Universal Health Care Reform in the United States

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Originally Posted by Dylan H

Its never that easy is it. What if you have to remain on fucitall for the rest of your life? What if there are no competitors or generics? Are you going to remain objective when you're ill, or are you simply going to want to do whatever you think will make you better? My experience suggests the latter.

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Perhaps healthcare shouldn't always be objective and rational. Objectivism and rationalism in healthcare lead to things like Logan's Run and Soylent Green. Obviously those are extreem examples, but if you follow things logically that's pretty much where you're led to. So you need some compassion, hope, and yes non-objective optimism sometimes.

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Originally Posted by Dylan H

In theory thats true but in practice people don't make rational decisions when their health is at stake even when knowledgeable. People don't choose a cancer drug using the same thought processes as they do when choosing between a Merc or Beemer. Thats why doctors are advised to see another doctor when they are ill, to retain objectivity that is easily lost when you're ill.

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You need a doctor to help guide you with or without Nationalising the whole system. That doesn't change anything.

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Originally Posted by Dylan H

Simple, transactions between pharm companies and the medical establishment need to be audited and offenders prosecuted. Doctors need to be named and shamed and prosecuted where required.

In the UK its always been illegal (and nearly impossible) for pharm companies to pay off individual doctors or hospitals to prescribe their drugs. All they can do is work out a special discount for individual hospital groups on top of what they've worked out with the NHS.

To get around this drug companies used to do what car companies still do with journos, invite top doctors to a launch event somewhere nice, followed by a weekend of golf or sightseeing. The hope was that those doctors would pressurise the hospital into buying that drug, or perhaps choose that drug over a competitor when prescribing. That was made illegal by limiting the amount of money drug companies could spend on events.

That way, drugs are purely prescribed on clinical grounds. Obviously reality is slightly different but cash incentives to prescribe are unheard of.

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As you just pointed out, there are always loopholes and work arounds. That's why I'm not sure how you could ever really stop any of this.

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Originally Posted by Dylan H

And the British government is better? I doubt that very much.

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As do I. You seem to be saying that the UK system is good, not me.

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Originally Posted by chuck34

Perhaps healthcare shouldn't always be objective and rational. Objectivism and rationalism in healthcare lead to things like Logan's Run and Soylent Green. Obviously those are extreem examples, but if you follow things logically that's pretty much where you're led to. So you need some compassion, hope, and yes non-objective optimism sometimes.

You need a doctor to help guide you with or without Nationalising the whole system. That doesn't change anything.

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Non-objective optimism? Thats what an economist would call a waste of money. If there isn't evidence or logic to back up a treatment, don't do it. Non-objective optimism isn't just a waste of money and resources, its also cruel to the patient by raising hopes that can't be delivered upon more often than not. I thought wasting money was precisely what you were against?

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Originally Posted by chuck34

As you just pointed out, there are always loopholes and work arounds. That's why I'm not sure how you could ever really stop any of this.

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You can't stop it but you can minimise it as I've suggested. The US is one of the few countries where such backhanders aren't even illegal and hasn't taken any steps to do anything about it. Even a small step can reduce the problem.

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Originally Posted by chuck34

As do I. You seem to be saying that the UK system is good, not me.

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Actually you were the one doubting that the US government could negotiate discounts like the one the British government has, hence suggesting that the US government is not as capable.

Starter, of course the US does indeed protect patents for longer than many other states but that again is the US's choice is it not? I don't think the role of any healthcare system should be to subsidise pharm companies or make drugs cheaper elsewhere. That appears to me to be a sideeffect of a shortfall in the system rather than a charitable act for the world.

That said, the drug companies that supply new patent protected pharm agents can be forced to reduce their charges in other ways.

One of my good friends is an executive at a US drug company but based at its research centre in the UK. Whilst he does not engage in negotiations with the UK government directly he knows exactly what the tactic is to drive down costs. The pharm company will try to charge what it can for its patent protected products. The government then suggests that if it doesn't cut the price then the pharm company may well find its other (often generic) products 'reconsidered'. IE if you don't cut the price you may find thats the last thing we buy from you. Looking at the whole product range it is then often in the pharm companies interests to negotiate a cheaper price, even operate at a loss for a brief period on that drug in the hope that its uptake will be higher than expected.

BTW your use of thalidomide as an example is flawed, it was introduced in Europe before rigorous testing was introduced and to the US much later. It is not a good illustration of the failures of drug testing systems around the world, although it is a good illustration of what happens when animal testing is skipped but thats another story.

These days pharm companies tend to get FDA approval first before approaching other countries, the reason being that many countries do not bother testing drugs themselves but use FDA approval as their own standard, ie if a drug is legal in America then it automatically gains approval in many other countries/markets. Certainly drugs tend to reach Britain later than the American market as the British still require separate tests and trials, although the trials required for FDA approval can be used to speed things along.

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Originally Posted by Dylan H

Non-objective optimism? Thats what an economist would call a waste of money. If there isn't evidence or logic to back up a treatment, don't do it. Non-objective optimism isn't just a waste of money and resources, its also cruel to the patient by raising hopes that can't be delivered upon more often than not. I thought wasting money was precisely what you were against?

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Well logically since somewhere in the neighborhood of 90% of a person's medical expences occur during the last 6 months of your life. And considering that the average life expectancy is somewhere around 72. Shouldn't we just off everyone at 71 and a half? That sure would solve a lot of the health care costs, logically.

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Originally Posted by Dylan H

You can't stop it but you can minimise it as I've suggested. The US is one of the few countries where such backhanders aren't even illegal and hasn't taken any steps to do anything about it. Even a small step can reduce the problem.

