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Health Care in the U.S.

YarYar Registered User regular
edited June 2007 in Debate and/or Discourse
Ok, we've flirted with it several times in other threads recently, so I thought I'd drag it out on its own again.

Universal Health Care. Socialized Medicine. National Health Coverage. Single Payer. What do you call it?

I call it inevitable.

Why? Well, it's the best of all evils at this point. Our current system is all fucked up and doesn't help anything. Health care is such an emotional issue that it simply can't support itself on cold-hearted economic theory that would tell us to go back to a pure competitive fee-for-service model.

Poor people want it. Businesses want it. Democrats want it. Even moderate Republicans have made several steps in that direction. Hell, I bet history will show that the major move towards Universal Health Care began with Bush's prescription plan. It was the biggest entitlement bill in history.

The big players have laid out their plans. I think this will be THE issue of the '08 election. Obama and Hillary are big on buzzwords and on "what this means to the average schmuck like you." Edwards is more detailed on how he's actually going to implement and pay for it, but scant on how it will affect people.

So what do you think? Is it really inevitable? Will this help businesses that are burdened by health care costs? Will it strengthen the safety net? Will it damage health care overall? Will there still be incentive for us to develop new medical technology? Is it Socialism? Are we doomed?

How should it be implemented? Do you prefer the current system, but just subsidize insurance companies and hospitals? A single payer system where everyone bills the government? The so-called "Schwarzenegger/Massachussetts" plan that involves a legal requirement to purchase health insurance, like with cars? Total government takeover of health care altogether?

As the thread suggests, I'm specifically talking about what's coming here in the U.S. But I also recognize this exists already in various forms throughout the modern world, with various successes and failures. Please comment as you see fit.

Yar on
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Posts

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited May 2007
    Yes, it's inevitable. There's a reason every other first world nation in the world has single payer. A country without government healthcare is like a country without a public fire department.

    Our best models are France and Germany. Both of those countries use hybrid systems where the government acts as a single player but citizens also have the option of buying private health insurance on their own or paying with cash if they desire. Doctors may work for the government directly or they may work for a private organization or they may be self-employed at their option. Health insurance in both countries is compulsory (ie, the Governator/Massachussetts plan).

    We also need to standardize medical record formats and insurance claim paperwork requirements and provide incentives to providers to implement electronic medical records. This can be done without any other change to the system, but would be easier once a single-payer system is in place.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • [Tycho?][Tycho?] Registered User regular
    edited May 2007
    Its worked very well in Europe and here in Canada. You just have to be willing to sink in a lot of money. Its expensive as all hell, but a properly funded health care system will really improve the lives of the people in the country. I would be willing to pay more taxes here if more money was put into health care, the liberals cut the hell out of it in the 90s, and now we are dealing with increasing wait times and shortages of beds, surprise surprise.

    ragesig.jpg

  • Irond WillIrond Will Dragonmaster Cambridge. MASuper Moderator, Moderator mod
    edited May 2007
    We just passed it in Massachusetts, but it's not a particularly good plan, and absolutely not conducive to reform. Basically it just requires employers to provide health insurance, requires the self-employed to buy health insurance, and subsidizes the purchase of approved health insurance among the uninsured.

    I mean it probably helps with the problem of uninsured people showing up to ERs and such, but the fact that it works through the existing private health care infrastructure without really getting at some of the key problems strikes me as rather a half-measure.

    Wqdwp8l.png
  • YarYar Registered User regular
    edited May 2007
    Edwards' plan, in not-so-few words, basically says we pull out of Iraq, but then continue spending all that money we spent in Iraq on health care. It would pay for decent health care for everyone.

  • dvshermandvsherman Registered User
    edited May 2007
    I would have to put my vote behind the "Schwarzenegger/Massachussetts" plan that involves a legal requirement to purchase health insurance, like with cars." The requirement could be for very affordable plans with deductibles in the $10,000 range. The monthly premiums for such plans are absurdly cheap, like in the area of $10 for middle aged smokers.

