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On April 15 2015 03:30 TheTenthDoc wrote:Show nested quote +On April 15 2015 02:51 cLutZ wrote:On April 15 2015 02:43 Gorsameth wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. But that wasn't the argument. The topic was not papers and studies but price and I doubt you believe that pharmaceuticals sell their drugs for lower prices on the European market out of the kindness of their heart. They do it because the marginal cost of a pill is 4 cents and they already have massive sunk costs. The reason they invest those costs in the first place is the US market. However, that is not the #1 reason the US has the most expensive medical care. On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. We are, through being the only profitable (if you include front end costs) region to sell medical developments. However, the reason the "socialist" systems are cheaper is almost entirely because of rationing. The US basically gives all the healthcare to everyone very quickly. European systems are different in that they don't provide certain services, or there are waitlists for them. This basic difference accounts for somewhere between 50-80% of why US healthcare is pricier than the EU systems. As a pharmacist who has spent six weeks in retail pharmacy calling doctors and insurance companies to get medications covered by insurance companies for the most basic of reasons, I can assure you this is not the case. Unless you mean that people can technically buy drugs out of pocket for hundreds/thousands of dollars quickly.
Do you have any experience in pharmacy in the EU? It might be worse. Instead of waiting while insurance companies drag their feet, you might wait for your turn in line.
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You will never have to wait in line for drugs in a pharmacy for more that maybe 15-30 minutes on an exceedingly busy day. You might have to wait in line at a doctors office for 30-60 minutes, but that depends a lot a) on the doctor and b) what kind of problem you have. As for hospitals and very hard procedures, i luckily don't have a lot of experience with those.
You seem to have a very weird image on how healthcare works in the EU (Well technically i only know how it works in Germany)
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On April 15 2015 03:39 Millitron wrote:Show nested quote +On April 15 2015 03:30 TheTenthDoc wrote:On April 15 2015 02:51 cLutZ wrote:On April 15 2015 02:43 Gorsameth wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. But that wasn't the argument. The topic was not papers and studies but price and I doubt you believe that pharmaceuticals sell their drugs for lower prices on the European market out of the kindness of their heart. They do it because the marginal cost of a pill is 4 cents and they already have massive sunk costs. The reason they invest those costs in the first place is the US market. However, that is not the #1 reason the US has the most expensive medical care. On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. We are, through being the only profitable (if you include front end costs) region to sell medical developments. However, the reason the "socialist" systems are cheaper is almost entirely because of rationing. The US basically gives all the healthcare to everyone very quickly. European systems are different in that they don't provide certain services, or there are waitlists for them. This basic difference accounts for somewhere between 50-80% of why US healthcare is pricier than the EU systems. As a pharmacist who has spent six weeks in retail pharmacy calling doctors and insurance companies to get medications covered by insurance companies for the most basic of reasons, I can assure you this is not the case. Unless you mean that people can technically buy drugs out of pocket for hundreds/thousands of dollars quickly. Do you have any experience in pharmacy in the EU? It might be worse. Instead of waiting while insurance companies drag their feet, you might wait for your turn in line.
There are no waiting lines for pharmaceuticals Oo waits are for surgeries and the likes because we only have so many surgeons and then only if there is no imminent further threat to your health.
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waiting at a doctors office can take up hours.
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On April 15 2015 03:12 Millitron wrote:Show nested quote +On April 15 2015 02:53 Acrofales wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. What? 1. Academic research is not considered in the cost of medical spending. This is clearly covered by other government institutions (which I agree are well-funded in comparison to some other countries). 2. Pharmaceutical research is paid for in the cost of medicine world wide. The medicine that is patented in the USPTO is equally protected in Europe. Even if the patent isn't deposited in the EPO, the US patents are generally adhered to. Only countries that might not be the case are upcoming economies that are far less interested in innovation and far more interested in getting cheap medicine to their population (India is generally cited as the most egregious offender). 3. It isn't very fair to compare the US to the UK, when the US has ~320million inhabitants and the UK ~60million. If we look at per capita research production, the UK actually outperforms the US using those numbers: 300/60 = 5 papers per million inhabitants, whereas 1200/320 < 4 papers per million inhabitants. 1) Private companies perform research, including writing research papers. 2) Sure, but a single pill might only cost a few cents to make. So they don't mind too much to not make 10,000% profits in Europe since they can still get away with it in the US. 3) The US makes 40% of the world's research papers. The US does not have 40% of the world's population. I only compared to UK because I was summarizing the Forbes article.
