For-profit universal healthcare: would it work in the US?

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So five years after the invention of television, it was more expensive to buy top-of-the-line than it is 30 years after color television to buy bottom? Great point!

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You're the one who keeps making ridiculous comparisons. Fact remains that televisions have gotten cheaper over the years and that their value has increased with more channels, better features, more convenience, video games, and DVDs.

You talk about movie theaters and concerts as if they are the be all end all of the entertainment industry. Sure they have gotten more expensive, but now they are competing with a vast selection of TV and radio choices, portable radios/CD/MP3 players, internet, and a variety of other new media for entertainment.

[Mad Cow]

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2) Very active and expensive R&D

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Ah, but why is R&D so expensive?


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Because you need hundreds of PhDs using very expensive equipment, and a lot of the research does not not bring one penny. A standard FDA application is dozens of thousands of pages long, and the work behind it is gigantic. It is not like developing a new corn flakes flavor. It is very expensive by definition.


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5) For very serious conditions, few returning customers

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Maybe you meant terminal conditions, in which case I was under the impression that they try to make you comfortable, not try and cure you. I think that "serious" conditions probably generate a lot of return unless they cure you with the first treatment.

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Most serious conditions only become terminal after trying treatments that are very expensive.



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6) Medicine does not scale well (face-to-face with MD, etc)

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Could you elaborate? I'm not sure I understand this part.

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Treatments are getting better, but the number of MDs and the cost of the equipment is rising, not decreasing. You can use electronic records or whatever, but you still need highly trained and expensive people in the chain. You don't self-diagnose a prostate cancer on a Web site, and you cannot buy a CT-Scan and a "Do-It-Yourself" DVD at WalMart.


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I don't think that the comparison with WalMart holds...

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Maybe, maybe not. Could you explain why you think it doesn't?

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Because medicine is a business at the opposite side of the spectrum:

- very high vs. very low wages
- tiny niche markets vs. general retailer
- invididual customer relationship vs. anonymous relationship
- etc.

Does it make sense?

[The Truth]

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Longevity: as lifespans increase, especially when they're prolonged by drugs, people are sick longer and use more drugs.

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And those drugs aren't getting cheaper or radically more effective why?

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They're getting better: I'm pretty impressed with the new HPV vaccine that came out a month or two ago. They're not getting cheaper though.


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I am starting to think Jogger is just a troll.



Why has the cost of health care been rising?

"Longevity: as lifespans increase, especially when they're prolonged by drugs, people are sick longer and use more drugs."

The cost of drugs is only a small portion of why health care cost has been rising. Longevity has little to do with it. Granted alot of health care expense is from the last years of a persons life, but it doesn't matter if that last year is 31, 49, 65 or 80.

The fee-for-service payment method that the goverment used for the longest time was extremely ineffecient. The markets punished its ineffencies. Fee-for-service rewarded procedural medicine and more work ups. It did not reward doing nothing or giving drugs.

So, if a patient comes to a specialist with a problem that could be cured with a 75 dollar perscription, or a procedure that nets 3000 dollars for the specialist... which one does he do?

The number of specialists coming out of medical school has been rising for a reason, that reason is money, and the goverment provides it (remember when the goverment subsidized people to go to medical school hoping for more primary care docs and instead got a huge outflux of specialists?).

Doctors kind of control demand in their industry. They can decide when these elective procedures get done. Patients are pretty much forced to go on what the doctor says. The doctor is motivated quite often by money. There have been hospitals getting in "trouble" for doing mass numbers of unnecessary heart surgeries. The things that pay the most, get done alot.

Doctors keep getting more and more patients to do procedures on. Raising the amt medicare is paying by ALOT. (it is important to note that this increase in amount of costly care has not translated to healthier/longer living patient populations.)


So, medicare just pays all this from tax money. Insurance companies raise premiums. The employer (which chooses the health care contracts instead of individual consumers due to wage controls during WW2) pays the premiums because all the money he gives the insurance company is tax deductable, so the employeer feels it less. (the tax deductions come out of the consumers pocket ultimately.)