    That amount of coverage definitely won't cover a visit to the doctor for a stuffy nose, but it would put a huge dent in the number of medical bankruptcies. This would also decrease the cost of health insurance across the board by increasing the number of premium paying participants. So should someone want a deductible lower than $10,000 the premiums would be much more affordable than now.

    This wouldn't require the creation of more government agencies, and keep the responsibility of administrating the plans to those that have the experience of doing it.

  • Irond WillIrond Will Dragonmaster Cambridge. MASuper Moderator, Moderator mod
    edited May 2007
    Yar wrote: »
    Edwards' plan, in not-so-few words, basically says we pull out of Iraq, but then continue spending all that money we spent in Iraq on health care. It would pay for decent health care for everyone.
    I could get behind something like this in principle. I don't really like the idea of institutionalizing some of the inefficiencies of the current system but the truth is that we have a panoply of existing socialized health systems to draw upon for inspiration.

    I just have a sinking feeling that any plan that's possible to pass will have an enormous drain because of mass-incorporation of the many private middlemen in the current health care system.

    Wqdwp8l.png
  • ThanatosThanatos Registered User regular
    edited May 2007
    dvsherman wrote: »
    I would have to put my vote behind the "Schwarzenegger/Massachussetts" plan that involves a legal requirement to purchase health insurance, like with cars." The requirement could be for very affordable plans with deductibles in the $10,000 range. The monthly premiums for such plans are absurdly cheap, like in the area of $10 for middle aged smokers.

    That amount of coverage definitely won't cover a visit to the doctor for a stuffy nose, but it would put a huge dent in the number of medical bankruptcies. This would also decrease the cost of health insurance across the board by increasing the number of premium paying participants. So should someone want a deductible lower than $10,000 the premiums would be much more affordable than now.

    This wouldn't require the creation of more government agencies, and keep the responsibility of administrating the plans to those that have the experience of doing it.
    Most plans just simply refuse to insure people who actually might need it. So, yeah, according to the tables, it might be $10 for a middle-aged smoker, but odds are, they would simply not approve him to buy it.

  • Irond WillIrond Will Dragonmaster Cambridge. MASuper Moderator, Moderator mod
    edited May 2007
    Thanatos wrote: »
    Most plans just simply refuse to insure people who actually might need it. So, yeah, according to the tables, it might be $10 for a middle-aged smoker, but odds are, they would simply not approve him to buy it.
    The collective bargaining that a state can bring to the table can influence this though. If an insurer refuses to accept certain classes of citizens, they just won't be added as a state-approved plan.

    Wqdwp8l.png
  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited May 2007
    Irond Will wrote: »
    Thanatos wrote: »
    Most plans just simply refuse to insure people who actually might need it. So, yeah, according to the tables, it might be $10 for a middle-aged smoker, but odds are, they would simply not approve him to buy it.
    The collective bargaining that a state can bring to the table can influence this though. If an insurer refuses to accept certain classes of citizens, they just won't be added as a state-approved plan.

    Requiring insurers to cover people with chronic conditions as individual policyholders is going to be an uphill battle, I'm afraid.

    That's why I've long been a proponent of expanding the current Medicare system to cover people with chronic conditions but are not actually disabled. It would be the first step to a real single payer system.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • Irond WillIrond Will Dragonmaster Cambridge. MASuper Moderator, Moderator mod
    edited May 2007
    Feral wrote: »
    Irond Will wrote: »
    Thanatos wrote: »
    Most plans just simply refuse to insure people who actually might need it. So, yeah, according to the tables, it might be $10 for a middle-aged smoker, but odds are, they would simply not approve him to buy it.
    The collective bargaining that a state can bring to the table can influence this though. If an insurer refuses to accept certain classes of citizens, they just won't be added as a state-approved plan.

    Requiring insurers to cover people with chronic conditions as individual policyholders is going to be an uphill battle, I'm afraid.

    That's why I've long been a proponent of expanding the current Medicare system to cover people with chronic conditions but are not actually disabled. It would be the first step to a real single payer system.

    I'd be in general sympathetic to such an expansion. Still I'm pretty sure that Mass has gotten some insurers to expand their coverage in order to meet requirements of being listed as an approved insurer. There's a lot of money on the line for them, and if it means taking a bath on the occasional grandpa with emphysema, it's still probably a net plus over not being included in the state system.

