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On February 09 2017 06:40 KwarK wrote:Show nested quote +On February 09 2017 06:31 cLutZ wrote:On February 09 2017 06:27 KwarK wrote:
One advantage though is that the NHS gets very different prices on drugs to US insurance companies. When you control access to 65,000,000 consumers and aren't afraid to say "no" drug companies will adjust accordingly because any price above the marginal price of each additional dose supplied (which is very different from price as calculated by the total cost of all doses(including all R&D) divided by the number of doses) is still profitable for them, even if it's below the amount they need to recover their money. What happens when all the countries have this model of "paying more than the marginal cost of a pill/treatment, but less than the cost needed to recover their money"? Companies manufacture products that people will buy. With expensive healthcare drugs in order to have any chance at generating a profit they need to sell it to people who A) Have that condition B) Have $X to spend on the drug those people*X = potential revenue If potential revenue < cost of producing the drug then the drug won't get produced. And don't delude yourself into thinking that right now all potential treatments are being funded. This process happens, whether collective bargaining exists or not. Rare conditions that mostly afflict the poor aren't going to be top of the list for research in the US either because there's no money to be made. The US insurance system increases X, I'll grant you, but it doesn't change the way this works. X still exists with collective bargaining, it's just calculated differently. The NHS would still represent a big customer for a potential drug that offered actual value for money. It's just for the purpose of the pharma company the population of the UK are all excluded from "Have $X to spend on the drug" if the price of the drug is higher than the NHS are willing to pay for it. For the purpose of how much the NHS has to spend on a drug, it's capped at whatever the value of the benefit is calculated to be. If you have a good drug at a good price you'll still be able to sell it at a premium. Collective bargaining doesn't disincentivise drug research. Those customers never existed at the price the drug companies wanted. They were all too poor to afford it. Collective bargaining allows the manufacturer to generate additional profits by expanding their customer base into a group that previously had been disregarded as not being potential customers.
I don't see how your conclusions make this out. Those customers do exist in a free market with traditional American insurance. They don't exist in a British system because they don't have that insurance because to get insurance that pays for it does not mean they stop paying for the public system. The difference is a deadweight loss that significantly reduces the number of potential customers.
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Frankly, I don't think we have a particularly good pharmaceutical R&D system as it is. You speak as if we're preserving something good but that's just not the case.
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United States43829 Posts
On February 09 2017 06:56 cLutZ wrote:Show nested quote +On February 09 2017 06:40 KwarK wrote:On February 09 2017 06:31 cLutZ wrote:On February 09 2017 06:27 KwarK wrote:
One advantage though is that the NHS gets very different prices on drugs to US insurance companies. When you control access to 65,000,000 consumers and aren't afraid to say "no" drug companies will adjust accordingly because any price above the marginal price of each additional dose supplied (which is very different from price as calculated by the total cost of all doses(including all R&D) divided by the number of doses) is still profitable for them, even if it's below the amount they need to recover their money. What happens when all the countries have this model of "paying more than the marginal cost of a pill/treatment, but less than the cost needed to recover their money"? Companies manufacture products that people will buy. With expensive healthcare drugs in order to have any chance at generating a profit they need to sell it to people who A) Have that condition B) Have $X to spend on the drug those people*X = potential revenue If potential revenue < cost of producing the drug then the drug won't get produced. And don't delude yourself into thinking that right now all potential treatments are being funded. This process happens, whether collective bargaining exists or not. Rare conditions that mostly afflict the poor aren't going to be top of the list for research in the US either because there's no money to be made. The US insurance system increases X, I'll grant you, but it doesn't change the way this works. X still exists with collective bargaining, it's just calculated differently. The NHS would still represent a big customer for a potential drug that offered actual value for money. It's just for the purpose of the pharma company the population of the UK are all excluded from "Have $X to spend on the drug" if the price of the drug is higher than the NHS are willing to pay for it. For the purpose of how much the NHS has to spend on a drug, it's capped at whatever the value of the benefit is calculated to be. If you have a good drug at a good price you'll still be able to sell it at a premium. Collective bargaining doesn't disincentivise drug research. Those customers never existed at the price the drug companies wanted. They were all too poor to afford it. Collective bargaining allows the manufacturer to generate additional profits by expanding their customer base into a group that previously had been disregarded as not being potential customers. I don't see how your conclusions make this out. Those customers do exist in a free market with traditional American insurance. They don't exist in a British system because they don't have that insurance because to get insurance that pays for it does not mean they stop paying for the public system. The difference is a deadweight loss that significantly reduces the number of potential customers.
