, less effective methods? We couldn't possibly pay for the treatments for everyone, but should they be subsidized for some? Would there be pressure to make the treatments illegal for those who can afford them? What if for a quarter of the price you get half the effects, but you can still only take it once a year. What would be the optimal time to not age/be disease free a month, a week, a day?
While we're theorizing, what if you knew you could make a pill that would be "a painless treatment once a year that would stop all aging and disease but costs $1 million." But it takes a company 50 years to develop and costs $1 trillion in research. Could a company take such a risk? Could the government?
Since Dean Kamen makes medical devices, doesn't he have a conflict of interest?
Basically, if the government tries to control costs, he will probably earn less per device.
Basically, if the government tries to control costs, he will probably earn less per device.
Since the gov't wants more control over all that money, doesn't IT have an even bigger conflict of interest?
The government doesn't make money, your government representatives do. I would think that the government representatives would make more money by keeping the healthcare lobbyists in place. Then again, maybe this healthcare threat is simply a shake-down to get the lobbyists to give them more money. Who knows.
Who said anything about the gov't making money? They want the POWER from CONTROLLING it.
I'm sorry, I know the man is a celebrated inventor and all, but this is hogwash. He's talking about how making health care accessible to all will make it accessible to none - an interesting thesis, but ultimately one that has been soundly disproved by the success of public health systems in most of Europe and Canada.
He is partially right - the lack of extreme-expense health care drives out extreme high-end solutions such as the article's highlighted "Luke" arm, a prosthetic that is almost as good as the real thing.
But really, what do we want as a society? For a two-digit number of extremely wealthy people to have access to the world's best prosthetics, stuff that is in the realm of sci-fi? Or for everyone to have access to "good enough" prosthetic technology that advances more slowly?
"if talented people are given resources they're going to keep driving us to having better, simpler, cheaper solutions to problems"
Absolutely false, and proven by his own highest-profile project; the Segway hasn't gotten significantly cheaper or more accessible despite years of R&D, and is unlikely to become affordable anytime soon. This man's own business is a textbook case of the lie behind this claim. In order for solutions to get cheaper there must be market pressure to reduce cost: this is something that doesn't exist in America's current health care system.
Health care providers don't care about cost - it's passed along to insurance companies and consumers anyway. Insurance companies care about cost, but not really - it's easily passed to sponsoring employers or individual buyers anyway. Really, the only people that truly want cost reduced are the endpoint patients and their employers, who generally lack the clout and influence to push for real cost reductions. The entire system is broken. Costs have not lowered for health care, and will not lower, until the system is reorganized such that cost reduction becomes advantageous to all stakeholders.
He does make a cogent point in the end: more R&D will lead to better solutions and lower costs (given the right structure and incentives). But this argument is really independent of the affordability issue that plagues America today. Where I come from (Canada) we do a huge amount of pharmaceutical research (in fact, we invented the insulin injection) on government funds. I personally know very talented people working every day on cancer research.
Yet we can still afford to give everyone health care. Imagine that. A person can still get a major disease without going broke. Imagine that.
I really do think Dean Kamen is conflating two unrelated issues. The lack of R&D funding is an issue, but increasing R&D need not come from the pockets of consumers. Just look at the existing private system - a third of every health care dollar spent is just on administrative costs. Imagine if we took this money and threw it into R&D.
He is partially right - the lack of extreme-expense health care drives out extreme high-end solutions such as the article's highlighted "Luke" arm, a prosthetic that is almost as good as the real thing.
But really, what do we want as a society? For a two-digit number of extremely wealthy people to have access to the world's best prosthetics, stuff that is in the realm of sci-fi? Or for everyone to have access to "good enough" prosthetic technology that advances more slowly?
"if talented people are given resources they're going to keep driving us to having better, simpler, cheaper solutions to problems"
Absolutely false, and proven by his own highest-profile project; the Segway hasn't gotten significantly cheaper or more accessible despite years of R&D, and is unlikely to become affordable anytime soon. This man's own business is a textbook case of the lie behind this claim. In order for solutions to get cheaper there must be market pressure to reduce cost: this is something that doesn't exist in America's current health care system.