    Wqdwp8l.png
  • Phoenix-DPhoenix-D Registered User regular
    edited May 2007
    Yar wrote: »
    Edwards' plan, in not-so-few words, basically says we pull out of Iraq, but then continue spending all that money we spent in Iraq on health care. It would pay for decent health care for everyone.

    Sort of. It doesn't address the problem of the defict and debt the Iraq war has piled on.

    Its a long term plan, but getting rid of those two would pay for it as well, indirectly. The US spends an absolutely ridiculous amount of its budget just on interest.

  • YarYar Registered User regular
    edited May 2007
    WRT accepting a middle-aged smoker:

    I have a relative who is on government health care because she works for the government. It's a good plan, but she has to go in for regular checkups to maintain it. And if she ever gets classified as "overweight" or is otherwise found to be living an unhealthy lifestyle, she gets dumped right off of the good plan.

    Do we allow people to live however they want and guarantee them we'll fix any problems we can fix, or do we make it hurt when they're found to be willfully harming their health and making it cost more? Should the system reward healthy behavior, or will that just put us right back into haves and have-nots?

  • ElJeffeElJeffe Super Moderator, Moderator, ClubPA mod
    edited May 2007
    I think we're going to start with a universal carrier plan, where everybody just bills the government. This will work well for awhile, until a few politicians start talking about how evil doctors are reaming the taxpayer. Then we'll start getting price caps on procedures and examinations and the like. Like all government-instituted price caps, they will have no bearing on reality, and will drive many practices out of business. Eventually the whole system will become mucked up to the point where a complete government take-over is "necessary". R&D as we know it will shrivel up and die, because the government will regulate the prices of related goods and services to the point where there's no real profit to be made in developing new methods and technologies, and the only R&D will come from government grants. Health care advances in general will stagnate and service will decline, but nobody will notice because they'll be too busy opining on how wonderful things are now that we've abandoned our barbaric reliance on - ick the "free market".

    Maddie: "I named my feet. The left one is flip and the right one is flop. Oh, and also I named my flip-flops."

    I make tweet.
  • YarYar Registered User regular
    edited May 2007
    ElJeffe wrote: »
    I think we're going to start with a universal carrier plan, where everybody just bills the government. This will work well for awhile, until a few politicians start talking about how evil doctors are reaming the taxpayer. Then we'll start getting price caps on procedures and examinations and the like. Like all government-instituted price caps, they will have no bearing on reality, and will drive many practices out of business. Eventually the whole system will become mucked up to the point where a complete government take-over is "necessary". R&D as we know it will shrivel up and die, because the government will regulate the prices of related goods and services to the point where there's no real profit to be made in developing new methods and technologies, and the only R&D will come from government grants. Health care advances in general will stagnate and service will decline, but nobody will notice because they'll be too busy opining on how wonderful things are now that we've abandoned our barbaric reliance on - ick the "free market".
    I sympathize with the concept of this slippery slope, but do you think there is a better way?

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited May 2007
    ElJeffe wrote: »
    I think we're going to start with a universal carrier plan, where everybody just bills the government. This will work well for awhile, until a few politicians start talking about how evil doctors are reaming the taxpayer. Then we'll start getting price caps on procedures and examinations and the like. Like all government-instituted price caps, they will have no bearing on reality, and will drive many practices out of business. Eventually the whole system will become mucked up to the point where a complete government take-over is "necessary". R&D as we know it will shrivel up and die, because the government will regulate the prices of related goods and services to the point where there's no real profit to be made in developing new methods and technologies, and the only R&D will come from government grants. Health care advances in general will stagnate and service will decline, but nobody will notice because they'll be too busy opining on how wonderful things are now that we've abandoned our barbaric reliance on - ick the "free market".

    There are already price caps on procedures and examinations billed to health insurance companies.

