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Re: Purpose of a Healthcare System

Posted: Mon May 06, 2019 7:16 pm UTC
by Angua
Also, do you think that other governments are inherently more competent to run these systems than the US? I mean, technically the CDC is run by the US government, what makes you think that you can't get another government agency to run healthcare like the rest of the world.

Do you think it took JFK (+his speech writers) that much time and money to come up with the 'ask not what your country can do for you, but what you can do for your country' line? IMO pithy lines are not that hard to come by.

Re: Purpose of a Healthcare System

Posted: Mon May 06, 2019 7:24 pm UTC
by Thesh
cphite wrote:Most people who look objectively at the problem understand that a single payer system - assuming it was run competently - would be more cost effective, both at the individual level and for society at large. We just don't trust our government to run it competently.


I would pretty much expect a mixed government/market system to come out of any objective effort to reform.

Of course, most of our problems are simply caused by the fact that insurers independently negotiate with each healthcare provider and if yours hasn't gone through the process then you pay heavily marked up rates. A law that stated that everyone had to pay the same price regardless of insurance plan or lack thereof would massively reduce overhead costs and barriers to entry for insurers (of course, we would probably put in an exception so we can charge tourists millions of dollars for a hospital stay).

Re: Purpose of a Healthcare System

Posted: Mon May 06, 2019 8:06 pm UTC
by cphite
Angua wrote:Also, do you think that other governments are inherently more competent to run these systems than the US? I mean, technically the CDC is run by the US government, what makes you think that you can't get another government agency to run healthcare like the rest of the world.


Just to be clear, I'm not saying it's impossible or even that I wouldn't support a reasonable effort... I was simply pointing out the reason that many opponents to single payer are actually opposed to the idea. It's not that we are opposed to the idea of single payer in and of itself. At least, not all of us.

But to answer your question... right now, my answer is unfortunately yes. In my opinion, the governments that do well with these programs aren't as bogged down by money and corruption as ours, and frankly unless we make some fundamental changes to our government and particularly how campaigns are paid for, I simply wouldn't trust our government with running healthcare. If that position offends certain people, so be it.

The CDC is a fine agency; but they're also a relatively small agency with a relatively clear and narrow focus. I still wouldn't want them controlling my access to my doctor.

Our government does okay with clearly defined goals that everyone more or less agrees upon. Healthcare isn't that.

Do you think it took JFK (+his speech writers) that much time and money to come up with the 'ask not what your country can do for you, but what you can do for your country' line? IMO pithy lines are not that hard to come by.


It was an exaggeration for humorous effect. Clearly, it missed.

Re: Purpose of a Healthcare System

Posted: Mon May 06, 2019 10:26 pm UTC
by Angua
cphite wrote:If that position offends certain people, so be it.
I wouldn't say it offends people, more of just baffling that you would accept for-profit insurance, where there is a demonstrable incentive not to pay out, and ignore that most of the world who can afford to have it have single payer healthcare of one description or another, that by most metrics does better than that of the US, despite the US spending a fortune on their healthcare.

Re: Purpose of a Healthcare System

Posted: Mon May 06, 2019 11:17 pm UTC
by Pfhorrest
Correct me if I'm wrong but I believe the statistics are that every single national health service performs better than the private health clusterfuck we have here in the US, so even if you don't trust the US government particularly, odds are that any government, even ours could do it better than the shitstorm we have going at present.

Also, do you really think the US government is really that much more incompetent than every other government out there? It sounds like you (cphite) are saying "governments generally run health care better than corporations, in principle, but not our government, they'd fuck it up even worse..."

(EDIT: I missed that there was a second page already, I guess I'm behind on the conversation).

Re: Purpose of a Healthcare System

Posted: Mon May 06, 2019 11:56 pm UTC
by Thesh
I think there are two main concerns that need to be considered: corruption by medical suppliers, and the malicious right. The first is a big problem in America just due to the amount of corporate influence in general - look at the tanks no one asked for or the 737 Max 8. These, of course, are both problems today in the medical industry, and I'm not sure how much would change. The malicious right is my bigger concern: "should we really spend money on people who are overdosing on drugs?"