1) Sure they do. I work for one! But the vast amount of scientific literature in all fields is produced with public money. Even when the research is performed in a company.
2) The pill itself might only cost a few cents (although given the specialized instruments and facilities, I doubt this is actually true except for the most basic and mass-produced medicines), but the reason the US pays more has nothing to do with Europe, it's because your system SUCKS and affords farmaceutical companies a strong bargaining position (because for some reason insurance companies are willing to pay anything, and then foist those costs off on consumers who cannot pay them, rather than the government mandating a bottom line of stuff insurance companies HAVE to pay for: something that the ACA does do).
3) Even if we look at percentages instead of raw numbers, it is still a false comparison, because high quality research is almost exclusively done in first world countries, and these are also the only countries worth comparing your health care system to. The costs of health care in Brazil, for instance, are irrelevant, because the average quality sucks.
Particularly medical research, which has very high costs, which developing countries cannot afford. So then you need to look at what percentage of the first world population lives in the US:
Western Europe: 400million
Australia: 25million
Japan: 130million
US: 320million
Percentage in the US: 37%. So 40% of the medical research is only very slightly above what you would expect. And most of that research is done because innovation directly benefits the local economy, not out of altruism. Countries fund research out of self-interest.
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On April 15 2015 03:45 Gorsameth wrote:Show nested quote +On April 15 2015 03:39 Millitron wrote:On April 15 2015 03:30 TheTenthDoc wrote:On April 15 2015 02:51 cLutZ wrote:On April 15 2015 02:43 Gorsameth wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. But that wasn't the argument. The topic was not papers and studies but price and I doubt you believe that pharmaceuticals sell their drugs for lower prices on the European market out of the kindness of their heart. They do it because the marginal cost of a pill is 4 cents and they already have massive sunk costs. The reason they invest those costs in the first place is the US market. However, that is not the #1 reason the US has the most expensive medical care. On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. We are, through being the only profitable (if you include front end costs) region to sell medical developments. However, the reason the "socialist" systems are cheaper is almost entirely because of rationing. The US basically gives all the healthcare to everyone very quickly. European systems are different in that they don't provide certain services, or there are waitlists for them. This basic difference accounts for somewhere between 50-80% of why US healthcare is pricier than the EU systems. As a pharmacist who has spent six weeks in retail pharmacy calling doctors and insurance companies to get medications covered by insurance companies for the most basic of reasons, I can assure you this is not the case. Unless you mean that people can technically buy drugs out of pocket for hundreds/thousands of dollars quickly. Do you have any experience in pharmacy in the EU? It might be worse. Instead of waiting while insurance companies drag their feet, you might wait for your turn in line. There are no waiting lines for pharmaceuticals Oo waits are for surgeries and the likes because we only have so many surgeons and then only if there is no imminent further threat to your health.
This is what I was referring to. Not whether it takes 15 minutes or 4 hours to get a prescription filled. Elective surgeries for chronic conditions, particularly for the elderly is where a lot of it comes from. Also hospital admittance for chronic conditions in the US is common while other countries restrict that much more.
Basically, because of the way 3rd party payer works, and the federal mandates that have been in place for decades, the United States has a lot more heathcare providers per person (there is a lot of demand, so supply has increased). The number one way other countries have kept healthcare costs down is by restricting supply (or at least, supply has not grown as fast, because it is not responsive to market forces). Thus, no proposal would actually bring US costs in line with other countries in the short term, and in the long term it would, only if the government was willing to reduce supply ala other nations.
