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A summary of American health care and its problems
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Clinically Insane
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Sep 17, 2013, 02:35 PM
 
     
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Sep 19, 2013, 01:41 PM
 
Originally Posted by besson3c View Post
He says only 28% of US get their health care paid for by government, about 1 in 3, as if thats a small number.

He's really over-simplified a complex topic - that would require a whole lot of lengthy reading and posts that most people wouldn't be interested in. But Ill try to sum it up.

Anyway I counter the arm-chair expert's simplistic rant with:

On pharmaceuticals
From the horse's mouth of Europe itself.
Europe pledges billions to solve its drug development woes
The center recently reported that of all the new active medical substances produced globally from 2003 to 2006, 55% were first launched in the US, compared to just 17% in Europe....

..Incerti says that the 35-employee IMI will be run "with the efficiency of a private company." Still, some outsiders raise their eyebrows at the idea of fostering speedy drug development with the creation of a new government bureaucracy. "That's the trouble with the EU," Davison says. "You're trying to reach a consensus of 27 different nations, each with different ideas of where the money should be spent." Indeed, it has already taken three years for the IMI to be approved.

Most pharmaceutical market analysts say that increased government funding alone is unlikely to create sweeping changes in the global research and development investment landscape. The restrictive price controls on drugs in Europe make it a far less attractive end market than the US....
There's a reason drugs are cheaper than in the US and it's not because the EU cares more about people and takes losses out of the goodness of their hearts. There's significant consequences for the way things work in Europe and they wouldn't even have the half baked system they have without big greedy pharma, and you, in the US subsidizing them.

On Lawsuits - Europe restricts them.
This is already too condensed to be paraphrased.
How Other Countries Judge Malpractice - WSJ.com

Medical Malpractice Liability: Germany | Law Library of Congress

Regulation
In the past I have proposed we shrink the required years of education for doctors in the US only to be met with liberals saying "we don want dat", more regulation please more... Well do y'all want to do things like Europe or not? You can't have your cake and eat it too. In other 'first world countries' total schooling to become a doctor is 6-11 years. In the US its more like 10-15. Time is money and we all pay for it.

Does no one else see a problem with the fact that 54% of applicants who had good grades are rejected med school each year? Supply and demand

Then there's the fact that insurance companies manage our health for us; destroying the free market forces that used guide the medical system back when it was cheap - Forcing profits of docs to be based on how many patients they can see in a day. Ban medical insurance and watch the price of medical services fall through the ground.

It seems the only part of "do things like Europe" liberals pay attention to is the single payer government system while ignoring the meat and potatoes of why things are actually cheaper.

...and for your reading entertainment
Obama Care Will End Drug Advances and Europe's Free Ride (Unless China Steps in) - Forbes
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Clinically Insane
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Sep 19, 2013, 02:02 PM
 
When there's little to no incentive, people won't do shit. How difficult is that to understand?
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Sep 19, 2013, 02:20 PM
 
Originally Posted by el chupacabra View Post
On pharmaceuticals
From the horse's mouth of Europe itself.
Europe pledges billions to solve its drug development woes

There's a reason drugs are cheaper than in the US and it's not because the EU cares more about people and takes losses out of the goodness of their hearts. There's significant consequences for the way things work in Europe and they wouldn't even have the half baked system they have without big greedy pharma, and you, in the US subsidizing them.
This one pisses me off more than pretty much anything else when it comes to discussions about the cost of health care.

Developing new pharmaceuticals costs billions of dollars in research and development. A company like Pfizer or Lilly might invest billions on a new drug, and then some unexpected side effect crops up during the first run of testing on human volunteers. The FDA steps in and immediately shuts down that new drug, because of the risks (no matter how small) associated with it. Now that pharma company is out the billions in R&D on a drug they can't sell.

In the meantime, countries in the EU force those same pharma companies to provide their products, still under patent, at drastically reduced prices. Those companies still need to recoup the billions they've invested, and turn a profit. They can't do this if they're forced to sell their products, from day one, at a loss.

The end result is that in America - and Canada, mind you, where healthcare is free but prescription drugs are not - we have to pay the price for the rest of the world being greedy and demanding everything at no cost to them. We have to pay the price for Americans being lawsuit-happy when it comes to medical services and pharmaceutical products.