Health care providers don't care about cost - it's passed along to insurance companies and consumers anyway. Insurance companies care about cost, but not really - it's easily passed to sponsoring employers or individual buyers anyway. Really, the only people that truly want cost reduced are the endpoint patients and their employers, who generally lack the clout and influence to push for real cost reductions. The entire system is broken. Costs have not lowered for health care, and will not lower, until the system is reorganized such that cost reduction becomes advantageous to all stakeholders.
He does make a cogent point in the end: more R&D will lead to better solutions and lower costs (given the right structure and incentives). But this argument is really independent of the affordability issue that plagues America today. Where I come from (Canada) we do a huge amount of pharmaceutical research (in fact, we invented the insulin injection) on government funds. I personally know very talented people working every day on cancer research.
Yet we can still afford to give everyone health care. Imagine that. A person can still get a major disease without going broke. Imagine that.
I really do think Dean Kamen is conflating two unrelated issues. The lack of R&D funding is an issue, but increasing R&D need not come from the pockets of consumers. Just look at the existing private system - a third of every health care dollar spent is just on administrative costs. Imagine if we took this money and threw it into R&D.
"Health care providers don't care about cost - it's passed along to insurance companies and consumers anyway. Insurance companies care about cost, but not really - it's easily passed to sponsoring employers or individual buyers anyway. Really, the only people that truly want cost reduced are the endpoint patients and their employers, who generally lack the clout and influence to push for real cost reductions. The entire system is broken. Costs have not lowered for health care, and will not lower, until the system is reorganized such that cost reduction becomes advantageous to all stakeholders."
I'm not sure if we really agree all that much or not, but I do agree with this. There's no way to keep from ballooning costs when the people paying are insulated from what they're paying for.
Unfortunately, it's largely broken as a result of some really strange incentives and a belief that employers should be responsible for their employees health care (rather than just paying employees and letting them deal with it). HMOs, tax incentives to employers to provide health care, tax incentives to employees to take it, are all terrible, terrible things.
Fixing it will require that people "pay" for what they don't feel they're paying for right now. I dunno about everyone else, but I'd rather be getting the extra $1200/yr my employer contributes to my health care and dealing in an actual free market than what we have now. I think we'd all be paying a lot less, and getting better service.
I'm not sure if we really agree all that much or not, but I do agree with this. There's no way to keep from ballooning costs when the people paying are insulated from what they're paying for.
Unfortunately, it's largely broken as a result of some really strange incentives and a belief that employers should be responsible for their employees health care (rather than just paying employees and letting them deal with it). HMOs, tax incentives to employers to provide health care, tax incentives to employees to take it, are all terrible, terrible things.
Fixing it will require that people "pay" for what they don't feel they're paying for right now. I dunno about everyone else, but I'd rather be getting the extra $1200/yr my employer contributes to my health care and dealing in an actual free market than what we have now. I think we'd all be paying a lot less, and getting better service.
"But really, what do we want as a society? For a two-digit number of extremely wealthy people to have access to the world's best prosthetics, stuff that is in the realm of sci-fi? Or for everyone to have access to "good enough" prosthetic technology that advances more slowly?"
I don't see this as an either-or situation; don't we have both right now? Especially if you look at legs instead of arms.
"... his own highest-profile project; the Segway hasn't gotten significantly cheaper or more accessible despite years of R&D,"
That doesn't make any sense at all. The Segway is the cheaper, more-accessible version of the IBOT, a mobility system. Besides, http://web.mit.edu/first/segway/ is one of many <$1000, DIY Segway projects, so this tech is getting cheaper and more accessible.
I don't see this as an either-or situation; don't we have both right now? Especially if you look at legs instead of arms.
"... his own highest-profile project; the Segway hasn't gotten significantly cheaper or more accessible despite years of R&D,"
That doesn't make any sense at all. The Segway is the cheaper, more-accessible version of the IBOT, a mobility system. Besides, http://web.mit.edu/first/segway/ is one of many <$1000, DIY Segway projects, so this tech is getting cheaper and more accessible.
"I don't see this as an either-or situation; don't we have both right now? Especially if you look at legs instead of arms."
We don't have this right now, that's the point. Yes, there are super-high-end prosthetics available to the uber-rich, and there is the regular stuff. But even the "regular stuff" is out of reach of most Americans, especially the millions that are uninsured (or underinsured by the employer) and thus SOL.