The American public are fine with paying $9,500 per person, per year, on healthcare. And furthermore they're fine with doing it super inefficiently. The well off get treatments which provide shitty value for money, the poor can't afford treatments which provide great value for money. This means that you have an inflated market for drugs which provide poor value for money and a reduced market for drugs which are good drugs but which the uninsured cannot get.
Meanwhile the British public only want to spend $4,000 per person, per year, on healthcare. And they do it in an extremely egalitarian way, the most cost effective treatment first, then the second and so forth. If your treatment makes the cut then everyone who needs it gets it, if it doesn't then nobody does.
The result is that the British public are treated as effectively not existing for the purpose of deciding whether or not to invent incredibly expensive drugs that provide very low value for money. Which is fine, so are the population of Zimbabwe, or Afghanistan, or wherever else can't afford them. They're also overrepresented for the purpose of deciding whether or not to invent drugs that are good value for money, but which every American might not have access to due to reasons of uneven access to healthcare.
It's just a different weighting. That's all. When examined as a market for drugs the US is assumed to be a country with extreme wealth inequality whereas the UK is assumed to be a country with extreme wealth equality. Therefore the US will have a greater market for extremely expensive inefficient drugs and a smaller relative market for cheaper more efficient drugs meanwhile the UK will have a cutoff where either everyone is a potential customer or nobody is.
Also don't try to describe the US system as a traditional free market. Nobody anywhere is buying that.
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On February 09 2017 07:03 LegalLord wrote:
Frankly, I don't think we have a particularly good pharmaceutical R&D system as it is. You speak as if we're preserving something good but that's just not the case.
Unless you have some specifics in mind for improvements, it sounds a bit like the classic "throw everything out and it'll be better next time" type of argument that usually ends up with everyone realizing the difficulty of the problem after they try starting over. The difficulty in part is why the system is bad in the first place. Not that there aren't things that could be vastly improved, but it's a difficult industry. It's not exactly the sort of industry that you can just predict results for and the day to day costs of the R&D is quite high.
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On February 09 2017 07:05 KwarK wrote:Show nested quote +On February 09 2017 06:56 cLutZ wrote:On February 09 2017 06:40 KwarK wrote:On February 09 2017 06:31 cLutZ wrote:On February 09 2017 06:27 KwarK wrote:
One advantage though is that the NHS gets very different prices on drugs to US insurance companies. When you control access to 65,000,000 consumers and aren't afraid to say "no" drug companies will adjust accordingly because any price above the marginal price of each additional dose supplied (which is very different from price as calculated by the total cost of all doses(including all R&D) divided by the number of doses) is still profitable for them, even if it's below the amount they need to recover their money. What happens when all the countries have this model of "paying more than the marginal cost of a pill/treatment, but less than the cost needed to recover their money"? Companies manufacture products that people will buy. With expensive healthcare drugs in order to have any chance at generating a profit they need to sell it to people who A) Have that condition B) Have $X to spend on the drug those people*X = potential revenue If potential revenue < cost of producing the drug then the drug won't get produced. And don't delude yourself into thinking that right now all potential treatments are being funded. This process happens, whether collective bargaining exists or not. Rare conditions that mostly afflict the poor aren't going to be top of the list for research in the US either because there's no money to be made. The US insurance system increases X, I'll grant you, but it doesn't change the way this works. X still exists with collective bargaining, it's just calculated differently. The NHS would still represent a big customer for a potential drug that offered actual value for money. It's just for the purpose of the pharma company the population of the UK are all excluded from "Have $X to spend on the drug" if the price of the drug is higher than the NHS are willing to pay for it. For the purpose of how much the NHS has to spend on a drug, it's capped at whatever the value of the benefit is calculated to be. If you have a good drug at a good price you'll still be able to sell it at a premium. Collective bargaining doesn't disincentivise drug research. Those customers never existed at the price the drug companies wanted. They were all too poor to afford it. Collective bargaining allows the manufacturer to generate additional profits