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"Fannie Mae Health Care":

John Calfee on the dangers of a "public plan" for health insurance:

a public plan would possess formidable and perhaps overwhelming competitive advantages -- generated not by efficiency but by the artificial advantages of "public" status. This would have two disastrous consequences. The first will be to cause most Americans now covered by private insurance to move to public insurance -- one step away from single-payer health care. The second will be to undermine incentives to develop more of the immensely valuable medical technology that is central to all of health care.

Related Posts (on one page):

  1. Mankiw on the Pitfalls of a Public Plan:
  2. "Fannie Mae Health Care":
Soronel Haetir (mail):
Honestly, stagnation has been my greatest worry in the push to control medical costs. We very likely could make nearly all current care affordable if we were to give up on adding anything to that portfolio.

And that is the mistake I think people make when they compare current costs to medical costs from previous generations is just how much more effective current treatment regimes are. People look at other fields, such as computers where due to inflation the gains are even more pronounced than straight dollar for dollar would lead one to believe and say "Why isn't medicine like that?"
6.27.2009 1:08pm
Donny:
Instead of parroting the talking points about the public plan, why don't you add something to the discussion?

For example, perhaps you could helpfully point out exactly what subsidies the public plan will receive instead of taking it on assumption.
6.27.2009 1:10pm
gab:

Why did practically all economically advanced nations dismantle their public airlines, phone companies, and so on, invariably obtaining lower administrative costs and consumer prices?



Wouldn't the next logical sentence then ask - "Why do practically all economically advanced nations have a single-payer health plan?"
6.27.2009 1:19pm
Soronel Haetir (mail):
gab,

Because they are able to/ have been able to sponge off the fantastic profits of the US medical system.
6.27.2009 1:24pm
ruuffles (mail) (www):

For example, the various sellers of cholesterol drugs (Lipitor, Crestor, and so on) have to compete with one another while they all face a single government negotiator. If one seller balks at government prices, it leaves competitors to pick up more sales.

Seriously? That's the definition of a free market. The buyer simply chooses the seller who offers the lowest price (and, obviously, a functional product). His complaint would hold water if the government were the one manufacturing drugs. Otherwise he's just shilling for BIGPharma.
6.27.2009 1:33pm
David Schwartz (mail):
The "definition of a free market" involves selling consumer goods to a single government negotiator? Really?
6.27.2009 1:37pm
David M. Nieporent (www):
David S: while I agree with your criticism of ruuffles' comment, let's not use the term "negotiator," okay? The government isn't "negotiating" for anything when it's a monopsony. It's simply dictating how much it will pay, or, in other words, deciding how much the companies are allowed to charge.
6.27.2009 1:42pm
Duracomm (mail):
ruuffles,

What you have when the government is the only buyer is a Monopsony. It is inherently destructive to innovation.

The foreign single payer plans have used their monopsony buying power to artificially lower prices and free load on pharmas research results from the US market.

Monopsony

It is an example of imperfect competition, similar to a monopoly, in which only one seller faces many buyers.

As the only purchaser of a good or service, the "monopsonist" may dictate terms to its suppliers in the same manner that a monopolist controls the market for its buyers.
6.27.2009 1:44pm
ruuffles (mail) (www):

The government isn't "negotiating" for anything when it's a monopsony. It's simply dictating how much it will pay, or, in other words, deciding how much the companies are allowed to charge.

Really? If you assuming there's no cutting corners in production, then there's a certain minimum cost that results from the production.

In other words, in a monopoly, there's no price ceiling. In a monopsony, you have a price floor.

As the only purchaser of a good or service, the "monopsonist" may dictate terms to its suppliers in the same manner that a monopolist controls the market for its buyers.

A monopolist says "pay X dollars" and thats it. A monpsonist says "I can only pay X dollars." If none of the sellers are able to produce the product at that price, then the buyer has to increase the price.
6.27.2009 1:50pm
ruuffles (mail) (www):

The foreign single payer plans have used their monopsony buying power to artificially lower prices and free load on pharmas research results from the US market.

How are they artificially lowering anything? They are not forcing the drug companies to sell to them. In fact, you could argue each country is a specific seller and the drug companies sell to all of them.

By not negotiating as an entity the US is simply putting itself at a disadvantage.
6.27.2009 1:52pm
ruuffles (mail) (www):
Besides, it is only a single buyer system when its single-payer, not with a public option.
6.27.2009 1:56pm
gab:
So let's stop subsidizing those mooches!
6.27.2009 2:07pm
interruptus:
The complaints about foreign governments supposedly not paying enough, despite nobody forcing anyone to sell to them, and in most cases the foreign countries not even being all that large, honestly sound like some of the lefty complaints about how Wal-Mart's ability to dictate to suppliers how much they can charge is unfair. If you want to sell in the Wal-Mart market, you play by Wal-Mart's rules, and if you want to sell in the German market, you play by Germany's rules.

Even in the U.S. case, I haven't seen very careful analyses of to what extent specifically the public, subsidized nature of the plan will result in lowering prices. To a large extent, someone like Medicare can negotiate lower prices simply because of their size---the same reason Wal-Mart can---not specifically because their status as government.
6.27.2009 2:13pm
gattsuru (mail) (www):
For example, perhaps you could helpfully point out exactly what subsidies the public plan will receive instead of taking it on assumption.

Under current legal doctrine, a federal public plan would not and could not be held to the same standards of capitalization and reporting as state law requires each private insurance provider to supply. Suits against a federal public plan would be vastly more difficult than those against a private plan.

And, more practically, I can not honestly see the public option forced to face the search for investors bankruptcy the first year it finds red ink. By default, it will be subsidized simply because it will be found too important to let fail.
They are not forcing the drug companies to sell to them.

The international status of patent law gives nations a unique power over companies selling to them; priced too high, the nation often brings legal muster against the opponent, or in some cases like Brazil simply bust the patent.

In the latter cases, they are forcing the drug company to sell to them, at the risk out outright theft if they do not.
6.27.2009 2:19pm
ruuffles (mail) (www):

The international status of patent law gives nations a unique power over companies selling to them; priced too high, the nation often brings legal muster against the opponent, or in some cases like Brazil simply bust the patent.

But that's unique to drugs and other patent-based products. What about apples? Suppose a country is in a climate that's hostile to the growing of apples. The government decides to purchase all its apples at the lowest price possible. How can "outright theft" happen in this case?
6.27.2009 2:23pm
theft?:

In the latter cases, they are forcing the drug company to sell to them, at the risk out outright theft if they do not.

The attempted theft is in the opposite direction: using state police power (in this case through the coercion of anti-sovereignty "international law") to try to impose an artificial scarcity on non-scarce goods.
6.27.2009 2:38pm
Soronel Haetir (mail):

But that's unique to drugs and other patent-based products. What about apples? Suppose a country is in a climate that's hostile to the growing of apples.
The government decides to purchase all its apples at the lowest price possible. How can "outright theft" happen in this case?


Your apple example does not apply because you have posited a condition that does not apply to the drug market. Sure, perhaps Kenya as an example does not have the infrastructure to produce any given drug for less than the US pharma co would charge. They would just contract with some other foreign provider to do the production irrespective of the patents in the US.

Canada, Europe and many other countries do however have the facilities to produce those compounds in-country, so for the pharma company it's either play ball or get nothing. If the US suddenly turns to the same modle who exactly is going to fund the research for new medications? Perhaps outsource to someplace with no profit motive but no liability until you have something worthwhile?
6.27.2009 2:39pm
seadrive:
It would rather depend on what the Gov't plan was. For example, if the Gov't offered community-priced plans and the private insurers offered individual and group plans, the private insurers would be in great shape.

Not likely to happen, but it illustrates the point.
6.27.2009 2:57pm
BGates:
But that's unique to drugs and other patent-based products.

Which by uncanny coincidence are exactly the products under discussion here.
6.27.2009 3:00pm
BGates:
The link provided by "theft?" is to an essay titled "Against Intellectual Property". The claim is that "The state works with monopolistic private producers to inhibit innovation and stop the progress of technology, while using coercion against possible competitors and against consumers."

Actually that's just from the summary; to see the whole essay you have to pay six bucks. Apparently it's printed on really high quality paper.
6.27.2009 3:06pm
Bruce Hayden (mail):
For example, perhaps you could helpfully point out exactly what subsidies the public plan will receive instead of taking it on assumption.
To start with, the cross-subsidization from all non-government payers. Right now, they are cross-subsidizing Medicare, Medicaid, etc., which set their reimbursement rates below cost.
A monopolist says "pay X dollars" and thats it. A monpsonist says "I can only pay X dollars." If none of the sellers are able to produce the product at that price, then the buyer has to increase the price.
Or, if they are the government, declare that the suppliers cannot sell to anyone else, if they won't sell to the government at whatever price the government sets.

That is one of the big problems with the current status of the industry, and what is left out of the debate. My understanding is that a provider is either in or out of the Medicare system, and if he is out, he can't take any Medicare payments whatsoever. And, right now, a lot of physicians are apparently fleeing the system. That cannot be allowed to continue, since if a large number of providers refuse to take Medicare, etc., and only take those who can pay their fair and full share of their costs (mostly the otherwise insured), then there won't be enough physicians treating the government insured.
6.27.2009 3:08pm
AnthonyJ (mail):
There is no possible fix to the cost of health care that doesn't have a side effect of some suppression of innovation -- reduce the money going into health care, and there's less money available for research. Beyond that, making health care efficient implies focusing on efficient treatments (high benefit/cost ratio), and most new treatments are not efficient.
6.27.2009 3:10pm
theft?:

Actually that's just from the summary; to see the whole essay you have to pay six bucks. Apparently it's printed on really high quality paper.

The book is available as a free PDF, if you prefer.
6.27.2009 3:11pm
Jim at FSU (mail):

And, right now, a lot of physicians are apparently fleeing the system.


I was unaware of this. If you could provide links to further information on this topic, I would be grateful.
6.27.2009 3:24pm
Allan Walstad (mail):
Calfee's piece is spot on. In the long run, the greatest evil of government domination is the least obvious. Innovation requires entrepreneurs free to develop new or improved products and sell them for what the free market will bear in order to recoup their expenses and justify the risk. However one might wish to quantify advances in medicine, the point is that even a small decrease in the rate of advance would, compounded over a few dozens years, make medicine vastly inferior to what it would have been. Since we can't run parallel universes and observe outcomes, the loss is invisible, however real.

As for other countries succeeding in reducing drug prices, it's easy to see how this happens without being a good example for us to follow. If drug companies can recoup their research costs by selling in the US, there's no reason for them not to sell elsewhere too, even at prices that would not have otherwise sufficed. This is basically the same phenomenon that allows reduced prices for the same meal at lunch versus dinner, or to stay at the same resort off-season or use large quantities of electricity at off-peak hours. The very existence of the lower off-peak price depends on sufficient demand at the on-peak price.
6.27.2009 3:29pm
Jim at FSU (mail):

Lakeshore managers last year took a hard look at reimbursements vs. the cost of services, and what they found stunned them: Every patient visit reimbursed by Medicaid lost the clinic $25; every visit reimbursed by Medicare, $10.

Doctors fleeing Medicare, Medicaid

"Doctors say the state-set reimbursement rates are already too low, in some cases covering only one-third of the actual costs of patient visits. Many physicians elect to treat Medicaid patients out of a sense of duty, rather than as a business decision," the AP reports, but even those may choose to spurn the program with further pay cuts. Experts say patients, "short on options, clock to emergency rooms and hospital clinics," a pattern that could end up costing the Michigan Medicaid program even more in the long run (Rogers, 6/7).

Michigan Doctors Flee Medicaid Program Cuts

While primary care physicians have generally stayed in the TennCare program, many subspecialists have bailed out, fed up with what they saw as a high hassle factor and low reimbursement rates. And as the TennCare network shrinks, the remaining subspecialists find it harder to stay in the network and deal with increased patient loads and heightened liability risks.

More Physicians Flee as TennCare Turmoil Rises
Yep, the domino effect- as providers refuse to participate in the welfare networks, every other provider is under increased pressure to also leave or go out of business.

This is actually awesome news. The entire medicare/medicaid system is actually collapsing. Adam Smith would be proud.
6.27.2009 3:34pm
rosetta's stones:
And, right now, a lot of physicians are apparently fleeing the system. That cannot be allowed to continue, since if a large number of providers refuse to take Medicare, etc., and only take those who can pay their fair and full share of their costs (mostly the otherwise insured), then there won't be enough physicians treating the government insured.

If Bruce's statements is correct, and if my statement is correct, that government is currently paying for about 60% of the health care in this country (and rising), then the irresistable force is colliding with the immovable object. Something has to give. Government either has to start paying more, or start covering less.

...or hijack the entire system with Obamacare.

...or, bust some of the crooks who are staying in the system, and ripping it off, perhaps saving a few dollars.
6.27.2009 3:39pm
Tom952 (mail):
Yea, yea, yea. And if you have been self employed and trying to maintain your own health coverage for the past 30 years you would have jumped at the chance to buy into Medicare or the Canadian Health System if you had the option.
6.27.2009 3:41pm
Jim at FSU (mail):
There is fraud, but the amounts still pale in comparison to the waste that is inherent in government funded health care of any kind.

And I think there is a pretty good case to be made that the fraud itself is encouraged by the existence of the government entitlement system. Government simply doesn't have the incentives in place to properly police the parties it transacts with. While a business that gets ripped off goes under, a government that gets ripped off only experiences negative effects to the extent that the story makes the evening news before an election.
6.27.2009 4:19pm
Richard Johnston (mail):

gattsuru said:

Suits against a federal public plan would be vastly more difficult than those against a private plan.



Probably not as true as you might think; private plans are getting away with murder insofar as civil litigation is concerned. Thanks to ERISA (as interpreted by the courts), if you get your insurance through your work, and you sue your health insurer over a denied service, you can count among other things on: having to show not just an incorrect decision but an abuse of discretion, no right to a jury, no or extremely truncated discovery, no meaningful remedy (i.e. all you get if you do manage to prevail is the benefit they were supposed to provide in the first place and maybe something on account of attorney fees). No extracontractual or consequential damages allowed.

It's always been my view that the numbers of the uninsured should include all who get insurance through their work, because they only think they have insurance. What they really have is an effectively unenforceable promise that some insurance company will cover a claim if they feel like it. Unless reform includes a way to effectively enforce insurance policies, then it's largely a waste of time.
6.27.2009 4:29pm
Tony Tutins (mail):
I'm rather shocked that a member of the American Enterprise Institute is exhorting Americans to continue to pay for health care development for the benefit of billions of free-riding foreigners.
6.27.2009 4:37pm
Tom952 (mail):
"but the amounts still pale in comparison to the waste that is inherent in government funded health care of any kind."

Jim - Where did you get that notion? Is that anything more than your opinion?

CMS is an astoundingly efficient government bureau. I have never read of a fraud involving CMS that compares to the magnitude of fraud revealed in the past few years on Wall Sreet.
6.27.2009 5:16pm
gattsuru (mail) (www):
Probably not as true as you might think; private plans are getting away with murder insofar as civil litigation is concerned.


Bringing concerns to the national government in similar situations as matters of health care -- for example, Veteran's Affairs office errors -- has demonstrated that you can only sue the government as allowed by statute. Full stop. Right now that means that feds decide what and even whether you deserve compensation, and then six months after they finish mucking around on that, you have to prove in court that it wasn't fair.

Extremely truncated discovery is child's play by comparison.
6.27.2009 5:43pm
Allan Walstad (mail):

I'm rather shocked that a member of the American Enterprise Institute is exhorting Americans to continue to pay for health care development for the benefit of billions of free-riding foreigners.