The USA currently has the full range of medical technology commensurate with how much you can afford - but the problem is that much of the really critical care (surgeries, etc) is completely out of reach of the average individual. It truly is a system where the rich receive the absolute best and the poor (or even middle class) can just crawl into a corner and die.
"Besides, http://web.mit.edu/first/segway/ is one of many <$1000, DIY Segway projects, so this tech is getting cheaper and more accessible."
This only proves my point. DIY geek projects aside, there is no low-cost Segway competitor on the market, likely due to patent issues (I have not looked into this myself, so correct me if I'm wrong). This is the same situation for pharmaceuticals - there is no incentive to reduce drug costs when your patients must buy from you and only you, due to patent law. So yeah, there are a bunch of DIY solutions, but still no competition on the open market, and thus prices stay up.
We don't have this right now, that's the point. Yes, there are super-high-end prosthetics available to the uber-rich, and there is the regular stuff. But even the "regular stuff" is out of reach of most Americans, especially the millions that are uninsured (or underinsured by the employer) and thus SOL.
The USA currently has the full range of medical technology commensurate with how much you can afford - but the problem is that much of the really critical care (surgeries, etc) is completely out of reach of the average individual. It truly is a system where the rich receive the absolute best and the poor (or even middle class) can just crawl into a corner and die.
"Besides, http://web.mit.edu/first/segway/ is one of many <$1000, DIY Segway projects, so this tech is getting cheaper and more accessible."
This only proves my point. DIY geek projects aside, there is no low-cost Segway competitor on the market, likely due to patent issues (I have not looked into this myself, so correct me if I'm wrong). This is the same situation for pharmaceuticals - there is no incentive to reduce drug costs when your patients must buy from you and only you, due to patent law. So yeah, there are a bunch of DIY solutions, but still no competition on the open market, and thus prices stay up.
Well said. He makes an argument that people are trying to "instill fear in ordinary Americans" and seems to think the system is working perfectly, without giving those that have no access to health care today even a token sentence.
The argument that those that can afford it should just continue spending loads of money on health care and eventually, through some unspecified process, this will make life better for all those who don't have access to health care at all sounds like a variant of "trickle-down" voodoo economics to me.
The argument that those that can afford it should just continue spending loads of money on health care and eventually, through some unspecified process, this will make life better for all those who don't have access to health care at all sounds like a variant of "trickle-down" voodoo economics to me.
Who in the United States doesn't have access to healthcare?
Quite honestly, I don't see why this is such a massive issue with everyone right now...
Medical innovation (in it's current state, meaning building things on a molecular level) is prohibitively expensive. Gone are the days when a guy in his basement can hack out (or stumble upon) some great new wonderdrug like penicillin.
These things are not cheap to do...
Also, how does the US Gov't plan on getting the cost of healthcare down? If there is some magic wand that they can wave and make everything cheaper, then why don't they do it? Why do they want control over this so badly?
Quite honestly, I don't see why this is such a massive issue with everyone right now...
Medical innovation (in it's current state, meaning building things on a molecular level) is prohibitively expensive. Gone are the days when a guy in his basement can hack out (or stumble upon) some great new wonderdrug like penicillin.
These things are not cheap to do...
Also, how does the US Gov't plan on getting the cost of healthcare down? If there is some magic wand that they can wave and make everything cheaper, then why don't they do it? Why do they want control over this so badly?
"Who in the United States doesn't have access to healthcare?"
I took the liberty of looking up some numbers, because clearly you haven't. The answer to your question is over 46.6 million Americans(1) (you have 300 million total), the ones without health insurance.
Add another 25 million Americans(2) who are underinsured and the number is scarier. Underinsured is defined as people who have insurance but end up spending >10% of their income on health care expenses.
The same source (2) indicates that 42% of working adults (19 to 64 years-old) are uninsured or underinsured.
So in short, who in the US doesn't have access to health care? Apparently 42% of them.
"Quite honestly, I don't see why this is such a massive issue with everyone right now..."
You don't see an issue with someone breaking a leg and going bankrupt because of it? You don't see an issue with a population going broke just to keep themselves hobbling along?
Here's some more fun. 50% of bankruptcies in the US today are due to health care costs (5). In fact, 68% of those who declare bankruptcy due to unaffordable health care costs have health insurance (4).
You don't see a problem here?
"Medical innovation (in it's current state, meaning building things on a molecular level) is prohibitively expensive."
