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One of the more interesting questions that needs to be explored is what impact government policies have on long term investments in health care. It may be true, for example, that Cuba can perform a particular test more cheaply than in a Western country, but that test or treatment was developed outside of Cuba, then incremental cost of performing that procedure understates its true cost. Wikipedia describes the extent of medical research in the US:
As in physics and chemistry, Americans have dominated the Nobel Prize for physiology or medicine since World War II. The private sector has been the focal point for biomedical research in the United States, and has played a key role in this achievement. As of 2000, for-profit industry funded 57%, non-profit private organizations such as the Howard Hughes Medical Institute funded 7%, and the tax-funded National Institutes of Health funded 36% of medical research in the U.S.[2] However, by 2003, the NIH funded only 28% of medical research funding; funding by private industry increased 102% from 1994 to 2003.[3]
The National Institutes of Health consists of 24 separate institutes, the NIH occupies 75 buildings on more than 1.2 km² in Bethesda, Maryland. The goal of NIH research is knowledge that helps prevent, detect, diagnose, and treat disease and disability — everything from the rarest genetic disorder to the common cold. At any given time, grants from the NIH support the research of about 35,000 principal investigators, working in every US state and several foreign countries. Among these grantees have been 91 Nobel Prize-winners. Five Nobelists have made their prize-winning discoveries in NIH laboratories.
NIH research has helped make possible numerous medical achievements. For example, mortality from heart disease, the number-one killer in the United States, dropped 41 percent between 1971 and 1991. The death rate for strokes decreased by 59 percent during the same period. Between 1991 and 1995, the cancer death rate fell by nearly 3 percent, the first sustained decline since national record-keeping began in the 1930s. And today more than 70 percent of children who get cancer are cured.
With the help of the NIH, molecular genetics and genomics research have revolutionized biomedical science. In the 1980s and 1990s, researchers performed the first trial of gene therapy in humans and are now able to locate, identify, and describe the function of many genes in the human genome. Scientists predict that this new knowledge will lead to genetic tests for susceptibility to diseases such as colon, breast, and other cancers and to the eventual development of preventive drug treatments for persons in families known to be at risk.
Research conducted by universities, hospitals, and corporations also contributes to improvement in diagnosis and treatment of disease. NIH funded the basic research on Acquired Immune Deficiency Syndrome (AIDS), for example, but many of the drugs used to treat the disease have emerged from the laboratories of the American pharmaceutical industry; those drugs are being tested in research centers across the country.
Dr. Sikora is undoubtedly right in implying that ideology is the bane of any public policy analysis. But even Dr. Sikora, who is no true believer in the US health care system, understands that choice and competition are key elements in any viable solution. Every health care system has gaps. Some countries with hybrid systems allow consumers to get private cover to supplement their state cover; and it is also possible to craft a policy in which the state can fill gaps in which the private market fails. The real test for any proposal is will it work; and will it work sustainably?
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Dan Hannon is terrific
Rationed care, higher death rates, insane waiting times, impossibility of getting an MRI: sounds great!
/sarc
Seriously, there are ways to help reduce the price of health care: freelancers pooling their resources (the Freelancers’ Union is doing this) to get a better deal, health savings accounts, better “safety nets” for the poor, and steering people to clinics and away from ERs, for example.
But the British system has a ton of problems, not least of which is that there is little incentive for the best and brightest to become doctors any more.
The danger for Obama and Dems is the trump card that the BNP have played. Socialism plus Nationalism.
The BNP admit that a socialist run system, like the National Health, must ration.
They argue, that native White Britons should come FIRST, and everyone else come LAST. If at all.
Now, get the electoral dynamite of what the BNP are doing. They are trying to peel off White Women, who are allied against White Native Men in the West, along with Blacks, Hispanics, in Europe Muslims, and Gays plus SWPL Yuppies, by arguing that they have a better deal.