Re: Purpose of a Healthcare System

Posted: Tue May 07, 2019 1:45 am UTC
by eran_rathan
Anyone in the position of power who has the ability and means to murder people by withholding life-saving drugs by reason of profit should be charged with depraved indifference homicide.

Re: Purpose of a Healthcare System

Posted: Tue May 07, 2019 6:15 am UTC
by elasto
eran_rathan wrote:Anyone in the position of power who has the ability and means to murder people by withholding life-saving drugs by reason of profit should be charged with depraved indifference homicide.

I hope not else we're all in trouble. You and I have the ability to save a life right now by making a donation to a third-world charity. It's not a crime that we choose not to (or that we choose not to give more).

It can't be a crime for a drug company not to give their drugs away to the sick any more than it'd be a crime for a farm not to give food away to the starving.

Having said that, I'd prefer a different model for drug research. Perhaps expand public universities to do more than basic drug research, or perhaps make all drug research bounty-based rather than patent-based. eg. 'develop a new type of antibiotic and receive a billion dollar prize' - but all such products automatically end up in the public domain...

Re: Purpose of a Healthcare System

Posted: Tue May 07, 2019 6:21 am UTC
by Pfhorrest
"by reason of profit" is the key phrase there

sacrificing lives to squeeze more money out of people is different from sacrificing some lives so you don't have to sacrifice others

providing life-saving aid at cost (after everyone has been paid for their work, before the excess profits are extracted) is not the same thing as requiring you or I to give up the pay from our work to save people in third world countries.

Re: Purpose of a Healthcare System

Posted: Tue May 07, 2019 6:29 am UTC
by elasto
I'm not sure that's a meaningful distinction. Should farms be required to give away the food they produce at cost too? Food is basically a life-saving drug.

Drugs are weird in that most of the costs come from the R&D not from the manufacturing - and the successful drugs have to cover the R&D costs of the failures.

I'm all for the banning of advertising of drugs to consumers though. Many countries do including the UK. That would reduce costs and therefore prices too.

Re: Purpose of a Healthcare System

Posted: Tue May 07, 2019 6:37 am UTC
by Thesh
Farms are one of the most mature industries; profits are supposed to go to zero in an efficient market and we already produce enough food to feed everyone in the world.

Re: Purpose of a Healthcare System

Posted: Tue May 07, 2019 12:03 pm UTC
by eran_rathan
elasto wrote:I'm not sure that's a meaningful distinction. Should farms be required to give away the food they produce at cost too? Food is basically a life-saving drug.

Drugs are weird in that most of the costs come from the R&D not from the manufacturing - and the successful drugs have to cover the R&D costs of the failures.

I'm all for the banning of advertising of drugs to consumers though. Many countries do including the UK. That would reduce costs and therefore prices too.


Not true. Merck spends 27% of profit on sales and advertising versus 17% on research. Pfizer spends 33% on advertising and 14% on R&D. Oh, and Merck's CEO made $17 million last year, with Pfizer's CEO making $28 million, a 60% jump over last year's compensation.

Re: Purpose of a Healthcare System

Posted: Tue May 07, 2019 11:34 pm UTC
by CorruptUser
Strange how we all expect the medical related professions to work for free because we need it, yet rarely ask that of others. While attorneys sort of have to work pro bono*, we dont routinely expect them to work for free to defend a poor person that needs better legal representation.

I understand the sentiment, especially with regards to pharmaceuticals where the actual cost of manufacture is less for the pills than the packaging itself, and they prevent other organizations from producing it at cost. However, you force companies to give the life saving drugs for free, and the only new drugs to hit the market are hair and boner pills.


*And often it ends up being some Philharmonic or other rich asshole org, ie, the lawyer is advertising to rich people rather than defending a poor person

Re: Purpose of a Healthcare System

Posted: Wed May 08, 2019 12:22 am UTC
by Thesh
Who's saying anything about anyone working for free?

Re: Purpose of a Healthcare System

Posted: Wed May 08, 2019 2:02 am UTC
by eran_rathan
CorruptUser wrote:Strange how we all expect the medical related professions to work for free because we need it, yet rarely ask that of others. While attorneys sort of have to work pro bono*, we dont routinely expect them to work for free to defend a poor person that needs better legal representation.