Yet Europe and Canada (and other first-world nations with public health care) are doing fine at their own medical research. It's s till expensive, but it's being funded by the government, and the people still get great health care (some of it is better than the US...).
Your thesis is one that is trotted out a lot by proponents of the private system, but it simply holds no water. We have many cases of massive medical R&D being done in countries where every single person receives free health care.
"Also, how does the US Gov't plan on getting the cost of healthcare down?"
Easy. By going public. You asked if there is a magic wand, and I'm here to tell you it doesn't get more magic-wand-y than this. Right now 25% of every health care dollar spent is going towards administrative expenses (2), compared to 1% to 5% for public health systems around the world (2).
By cutting out the private insurance companies you instantly gain a 26-32% efficiency on your health care dollars. Imagine the number of people you can cover with that massive amount of money (some $400 billion per year as of 2003).
(1) http://www.cbpp.org/cms/?fa=view&id=628
(2) http://health.usnews.com/articles/health/healthday/2008/06/1...
(3) http://www.medicalnewstoday.com/articles/8800.php
(4) http://www.nchc.org/facts/cost.shtml
(5) http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf
I took the liberty of looking up some numbers, because clearly you haven't. The answer to your question is over 46.6 million Americans(1) (you have 300 million total), the ones without health insurance.
Add another 25 million Americans(2) who are underinsured and the number is scarier. Underinsured is defined as people who have insurance but end up spending >10% of their income on health care expenses.
The same source (2) indicates that 42% of working adults (19 to 64 years-old) are uninsured or underinsured.
So in short, who in the US doesn't have access to health care? Apparently 42% of them.
"Quite honestly, I don't see why this is such a massive issue with everyone right now..."
You don't see an issue with someone breaking a leg and going bankrupt because of it? You don't see an issue with a population going broke just to keep themselves hobbling along?
Here's some more fun. 50% of bankruptcies in the US today are due to health care costs (5). In fact, 68% of those who declare bankruptcy due to unaffordable health care costs have health insurance (4).
You don't see a problem here?
"Medical innovation (in it's current state, meaning building things on a molecular level) is prohibitively expensive."
Yet Europe and Canada (and other first-world nations with public health care) are doing fine at their own medical research. It's s till expensive, but it's being funded by the government, and the people still get great health care (some of it is better than the US...).
Your thesis is one that is trotted out a lot by proponents of the private system, but it simply holds no water. We have many cases of massive medical R&D being done in countries where every single person receives free health care.
"Also, how does the US Gov't plan on getting the cost of healthcare down?"
Easy. By going public. You asked if there is a magic wand, and I'm here to tell you it doesn't get more magic-wand-y than this. Right now 25% of every health care dollar spent is going towards administrative expenses (2), compared to 1% to 5% for public health systems around the world (2).
By cutting out the private insurance companies you instantly gain a 26-32% efficiency on your health care dollars. Imagine the number of people you can cover with that massive amount of money (some $400 billion per year as of 2003).
(1) http://www.cbpp.org/cms/?fa=view&id=628
(2) http://health.usnews.com/articles/health/healthday/2008/06/1...
(3) http://www.medicalnewstoday.com/articles/8800.php
(4) http://www.nchc.org/facts/cost.shtml
(5) http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf
The answer to your question is over 46.6 million Americans(1) (you have 300 million total), the ones without health insurance.
Lacking health insurance (i.e., a financial services product) is not the same thing as lacking medical services.
But lets ignore that and look more closely at your numbers. Of the 46.6 million uninsured, 14 million are eligible for medicaid/SCHIP, but haven't bothered to sign up. 27 million make at least $50,000/year and simply choose to spend money on other things. Another fun fact: excluding people eligible for medicaid, 70% are uninsured 4 months or less.
http://www.washingtontimes.com/news/2009/jun/25/who-are-the-...
That leaves about 5.6 million people. I expect we could solve the problem of those 5.6 simply by enforcing our immigration laws.
Lacking health insurance (i.e., a financial services product) is not the same thing as lacking medical services.
But lets ignore that and look more closely at your numbers. Of the 46.6 million uninsured, 14 million are eligible for medicaid/SCHIP, but haven't bothered to sign up. 27 million make at least $50,000/year and simply choose to spend money on other things. Another fun fact: excluding people eligible for medicaid, 70% are uninsured 4 months or less.
http://www.washingtontimes.com/news/2009/jun/25/who-are-the-...