I'd much rather have things be the way they are than have the federal government in the United States step in and force these companies to sell their drugs at a loss. I've been on a particular medication for the past five years that absolutely saved my life (literally). It's also under patent, and without insurance, it would cost me $150 a month. My friend in Canada happens to be taking the same medication, and it does cost him $150 a month. I'm grateful that the American pharmaceutical patent system exists, because it allows these companies to develop new medications and medical solutions at much faster rate than if they were beholden to the government to only charge pennies for drugs that have just hit the market.

And I'm dead serious when I say that had this drug not hit the market when it did and instead came out years later because of lack of funding for R&D, I wouldn't be here today.
     
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Sep 19, 2013, 02:25 PM
 
Originally Posted by Shaddim View Post
When there's little to no incentive, people won't do shit. How difficult is that to understand?
It's very difficult to accept for people who desperately want to believe that human beings are naturally and inherently unselfish and altruistic.
     
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Sep 19, 2013, 03:48 PM
 
Originally Posted by shifuimam View Post
And I'm dead serious when I say that had this drug not hit the market when it did and instead came out years later because of lack of funding for R&D, I wouldn't be here today.

Why do you feel that health care reform of some form would take away drug R&D funding?

Correct me if I'm wrong, but your line of thinking is that profit is a research incentive, and that we can only tweak at what point drugs should become generic up to a point until that incentive is taken away?

I agree with this, but we can also separate prescription drug costs from health care costs much better so that there would be literally no changes on this front. We've all heard about that $50 hospital aspirin thing, right? To me this is a symptom of drug costs not being separate from health care costs.

In Canada, you pay for your own prescription drugs, AFAIK they cost whatever the pharmaceuticals charge up until they become generic. However, these bleeding edge drugs can also be a cheaper when the government can negotiate with the drug companies. This isn't "we're going to take away your profits, suck it drug companies", this is simple volume based sales. That many of these drugs comes from the US has a lot to do with the economic power of the US and its population.

I don't see the prospects of health care reform as any sort of threat to the stuff you are talking about, shifuimam. In fact, it might even help with the volume of customers a large Medicare-esque health insurance program could bring to these companies.
     
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Sep 19, 2013, 05:58 PM
 
I'm not going to delve too deeply into this, but I've got a disabled kid with a rare disease. I've gone from comfortable middle class to just barely hanging on in five years, primarily due to how the US healthcare system works. It's not going to get any better under Obamacare, and in some situations, her level of care will fall, according to her current specialists.

Take it as you will.
     
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Sep 19, 2013, 08:52 PM
 
Some drugs don't make any profit at all. The very large European confederation is only recently starting to mimic some of the US policy to get companies innovating new drugs.

One of the primary rants in the video was about how pharmaceuticals are overcharging us. He didn't suggest we separate drug costs from the rest of health services.

And it's not "volume based sales" that lower prices in Europe. If our government said "go out everyone invest all your money in developing the asthma medication of the future; whoever makes the cheapest one wins ALL our business for the next 4 years and the rest of you get nothing", then very few companies would ever do the research, do to the all or nothing risk, not unless the banks will give them free loans to play this lottery. Now 4 years later most the other pharmaceuticals would have gone out of business since all sales the past 4 years went to 1 single monopoly... So why would the last few remaining lower their prices for the next government contract, they're monopolies. On top of that when companies in the US get a government contract, the "government price" is usually higher than normal not "volume priced".

Volume pricing only drives prices lower if there is a lot of constant continuous competition.
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Clinically Insane
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Sep 19, 2013, 10:42 PM
 
Originally Posted by el chupacabra View Post
One of the primary rants in the video was about how pharmaceuticals are overcharging us. He didn't suggest we separate drug costs from the rest of health services.
I don't remember this part of his video, maybe he could have said this differently/better, but he is right, relative to what the drugs could cost if the the government and/or the very large insurance insurance companies could negotiate with the companies and their customer base was much larger. The "relative to" bit is an important caveat though.

And it's not "volume based sales" that lower prices in Europe. If our government said "go out everyone invest all your money in developing the asthma medication of the future; whoever makes the cheapest one wins ALL our business for the next 4 years and the rest of you get nothing", then very few companies would ever do the research, do to the all or nothing risk, not unless the banks will give them free loans to play this lottery. Now 4 years later most the other pharmaceuticals would have gone out of business since all sales the past 4 years went to 1 single monopoly... So why would the last few remaining lower their prices for the next government contract, they're monopolies. On top of that when companies in the US get a government contract, the "government price" is usually higher than normal not "volume priced".

