Poor people, health care, and the United States

[Fmr. Gov. NickG]

Why does anyone expect that the cost per person will go down 50% if the government covers everyone?

For the trillionth time, it will go down because of billions saved on paperwork, actuarial costs, and other overhead. In addition, it will go down through cost controls on prescription drugs and medical procedures.

Why is that so hard to understand?

And for the record, it won't go down 50%, but it will go down.

For the trillionth time from me show me the numbers. Why will the paperwork for Medicaid and Medicare be less if the program applies to 295 million people instead of 90 million people?

You talk about cost controls. That means wage and price controls. Getting the costs down to where they are comparable with Canada would require a 50% cut. So you just have to tell the doctors, nurses, floorsweepers and everyone else in the medical field that their salary has been cut in half. Now that I think of it maybe that's not bad since it would probably cause all of them to become Libertarians.

Overall health care costs aren't going to be reduced to Canada's level just by changing the way health care is funded.  That's because Americans just aren't as healthy on average as Canadians.

But we can reduce costs dramatically by setting price controls on drugs if nothing else, or better yet, nationalizing the entire pharmaceutical research industry. 

Most of the truly innovative drug research is already done by the government; it is mostly just minor modifications that are done by private companies, largely just to establish an intellectual property claim to a drug.   The money wouldn't be taken away from doctors and nurses, but from drug company profits and drug lobbyists and advertisers.  Most drugs are incredibly inexpensive to reproduce...there is no reason why they shouldn't be cheap and plentiful to everyone except for collusion on the part of drug companies, and a desire to protect the profitability of their patents.

No sh**t they want to profit off their patents, given that they spent hundreds of millions on each new drug, they damn well need to make some money back.  Or did you not realize that price controls will kill investment in new drugs and reduce the supply of pharmaceuticals, leaving patients screwed?  Do liberals not learn from their idiotic rent control experiments?

I'm simply going to assume that you were speaking in jest when you suggested nationalizing the drug industry, as their is no other rational explaination for that comment.  Speaking of which, have you been taking your medication?

Nationalization would not kill investment in new drugs.  Most truly innovative investment in new drugs is already done by the government.  Most investments made by private industry is just slight variations designed purely to get around patents and increase marketability.  Plus, the actual scientists doing the research don't care whether their company makes a profit or not...I'm sure they would be just as happy working for the government if it paid them the same salary.

[Fmr. Gov. NickG]

Its because those products are sold in a competitive free market. The Prescription drugs are not sold that way. You don't know the price until the druggest has already filled the prescription. You don't see competitive products. Prices are rarely advertised so you don't know which pharmacy has the best prices or which manufacturer has the least expensive product. That's not a free market. That's a government controlled monopoly and it will always result in high prices.

So you admit prescription drugs are not a free market.   This sounds like an argument for socialized medicine.  There are a number of unusual aspects to the market for prescription drugs that make it almost impossible to create price competition.  For one, how will you force price competition in a market where only one firm has the patent for a particular drug?  The only way to really reduce prices on such drugs is to regulate or nationalize as governments do with any natural monopoly.

[True Federalist (진정한 연방 주의자)]

When I got to my local drug store looking for over the counter medicine, I find a huge array of products for various conditions and from many manufacturers. The prices are shown and I can pick the one that meets my needs and my pocketbook. Those products are safe and effective. They are also very inexpensive compared to the Prescription drugs. Why is that? Its because those products are sold in a competitive free market. The Prescription drugs are not sold that way. You don't know the price until the druggest has already filled the prescription. You don't see competitive products. Prices are rarely advertised so you don't know which pharmacy has the best prices or which manufacturer has the least expensive product. That's not a free market. That's a government controlled monopoly and it will always result in high prices.

I have yet to find a druggist who will not tell you the price of  aprescription drug if you ask first.  I’ll grant that our current health care system is not particularly price sensitive when it come to drugs, but when you consider that the majority of people who have health insurance have a drug benefit that flattens out the price by establishing the same co-pay (usually these days with a difference between generic and brand name) no matter whether the prescription costs $40 or $400, so that for the consumer they all cost the same out of pocket, it is no surprise that most consumers of health care have no incentive to choose less expensive alternatives.

Flat-rate co-pays on private insurance are not government mandated so far as I know, but used by the insurance industry because they are simple to administer.  Those flat rate co-pays are what deprive the medical market of sufficient price feedback to control costs.  Now unless you want to mandate that insurance companies must base copays on a percentage of the price rather than a flat rate, I don’t see what action other than getting rid of drug patents that the government could undertake to change the market so as to lower prices.

