What to Do if You Can't Afford Healthcare

dimsie--

Something else you need to realize about the "wonderful" healthcare systems around the world. Most prescription drugs are priced much higher in the US due to the price ceilings set up by the various governements in Europe and elsewhere, causing the drug manufacturers to need a higher price in the US to cover their R&D costs. So in a way the US is subsidizing these drugs overseas. So what if the US sets up one of these systems? The drug companies will NOT be able to make their profit and they won't expend as much in R&D, so future drug innovations will be limited.

 

Oh, you're one of those laissez-faire types. Gee, that's an original position for a Texan to take. What you call 'governmental intrusion', some other people call 'governmental regulation'. You know, because the last time laissez-faire was taken seriously, about 120 years ago, it failed. The late nineteenth century basically sucked for the vast majority of people due to the *lack* of 'governmental intrusion' in industrial society. Ask some 1890s factory worker with galloping consumption how much he liked your precious economic theories when he died penniless in his forties.

Your little diatribe about the poor wee profit-losing drug companies sounds like so much bollocks to me. Since when do drug companies lose money *anywhere*? I'd like to see some kind of figures breakdown there if you can produce it.

My point is simple. Universal health care is fairer, and in many cases more efficient according to the WHO, than your system. Therefore, your system needs reform. QED.

I've read your posts for a while now, btw, and I don't think you have any room to call anyone caustic. Knock yourself out if you like, though. Oh, and I believe my posts are obscene (example: 'f*ck') rather than profane (example: 'Jesus F*cking Christ').

 

To equate the government absobing 10 to 14% of the GDP with fixing the working conditions that existed back then is a little extreme. It not laissez-faire...it's not wanting the government in control of that large a chunk of the economy.

Just about every news outlet has recently done some kind of story about how Americans pay more for their drugs here than anywhere else in the world. That's because the socialistic countires have price ceilings. We make up the difference. I guess you can choose not to believe it.

 

Just one thing to point out though. In the past decade pharmaceutical companies had higher profits then any other industry in the history of our country... ever.

I think with that being said and plenty of people not able to afford their drugs it's not only about price ceilings. It's at least in some part about pharmaceutical companies greed. I'm not against anyone making a profit. But there are extremes, and when their profits have been the highest of any single industry ever, I think there is room to compromise a bit so some more people can buy affordable drugs.

 

I'm not disputing that. I am saying that Americans pay more for their drugs because the companies cannot charge the prices they want in other countries. Were it not for huge profits, they wouldn't expend the R&D. I think that much is clear.

 

The information I've just gleaned about drug company profits in other countries notes that they are able to earn 17-21% profit in the United Kingdom - I assume the margin is similar elsewhere. I'm not an economist, but would the world come to an end if American drug companies were similarly curtailed? I just don't believe that research and development would suddenly cease if the US federal government set a profit ceiling for drug companies, particularly if, as FranchiseBlade notes, they're making more profit than anyone *ever* right now! Research and development happens in other countries too, even those with universal systems and limited drug company profits.

Besides, surely we should be more worried about people who don't have basic healthcare, not whether or not drug companies are going to make the right amount of profit this year.

 

Hey researcher, what difference does the profit margin make when Amnericans may pay several times more for the same drug?
Why did you sidestep the comment that the US essentially subsidises prescriptions in other countries with the exorbidant rates that we pay?

Some Examples:

DRUG US CAN
C Lonazepin $83 $10
Tamoxifen $241 $34
Glucophage $64 $14
Amitriptyline $20 $5
Imdur $109 $30

BTW, which Rx companies in the UK make 17-21%? Are they subsidiaries of multinationals? How are they costing their products? Don't tell me they don't play games with how they allocate R & D and COGS, I won't believe it.

And your 'besides', the percentage of American healthcare dollars that go to prescription drugs has steadily increased. It has been highly resistant to management by health plans and the government gets lobbied too heavily to take any serious action. As per unti script costs increased, people lose healthcare coverage.

From http://bernie.house.gov/prescriptions/profits.asp :
'As the new numbers show, the 12 pharmaceutical companies in the Fortune 500 made $10 billion more than the top 24 motor vehicle industry companies, which includes Ford and GM'

 

This would assume that in addition to being a historian, healthcare expert and political scientist that dimsie is also an accountant.

 

Hey dimsie! Haven’t seen you around in a while. How’s life down under?