by expanding their customer base into a group that previously had been disregarded as not being potential customers. I don't see how your conclusions make this out. Those customers do exist in a free market with traditional American insurance. They don't exist in a British system because they don't have that insurance because to get insurance that pays for it does not mean they stop paying for the public system. The difference is a deadweight loss that significantly reduces the number of potential customers. The American public are fine with paying $9,500 per person, per year, on healthcare. And furthermore they're fine with doing it super inefficiently. The well off get treatments which provide shitty value for money, the poor can't afford treatments which provide great value for money. This means that you have an inflated market for drugs which provide poor value for money and a reduced market for drugs which are good drugs but which the uninsured cannot get. Meanwhile the British public only want to spend $4,000 per person, per year, on healthcare. And they do it in an extremely egalitarian way, the most cost effective treatment first, then the second and so forth. If your treatment makes the cut then everyone who needs it gets it, if it doesn't then nobody does. The result is that the British public are treated as effectively not existing for the purpose of deciding whether or not to invent incredibly expensive drugs that provide very low value for money. Which is fine, so are the population of Zimbabwe, or Afghanistan, or wherever else can't afford them. They're also overrepresented for the purpose of deciding whether or not to invent drugs that are good value for money, but which every American might not have access to due to reasons of uneven access to healthcare. It's just a different weighting. That's all. When examined as a market for drugs the US is assumed to be a country with extreme wealth inequality whereas the UK is assumed to be a country with extreme wealth equality. Therefore the US will have a greater market for extremely expensive inefficient drugs and a smaller relative market for cheaper more efficient drugs meanwhile the UK will have a cutoff where either everyone is a potential customer or nobody is. Also don't try to describe the US system as a traditional free market. Nobody anywhere is buying that.
I certainly don't, that is one of its problems when it comes to medical innovation.
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United States43829 Posts
When you have investments with very high upfront costs, but very low marginal costs for additional sales, you get counter-intuitive situations.
If a product costs $1,000,000 (for the factory) + $1 per unit to produce then if you have 1,000 customers in a region then they each need to be willing to pay $1,001 for you to break even. If there are 500 potential customers in another region, all willing to pay $500 for it, well, you'd still be technically making a loss on those. At 1500 customers you've got total costs of $1,001,500/1500 = $668/unit. So in theory every sale you make at $500, you lose $168 on. But as long as the different regions aren't able to trade your product then it doesn't work like that at all. If they're willing to pay $500 for it, well, that's $499*500 in profit right there.
Sunk costs and marginal costs are strange, but having the NHS buy your drugs, even at a "loss" is still beneficial for the drug companies. And that additional revenue stream allows them to produce drugs that would otherwise not be cost efficient. They cannot allocate such a high portion of the overhead to the British consumer as they can to the American consumer, but they can still allocate some.
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On February 09 2017 07:10 Logo wrote:Show nested quote +On February 09 2017 07:03 LegalLord wrote:
Frankly, I don't think we have a particularly good pharmaceutical R&D system as it is. You speak as if we're preserving something good but that's just not the case. Unless you have some specifics in mind for improvements, it sounds a bit like the classic "throw everything out and it'll be better next time" type of argument that usually ends up with everyone realizing the difficulty of the problem after they try starting over. The difficulty in part is why the system is bad in the first place. Not that there aren't things that could be vastly improved, but it's a difficult industry. It's not exactly the sort of industry that you can just predict results for and the day to day costs of the R&D is quite high.
The way I see it, running medicine as a business is a flawed idea in and of itself - and that extends to pharmaceuticals. I'd run it more as an academic enterprise more akin to the national labs system - which, incidentally, do some fairly decent work on medical devices.
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On February 09 2017 05:27 LegalLord wrote:Show nested quote +On February 09 2017 05:19 Simberto wrote:On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too. I personally would like a universal healthcare system. But Americans would never get behind that because "socialism."