Their free ridership is a drag, no doubt. Sharp of you to recognize it for what it is. What if the alternative, for us, is to rip the guts out of our capacity for future medical advances?
6.27.2009 5:50pm
RPT (mail):
Another corporate sponsored AEI lobbyist explains why the status quo should not be disturbed. Change=End of the World.
6.27.2009 5:53pm
pluribus:
This discussion is hitting me in a very sore spot, as my significant other is currently in the midst of a combined surgery and chemoterhapy treatment for cancer. The costs are truly, truly frightening. The cost of the drugs for one single treatment of chemotherapy is $10,000. And that doesn't include the costs of the doctors, nurses, and facility that administer it. And there will have to be at least twelve such treatments--possibly more. My significant other is over 50, but not eligible for Medicare. Many of the costs are not covered by health care insurance offered under the sponroship of AARP. The cost of this single chemotherapy regime could easily reach $250,000, and we are learning that much of it is not covered by any insurance. Where is an ordinary person going to come up with that much money--in cash--before the bill is referred to a collection agency, and liens are filed on our house? We are not impoverished, but we are not rich either, and up to now we have been able to pay our way in the world, working hard, paying our taxes. Now I doubt if that ability isn't going to be crippled. If the government were to impose limits on the costs of these treatments, as they currently do in Canada and other western countries, I would not cry bitter tears. If a public plan would help them to reduce costs, so that health care were more equally available to the general population, I would not be up in arms. Cry monopsony all you want. I'm not scared by words I've never heard of before, uttered by ideologues. I am scared by having to choose between a life of poverty and spending the rest of my life without the most important person in the world to me. And I am learning that there are millions of Americans in the same position we're currently in.
6.27.2009 6:19pm
David Schwartz (mail):
I think the primary drag on medical innovation is the lack of stratification. If you invent something that makes medical care better, either nobody's supposed to get it or everyone's supposed to get it. If you don't have a premium market for those who are willing and able to pay more, you won't get the 'push down' effect, a major driver of innovation.

It's because of this effect that you probably have a computer with an LCD display. It's because of this effect that widescreen televisions are affordable. It's because of this effect your $200 CPU today is faster than a $1,000 CPU from 8 years ago.
6.27.2009 6:29pm
Kazinski:
Pluribus,
If the government were to impose limits on the costs of these treatments, as they currently do in Canada and other western countries, I would not cry bitter tears.

Yeah, they impose limits on the costs of treatments by rationing. When I take my wife in for her semi-annual PET scan, the waiting room is 1/4 Canadian patients. There is a 6 month waiting list in Canada, and most patients can't wait that long. MRI's also have multi-month waiting lists. It takes about 2 months to start treatment for many cancers after initial diagnosis in Canada.

Don't be so concerned with money, just be glad your SO is getting her treatment in a country that puts quality first, not money. In Canada and GB they put money first and the quality suffers.
6.27.2009 6:50pm
MCM (mail):
And of course, there's absolutely no way the government could subsidize the production of MRI machines or PET scanners. If we had socialized medicine, it would necessarily be exactly like it is in Canada, right?
6.27.2009 7:00pm
Bonze Saunders (mail):
From the article:


...a public plan would... have two disastrous consequences. The first will be to cause most Americans now covered by private insurance to move to public insurance -- one step away from single-payer health care. The second will be to undermine incentives to develop more of the immensely valuable medical technology that is central to all of health care.

Disaster #1, "single-payer health care," is not necessarily a disaster. It could be awful, it could be mediocre... or it could be an improvement on a "system" which is... a disaster.

As for Disaster #2, "medical technology... is central to all of health care" is a fallacy which is obvious on its face: preventive care which reduces bad health habits has a much better payoff than treating the resulting diseases.
6.27.2009 7:16pm
Kirk:
Pluribus,

You write as if the only other option is your SO gets the best treatment, but it costs you less out of pocket.

Sorry, but it's even more likely that the option is going to be, you don't get the $250k treatment approved in the first place.
6.27.2009 7:18pm
pluribus:
Kazinski:

When I take my wife in for her semi-annual PET scan, the waiting room is 1/4 Canadian patients. There is a 6 month waiting list in Canada, and most patients can't wait that long.


We have a close friend in BC who is employed in a responsible position in the Canadian system. He visited us for a week after the beginning of this cancer crisis and informed us that critical or emergency care (such as treatment for the kind of cancer we are now experiencing) is handled without delay in Canada. Patients with these kinds of needs are moved to the head of the line. So please retire that bugaboo about lone lines for critical care in Canada.

Are you aware that there are many Americans who seek health care outside the US? Our daily paper recently detailed the story of a local man in Arizona, self-employed, who could not afford the astronomic costs of knee replacement surgery in the US and went instead to New Zealand, where the same surgery was provided at a fraction of the cost.

Further, there are many Americans who go to Canada for drugs. They find the costs there much, much less than in the US. Traffic across the US-Canadian border moves both ways.
6.27.2009 7:20pm
interruptus:

In Canada and GB they put money first and the quality suffers.

Although this is popular to state without evidence, the actual empirical data is quite mixed: studies attempting to quantify health outcomes are all over the map, with the plurality showing no statistically significant difference, and the rest falling about equally on one side or the other.

There's evidence of indirect variables like waiting times, but direct statistical evidence of treatment outcomes, i.e. that a cancer sufferer in one country has better odds of survival than a sufferer of the same cancer with he same demographics in the other country, seems to be inconclusive at best.

Although it's written by Canadians, this review article appears to be a fair summary of 50 or so studies that have tackled the issue, and you can dig into the studies themselves (most of which are written by Americans) if you wish.
6.27.2009 7:20pm
eyesay:
Mr. Calfee is a resident scholar at the American Enterprise Institute. As such, he is paid, not to do actual unbiased research and report the findings, but to generate creative writing that agrees with the institute, which is dedicated to preserving corporate profits and corporate welfare, and has no concern whatsoever for the poor, the ill-fed, the ill-housed, and those with inadequate health care. His writing is full of unsupported assertions, many of them using undefined terms. For example, he frets endlessly about motivating R&D, but there is no discussion of whether this is R&D in the development of vaccines, drugs, surgical techniques, diagnostic tools, or even motivating patients to live healthier lifestyles and follow prescribed regimens. And there is no evidence presented showing how innovations in these areas have been generated in the past (including by government and nonprofit agencies), how significant the profit motive was in their discovery, and how profit opportunities for future innovations would be affected by having national health care insurance for working families, as we already do for retirees.

Like all pundits standing in the way of what the public wants, which is single-payer health care or at least a federal option, Mr. Calfee is great generating speculative creative writing but short on evidence. This is hardly surprising, given that every industrialized nation in the world, except the one in which the American Enterprise Institute is headquartered, has nationalized health care that provides better care at lower cost than the cockamamie system the American Enterprise Institute seeks to preserve.
6.27.2009 7:22pm
rosetta's stones:
I've told this anecdote in here before, I believe, about the Canadian health system. My Great Aunt Catherine in Windsor had her knee replaced successfully years ago, and when it came time for the other one, she wanted to go with the first doctor, but no dice, she was forced to go with the next guy in the queue, who botched it. Dear Aunt Catherine suffered the rest of her life with that botch.
6.27.2009 7:27pm
pluribus:
Kirk:

You write as if the only other option is your SO gets the best treatment, but it costs you less out of pocket. Sorry, but it's even more likely that the option is going to be, you don't get the $250k treatment approved in the first place.

This is not a new or experimental treatment, but a medical treatment available on a standard basis all over the United States. The oncologist informed us that the same treatment would be available here as at MD Anderson in Houston, run in conjunction with the University of Texas (yes, I know, a hated governmental agency!). Anderson is the world's most respected cancer treatment center. A Turkish friend informs us that people from his country come here for treatment at Anderson. Some Americans can afford the kind of treatment we are receiving, some cannot. Some write out a check for the full amount, or have their insurance companies do so. Some are forced into bankruptcy. Some fight for their lives while they are also fighting their insurance companies for the coverage necessary for this kind of treatment. Don't tell me that the government plan will give treatment to some but not all, if it requires that all be insured.
6.27.2009 7:28pm
pluribus:
rosetta's stones:

Dear Aunt Catherine suffered the rest of her life with that botch

You're not arguing that medical malpractice is unique to the Canadian system, are you? Or that botched knee operations never happen in the US?
6.27.2009 7:31pm
Borris (mail):

If we had socialized medicine, it would necessarily be exactly like it is in Canada, right?

Doubt it'll be so nice.
Probably just like England's.
6.27.2009 7:32pm
rosetta's stones:
"...what the public wants, which is single-payer health care or at least a federal option..."

You sure that's what the public wants? I certainly don't.

I don't know what you mean by "federal option", and I guess we're guessing what'll be in that 2,000 pages of legislation, and hope somebody will know.

I can tell you that MA and TN have both tried versions of what it appears some want, and the results appear mixed at best. TN was seeking to dump that system shortly after it came about. MA has been panned in places.

Try reforming Medicare and Medicaid first, then get back with us about the latest scheme.
6.27.2009 7:34pm
Borris (mail):

As for Disaster #2, "medical technology... is central to all of health care" is a fallacy which is obvious on its face: preventive care which reduces bad health habits has a much better payoff than treating the resulting diseases.


And I think you have stumbled across one of the pain problems of Gov' health care.
Once the Gov gets to decide what medical costs it'll cover, it gets to dictate your "health habits" **cough** how you live your life **cough**.

After all, with the state paying for health care, it has every right to keep an eye on what you eat ... smoke .. do with your leisure time/hobbies.
The Gov gets to choose which lifestyles are medically covered and which aren't.
6.27.2009 7:42pm
Kirk:
Bonze,

Not all diseases are the result of "bad health habits"; in fact it's safe to predict that we're all going to die of something regardless of our habits, and there's no way to predict which disease of our old age is going to end up being the fatal one that we shouldn't have spent money on until it proves to be fatal.
6.27.2009 7:45pm
rosetta's stones:
"You're not arguing that medical malpractice is unique to the Canadian system, are you? Or that botched knee operations never happen in the US?"

Medical malpractice is actionable in the US. I suspect the Canadian government would tend to discourage that which we celebrate here, as that would be their prime motivation, to save money. People tend to stay on their toes if the lawyer sharks are on the prowl, and might tend to slack off if they're not, particularly the bureaucrats of the system.

I can't believe I'm actually assigning a good to litigators. I did call them sharks though.

The evil with Aunt Catherine's case is that first, she didn't get to choose her doctor, one she'd already had successful experience with. If I put her story up to the AEI, and showed it to seniors across the land, socialized medicine would be dead as disco here. I watched her limp around, with a walker, face twisted with pain, finally immobilized.

Malpractice maybe, but they stole her freedom to choose her medical practicioner. That won't play here. Even more, rationing will bring on riots.

Again, this is anecdotal, and I'm not condemning anything Canadian, and maybe even things have changed there since then, but this is a true horror story, imo.
6.27.2009 7:46pm
Allan (mail):
One big problem with government run anything is due process.

For example, if a supplier screws company X, or ccmpany X even thinks it was screwed, it can cease doing business with the supplier. Companies don't even need a reason to change suppliers.

The government, on the other hand, must give the supplier due process. That protects against corruption, but it also provides undue protection to cheats.
6.27.2009 7:52pm
pluribus:
rosetta's stones:

Malpractice maybe, but they stole her freedom to choose her medical practicioner. That won't play here. Even more, rationing will bring on riots.

So rationing of health care will bring on riots, but 47 million uninsuired Americans won't? You have a strange idea of what makes people riots. BTW, we do have health rationing in this country now. Health care is made available at astronomic prices to those who can afford to pay it, and rationed out through emergency rooms and clinics to those who can't--but only after they have first impoverished themselves to qualify for the emergency rooms and clinics. You would think that would bring on riots, too, wouldn't you?

Your story about Aunt Catherine breaks down on the part about choosing her own physicians. I suppose you have heard Obama say repeatedly, over and over again, that people will be able to keep their present health care plans if they are satisfied with them. Ifd their present plan gives them the right to pick their own physicians, they will continue to be able to do so. That will be written into the law. And the government will enforce the law.


Again, this is anecdotal, and I'm not condemning anything Canadian, and maybe even things have changed there since then, but this is a true horror story, imo.

Yes, I realize you just threw that bit about riots out for laughs--not to condemn the Canadian system. But are you quite sure that Canadian law provides no compensation for the victims of medical malpractice, or that it does not impose penalties on perpetrators of malpractice? Is it the policy of the Canadian law that medical malpractice is just fine--no problem at all? I seriously doubt it.
6.27.2009 8:13pm
Soronel Haetir (mail):
pluribus,

And if you don't believe that particular part of the plan? That promise is entirely dependant upon someone keeping whatever coverage they currently have. Even for the case of someone moving from self coverage to a subsidized plan that's not covered in the outline. And there is ample reason to believe that private plans would rapidly get phased out or altered.
6.27.2009 8:26pm
rosetta's stones:
"So rationing of health care will bring on riots, but 47 million uninsuired Americans won't? You have a strange idea of what makes people riots."

Tell the seniors of this country you intend to inflict an Aunt Catherine on 'em, then get back with me. No politician will go for this, because they fear being tossed out on their butt, following the riots.


"Health care is made available at astronomic prices to those who can afford to pay it..."

They're the ones paying it, so why are you concerning yourself? Stick to solving problems, and keep it simpler, and you may get some traction on something. Right now, with a bayonet in your teeth, climbing the socialist medicine ramparts, you're doomed to fail. It's happened before.

"...and rationed out through emergency rooms and clinics to those who can't..."

But they get health care, no?

"--but only after they have first impoverished themselves to qualify for the emergency rooms and clinics. You would think that would bring on riots, too, wouldn't you?"

Hasn't so far, so I guess they're fine with it. I think you may find that most of the 47M you're claiming to be uninsured are already impoverished. There is a subset that we may wish to address, but you've proposed nothing to either identify or address them.

"Your story about Aunt Catherine breaks down on the part about choosing her own physicians. I suppose you have heard Obama say repeatedly, over and over again, that people will be able to keep their present health care plans if they are satisfied with them."

And I should believe him, right? Silly me, why didn't I think of that? Just believe, and it will be so.

Aunt Catherine's story broke down the instant socialized medicine denied her a choice of doctors.


"Ifd their present plan gives them the right to pick their own physicians, they will continue to be able to do so. That will be written into the law. And the government will enforce the law."

Until they don't.




"But are you quite sure that Canadian law provides no compensation for the victims of medical malpractice, or that it does not impose penalties on perpetrators of malpractice? Is it the policy of the Canadian law that medical malpractice is just fine--no problem at all? I seriously doubt it."

My contribution here is anecdotal, but if you're firmly interested in malpractice in Canada, bring us some data for review.
6.27.2009 8:38pm
interruptus:

Aunt Catherine's story broke down the instant socialized medicine denied her a choice of doctors.

Since the current system does likewise, how is this a change? I'm not able to go to the dermatologist I used to go to, because he's no longer in my HMO network. This happens all the time.
6.27.2009 8:40pm
pluribus:
Soronel Haetir:

That promise is entirely dependant upon someone keeping whatever coverage they currently have. . . . . And there is ample reason to believe that private plans would rapidly get phased out or altered.

Private plans would not be phased out or altered if the public thinks the private plans are preferable. If the private plans are in fact better than the public plan, the private plans will succeed in the competetive markeplace, and the public plan will have to improve or wither away. If the private plans are not better, the public plan will succeed. Isn't that the nature of competition?
6.27.2009 8:42pm
Pro Natura (mail):
Several times MRIs and CAT scans have been mentioned. Today these are available in almost every hospital in the US.

I was doing health care policy analysis in Massachusetts back in the late 1970s, early 1980s when these technologies were first coming on line. At the time the same liberals who today are so enthused by Obamacare were ecstatic over a new government program to reduce medical costs called Certificates of Need (CON for short--funny how the acronym sometimes captures the essence of a program).