FIRST not last place in the coalition, keeping the Socialism, merely making it Nationalist and accepting the group identity politics now ingrained among Women in particular, and drawing it to it’s natural conclusion.
The alternative to really kill Obama’s plan is to say, “yes let’s have national health. And lets make sure the Majority gets served first by excluding everyone else, mostly by kicking them out of the nation. Majority White Population gets the biggest slice (nearly all) the pie, and everyone else gets a few crumbs if we feel generous. Or not.”
Yes the Media/Dems will cry racism. After Rev. Wright back in the spotlight (he can’t shut up) and Obama’s Muslim pandering, who cares? Moreover, the play is brilliant. It offers women a far more lucrative and stable deal. They get old too, and the temptation to screw over White Women to benefit illegal aliens, Blacks, etc. is just too high and a real threat to Obama’s deal. Since no one trusts him.
Huckabee can sell this in a heartbeat. I don’t like it. But in terms of deal making, it’s a proven electoral winner. Even with the BNP the target of opprobrium of the entire Press, this issue got Nick Griffin elected.
Detroit, Newark, Washington DC and a hundred other government run, with a Federal Department of Edjamakition billion dollars every year and all for sorry ass, worthless 25% high school graduation rates. And, what graduates too!
Oh yeah, give me some more of that public health care just like even my all white, lousy, mind numbing, waste of time public sleep fest of an ‘education’.
“But the British system has a ton of problems, not least of which is that there is little incentive for the best and brightest to become doctors any more.”
This is the great hidden cost which is being studiously avoided. Diminishing monetary incentive for people to enter the medical fields will, over time, decrease the average skill and comptenece level of doctors, as it would in any field, by making it less attactive to the most capable students vs other areas of employment.
But the lag time on this is at least seven or eight years, the time it takes for someone to complete medical school, get through all their residencies and internships, and start practicing. Conveniently, this effect will therefore occur after the Messiah leaves office. Where said decline will then be blamed, by the myopic and agenda driven infotainment industry, on his successor.
The more immediate drop that cannot be swept away in the event of a government takeover of medicine is that which will occur as thousands of currently practicing doctors leave the profession – predominantly from the ranks of the most skilled and highly competent – decide that the cut in pay (necessary in order for Obamacare to function) and the draconian regulatory burden aren’t worth whatever the remaining pay might be, and leave the profession NOW for other fields. The cost in terms of lost life and untreated illness etc. will significant.
Should the administration get their way and effect a government takeover of health care, they will try find a way to broom all this under the rug, with the help of their allies in the new industry. Even if they can’t, I’m sure the press will find a way to blame any negative outcome on conservative Christians and capitalism.
Whiskey, socialism+nationalism is exactly what FDR did during the 1930′s. He was able to guarantee loyalty from southern states by maintaining and extending racist policies in terms of economic favors with government money.
no mo uro 4:
It takes a long time for socialism to destroy wealth in a wealthy country. In a Zimbabwe, it took no time at all. In Britain, it took many years.
I worked in the NHS in the 1970s. When they were nationalizing in 1948, the major obstacle was their hospital doctors (“consultants”). They way Bevan got around this was to pay them more, in his memorable words, he “stuffed their mouths with gold”. The state took over perfectly good, modern, functioning hospitals (for 1948), and then over the next 30 years invested – zero.
So, while in 1948 the US invested its Federal dollars in the private system (Hill-Burton Act $$) and built thousands of shiny, new, modern hospitals, the NHS over that time built or developed little.
The slow degradation of UK medical students has taken 50+ years, because after 1948 it was BETTER to be a doctor than before 1948 (more $$). When I was there in 1976, most junior hospital doctors were still British – bright, dedicated, wonderfully educated.
However, most of them couldn’t get NHS jobs, because after stuffing the consultants of 1948 mouths with gold, the state froze the number of consultants such that no senior registrars (residents) could become consultants until nature opened a vacancy. In my hospital (in 1976), of six senior registrars, five were leaving the country (4 to Australia or Canada, one [shhhh!] to America).