That leaves about 5.6 million people. I expect we could solve the problem of those 5.6 simply by enforcing our immigration laws.
The answer to your question is over 46.6 million Americans..., the ones without health insurance
As the sibling replies noted, everyone in America does have access to at least basic healthcare. If a homeless person is brought into the emergency room after being hit by a car, he won't be denied treatment. The Medicaid program in America reimburses hospitals (and other providers) for charity and bad debt expenses.
Right now 25% of every health care dollar spent is going towards administrative expenses
I've got an unusually close view of this, as my wife is the manager of budget and reimbursement at a largish urban hospital. Most of her job is dealing with Medicaid and Medicare, getting the hospital reimbursed for caring for these people. The reason that she spends most of her (and her department's) time on this is because of the illusion that M&M have efficient administration.
In reality, Medicare and Medicaid account for a huge portion of cases in an urban hospital. They're an 800-lb gorilla: since they account for so much of the hospital's business, the hospitals have little choice but to provide whatever administrative functions that M&M demand. For example, every year my wife must submit the dreaded "Medicare Cost Report". This is literally a crate of documents that my wife's team creates (it takes the team weeks) to document their Medicare charges over the past year. Some time later, the government audits them on this entire crate.
What I'm trying to illustrate is that the actual administrative expenses of Medicare and Medicaid are not really lower than our traditional model. It's just that the regulators force the participants to run it in such a way that the providers bear a large portion of the administrative burden. Since it's on the providers, the costs don't show up on M&M's reports as admin expenses. Instead, they contribute to higher prices billed for the underlying services.
When you look at the big picture, Medicare and Medicaid are certainly no more efficient than conventional providers, and possibly less so.
For example, one of the concerns in rising costs is unnecessary tests. However, M&M regulations tend to cause this. They will refuse to cover the costs associated with various types of infections (e.g., urinary infections) unless the provider can prove that the infection was already present when the patient was admitted. This effectively forces the hospital to test all patients for UTI at the time they're admitted, which is completely unnecessary for actual medical reasons.
Any expectation that total costs would go down due to some miracle of government administration is pure fantasy. Seriously: have you ever been to the DMV, or seen an Immigration office? Why would you believe that a private insurer, given the opportunity to increase profits by lowering their own admin expenses, would not do so? The idea that government-provided healthcare, or government-single-payer, would lower costs really is magic. Just like a belief in the magic of Tinkerbell and Harry Potter.
(Note: I lumped Medicare and Medicaid together for simplicity. While these are related, they're separate entities and anybody who knows the details will probably object. But there's only so much space here.)
As the sibling replies noted, everyone in America does have access to at least basic healthcare. If a homeless person is brought into the emergency room after being hit by a car, he won't be denied treatment. The Medicaid program in America reimburses hospitals (and other providers) for charity and bad debt expenses.
Right now 25% of every health care dollar spent is going towards administrative expenses
I've got an unusually close view of this, as my wife is the manager of budget and reimbursement at a largish urban hospital. Most of her job is dealing with Medicaid and Medicare, getting the hospital reimbursed for caring for these people. The reason that she spends most of her (and her department's) time on this is because of the illusion that M&M have efficient administration.
In reality, Medicare and Medicaid account for a huge portion of cases in an urban hospital. They're an 800-lb gorilla: since they account for so much of the hospital's business, the hospitals have little choice but to provide whatever administrative functions that M&M demand. For example, every year my wife must submit the dreaded "Medicare Cost Report". This is literally a crate of documents that my wife's team creates (it takes the team weeks) to document their Medicare charges over the past year. Some time later, the government audits them on this entire crate.
What I'm trying to illustrate is that the actual administrative expenses of Medicare and Medicaid are not really lower than our traditional model. It's just that the regulators force the participants to run it in such a way that the providers bear a large portion of the administrative burden. Since it's on the providers, the costs don't show up on M&M's reports as admin expenses. Instead, they contribute to higher prices billed for the underlying services.
When you look at the big picture, Medicare and Medicaid are certainly no more efficient than conventional providers, and possibly less so.
For example, one of the concerns in rising costs is unnecessary tests. However, M&M regulations tend to cause this. They will refuse to cover the costs associated with various types of infections (e.g., urinary infections) unless the provider can prove that the infection was already present when the patient was admitted. This effectively forces the hospital to test all patients for UTI at the time they're admitted, which is completely unnecessary for actual medical reasons.