But they already are. It's not Americans that have to be convinced, it's our government.
http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx
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On February 09 2017 07:25 LegalLord wrote:Show nested quote +On February 09 2017 07:10 Logo wrote:On February 09 2017 07:03 LegalLord wrote:
Frankly, I don't think we have a particularly good pharmaceutical R&D system as it is. You speak as if we're preserving something good but that's just not the case. Unless you have some specifics in mind for improvements, it sounds a bit like the classic "throw everything out and it'll be better next time" type of argument that usually ends up with everyone realizing the difficulty of the problem after they try starting over. The difficulty in part is why the system is bad in the first place. Not that there aren't things that could be vastly improved, but it's a difficult industry. It's not exactly the sort of industry that you can just predict results for and the day to day costs of the R&D is quite high. The way I see it, running medicine as a business is a flawed idea in and of itself - and that extends to pharmaceuticals. I'd run it more as an academic enterprise more akin to the national labs system - which, incidentally, do some fairly decent work on medical devices.
And we move right back into the taxes issue...
"I wish we did ____ with federal money" => "I can't believe you're taxing us!"
"Lets move it to private then..." => "I can't believe the cost of this!"
"Fine... let's go back to federal-" => "I can't believe you're taxing us!"
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On February 09 2017 07:37 Thieving Magpie wrote:Show nested quote +On February 09 2017 07:25 LegalLord wrote:On February 09 2017 07:10 Logo wrote:On February 09 2017 07:03 LegalLord wrote:
Frankly, I don't think we have a particularly good pharmaceutical R&D system as it is. You speak as if we're preserving something good but that's just not the case. Unless you have some specifics in mind for improvements, it sounds a bit like the classic "throw everything out and it'll be better next time" type of argument that usually ends up with everyone realizing the difficulty of the problem after they try starting over. The difficulty in part is why the system is bad in the first place. Not that there aren't things that could be vastly improved, but it's a difficult industry. It's not exactly the sort of industry that you can just predict results for and the day to day costs of the R&D is quite high. The way I see it, running medicine as a business is a flawed idea in and of itself - and that extends to pharmaceuticals. I'd run it more as an academic enterprise more akin to the national labs system - which, incidentally, do some fairly decent work on medical devices. And we move right back into the taxes issue... "I wish we did ____ with federal money" => "I can't believe you're taxing us!" "Lets move it to private then..." => "I can't believe the cost of this!" "Fine... let's go back to federal-" => "I can't believe you're taxing us!"
Yes, this is an issue of people being complete irrational bitches when it comes to taxes - even if the taxes make things cheaper overall.
Although a lot of national labs are run privately, with government money, a standard and acceptable compromise for Americans.
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On February 09 2017 07:36 GreenHorizons wrote:Show nested quote +On February 09 2017 05:27 LegalLord wrote:On February 09 2017 05:19 Simberto wrote:On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too. I personally would like a universal healthcare system. But Americans would never get behind that because "socialism." But they already are. It's not Americans that have to be convinced, it's our government. http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx
Good old "conservative Democrats" that were worried about the fallout of the public option.
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On February 09 2017 07:42 LegalLord wrote:Show nested quote +On February 09 2017 07:36 GreenHorizons wrote:On February 09 2017 05:27 LegalLord wrote:On February 09 2017 05:19 Simberto wrote:On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too. I personally would like a universal healthcare system. But Americans would never get behind that because "socialism." But they already are. It's not Americans that have to be convinced, it's our government. http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx Good old "conservative Democrats" that were worried about the fallout of the public option.
I mean it's not as strong as universal background checks but I think it stands as another example of where they tell us they are fighting for our points of view, but when we agree on something they can't seem to get it done if it conflicts with their corporate sponsors preferences.
EDIT: I don't know how everyone hasn't arrived at the conclusion that our democracy is, at best, in disrepair. When ~90% of Americans can agree on something and congress can't get a bare majority in support, people should realize that they aren't representing them.
