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  #101  
Old 04-04-2012, 02:04 AM
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Wow, this thread went completely south on the health care system!

Healthcare is a very complicated system to change and any government that has a pair big enough to take this on, especially in the USA, is either suicidal or hates the current system enough to try to make a change.

I am divided on my opinion on the best way forward for a country like America for its health care.

In the UK our National Health system works, though yes, there are a lot of complaints that are appearing, but this is because it was put in place just after WWII so as to lok after the nation, it was designed to handle the vast influx of people coming into the country and claiming on it. This is causing it to melt down.

It will be a complete nightmare to try to pass through a similar system in the USA becaue;

1, The Insurance companies will be all over it and try to stop it.
2, Pharmaceuticals will be all over it and try to stop it.

To bring in a National Health System, the Insurances will lose all their profits and the pharma's will not wield as much power anymore over drug pricing.

Ok, this sounds good in theory but one must also consider just how many unemployed this will create in both those industries, especially during a time when we have a financial crisis on.
 
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  #102  
Old 04-04-2012, 04:00 AM
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Ok, this sounds good in theory but one must also consider just how many unemployed this will create in both those industries, especially during a time when we have a financial crisis on.
One might argue it's better to be unemployed then unhealthy. The fundamental question here is does the purpose of government to provide for the well being of their own citizens include their health? I believe it does, and am glad to be living in Europe for that matter. It's unimaginable here to reject an injured person or send him to a different hospital simply because it's cheaper for the insurance. My sister visited USA few years ago, first thing we had to resolve for her was the travel and health insurance, it was an official recommendation from both the Croatian embassy as well as her university. I can quote the person responsible "You don't wont to be hurt/injured there without an insurance" accompanied with a serious stare. Anyway, on a more economical note I believe the current system places profit over health, which gives US government certain financial advantage. However, the price is paid with the health of citizens and numerous problems which arise from that.
 
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  #103  
Old 04-04-2012, 06:03 AM
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I travel a few times a year to the US and have used their healthcare over there.

Our NHS is pretty good but I must say, if you can afford it, theirs is better. Ok, we are back to the point of affordability and health should not come at a high price, but then again, ours is also seriously flawed.

Example, NHS based healthcare will only screen women for mammograms every 3 years due to government expense. In the US it is every year, and yes, they do catch a lot more cancerous cases much earlier than we do. This is just one example and I could go on.

Believe it or not, we NEED the USA to keep their expensive systems in place as though it costs so much, they have some of the most advanced research centres in the world and then this knowledge is filtered down - (John Hopkins Institute etc)

Granted, it is at the loss of around 50 million American citizens without full healthcare, but as a European, this really isn't my problem, it's theirs. I know that sounds coldhearted but hey, if they're happy with their healthcare, then who am I to complain
 
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  #104  
Old 04-04-2012, 10:40 AM
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I don't think anyone is "happy" with it ... although as you say, the situation is massively complicated.

From what I've heard over the years, Canada does seem to have a system in place that is infinitely preferable to what we have in the US.

Problems? Sides ... there are so many ...

I was in the VA system at one time. Needed a particular med. Instead they gave me something else because it was cheaper, even though it wasn't the right thing and didn't address the problem.

My ex was in the VA system, and suffering SERIOUS health complications. A new drug came out. The VA wouldn't pay for it, because it was massively expensive. It was massively expensive because the pharmaceutical companies had spent vast sums developing it, and they wanted to get their $$ out of the deal. So ... only very rich people could afford it, and everyone else who needed it just suffered until the pharma company was happy it had made enough money and chose to lower the price. Of course, a lot of people lost a lot of ground (and I'm sure some died) as a result. But it's a free enterprise system ... who can tell the pharma they don't have the right to make $$ ... but it is a cold and heartless system. I can tell you I wasn't happy the day I learned of it.

Again, me in the VA system. Needed a specialist. Took a LONG time to get an appt, I had to drive hours for it. Over icy roads, took my life in my hands keeping that appt, but I had been pre-warned that if I didn't show up, that was my one shot and I'd lose care after that.