[David S]

Its because those products are sold in a competitive free market. The Prescription drugs are not sold that way. You don't know the price until the druggest has already filled the prescription. You don't see competitive products. Prices are rarely advertised so you don't know which pharmacy has the best prices or which manufacturer has the least expensive product. That's not a free market. That's a government controlled monopoly and it will always result in high prices.

So you admit prescription drugs are not a free market.   This sounds like an argument for socialized medicine.  There are a number of unusual aspects to the market for prescription drugs that make it almost impossible to create price competition.  For one, how will you force price competition in a market where only one firm has the patent for a particular drug?  The only way to really reduce prices on such drugs is to regulate or nationalize as governments do with any natural monopoly.

What makes you think there are no competitive products? The fact that one company comes up with a product that works does not prevent other companies from creating other products that work as well. Also as soon as a patent expires other companies can market generics.

BTW what drug has the US government created that cures anything?
Small pox vaccine, the polio vaccine, and penicillin were not developed by government. Those are wonder drugs that have saved millions of lives, but what wonder drugs did the government make?

Nationalizing the drug companies is a way to make things worse not better. Government intervention is the problem not the solution.

[David S]

An example of government run health care.
http://www.commonvoice.com/article.asp?colid=1786

Tennessee test flies, crashes Hillary Care
Ralph Bristol
December 8, 2004

In all of the debate over state’s rights, one extremely important aspect gets too little attention. The 10th Amendment to the Constitution, properly applied, is the vehicle that allows states to experiment with potentially great, or very bad, ideas. Other states can adopt the good and great ideas. They can avoid the bad ideas like the plague.
One of the most glaring examples of the latter is TennCare, the healthcare program that Tennessee is now dismantling after a decade of mismanagement, lawsuits and bloated budgets. As the Wall Street Journal reported this week, Tennessee adopted the government-managed health care system similar to the one Hillary Rodham Clinton pitched to the nation. Proponents expected TennCare to reduce costs and cover more of the uninsured. After 10 years, both political parties concede the program is a failure that can’t be fixed, so they are sending it to the junkyard of well-intended bad ideas.
According to the Wall Street Journal:
· Over the years, the cost of TennCare ballooned to consume one-third of the state’s entire budget.
· Three of the 11 firms that insure TennCare patients have gone into bankruptcy.
· There are about 10,000 appeals filed each month to denied claims, and it costs the state an average of $1,600 in legal fees to fight each appeal.
· Attempts to rein in the costs have failed, partly because social activists have repeatedly sued the state to underwrite the cost of nearly unlimited care.
TennCare provided evidence, if not proof, that moving the financier of healthcare even farther from the consumer of the care increases, rather than decreases, the price of healthcare, making it even less affordable.
I’m not sure why anyone doubted this outcome in the first place, but Tennessee was a valuable, albeit foolhardy, laboratory for the exploration a very bad idea. Because states still have some right to conduct different social experiments, all non-Tennesseans are potentially better off.
That is in large part the magic and the glory of the 10th Amendment to the U.S. Constitution, which must be preserved, even (maybe especially) when it is used for incredibly dumb social experiments.

[Fmr. Gov. NickG]

Its because those products are sold in a competitive free market. The Prescription drugs are not sold that way. You don't know the price until the druggest has already filled the prescription. You don't see competitive products. Prices are rarely advertised so you don't know which pharmacy has the best prices or which manufacturer has the least expensive product. That's not a free market. That's a government controlled monopoly and it will always result in high prices.

So you admit prescription drugs are not a free market.   This sounds like an argument for socialized medicine.  There are a number of unusual aspects to the market for prescription drugs that make it almost impossible to create price competition.  For one, how will you force price competition in a market where only one firm has the patent for a particular drug?  The only way to really reduce prices on such drugs is to regulate or nationalize as governments do with any natural monopoly.

What makes you think there are no competitive products? The fact that one company comes up with a product that works does not prevent other companies from creating other products that work as well. Also as soon as a patent expires other companies can market generics.

BTW what drug has the US government created that cures anything?
Small pox vaccine, the polio vaccine, and penicillin were not developed by government. Those are wonder drugs that have saved millions of lives, but what wonder drugs did the government make?

Nationalizing the drug companies is a way to make things worse not better. Government intervention is the problem not the solution.