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Err, just a comment on the drug development pipeline:
Most initial research is done in academic labs and such with significant public funding via the NIH. These are usually pretty basic studies that look at molecular interaction and very simply systems with bacteria and maybe up to mice. This stuff is *relatively* cheap (though when I worked in a lab, I probably burned through $1000+ in disposable equipment a day)
After one of these labs has a promising drug candidate, they pass it to the pharmaceutical companies. These firms take on a ton of risk to go through the FDA phase 1, 2 and 3 trials. I think the estimated success rate is like 10-20% depending on if it's a large or small molecule drug. Having to do these clinical trials with hundreds if not thousands of individuals is expensive as heck, and every drug that makes it through has to cross subsidize the failed ones. I don't think that these trials get that much funding.
There's actually an interesting intermediate between drug companies and research labs now that handles some of the mid-level testing since drug companies don't want the risk. But that's just a sidenote.
I'd hazard to guess that the US is basically paying for the rest of the world's drugs actually.You guys are like "lol yeah US system sucks", which it does, but if it didn't you guys would have to pay more for drugs. Pharma operates on a tiered pricing model, they make so much off the US that international is just gravy. If the US part got smaller, they'd look to squeeze money from elsewhere.
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On April 15 2015 03:51 Acrofales wrote:
Western Europe: 400million
Australia: 25million
Japan: 130million
US: 320million
Yeah, I'm not getting into the silly debate going on above, but this list of numbers as a sum total of the population of the developed world is all kinds of wack. To ignore South Korea/Taiwan/Singapore on a Starcraft forum is particularly entertaining. That's 80 Million missing. Never mind Canada, Hong Kong, and the parts of the EU you're not counting that, say, the IMF does.
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On April 15 2015 03:59 cLutZ wrote:Show nested quote +On April 15 2015 03:45 Gorsameth wrote:On April 15 2015 03:39 Millitron wrote:On April 15 2015 03:30 TheTenthDoc wrote:On April 15 2015 02:51 cLutZ wrote:On April 15 2015 02:43 Gorsameth wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. But that wasn't the argument. The topic was not papers and studies but price and I doubt you believe that pharmaceuticals sell their drugs for lower prices on the European market out of the kindness of their heart. They do it because the marginal cost of a pill is 4 cents and they already have massive sunk costs. The reason they invest those costs in the first place is the US market. However, that is not the #1 reason the US has the most expensive medical care. On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. We are, through being the only profitable (if you include front end costs) region to sell medical developments. However, the reason the "socialist" systems are cheaper is almost entirely because of rationing. The US basically gives all the healthcare to everyone very quickly. European systems are different in that they don't provide certain services, or there are waitlists for them. This basic difference accounts for somewhere between 50-80% of why US healthcare is pricier than the EU systems. As a pharmacist who has spent six weeks in retail pharmacy calling doctors and insurance companies to get medications covered by insurance companies for the most basic of reasons, I can assure you this is not the case. Unless you mean that people can technically buy drugs out of pocket for hundreds/thousands of dollars quickly. Do you have any experience in pharmacy in the EU? It might be worse. Instead of waiting while insurance companies drag their feet, you might wait for your turn in line. There are no waiting lines for pharmaceuticals Oo waits are for surgeries and the likes because we only have so many surgeons and then only if there is no imminent further threat to your health. This is what I was referring to. Not whether it takes 15 minutes or 4 hours to get a prescription filled. Elective surgeries for chronic conditions, particularly for the elderly is where a lot of it comes from. Also hospital admittance for chronic conditions in the US is common while other countries restrict that much more. Basically, because of the way 3rd party payer works, and the federal mandates that have been in place for decades, the United States has a lot more heathcare providers per person (there is a lot of demand, so supply has increased). The number one way other countries have kept healthcare costs down is by restricting supply (or at least, supply has not grown as fast, because it is not responsive to market forces). Thus, no proposal would actually bring US costs in line with other countries in the short term, and in the long term it would, only if the government was willing to reduce supply ala other nations.
That's not true-- the US has half the number of healthcare professionals per capita compared to other developed nations.