Now, what the free labor market has done since then is to import a class of people from Africa and Asia for whom permanent life as a junior hospital doctor feels like having died and gone to heaven. Of course, the result is that there are very few white British juniors to replace the aging consultants of a previous generation.
My point is, the medical system in 1948 in the UK was FABULOUSLY wealthy for its time. It’s taken a long time to wreck it, to use up all the wealth, knowledge, and talent which was invested in it prior to 1948.
Now, it would have taken less time, much less, if Bevan had decided to build up the hospitals and smash the doctors. Smashing the doctors, of course, is job #1 for the US nationalizers, so I expect wrecking health care here won’t take very much time at all.
For someone with the name of gokart-mozart he seems to know a lot!
Actually, the Republicans have had a good health care reform plan, and have had it for the last twenty years. It is the Democrats (especially the left Democrats who run the network news) that have stopped health care reform. They are interested in a Washington power grab.
Dr. Sikora, using delicate phraseology, spoke of bumping severely ill patients to the back of the line. How I say this is: the government creates incentives to intensely treat well people, because you’ll get paid the same and well people are less bother.
If the government system will not adopt a new drug or technique for ten years, can we say that the new drug is not being developed for that system? How do you get bio-markers if they cost billions to develop but there is no prospect of making the money back?
Actually, government run health care has piggybacked on the US system for years. Strip away techniques developed for the US market and then compare it with government run systems. Then you can get an idea of the opportunity costs of the Obama system. If the US had gone NHS, than we would have not much of anything beyond what we had in 1955 (and not much of that).
The Democrats are interested in grabbing power so they try to make the electorate focus on those who are interested in making money. I talk to people who are more upset about what a professional athlete is making then they are Barney Frank’s rape of the banking system.
One way to undermine their drive in health care are the words “wage and price controls.”
hdgreene 7: “If the government system will not adopt a new drug or technique for ten years, can we say that the new drug is not being developed for that system? How do you get bio-markers if they cost billions to develop but there is no prospect of making the money back?”
No new drugs will be developed. THAT’S obvious.
About a month or so ago my wireless mouse was eating batteries so I went to Home Depot and got the big set of 48 AA batteries in the G-D clamshell case. Taking out my very nice Gerber folding knife I proceeded to cut my thumb next to the nail. Cursing my stupidity and dripping blood I walked over to the nearest ER, a branch of Long Island Jewish. I told them I had no job and no insurance and no money and wanted to know if I should go to the City hospital or the VA or if I needed a stitch. They said not to worry and I sat for about an hour. Eventually a young man, possibly a med student but probably an intern, ran some water over the thumb, said I was fine and needed nothing and I could go home. I stopped at the desk and again they declined to quote any prices, although I had repeatedly asked what if anything I would be charged. A week later I received a bill for $1,111. They can go hang themselves. I will not pay. It is that simple and if I ever win the lottery then I will hire lawyers to charge them with fraud. As far as I am concerned it is the same as if you walked into a restaurant and looked at a menu and smelled the kitchen odors and then were handed a bill before you walked out. To me it is as if you and your neighbor found a box and were arguing over who it belonged to so you took it to a lawyer and asked him how much it would cost to settle the dispute and he said “I’ll tell you after we open the box,” which turns out to have nothing but a roll of moldy toilet paper in it, resulting in the lawyer then charging you the thousand dollars.
The best way to waste your money is to let someone else spend it. Ban group health insurance. Make individuals buy their own health insurance. Insurance companies will be forced to balance overall cost with overall benefit. It works for car insurance; it can work for health insurance.
And kill all the lawyers.
You learn early on in healthcare that the way to keep things from getting financially out of balance is to make up from those that have for those that don’t. LOTM’s experience demonstrates how we tax, in house, to make up for the hits that are taken for providing public care and free care, of which there must be lots in an ER.
In my field, I’ve not been able to take Medicare for years because I would be better off panhandling for two hours a day. Medicaid has been the same kind of drain as well. I long for a day when I can cut my fees in half and just take cash at the door.