The idea was that government bureaucrats would determine whether or not a hospital or medical practice needed a new technology and if they decided it did a CON would be issued allowing the hospital to purchase the desired equipment. The bureaucrats in Massachusetts decided the state needed only two MRIs.

Fortunately, the hospitals and doctors revolted and CON programs across the country were scrapped. If the government bureaucrats had won, today MRI scans would be as rare as face transplants and in the meantime millions of people would unnecessarily have died from diseases such as renal cancer. Every time the government of this country gets involved in the country's medical system great harm is done. Nothing will be different with this latest plan.
6.27.2009 8:46pm
pluribus:
rosetta's stones:

Your comments here are quite flippant. Not the sort of responses I would expect from someone who has actually experienced the horrors of the present system. I am experiencing them right now, and to me the subject is deadly serious.

My contribution here is anecdotal, but if you're firmly interested in malpractice in Canada, bring us some data for review.

Dear rosetta's stones, you suggested here that Canadian law doesn't provide redress for malpractice. I did not suggest anything on that subject, but merely asked if you were sure about that. If data is to be brought in, I urge you to do it. You must be aware that Obama is firmly supportive of the present American tort system. I believe it needs substantial reform, and on that subject I part ways with him. But please do not argue that he wants to put in place a health care system without malpractice liability. It just isn't so.
6.27.2009 8:51pm
Borris (mail):

One big problem with government run anything is due process.


Let us not forget equal protection.

All of the other Anglo-countries that have socialized medicine don't have written Constitutional rights.

Wait until a black man and a white man both need a liver transplant, and the white man gets it.
You'll see that case in court ASAP.
6.27.2009 8:51pm
geokstr (mail):

pluribus:
So rationing of health care will bring on riots, but 47 million uninsuired Americans won't?

Can we please stop using this propaganda about the 47 million uninsured Americans?
The '47 Million Uninsured' Myth

Huge blocks of this "47 million" are made up of people with incomes over the median who can afford health insurance but choose not to buy it, others who are young and consider it not worth paying for, more who are uninsured for only a few months (between jobs, etc), illegal undocumented differently papered aliens workers, and/or who are eligible for government programs of one sort or another but who have not signed up.
6.27.2009 8:55pm
Tony Tutins (mail):

What if the alternative, for us, is to rip the guts out of our capacity for future medical advances?

Because we are the only people in the developed world who can benefit from medical advances? Or because rolling over and playing dead is the most our capitalists are capable of?

The idea was that government bureaucrats would determine whether or not a hospital or medical practice needed a new technology and if they decided it did a CON would be issued allowing the hospital to purchase the desired equipment. The bureaucrats in Massachusetts decided the state needed only two MRIs.

There were only a handful of MRIs in the world around 1980. Owning your own MRI back then would be like owning your ENIAC.

My brother needed a CAT scan in 1974, so he was sent to a nearby medical center. Newly developed technology is often insanely expensive, to own, to maintain, and to operate.

But technology marches on. The Apple II outperformed the IBM 360 of a dozen years before.
6.27.2009 9:17pm
Tony Tutins (mail):

Huge blocks of this "47 million" are made up of people with incomes over the median who can afford health insurance but choose not to buy it, others who are young and consider it not worth paying for, more who are uninsured for only a few months (between jobs, etc), illegal undocumented differently papered aliens workers, and/or who are eligible for government programs of one sort or another but who have not signed up.

So the truth behind the myth of the 47 million uninsured is that there are actually 47 million uninsured.

Similarly, the number of people who are not employed includes people who could start their own businesses but choose not to, others who are young and travelling the world, some who are unemployed for only a few months, people who are not supposed to be here but are out of work, and people who probably could get jobs if they would only apply.
6.27.2009 9:21pm
Bruce Hayden (mail):
The demographic that was not included in geokstr's article are the young adults who voluntarily go without health care because they have better things to spend their money on (and they know they are going to live forever anyway). These are likely a decent percentage of the citizens and legal residents who are in the lower income brackets.

My anecdote - maybe four years ago, I was working as a volunteer at a ski area. Most of the paid staff who worked with me were single males in the 18-28 year old bracket. At about $10 per hour, they would likely fall into the under $25k income bracket. One day, one of guys tried to do a flip on his board, landed on his head/neck, and was hauled off the mountain on a backboard. He thought he was fine, but they wouldn't release him for work without a CAT scan (remember, he spent his work time riding his snowboard all day). He couldn't get a CAT scan, because he didn't have any insurance, so he worked for the rest of the season as our dispatcher, riding the lift up in the morning, sitting in the hut during the day, and then down at night.

The ski area was owned by Vail Resorts, which offered a $5 a month accident policy (which would have paid for the CAT scan), and a fairly cheap medical policy (ditto). He had neither. For the price of one beer a month, he went without even an accident policy.

But he wasn't alone. Out of maybe a dozen young male adults in their early 20s working with him, NONE of them were carrying the very cheap insurance that VR was providing them. ALL of them were skipping even the accident policy, for the one extra beer a month it saved them.
6.27.2009 9:25pm
Ben P:

Huge blocks of this "47 million" are made up of people with incomes over the median who can afford health insurance but choose not to buy it, others who are young and consider it not worth paying for


You're missing the obvious here.

These "uninsured" might pay day to day medical expenses, but if they get in a Catastrophic accident they almost universally lack the ability to pay the massive costs associated. So they're just as much a cost on the system as the "legitimately" (whatever that means) uninsured.

Besides, how are you going to draw a line between a person who "can't" afford insurance, and a person who thinks "I can spread it really thin and get health insurance" or live slightly better and not have it.


Either way the primary cost on the system from the uninsured isn't that they aren't paying for insurance or that they pay themselves for routine medical care, but that when they need the real care, they have to go to an emergency room and they get that care for "free" under EMTALA and then hospitals have to pass the cost onto everyone else.
6.27.2009 9:28pm
Bruce Hayden (mail):
So the truth behind the myth of the 47 million uninsured is that there are actually 47 million uninsured.
No one is denying that. The question is why are they uninsured, and whether it is our obligation to address that problem, esp. at the probable cost of destroying our current health care system.

The problem is that if you remove those who can afford insurance and don't have it, those who are here illegally (and arguably shouldn't be covered by the government), and those already eligible for some state or federal program but not already enrolled therein, then there don't appear to be that many uninsured left, and it may be much more efficient to just address covering them with existing programs.
6.27.2009 9:31pm
Toby:
Pluribus

- you commented that treatment was common all over the country and folks come from all over the world to get it. I presume you recongnize that, means that people all over the world, based on your account, cannot get it at home. And yet you argue that you want a systems as is in use all over the world.

- To extend on geostkr's comments, one reason that health insuance is too expensivce for the young is that they must subsidize the old, and those who have made expensive life style choices. A civilization that does not respect the old is doomed. A civilization that does not look to the future is doomed even faster. We as a civilization are taxing the young for health.
6.27.2009 9:32pm
Lib (mail):
pluribus:

If the government were to impose limits on the costs of these treatments, as they currently do in Canada and other western countries, I would not cry bitter tears.
Suppose the expensive medication you mentioned were not available today and your SO succumbed to cancer. If the treatment then became available in 2019 and it turned out that all the technology (including the actual drug showing success in lab animals) was in place in the 1990's but wasn't pursued because the cost of completing development and trials was high and had a significant chance of failure after spending hundreds of millions of dollars but the profit would likely have been severely limited by government cost controls. Would you cry any bitter tears because government cost controls had denied your SO (and hundreds of thousands of others for over a decade) of effective care? True, it would have been "fair" (no one got the medication - rich and poor alike), but I would not consider this a better outcome.

Compounded interest and technology growth are not dissimilar. Seemingly minor reductions in annual interest or technology growth (say from 8% down to 6%) has stunningly (to those that went to public schools that is) negative impacts on the account balance or state of technology in fifty years.

Slowing the growth of health care technology will kill people as surely as denying them expensive care because they can't afford it. Advanced technology over time become more cost effective (both because initial development costs have been recovered and because as more copies are made, the more optimization and incorporation of other technology occurs) and will usually become available to a much wider range of patients anyway.

I believe that if one is unwilling to accept as the "national standard of care" the level of medical technology from 25 years ago (if memory serves me well, PET scans were not yet available, MRI scans were fairly rare, and CT scans much less common and much less sophisticated than today), one should be very concerned about condemning future generations to "substandard care" in order to be "fair" to everyone in the U.S. today.
6.27.2009 9:32pm
Libertarian1 (mail):
Because of my deep respect for most anything law-related I have been an active participant here for years. I know very little about law but as a physician, pharmacist, pharmacologist, researcher and practitioner know quite a bit about medicine. I have been reading blogs and columns about the proposed Obama/Kennedy plans and am shocked at the lack of knowledge by commenters.

My interpretation is the proponents think there are major major problems in our health care system, 47 million uninsured, high costs, average results, a system not functioning well. Rather than saying what can we do to fix it we have the the highly unscientific approach of lets make changes first and see what that produces. If it makes it worse than consider alternatives. Also don't listen to warnings about other countries attempts to solve this universal problem. Sugar coat or deny deficiencies.

Rather than ask people who live every day of their lives treating patients, since you don't trust them, you ignore their warnings.

We have an injectable available to treat cripling, life ruining arthritis. Cost $15,000/$20,000 year for the rest of the patients life. Pluribus, here is how Medicare handles it. Treat with alternate cheaper therapy A for 6 months and if it doesn't work use alternate therapy B for 6 months. Then call us. Is this what you want for your wife? That is what you will get. Especially because she is older. Don't be in denial. The UK severely limits therapy for the elderly as it is not as cost effective. That is why the US is #1 in longevity of patients aged 65+. We at least treat some of them. If you really think Medicare, and by extension single payment, is going to treat every American who would like the $250,000 drug I have this bridge to sell you. You are taking every problem you see in our system and think somehow magically single payer or Obamacare will solve them.

The answer that obviously comes first to the liberal mind is, why should the drug cost $250,000? Lets cut the price. Simple solution. First fact, a new breakthrough medication costs an average of $1B to research and develop. Just where do you think the therapy will come from if this miracle drug you want for your wife doesn't work. Who will finance the $1B? The only thing I can guarantee is won't come from the government. We have government medicine throughout Europe and Canada. How many medications have their governments developed. Just doesn't happen.

Someone asked if doctors are dropping out of Medicare. Firstly it is accepted that there are far too few "generalists". Secondly every year Medicare cuts physicians payment by around 4%. Where are we going to get the physicians to treat these extra 47 million patients. (BTW, 10/47 are "undocumented" or "illegal" We need a policy decision if America wishes to cover them). Now, just where are we going to get brilliant new physicians from? I can picture the ad- we pay less and you have less prestige and can't do half the treatments you want but go into medicine.

I am older so my demographic of friends skews old but my friends are dropping out of accepting medicare at a rapid rate. Medicare covers 91% of the cost of a hospitalized patient and the difference is made up through private paying patients. What is Obamacare going to do when there are no more major Oxford, Guardian, Aetna etc and hospitals begin to close?
6.27.2009 9:33pm
Bruce Hayden (mail):
Either way the primary cost on the system from the uninsured isn't that they aren't paying for insurance or that they pay themselves for routine medical care, but that when they need the real care, they have to go to an emergency room and they get that care for "free" under EMTALA and then hospitals have to pass the cost onto everyone else.
I am not sure though how that justifies the proposed Obamacare. Their catastrophic care is already being factored into everyone else's health care costs (as is their more routine care at the ER). And, if their non-critical care is somehow limited because of their voluntary non-insurance, then why is it everyone else's responsibility?
6.27.2009 9:37pm
rosetta's stones:
Dear rosetta's stones, you suggested here that Canadian law doesn't provide redress for malpractice.

No, I didn't. Work on your comprehension.

I pointed out the obvious bias that socialized medicine will bring on, against malpractice actions that take money directly from government.


If data is to be brought in, I urge you to do it.

You're the one interested in malpractice, so that falls to you. I'm quite comfortable that government will dampen malpractice, once they're directly responsible for paying for it. Should you be able to campen my comfort level, show me the data that does so. Nothing but data will do that, and I'll remain comfortable until you produce some.

"But please do not argue that he wants to put in place a health care system without malpractice liability."

Again, work on your comprehension skills, as you seem to be fantasizing arguments that I haven't made.

Oh, and your opinions on the presence or absence of flippancy, or experience level, or anything else you seem to be fantasizing over, is irrelevant. Stick to the topic, try to comprehend better, and you'll be fine.
6.27.2009 9:43pm
Bruce Hayden (mail):
Medicare covers 91% of the cost of a hospitalized patient and the difference is made up through private paying patients.
That is, of course, an average. I was talking on the plane the other day with a CFO of a hospital. He claimed that at his hospital, Medicare was paying at about 50% of cost, and the state plan at significantly less than that. And, as pointed out, that means that everyone else was picking up the difference.
What is Obamacare going to do when there are no more major Oxford, Guardian, Aetna etc and hospitals begin to close?
This is really the biggest problem with the government entering the "insurance" market. The more people who join its plans, the more care will be significantly under reimbursed, and the more everyone else will have to pay through their private health care policies to fund it, with fewer and fewer people people covering more and more of the government underpayments. It is this leverage that is so potentially devastating in a government alternative, and why ultimately the government will be covering most of the population. And then, it won't have a choice of rationing or cramming down reimbursement rates, since there won't be anyone else left to pay for the difference between the cost of the services and what the government pays for them.
6.27.2009 9:48pm
Ben P:

I am not sure though how that justifies the proposed Obamacare. Their catastrophic care is already being factored into everyone else's health care costs (as is their more routine care at the ER). And, if their non-critical care is somehow limited because of their voluntary non-insurance, then why is it everyone else's responsibility?


In part because that method of treating the uninsured (for actual disease based things as opposed to true accidents) is about the most inefficient way of treating people who lack insurance.
6.27.2009 9:48pm
BGates:
I suppose you have heard Obama say repeatedly, over and over again, that people will be able to keep their present health care plans if they are satisfied with them

I've heard him say no taxes on anyone making less than $250k, no executive authority for indefinite detentions, no lobbyists in the administration, 5 days' review before signing any bill, he's as close to former tangential acquaintance Jeremiah Wright as he was to his own grandmother, passing the stimulus bill will cap unemployment at 8%, etc, etc, etc.
6.27.2009 9:49pm
BGates:
So the truth behind the myth of the 47 million uninsured is that there are actually 47 million uninsured.

The truth is there are over 3 billion uninsured. You're making an arbitrary if not racist decision to ignore non-citizens who haven't snuck into the country yet, so you can hoard all your cracker money instead of bringing health care to The People (who, if united, shall never be defeated). I disagree that I have a moral obligation to a person based on his disregard for immigration law.
6.27.2009 9:55pm
Bruce Hayden (mail):
In part because that method of treating the uninsured (for actual disease based things as opposed to true accidents) is about the most inefficient way of treating people who lack insurance.
Then, fine, figure out a way to cover them, and for those of them who can afford it, to pay for it, and ignore those who shouldn't be able to depend on our government because they aren't here legally. Once you break down the population of uninsured into its constituent parts, the problem is very tractable.

But that isn't what is being proposed.
6.27.2009 10:00pm
JoeSixpack (mail):
pluribus:


"If the government were to impose limits on the costs of these treatments, as they currently do in Canada and other western countries, I would not cry bitter tears."