Any expectation that total costs would go down due to some miracle of government administration is pure fantasy. Seriously: have you ever been to the DMV, or seen an Immigration office? Why would you believe that a private insurer, given the opportunity to increase profits by lowering their own admin expenses, would not do so? The idea that government-provided healthcare, or government-single-payer, would lower costs really is magic. Just like a belief in the magic of Tinkerbell and Harry Potter.
(Note: I lumped Medicare and Medicaid together for simplicity. While these are related, they're separate entities and anybody who knows the details will probably object. But there's only so much space here.)
I am sorry you answered the wrong question. This is why politics stink. He is right, everyone has access to healthcare in America. And you are right not everyone has insurance.
These are two different things.
These are two different things.
Who in the United States doesn't have access to healthcare?
You're joking, right?
You're joking, right?
>but ultimately one that has been soundly disproved by the success of public health systems in most of Europe and Canada.
Yes, but the success of those systems is dependent upon the (semi) free-market health system in the United States.
Yes, but the success of those systems is dependent upon the (semi) free-market health system in the United States.
Here is an anecdote from an expat American here living in Sweden. I require immunoglobulin as my body doesn't produce it naturally like it should. In Sweden I'm on a subcutaneous treatment that greatly improves my quality of life. I can take and do the drugs myself without having to at least get an IV line started like in the US. The subcutaneous treatments are starting in America, but slowly and not as widely as they are relied in Sweden. The benefits are increased independence for patients, safer since it is absorbed through the fat instead of straight into the blood stream, and perhaps most importantly it costs less than half of the IV treatment. This subcutaneous treatment was pioneered, tested and deployed in Europe.
That pharmaceuticals in the US are going to stop R&D is BS. I bet there are many 'hacker' scientists that would happily keep doing their job as long as someone employees them. So maybe it won't be Wall St. but there is still money in it, job satisfaction and they aren't going to trade in their lab coats for McDonald's uniforms. Look at stem cell research, private companies could still fund it all they wanted, but once the federal government's teat was shut off research died. Public healthcare wouldn't diminish the government's interest in funding research. Sweden still has many notable things in the field of medical research, and all from a country with a GDP roughly that of North Carolina.
That pharmaceuticals in the US are going to stop R&D is BS. I bet there are many 'hacker' scientists that would happily keep doing their job as long as someone employees them. So maybe it won't be Wall St. but there is still money in it, job satisfaction and they aren't going to trade in their lab coats for McDonald's uniforms. Look at stem cell research, private companies could still fund it all they wanted, but once the federal government's teat was shut off research died. Public healthcare wouldn't diminish the government's interest in funding research. Sweden still has many notable things in the field of medical research, and all from a country with a GDP roughly that of North Carolina.
How so?
You seem to be suggesting that if the US went to the same model as the rest of the world, we would all collectively implode? You need to explain that position a little deeper.
You seem to be suggesting that if the US went to the same model as the rest of the world, we would all collectively implode? You need to explain that position a little deeper.
I've heard this argument a bunch recently. You're suggesting the rest of the developed world has somehow made the US its bitch as far as medical research and development goes - the US does all the hard work, and everyone else with a public health system reaps the rewards.
I don't buy it.
I don't buy it.
It also ignores the fact that even if we accept his premise and if we assume that every single cent of the R&D money put up by the US comes in via high health care payments (it doesn't - a bunch of it is government funded and/or funded through charitable organizations), then if the US going to a universal healthcare system somehow halved the cost (bringing it down to the French level, while extending coverage to all), and this price cut somehow only came out of the money that'd get pumped into R&D and thus cut it to the bone, nothing would be stopping America from taking the savings and putting them right back into R&D.
In other words: Money doesn't magically disappear just because the way it is distributed changes.
In other words: Money doesn't magically disappear just because the way it is distributed changes.
"Money doesn't magically disappear just because the way it is distributed changes." Sure it does. Do you think these private groups would be making multi-million dollar bets if the prize of huge profits weren't out there?
http://www.xconomy.com/tag/Life-Sciences
Not all the cash is redistributed taxes - there is tons of private investment going to develop treatment
http://www.xconomy.com/tag/Life-Sciences
Not all the cash is redistributed taxes - there is tons of private investment going to develop treatment
"(in fact, we invented the insulin injection) on government funds."