That being said, it needs to be recognized that we currently have the best healthcare system in the world — still. We just need to decide whether we want to spend this much money on healthcare or not. Gov healthcare programs would mean that we don’t. And that decision will have huge ramifications, since it’s big pharma that’s been acting like the U.S. military for decades, providing needed services and advances that no one else can/will. The losses due to declining advances in and production of medications will be staggering in the long run. Even now, we’re seeing the backlash of generic drugs, manufactured in poorly monitored places in the world, causing health problems for those who switch to them.
And someone needs to do something about this bogus 40 to 50 million figure of uninsured that keeps getting tossed around. First of all, this includes illegals and young people who just don’t want to spend the money on health insurance. Secondly, it makes it sound like the uninsured don’t get cared for when, in fact, they’re why LOTM got charged a thousand dollars for someone to look under his bandaid.
I was recently at an NPR sponsored forum (bout 200 people) presenting several issues (war & peace / immigration / social security / healthcare) with a long term perspective (over 50+ years). When the discussion got to healthcare it revolved around the basic “how do I (or my group)get more for less”? Now this would normally be very good if we focussed on how do we make the market more efficient. But in that audience the positions were all about gov’t control, regulation and manipulation – basically rent-seeking behavior that allows the most to fall in the subsidized group and some vague “other” (the “rich” presumably via genral taxation) to pick up the tab…
Geo Bernard Shaw, the old socialist, had it right: “The gov’t that proposes to rob Peter to pay Paul can always count on the support of Paul.”
LOTM> I stopped at the desk and again they declined to quote any prices, although I had repeatedly asked what if anything I would be charged. A week later I received a bill for $1,111. They can go hang themselves. I will not pay.
I suspect that you if made a counter-offer, they’d take it. Somewhere in the $150 to $300 range, perhaps.
After all, that’s what the insurance company would do, although it would waste a bunch of people’s time to get there. You could say, “$200 cash, now, final offer.” And if they disagree, all but threaten to play footsie with them for the next three years while the statute of limitations runs out on them seeking redress in court.
Sadly, $150 to $300 is the proper range for services rendered in an ER. You should have cleaned it, poured alcohol on it, bandaged it, and then tried to stick yourself into the next available slot at your GP, or gone to a doc-in-a-box or urgent care clinic.
ERs are not cheap, and really should not be visited except in the most dire of circumstances.
You may balk at the idea of paying $200 to sit in an ER, wait for help, and then have a doc do nothing more than tell you to clean it and bandage it, but you have to keep the base level costs of an ER in perspective. Even an electrician/plumber/AC-guy will pop you for $100 just to show up for a five minute, no parts service call.
That’s why it puzzles me that hospitals don’t subsidize their own urgent care clinics and basic-care general practitioners. It would dramatically drop their costs, result in a healthier population, probably generate more jobs, and make everybody happier all around.
In my city and probably most city MD’s do not work on the weekends except for the ER MD’s and those in the practices that are on phone on calls. So I can get a prescription renewed on the weekend or a medicine prescribed based on what I can figure out about my symptoms.
We used to have emergency clinics open on the weekends with one MD and a nurse but I think that they are gone.
My family internist does not work on Wednesdays but I would probably be seen by one his partners if I was in trouble that day.
Most MD’s do not use e-mail and they do not even buy systems to manage appointments.
I had some medical training at Stanford in 1962-63 as a grad student in statistics. The medical school had a special program for non medical students who were interesting in working in the medical field. Most of the medical students then were basically interested in the money they expected to earn and were cynical about what medicine could do except for the cardiologists and the bone guys.
Here most of my MD’s like medicine. Still there is a lack of creative use of computing power except for the xray doctors who use multibeam radiation and they employ phycicists and engineers to calibrate and run the system except for one female radialogist in Houston whom trades old pots with my wife at shows. She developed her own software for controlling the beams.