As the goverment runs around spending other peoples money, it doesn't really do much analysis of whats going on.

I loved when Tenent/NME just massively raised a charge by like 1000% one quater to punish how medicare pays out for some complicated end of life patients who suffer from multiple diseases. This resulted in Tenet raising its quarterly earn by like 30% due to medicare charging incorrectly.




Drugs.


"They're getting better: I'm pretty impressed with the new HPV vaccine that came out a month or two ago. They're not getting cheaper though."

The drug companies spend most of their time releasing copy-cat drugs that make no clear progress. They spend more money on advertising than they do on research. Researching drugs that cure diseases isn't profitable. So, they research offshoots of drugs that already work well. Make them a little different, say they are better, and sell them. It takes many years to prove if they are better or not. Look at what went on with Vioxx. If we had electronic medical records, then the drug companies would be in a world of hurt.

The bayh-dole act in the 80s helped to punish the US consumer. Most good drug research is done at universities.

Whomever asked this "And those drugs aren't getting cheaper or radically more effective why?" was dead on.

[The Truth]

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2) Very active and expensive R&D

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Ah, but why is R&D so expensive?


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Because you need hundreds of PhDs using very expensive equipment, and a lot of the research does not not bring one penny. A standard FDA application is dozens of thousands of pages long, and the work behind it is gigantic. It is not like developing a new corn flakes flavor. It is very expensive by definition.



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The major drug companies spend more on advertising than they do on research.

The companies dont share results; so both companies are duplicating research and not sharing results. =higher cost to consumer.

Easiest way for them to make money is to make drugs that get to the market and through FDA quickly. These drugs are not revolutionary drugs. These are modifications of drugs that work.


The VA was able to negiotiate with drug companies to get lower prices. Why aren't other hostpitals doing the same?

[Crazy_Swiss]

I hope you all vote. people generally type on these forums and then don't do anything.

[Mad Cow]

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2) Very active and expensive R&D

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Ah, but why is R&D so expensive?


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Because you need hundreds of PhDs using very expensive equipment, and a lot of the research does not not bring one penny. A standard FDA application is dozens of thousands of pages long, and the work behind it is gigantic. It is not like developing a new corn flakes flavor. It is very expensive by definition.



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The major drug companies spend more on advertising than they do on research.

The companies dont share results; so both companies are duplicating research and not sharing results. =higher cost to consumer.

Easiest way for them to make money is to make drugs that get to the market and through FDA quickly. These drugs are not revolutionary drugs. These are modifications of drugs that work.


The VA was able to negiotiate with drug companies to get lower prices. Why aren't other hostpitals doing the same?

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I am in favor of any policy that slows the rising costs of medicine, as long as they are safe (electronic records, first consult a general practictioner before seeing a specialist, negotiate bulk prices with pharmas, etc).

But modern medicine will remain expensive.

If you want less than 15% of uninsured people, the governement has to inject some money. There are various ways to do so, and it was the topic of my post.

[Copernicus]

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first consult a general practictioner before seeing a specialist



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where have you been the last 20 years? Gatekeepers have proven to be extremely inefficient and have all but been abandoned from insurance models. The sick know when they need a specialist the vast majority of the time, and the visit to the GP is a waste of money.

[TomCollins]

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I hope you all vote. people generally type on these forums and then don't do anything.

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If an election I could have voted in ends with a tie, you can reprimand me then.

[blackize]

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If you want less than 15% of uninsured people, the governement has to inject some money. There are various ways to do so, and it was the topic of my post.

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The bolded is completely wrong. Quality healthcare is affordable for nearly all Americans if they want it. Joe Six Pack would rather spend his 200/mo on booze, inflated car payments he doesn't need, and going out to eat.

[Brainwalter]

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If you want less than 15% of uninsured people, the governement has to inject some money. There are various ways to do so, and it was the topic of my post.

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The bolded is completely wrong. Quality healthcare is affordable for nearly all Americans if they want it. Joe Six Pack would rather spend his 200/mo on booze, inflated car payments he doesn't need, and going out to eat.

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And why.. because government is already, or is promising to, pick up the tab!