Easily found on the internet: Insulin injections developed in the 1920's, socialization of Canadian medicine began in the 1950's. No link between the two events, not clear in your post if you are arguing this or not.
According to: http://www.canadianaconnection.com/cca/banting.htm, funding during the summer of 1921 was from his family. Not sure as to the accuracy of this website nor do I know of other sources as to funds for the research.
If you would like to supply references as to the funding of the insulin research and development being government funded then please do so. Just because research is performed at a university does not mean the funds are from the government.
Your point and others in this forum is that socialism is better, Kamen and others disagree.
Personally I think US Medicare is a good example of why government programs are not the best. Doctors do not want to accept new Medicare patients due to lack of money, one article I recently read had a doctor state the cost for one supply was as much as could be billed by the doctor.
The US system is quasi-socialism at the very least. Since government is partially controlling costs via one program (if you consider Medicare and Medicaid the same) and access via other programs/legislation including the tax laws.
One item to consider in this debate is that in the US at least since Hamilton, influence has enabled legislation to be enacted to favor your point of view, aka a mercantile economy. Such that you can not in the least bit consider the US Health system as non-government influenced.
The only expensive medical procedure I've undergone was paid by the insurance company at around $.50 to the dollar amount billed by the doctor and hospital. I paid around $.10 to the dollar. This raises the question as to how much of the cost is actually price inflation by the medical establishment to ensure they can pay their actual costs. Some items when price compared to the local pharmacy had a mark up of 200-500%, this was only for a couple of items I remembered while waiting for an order to be filled and is not a rigorous assertion on my part.
http://content.healthaffairs.org/cgi/reprint/17/1/225.pdf has some interesting data regarding Canadians visiting the US medical system. The point I saw is that when the northern system reduced the amount paid in Oct 91 (page 226 of the article) the subsequent amount spent was significantly less, chart on page 229. Not sure the data would allow analysis as to how much voluntary/elective payments were reduced as my quick read suggest some of this was transferred to private insurance. And this particular study indicates only 3% of expenditures in the Canadian system are to out of province providers.
Highly recommend that you read 'The Politically Incorrect Guide to Capitalism' if for no other reason than you know what you are arguing against. Free Enterprise is the best solution to any problem unfortunately like pure communism, it is not found in its pure form due to human nature.
Easily found on the internet: Insulin injections developed in the 1920's, socialization of Canadian medicine began in the 1950's. No link between the two events, not clear in your post if you are arguing this or not.
According to: http://www.canadianaconnection.com/cca/banting.htm, funding during the summer of 1921 was from his family. Not sure as to the accuracy of this website nor do I know of other sources as to funds for the research.
If you would like to supply references as to the funding of the insulin research and development being government funded then please do so. Just because research is performed at a university does not mean the funds are from the government.
Your point and others in this forum is that socialism is better, Kamen and others disagree.
Personally I think US Medicare is a good example of why government programs are not the best. Doctors do not want to accept new Medicare patients due to lack of money, one article I recently read had a doctor state the cost for one supply was as much as could be billed by the doctor.
The US system is quasi-socialism at the very least. Since government is partially controlling costs via one program (if you consider Medicare and Medicaid the same) and access via other programs/legislation including the tax laws.
One item to consider in this debate is that in the US at least since Hamilton, influence has enabled legislation to be enacted to favor your point of view, aka a mercantile economy. Such that you can not in the least bit consider the US Health system as non-government influenced.
The only expensive medical procedure I've undergone was paid by the insurance company at around $.50 to the dollar amount billed by the doctor and hospital. I paid around $.10 to the dollar. This raises the question as to how much of the cost is actually price inflation by the medical establishment to ensure they can pay their actual costs. Some items when price compared to the local pharmacy had a mark up of 200-500%, this was only for a couple of items I remembered while waiting for an order to be filled and is not a rigorous assertion on my part.
http://content.healthaffairs.org/cgi/reprint/17/1/225.pdf has some interesting data regarding Canadians visiting the US medical system. The point I saw is that when the northern system reduced the amount paid in Oct 91 (page 226 of the article) the subsequent amount spent was significantly less, chart on page 229. Not sure the data would allow analysis as to how much voluntary/elective payments were reduced as my quick read suggest some of this was transferred to private insurance. And this particular study indicates only 3% of expenditures in the Canadian system are to out of province providers.