90% is more than the percentage of Americans who believe the earth revolves around the sun
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On February 09 2017 07:25 LegalLord wrote:Show nested quote +On February 09 2017 07:10 Logo wrote:On February 09 2017 07:03 LegalLord wrote:
Frankly, I don't think we have a particularly good pharmaceutical R&D system as it is. You speak as if we're preserving something good but that's just not the case. Unless you have some specifics in mind for improvements, it sounds a bit like the classic "throw everything out and it'll be better next time" type of argument that usually ends up with everyone realizing the difficulty of the problem after they try starting over. The difficulty in part is why the system is bad in the first place. Not that there aren't things that could be vastly improved, but it's a difficult industry. It's not exactly the sort of industry that you can just predict results for and the day to day costs of the R&D is quite high. The way I see it, running medicine as a business is a flawed idea in and of itself - and that extends to pharmaceuticals. I'd run it more as an academic enterprise more akin to the national labs system - which, incidentally, do some fairly decent work on medical devices.
Yeah, I don't fundamentally disagree with that, but there are some problems there too so it wouldn't be a catch all, I would be worried about the ability of an academic based solution to be flexible and responsive enough to respond new innovations and health concerns or properly scale the amount of resources on different issues (I'd be a bit worried about an academic solution pushing the # of people on a problem well past the point of diminishing returns).
Not that I think it's a bad idea, I just think it's a tricky situation. I'd also be curious about solutions that involved, weaker IP laws, and better incentive for generic medicines once the patents expire.
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On February 09 2017 07:49 Logo wrote:Show nested quote +On February 09 2017 07:25 LegalLord wrote:On February 09 2017 07:10 Logo wrote:On February 09 2017 07:03 LegalLord wrote:
Frankly, I don't think we have a particularly good pharmaceutical R&D system as it is. You speak as if we're preserving something good but that's just not the case. Unless you have some specifics in mind for improvements, it sounds a bit like the classic "throw everything out and it'll be better next time" type of argument that usually ends up with everyone realizing the difficulty of the problem after they try starting over. The difficulty in part is why the system is bad in the first place. Not that there aren't things that could be vastly improved, but it's a difficult industry. It's not exactly the sort of industry that you can just predict results for and the day to day costs of the R&D is quite high. The way I see it, running medicine as a business is a flawed idea in and of itself - and that extends to pharmaceuticals. I'd run it more as an academic enterprise more akin to the national labs system - which, incidentally, do some fairly decent work on medical devices. Yeah, I don't fundamentally disagree with that, but there are some problems there too so it wouldn't be a catch all, I would be worried about the ability of an academic based solution to be flexible and responsive enough to respond new innovations and health concerns or properly scale the amount of resources on different issues (I'd be a bit worried about an academic solution pushing the # of people on a problem well past the point of diminishing returns). Not that I think it's a bad idea, I just think it's a tricky situation. I'd also be curious about solutions that involved, weaker IP laws, and better incentive for generic medicines once the patents expire.
An academic system would mostly just turn market incentives into a competition for grant money. I would not be particularly happy with such a dependency but perhaps some costs could be offset through making deals for exclusive production rights. It wouldn't be a very simple solution, in that government ventures are beholden to budgets, rather than profits.
The fundamental problem of private pharmaceutical R&D is that it's concerned with profits rather than public health. The incentives are all wrong here, and it simply would be better for the government to do that R&D. And since the government is ultimately the final arbiter of quality on new pharmaceuticals, perhaps this kind of approach would allow them to skip an expensive step in the process.
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On February 09 2017 07:42 LegalLord wrote:Show nested quote +On February 09 2017 07:36 GreenHorizons wrote:On February 09 2017 05:27 LegalLord wrote:On February 09 2017 05:19 Simberto wrote:On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too. I personally would like a universal healthcare system. But Americans would never get behind that because "socialism." But they already are. It's not Americans that have to be convinced, it's our government. http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx Good old "conservative Democrats" that were worried about the fallout of the public option.
Its amazing what 6 years and the pending threat of being denied for pre-existing conditions will do for public opinion.
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On February 09 2017 07:57 Plansix wrote:Show nested quote +On February 09 2017 07:42 LegalLord wrote:On February 09 2017 07:36 GreenHorizons wrote:On February 09 2017 05:27 LegalLord wrote:On February 09 2017 05:19 Simberto wrote:On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too. I personally would like a universal healthcare system. But Americans would never get behind that because "socialism." But they already are. It's not Americans that have to be convinced, it's our government. http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx Good old "conservative Democrats" that were worried about the fallout of the public option. Its amazing what 6 years and the pending threat of being denied for pre-existing conditions will do for public opinion.