Suppose the government says it won't pay for your significant other's treatment, but it will pick up the cost of euthenasia?

http://www.foxnews.com/story/0,2933,392962,00.html
6.27.2009 10:11pm
David M. Nieporent (www):
So rationing of health care will bring on riots, but 47 million uninsuired Americans won't?
There are not 47 million uninsured Americans. There are about 35 million uninsured Americans and 12 million uninsured illegal immigrants, and by "35 million uninsured Americans" we actually mean 35 million Americans who went without insurance at some point in a year (rather than people without insurance at all), and of course being "uninsured" is not at all the same thing as not receiving medical care, despite left-wing propaganda designed to obscure the difference.
6.27.2009 10:16pm
pluribus:
rosetta's stones:

Work on your comprehension

Thank you for your sympathetic apparoach to this problem. I am in a personal crisis, and I appreciate sympathy. I am sorry that you have so little respect for my comprehension. If everyone comprehended the problem as well as you, I am sure we wouldn't have any problems.
6.27.2009 10:17pm
Ben P:

Then, fine, figure out a way to cover them, and for those of them who can afford it, to pay for it, and ignore those who shouldn't be able to depend on our government because they aren't here legally. Once you break down the population of uninsured into its constituent parts, the problem is very tractable.

But that isn't what is being proposed.


How much are you willing to spend differentiating between those who can and can't?
6.27.2009 10:22pm
David M. Nieporent (www):
Should have read further before posting, as geokstr made the point.

In any event:
Either way the primary cost on the system from the uninsured isn't that they aren't paying for insurance or that they pay themselves for routine medical care, but that when they need the real care, they have to go to an emergency room and they get that care for "free" under EMTALA and then hospitals have to pass the cost onto everyone else.
One of those talking points that makes no sense, that shows one is simply parroting talking points. It makes less than zero sense to campaign for socialized medicine by attacking EMTALA for forcing hospitals to "pass the cost onto everyone else," when the entire purpose of socialized medicine is to "pass costs onto everyone else."
6.27.2009 10:24pm
rosetta's stones:
For whatever personal crisis, you have all my sympathy. You seem to want more than that, however, and that's what is being discussed here.

It's not a matter of my opinion of your comprehension, it's the fact that you haven't demonstrated the ability to comprehend... and appear to fantasize what's posted.

You also appear to conclude that I comprehend "the problem" better than "everyone". A curious conclusion, and it'd be hard for me to come to such a conclusion, based upon what I've posted here, but go for it if you wish.
6.27.2009 10:26pm
Bruce Hayden (mail):
How much are you willing to spend differentiating between those who can and can't?
The problem is mostly between those who won't, those who shouldn't be covered (because they are illegal), and those who are eligible for some government program and aren't enrolled.

I think the thing that we need to do first is determine how much health care we, as a society, want to provide those who cannot pay for it themselves, and from there work backwards. And that would require a national debate, which may not give the results that the politicians pushing this would like.

Instead, we have a rush to implement their plan, whatever it is, before we can have that debate, and, really ignoring the question of what is needed and what (and for whom) the American people are willing to pay for, because, I think, the answers would not be what those politicians want to hear.

So, I don't know what would be a good overhead rate for determining who should get free health care, and who shouldn't. But a lot of that is because I don't know the metrics of what we want to accomplish here.
6.27.2009 10:38pm
JK:
I don't think anyone has pointed out yet that modern pharmaceutical research is essentially just gaming patent law, and results in extremely little useful innovation for the massive windfalls that are given.
6.27.2009 10:40pm
JK:

Instead, we have a rush to implement their plan, whatever it is, before we can have that debate, and, really ignoring the question of what is needed and what (and for whom) the American people are willing to pay for, because, I think, the answers would not be what those politicians want to hear.


Are you kidding me? Where have you been the past 50 years? If you, or anyone else, has opted not to take part in this debate, then that's unfortunate, but people have been debating these issues for my entire life. The idea that this is some new issue that needs further debate (among serious people who understand the current system) is a joke.
6.27.2009 10:44pm
Ellen K (mail) (www):
My concern about the Obamacare plan is that it will produce an insatiable agency which will demand just as much if not more from our paychecks than currently deducted. We are barely making it now, if they double the deductions, I might as well not work at all.
6.27.2009 10:55pm
Pro Natura (mail):
I don't think anyone has pointed out yet that modern pharmaceutical research is essentially just gaming patent law, and results in extremely little useful innovation for the massive windfalls that are given.
Then the new treatment pluribus has been posting about must just be a figment of his imagination.
6.27.2009 11:01pm
mcbain:

I don't think anyone has pointed out yet that modern pharmaceutical research is essentially just gaming patent law, and results in extremely little useful innovation for the massive windfalls that are given.


No, you are the first. Also, wrong.
6.27.2009 11:24pm
Michelle Dulak Thomson (mail):
Pro Natura,

I think I would have put that a little more tactfully, but you do have a point. If the treatment pluribus' SO is looking at isn't a significant advance over the standard of, say, 20 years ago, would anyone waste time considering it? If it's not a significant improvement, obviously it's hideously overpriced; but, then, if it's not a significant improvement, you don't bother complaining that it's hideously overpriced; you just ignore it and try something else.

Someone who pipes up in discussions of this subject on this and other blogs remarked once, IIRC, that we could make Medicare and Medicaid solvent, and insure the rest of the country to boot, if we pledged to use only medicines and techniques developed by the end of the Carter Administration. I don't know if that's true, but it's uncomfortably plausible. It's the fancy new stuff that costs the big bucks.

But, anyway, if "Obamacare" were about addressing situations like pluribus' one, where the illness is rare and the treatment horrendously expensive, I wouldn't mind it. That's what insurance is ordinarily for. It's when it turns into a "healthcare plan" and covers every conceivable medical expense that I worry about it. Universal insurance against catastrophic medical expense strikes me as a good idea, and I wouldn't mind even the government running it.
6.27.2009 11:42pm
Kazinski:
pluribus:
Thank you for your sympathetic apparoach to this problem. I am in a personal crisis, and I appreciate sympathy. I am sorry that you have so little respect for my comprehension. If everyone comprehended the problem as well as you, I am sure we wouldn't have any problems.

I appreciate your position. My wife has stage IV cancer, and I am convinced she would be dead or dying today under a single payer health plan. Your concern seems to be your checkbook, not the quality of care your SO is getting. My concern is sacrificing quality, and innovation, in order to save money.

When you say that:

We have a close friend in BC who is employed in a responsible position in the Canadian system. He visited us for a week after the beginning of this cancer crisis and informed us that critical or emergency care (such as treatment for the kind of cancer we are now experiencing) is handled without delay in Canada. Patients with these kinds of needs are moved to the head of the line. So please retire that bugaboo about lone lines for critical care in Canada.

That may be true, but time is of the essence for every cancer patient. In my wife's case when she initially got treatment, her case was considered routine, she wouldn't have been moved to the head of the line. As it was she started treatment within a week, routine case or no. It wasn't until 6 months later that we found out how critical time was at the time. She would be dead now if she were Canadian.

Then I read breathtakingly stupid comments like this one:

And of course, there's absolutely no way the government could subsidize the production of MRI machines or PET scanners. If we had socialized medicine, it would necessarily be exactly like it is in Canada, right?

Once the government takes over health care all expenditures will be a line item in the budget. Of course they'll subsidize it, but it still is not an unlimited fund.

Answer me this, if the choice is an MRI machine in a republican district, or refurbishing a terminal in John Murtha Airport, which one do you think is going to make into the budget. We don't need health care expenditures competing with congressional pork requests, because we all know what is going to win.
6.27.2009 11:45pm
JK:

No, you are the first. Also, wrong.


yeah, pharmaceutical companies would never game the system, they're part of infinitely perfect free market, and can therefore do no wrong.

Here's some further reading from fellow communists:
nytimes

Stanford University

Hopefully those links worked, I haven't done that embedding before, darn 60 character limit.
6.27.2009 11:48pm
interruptus:

Then the new treatment pluribus has been posting about must just be a figment of his imagination.

There are no doubt new treatments, but life expectancy hasn't been particularly improved by them, as far as any empirical data I can find shows. US life expectancy has indeed gradually crept upwards over the past 50 years (from about 70 in 1960 to about 78 today), but almost entirely due to a combination of more widespread childhood vaccination (using, in most cases, pretty old vaccines), decrease in infant mortality (mostly through better hygiene and nursing conditions), and decrease in smoking.

I'd be interested in contrary empirical data, though. Can some area of pharmaceutical advances be ascribed an empirically demonstrable significant role in health or longevity improvements? I'd guess newish vaccines, antibiotics, or antifungals are the most likely candidates, if there are any.
6.27.2009 11:54pm
JK:
Looks like my embedding didn't work, but if you actually care, I'm sure the same 2 minutes on google will allow you to find plenty of info.
6.28.2009 12:02am
Cornellian (mail):
Yeah, they impose limits on the costs of treatments by rationing. When I take my wife in for her semi-annual PET scan, the waiting room is 1/4 Canadian patients. There is a 6 month waiting list in Canada, and most patients can't wait that long.

First, healthcare is largely provincially funded in Canada so this sort of thing varies from place to place. A uniform 6 month waiting list would strike any Canadian as an absurd assertion since if nothing else it would be an incredible coincidence.

Second, what you're saying is that Canadians have the best of both worlds. They get government paid-for health care whenever they like as well as the freedom to purchase health care in the U.S. whenever they want it and can afford it, just like Americans. So how are Canadians worse off?
6.28.2009 12:09am
Cornellian (mail):
My significant other is over 50, but not eligible for Medicare. Many of the costs are not covered by health care insurance offered under the sponroship of AARP. The cost of this single chemotherapy regime could easily reach $250,000, and we are learning that much of it is not covered by any insurance. Where is an ordinary person going to come up with that much money--in cash--before the bill is referred to a collection agency, and liens are filed on our house?

In a free market system you're not expected to come up with the money, you're expected to do without the chemo and get by on the comfort of knowing you're supporting a system that fosters innovation. Canadians get treatment, Americans get a system that fosters innovation.
6.28.2009 12:12am
geokstr (mail):

Ben P:

Huge blocks of this "47 million" are made up of people with incomes over the median who can afford health insurance but choose not to buy it, others who are young and consider it not worth paying for

You're missing the obvious here.

These "uninsured" might pay day to day medical expenses, but if they get in a Catastrophic accident they almost universally lack the ability to pay the massive costs associated.

I don't think I'm missing anything. It is my understanding that the cost of insurance that would cover "catastrophic" conditions, with a very high deductible, say $5-$10K, is quite low, relative to the cost of insurance with low deductibles that covers everything. Wouldn't that solve a lot of the "massive costs" of catastrophic accidents?
6.28.2009 12:14am
geokstr (mail):
PS...to my previous comment, part of the problem with buying even insurance with high deductibles to cover those catastrophic conditions is that you can't wait until you need it to do so, because no insurance company would be dumb enough to sell it to you then. You may have to actually pay for the "insurance" against those conditions for a long time before you actually get to use it. It is my experience that most people, including myself, don't think long term enough to do that.
6.28.2009 12:19am
geokstr (mail):

Cornellian:
Second, what you're saying is that Canadians have the best of both worlds. They get government paid-for health care whenever they like as well as the freedom to purchase health care in the U.S. whenever they want it and can afford it, just like Americans. So how are Canadians worse off?

As long as they have us down here to provide that expensive care when they need it and can afford it, they are obviously not worse off. However, as many of the previous commenters have noted, there are many who believe that if we let Obamacare in here, soon enough there won't be that US safety valve for Canadians or anyone else. Even the rich here will have to go to some other country where the controls haven't killed the best of the best care - say, India, or perhaps to Caribbean islands that will become health providers to the wealthy.
6.28.2009 12:27am
JK:
I must be missing something, how does a public plan stop rich people from purchasing health insurance on a private market? I suppose it's possible with some really odd sitipulations in the bill, but it's a long way from an inherent effect resulting from the fundamentals of a public option.
6.28.2009 12:32am
Kazinski:
Cornellian,

First, healthcare is largely provincially funded in Canada so this sort of thing varies from place to place. A uniform 6 month waiting list would strike any Canadian as an absurd assertion since if nothing else it would be an incredible coincidence.

You are right, that's why in Ontario (the most populous province) PET scans are restricted to clinical trials, and most people can't get them no matter how long they wait. I live close to BC, which has a better situation, they can wait months, or come down to Seattle for a scan within a week.

In Ontario they have horses ass medical bureaucrats that are blocking PET scans for routine use. That is what we are signing up for with government run health care:

"That's an absolute disgrace coming from Ontario," said James Gowing, a hematologist-oncologist based in Cambridge, Ont., and board chairman of the Cancer Advocacy Coalition of Canada.

"I've been embarrassed a number of times to tell people I'm from Ontario and this would be another one."

Dr. Gowing's comments follow a Globe and Mail story that revealed how the University of Western Ontario must send its nuclear-medicine residents to the United States and elsewhere for three months to train on a Positron Emission Tomography machine.

The university cannot offer that training at St. Joseph's Health Care in London due to the low number of cancer patients eligible for the scans in Ontario.

That hospital scans as few as four patients a week, sometimes none.

The residents learned that they had to relocate for PET training after an evaluation conducted by the Royal College of Physicians and Surgeons of Canada, a body that accredits postgraduate medical programs in addition to certifying specialists.


The fact that they have PET scanners and are only using them as little as zero to four times a week is the most damning thing of all.
6.28.2009 12:47am
John Moore (www):

I don't think I'm missing anything. It is my understanding that the cost of insurance that would cover "catastrophic" conditions, with a very high deductible, say $5-$10K, is quite low, relative to the cost of insurance with low deductibles that covers everything. Wouldn't that solve a lot of the "massive costs" of catastrophic accidents?

That takes care of massive accidents, but there are a couple of little problems:

If you have "pre-existing conditions," you may not be able to buy even high deductible insurance at any price. Many Americans today are stuck with their current employer because of this.

Even if you have insurance, the company may cancel the policy after you start incurring large expenses - even if you make all your (rapidly escalating) payments on time. This is called "recision" and is done even by non-profit Blue Cross insurance.

Obama care isn't a solution, but until something is done about the non-portability of insurance, recision of existing policies, and medical underwriting (pre-existing conditions), our system has some big holes.
6.28.2009 12:51am
John Moore (www):

There's evidence of indirect variables like waiting times, but direct statistical evidence of treatment outcomes, i.e. that a cancer sufferer in one country has better odds of survival than a sufferer of the same cancer with he same demographics in the other country, seems to be inconclusive at best.

Actually, there is statistical evidence that cancer survival rates in the US are substantially better than in other first world countries - specifically due to the availability of better treatments that are rationed or delayed elsewhere.

When one looks at overall outcomes, the picture is muddier, but the advocates of socialized medicine, who claim that socialized systems produce better outcomes, are using highly bogus statistics.
6.28.2009 12:53am
Kazinski:
I wouldn't be opposed to a State or Federal Catastophic insurance program, since it would leave the bulk of health care in private hands. It may even improve things as it would encourage people to drop their health insurance and pay as you go, thus add a lot more competition and cost consciousness for the consumer, which is lacking in today's system.

The benefits of such a system is it would leave details about compensation rates and treatment availability mainly subject to the market. With a 5000-10,000 deductible, government decisions wouldn't start kicking in until after initial treatment decisions have been made, and hopefully do less harm.
6.28.2009 1:06am
EMG:
We have an injectable available to treat cripling, life ruining arthritis. Cost $15,000/$20,000 year for the rest of the patients life. Pluribus, here is how Medicare handles it. Treat with alternate cheaper therapy A for 6 months and if it doesn't work use alternate therapy B for 6 months. Then call us.

Interesting to see that brought up - my SO needs that drug to be able to function. Which means that sometimes, he doesn't function. Though a highly skilled professional, he can't hold down a corporate job because of his condition (and the insurance plan offered by such employers is unlikely to cover this drug). Through self-employment, sometimes we make enough to cover the drug and other expenses - sometimes we don't.

Before our income reached a point where paying the full price out of pocket while still supporting our family became realistic, no doctor ever even informed him of the existence of this treatment. It was "treat with alternate cheaper therapy indefinitely." He is uninsurable on the individual market because of his pre-existing condition.

Maybe some would count him among those who "should" be on a government program, because he could conceivably file for disability. But he prefers to be as productive as possible.

