(10-22-2015 11:15 PM)Ole Blue Wrote: We need a single-payer system with healthcare for all in this country. The system is broken, pharma companies are out of control, and our system is the LEAST efficient out of all developed countries on this planet. That's freaking stupid. Don't kid yourselves - it won't get better with free markets. How do you think we're in this mess in the first place? Without a better-built state-assisted medicare program, it will stay crappy and inefficient.
I'm sorry, but anybody who thinks we need a single-payer system (or a single-provider system, which is what I think most people mean when they say we should have single-payer--UK is single-provider, Canada is single-payer) does not really understand how single-payer and single-provider work. You get whatever health care some government bureaucrat has decided to provide, and if that's not what you need then you get sent home to die waiting in a queue. And that's considered a good result, because it saves money and because dying while waiting in the queue means that you are not in the system so you are not a bad "outcome."
Single-payer/single-provider systems do a good job of keeping well people well, but a poor job of treating sick people. Our current system does a much better job of treating sick people, because the can actually get care instead of taking a number in a queue, but it is less effective than single-payer/single-provider at keeping well people well. It is more cost effective over a whole population to keep well people well than to treat sick people, but that is of little comfort to anyone who is truly sick--or badly injured--in a single-payer/single-provider system.
What we need is a Bismarck system, which basically keeps well people well the same way single-payer/single-provider do, and treats sick people the way our system does. Cost-wise, Bismarcks tend to line up with the upper end of single-payer/single-provider, which makes sense because actually providing care to sick people costs more than giving them a number and sending them home to die waiting in the queue. That's a considerable savings from our current system, primarily because doing a better job of keeping well people well is relatively cheap and cost-effective. On a "bang for the buck" basis, they rate very high. Overall, they are the best systems in the world.
Other than very small countries the single-provider systems don't rank very high. And in the infamous WHO study of 2000, only one true single-payer system (Canada) ranked slightly higher that we did (30th v 37th), and all the rest were far worse. And remember, those rankings were based far more on cost and universality than quality. The US actually ranked #1 in the ranking component that most nearly reflected quality. And even with the rankings skewed in favor of cost and universality, the US was #1 among countries with over 130 million population, #2 among countries with over 80 million, and #4 among countries with over 60 million; and the three countries ahead of us at that point were all Bismarcks (France, Germany, Japan), while the single-payer/single-provider systems with populations in those ranges were nowhere close. Nobody has ever made single-payer/single-provider work well in any system even approaching ours in size. They work fairly well in the Nordic countries, with extremely homogeneous populations in the 5 million range, but that's about it; and even the Nordics have massive and apparently unsolvable problems with waiting times.
As for pharma companies, do you understand what is going on? They do a lot of R&D here, because of our liberal R&D tax credits (if you want to take that loophole away, try running it by those in academia who are living off corporate research grants). So the development costs are here, and foreign countries want to pay only the marginal costs of making one pill, and leave the US to absorb all of the related R&D costs. Let's say you spend $100 million developing a pill that costs $1/pill to manufacture, and you expect to sell 1 million pills per year in the US, 1 million a year in the developed world, and 1 million a year in the undeveloped/developing world, and you expect a useful life of 20 years. Currently, you sell the foreign pills for $1 (ignoring profit and the time value of money, to make the math simpler). In order to break even, you have to absorb the $100 million development costs over 20 million US sales (20 years at 1 million/year), or an additional $5/pill. So the pill sells for $6 in the US and $1 overseas. US customers are subsidizing the rest of the world's opportunity to have the pill. I have no problem subsidizing the pill in undeveloped/developing countries. But I have a major problem subsidizing other developed countries that can afford to pay. Suppose they agreed to cover their fair share of R&D. Now the development costs would be amortized over 40 million pills, or $2.50/pill, and the cost per pill would be $3.50 in the US and other developed countries, and still $1 for undeveloped/developing countries. We need a leader with the guts to push that. If we follow the approach of reducing the US price to the $1/pill that some advocate, all those R&D costs get stranded. That's the end of medical progress forever. To the idea that government would fund R&D, no thanks, that kind of bureaucratic nightmare would effectively end R&D as well. There would be scattered academics performing pure research, but nobody figuring out commercials viable applications. Nobody is going to eat the cost of FDA testing, because nobody can afford to. That's not how one gets progress.
As to the notion the the free market can't fix it, that's based on what? Certainly our current health care system bears no resemblance to a free market and hasn't for decades. I find it both amusing and concerning the way the left likes to say that all the good things that happen in our system are because it is a mixture of capitalism and socialism (the whole "you didn't build that" argument, for one thing) but whenever there's a problem, it's always free market capitalism to blame. That's pretty dishonest, don't you think? Actually, Bismarck systems are far more free market that our health care has been since at least the 1960s, and they are the best systems in the world.
We're not in our current health care situation because of any free market. Most of the problems are largely the result of government intrusion into the market place. More government intrusion, however well intended, won't solve that.
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States refusing expansion of Obamacare are paying more?
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to rays of sunshine..... 