Now it's very important to me to stay healthy -- more preventative stuff. I had plenty of issues when I was younger, and whatever your thoughts on the subject, I can tell you I'm MUCH MUCH healthier since I went natural and preventive. But ... there are very few insurance companies that will pay for it. So no matter if I have insurance or not, I'm still out of pocket if I want to stay well. My only option for having them pay for it is if I let it all go and get sick and need the pharma and docs ... which I'd prefer not to do.

And about requiring folks to buy insurance? As it is a legal requirement, I know of at least one situation where it was a requirement of employment. And being as the job was off and on and ended up being part-time ... it turns out that a HUGE percentage of income was going just for health insurance. So much so that by the time gas was figured in, it makes more sense to quit, since it paid nothing in the end.

I'm sure pretty much anyone you ask can give you at least that many examples of problems. It's going to be terribly complicated to sort it all out. And nothing will make everyone happy.

But I can't help but think that with the track record of years past, it's going to end up heavily slanted in favor of interest groups, rather than the people.
 
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  #105  
Old 04-04-2012, 12:49 PM
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I totally see your point Inky , and the major problem arises once healthcare is turned into a profitable business where its primary role is to the shareholders before the sick people.

There are a few things in life that should be about life first and profit later, healthcare being one of them.

Like you said, the companies have to get their return investment before lowering the price, but the problem here is that the return investment includes major bonuses for bosses and shareholders alike. I have nothing against people making a profit, I just have something against people making a profit at the expense of human life, especially when they claim to be trying to save lives in the process.

Wow, this went off topic, though I guess it is still government related in some way :-)
 
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  #106  
Old 04-04-2012, 04:50 PM
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Believe it or not, we NEED the USA to keep their expensive systems in place as though it costs so much, they have some of the most advanced research centres in the world and then this knowledge is filtered down - (John Hopkins Institute etc)
Have never considered the subject from this angle, interesting viewpoint.
 
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  #107  
Old 04-04-2012, 05:06 PM
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I totally see your point Inky , and the major problem arises once healthcare is turned into a profitable business where its primary role is to the shareholders before the sick people.
Just because a business in for profit doesn't mean that it primary focus is on the shareholders and not the customer. In general that is a poor way of doing business and in the long run hurts a company.

We have a system that provides a huge incentive for companies to take large financial risks and create new drugs. These drugs save peoples lives and better their health. If the companies don't make a profit that justifies the risk, these drugs don't get invented. That means more people die and more people suffer. Currently 60% of the new drugs are invented in the US do to that inventive. So what happens to the world when those incentive goes away.

Lets look at those stock holders. Currently ~55% of the US population holds stocks in one form or another. That mean those stockholders in general are us. Those stocks go into our investments, IRAs, 401Ks etc.

Based on this, lets do a thought experiment: we could as a group state that we will accept less of a return on our investments in turn for the drug being sold at a lower price. So a drug that would bring in 100 million would now only bring in 20million. Those needing the drug would get it at a cheaper price but on the other side 80 million in wealth would never materialize. So as a group we would have 80 million less in wealth. That would mean fewer products ordered, fewer services purchased, etc. In general the economy would be 80 million dollar less than it could have been. That directly means fewer jobs, lower paying jobs and a general decrease the general welfare.
 
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  #108  
Old 04-04-2012, 06:37 PM
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Originally Posted by Nealrm View Post
Just because a business in for profit doesn't mean that it primary focus is on the shareholders and not the customer. In general that is a poor way of doing business and in the long run hurts a company.

We have a system that provides a huge incentive for companies to take large financial risks and create new drugs. These drugs save peoples lives and better their health. If the companies don't make a profit that justifies the risk, these drugs don't get invented. That means more people die and more people suffer. Currently 60% of the new drugs are invented in the US do to that inventive. So what happens to the world when those incentive goes away.

Lets look at those stock holders. Currently ~55% of the US population holds stocks in one form or another. That mean those stockholders in general are us. Those stocks go into our investments, IRAs, 401Ks etc.