Then there's the radical libertarian notion that our problems are our own and it's just tough luck. That doesn't have much political (or moral) traction. IMO most people who pretend to espouse this are deceiving themselves by conveniently ignoring the reality of others' suffering.

Considering his budget policy so far, I am nervous about Obama's ability to carry it off, but I am in favor of anything that would lessen the number of good, honest people like my SO who find themselves in dilemmas like this.
6.28.2009 1:16am
Cornellian (mail):

In Ontario they have horses ass medical bureaucrats that are blocking PET scans for routine use. That is what we are signing up for with government run health care

Read to the end of the article you cite. It says PET scans are NOT covered under Ontario's public insurance plan.

Shelley Martel, the NDP health critic, said PET scans should be covered under Ontario's Health Insurance Plan.

"They are an excellent new technology and people should not have to pay out of pocket to access them," Ms. Martel said, noting that some cancer patients have purchased the scans at a private clinic.


In other words, you have to pay for PET scans and some people buy them at private clinics. Whatever the problem is up there, it's not a function of PET scans being "socialized medicine."
6.28.2009 1:28am
Kazinski:
Cornellian,
Use some thinking skills. PET scans are not covered under Ontario's health plan because a government bureaucrat decided it wasn't. It is covered under BC's plan because bureaucrats decided it was, but there is typically a multi-month waiting period, because they have not funded enough scanners to meet the need, so they ration it.

Here in Seattle, I can pick from 1/2 dozen clinics, that take all comers, welfare patients, private insurance, and desperate people coming down from Canada.
6.28.2009 1:44am
josh bornstein (mail) (www):
I've said it before; others have said it before: If Obama does get a new health care system, assuming it provides a basic level of care (i.e., a more obvious form of the rationing that goes on right now via the insurance company's approving or disapproving treatments/drugs), what on earth stops private insurance companies from offering (in addition to plans that directly compete with the govt option) "supplemental" plans? In other words, plans that will work in combination with the govt-run plan.

I have no real knowledge of of the health care industry above that of a lay-person, but I can think of all sorts of possible plans that private insurance might market to me:
-To cover whatever co-payments the govt plan charges.
-An obligation to cover certain treatments within a specific time period, if the govt plan puts me at the end of a queue.
-To cover treatments that the govt will not cover.
-Higher ceilings (yearly or lifetime)
-Pay for drugs not covered under the govt plan.
etc., etc. (I am sure that many of you with actual expertise can think of a dozen more possible plans.)

I am in favor of a comprehensive change to the US system. But I am not an idiot, or a liar, so I will acknowledge that--5 or 10 years from now--I may look back and say, "Wow, Obama really did long-term damage to our standard of care here in America." It is a possibility, even though I think the risks of keeping things as they are outweighs the risks of making changes. On the other hand, it also is possible that, over that same time-period, we all will be surprised and pleased to discover that the insurance companies are doing great. That they are selling creative policies, and (since everyone who wants has decent basic coverage through the govt) people are actually satisfied with insurance companies and with the extra products they are selling to us. That people are getting better care. More preventative care. ERs are no longer being overwhelmed with uninsured coming in for routine care (or serious problems that would have been cleared up cheaply and easily with preventative care).

That's the worst-case and best-case scenarios. Likely, what we'll see is something in between. It does seem inescapable to me that the one thing we all can agree on is: Things cannot continue as they are right now. Given how fast insurance rates are rising, and consistently faster than the rate of inflation, we will soon be in dire straits without a sea change. It's not as though Republicans have not has ample opportunities to make changes over the past many administrations, and they've made a conscious choice to avoid doing this. You might think that was a wise decision. But I suggest that a significant percentage of the population would disagree.

Final thought: I think that--between things as they are right now, and "Big Pharma will get totally screwed and will not be able to make any profits--there is a huge middle-ground. I suspect that, even under a single-payer plan (which the Dems have totally wimped out on pursuing), intelligent minds can come up with plans that will protect the Rx companies' ability to turn a profit. It's not like Pharma is an under-represented lobby in Congress, so I trust that their interests will be factored in at every stage of the legislative process.
6.28.2009 1:52am
Cornellian (mail):
I'm quite comfortable that government will dampen malpractice, once they're directly responsible for paying for it.

Doctors make mistakes in Canada and get sued for it, just as they do here. They're not government employees (for the most part) and they have to purchase malpractice insurance. I'm not sure why you'd think Canadian governments are responsible for paying medical malpractice awards, but they're not.

Granted, malpractice suits are much less of a threat in Canada than they are here, but that applies to tort lawsuits in general, not just medical malpractice, and it's a function of Canada having a relatively sane system of tort litigation compared to the one that afflicts the United States.
6.28.2009 1:52am
Lib (mail):
interruptus:
I'd be interested in contrary empirical data, though. Can some area of pharmaceutical advances be ascribed an empirically demonstrable significant role in health or longevity improvements? I'd guess newish vaccines, antibiotics, or antifungals are the most likely candidates, if there are any.
While I don't have cost effective access to the necessary medical databases, I'm confident that it's safe to say that a number of the monoclonal antibodies are very effective at curing diseases or improving quality of/extending life.

There may be a fairly small percentage of patients that benefit from mAb therapy - cancer patients with specific cancers (sometimes, only those whose biopsy reveal that are "lucky" with respect to CD20), certain auto-immune disease patients, and certain transplant patients. However, I'm quite confident that these patients can benefit dramatically. Also, in the absence of government interference, we are only in the infancy of mAb rollout - these are extremely safe targeted medications, not things with a lot of horrible or unpredictable side effects -- it will be very sad if these advances are delayed (or never made) just because we can't afford to deploy them "fairly and free" to all in the first months of their approval.
6.28.2009 1:56am
Jim at FSU (mail):

ut I am not an idiot, or a liar, so I will acknowledge that--5 or 10 years from now--I may look back and say, "Wow, Obama really did long-term damage to our standard of care here in America."

And just like medicare and medicaid, it won't make the slightest difference 10 years later. The program will be politically entrenched.

The only way these government programs ever go away is when the tax base supporting the government (ie, the private sector) collapses under the weight of these burdens.
6.28.2009 2:19am
John Moore (www):

Can some area of pharmaceutical advances be ascribed an empirically demonstrable significant role in health or longevity improvements?

Try Embrel and Humera - the anti-autoimmune drugs discussed above that cost so much. They make a radical difference in patient functioning.

Likewise, many "orpan drug" pharmaceuticals are terribly important to those they benefit.

Some of the new atypical anti-psychotics likewise provide substantially improved treatments that can make the difference between a functional individual and an institutionalized welfare case. Note "atypical" as in not just another variant of a patent-expired anti-psychotic.

And, of course, the numerous medications that have transformed HIV infection from an almost certain early death sentence to a manageable disease.

Also, there is Relenza and Tamiflu - which may save a whole lot of lives later this year as the swine flu winter phase comes back to the northern hemisphere.
6.28.2009 2:22am
Another pinhead (mail):
The crux of the problem is whether you want to have the choice of potentially life saving therapy, like monoclonal antibodies for cancer. They are undeniably expesive, but they have the potential for curing some types of cancer where conventional chemotherapy only extends life span by a few months or a year. I have never faced this type of decision, but I imagine it would be terribly difficult.

At the moment, many insurance companies limit access to these expensive therapies by capping the amount they will pay. It is understandable that one would be angry about this limitation. Undoubtedly, a government run health care plan would also deny access to advanced treatments as a means of controlling costs. These advanced treatments are not approved or access is limited by other government health care systems. It wouldn't make me feel any better to have the government deny access to these treatments. If government run health care advances, at least you won't have to make as many of these decisions because because the advanced treatments won't be developed.

On the other hand, the cost of all new drugs and treatments drops as development costs are paid off, competing drugs enter the marketplace, production improves and drugs come off patent. Do you want to give up the development of new drugs because only some people can afford them when they are first introduced?

The uncertainty regarding health care is already impacting new drug development. I am associated with a biotech company that is trying to raise capital for a human clinical trial of a monoclonal antibody. People that we were talking to last year don't want to hear about it for now. Government SBIRs are the only source of potential funding for now, and that isn't enough money to get very far.
6.28.2009 2:32am
JK:

Some of the new atypical anti-psychotics likewise provide substantially improved treatments that can make the difference between a functional individual and an institutionalized welfare case. Note "atypical" as in not just another variant of a patent-expired anti-psychotic.


Well I don't know about you're other examples, but I know that this is pure BS. First atypical antipsychotics aren't really that new, it's all been tweaking (i.e. gaming patent laws to get a full new patent when you only made a very minor improvement) since the early 90s. Second, they're not nearly as good as the drug companies claimed( maybe not the best source, but what I could find quickly). Third, the side effects are not nearly as much of an improvement over older meds then was once hopped/claimed.

Since I know that example is a BS claim from a big pharma flyer I'm going to assume your other examples are also.
6.28.2009 3:02am
JK:
I'll try again on the link

link
6.28.2009 3:04am
Tony Tutins (mail):

Also don't listen to warnings about other countries attempts to solve this universal problem.

If one listened only to the naysayers and the prophets of doom, one would never hear about the French system, the German system (133 years old this year) or even the Dutch system. The only countries cited are the UK's NHS (circa 1974) and the "Canadian" system. Maybe because, for example, neither Germany's system nor The Netherlands' system is single-payer.

We don't have the UK's gun regulations, and we don't have Canada's liquor regulations, so I fail to see why we would end up with either's public options for health care.

Government run health care is already here. Rather than try to shove that horse back into the barn, why not take ideas from the best functioning universal health care systems from around the world, and make sure they're incorporated into "Obamacare."

Wouldn't that be more productive than running around like Chicken Little? "The sky is falling, the sky is falling!"
6.28.2009 3:30am
interruptus:

Actually, there is statistical evidence that cancer survival rates in the US are substantially better than in other first world countries - specifically due to the availability of better treatments that are rationed or delayed elsewhere.

Hmm, it does seem to be true that they're better, though around 1-2% better for 5-year survival rates for most cancers as far as I can find, which may or may not count as "substantial". Picking one fairly representative cancer, the 5-year breast cancer survival rate for the US as a whole is ~83%, and for Canada as a whole is ~81%. There seem to be significant intra-country variations, though: it's ~85% for British Columbia, for example.
6.28.2009 4:00am
josh bornstein (mail) (www):
interruptus,
Interesting statistics. Do you happen to know, for example, what the breast cancer rates are for--say--North Carolina or Mississippi? For Florida or California? And so on. I'd expect that there'd be significant variation state-to-state, but maybe I'd be wrong about that.
6.28.2009 5:22am
interruptus:
josh bornstein: Yes, there was significant variation state-to-state as well, and among urban areas. I don't have the paper I was citing from handy at the moment (don't have free journal access from home), but I recall that Hawaii had the highest survival rates for nearly all cancers for some reason, up in the ~89% range for breast cancer. In case you've got anywhere you can access journals from, the article is "Cancer survival in five continents: a worldwide population-based study" (The Lancet Oncology 9(8), Aug. 2008).
6.28.2009 5:33am
Anon1111:


Well I don't know about you're other examples, but I know that this is pure BS. First atypical antipsychotics aren't really that new, it's all been tweaking (i.e. gaming patent laws to get a full new patent when you only made a very minor improvement) since the early 90s. Second, they're not nearly as good as the drug companies claimed( maybe not the best source, but what I could find quickly). Third, the side effects are not nearly as much of an improvement over older meds then was once hopped/claimed.

Since I know that example is a BS claim from a big pharma flyer I'm going to assume your other examples are also.


If a minor change in the composition of a drug led to a new patent without improvement for some people, why would anyone buy the "new", "tweaked" drug and pay monopoly prices on that drug when they could buy the "old", "untweaked" drug as a generic at non-monopoly pricing? After all, its the same drug as the new one isn't it, with just one minor thing changed that didn't add any real value? People must be morons.

Or, maybe the change in the drug brought on some new efficacy that makes a difference in people's lives. Go talk to someone with bad allergies about how being able to cycle through steroid nasal sprays and antihistamines make life much, much better. To say nothing of being able to vary antibiotics, antidepressants, antiinflamotories, etc., etc., etc.

Perhaps we should just dismiss all your arguments out of hand as complete BS, since they are the same tired anti-capitalism, anti-property arguments made for the last two centuries by gaggles of anarchists, socialists and communists. I'm glad you're so confident that you're willing to endorse a plan that will kill people in the name of equality.
6.28.2009 7:15am
pluribus:
Pro Natura:

Then the new treatment pluribus has been posting about must just be a figment of his imagination.

I don't think I said it is a new treatment. I thought I said it is a standard treatment, which is what the oncologist informed us. We are also informed that vast improvements in cancer treatment have been made in the last eight years or so. That is, of course, the result of innovation, which in turn depends on risk-taking, which in turn depends on the profit motive. But I do not understand why innovation can only thrive when prices are beyond the reach of the average consumers. Nor do I understand why innovation can only be accomplished in the US and only by perpetuation of the present system, which excludes insurance coverage for some 47 million people. I'm all for profits that drive innovation, and I'm all for univrersal insurance coverage. I don't regard the two goals as incompatible.
6.28.2009 7:43am
pluribus:
JoeSixpack:

Suppose the government says it won't pay for your significant other's treatment, but it will pick up the cost of euthenasia?

First of all, I don't want the government to pay for the treatmnent. I want the insurance company to pay for the treatment. I want everybody to have insurance so everybody's insurance company will pay for their necessary treatment. Second, your comment about euthanasia is ugly. No, I want to overcome this cancer, not to surrender to it. Is that a hard concept?
6.28.2009 7:48am
lonetown (mail):
Why is tort reform no longer mentioned?

Do single payer systems allow law suits?

Does it matter if your doctor has a 6 figure insurance bill?
6.28.2009 7:50am
pluribus:
Kazinski:
pluribus:

Your concern seems to be your checkbook, not the quality of care your SO is getting.

You have no basis for saying this. I am paying bills that the insurance company won't pay, but doing so with anxiety and trepidation, hoping the money doesn't run out before the treatment is completed. And what then? A system that says "your money or your life" (or maybe "your money and your life") is not my idea of a just system. Why does a single, standard chemotherapy treatment have to cost $18,000? It is hard when people are fighting for their lives, doubly hard when they are fighting their insurance companies and bill collectors at the same time.
6.28.2009 8:11am
Grover Gardner (mail):

I'd expect that there'd be significant variation state-to-state, but maybe I'd be wrong about that.


More disturbing is that US blacks have a much lower survival rate that US whites.
6.28.2009 8:33am
Soronel Haetir (mail):
pluribus,

One reason I've seen for a few extremely expensive treatments, not that I am saying this is true of the particular medication you are dealing with: some compounds break down within a matter of hours, yet are only manufactured in one or two facilities in the entire nation. In order to deliver these medications to where they are needed special jet courier services are used in which the only item being transported is the medication and perhaps one or two courier personel. As you might imagine, these restrictions make for prohibitivily expensive choices.
6.28.2009 8:47am
Soronel Haetir (mail):
Also, many drugs have a small target audience. A drug that is going to be needed by just 250 people each year is going to be far more expensive than one used by millions. The most expensive medication I've encountered so far controls abnormal blood vessel growth inside the eye, its current cost is close to $4k for less than .1mL.

There just aren't that many people with that form of blood vessel growth.
6.28.2009 8:56am
Bruce Hayden (mail):
Why is tort reform no longer mentioned?

Do single payer systems allow law suits?

Does it matter if your doctor has a 6 figure insurance bill?
Follow the money. Look to see which voting block gave money to Obama and the Democrats, and which one gave more to the Republicans. And you get the answer to your medical malpractice question.

All of these legislative rush jobs are political payback, which is one reason they are being so rushed. The House just passed a Global Warming bill where a 300 page amendment (to the 1,000 page bill) was produced just hours before the voting started, on a putative problem where we are talking 100 year timelines. I would be surprised if more than a couple, if that, of the 435 members of the House had read the entire bill before the vote. Why the rush? Politics, and the more people knew about the bill, the lower its approval rating.