The Obamites are destroyers. They will hire the best physicians with the loot they steal while “doing good for us”.
LOTM: Hospitals all have charitable funds that they write stuff off against. They do *not* advertise their funds, nor do they suggest that you apply your ER visit against their charitable fund. It’s their secret little stash fund to be dipped into when their billing department hasn’t been able to wring real money out of their patients.
I had a hospital send me a ginormous bill for some sooper-dooper 21st & a half Century testing they did on me, after I had been repeatedly assured that my insurance would cover it and there would be no cost to me. I sent the hospital a longish letter delineating the blow by blow and why I didn’t think I should have to pay any more than I the amount I had been promised would be covered by my insurance company.
I heard nothing further from the hospital. I am assuming they ate the cost of the testing over and above what my insurance paid for. I think you should dispute your hospital bill, saying that you never agreed to the service or any charge. Then if they come back, make a lower offer of whatever you feel comfortable offering.
Ignoring it until it goes away strikes me as being the worst thing you can do, since the hospital *must* have a department full of people whose sole job and responsibility is to go after people who ignore them; i.e., all the illegals who blithely use hospital ER’s for visits of all kind and don’t understand (or care) that someone some time some where will have to pay for it.
“well, relatively civilized”
Relative to what, Great Britan? I’ve seen their football/soccer fans.
A few years ago an article was published in the British Medical Journal; the lead author was Richard Feachem, who is British but works at UC San Francisco. The study compared cost of services (adjusted for purchasing power parity) between the UK NHS and the Kaiser Permanente system in California.
Their findings were that the adjusted cost of care with Kaiser is within 10% of the cost of the NHS; but in waiting times, access to specialists, and other measures Kaiser was far ahead of the NHS. This study was timely, in that many in the UK were saying that the problem with the NHS was lack of resources. The implication of the study is that it is failure of incentives to provide access to care that is the problem, not the amount of resources.
Having worked for many years in Kaiser Permanente, I can tell you that 25-30 years ago they were very inexpensive compared with other health insurance plans; as a result did not have to compete on the basis of quality or access, and it showed. The organization remade itself into one that can compete at the highest levels of quality–but is no longer the least expensive alternative. In any case, it is competition that has made KP as good as it is. Without competition of the free market, it would be like the VA system or the NHS in terms of access to care.
HDGreene #7 and Gokart-Mozard #8: “hdgreene 7: “If the government system will not adopt a new drug or technique for ten years, can we say that the new drug is not being developed for that system? How do you get bio-markers if they cost billions to develop but there is no prospect of making the money back?”
No new drugs will be developed. THAT’S obvious.”
Maineman #11: “The losses due to declining advances in and production of medications will be staggering in the long run. Even now, we’re seeing the backlash of generic drugs, manufactured in poorly monitored places in the world, causing health problems for those who switch to them.”
You guys are obviously clued in. I have been in biopharma for nearly 2 decades and it’s gone from OK to bad to worse to terminal. If Obama gets his NHS program –and odds are good that he will– then it’s going to be lights out. Not all at once, and for some niche or trendy areas (or for those who succeed at rent-seeking and nepotism with the political ruling class) things will be quite bright. But overall there will be, to quote Ross Perot, a giant sucking sound as capital leaves the business. No way will investors pay billions for R&D bets today in hopes of being able to beg some government paymaster for 10 cents on the dollar 15 years later. Never mind the litigation and endless bitching about “safety” from the illiterate.
In 20 years we will be lucky if the Chinese let us buy their stale-dated generics, and issue visas for our most needy (and self-funded) medical cases to enter their country for treatment.
What do you really learn from all this? The USA does NOT have a healthcare problem. We have a financial problem. Nmaely how to pay for all this wunnerful, wunnerful stuff.
The Prophet Obama now spaketh. He sayeth,
“no more wunnerful stuff, except for your
superiors”.
A handfdul of people will be Paul. The rest of us will be Peter.