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On April 15 2015 03:59 cLutZ wrote:Show nested quote +On April 15 2015 03:45 Gorsameth wrote:On April 15 2015 03:39 Millitron wrote:On April 15 2015 03:30 TheTenthDoc wrote:On April 15 2015 02:51 cLutZ wrote:On April 15 2015 02:43 Gorsameth wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. But that wasn't the argument. The topic was not papers and studies but price and I doubt you believe that pharmaceuticals sell their drugs for lower prices on the European market out of the kindness of their heart. They do it because the marginal cost of a pill is 4 cents and they already have massive sunk costs. The reason they invest those costs in the first place is the US market. However, that is not the #1 reason the US has the most expensive medical care. On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. We are, through being the only profitable (if you include front end costs) region to sell medical developments. However, the reason the "socialist" systems are cheaper is almost entirely because of rationing. The US basically gives all the healthcare to everyone very quickly. European systems are different in that they don't provide certain services, or there are waitlists for them. This basic difference accounts for somewhere between 50-80% of why US healthcare is pricier than the EU systems. As a pharmacist who has spent six weeks in retail pharmacy calling doctors and insurance companies to get medications covered by insurance companies for the most basic of reasons, I can assure you this is not the case. Unless you mean that people can technically buy drugs out of pocket for hundreds/thousands of dollars quickly. Do you have any experience in pharmacy in the EU? It might be worse. Instead of waiting while insurance companies drag their feet, you might wait for your turn in line. There are no waiting lines for pharmaceuticals Oo waits are for surgeries and the likes because we only have so many surgeons and then only if there is no imminent further threat to your health. This is what I was referring to. Not whether it takes 15 minutes or 4 hours to get a prescription filled. Elective surgeries for chronic conditions, particularly for the elderly is where a lot of it comes from. Also hospital admittance for chronic conditions in the US is common while other countries restrict that much more. Basically, because of the way 3rd party payer works, and the federal mandates that have been in place for decades, the United States has a lot more heathcare providers per person (there is a lot of demand, so supply has increased). The number one way other countries have kept healthcare costs down is by restricting supply (or at least, supply has not grown as fast, because it is not responsive to market forces). Thus, no proposal would actually bring US costs in line with other countries in the short term, and in the long term it would, only if the government was willing to reduce supply ala other nations.
That is fine. You need to state that explicitly, though. The taboo on discussing price when discussing healthcare needs to be broken down. I think it is a reasonable position to say that in the US healthcare is inherently more expensive, because more expensive treatments (or higher risk treatments) are being paid for.
However, it needs to be made explicit. Is it really worth paying $200k more for a medicine that performs 5% better than the baseline medicine? What if it performs 100% better for 5% of the population (those with gene XYZ), but not better at all for the rest? What if it performs 50% better but only in seniors? Or only in children?
How much is a human life worth?
Those are questions that impact health care, and if the bar is higher in the US (I'm not sure it actually is), then that is a perfectly valid reason to consciously decide that it is okay to spend more. However, that discussion is always avoided, because it is basically political suicide (worldwide) to frame the discussion in this manner.
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On April 15 2015 03:51 Acrofales wrote:Show nested quote +On April 15 2015 03:12 Millitron wrote:On April 15 2015 02:53 Acrofales wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. What? 1. Academic research is not considered in the cost of medical spending. This is clearly covered by other government institutions (which I agree are well-funded in comparison to some other countries). 2. Pharmaceutical research is paid for in the cost of medicine world wide. The medicine that is patented in the USPTO is equally protected in Europe. Even if the patent isn't deposited in the EPO, the US patents are generally adhered to. Only countries that might not be the case are upcoming economies that are far less interested in innovation and far more interested in getting cheap medicine to their population (India is generally cited as the most egregious offender). 3. It isn't very fair to compare the US to the UK, when the US has ~320million inhabitants and the UK ~60million. If we look at per capita research production, the UK actually outperforms the US using those numbers: 300/60 = 5 papers per million inhabitants, whereas 1200/320 < 4 papers per million inhabitants. 1) Private companies perform research, including writing research papers. 2) Sure, but a single pill might only cost a few cents to make. So they don't mind too much to not make 10,000% profits in Europe since they can still get away with it in the US. 3) The US makes 40% of the world's research papers. The US does not have 40% of the world's population. I only compared to UK because I was summarizing the Forbes article. 1) Sure they do. I work for one! But the vast amount of scientific literature in all fields is produced with public money. Even when the research is performed in a company. 2) The pill itself might only cost a few cents (although given the specialized instruments and facilities, I doubt this is actually true except for the most basic and mass-produced medicines), but the reason the US pays more has nothing to do with Europe, it's because your system SUCKS and affords farmaceutical companies a strong bargaining position (because for some reason insurance companies are willing to pay anything, and then foist those costs off on consumers who cannot pay them, rather than the government mandating a bottom line of stuff insurance companies HAVE to pay for: something that the ACA does do). 3) Even if we look at percentages instead of raw numbers, it is still a false comparison, because high quality research is almost exclusively done in first world countries, and these are also the only countries worth comparing your health care system to. The costs of health care in Brazil, for instance, are irrelevant, because the average quality sucks. Particularly medical research, which has very high costs, which developing countries cannot afford. So then you need to look at what percentage of the first world population lives in the US: Western Europe: 400million Australia: 25million Japan: 130million US: 320million Percentage in the US: 37%. So 40% of the medical research is only very slightly above what you would expect. And most of that research is done because innovation directly benefits the local economy, not out of altruism. Countries fund research out of self-interest.