Your examples prove my point perfectly.  Penicillin and polio vaccine were both discovered by academics at public universities.  Jonas Salk famously refused to patent his vaccine so that it could reach more people.  Smallpox vaccine has been around forever, but the disease was eradicated in modern times thanks to the WHO and CDC, not because of some massive advertising campaign. 

The scientists actually making the discoveries don't care about patents; they got into their profession because they want to help people.  It's the constraints of the capitalist system that keep drugs so expensive, and out of the hands of people who need them.  No public drug company could refuse to patent one of its discoveries...even if executives were willing to do it, it would be against the interest of shareholders. 

[True Federalist (진정한 연방 주의자)]

The main problem with TennCare was that the way the system was set up, private insurers were able to cherry pick the healthy people that don’t cost much while the unhealthy people that cost a lot were shifted off to TennCare.  Under those conditions its no wonder that TennCare went bust.

[opebo]

The main problem with TennCare was that the way the system was set up, private insurers were able to cherry pick the healthy people that don’t cost much while the unhealthy people that cost a lot were shifted off to TennCare.  Under those conditions its no wonder that TennCare went bust.

Isn't that normally what happens with a mix of State and private medical insurance?

[Shira]

Question:
In west Europe the people have free choice to decide what kind of Health Care system they want. Why did they decide to have HC system run by the government?

Remember that before WW2 the European system was like the American one.

[Jake]

Where is the right to health care in the Constitution again and if it isn't there, why are we even wasting time trying to find a cheap plan that covers the poor?

[opebo]

Where is the right to health care in the Constitution again and if it isn't there, why are we even wasting time trying to find a cheap plan that covers the poor?

I suppose the obvious reason is that the poor might want to vote for candidates that provided such a plan.

[Jake]

That was random. Of course poor people will vote for those who give them more if that is all they are looking for. Answer the question though. Where is the right to government paid for health care in the Constitution?

[opebo]

That was random. Of course poor people will vote for those who give them more if that is all they are looking for. Answer the question though. Where is the right to government paid for health care in the Constitution?

Why would it need to be in the Constitution?  Congress can just legislate it.

[True Federalist (진정한 연방 주의자)]

The main problem with TennCare was that the way the system was set up, private insurers were able to cherry pick the healthy people that don’t cost much while the unhealthy people that cost a lot were shifted off to TennCare.  Under those conditions its no wonder that TennCare went bust.

Isn't that normally what happens with a mix of State and private medical insurance?

If you have idiotic so-called “health-care advocates” who fail to realize that you can’t run a premium-funded insurance system like a tax-funded universal health-care system, you do.  You could have a non-profit public or government run insurer that would compete with private insurance in a manner analogous to the competition between credit unions and private banks, which I believe was what was hoped for with TennCare.  Such a public insurer could use part of the profits that would normally go to shareholders with private insurance to instead subsidize high-cost insurers.  The idiots who sued TennCare into the ground tried to make TennCare subsidize more than it could afford to.  They made the mistake of assuming that once started TennCare would never be rolled back.

[Fmr. Gov. NickG]

That was random. Of course poor people will vote for those who give them more if that is all they are looking for. Answer the question though. Where is the right to government paid for health care in the Constitution?

It's not in the Constitution...that means that no citizen is guaranteed the right to free health care.  As in, they can't sue the government and force them to establish socialized medicine (like they could do in the case of the school segregation).  But it's certainly within the commerce power for the government to create such a system if it wishes.

[David S]

Its because those products are sold in a competitive free market. The Prescription drugs are not sold that way. You don't know the price until the druggest has already filled the prescription. You don't see competitive products. Prices are rarely advertised so you don't know which pharmacy has the best prices or which manufacturer has the least expensive product. That's not a free market. That's a government controlled monopoly and it will always result in high prices.

So you admit prescription drugs are not a free market.   This sounds like an argument for socialized medicine.  There are a number of unusual aspects to the market for prescription drugs that make it almost impossible to create price competition.  For one, how will you force price competition in a market where only one firm has the patent for a particular drug?  The only way to really reduce prices on such drugs is to regulate or nationalize as governments do with any natural monopoly.

What makes you think there are no competitive products? The fact that one company comes up with a product that works does not prevent other companies from creating other products that work as well. Also as soon as a patent expires other companies can market generics.

BTW what drug has the US government created that cures anything?
Small pox vaccine, the polio vaccine, and penicillin were not developed by government. Those are wonder drugs that have saved millions of lives, but what wonder drugs did the government make?

Nationalizing the drug companies is a way to make things worse not better. Government intervention is the problem not the solution.