Based on this, lets do a thought experiment: we could as a group state that we will accept less of a return on our investments in turn for the drug being sold at a lower price. So a drug that would bring in 100 million would now only bring in 20million. Those needing the drug would get it at a cheaper price but on the other side 80 million in wealth would never materialize. So as a group we would have 80 million less in wealth. That would mean fewer products ordered, fewer services purchased, etc. In general the economy would be 80 million dollar less than it could have been. That directly means fewer jobs, lower paying jobs and a general decrease the general welfare.
Your reasoning with a quick read looks entirely valid to me. G10 also made a very valid point.

IMO we don't need to socialize or reign in the drug companies. They are a very small piece of the overall cost. Companies who risk big bucks should be entitled to big rewards.

IMO the problem with health care is two fold. One is for profit service providers, not Doctors, nurses, etc. but the people who employ them. The other bigger part is that mediscare and the insurance companies only pay about 50% of the scheduled price. Walk in off the street and pay cash for service x; your cost 100-150 bucks. Walk in with mediscare or insurance and they only pay 50-60% of that amount. I can scan documents to prove what I am claiming here; so don't tell me I am making up numbers.

The whole darn thing is a racket!!!! Mediscare started it with their 'usual and customary charge' method and the insurance lobbyist said we want to play to.

If everyone paid the same fixed rate costs would be lower across the board. If everyone and I do mean everyone had a copay amount the needless use of medical services would go down. If preventive care had a lower copay than a visit to the emergency room our costs would go way down. If we did not provide free medical services for illegal aliens our costs would go down. If we only provided palliative care for the terminally ill our costs would go way down. If health care providers had better lawsuit protection our cost would go way down.

Before I write a novella, I will stop and await some replies.
 
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  #109  
Old 04-04-2012, 07:51 PM
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IMO one of the problems is that health care is no longer a free enterprise system. Why because the people that get the service are disconnected from paying for that service. Most people in the US get their health insurance as a benefit of employment with a company or union. They don't pay for the insurance, so there is not an incentive to keep cost down. In fact there are incentives for both the patient and the doctors to preform more testing and procedure than necessary. The insurance company are not really worried about the cost, because they are skimming off a percent as their profit. So the larger the bill, the better their profit. The loser is the companies that supply have to pay the benefits.

So how to stop this spiral. Remove the tax incentives for companies to provide health insurance and require a percent copay on all procedures. The would force health insurance to be more like auto insurance. A highly competitive market, with insurance companies competing on who can provide the most bang for the buck. With a copay in place, there would also be an incentive in place for the patient to pressure the medical providers to keep the cost down. People would start challenging 2 dollar tissues. There would need to be some safeguards in place. HSA accounts would need to be more common, the state would also need to subsidize a high risk pool.
 
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  #110  
Old 04-04-2012, 08:16 PM
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Originally Posted by Nealrm View Post
...Most people in the US get their health insurance as a benefit of employment with a company or union. They don't pay for the insurance, so there is not an incentive to keep cost down.
Do you have a resource to back that up? Most people that I know pay at least part (as much as 50%) of the premium through their work.
 
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  #111  
Old 04-04-2012, 08:26 PM
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I should have phrased that better. A better phrasing would be that most don't pay the complete health insurance cost.
 
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  #112  
Old 04-04-2012, 09:03 PM
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Health care makes up 17-percent of the entire U.S. economy. At least one estimate suggests that one-third of what we spend on health care is wasted. After watching Dr. Jon LaPook's report on the overuse and misuse of health care, let us know what you think: should we be looking to cut back on potentially unnecessary tests, medicines and procedures? Or is it really just a necessary overabundance of caution?
http://www.cbsnews.com/video/watch/?id=7404316n
Interesting thought?
 
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  #113  
Old 04-04-2012, 09:04 PM
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Question: When did government become involved in health care? Should they even be involved?
 
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  #114  
Old 04-04-2012, 11:44 PM
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Question: When did government become involved in health care? Should they even be involved?
They have been involved all along, just in a different way than our european systems as lets face it, it is you guys that pay for things like medicaid via your taxes anyway.

One thing that did concern me a little during my research was things like this..

Quote:
Public Health Impacts:

A 2011 paper by the Massachusetts Institute of Technology and the Harvard School of Public Health, “The Oregon Health Insurance Experiment: Evidence from the First Year,” utilized Oregon’s 2008 decision to hold a randomized lottery for the provision of Medicaid insurance in order to measure the impact of health insurance on an individual’s health and well-being.