Volume pricing only drives prices lower if there is a lot of constant continuous competition.

But it would only be a lottery if the winner did take all, who is to say that the "loser" couldn't work out a deal with another insurance company or just sell their drugs abroad? Who is to say that the government couldn't have negotiations with multiple drug companies that make drugs for the same sort of conditions? Most likely the drug variations would have unique strengths and weaknesses that are suitable for certain circumstances, perhaps just like there are multiple pain killers that are useful for different kinds of pain?
     
Clinically Insane
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Sep 19, 2013, 10:42 PM
 
Originally Posted by EstaNightshift View Post
I'm not going to delve too deeply into this, but I've got a disabled kid with a rare disease. I've gone from comfortable middle class to just barely hanging on in five years, primarily due to how the US healthcare system works. It's not going to get any better under Obamacare, and in some situations, her level of care will fall, according to her current specialists.

Take it as you will.

I'm sorry to hear that! I hope for your sake, and for the sake of all of us that your specialists are wrong...
     
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Sep 19, 2013, 11:01 PM
 
Originally Posted by besson3c View Post
I'm sorry to hear that! I hope for your sake, and for the sake of all of us that your specialists are wrong...
Yup, us too.
     
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Sep 19, 2013, 11:14 PM
 
Originally Posted by Shaddim View Post
When there's little to no incentive, people won't do shit. How difficult is that to understand?
Originally Posted by shifuimam View Post
It's very difficult to accept for people who desperately want to believe that human beings are naturally and inherently unselfish and altruistic.
It really doesn't matter how unselfish and altruistic an individual, or even many people are. If they can't afford the setup to do their research (millions of $) then they can't do squat. What sort of incentive is there for a corporation to be altruistic and unselfish? Absolutely zero, especially since modern corporations are all about "investor return" instead of "building the company on providing a valuable service/product/etc."

The days of Flemming discovering penicillin accidentally are gone; it takes a huge investment to just do the chemistry, let alone the enormously vast setups for the biological research, to establish valid and meaningful trials in animals and then in humans to verify efficacy, obtain regulatory approval, and so on. Medicines are expensive to develop, and nobody just throws a few million bucks at some bright kid with a great concept "just in case."

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Clinically Insane
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Sep 20, 2013, 01:37 AM
 
I have to wonder if the idea of not separating health care from drugs is some sort of unintentional strawman argument? Is there anybody advocating to make any significant changes to the pharmaceutical industry?
     
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Sep 20, 2013, 01:46 AM
 
Because pharma is integrated into every part of modern medicine and 99% of treatments for illness? We could all try simply going to chiropractors for everything...
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Sep 20, 2013, 01:55 AM
 
Originally Posted by Shaddim View Post
Because pharma is integrated into every part of modern medicine and 99% of treatments for illness? We could all try simply going to chiropractors for everything...

Of course it is, but pharma has been one of the successes of American health care (minus the inflated cost which I think is more a product of the system as a whole), I've yet to hear any proposals to eliminate the free market edge from pharma, it's virtually everything else that blows.
     
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Sep 20, 2013, 04:08 AM
 
The high price of new drugs is a very large portion of our higher healthcare expenses. Europe has lower drug costs, which drives down their overall medical by dictating pricing, at the expense of development. That's what was posted before:

The center recently reported that of all the new active medical substances produced globally from 2003 to 2006, 55% were first launched in the US, compared to just 17% in Europe.
You can chip away at what the hospitals and doctors make, and try to fix administration and paperwork costs, but that won't change enough of the picture (then you end up with fewer doctors, nurses, and technicians because the pay won't be as high and students will choose a different field). Around here we have more and more doctors who no longer take insurance at all, private or government-based, they only accept cash, and there's going to be a lot more like them in the coming years.
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Sep 20, 2013, 07:51 AM
 
A lot of the inflated pricing in health care comes from the bureaucracy behind both Medicare and private insurance. The private insurers don't bother "reinventing the wheel" in terms of documentation, recordkeeping, and especially the fine detail needed in medical records (that have little to do with the actual efficacy of a treatment but are supposed to help prevent (or catch) abuse and fraud.