Highly recommend that you read 'The Politically Incorrect Guide to Capitalism' if for no other reason than you know what you are arguing against. Free Enterprise is the best solution to any problem unfortunately like pure communism, it is not found in its pure form due to human nature.
> He is partially right - the lack of extreme-expense health care drives out extreme high-end solutions such as the article's highlighted "Luke" arm, a prosthetic that is almost as good as the real thing.
But this isn't even a discussion point in most countries with socialized health-care: Only a handful of countries worldwide prevent private treatments and/or private health insurance on top of the government provided options.
In the UK for example, the two work fine side by side. Everyone has access to the NHS, for "free" (i.e. for their portion of taxes, possibly 0), while people who want to pay extra can pay for the fancy extras that are deemed too expensive or unnecessary.
Apart from dental (which is poorly covered) and purely elective procedure, like most cosmetic surgery, most people show little to no interest in going beyond the NHS - only about 10% have private insurance.
But this isn't even a discussion point in most countries with socialized health-care: Only a handful of countries worldwide prevent private treatments and/or private health insurance on top of the government provided options.
In the UK for example, the two work fine side by side. Everyone has access to the NHS, for "free" (i.e. for their portion of taxes, possibly 0), while people who want to pay extra can pay for the fancy extras that are deemed too expensive or unnecessary.
Apart from dental (which is poorly covered) and purely elective procedure, like most cosmetic surgery, most people show little to no interest in going beyond the NHS - only about 10% have private insurance.
"But really, what do we want as a society? For a two-digit number of extremely wealthy people to have access to the world's best prosthetics, stuff that is in the realm of sci-fi? Or for everyone to have access to "good enough" prosthetic technology that advances more slowly?"
If you choose the latter then you are short-sighted, because in the future everyone will be worse off.
If you choose the latter then you are short-sighted, because in the future everyone will be worse off.
It's a stupid argument in the first place. If there was a social healthcare system in the US, then do rich people somehow have less money? Do people really believe that there won't be better 'cutting edge' techniques that are expensive, but you can only pay for 'out of pocket' or with a private insurance company?
It's not like private insurance doesn't exist in Canada (for example). You're just guaranteed a certain base-level of medical care by the government. You still have to pay for things like prescriptions unless you have private insurance. Things -- like dental work -- are not covered either unless you have private insurance plan that covers it.
{edit} You have to pay for non-life threatening prescriptions, like anti-depressants or antibiotics. Just thought that I should clarify that IIRC, things like insulin which a person needs to stay alive are covered by the government {/edit}
It's not like private insurance doesn't exist in Canada (for example). You're just guaranteed a certain base-level of medical care by the government. You still have to pay for things like prescriptions unless you have private insurance. Things -- like dental work -- are not covered either unless you have private insurance plan that covers it.
{edit} You have to pay for non-life threatening prescriptions, like anti-depressants or antibiotics. Just thought that I should clarify that IIRC, things like insulin which a person needs to stay alive are covered by the government {/edit}
see http://accounting.suite101.com/article.cfm/fixed_and_variabl... for an explanation for fixed/variable costs, and why companies will charge less than the average cost to produce something as long as they can get more than the marginal cost per item.
Most people know that drugs have high fixed and low variable costs, but that also is frequently true of new treatments/techniques; it costs far more to develop it than it does to apply it once it exists.
Other countries get low prices by paying the marginal costs, while the US ends up paying most of the fixed cost.
Most people know that drugs have high fixed and low variable costs, but that also is frequently true of new treatments/techniques; it costs far more to develop it than it does to apply it once it exists.
Other countries get low prices by paying the marginal costs, while the US ends up paying most of the fixed cost.
You do realize though that the rest of the modern world looks at the US in this one issue the same way we looked at you when you had legalized segregation?
The rest of us can't even understand why this is a debate. How is it that someone can argue in favour of people not having the ability to access a doctor? Would you also argue that people shouldn't have access to fire-fighters unless they pay the fire-fighter's tax? Police? The protection of an Army?
Our socialized systems aren't a panacea, but the trade-offs of having someone wait for knee surgery so that another can get cancer treatment seem pretty fair to me. Sometimes, I simply don't understand the American perspective.