1) Ok? Point being what? That only supports the idea that the US subsidizes the world's research.
2) Yeah, I've said all along the system sucks. The ACA doesn't exactly help though, because it further strengthens pharmaceutical companies' bargaining position. That bottom line you mention are things insurance companies MUST cover, meaning they have no real choice but to pay whatever big pharma says. The ACA is a poor substitute for a system at either end of the spectrum; either single payer or a true free market solution.
3) Much of the research done in the EU and elsewhere is collaborative, with a great deal of help from the US. So even UK's 300 articles must count at least partially towards the US.
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The White House announced on Tuesday that President Obama intends to remove Cuba from the American government’s list of nations that sponsor terrorism, eliminating a major obstacle to the restoration of diplomatic relations after decades of hostilities.
Source
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On April 15 2015 04:09 Millitron wrote:Show nested quote +On April 15 2015 03:51 Acrofales wrote:On April 15 2015 03:12 Millitron wrote:On April 15 2015 02:53 Acrofales wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. What? 1. Academic research is not considered in the cost of medical spending. This is clearly covered by other government institutions (which I agree are well-funded in comparison to some other countries). 2. Pharmaceutical research is paid for in the cost of medicine world wide. The medicine that is patented in the USPTO is equally protected in Europe. Even if the patent isn't deposited in the EPO, the US patents are generally adhered to. Only countries that might not be the case are upcoming economies that are far less interested in innovation and far more interested in getting cheap medicine to their population (India is generally cited as the most egregious offender). 3. It isn't very fair to compare the US to the UK, when the US has ~320million inhabitants and the UK ~60million. If we look at per capita research production, the UK actually outperforms the US using those numbers: 300/60 = 5 papers per million inhabitants, whereas 1200/320 < 4 papers per million inhabitants. 1) Private companies perform research, including writing research papers. 2) Sure, but a single pill might only cost a few cents to make. So they don't mind too much to not make 10,000% profits in Europe since they can still get away with it in the US. 3) The US makes 40% of the world's research papers. The US does not have 40% of the world's population. I only compared to UK because I was summarizing the Forbes article. 1) Sure they do. I work for one! But the vast amount of scientific literature in all fields is produced with public money. Even when the research is performed in a company. 2) The pill itself might only cost a few cents (although given the specialized instruments and facilities, I doubt this is actually true except for the most basic and mass-produced medicines), but the reason the US pays more has nothing to do with Europe, it's because your system SUCKS and affords farmaceutical companies a strong bargaining position (because for some reason insurance companies are willing to pay anything, and then foist those costs off on consumers who cannot pay them, rather than the government mandating a bottom line of stuff insurance companies HAVE to pay for: something that the ACA does do). 3) Even if we look at percentages instead of raw numbers, it is still a false comparison, because high quality research is almost exclusively done in first world countries, and these are also the only countries worth comparing your health care system to. The costs of health care in Brazil, for instance, are irrelevant, because the average quality sucks. Particularly medical research, which has very high costs, which developing countries cannot afford. So then you need to look at what percentage of the first world population lives in the US: Western Europe: 400million Australia: 25million Japan: 130million US: 320million Percentage in the US: 37%. So 40% of the medical research is only very slightly above what you would expect. And most of that research is done because innovation directly benefits the local economy, not out of altruism. Countries fund research out of self-interest. 1) Ok? Point being what? That only supports the idea that the US subsidizes the world's research. 2) Yeah, I've said all along the system sucks. The ACA doesn't exactly help though, because it further strengthens pharmaceutical companies' bargaining position. That bottom line you mention are things insurance companies MUST cover, meaning they have no real choice but to pay whatever big pharma says. The ACA is a poor substitute for a system at either end of the spectrum; either single payer or a true free market solution. 3) Much of the research done in the EU and elsewhere is collaborative, with a great deal of help from the US. So even UK's 300 articles must count at least partially towards the US.