In fact, much of the recordkeeping burden comes from establishing that a practitioner is doing something appropriate (and covered) instead of just milking the insurer. And we have seen how poorly that works, especially with Medicare's payment structure being at least 30-60 days after the fact, and Medicare's fraud detection structures being "retrospective" with "cost recovery" instead of "hey, that looks fishy" when the initial treatment is performed.

In my practice, I've wound up having to do extra paperwork depending on the patient's insurance. Not just "Mr. Jones has insurance through Aetna while Ms. Smith is insured by Humana," but "Mr. Jones has 'Plan A3' and Ms. Smith has 'Medicare Replacement Platinum'" so there are different forms needed to document therapy on the two of them ON TOP OF the normal documentation required for everyone. In some cases, I have to do a lot of different paperwork for two patients who are covered by the same insurer but on different plans with that insurer...

If it were a simple issue, it would already have been fixed. If it were a well structured problem, it would be easy to build a process to fix things stepwise. And with the Republicans still acting like little kids who lost at a game and trying to ransom the whole US economy using the Affordable Care Act as a hostage, there's no way to even know if the thing could actually work. If every thing the Republicans said was really wrong with ACA, why not just sit back and be able to say "I told you so?" Oh, because they can't act like adults with responsibilities to millions of people! Yeah, that's why!

Glenn -----OTR/L, MOT, Tx
     
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Sep 20, 2013, 10:29 AM
 
There are so many problem with John Green's simpleton breakdown of flashing images of charts for those trusting individuals with a real short attention span, it's hard to know where to start. El, Shif, and others have done a great job so I'll just touch on a couple more...

Higher taxes in US spent on health care?
  • Yes, BUT health care in the US generally includes vision and dental. Let's compare how frequently you're in front of a medical professional for a disease or broken limb vs say... a root canal, work on a cavity, corrective eyewear and related exams... yeah, it adds up. For example, $104.8 billion was spent in 2010 on US dental services alone. Single-payer systems generally send you to a private provider for dental and vision, but are not included in "health care" expenditures. Odd that. Yes, odd indeed. I mean, that's kind of a HUGE chunk of change just to be ignored entirely right? Of course it is.
  • Since John Green wanted to talk about taxes spent on "HEALTH CARE", why don't we look at the taxing structure of the host country overall? Well, because that wouldn't be politically expedient. You see, what happens then is you'd have our resident leftists up in arms about "FEEDING THE RICH ON THE BACKS OF THE POOR!!!" What am I talking about? I'm talking about the tax structures of say -- Sweden and/or Canada where the lowest bracket pays 7% higher in taxes than in the US and the highest bracket pays 5% lower in taxes than in the US and a Corporate tax rate on average 10% lower than in the US. Oh and, don't forget that "Church Tax" because of course we all go to the same church right? Yeah, not going to happen. So, while some of that is obviously not going into health care directly, it's paying for the other things with diverted focus FROM healthcare expenditures. Does this mean the provinces of Canada aren't pleading with their health care authority for more funds every year and complaining about the unequal distribution of those funds? Yeah. All the time. It remains a top-tier concern of voters in Canada just as it does in the US.

Life expectancy? So many variables, it's nearly impossible to compare. We can start with infant mortality or we can start with small, homogenous regions of the globe representing the size of say -- a handful of US cities. Well, there are a handful of US States that fare better or worse than others for example so wouldn't a more apt comparison be between those smaller systems? Of course it would, just not as politically expedient. The US system more commonly resuscitates premature and nonviable-birth babies; these babies later die but are treated as “live births” in U.S. statistics. Countries such as France and Japan classify such babies as stillbirths, which aren’t counted. We already know that infant mortality rates are also affected by outside factors such as the mother’s behavior and lifestyle (e.g., obesity, tobacco use, excessive alcohol use, recreational drug use, and marital status). Or we can look at those 50 and older to see a much better quality of life and where the focus of our health care system resides in the US. We can look at post-disease quality of life and longevity for the most expensive disease treatment regimen available; cancer. Your odds of surviving cancer in the US are exponentially greater than anywhere else on the globe. Hands down.