    If I go to the ER for a migraine and my doctor gives me a Toradol IV, my insurance company will pay $250* for that IV. It doesn't matter if it took the nurse a half-hour to find an uncollapsed vein on me because of my old heroin habit** or if there was a Toradol shortage and the price tripled. It will always be $250, until hospital and the insurance company enter their annual or biannual fee negotiation process.

    * - made-up number. I really don't know how much my insurance would pay for that.
    ** - I've never actually had a heroin habit.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • nexuscrawlernexuscrawler Registered User regular
    edited May 2007
    Pretty much it'd be taking the power from corporate insurance bureacrats and putting into it government ones. the government sucks at lots of things but a least it's not 100% profit driven.

  • YarYar Registered User regular
    edited May 2007
    Pretty much it'd be taking the power from corporate insurance bureacrats and putting into it government ones. the government sucks at lots of things but a least it's not 100% profit driven.
    And that's better?

  • ElJeffeElJeffe Super Moderator, Moderator, ClubPA mod
    edited May 2007
    Yar wrote: »
    I sympathize with the concept of this slippery slope, but do you think there is a better way?

    That's politically feasible? No.

    A strong degree of privatization is necessary to keep things operating smoothly, to ensure the industry's employees gives a shit, and to make sure R&D is strongly encouraged via financial incentives. However, there's no road to partial nationalization of the industry that won't get grandstanded into a complete government takeover.

    The problem is the insistence that having another person care for you when you're sick is a god-given right on par with free speech and the like. The second you decide that having someone else provide you with a service is an inalienable right instead of just something that's a really good idea to have, you require that every single last person in the nation get the exact same treatment. And there's no way to make sure every single last person in the nation gets the exact same treatment unless the government is controlling every step of the process.

    If I was running the show, I would toss out the notion that any plan that doesn't cover 100.0% of the people 100.0% of the time is a failure. Right now, tens of millions of people have really good health coverage that perfectly serves their needs. There's no reason to even touch their health care. Let them be. There are tens of millions of other people who have health care that usually or mostly serves their needs. We should leave them alone, too. There are the people who don't have health care, but don't really want it or need it that badly. We should think very hard before addressing them.

    Who should we be addressing? For starters, the roughly 5% of the people who both want health care services and are chronically unable to acquire them. This doesn't include people who are without health care for a month in between jobs, or people who don't have care but don't give two shits, or people who are illegal immigrants who we should be dropping billions of dollars to care for. We should also worry about the many people who have insufficient coverage and get hammered by catastrophic health issues.

    Suddenly, we've whittled the problem down from addressing 300 million people to addressing maybe a quarter of that, tops. And we should try to individualize the issue, if we can. The woman who has health insurance that was fine until she developed breast cancer? Sure, let's help her out. Let's try to get her the hundred grand she needs to get better. Let's not spend a quarter-million dollars to take over her health care payments for the rest of her life, because except for this one issue, she's doing fine.

    That is how I would address the problem. I would also, of course, tackle many of the problems deeply ingrained within the health care system, such as skyrocketing medical malpractice insurance costs, and the ridiculous amount of overeducation that's required for someone to even qualify to look in your ear and say, "You have an infection." Chances are, if you had to go to school for 8 years to tell me what I already knew from spending 10 minutes on WebMD, you spent too much time in school.

    Maddie: "I named my feet. The left one is flip and the right one is flop. Oh, and also I named my flip-flops."

    I make tweet.
  • ElJeffeElJeffe Super Moderator, Moderator, ClubPA mod
    edited May 2007
    Feral wrote: »
    There are already price caps on procedures and examinations billed to health insurance companies.

    Yes, but these price caps are not determined by the extent to which a Louisiana congressman stood on a podium and prattled on about injustice.

    Maddie: "I named my feet. The left one is flip and the right one is flop. Oh, and also I named my flip-flops."

    I make tweet.
  • Phoenix-DPhoenix-D Registered User regular
    edited May 2007
    Yar wrote: »
    Pretty much it'd be taking the power from corporate insurance bureacrats and putting into it government ones. the government sucks at lots of things but a least it's not 100% profit driven.
    And that's better?

    Yes. There are ample examples of insurance companies being "penny wise, pound foolish" because they only consider next quarter's revenue reports. Or worse, because they -are- looking ahead and its cheaper to stiff people.