Re 1: perhaps, but it's irrelevant. We were discussing the cost of heatlhcare which is disproportionally high in the US. Whether or not the US pays more than its fair share for research is beside the point, because this cost is not rolled into the cost of health care, except when we are purely discussing the cost of developing new medicines and medical machines, in which case that cost is charged from anybody buying those medicines, including all of Europe.
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On April 15 2015 04:33 Acrofales wrote:Show nested quote +On April 15 2015 04:09 Millitron wrote:On April 15 2015 03:51 Acrofales wrote:On April 15 2015 03:12 Millitron wrote:On April 15 2015 02:53 Acrofales wrote:On April 15 2015 02:08 Millitron wrote:On April 15 2015 02:02 Simberto wrote:
So why don't all these problems also appear in european countries with a more socialist medical system? Doctors here are still paid well and need lots of education, expensive treatments are very often administered (people have a big aversion to someone dieing due to their insurance not covering their treatment because they fear it could be them next time), especially to very old people.
And i don't really buy into the whole "Well the US is subsidizing everyone else" story, because that sounds way too much like putting a spin on the situation where the fact that your system is just really bad and expensive is turned into some sort of altruistic decision. The US does subsidize quite a lot. http://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/Researchers in the US write 40% of the world's medical research papers, totaling 1,169 in 2009. The next highest was Great Britain at only around 300. The number for the US has also grown at an above-average rate of 7% between 2005 and 2009. What? 1. Academic research is not considered in the cost of medical spending. This is clearly covered by other government institutions (which I agree are well-funded in comparison to some other countries). 2. Pharmaceutical research is paid for in the cost of medicine world wide. The medicine that is patented in the USPTO is equally protected in Europe. Even if the patent isn't deposited in the EPO, the US patents are generally adhered to. Only countries that might not be the case are upcoming economies that are far less interested in innovation and far more interested in getting cheap medicine to their population (India is generally cited as the most egregious offender). 3. It isn't very fair to compare the US to the UK, when the US has ~320million inhabitants and the UK ~60million. If we look at per capita research production, the UK actually outperforms the US using those numbers: 300/60 = 5 papers per million inhabitants, whereas 1200/320 < 4 papers per million inhabitants. 1) Private companies perform research, including writing research papers. 2) Sure, but a single pill might only cost a few cents to make. So they don't mind too much to not make 10,000% profits in Europe since they can still get away with it in the US. 3) The US makes 40% of the world's research papers. The US does not have 40% of the world's population. I only compared to UK because I was summarizing the Forbes article. 1) Sure they do. I work for one! But the vast amount of scientific literature in all fields is produced with public money. Even when the research is performed in a company. 2) The pill itself might only cost a few cents (although given the specialized instruments and facilities, I doubt this is actually true except for the most basic and mass-produced medicines), but the reason the US pays more has nothing to do with Europe, it's because your system SUCKS and affords farmaceutical companies a strong bargaining position (because for some reason insurance companies are willing to pay anything, and then foist those costs off on consumers who cannot pay them, rather than the government mandating a bottom line of stuff insurance companies HAVE to pay for: something that the ACA does do). 3) Even if we look at percentages instead of raw numbers, it is still a false comparison, because high quality research is almost exclusively done in first world countries, and these are also the only countries worth comparing your health care system to. The costs of health care in Brazil, for instance, are irrelevant, because the average quality sucks. Particularly medical research, which has very high costs, which developing countries cannot afford. So then you need to look at what percentage of the first world population lives in the US: Western Europe: 400million Australia: 25million Japan: 130million US: 320million Percentage in the US: 37%. So 40% of the medical research is only very slightly above what you would expect. And most of that research is done because innovation directly benefits the local economy, not out of altruism. Countries fund research out of self-interest. 