We should've known John's breakdown was awfully simpleton upon hearing that disease prevalence does not affect health care costs. Really? Hmm... Tell that to EstaNightshift. Needless to say, the only thing that blew my mind about this breakdown of health care in the US is the abject ignorance behind it.
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Sep 20, 2013, 11:34 AM
 
Originally Posted by shifuimam View Post
In the meantime, countries in the EU force those same pharma companies to provide their products, still under patent, at drastically reduced prices.
Citation needed - what country does this? As far as I'm aware, you can charge what you want for your drugs. The pricing pressure is that they are not subsidized by the national healthcare insurance systems if they're too expensive. This means that a company will sell enough more that it makes financial sense to sell them at the reduced price in many cases. The point here is that the number of pills sold goes up from X to Y even as the price drops from A to B - if Y*B > X*A, the company still makes more money. Now, the company of course wants Y*A, but that was never an option.

The other complaint from the US to the EU regarding pharmaceuticals is the transshipping issue. If a company produces a generic drug in some country where that is legal - say because the patents are not valid there, India is the typical case - and then sells it to another country where it is also legal - most African countries - EU countries will not attempt to stop those shipments in EU territorial waters or ports. The US will (at least in ports), which means that those shipments have to route around US territory as if they had Snowden aboard. The US periodically tries to push the EU on that point, but there is a public uproar whenever they do.
The new Mac Pro has up to 30 MB of cache inside the processor itself. That's more than the HD in my first Mac. Somehow I'm still running out of space.
     
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Sep 20, 2013, 12:59 PM
 
Originally Posted by el chupacabra View Post
Does no one else see a problem with the fact that 54% of applicants who had good grades are rejected med school each year? Supply and demand
The Looming Doctor Shortage | Washington Policy Center

http://www.nytimes.com/2012/07/29/he...ties.html?_r=0

U.S. Faces Shortage of Doctors - WSJ.com
     
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Sep 20, 2013, 01:09 PM
 
In France if you don't take the generic equivalent, you pay. Saying that, the Frogs love their pills.

One should also be very careful when comparing countries in Europe to the US : a model used in country A with a population of 10 million will not work the same as in country B with 300 million.
     
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Sep 20, 2013, 04:54 PM
 
Smaller countries enjoy better pharmaceutical products and more advanced medical care due to the US spending so much on it. While we don't pay for all study and research, we definitely pay more than "our share". The fact is, they should beg us to stay the way we are, because if we shift over to their type of system, they're going to have to start paying considerably more for progress in research and development.
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Sep 20, 2013, 05:10 PM
 
Originally Posted by Shaddim View Post
Smaller countries enjoy better pharmaceutical products and more advanced medical care due to the US spending so much on it. While we don't pay for all study and research, we definitely pay more than "our share". The fact is, they should beg us to stay the way we are, because if we shift over to their type of system, they're going to have to start paying considerably more for progress in research and development.

How is "their system" different? What countries do not have a free market based pharm industry?
     
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Sep 20, 2013, 06:10 PM
 
Originally Posted by besson3c View Post
How is "their system" different? What countries do not have a free market based pharm industry?
They don't put in as much money and resources because "why should we?" The USA takes care of that for a lot of them.
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Sep 20, 2013, 07:03 PM
 
Originally Posted by Shaddim View Post
They don't put in as much money and resources because "why should we?" The USA takes care of that for a lot of them.
That doesn't make any sense.

The free market operates to provide profit earning incentive, not to fulfill specific needs within a society. If these countries felt like there were profits to be had, they would go for it, but competing against an economic superpower with 300 million people in it is tough. So, they don't put money and resources into it because they feel this would be a bad business idea, not because they are being lazy and letting somebody else take advantage of these sorts of opportunities.
     
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Sep 20, 2013, 07:20 PM
 
You can't believe that these other countries can put up the amount of capital needed for that level of research, can you? The amount of cash provided by the USA, in research and study grants, is mind-boggling. It isn't like, "Hey, let's start a pharmaceutical company, I'll get a loan from the bank and we'll make $billions$!"
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Sep 20, 2013, 08:49 PM
 
Originally Posted by Shaddim View Post
You can't believe that these other countries can put up the amount of capital needed for that level of research, can you? The amount of cash provided by the USA, in research and study grants, is mind-boggling. It isn't like, "Hey, let's start a pharmaceutical company, I'll get a loan from the bank and we'll make $billions$!"
Of course they can't, not nationally, but internationally perhaps.

We are saying the same thing basically. My point is simply that the output of other countries is not due to purposefully being lazy and letting the US do the work, it's because of exactly what you're saying here: the US is an economic powerhouse, how can any single country compete with what the US can do right now?
     
   
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