In the case of medical malpractice reform, many of the attorneys gave to the Democrats, while their opponents, the Doctors, gave more readily to the Republicans. So, malpractice reform was never on the table, and the solution provided had to work around that limitation.

The big question when it comes to single payer systems is who is the single payer. You can only sue the government if it allows you to, whereas you can sue anyone else, unless the government prohibits you from doing so (and these two doctrines don't work out to be anywhere close to the same, which is one reason that lawyers love double negatives).

So, if the doctors are working for the government, then they would likely have some sort of immunity. Likely not so (esp. given the politics above), if the government is just acting like an third party payer.
6.28.2009 9:04am
BN (mail) (www):
The "oh no!! rationing" argument is a strange one to me. Right now the supply of medical care is on par with the demand for medical care. (People without insurance don't demand as much medical care) When more people can afford to have an MRI (because they have insurance) there will be more companies to provide those MRI's. The market will adjust itself accordingly. It won't happen overnight, but 5/10 years down the road the supply will meet the demand very easily. It is basic economics.
6.28.2009 9:12am
mcbain:
JK,

Allow me to reming you what you said:


modern pharmaceutical research is essentially just gaming patent law


Now unless you live in some sort of alternate universe where white coat clad patent attorneys generate and test new compounds through sheer power of their word processors, that statement is laughably rididculous.

There were a few times that I am familiar with when a lager pharma employed legal methods to extend the lives of their patents.

If this is a problem, a rational person might suggest reforming the patent system and the FDA. You on the other hand suggest defunding pharma research in the United States. This would be funny if it weren't a typical left-wing solution to reforming any regulatory body.
6.28.2009 9:13am
mcbain:
Pluribus,

I realize this is cold comfort, but you are not paying the price of manufacture, you are paying the price of research. This price due to several factors (including the CYA disfunction within the FDA) is very high.

For every drug that is put on the market at least one hundred fail in various stages of development, so when a company puts something on the market it charges not only to cover the development of the drug being sold, it is charging for the development of the drugs that never made it to market.

This is the only way to for pharma to maintain solvency. As someone mentioned above the break even price point is lower for drugs that treat common diseases, but even for those, the pricing is usually orders of magnitude above manufacture cost.
6.28.2009 9:26am
Bruce Hayden (mail):
You have no basis for saying this. I am paying bills that the insurance company won't pay, but doing so with anxiety and trepidation, hoping the money doesn't run out before the treatment is completed. And what then? A system that says "your money or your life" (or maybe "your money and your life") is not my idea of a just system. Why does a single, standard chemotherapy treatment have to cost $18,000? It is hard when people are fighting for their lives, doubly hard when they are fighting their insurance companies and bill collectors at the same time.
The problem is that under any real movement towards more government intervention here, the question will no longer be between your money or your life, because you won't have the first option.

I too emphasize about the money side of it. Over the last 10 years, my SO, her ex, and I have paid some $150k or so above and beyond what insurance and Medicare pay for things. But at least the treatments were available, which I doubt they would have been under any move towards more government involvement in paying for our healthcare.
6.28.2009 9:29am
Bruce Hayden (mail):
The "oh no!! rationing" argument is a strange one to me. Right now the supply of medical care is on par with the demand for medical care. (People without insurance don't demand as much medical care) When more people can afford to have an MRI (because they have insurance) there will be more companies to provide those MRI's. The market will adjust itself accordingly. It won't happen overnight, but 5/10 years down the road the supply will meet the demand very easily. It is basic economics.
You have ignored one big element of supply and demand - price. Those curves only get to equilibrium when the price paid for goods and services can adjust to the supply at those prices. The problem is that the further we separate demand from cost (i.e. who is actually paying for the stuff), the further from equilibrium they price and quantity will be.

The other part of this dynamic is that the government does not pay its full share of the cost right now, where it is the insurer. Somewhere between a quarter and half of the costs of Medicare treatments are paid for by everyone not covered by government insurance. And the situation is getting worse, as the government reduces Medicare reimbursement rates, while actul costs are rising.

It only works because of inertia and that the rest of us are willing to pay that much more for our health care. But the more people there are under government insurance, the more cost shifting there is going to be, and the more the rest of the paying customers are going to cross-subsidize those who are government insured.

The other thing to keep in mind is that government insurance doesn't work quite the same way as private insurance. In the end, it really doesn't matter that much whether something is effective, but rather, how much of it the government is willing to pay for. So far, our government has not rationed health care that much for those it mostly pays for, since the rest of the population is paying for it, both through cross-subsidization and Medicare payments. But that is rapidly coming to an end, as the Baby Boomers enter their Golden Years. That is without doing anything more, and a lot more is being planned.
6.28.2009 9:42am
Cato The Elder (mail):
I could agree to a "public health option" with the following two provisos:

1. Any politicians (along with their immediate extended family) who vote for the reform must be strictly bound to the "public option's" regime of payments and health services for at least 20 years; i.e., none of those people should be able to utilize private health insurance even in the presence of "mitigating" reform over that duration.

2. Any economists and other prominent members of whichever think tanks who have their work cited or promulgated to the effect of supporting this reform, in the case of its "failure", should be stripped of their Ph. Ds, and thrown in jail for a length of time directly proportional to the "excess deaths" over the alternative health regime of our "flawed system". Of course, the methodology of this metric should be specified a priori, and since my proposed penalties are in fact weighty, these policymakers should have a substantial voice in its choosing.

I don't think it too much to ask that those who feel induced or compelled to make life-or-death decisions for other people, should be forced by the same logic, for simple accountability reasons, to stake their bets over their livelihoods. Perhaps there are overwhelming reasons to ignore the data points we have received from similar plans in Massachusetts and Britain's NHS. Surely mere penalties, hardly likely to be incurred in any case, pale in comparison to the moral satisfaction and greatness of saving lives. Surely I am not asking too much of our fellow compassionate liberal lions.
6.28.2009 9:54am
AnonLawStudent:
Pluribus,

You seem to have very little knowledge of what you are discussing; as a result, your argument seems to consist solely of "the drug is expensive, but I shouldn't have to pay for it." Penicillin was once expensive too - so rare and expensive that it was filtered from the urine of the first patient for reinjection. The average wholesale price ("AWP") for penicillin is now (literally) a few pennies per dose, and it is widely available even in the most remote and primitive parts of the world.

If you want a bit of knowledge specific to your life, modern anti-neoplastic agents can be extremely difficult to synthesize. As a result, they often require vast inputs of natural resources or synthesis through horribly low-yielding processes. See, e.g., Taxol (paclitaxel). As to the effectiveness of government research, consider the billions of dollars the government spent studying HIV beginning in the 1980's and '90s. The first (marginally) effective anti-HIV treatment was AZT, developed by Burroughs Wellcome in the mid-1980's. Despite massive government funding of research, the marginal effectiveness of AZT, and the severe side effect profile of AZT, a successful anti-HIV treatment wasn't produced until Glaxo developed 3TC (for use in a synergistic combination with reduced-dose AZT) in the mid-1990s.
6.28.2009 10:10am
BN (mail) (www):
You have ignored one big element of supply and demand - price. Those curves only get to equilibrium when the price paid for goods and services can adjust to the supply at those prices. The problem is that the further we separate demand from cost (i.e. who is actually paying for the stuff), the further from equilibrium they price and quantity will be.


The gov't isn't going to be competing with other buyers for these services so the price will only be a factor if it is too low for anyone to provide the service or too high for the gov't to pay for it.
6.28.2009 10:25am
Joseph Slater (mail):
Nice debunking of the "rationing" scare talk here.
6.28.2009 11:27am
Cornellian (mail):
You have no basis for saying this. I am paying bills that the insurance company won't pay, but doing so with anxiety and trepidation, hoping the money doesn't run out before the treatment is completed. And what then? A system that says "your money or your life" (or maybe "your money and your life") is not my idea of a just system. Why does a single, standard chemotherapy treatment have to cost $18,000? It is hard when people are fighting for their lives, doubly hard when they are fighting their insurance companies and bill collectors at the same time.

It is precisely this scenario that Canadians never face and why Canadian public opinion and every major Canadian political party (including the Conservative party) opposes privatizing health care in Canada.
6.28.2009 11:30am
Libertarian1 (mail):
Go talk to someone with bad allergies about how being able to cycle through steroid nasal sprays and antihistamines make life much, much better. To


We have an injectable available to treat crippling, life ruining arthritis. Cost $15,000/$20,000 year for the rest of the patients life.

"Interesting to see that brought up - my SO needs that drug to be able to function. Which means that sometimes, he doesn't function. Though a highly skilled professional, he can't hold down a corporate job because of his condition (and the insurance plan offered by such employers is unlikely to cover this drug). Through self-employment, sometimes we make enough to cover the drug and other expenses - sometimes we don't."





I have appreciated the many intelligent comments posted here.

Very personal but while working for Big Pharma I headed the team that did the research and got FDA approval for the first major steroid nasal spray (Vancenase).

Re Enbrel: What I have done for my patients who didn't have insurance and couldn't afford the biologics is to actually call the manufacturer. They have a program in place to help these patients financially. Dicuss this with your physician.

One of the problems in discussing effectiveness of medications with non physicians is subtleties that are not understood. It was mentioned that Big Pharma plays patent games.

What is unappreciated is what we call biologic variation. I treat patients A and B with an approved old medication. It works beautifully for patient A but fails in patient B. I then give patient B the brand new slightly manipulated expensive patented cousin. It works like a charm and Patient B is very satisfied. That situation literally happens every day of my life in practice. If you don't want patents for these slight modifications you are dooming Patient B to years of misery.

Pluribus: You have my sympathy and my prayers. Good luck.

What I am going to discuss next is frightening but actually under discussion. It was attempted a few years ago by private insurance but physicians were able to fight it off. I don't know if we would be successful under Obamacare.

The concept is called "holdbacks". Say I treat a patient for the required 15 minutes and earn $38. The payer sends me a check for that amount less 10% being held back. At the end of the year the total medical expenses that I generate for my patients is added up. Office time, lab tests, X-rays, medications etc. If I have overspent the amount allocated to me than the differences are actually subtracted from my holdback (ratio). My end of the year check will be less or non-existent. That means if I treat Pluribus and generate $250,000 in expense I personally may be paying for it.

Some people have called that a negative incentive.
6.28.2009 11:39am
Brian K (mail):
Hmm, it does seem to be true that they're better, though around 1-2% better for 5-year survival rates for most cancers as far as I can find, which may or may not count as "substantial". Picking one fairly representative cancer, the 5-year breast cancer survival rate for the US as a whole is ~83%, and for Canada as a whole is ~81%. There seem to be significant intra-country variations, though: it's ~85% for British Columbia, for example.

don't forget that the problem with 5 year (or any) survival rates is lead time bias. you can increase X-yr survival rates by just catching the problem earlier even though there might be no change in actual survivability.
6.28.2009 1:25pm
John Moore (www):

Well I don't know about you're other examples, but I know that this is pure BS. First atypical antipsychotics aren't really that new, it's all been tweaking (i.e. gaming patent laws to get a full new patent when you only made a very minor improvement) since the early 90s.

"Since the early 90s" - that's pretty darned new. I guess you would be happy to stop pharma research at the stage where Thorazine was the treatment of choice?

As to the rest of my claims, since you obviously know nothing about the subject, calling BS on them is pathetic

There is no doubt that the pharma companies do patent gaming, but the existence of that practice does not mean that all of their R&D is in that area.

For instance, in the current decade, my daughter was involved in NAS funded academic research on a genetic basis of Schizophrenia. Their biggest competitor in the "find and publish first" race was a Pharma company.

The point is: big Pharma produces important new treatments, because capitalism works. Big government produces important basic research, but in most cases, that's it. It takes capitalism, incentivated by the real chance to make a profit, to fund the billion dollars per new drug cost of introduction.
6.28.2009 1:52pm
byomtov (mail):
Libertarian1,

I understand the point about biologic variation, and the value of some new medications that are only slightly different than existing ones.

I do have a question, though.

Is the R&D and testing necessary to bring the new variant to market equivalent to that needed for the original drug? If not, (and I don't claim to know) then the amount of patent protection needed to give manufacturers an incentive to develop the variant is certainly less than that needed for completely new medications, isn't it?
6.28.2009 1:53pm
John Moore (www):
Oh, and btw, your link is old news and is typical newspaper sensationalism.

Yes, the farma's overmarket their product (duh, what a surprise). Yes, they are not the right treatment for everyone. Psychiatrists know, but reporters apparently do not, that treatment of mental disorders has to be highly individualized - drugs which are not very good on average may be extremely good for a small subset of patients. Furthermore, the "safety" issue in your link is classic tort lawyer fodder. It has long been known that psychiatric medication usage is correlated with various risks. As is typical of scare reportage, the links do not give percentages (which are very, very small in some of the cases). The link also doesn't point out that these effects are well known and included in the medication warnings.
6.28.2009 1:59pm
Andrew J. Lazarus (mail):
I don't follow this debate as carefully as I should. I've long thought, though, that statements like
Granted, malpractice suits are much less of a threat in Canada than they are here, but that applies to tort lawsuits in general, not just medical malpractice, and it's a function of Canada having a relatively sane system of tort litigation compared to the one that afflicts the United States.
miss an important point. Under the USA health insurance system, when there is a problem with a baby delivery or another misfortune the family's only hope to avoid permanent destitution (even if they have "average" US insurance) is to hit the lawsuit lottery—even if the doctor was not at fault. Maybe if the government health care system enabled families of grokked kids to get care some other way, we could talk about tort reform.

And, yes, I know families with such kids. Fights over expenses and exhausted parent caretakers have resulted in divorce in every single example of personal acquaintance.
6.28.2009 2:47pm
Leo Marvin (mail):
Kazinski,

Answer me this, if the choice is an MRI machine in a republican district, or refurbishing a terminal in John Murtha Airport, which one do you think is going to make into the budget. We don't need health care expenditures competing with congressional pork requests, because we all know what is going to win.

First of all, when blue states like California approach parity on return of their federal tax dollars you can insinuate this is a Democratic problem. But back to the point, I'm glad your family benefited from our current system, but you have to know there's no shortage of anecdotes going the other way. Here are a couple:

One friend, a 42 year old woman, had employer provided Blue Cross PPO coverage when she was diagnosed with multiple myeloma. The co-pays have consumed her house and savings, including everything she put away for her kids' education. She's also used up most of her lifetime limit for certain treatments, so if she needs any more marrow or plasma transplants, tough. Of course she had to stop working, since though her salary wasn't enough to support her, her kids, her health premiums and co-pays, it was still too much for her to be on Medicaid. For a while she had to cross her fingers and delay treatment while waiting for the Medicaid to kick in. When her kids are grown, they'll remember a few years when they were middle class before suddenly being poor when mommy got sick. And this was with good, albeit not gold-plated, health insurance.

Another friend, a seemingly healthy, very athletic 55 year old man, lost his job. After a few months of job hunting, he couldn't afford both his mortgage and his health insurance, so he crossed his fingers and kept paying the mortgage. Six weeks later he was diagnosed with diabetes, and now has neither a house nor health insurance. Lucky him, he's poor enough to get treated at the local clinic, but half the time he's in such severe pain he can't walk, and try getting useful pain medication from a clinic.