The study examined the outcomes of the 10,000 lower-income people eligible for Medicare who were chosen by this randomized system, which helped eliminate potential bias in the data produced. The study's authors caution that the survey sample is relatively small and "estimates are therefore difficult to extrapolate to the likely effects of much larger health insurance expansions, in which there may well be supply side responses from the health care sector."

Nevertheless, the study finds evidence that:

1) Hospital utilization increased by 30% for those with insurance, with the length of hospital stays increasing by 20% and the number of procedures increasing by 45% for the population with insurance;

2) Medicaid recipients proved more likely to seek preventative care. Women were 60% more likely to have mammograms, and recipients overall were 20% more likely to have their cholesterol checked;

3) In terms of self-reported health outcomes, having insurance was associated with an increased probability of reporting one’s health as “good,” “very good,” or “excellent” — overall, about 25% higher than the average;

4) Those with insurance were about 10% less likely to report a diagnosis of depression.

source
I can't prove the above to be true or not, but if it is, then one begins to get an idea why health insurance is so damned expensive over there as it seems like everyone is after a slice of the cake and it is ultimately the public that will pay for it via higher premiums.

Should the government be involved in it? I would say yes, because if they weren't, there would be too many people that think they know best and not pay anything and let's face it, no country is just going to leave millions to just die as then the country would be clasified as third-world standards, so it will ultimately come from your taxes anyway.
 
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  #115  
Old 04-05-2012, 12:55 AM
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Originally Posted by Nealrm View Post
Lets look at those stock holders. Currently ~55% of the US population holds stocks in one form or another. That mean those stockholders in general are us. Those stocks go into our investments, IRAs, 401Ks etc.

Based on this, lets do a thought experiment: we could as a group state that we will accept less of a return on our investments in turn for the drug being sold at a lower price. So a drug that would bring in 100 million would now only bring in 20million.
First ... are you saying that 55% of the US population holds stocks? Really??? You may be right, but I have a hard time believing it. Maybe I run in the wrong circles, but I've only known a few to have much of a portfolio, and many, many who don't have any at all. Unless you are counting a savings bond or two tucked away somewhere ... that's all I've ever had.

Anyway, my real point is that I'm not so sure the second statement is true either. The drug I mentioned that no one could afford that my ex needed ... they got $200 per dose for it. Actual cost was quite low, but that's beside the point, since they had developed it, and they had the patent, and could charge what they wanted. But ... how many people could afford the $200?

Now, I don't have figures to back this up. I have no idea, really. But let's just say that 100 people could afford the $200 dose. So they made $20,000 per needed dose. Less their cost, which as I said was miniscule, comparatively (cost having been paid already through R&D, mostly).

But what if 10,000 people actually NEEDED the medicine? What if they sold it for $20 a dose? (Which they did some years later.) Now, they are making $200,000 per dose. Their costs are 100x higher, but ... if they are making money on $20 a dose (and surely they are not selling it out of the goodness of their hearts at a loss) ... then they could have made money on it at the start.

So why not let more people use it for more modest profits per dose, when the overall profit could be higher? Assuming of course if my numbers were correct, which I'm sure they are not. But the scenario may play out something like that.

But I'd be willing to bet the pharma company found out how many people needed it, what income brackets they were likely to be in, and probably figured out how much they could afford to sell it for at maximum profit for what windows of time. The put so much $$ in R&D, they probably figure out stuff like that too.

Sorry, I'm starting to feel sick all over just thinking about it. I honestly DON'T think it's right.

I've been in business. There are two ways to do it. You can compete based on price, try to sell cheaper. You will probably get more business that way. But you have to work harder for it. Overall you can make a lot of money though.

You can also compete based on something else, and charge more for your product/service. You still make money, but you work less hard because you're bringing in more per customer/sale/whatever.

I've done it both ways. I admit, I LIKE competing on something besides price and making more money for the same effort. At least as it purely applies to me. But somehow applying that people's lives and health doesn't seem right.