Your examples prove my point perfectly.  Penicillin and polio vaccine were both discovered by academics at public universities.  Jonas Salk famously refused to patent his vaccine so that it could reach more people.  Smallpox vaccine has been around forever, but the disease was eradicated in modern times thanks to the WHO and CDC, not because of some massive advertising campaign. 

The scientists actually making the discoveries don't care about patents; they got into their profession because they want to help people.  It's the constraints of the capitalist system that keep drugs so expensive, and out of the hands of people who need them.  No public drug company could refuse to patent one of its discoveries...even if executives were willing to do it, it would be against the interest of shareholders. 

This is one way in which the government, via the FDA, prevents independent researchers from introducing new drugs. http://www.haciendapub.com/blevins1.html

[Fmr. Gov. NickG]

Nice to see that you completely change the subject when I point out how backwards your initial arguments were. 

[David S]

Whats backward is that I take you outside at noon and show you that its sunny with no clouds and you conclude that its nighttime. You claim that only government can create new drugs but you have not named any that they have created. I show you why independent researchers do not create more new drugs and you say I'm changing the subject.

[Jake]

That was random. Of course poor people will vote for those who give them more if that is all they are looking for. Answer the question though. Where is the right to government paid for health care in the Constitution?

It's not in the Constitution...that means that no citizen is guaranteed the right to free health care.  As in, they can't sue the government and force them to establish socialized medicine (like they could do in the case of the school segregation).  But it's certainly within the commerce power for the government to create such a system if it wishes.

Don't talk about it as a right then, talk about it as a privelege they should be lucky they have. And if someone decides that they no longer get it, they should keep quiet.

[A18]

No, the federal government can regulate commerce among the states, but not commerce period.

[Fmr. Gov. NickG]

That was random. Of course poor people will vote for those who give them more if that is all they are looking for. Answer the question though. Where is the right to government paid for health care in the Constitution?

It's not in the Constitution...that means that no citizen is guaranteed the right to free health care.  As in, they can't sue the government and force them to establish socialized medicine (like they could do in the case of the school segregation).  But it's certainly within the commerce power for the government to create such a system if it wishes.

Don't talk about it as a right then, talk about it as a privelege they should be lucky they have. And if someone decides that they no longer get it, they should keep quiet.

You are the only one who has mentioned it as a right in this thread.  Yes, we would all be much "luckier" if government would grant us the "privilege" of socialized medicine.

[Shira]

Try to be more scientific and less emotional.
Why all this arguing back and forth?
There are countries with Health Care system run by their governments and countries where the Health Care system is mostly private.
Simply compare the major numbers that the specific Health Care system is producing and the cost per capita needed to maintain this system.

[Fmr. Gov. NickG]

Whats backward is that I take you outside at noon and show you that its sunny with no clouds and you conclude that its nighttime. You claim that only government can create new drugs but you have not named any that they have created. I show you why independent researchers do not create more new drugs and you say I'm changing the subject.

I pointed out that the two examples you used, penicillin and polio vaccine, were created by doctors at state institutions with no profit motive.   Doesn't that answer your question?

As for the FDA, it really has nothing to do with the fundamental characteristics of the market for drugs.  I'm sure you can find anecdotal evidence that they are sometimes over-protective, but if they didn't exist, you would find plenty of anecdotal evidence of people being killed due to unsafe drugs.

Big drug companies don't tend to do truly innovative new research because it is too risky and not profitable enough.  For instance, why do you think there is so little private research into stem cells?  It's because it's not clear who this research is of specific value to or when that value will accrue, despite the fact that the potential is huge.  The government will be forced to do all the "dirty work", while the private companies will jump into this research once it is 95% done, making some minor modifications and running to the patent office.

[True Federalist (진정한 연방 주의자)]

Whats backward is that I take you outside at noon and show you that its sunny with no clouds and you conclude that its nighttime. You claim that only government can create new drugs but you have not named any that they have created. I show you why independent researchers do not create more new drugs and you say I'm changing the subject.

If that doctor was your best example, you don't have much of a case.  His treatment has been stuck in Stage II trials since 1991 because he hasn’t been able to get enough people to be willing to sign up for them to be completed.  Keep in mind that Stage II trials exist to show that there is theraputic effect and until those are finished, they can’t proceed to the Stage III trials to show how it compared to other treatments.  You’d think that if it were such a great treatment, he’d have plenty of desire to see it proven and attact enough people in 14 years tohave it finish the Stage II trials.

[Shira]

The poor are poor because they are lazy. Why should hard-workining Americans pay for their health Care?