    Good example: If a patient stays with an insurance company for only a few years on average, they have no profit-driven reason to fund preventative medicine. Why? By the time the patient gets sick from the lack of that funding, they'll probably be with another insurance company..

  • nexuscrawlernexuscrawler Registered User regular
    edited May 2007
    I think so. it's not without it's drawbacks. I think under a governmetn system people would likely have better access to the basics of health care. A government program would actually cut it's costs by encouraging people to stay healthy(regular checkups etc). In the end there's always going to be someone deciding what care is neccessary and cost-effective. Right now it's in the hands of insurance provider bean counters. say I have a terminal illness and they decide it's more cost-effective for me to die? I'm probably going to die unless i'm rich enough to sue them and win(which is bloody near impossible). Hopefully a government system would utilize more medical professionals in determining care.

    A government system would still have budget concerns but not profit concerns.

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited May 2007
    ElJeffe wrote: »
    A strong degree of privatization is necessary to keep things operating smoothly, to ensure the industry's employees gives a shit, and to make sure R&D is strongly encouraged via financial incentives. However, there's no road to partial nationalization of the industry that won't get grandstanded into a complete government takeover.

    The problem is the insistence that having another person care for you when you're sick is a god-given right on par with free speech and the like. The second you decide that having someone else provide you with a service is an inalienable right instead of just something that's a really good idea to have, you require that every single last person in the nation get the exact same treatment. And there's no way to make sure every single last person in the nation gets the exact same treatment unless the government is controlling every step of the process.

    There are actually very, very few totally socialized health care systems and they're in countries which are, well, already socialist (Finland and Sweden come to mind). Most countries have some level of privatization, although some more than others. Having a government system that provides for basic health maintenance and catastrophic care while allowing individuals and employers to obtain private health insurance seems to work for a lot of countries.

    BTW, I don't believe in a right to health care, but I believe that having the government play a major hand in health care makes more economic sense than a more privatized approach, for many of the same reasons I believe it makes more economic sense to have public fire departments and public transportation. I just happen to believe this very passionately.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • ThanatosThanatos Registered User regular
    edited May 2007
    ElJeffe wrote: »
    I would also, of course, tackle many of the problems deeply ingrained within the health care system, such as skyrocketing medical malpractice insurance costs, and the ridiculous amount of overeducation that's required for someone to even qualify to look in your ear and say, "You have an infection." Chances are, if you had to go to school for 8 years to tell me what I already knew from spending 10 minutes on WebMD, you spent too much time in school.
    How much have medical malpractice insurance costs gone up, on average? What percentage of a doctor's expenses does it comprise?

  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited May 2007
    Thanatos wrote: »
    ElJeffe wrote: »
    I would also, of course, tackle many of the problems deeply ingrained within the health care system, such as skyrocketing medical malpractice insurance costs, and the ridiculous amount of overeducation that's required for someone to even qualify to look in your ear and say, "You have an infection." Chances are, if you had to go to school for 8 years to tell me what I already knew from spending 10 minutes on WebMD, you spent too much time in school.
    How much have medical malpractice insurance costs gone up, on average? What percentage of a doctor's expenses does it comprise?

    I'm pretty sure the premiums have tripled in the last 10 years, if memory serves (which far outstrips the rate of growth of claims). How large a proportion of expenses it represents I personally can't answer. For doctors in private practice, it's a pretty major expense. It becomes easier if you work for a hospital or HMO, but then you're talking about a whole new set of economic issues.

    I would like to see some reform in that area, as long as reform isn't a trojan horse for patient-fuckage.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • ElJeffeElJeffe Super Moderator, Moderator, ClubPA mod
    edited May 2007
    Thanatos wrote: »
    ElJeffe wrote: »
    I would also, of course, tackle many of the problems deeply ingrained within the health care system, such as skyrocketing medical malpractice insurance costs, and the ridiculous amount of overeducation that's required for someone to even qualify to look in your ear and say, "You have an infection." Chances are, if you had to go to school for 8 years to tell me what I already knew from spending 10 minutes on WebMD, you spent too much time in school.
    How much have medical malpractice insurance costs gone up, on average? What percentage of a doctor's expenses does it comprise?