The bottom line is we're already rationing health care. It's not that the poor, or even more-so, the not yet poor enough, don't get treatment. They just get less, and generally inferior treatment. In some ways that's fine. Poor people don't deserve hair plugs. But they also have shorter life expectancies that can't be completely accounted for by drive-by shootings and trailer park tornadoes. Part of this debate is about how much of that lifespan discrepancy we institutionalize into our health care system. I realize it's good sport to ridicule Canadians and Europeans -- I've been know to join in myself -- but on this point I think their policies are those minimally required by any moral, affluent society, and ours are a disgrace.
6.28.2009 3:09pm
Andrew J. Lazarus (mail):
A liberal is a conservative who gets sick.
6.28.2009 3:14pm
Cato The Elder (mail):
No, after reading AJL's comment, I think I might much better characterize conservatives, or the very least libertarians, as people who have a healthy respect for process, the right of self-determination, and their own fallibility.
6.28.2009 3:19pm
Richard Johnston (mail):
gattsuru said, apropos of ERISA making it unduly difficult to enforce insurance contracts:



Bringing concerns to the national government in similar situations as matters of health care -- for example, Veteran's Affairs office errors -- has demonstrated that you can only sue the government as allowed by statute. Full stop. Right now that means that feds decide what and even whether you deserve compensation, and then six months after they finish mucking around on that, you have to prove in court that it wasn't fair.

Extremely truncated discovery is child's play by comparison.


That sounds very much like what ERISA does wrt private employer-based insurance contacts. Your only claim is that provided by ERISA; state law is preempted. And you have to exhaust administrative remedies, in the form of an appeal back to the same insurer who denied the claim. And then, in court, you have to prove their decision was not only wrong or "not fair" but was an affirmative abuse of discretion.

It sounds like both systems make it unduly difficult to enforce contractual entitlements. One is no doubt worse than the other, but in any case providing universal insurance coverage is an empty endeavor if the promises made in the terms of the coverage cannot be meaningfully enforced.

Consider this: ERISA tells private insurers there is no practical legal consequence for defrauding their insureds, and indeed they are quite likely to get away with it so long as it can be dressed up an an exercise of "discretion." Insurers have obligations to maximize shareholder value. If the law tells them they can do that by committing fraud with impunity, what are they going to do?
6.28.2009 3:23pm
Toby:
Boomsday!
6.28.2009 3:34pm
Cato The Elder (mail):
Leo Marvin,

The failure to acknowledge, or even grasp, that the life expectancy gap between the poorest and wealthiest classes in this country, who also have prominent differences in their respective demographics, could be driven in some measure by genetics means it is hard to take many of those passionate advocates seriously as unbiased assessors of the state of our health-care system. And that's not even mentioning the oft-cited, and perhaps more malleable, lifestyle disparities consciously chosen by the Americans and the Continentals. Evolutionary theory would predict exactly the disparities we do see, noting the longer-lived Asians in Japan to shorter-lived Blacks in the United States, but to employ such reasoning in the academic sphere is routinely decried as "racist", so I won't belabor the entire point.

Is it to strange to reason that Blacks, hailing from an environment that required longer bursts of sustained energy, might be exposed to greater amounts of oxidative stress in their heart tissues, more so than other groups, a stress which we increasingly realize as a major culprit in the aging process? OK, perhaps it might be more instructive to explore the role of genetics, by noting the differential gap in life expectancy between males and females, which I recall from the top of my hand was at least 4 years in the United States (72-76), and increasing. Look at this chart of the oldest living people in the world, and you will understand exactly what I mean (all female), since these differences will often be quite prominent at the tails of the distribution. Note too that these disparities fly in the face of slippery and not very rigorous theories of our classist, sexist health care system...

Certainly the United States, we can all grant, lies at the tail of the distribution of economic prosperity, implying that those same genetic differences might play a more salient role in your narrative, once coupled with the knowledge that most medical spending is not efficacious at extending life; and yet that knowledge certainly does not capture other metrics by which we are supreme. Indeed, it would also serve you well to remember the reasons the United States came to enjoy such outlier status in the first place.
6.28.2009 3:56pm
Cato The Elder (mail):
Leo Marvin,

I should add to my previous statements that medical spending does not seem to be efficacious at extending life past a certain point, at least outside of a few, well-characterized, public health interventions; it appears that, as one ages, failures in multiple bodily systems become common, and as of yet we just do not have the requisite medical knowledge to competently address such multi-factorial sources of complexity.
6.28.2009 4:28pm
Cornellian (mail):
One friend, a 42 year old woman, had employer provided Blue Cross PPO coverage when she was diagnosed with multiple myeloma. The co-pays have consumed her house and savings, including everything she put away for her kids' education. She's also used up most of her lifetime limit for certain treatments, so if she needs any more marrow or plasma transplants, tough. . . . When her kids are grown, they'll remember a few years when they were middle class before suddenly being poor when mommy got sick. And this was with good, albeit not gold-plated, health insurance.

And again, this is a scenario that every American risks every day, except for a few who are extremely wealthy. It is a scenario that Canadians never risk. Do you think Canadians would be willing to trade their system, whatever its flaws, for our system? Read their opinion polls. Any Canadian politician who came out in favor of privatizing health care would have about as much chance of getting reelected as Dick Cheney has of getting elected mayor of San Francisco.
6.28.2009 4:59pm
Cornellian (mail):
2. Any economists and other prominent members of whichever think tanks who have their work cited or promulgated to the effect of supporting this reform, in the case of its "failure", should be stripped of their Ph. Ds, and thrown in jail for a length of time directly proportional to the "excess deaths" over the alternative health regime of our "flawed system"

Interesting approach. If the deaths go down instead of up, do you then imprison the ones who opposed the reform?
6.28.2009 5:02pm
Libertarian1 (mail):
byomtov: asked
Libertarian1,
Is the R&D and testing necessary to bring the new variant to market equivalent to that needed for the original drug? If not, (and I don't claim to know) then the amount of patent protection needed to give manufacturers an incentive to develop the variant is certainly less than that needed for completely new medications, isn't it?



There are many different steps involved in bringing a new drug to market. The first is the chemical synthesis and then wide range of animal screening tests to determine if there is any biologic activity and any activity against disease. The most expensive involves brand new never before seen chemical compounds. But lets say you have successful drug A and just want to add an OH here or a S etc. Then that is relatively inexpensive.

Then when I entered the program conducting phase I studies on humans from then on you were at stage I and had to conduct every single safety and efficacy study all over again. It is probable if by the time you get to Phase III and discuss that step, in advance with the FDA, they may only ask for 3000 patients rather than 5000 in order to be convinced. To give perspective if I contracted with an investigator and needed 30 patients from him my grant would be $50,000-$100,000. My studies (see Vancenase) were not relatively complex. Visualize AIDS or cancer studies where you need 5 and 10 year follow-ups. Bottom line- to develop a near cousin to a successful marketed drug should cost in the neighborhood of $5-10M for my field of Dermatology/allergy. For comparison to R&D a new chemical formula in the relatively easy Derm field will cost $100M+. Just to remind you before that one compound was given to me maybe 30 other cousins were synthesized and screened. That is a separate line item expense.

Just as a reminder re other governments coping a formula. Unlike the Coca Cola formula there are no secrets. By law every single step in manufacturer must be laid out in excruciating detail in the NDA. That document is not a privileged hidden company secret but available to everybody under FOIA. Any generic drug manufacturer can exactly duplicate the formula and of course they do. It costs them nothing to put out a exact competitor.
6.28.2009 5:10pm
Andrew J. Lazarus (mail):
Cato, can you explain genetically why the life expectancy of all Canadian males exceeds that of white American males?
6.28.2009 5:23pm
Dan Ensign (mail):
Re Enbrel: What I have done for my patients who didn't have insurance and couldn't afford the biologics is to actually call the manufacturer. They have a program in place to help these patients financially. Dicuss this with your physician.


This is great; it fits right in with the conclusion I've come to about these issues, as I've been thinking all weekend in regard to comments here (thanks, by the way).

Although too broad a brush should never be painted, hatred of the medical establishment and its evil profits is misapplied. People, it seems, really do want to help people; that they need profits to pay their workers and pay themselves is not necessarily a bad thing.

This suggests a possible solution to a dilemma like pluribus': ask people for money, nicely. Call around. Start a charity with a web site. I'd definitely give $10 to help your SO, and I bet a lot of people would give a lot more. Thing is, people are generally pretty compassionate and really do care about their neighbors, and even if they aren't, you don't need everyone to be super nice, just 25,000 people $10 nice, or 2,500 people $100 nice, or whatever.

Trying to demand health care is using government to coerce people to give money, which is surely why government plans are hated by any true liberal or libertarian (who are probably just as compassionate and generous as anyone else--if not more, since I think libertarians really believe everyone would benefit living in a libertarian world). An analogy, to divorce this a bit from emotion: say you needed a cup of flour. Wouldn't it be more polite, more likely to get a positive response, and more polite to just ask me for the flour? Doesn't it feel inappropriate to use the government to force me to give you flour?

In fact, pluribus, if you set up a paypal account or what have you, I'd be happy to give you a little bit of money to help your family. I can't give a lot, because I have my own family to look after. I'd bet another $10 that other people would do it as well--if you ask nicely, instead of trying to get the government to force them to help you.
6.28.2009 5:41pm
rosetta's stones:
The other part of this dynamic is that the government does not pay its full share of the cost right now, where it is the insurer. Somewhere between a quarter and half of the costs of Medicare treatments are paid for by everyone not covered by government insurance. And the situation is getting worse, as the government reduces Medicare reimbursement rates, while actul costs are rising.

Yes, the government is not paying its portion of medical care now.

And some want to turn the wheel completely over to these people? Please.

They are not paying what they are supposed to be paying right now.

They are showing us what to expect, and we're seeing it right in front of us. No need to speculate what might happen in 10 years, after "reform". Take a look for yourself, in the now.


They will cut payments, because that is what they do. Stroke of a pen. Murtha and Obama, or equal, holding that pen. Other things are more important than those Medicare payments now, why would you think that will suddenly change? Magic? Hope and change?

Please. To deny this is to deny reality.
6.28.2009 5:44pm
rosetta's stones:
"What I am going to discuss next is frightening but actually under discussion. It was attempted a few years ago by private insurance but physicians were able to fight it off. I don't know if we would be successful under Obamacare.

The concept is called "holdbacks". Say I treat a patient for the required 15 minutes and earn $38. The payer sends me a check for that amount less 10% being held back. At the end of the year the total medical expenses that I generate for my patients is added up. Office time, lab tests, X-rays, medications etc. If I have overspent the amount allocated to me than the differences are actually subtracted from my holdback (ratio). My end of the year check will be less or non-existent. That means if I treat Pluribus and generate $250,000 in expense I personally may be paying for it.

Some people have called that a negative incentive."


Libertarian1's hypothetical is the type of negative incentive that a faceless bureaucracy will inevitably evolve to, imo. Either this, or they'll simply hold back money as they are currently doing.

It's just numbers on a shreadsheet, and that spreadsheet includes the John Murtha memorial golf course. So somebody's medical care has to go unpaid, because that golf course is gonna get built, just as all those pork barrel projects currently are.

If it pays for its current commitments, government might be trusted. It's not.

There are some real issues, and some reasonable proposals for them out there, but the execution of massive change cannot be entrusted to the current crop of clowns. Check the global warming circus the other day, if you require confirmation.

Pay for what you've committed, first.
6.28.2009 5:55pm
pluribus:
Dan Ensign:

In fact, pluribus, if you set up a paypal account or what have you, I'd be happy to give you a little bit of money to help your family. I can't give a lot, because I have my own family to look after. I'd bet another $10 that other people would do it as well--if you ask nicely, instead of trying to get the government to force them to help you.

I take your gesture in the generous spirit in which you say it is intended. But you haven't read all my posts here, and you badly misinterpret my wishes.

First, we are not impoverished, as I said above. I would never accept donations from strangers when I have my own money. I have never done so in what has already been a longer than average life, and I hope I can finish out my days without doing that.

Second, I am not trying to get the government to "force" anybody to help me. I would like to see a system, much like the one I have heard Obama describe, in which everybody is insured--adequately insured--so everybody contributes to the costs of health care and everybody is covered in the event of a health care catastrophe. I would like to see a system in which costs are brought under some control, so that some providers don't get rich while 47 million Americans are uninsured, and nobody lives in fear of bankruptcy or abject impoverishment. Did I just hear on television that one million Americans are forced into bankruptcy each year because of health care costs they can't meet? Even if that number is exaggerated, I don't like the sound of it. I don't regarding it as a "forcing" anybody to help me if I want a system where everybody contributes, everybody is protected, and costs are affordable.
6.28.2009 5:55pm
interruptus:

Yes, the government is not paying its portion of medical care now.

There's no mandate for any particular physician or hospital to accept Medicare/Medicaid, so why would they accept it if it's not sufficient payment? It seems either it must indirectly be sufficient (e.g. by generating goodwill, bringing in paying friends/acquaintances of the Medicare/Medicaid patients, generating volume that the hospital can use to negotiate better prices with suppliers, etc.), or there are many more hospitals and doctors acting purely as philanthropists than I would've expected.
6.28.2009 6:19pm
Libertarian1 (mail):
Cato, can you explain genetically why the life expectancy of all Canadian males exceeds that of white American males?



The subject of death rates and life expectancies came up at a discussion I attended last week. The response given was if you subtract deaths from automobile accidents and violence (by definition- not connected to our health care delivery system) the US becomes the highest rated in the world in those areas.

To put our automobile death rates in perspective every single month in the US more Americans are killed on the highways than have died during the entire Iraq war. That is really frightening.
6.28.2009 6:23pm
rosetta's stones:
"There's no mandate for any particular physician or hospital to accept Medicare/Medicaid, so why would they accept it if it's not sufficient payment? It seems either it must indirectly be sufficient (e.g. by generating goodwill, bringing in paying friends/acquaintances of the Medicare/Medicaid patients, generating volume that the hospital can use to negotiate better prices with suppliers, etc.), or there are many more hospitals and doctors acting purely as philanthropists than I would've expected."

Yes, there are reasons why providers may choose to accept 3/4 of a loaf, no doubt, and I don't discount philanthrophy in some cases, as you cynically appear to do.

However, scroll up, and you'll find at least anecdotal evidence that the % of providers participating is falling, as would be expected given the inputs (or in this case, the lack thereof. For those people, the reasons or the philanthropy have run out.

The single payer advocates see these trends, and see the demographics, and see that the congresscritters aren't even funding their commitments now, even as the situation erodes.

So, government either has to pay more from the Treasury to honor their commitments, or watch more and more providers reject Medicare/Medicaid.

Or, hijack the whole thing, and force them to accept them.
6.28.2009 6:39pm
Leo Marvin (mail):
Cato,

My only response to your comment is, I never denied other variables affect life expectancy. In fact, I implicitly acknowledged as much. But even assuming, arguendo, all your genetic theories are valid -- and "arguendo" is the only way I'll make that assumption -- do you deny that disparities in health care access play a role in life expectancy?
6.28.2009 7:18pm
Bob Goodman (mail) (www):
Well, I am impoverished and would be very gratified to take money from strangers. My apt. rent is $700/mo. here in NYC and I haven't paid this month's yet. My prospects for employment always seem to be excellent (at least nobody tells me there's anything wrong with my qualif'ns, except that I'm not licensed for anything requiring one), yet I seem unable to get enough to pay my living expenses, and now I'm out of money and in debt. Please e-mail me to suggest any amount you'd like to donate, and I can send PayPal buttons. TIA to all.
6.28.2009 7:18pm
Dan Ensign (mail):
pluribus:

But you said:
Where is an ordinary person going to come up with that much money--in cash--before the bill is referred to a collection agency, and liens are filed on our house? We are not impoverished, but we are not rich either, and up to now we have been able to pay our way in the world, working hard, paying our taxes. Now I doubt if that ability isn't going to be crippled.

But there is no reason to be crippled. You (or whatever "you" is the the one with the lien) can ask your friends, your church, your chess club, your community, and total strangers for help.

First, we are not impoverished, as I said above. I would never accept donations from strangers when I have my own money. I have never done so in what has already been a longer than average life, and I hope I can finish out my days without doing that.