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I'm not saying that we shouldn't take those steps. Far from it, we should do that. It just doesn't require Nationalization to do it.

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Originally Posted by Dylan H

Actually you were the one doubting that the US government could negotiate discounts like the one the British government has, hence suggesting that the US government is not as capable.

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Ok the US system is broken, and by your own admission the UK system isn't perfect. So why again should we follow the UK model? Shouldn't we try something completely different? Wouldn't something different be to put insurance solely in the hands of the individual?

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Originally Posted by chuck34

I'm not saying that we shouldn't take those steps. Far from it, we should do that. It just doesn't require Nationalization to do it.

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I couldn't agree more with that statement, which is why I said above that this is a separate issue from state funded healthcare, something that Obama isn't dealing with with his reforms yet could save a lot of money relatively painlessly.

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Originally Posted by chuck34

Ok the US system is broken, and by your own admission the UK system isn't perfect. So why again should we follow the UK model? Shouldn't we try something completely different? Wouldn't something different be to put insurance solely in the hands of the individual?

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No healthcare system is perfect, it would be foolish to think so yet there is nothing wrong with learning from other systems. Redefining the relationship between US healthcare and the pharm industry to cut costs for the former doesn't require socialisation, nationalisation or whatever term you want to use for it. There's no need to be ripped off and carry on being ripped off because you don't want to adopt someone else's system for the sake of it.

A couple of my Texan friends just told me that their Aunty told them that one of Obama's plans is to counsel the old and sick about death, so that they don't ask for more health care and thus die quicker.

Obama really needs to sort out what the hell his plan is, cos such rumours due to him being unclear really aren't going to help him.

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Originally Posted by Dylan H

I couldn't agree more with that statement, which is why I said above that this is a separate issue from state funded healthcare, something that Obama isn't dealing with with his reforms yet could save a lot of money relatively painlessly.

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Ok I must have missed it when you said that this should be done despite anything else. Sorry :-)

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Originally Posted by Dylan H

No healthcare system is perfect, it would be foolish to think so yet there is nothing wrong with learning from other systems. Redefining the relationship between US healthcare and the pharm industry to cut costs for the former doesn't require socialisation, nationalisation or whatever term you want to use for it. There's no need to be ripped off and carry on being ripped off because you don't want to adopt someone else's system for the sake of it.

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Right, I'm not advocating discarding the UK model "for the sake of it". I'm saying, and you have said as well, that the UK model is not perfect. So why not strive for something better?

It seems to me that from what I can gleam from the jumbled mess comming out of Washington is that the Pres, and Congress are trying to inact some sort of mish-mash of the Canadian and UK systems. And they appear to be using the worst parts of both systems. On top of that they are trying to do it so fast that no one has time to examine exactly what they are doing, and stop it. I'm failing to see any logic in any of this except when you go back to then-Senator Obama's comments about wanting to have a single payer system.

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Originally Posted by chuck34

BS!!!! I can't say this any stronger without being censored. BS!!!!!!!

10-15 million of those are ILLEGAL. Why do we have to pay for someone that is here illegally? BS!!!!!

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Healthcare statistics as compiled by the United States Department of Health and Human Services as as their primary collection device the Social Security Number (SSN).

If you don't have an SSN then you are not included in the statistics, so whilst there may in fact be 10-15 million illegal immigrants to the United States, they never appear in the statistics by the United States Department of Health and Human Services and as such aren't included in the 45-50 million people who do not have health care.

It's a subtle point, but one which was made in the Senator by Robert Byrd who is the current "Father of the House"

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Originally Posted by Rollo

Healthcare statistics as compiled by the United States Department of Health and Human Services as as their primary collection device the Social Security Number (SSN).

If you don't have an SSN then you are not included in the statistics, so whilst there may in fact be 10-15 million illegal immigrants to the United States, they never appear in the statistics by the United States Department of Health and Human Services and as such aren't included in the 45-50 million people who do not have health care.

It's a subtle point, but one which was made in the Senator by Robert Byrd who is the current "Father of the House"

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I still think we have to know a little more about data collection methods.

I don't want to take this thread in another direction, but working and selling in construction, companies I have worked for and sell to all take out social security and medicaire taxes on their employees, and I would say fully 75% or more are illegal based on the #'s of mismatched letters recieved, but we would just stick them in the file and go on. They all had social security #'s.

Any survey of employers would show X # of workers not covered by insurance.

Also, this is OT, but our wages to workers actually went up when the Hispanic work force came in to Memphis in the mid-90's, but they were worth the higher wages, production went up so wages went up, and you wanted to keep them.

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Originally Posted by Rollo

Healthcare statistics as compiled by the United States Department of Health and Human Services as as their primary collection device the Social Security Number (SSN).

If you don't have an SSN then you are not included in the statistics, so whilst there may in fact be 10-15 million illegal immigrants to the United States, they never appear in the statistics by the United States Department of Health and Human Services and as such aren't included in the 45-50 million people who do not have health care.

It's a subtle point, but one which was made in the Senator by Robert Byrd who is the current "Father of the House"

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I don't know where Byrd got his info. And I'm not sure he's the most reliable source anyway. Here's a few links from just a quick Google search to look at. Especially look at the WSJ one, it's really good.

http://online.wsj.com/article/SB124579852347944191.html
http://cnsnews.com/news/article/52593
http://keithhennessey.com/2009/04/09...rom-taxpayers/

How many more do you want? Can you link to the HHS report? Everything that I can find says 9-10million illegals being counted in that number of 46-50million uninsured.

And as Alex pointed out, there are plenty of illegals that have SSN's. So that doesn't really mean too much to me.