I don’t have a comparison, but we a significant level of government sponsored research here (as well as private companies). It’s a very competitive process too. If you don’t get results, (as judged by a panel of your peers), you don’t get your funding renewed. I don’t think there is any evidence to suggest that good people stop going to med school if they get paid a little less. Money is not the primary motivator in choosing a career, and it certainly shouldn’t be in medicine, IMO. Wealthy people in Canada do often go to the states for elective procedures, and to jump cues. If you can pay for it you can get quicker, not necessarily better, care in the US. But for the majority of the people the Canadian system is much better. We switched in the mid 60’s to early 70’s, depending on where you live in the country, so there are many people here who still remember the old system, which was essentially your system. My parents, upper middle class professionals who could afford the old system, would never dream of going back. When every other advanced country uses some variation of the single payer system, and you are the only ones who don’t, I think you have to start taking a more critical look at whether your system still makes sense.

And I would add that most people in the overwhelming majority of advanced countries believe that good primary healthcare is a basic human right.

The fact that they are going bankrupt does not necessarily mean that they are not overpriced. They may just not be efficient enough to be able to make money at the current demand level, given the available resources for medical care in society in general.

 

I really hope the sarcasm in that comment came through. I'm not saying she isn't smart. But I do believe that she has some fundamental misunderstanding about the pure capitalism that this country is based on. That's all...nothing more.

 

I disagree. Regardless of what a person does to forge a living, they aren't there for kicks and grins. An individual wouldn't go through the hell that is med school and residency if not for the hope of compensation. I understand your point, and certainly it isn't the only motivator but it is a pretty strong one.

A friend of mine has relatives in Montreal who may wish to disagree.

Medicare and Medicaid drive the prices for services. They are in many cases artifically low. That tends to negate them being overpriced.

People will sue doctors regardless of the system.

Part of the problem is that the US has way more immigrants coming in every year than do the other countires of which you speak. I'm NOT saying that is a bad thing. But the vast majority of these immigrants are in the lower income brackets. Therefore the same amount of money coming in and more going out. I think we can all see how this won't work in the long term. But aside from that we hold pure democracy as a treasure. A good many Americans do not want the government calling the shots. The results could be disasterous.

Not in the least. I hope I have not either. Your input is very politely put and shows another perspective without being heavy handed.

 

Hi Grizzled! Pretty good down here. Nice and cold. How's Canadian summer?

I didn't sidestep that question at all. I noted that drug companies make 17-21% profit in countries with universal systems. So, therefore, it would be entirely possible for them to make a similar profit in the United States - although since you won't believe that they aren't 'playing games' with their profit margins, I don't suppose I can convince you. As Grizzled says, governmentally sponsored research and development is extremely competitive and often fruitful. Plus, it's way cheaper.

On another note, are drugs really the answer to the health of populations in general? Shouldn't we be thinking about basic preventative care for everyone, *then* following it up with more specialised medication?

By the way, save the lameass belligerence. I'm way better at it than you.

Since the New Deal at least, the United States has not been, and is still not, based on 'pure capitalism'. Moreover, to address a point you made in your reply to Grizzled, laissez-faire capitalism and democracy are not synonymous.

Oh, and Jeff: I think I'm just about as straight-talking as your wife. But hey, you love her.

 

They are when you have a disease. I sure wouldn't want to be an epileptic without my meds. In the future there will be drugs to cure diabetes, etc. Drugs are a vital part to the health of populations.

Give me examples of industries that comprise such a large percentage of GDP that have been taken over by the government in the US. That is what I mean by pure capitalism. We could play semantics all day but it won't be very productive nor germane to the discussion at hand.

Point well taken. I will be more careful in the future so I can avoid further semantics.

 

Originally posted by dimsie
I didn't sidestep that question at all. I noted that drug companies make 17-21% profit in countries with universal systems. So, therefore, it would be entirely possible for them to make a similar profit in the United States - although since you won't believe that they aren't 'playing games' with their profit margins, I don't suppose I can convince you.

You didn't understand the accounting issues and comparative revenue level issue. If you really want to listen, I'll help you, if not, no loss.

As Grizzled says, governmentally sponsored research and development is extremely competitive and often fruitful. Plus, it's way cheaper.

We have significant government sponsored research in this country, in addition to the private sector. We get the best of both worlds in R & D.

On another note, are drugs really the answer to the health of populations in general? Shouldn't we be thinking about basic preventative care for everyone, *then* following it up with more specialised medication?

It's a combination of the two. Regular and preventative care will only go so far. It certainly helps to identify and treat medical conditions before they have progressed, but will it enable people to avoid the flu, diabetes, asthma, cancer, etc., I don't think so.