1) Ok? Point being what? That only supports the idea that the US subsidizes the world's research. 2) Yeah, I've said all along the system sucks. The ACA doesn't exactly help though, because it further strengthens pharmaceutical companies' bargaining position. That bottom line you mention are things insurance companies MUST cover, meaning they have no real choice but to pay whatever big pharma says. The ACA is a poor substitute for a system at either end of the spectrum; either single payer or a true free market solution. 3) Much of the research done in the EU and elsewhere is collaborative, with a great deal of help from the US. So even UK's 300 articles must count at least partially towards the US. Re 1: perhaps, but it's irrelevant. We were discussing the cost of heatlhcare which is disproportionally high in the US. Whether or not the US pays more than its fair share for research is beside the point, because this cost is not rolled into the cost of health care, except when we are purely discussing the cost of developing new medicines and medical machines, in which case that cost is charged from anybody buying those medicines, including all of Europe.
This cost is mostly covered by the US market though. As others have pointed out, pharma companies price gouge the US market because their bargaining position is so much stronger here. Big Pharma cares about it's profits from the US market, whatever it gets overseas is just a bonus. They're fine with much lower profit margins in the EU because they know the US will more than cover their initial capital investment.
Would you really be bothered by selling a product for only 10% profit in a smaller market, when at the same time in your main market you were making 1000% profit?
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Pharmaceutical spending is ~10% of healthcare spending. Even if we were subsidizing the rest of the world, you're talking small potatoes in the grand scheme of things.
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On April 15 2015 04:40 JonnyBNoHo wrote:
Pharmaceutical spending is ~10% of healthcare spending. Even if we were subsidizing the rest of the world, you're talking small potatoes in the grand scheme of things.
General medical equipment suffers from the same problems. Why does an X-ray cost hundreds? It takes seconds, and doesn't use anything up.
The answer is the company that builds X-ray machines price gouges, and hospitals are forced to pass that cost on to the customer.
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On April 15 2015 04:43 Millitron wrote:Show nested quote +On April 15 2015 04:40 JonnyBNoHo wrote:
Pharmaceutical spending is ~10% of healthcare spending. Even if we were subsidizing the rest of the world, you're talking small potatoes in the grand scheme of things. General medical equipment suffers from the same problems. Why does an X-ray cost hundreds? It takes seconds, and doesn't use anything up. The answer is the company that builds X-ray machines price gouges, and hospitals are forced to pass that cost on to the customer.
I can also imagine resource low utilization rates causing the same issue. Do you have a source for your price gouging claim or is that just an assertion?
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On April 15 2015 04:49 JonnyBNoHo wrote:Show nested quote +On April 15 2015 04:43 Millitron wrote:On April 15 2015 04:40 JonnyBNoHo wrote:
Pharmaceutical spending is ~10% of healthcare spending. Even if we were subsidizing the rest of the world, you're talking small potatoes in the grand scheme of things. General medical equipment suffers from the same problems. Why does an X-ray cost hundreds? It takes seconds, and doesn't use anything up. The answer is the company that builds X-ray machines price gouges, and hospitals are forced to pass that cost on to the customer. I can also imagine resource low utilization rates causing the same issue. Do you have a source for your price gouging claim or is that just an assertion?
I don't have a source, but much of the same setting is true for medical equipment as well as pharmaceuticals. Both need very long testing periods. Both are covered by insurance. Both take a great deal of research.
As for low utilization rates, I find that hard to believe considering how packed the outpatient lab waiting room is.
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You in general should just stop talking about european healthcare systems because:
1: You have no clue about them.
2: They vary widely from country to country.
3: You think there are waiting lines in pharmacies because... I don't know, no one does, because these don't exist, at least not more than at your average walmart....
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EPT