Then you'll be okay paying the $250K? That's good to hear. I would hate for you to have to choose between a loved one's life and your pride. Me, I never want to take donations, either, but my pride is not more important than the health and safety of my family.

Second, I am not trying to get the government to "force" anybody to help me. I would like to see a system, much like the one I have heard Obama describe, in which everybody is insured--adequately insured--so everybody contributes to the costs of health care and everybody is covered in the event of a health care catastrophe. I would like to see a system in which costs are brought under some control, so that some providers don't get rich while 47 million Americans are uninsured ...

I haven't misinterpreted your wishes: you wish for government intervention into health care in order to reduce costs. Whenever the government intervenes, it necessarily uses force. That's what the government is for, whether it's using force to prevent others from using force on you, or forcing individuals or corporations to pay for something seen as a public good.

My solution--voluntarily helping one another, which could easily be facilitated by government--is better, because it doesn't force "everybody" to help everybody, even if they have better things to do with their money. Investment and saving are societal goods, too; not to mention providers paying their employees so they can be cared for, as well.

In the end, I agree with your stated goal of getting everybody insured, at least everybody who wants to be insured. But a single-payer, or a "public option," is not the right way to do that. That necessarily involves fixing prices, which makes things more expensive than they otherwise would be, rather than less.
6.28.2009 7:36pm
Cornellian (mail):
Cato, can you explain genetically why the life expectancy of all Canadian males exceeds that of white American males?

I seem to recall Canada does better at the other end of life as well - lower infant mortality than the US, all while spending much less per person on health care than America does.
6.28.2009 8:38pm
pluribus:
Dan Ensign:

I haven't misinterpreted your wishes: you wish for government intervention into health care in order to reduce costs.

Don't try to tell me what I wish. You are not a mind-reader. I can tell that just from the above statement. Please tell me and the other posters what you wish, and let me tell them what I wish.

Also, please get it clear that I did not come on this thread to solicit charity. If you feel charitable, great, give your handout to a bum on the street, or to your church, or to any other charity you choose, but don't pick on me for your largesse. I don't need it. I don't want it. And, frankly, I resent the implication that I do. I have paid my taxes all my life long. I have paid my insurance premiums. I expect something in return for having done all of that, and do not think it means I have to start begging on the street--or on a website.

Whenever the government intervenes, it necessarily uses force. That's what the government is for, whether it's using force to prevent others from using force on you, or forcing individuals or corporations to pay for something seen as a public good.

No. When the government intervenes, it uses the law to do so. The law is not synonymous with force. Most people obey the law without being "forced" to do so. I obey the law because I am a law-abiding citizen. Nobody has to put their hands on me and physically "force" me to obey it. Some people have to be "forced." I guess that's what we have prisons for. You are using "force" as a scare word. It doesn't scare me.

In the end, I agree with your stated goal of getting everybody insured, at least everybody who wants to be insured.

If you agree, then what's the beef? Do you go out of your way to find disagreements, or do they come to you just by accident?

But a single-payer, or a "public option," is not the right way to do that.

You are entitled to your opinion. I am also entitled to my opinion. And I disagree with your opinion. The public option plan that Obama proposes is not a single-payer system. It will leave in place the existing health care insurers (there are currently well over a hundred of them) and give them the legal right to continue to compete for insurance business, just as they do now. Competition is good, right? What's wrong with letting the private insurers compete for the health care business of the American public? If they can't compete successfully, why should the government guarantee their continuing business? If you are using a slippery slope argument, saying OK, it's not single-payer, but it would lead to that--my answer is that it would require a change of the law, passed by the Congress and signed by the president at that time, to bring about such a change. And public opinion would have to support the change. That's not an easy hurdle to overcome, especially if a single-payer system is as bad as you claim it is.
6.28.2009 8:49pm
Mark Buehner (mail):

Cato, can you explain genetically why the life expectancy of all Canadian males exceeds that of white American males?

Can you explain why Canadians are less likely to die in car accidents? Does Canada have better auto insurance?

Canadians also die less often of violence.

Americans smoke more, shoot each other more, and smash each others cars more often. Think that has anything to do with the life expectancy?

Canadians die more often of strokes, stomach cancer, and breast cancer than Americans. How can that be with their superior healthcare?
6.28.2009 9:04pm
pluribus:
I hope all those who are taking such joy in slamming the Canadian system realize (I'm actually pretty sure they do) that it's a complete strawman. Obama has not proposed anything like the Canadian system. Whatever its faults or virtues, the Canadian system is not what Obama proposes. Lawyers are familiar with the concept of irrelevancy. In court, it's ruled inadmissible. We don't argue it. It's out of bounds. I suppose there are lots of non-laywers participating in this discussion. The fact that so many here want to talk about Canada leads me to believe that they don't really want to talk about the Obama plan. Is it because, if the public understood his proposal, they wouldn't find it really, really scary? And the opponents, of course,want them to think it is really, really scary.
6.28.2009 9:22pm
Mark Buehner (mail):
The point of comparing Canada is to judge the quality of the US system in comparison. We would do well to consider if our healthcare is truly as bad as is being alleged before we go making huge systematic changes, right?

Unfortunately too many people play the game of comparing Canadian health, which isn't the same thing. You have to control for all sorts of cultural and demographic differences.
6.28.2009 9:29pm
Toby:
Now Pluribus

You've gone from a sympathetic figure to one of derision. WEverything the government does is force. Don't think so? Try skipping on your taxes. Oops, now he nice men come and make you sit in a bad place. With force.

You have just said that your pride is more important than acknowledging that you want someone else to come and force other people to give you money. Because that's where it comes from. Maybe I was planning to send my parents better medical care. Maybe I was trying to do something for my SO, whether it was to take her to France or to keep her from walking out on me. Maybe it was my wanting to spend money on the education of my children. Maybe I want to spend it on a weekend in Vegas. It doesn't matter. You want someone else to take it from me to ease your problems, because you know that your pain is more important than the satisfaction anyone else gets from their life. No matter how you couch it, that is a selfish position

You can say your pride doesn't let you beg, but apparently your pride justifies you standing by while someone else takes the sweat of a third party's brow to easy your issues. Which suggests you are not man enough to face the essential truth of your wants, so you want someone else to give you some cover?

You are a thief, and one whose wants to pretend otherwise be lying to yourself and others. Shame!
6.28.2009 9:37pm
pluribus:
Toby:

You are a thief, and one whose wants to pretend otherwise be lying to yourself and others. Shame!

There used to be an unwritten rule on internet blogs: the first one to resort to name-calling automatically loses the argument. I'm not invoking the rule, just observing it. You don't know me, of course, and if you did I suppose you would be more civil. At least I hope you would.
6.28.2009 9:59pm
SG:
The fact that so many here want to talk about Canada leads me to believe that they don't really want to talk about the Obama plan.

Do you have any reasonably objective links to details of the Obama plan? I haven't seen anything with any real detail, although given the his governance to date (stimulus package, Chrysler/GM, cap-and-trade, etc. ), I've become highly skeptical of any Obama plan.

And come on - any universal plan will by definition be coercive. That doesn't necessarily make it bad policy, but be honest with yourself and recognize that your preferred policy will require compelling people (under penalty of law) to do things they would not voluntarily choose to do.
6.28.2009 10:50pm
Leo Marvin (mail):
pluribus:

You don't know me, of course, and if you did I suppose you would be more civil.

I'm sure you're right, and I'll probably hate myself in the morning, but for now I'm clinging to the persuasive illusion he's just a jerk.
6.29.2009 12:02am
Careless:
Pluribus

. The law is not synonymous with force

Well, that's the last time one needs to take him seriously.
6.29.2009 1:17am
Careless:
Anyway, Pluribus, as someone who was related to a cancer patient much younger than your significant other and would have had treatment denied, I really think you need to acknowledge the fact that national health care is going to kill people over 50 with expensive problems in favor of people under 50 and with cheap problems
6.29.2009 1:21am
John Moore (www):
I am saddened to see those slamming Pluribus, given his circumstance.

It is the sort of callous disregard for people like PLuribus that has handed the whole health care debate to the Democrats. There are many people who fear they will end up with the same problem. There are many people who will end up with similar problems.

Until those on the free-market side can recognize the areas where that ideology will fail (read: private health insurance), they are doomed to look like fools to anyone who understands the issue.

And the result of that will be what they fear the most - a socialized and ultimately very harmful system which will kill many of us.
6.29.2009 2:03am
Leo Marvin (mail):
John Moore,

Your last comment confirms my long-held suspicion that there's a decent guy lurking behind your political views, some of which, I admit, make my hair stand on end. Thanks for that. It's exactly the kind of reassurance I needed after this thread.
6.29.2009 2:48am
pluribus:
Thank you John Moore and Leo Marvin, and others who have expressed similar views. To me, the sad part is not the situation my significant other and I find ourselves in (though that is personally painful), but the fact that there are a whole lot of Americans facing similar crises (millions, I'm told) and a whole lot of other Americans who don't give a damn.
6.29.2009 6:42am
Cornellian (mail):
Americans smoke more, shoot each other more, and smash each others cars more often.

Canadians die more often of strokes, stomach cancer, and breast cancer than Americans.

How can that be with their superior healthcare?


Have you considered that perhaps your first sentence answers the question?
6.29.2009 8:42am
Cornellian (mail):
I am saddened to see those slamming Pluribus, given his circumstance.

It is the sort of callous disregard for people like PLuribus that has handed the whole health care debate to the Democrats. There are many people who fear they will end up with the same problem. There are many people who will end up with similar problems.


That is certainly part of the problem. Every proposal to reform health care sees the usual suspects issuing their talking points from their offices at the usual think tanks predicting the sky will fall if the reform is implemented. Then, once the reform fails, they disappear once again, as if the status quo were some kind of free market nirvana which could never be improved.

It is the refusal to recognize that situations like Pluribus's are a problem that needs to be addressed that leave them on the losing side of the health care reform debate. That, plus the desire of businesses to get out of the cost of providing health insurance.
6.29.2009 8:46am
Toby:
I apologize for going over the top on Pluribus, who is obviously hurting, and scared, and pleading with the uncaring maw of mortality. I can only plead the unwisdom of late night posting.

I must admit, though, that being called uncaring by folks who want to throw someone else's dollars at problems angers me more than a little. For some years, I spent my volunteer time holding the hands the dying, simply being there when their relatives and friends, to uncomfortable with their own mortality to be near someone else's. I used to spend time in NICU's, playing ("stimulating") babies whose crime was to not be perfect, or to look like the mailman rather than the father.

The allegation of not caring is the worse slur, it is used all too frequently those who imagine that the state somehow cares. It doesn't.

Will Pluribus feel better when his SO is denied care by the state board? Will he embrace its fairness then, even as a politician somehow slips to the head of the queue? I suspect he will not. He put his finger on it in his last post. No one seems to give a damn. That bespeaks a need to reconnect to others outside his tight circle. One such path connection was offered in this thread, and he spurned it. The state will never offer him salvation or fulfillment.

It is an old truism that hard cased make bad law. Medicine is chock full of hard cases every day. This law will make many of them worse.
6.29.2009 9:24am
pluribus:
Toby:

I apologize for going over the top on Pluribus. . . .

Thanks. You sound better in the morning than late at night.

I must admit, though, that being called uncaring by folks who want to throw someone else's dollars at problems angers me more than a little.

I have paid taxes all my adult life. I have paid health insurance premiums all my adult life. My SO has done the same. Why do you say I want to throw "somebody else's dollars" at the health care problem? Whose dollars are they if they aren't those of us--millions and millions--who have paid and are continuing to pay into the system, and feel like we are entitled to share in the benefits when we encounter a life-threatening illness?
6.29.2009 9:49am
rosetta's stones:
"Until those on the free-market side can recognize the areas where that ideology will fail (read: private health insurance), they are doomed to look like fools to anyone who understands the issue."

However, JM, those who cling to ideology that slams down $1.8T and counting onto the heads of children yet unborn, are also doomed to look like fools, only it will be a generation down the road, and those children will be paying for the fools' foolishness... not the fools themselves.

There is a moral question here, and the single payer zealots refuse to recognize it.

Pay for your current health care commitments first, and then we can legitimately address your latest schemes. You aren't doing so... and are in fact going in the other direction... and bankrupting us even further.
6.29.2009 11:20am
Tony Tutins (mail):
"I swear by my life and my love of it that I will never live for the sake of another man, nor ask another man to live for mine, except that I would gladly bankrupt myself to cover the cost of R&D, so that billions of foreigners can enjoy medical breakthroughs at low cost." -- John Galt, as John Calfee would have him be.
6.29.2009 12:26pm
Dan Ensign (mail):
pluribus, I'm deeply sorry that I confused your unwillingness to pay for cutting-edge treatments with an inability to pay for those treatments. My mistake.

However, don't pretend that our agreement on getting insuring all who wish to be insured is agreement on policy. The first step to insuring everyone should not be deeper government control of health care and insurance costs. Rather, the government needs to identify and eliminate its own policies that make health care more expensive.

Toby: your explanation of government and force is exactly what I meant; thank you.
6.29.2009 1:36pm
pluribus:
Dan Ensign:

pluribus, I'm deeply sorry that I confused your unwillingness to pay for cutting-edge treatments with an inability to pay for those treatments. My mistake.

It seems that a lot of people here are so anxious to reply to other posters that they don't first read what the other posters have actually said.

First, I'm not unwilling to pay for the chemotherapy.

Second, I'm deeply disturbed that the insurance company isn't paying many of the costs, but will certainly pay for what they don't, as long as I can.

Third, since I'm not currently unable to pay the costs, I'm not suffering from "inability to pay."

Fourth, the costs are large--frighteningly large ($18,000 for the drugs for one chemotherapy session lasting about 4 hours, not including the costs of the nurses, doctors, and the facility). I pointed this out above.

Fifth, I deeply wish the system worked more equitably, and that health insurance could be more reliably depended on, and I am profoundly sorry that people like me--and even more so, people who don't have as much money as I do--are put in financial crises at the same time they encounter health care crises. I believe health care costs are out of control. About one million Americans every year are forced into bankruptcy because of health care needs.

Sixth, the treatment my SO is receiving is not, as far as I know, "cutting edge." On the contrary, the oncologist informed us that it is "standard" treatment, as I stated above. He said it is treatment that is available all over the country.


[D]on't pretend that our agreement on getting insuring all who wish to be insured is agreement on policy. The first step to insuring everyone should not be deeper government control of health care and insurance costs.

Well, I do agree with you here. That is a point I have made here several times. I am "pretending" that we agree on this, or is this real?
6.29.2009 2:35pm
John Moore (www):

Sixth, the treatment my SO is receiving is not, as far as I know, "cutting edge." On the contrary, the oncologist informed us that it is "standard" treatment, as I stated above. He said it is treatment that is available all over the country.

These days, that may still be "cutting edge." Some of these treatments move out very rapidly.
6.29.2009 2:56pm
Leo Marvin (mail):
Toby,

Glad you came to your senses. I withdraw my own intemperate remark.
6.29.2009 4:51pm
Desiderius:
John Moore,

"It is the sort of callous disregard for people like PLuribus that has handed the whole health care debate to the Democrats. There are many people who fear they will end up with the same problem. There are many people who will end up with similar problems."

Exactly. And once one gets to where pluribus is, charity is likely to be at best a sad drop in a huge bucket, although depending on the hospital, he may be able to work something out on that side. Charity, through various foundation programs, does good work on the pre-bargaining side, but once you're on your own, it's hellish.

"Until those on the free-market side can recognize the areas where that ideology will fail (read: private health insurance), they are doomed to look like fools to anyone who understands the issue."

I think there is just a lot of frustration that ideas such as those Cato (very much not supporting the status quo) has advanced have been ruthlessly crushed by an alliance of those whom the status quo favors and those who should know better but seem to be motivated by little other than strangling ideas that any Republican might support in their crib, regardless of their liberality.
6.30.2009 6:23pm

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