I've been in health care, though not from the pharmaceutical standpoint. I've found ways to help people who needed it who couldn't afford it. And I felt good for having done it. I may not have earned $$ doing it, but I earned self-respect and the gratitude and friendship of people I helped, and the satisfaction of having done the right thing and seeing people's lives and health improved. I guess I'm just old-fashioned about that, but I'd rather be me doing it my way than theirs.
 
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  #116  
Old 04-05-2012, 12:58 AM
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Originally Posted by Nealrm View Post
So how to stop this spiral. Remove the tax incentives for companies to provide health insurance and require a percent copay on all procedures. The would force health insurance to be more like auto insurance. A highly competitive market, with insurance companies competing on who can provide the most bang for the buck. With a copay in place, there would also be an incentive in place for the patient to pressure the medical providers to keep the cost down. People would start challenging 2 dollar tissues.
Now this makes a lot of sense to me.
 
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  #117  
Old 04-05-2012, 05:03 AM
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First ... are you saying that 55% of the US population holds stocks? Really???
Based on the latest numbers I found. But that number does go up and down. This number also include mutual funds. Many people don't think they own stock because they are hidden inside a 401K or IRA investment package.


What you are discussing is called the supply / demand curve. It is well know by businesses. It addresses demand at a given price, supply at a given price and where those meet. It is one of the key concepts companies use to set price.

Quote:
I've been in health care, though not from the pharmaceutical standpoint. I've found ways to help people who needed it who couldn't afford it. And I felt good for having done it. I may not have earned $$ doing it, but I earned self-respect and the gratitude and friendship of people I helped, and the satisfaction of having done the right thing and seeing people's lives and health improved. I guess I'm just old-fashioned about that, but I'd rather be me doing it my way than theirs.
I think this is great that you did this. I believe that everyone should do some form of charitable work. While charitable work does have many benefits, those benefits don't include putting food on the table. Without food you starve, die and stop doing any more charitable work. This is an unpleasant side of pharmaceutical work. They have to make money in order to keep inventing new and better medicals. That limits them from just giving away the drugs once the R&D is complete.

--------------

I did some more thinking about the effects of drug price controls. Currently many countries have set price controls on drugs. Because of this, they have enjoyed cheaper medication. But the R&D, return and manufacturing costs are still there. So what happens to those costs. They are being forced back on the US public in the form of higher priced drugs. So the US public is effectively subsidizing the supply of drugs to much of the world. If we want to reduce drug cost we need to put a stop this. What would Canada do if we told the lumber companies they had to sell their product in the US under cost so that we could house more people????? How about if we told Germany that none of the cars they sell in the US can include any of the design or setup cost, only what is actually cost to produce the car????
 
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  #118  
Old 04-05-2012, 05:27 AM
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The more I think about the price controls the more I think this is a major issue. If the drug companies need to sell a pill at $10 to make up of R&D and other costs but Canada states they can only sell it at $5, that $5 gets tacked on our cost. We now get charged $15 per pill. If you through in Germany, Britain, France and a few other countries into the mix, the drug now cost us $50 per pill. To top it off, these same companies then brag about their lower medical cost and tell us we need to do something to make healthcare affordable to everyone.
 
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  #119  
Old 04-05-2012, 03:09 PM
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The interested can look up the numbers for themselves. The reason drugs, especially new drugs like the $200 per dose one mentioned cost so much in the US is that a new drug is exclusive to the company for a period of time, 7-10 years, before it can be made and sold as a generic. A company must recoup the R&D and make a profit during the exclusive period for then everyone can make and sell it.

The actual % of developed drugs that make make thorough clinic trials and are approved is a small % of the developed drugs so the R&D costs on the losers has to be covered by the winners if the company is to remain profitable.

As a general rule US users pay the R&D cost for the rest of the world because their socialized medical plans do not allow enough cost recovery for the company to profit. Now should we choose a different path the rest of the world will need to step up and pay more or the new product pipeline will dry up. This is just common sense. There is no magic reasoning here.

I have found drug company stocks to be about as reliable as utility company stocks for moderate growth and dividends. IMO, that is as it should be.
 
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  #120  
Old 04-05-2012, 04:06 PM
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FYI - the exclusive period is not just for drug, all new inventions have an exclusive period. It is part of the copyright protection.
 
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