By the way, save the lameass belligerence. I'm way better at it than you.

I don't doubt that.

You state rather weak industry credentials, combine that with an abrasive, 'never-wrong', 'your system sucks' attitude, and you will be the target of a little sarcasm.

You may be quite bright, but you still have a lot to learn, as all the rest of us do. Your ego takes you places you're not ready to go.

You've looked at statistics and read analysis, then came to your unwavering view of reality.

You don't really understand healthcare and its problems, or a vision for where it needs to go. You are willing to risk breaking our system further and potentially negatively impacting healthcare innovation (that effects all countries) by barging ahead for a single (admittedly important) goal.

You feel compelled to argue against the American system on every point (unbiased historian, eh? ), yet those in the industry (even yours) would never try to support that perspective (just like I won't defend it on every point).

How many uninsured people die in the US each year because they were uninsured? I am not sure, are you?

How many people die in the US alone each year because of adverse drug reactions or drug administration errors? Up to 140,000. (http://consumerlawpage.com/article/drugs_that_kill.shtml ) Would you rather have the government take its time to develop a system to monitor these and save lives, or have the private sector develop multiple systems ASAP and let the best ones be used? (Actually, the CDC does have an adverse reactions database...see how effective it is?)

That's just one example.

Everyone believes that healthcare is so advanced. The reality is that the dissemination of information and knowledge is deplorable, and an unbelievable number of patients have outcomes fall far short of what can be done for them, and many many others die needlessly through either imperfect decision-making or iatrogenic and nosocomial illness. How about some compassion for them and their families? Trust the government to move fast and help them? Not me.

 

dimsie -- please tell us something you like about the united states!

I went to school to get a law degree...my wife put me through school...we took out student loans and incurred some credit debt as well...I worked hard...I got out of school and realized my goals of opening my own practice...I wake up between 5:45 and 6 every morning...i shave and get dressed...i kiss my wife goodbye, wishing i could crawl back in bed with her...i then get in my car and brave a rush hour commute...i get to work around 7:15...I bust ass most of the day (except when I stop in here)...I take on my clients' worries many times...I don't leave till the job is done...I work hard to be a good attorney...I do that because I want more clients...I want more clients because I'd like to make more money...I want more money for a variety of reasons, including the support of my family, my church, etc....

make no mistake...without real compensation for going to school and busting ass all day, I don't do the above...I don't even set the alarm for 5:45...people need incentives. profit is a great incentive...it brings out a competitive spirit and has fueled a veritable ass-load of innovation from the United States...that record is hard to argue against, though I am sure you will! take away the above incentives, and I'll find an easier job...i'm sure there are lots of doctors who feel the same way...

 

It may not be productive to the conversation at hand, and please forgive me if it sidetracks things, but The internet which was responsible for a large part of the economic boom in the 90's was totally govt. subsidized. It was in the govt. first and then came down to the rest of us. In fact lots of technology which may be one of the countries biggest exports is in large part govt. subsidized through defense department contracts, NASA etc. Govt. agencies often get the technology first and then it comes down to the rest of us. Taxbreaks for corporations etc. aren't exactly pure 'free-market' economy.

Anyway sorry to digress from the topic at hand.

 

The only thing 'universal' about the rest of the world is how they take your money.

Regards,
From the U.K.

 

Hey dimsie! It’s been pretty darn cold here too. I went to the mountains for the Canmore Folk Music Festival last weekend and it dropped to 7C for the evening acts! Saw the Waifs, though, and that made up for it.

Refman: With regard to efficiency, I was thinking more of the cost of administering the multiple insurer system. Here’s an article I found a while back that gives a pretty good overview of the history of the Canadian system. I don’t know the site, but the info in the article is pretty close to what I’ve seen elsewhere.

http://www.newrules.org/journal/nrwin01health.html

Here are a few selected quotes:

“In 1971, the year that all ten provinces adopted universal hospital and medical insurance programs, Canadian health care costs consumed 7.4 percent of national income in Canada, compared to 7.6 percent in the United States. In the thirty years since, however, Americans’ health care expenditures as a percentage of Gross Domestic Product (GDP) have nearly doubled–to 14 percent–while Canadians’ have remained relatively stable, increasing only to about 9 percent. And despite its high cost, the U.S. system fails to insure more than 44 million of its citizens. Some analysts predict that figure will grow to 60 million by 2008.”

“Single-payer public insurance creates enormous administrative savings compared to a multi-payer managed care system. The difference is due to huge insurance bureaucracies and the duplication of administrative efforts between companies and marketing expenses: in a public program, such duplication would be superfluous.”