Tracking the trajectory of public opinion on Obamacare has been... interesting, to be sure. I suppose people are rallying slowly but surely around, "it isn't great but it helps with a lot of problematic aspects of our healthcare system."
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Public opinion over time is great peculiar indeed.
it's also interesting how congress has terrible approval ratings, but trump manages to get only poor ones.
I'm reading through the economist/yougov poll in detail, to browse the results for funny and peculiar things, and for general knowledge.
I wonder what the net system effect would be of requiring bipartisan support via a 2/3 majority for many things.
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United States43829 Posts
On February 09 2017 08:06 LegalLord wrote:Show nested quote +On February 09 2017 07:57 Plansix wrote:On February 09 2017 07:42 LegalLord wrote:On February 09 2017 07:36 GreenHorizons wrote:On February 09 2017 05:27 LegalLord wrote:On February 09 2017 05:19 Simberto wrote:On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:
[quote]
The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not.
EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too. I personally would like a universal healthcare system. But Americans would never get behind that because "socialism." But they already are. It's not Americans that have to be convinced, it's our government. http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx Good old "conservative Democrats" that were worried about the fallout of the public option. Its amazing what 6 years and the pending threat of being denied for pre-existing conditions will do for public opinion. Tracking the trajectory of public opinion on Obamacare has been... interesting, to be sure. I suppose people are rallying slowly but surely around, "it isn't great but it helps with a lot of problematic aspects of our healthcare system."
I think that's overly optimistic. People may go "I'm sad I don't have that cake anymore but I like the way it tasted" but they'll still vote for the guy who promises to let them have it both ways.
Democrats should have also campaigned on removing the penalty while keeping the precondition rules etc rather than allow themselves to get outflanked by the fantasy. It's absurd but people don't want to vote for things that aren't great.
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On February 09 2017 07:57 Plansix wrote:Show nested quote +On February 09 2017 07:42 LegalLord wrote:On February 09 2017 07:36 GreenHorizons wrote:On February 09 2017 05:27 LegalLord wrote:On February 09 2017 05:19 Simberto wrote:On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too. I personally would like a universal healthcare system. But Americans would never get behind that because "socialism." But they already are. It's not Americans that have to be convinced, it's our government. http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx Good old "conservative Democrats" that were worried about the fallout of the public option. Its amazing what 6 years and the pending threat of being denied for pre-existing conditions will do for public opinion.
Is it though?
From February 2009:
Americans are more likely today to embrace the idea of the government
providing health insurance than they were 30 years ago. 59% say the
government should provide national health insurance
Source
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On February 09 2017 08:10 KwarK wrote:Show nested quote +On February 09 2017 08:06 LegalLord wrote:On February 09 2017 07:57 Plansix wrote:On February 09 2017 07:42 LegalLord wrote:On February 09 2017 07:36 GreenHorizons wrote:On February 09 2017 05:27 LegalLord wrote:On February 09 2017 05:19 Simberto wrote:On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:
[quote]
Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death.
To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too. I personally would like a universal healthcare system. But Americans would never get behind that because "socialism." But they already are. It's not Americans that have to be convinced, it's our government. http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx Good old "conservative Democrats" that were worried about the fallout of the public option. Its amazing what 6 years and the pending threat of being denied for pre-existing conditions will do for public opinion. Tracking the trajectory of public opinion on Obamacare has been... interesting, to be sure. I suppose people are rallying slowly but surely around, "it isn't great but it helps with a lot of problematic aspects of our healthcare system." I think that's overly optimistic. People may go "I'm sad I don't have that cake anymore but I like the way it tasted" but they'll still vote for the guy who promises to let them have it both ways. Democrats should have also campaigned on removing the penalty while keeping the precondition rules etc rather than allow themselves to get outflanked by the fantasy. It's absurd but people don't want to vote for things that aren't great.
Obamacare simply is too troubled to have a future politically. It's going to be replaced sooner or later - hopefully with a real UHC system. What was supposed to be a real overhaul turned into a stopgap that created some new problems while solving a lot of old ones - making it hard both to leave and to remove.
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EPT