    Here's an article about it. Short answer: a lot.

    Maddie: "I named my feet. The left one is flip and the right one is flop. Oh, and also I named my flip-flops."

    I make tweet.
  • YarYar Registered User regular
    edited May 2007
    ElJeffe wrote: »
    make sure R&D is strongly encouraged via financial incentives.
    Can't grants do this? Don't a lot of the real breakthroughs (other than yet another symptom-treating drug) come from the grant/academic system anyway?
    ElJeffe wrote: »
    The problem is the insistence that having another person care for you when you're sick is a god-given right on par with free speech and the like.
    Life, liberty and the pursuit of something-something. I agree with you for the most part, but it is way too emotional when you can place a little boy who's going to die without heart surgery next to a multi-billion-dollar government that is supposed to be watching out for him.
    ElJeffe wrote: »
    Right now, tens of millions of people have really good health coverage that perfectly serves their needs. There's no reason to even touch their health care. Let them be.
    Just double their effective tax rate to pay for everyone else's care.
    ElJeffe wrote: »
    There are the people who don't have health care, but don't really want it or need it that badly. We should think very hard before addressing them.
    But they find their way into the latter category eventually.
    ElJeffe wrote: »
    people who are illegal immigrants who we should be dropping billions of dollars to care for.
    Oh no you dint. If the goal is to provide care for someone who needs care and can't afford it, why does it matter which patch of soil they popped out their mama's cooch onto?
    ElJeffe wrote: »
    Chances are, if you had to go to school for 8 years to tell me what I already knew from spending 10 minutes on WebMD, you spent too much time in school.
    Some third world countries are trying this model, passing more and more stuff down to less-qualified-but-nevertheless-exceedingly-qualified practitioners. We do it here, too, actually. I only see my doctor if the insurance company requires that I see an actual doctor for the particular service to get paid. 90% of the time now I see a nurse practitioner, who looks dresses and acts like a doctor, and bosses the other nurses around like a doctor, but isn't.
    ElJeffe wrote: »
    Here's an article about it. Short answer: a lot.
    And it has been found that on average, a doctor does not even perform the minimum set of activities for a patient based on the symptoms and data provided. The oversight from the insurance company is what keeps doctors in check.

  • ElJeffeElJeffe Super Moderator, Moderator, ClubPA mod
    edited May 2007
    Feral wrote: »
    I'm pretty sure the premiums have tripled in the last 10 years, if memory serves (which far outstrips the rate of growth of claims). How large a proportion of expenses it represents I personally can't answer. For doctors in private practice, it's a pretty major expense. It becomes easier if you work for a hospital or HMO, but then you're talking about a whole new set of economic issues.

    I would like to see some reform in that area, as long as reform isn't a trojan horse for patient-fuckage.

    My wife worked for an OB/GYN who was driven out of business by insurance premiums combined with a large number of Medicare patients. See, he was required by law to take them and treat them, and the government pays him a fixed amount that is substantially less than his actual costs. Basically, the government expects doctors to subsidize Medicare costs.

    Anyway, the problem of malpractice premiums apparently has to do partially with lower returns on investments made by insurance providers, and partially to do with a number of carriers closing up shop. I read about a study that seemed to nix the idea that rising jury awards has anything to do with it, on account of them not actually rising.

    Maddie: "I named my feet. The left one is flip and the right one is flop. Oh, and also I named my flip-flops."

    I make tweet.
  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited May 2007
    Yar wrote: »
    ElJeffe wrote: »
    make sure R&D is strongly encouraged via financial incentives.
    Can't grants do this? Don't a lot of the real breakthroughs (other than yet another symptom-treating drug) come from the grant/academic system anyway?

    Yes, although it's not as simple as symptom-treating versus cost-treating.

    I've been itching to post something along these lines for a while. The way pharma R&D works is basically this: you discover that a molecule [X] has a certain health effect. Generally this is discovered by doctors in the field or by academic researchers. Occasionally it's stumbled upon by pharma companies themselves, but that's relatively rare. Example: doctors discovered that patients treated for tuberculosis with antihistamines had unusually low rates of depression for such sick patients.