Well, the CIA World Fact Book says that Canada has a higher immigration rate than the US, so I don’t think that point works for the Canada/US comparison.
http://www.odci.gov/cia/publications/factbook/index.html

I think this may be a big factor, but perhaps more because you have a somewhat more troubled democracy than we do? No country is either purely market regulated or purely government regulated of course. It’s just a matter of degree regarding what and how much we want regulated by our governments. I have noticed that Americans are quite sceptical about their government’s ability to manage. I also note that there seems to be a great deal of apathy by the general public about your electoral process. You seem to regularly get only around a 50% turn out at your elections. You have a two party system, both of which tend to be controlled by a relatively narrow demographic of monied people. You also have had some rather dramatic instances of government waste and corruption. I might be quite cynical about the government too if those were the conditions I lived under.

While it would be quite untrue to suggest that there is no cynicism about politics and politicians here, or that no government waste and corruption occur, I think that in general our democracy is somewhat healthier than yours, and that Canadians trust the government more to run things. I think we also feel that we have more ability to toss the bums out if we feel they’ve screwed us. This varies form province to province and federally it is at a current low point, but still better than yours in most places, I think. Our last federal election had a voter turnout of just under 70%, IIRC, and this was the lowest it has been in a long while. It typically has been well over 70%. We have traditionally had a rightwing, a moderately right wing, and a democratic socialist party to chose from federally. While the socialist party has never formed a government, they have been large enough to influence policy in a number of areas. (Currently we have 2 right wing parties and a major Quebec based “separatist” party as well as the centre and left wing parties. This is a mess to be sure, but other regional issues are the cause of this situation.) We have relatively low spending limits on our campaigns meaning that average people can and do run for office. Our current Prime Minister is a lawyer from a modest family. The Premier of my province, Alberta, was a journalist. The Premier of my home province, Saskatchewan, is a former church minister. Most politicians here come from middle to upper middle class backgrounds. The are much more “the guy next door,” not distant and inaccessible people.
http://www.parl.gc.ca/information/a...nguage=E&Source=AboutParl_Process&Search=Gres

And if we don’t like what they are doing, we turf them out of office. Saskatchewan has had 6 different Premiers representing 3 different parties in the last 40 years. (Alberta, otoh, has had only 4 Premiers representing 2 different parties in that time). So in general, I think we feel more connected to, and more in control of, our politicians and governments.

I think it may also be useful make the general note that in relatively smaller countries (Canada had just over 30 million people) there are many more sectors that can’t be effectively managed by the private sector, because the critical mass just isn’t there. Many provinces here have had their own power distribution systems, telephone and telecommunications systems, and even automobile insurance. (These are called “Crown Corporations” btw., as in they are owned by the “Crown,” meaning the government.) This point doesn’t relate so much to healthcare, just our general comfort level in having governments run things. Where possible we prefer things to be run by the private sector, (and in fact many Crown corporations have been privatised in the last couple of decades), but in many areas the most efficient and effective system, and the one that best insures that the interests of Canadians will be looked after, (something that doesn’t always happen when large American corporations dominate a sector), is a system run by our governments and accountable to our people through elections.

 

Originally posted by FranchiseBlade
It may not be productive to the conversation at hand, and please forgive me if it sidetracks things, but The internet which was responsible for a large part of the economic boom in the 90's was totally govt. subsidized.

It was in the govt. first and then came down to the rest of us. In fact lots of technology which may be one of the countries biggest exports is in large part govt. subsidized through defense department contracts, NASA etc. Govt. agencies often get the technology first and then it comes down to the rest of us. Taxbreaks for corporations etc. aren't exactly pure 'free-market' economy.

Anyway sorry to digress from the topic at hand.


You give the government total credit for the Web? What about Gore?

Government money is very important in research, whether healthcare or other industries like technology (with $2 trillion dollars a year, you'd think some would make it into research, didn't you?).

The government's impact on technology is largely through defense r & d. Defense is competitive in nature, in fact, ARPAnet's genesis was the launch of Sputnik.

Unlike defense, healthcare is not competitive between countries. Governments spend on healthcare to reduce costs and because constituents demand it. That's very helpful, but there simply is not enough money there to do all that needs to be done. Governments may thus allocate research dollars to help the most vocal population, but ignore others. The private sector will seek profits, which has its own biases. Both are better than just one. (The private sector does function in countries with single payer, but with bureaucrats determining reimbursement rates for all services, the government's bias' will persist)