I understand the sentiment, especially with regards to pharmaceuticals where the actual cost of manufacture is less for the pills than the packaging itself, and they prevent other organizations from producing it at cost. However, you force companies to give the life saving drugs for free, and the only new drugs to hit the market are hair and boner pills.


*And often it ends up being some Philharmonic or other rich asshole org, ie, the lawyer is advertising to rich people rather than defending a poor person


No, no, no. Don't move the damn goal posts. No one said anything about giving anything away - I said specifically that "withholding life-saving drugs by reason of profit" was equivalent to murder. No one said free, but there is no way anyone can convince me that something caused a magical 2000% increase in the cost of producing insulin in the past ten years. A fair price, not price gouging.

Re: Purpose of a Healthcare System

Posted: Wed May 08, 2019 2:35 am UTC
by SecondTalon
If the US Government can purchase surplus milk to keep dairies operating, they can sure as fuck buy insulin so people don’t die.

Re: Purpose of a Healthcare System

Posted: Wed May 08, 2019 8:30 am UTC
by Angua
Do government ministers work for free? No? Military? No? People who do R&D for the military? No?

Talk about the strawiest strawman to ever strawman.

Re: Purpose of a Healthcare System

Posted: Wed May 08, 2019 10:40 am UTC
by PAstrychef
This idea that tax-funded programs are somehow “free” is one of the push points for the right wing in the USA. They act as though supporters of higher education and good healthcare are so naive that we expect them to rain down like manna from the heavens. We understand the costs just fine, we just want, in effect, to pay them upfront in our taxes, instead of having that bill shred our lives like a tornado.
Not to mention that no one actually knows what anything in American healthcare really costs, or “ought” to cost at all. What goes on the bill is almost never what gets paid, the prices for items like aspirin are obviously and ridiculously inflated beyond absurdity, market forces have little effect on what practitioners charge either patients or hospitals (since no one understands what they charge what they charge), patients aren’t in a place to negotiate with doctors, especially surgeons. This guy is going to cut you open and remove that tumor, or fix that organ? You really don’t want him rushing or doing substandard work on you, right?
Way too many Americans feel that taxes are theft by the government. They say this while using all of the things that taxes pay for and idolizing the military that taxes pay for (50% of the budget goes to the military here) and supporting the corporations that avoid taxes (because if taxes are theft, then not paying anything is brilliant, right?) all the while paying so little that their employees qualify for food stamps, thereby costing the government even more.
Even a more perfect healthcare system would not be able to cure that stupidity.

Re: Purpose of a Healthcare System

Posted: Thu May 09, 2019 1:14 pm UTC
by elasto
eran_rathan wrote:
elasto wrote:Drugs are weird in that most of the costs come from the R&D not from the manufacturing - and the successful drugs have to cover the R&D costs of the failures.

I'm all for the banning of advertising of drugs to consumers though. Many countries do including the UK. That would reduce costs and therefore prices too.


Not true. Merck spends 27% of profit on sales and advertising versus 17% on research. Pfizer spends 33% on advertising and 14% on R&D. Oh, and Merck's CEO made $17 million last year, with Pfizer's CEO making $28 million, a 60% jump over last year's compensation.

I guess you misunderstood me. I said 'I'm all for banning the advertising of drugs' therefore I was excluding advertising costs.

What I said was true: Unlike many other physical products, most of the cost comes from the R&D as opposed to manufacturing - eg. a pill that retails at $100 might cost a cent to make. But $100 might none-the-less be a fair price.

It puts it in a similar category to software, say, where it would cost nothing to 'manufacture' a new copy of Windows, but it would quite reasonably retail at a three-figure sum.

But unlike software, healthcare is not an optional luxury; It's an essential like food - but it's easy to see if food is overpriced because almost all the costs are from production - and Western markets are diversified and oversupplied enough that if one food item goes up in price people can move to another.

The government should definitely be involved in the supply side to smooth out big hikes in drug prices, especially for staples such as insulin. If it can stockpile Helium (which it should) it can stockpile insulin. It's more or less a national security issue...