    Once that discovery is made and a pharma company decides that there's a market for this health effect, they'll rapidly synthesize as many different variations on that molecule they can. then they'll try to just as rapidly eliminate variations - in the old days, they'll eliminate possibilities by testing them on animals. Today they can use protein and tissue tests and computer analysis. Basically, they want to eliminate the molecules that don't work very well as soon as possible. The concept of "high-throughput screening," or increasing the number of molecules or proteins that you can filter out at one time, is a huge industry buzzword. (Example: Eli Lilly started synthesizing variations on antihistamines in the 1970s and eventually found Prozac.)

    The mantra in pharma R&D is "fail early."

    Eventually you end up with two or three molecules that are promising: safe, efficacious, few side effects. Maybe they treat symptoms, maybe they treat causes.

    Decrease R&D dollars, and you'll still get drugs. You'll still get good drugs. What you'll lose are the fringe drugs - drugs for exotic diseases, or drugs for common diseases but exotic interactions and sensitivities. Like all the people who couldn't take Prozac because of an allergy but can now take Zoloft... well, Zoloft might not be around if there were few R&D dollars to go around. But Prozac still would, and most or all of the drugs prior to Prozac still would.

    So what happens to these people? well, in the case of exotic diseases, the government would have to step in again and offer the pharma companies a carrot to find cures for them. This already happens a lot; most of the for-profit R&D done on rare genetic diseases (like, say, hemophilia) are government-subsidized (and not necessarily by our government; lots of first-world countries contribute to this pursuit). People who have common diseases but weird allergies... well, they'd be kind of SOL. Not totally SOL, as they could use older drugs - there are very few diseases that we can't at least treat with current drugs, just the newer drugs might work better.

    The industries that would really feel the burn from fewer R&D dollars are medical devices and diagnostics, because those follow a much more typical directed engineering model of R&D.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • Johnny NopantsJohnny Nopants Registered User
    edited May 2007
    My biggest problem with socialized medicine is the whole slavery thing. Money is being taken from me under duress and being given to people who did nothing to deserve it other then claim they "need" it or have a "right" to it. I do not think this is right.

  • ElJeffeElJeffe Super Moderator, Moderator, ClubPA mod
    edited May 2007
    Feral wrote: »
    The industries that would really feel the burn from fewer R&D dollars are medical devices and diagnostics, because those follow a much more typical directed engineering model of R&D.

    Right. Devices that, say, can find cancer much earlier, or can determine if the kid in your belly is likely to kill you on the way out.

    Maddie: "I named my feet. The left one is flip and the right one is flop. Oh, and also I named my flip-flops."

    I make tweet.
  • FeralFeral Who needs a medical license when you've got style? Registered User regular
    edited May 2007
    My above post shouldn't be taken to mean that I think a national health care system would necessarily decrease R&D spending. I think a bad one definitely could, but it is entirely possible to build one that does not.

    And BTW...
    My biggest problem with socialized medicine is the whole slavery thing. Money is being taken from me under duress and being given to people who did nothing to deserve it other then claim they "need" it or have a "right" to it. I do not think this is right.

    Single payer is not socialized medicine.
    Taxation is not slavery.
    Critical failure, try again.

    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
    the "no true scotch, man" fallacy.
  • WalrusWalrus Registered User
    edited May 2007
    My biggest problem with socialized medicine is the whole slavery thing. Money is being taken from me under duress and being given to people who did nothing to deserve it other then claim they "need" it or have a "right" to it. I do not think this is right.

    Surely the only people who deserve medical treatment are those who need it?

  • ShintoShinto __BANNED USERS
    edited May 2007
    I just listened to Obama's healthcare proposals and I'm in the middle of Hillary's speech on the same.

    I don't know what Edwards plan is yet - but O & H aren't really talking about single payer socialized medicine. Like, at all.

    I am not even kidding. I can not emphasize this enough.

    By the way - God damn Hillary Clinton is incredibly impressive on this issue. I am blown away and will now probably vote for her in the primary.

