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.

[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.

[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. 

[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.

[Fmr. Gov. NickG]

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

[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.

[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.

[Fmr. Gov. NickG]

IMHO this is how routine healthcare should be handled. Administrative costs are virtually eliminated.
http://www.detnews.com/2005/business/0505/11/C01-177938.htm
Clinics offer pay-as-you-go health care for uninsured
But the cash-only service doesn't help those who need more than routine checkup.
By Sharon Terlep / The Detroit News
 
Daniel Mears / The Detroit News
 

GARDEN CITY -- Patients shouldn't bother flashing an insurance card for Dr. Deanna Master -- she won't take it.
The Garden City physician is among a small but growing number of doctors shunning the red tape and bureaucracy of health insurance in favor of a cash-only system.
Doctors who've stopped taking medical insurance say the money they save by not having to process paperwork allows them to keep rates affordable for people who have jobs but are uninsured -- a growing demographic in Michigan. More than 300,000 of the state's 1.1 million uninsured have jobs, based on data from the National Health Interview Survey.
Master opened her clinic on Cherry Hill Road about a year ago and draws about 120 patients a week who pay a set fee for a specific service: $45 for an office visit, $10 for most tests and more than $35 for procedures such as a skin biopsy.
It's pay-as-you-go health care that harkens to a time before HMOs, PPOs, deductibles and co-pays. Master says she's able to spend more time with patients and work shorter hours because her system is more efficient.
"This is how medicine used to be," Master said. "You get a service, and then you pay for it."

Doctors couldn't make a decent living this way because people would never go to the doctor.  This would truly damage the cause of preventative medicine...people would never get check-ups, and would just wait until their problems got serious enough to go to the hospital.