  • ElJeffeElJeffe Super Moderator, Moderator, ClubPA mod
    edited May 2007
    Shinto wrote: »
    I just listened to Obama's healthcare proposals and I'm in the middle of Hillary's speech on the same.

    I don't know what Edwards plan is yet - but O & H aren't really talking about single payer socialized medicine. Like, at all.

    I am not even kidding. I can not emphasize this enough.

    By the way - God damn Hillary Clinton is incredibly impressive on this issue. I am blown away and will now probably vote for her in the primary.

    Care to give us the Cliff's Notes version of their respective plans? I'll probably go back and read them in time, but I'm impatient.

    Maddie: "I named my feet. The left one is flip and the right one is flop. Oh, and also I named my flip-flops."

    I make tweet.
  • Johnny NopantsJohnny Nopants Registered User
    edited May 2007
    Feral wrote: »
    Single payer is not socialized medicine.
    Taxation is not slavery.
    Critical failure, try again.
    Something I work for is being taken from my by threat of force against my will and given to someone who had nothing to do with me generating it. That is pretty much a working definition of slavery.
    Walrus wrote:
    Surely the only people who deserve medical treatment are those who need it?
    I am not really sure what you are getting at here. Could you please clarify?

  • Irond WillIrond Will Dragonmaster Cambridge. MASuper Moderator, Moderator mod
    edited May 2007
    Shinto wrote: »
    By the way - God damn Hillary Clinton is incredibly impressive on this issue. I am blown away and will now probably vote for her in the primary.
    She's actually incredibly impressive on pretty much all nuts-and-bolts issues.

    Wqdwp8l.png
  • Nova_CNova_C Social Justice Haruspex Beyond The WallRegistered User regular
    edited May 2007
    My biggest problem with socialized medicine is the whole slavery thing. Money is being taken from me under duress and being given to people who did nothing to deserve it other then claim they "need" it or have a "right" to it. I do not think this is right.

    You can't be serious. Socialized medicine is like any other government program. Do you also believe that cancer research should only be supported by those who have cancer?

    My blog: www.jonathanirons.net
    My Twitter: IronBorealis
    Be advised, I'm not the best at keeping either updated. >.>
  • Irond WillIrond Will Dragonmaster Cambridge. MASuper Moderator, Moderator mod
    edited May 2007
    Okay - anyone wanting to respond to this libertarianism thing (and this includes you, Libertarian) make fucking sure it specifically deals with health care.

    Do not derail this thread into another fucking "taxes r slavery lol" thread. Make another one if you must have that discussion.

    Wqdwp8l.png
  • ShintoShinto __BANNED USERS
    edited May 2007
    ElJeffe wrote: »
    Shinto wrote: »
    I just listened to Obama's healthcare proposals and I'm in the middle of Hillary's speech on the same.

    I don't know what Edwards plan is yet - but O & H aren't really talking about single payer socialized medicine. Like, at all.

    I am not even kidding. I can not emphasize this enough.

    By the way - God damn Hillary Clinton is incredibly impressive on this issue. I am blown away and will now probably vote for her in the primary.

    Care to give us the Cliff's Notes version of their respective plans? I'll probably go back and read them in time, but I'm impatient.

    You'll have to wait until this weekend. I'd have to go back and be taking notes to sum things up properly. Their plans are already running together in my head. I get the impression Hillary Clinton is more willing to force the insurance companies to do certain things via regulation and pressure to increase efficiency - but I suspect this is a product of her superior technical mastery of the issue.

  • WalrusWalrus Registered User
    edited May 2007
    Feral wrote: »
    Single payer is not socialized medicine.
    Taxation is not slavery.
    Critical failure, try again.
    Something I work for is being taken from my by threat of force against my will and given to someone who had nothing to do with me generating it. That is pretty much a working definition of slavery.
    Walrus wrote:
    Surely the only people who deserve medical treatment are those who need it?
    I am not really sure what you are getting at here. Could you please clarify?

    You would only give someone medical treatment if they need it. You don't give someone a chemotherapy course just for kicks.

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