Healthcare

Well, healthcare companies like GSK and Pfizer seem to operate here fine.

Heck, GSK is a British company. In Britain, private healthcare isn't as much used as on the Continent. I'm sure it could easily adapt to working in a new, mixed-healthcare system, at the very least, in the US.

Actually the argument about R&D makes a very large assumption:

The dollars spent correlate well with development of important medicines.

It does not.

Where did insulin come from? A cheapass grant from the Canadian government to a university professor. Today's anti-HIV vaccine is coming from exactly that as well, in Canada, by a university professor performing research. Recent developments in trying to extend the lifetime of knee prosthetic was through grant money at a university. The vast majority of R&D dollars of pharmaceutical companies are so damn useless, it literally does less than government grant based research in developing major breakthroughs. There's not a single vaccine, cure or medical procedure that reshaped the medical world like those created by non-profit seeking individuals (well maybe you can find something if you look hard enough). Everything important was resolved by non-profit government tax-funded projects.

edited 20th Mar '12 9:47:41 AM by breadloaf

@Some: I think there's a difference in how we're defining healthcare. I define it as an application of medicine, and medicine is produced by pharmaceutical companies. Even if you're not taking drugs and you're just in for surgery or something, someone had to develop the anesthetic and the anti-septics.

@Ace: That's some dangerous thinking. Essentially you're throwing all the good a company has done and that they could do under the bus because you are personally offended by their business practices. It's not a trivial thing to replace infrastructure and resume work that's been going on for years. As for the taxes, my gut says it can be done, but seeing as more is spent on healthcare than on defense, I'm not really sure what kind of increase we'd be looking at.

@Tomu: This is somewhat similar to the discussion we had in the piracy thread—what is the incentive of innovating or continuing business if your costs are high, your risks are higher, and your reward is lower? And then risk is increased by making the pool of available money smaller?

@Fighteer: I don't think the argument is simply "they're incompatible." The argument made was that it's not feasible for the government to pay for that in such a way that would significantly cut costs.

There's also a fundamental misunderstanding of companies and an overly idealistic view of the free market. Big companies are almost as slow as governments to change. For example, take Blockbuster and Netflix. Blockbuster built its business model on late fees; Netflix completely rewrote that with its digital subscription model. Even if Blockbuster wanted to change to that model, they wouldn't be able to because it would cost too much to tear down and rebuild infrastructure, and so they've effectively died.

Sure, you can say that Blockbuster was awful anyway, and hooray, the market provided for a new niche with Netflix, but this isn't digital distribution. It takes on average 7 years for a pharmaceutical to go from conception to production. Marginal cost is not effectively zero as it is with digital goods, and so physical infrastructure is needed for distribution.

As for divorcing sales from R&D, my friend pointed out that sales aren't figuring out how to make the big bucks; it's about letting doctors know that a product exists to treat certain ailments. Money has to be spent on it, and money has to come from somewhere.

You mention that they'd still need to answer to their shareholders, so I'm guessing that means you don't actually mean you want to socialize R&D fully, and that's something I've been thinking about. Could you elaborate more on that?

@Hopeless: If you look at GSK's annual finance statement for 2011, you can see that the US is actually responsible for about 40% of their world wide revenue*

. There's an interesting statement in there, too, that states that the federal government is already responsible for paying most of that, not the end consumers.

"Never let the truth get in the way of a good story." Twitter

To address a point made earlier, ch00beh, there is no causal link between amount of money spent on R&D and the resulting innovation. A lot of R&D is spent on studying a product to make sure it's safe and effective, which is where the interaction between the pharmas and the FDA comes in.

If we can demonstrate that it works better when entirely government run rather than in the hands of a business, then I'd not balk at nationalizing R&D as well. The same applies for healthcare providers.

More later when I'm not distracted by work.

edited 20th Mar '12 10:01:59 AM by Fighteer

"It's Occam's Shuriken! If the answer is elusive, never rule out ninjas!"

ch00b, I don't endorse a market based solution to R&D in the first place. Let medical schools have university staff compete over who can earn the most prestige by curing cancer instead.

http://www.cnn.com/2012/03/27/health/health-care-insurance-lifetime-caps/index.html?eref=mrss_igoogle_cnn

Here's a Goddamn good reason to keep our current reforms. Unexpected shit happens, and with it this family and others like them that find themselves in incredibly unexpected situations won't have to worry about making sure their child stays healthy. Taking it away throws millions of people under the bus.

@Choobs; if a pharma company fails under new laws then they clearly weren't worth keeping around. The ones that adjust can hire the guys that get fired; it's not like there's a glut of people going into the R&D field for medicine. I care far, far more about insurance companies playing fair and doing right by people than I do about whether or not companies continue to exist. Progress is not the sole province of any one pharma company out there right now.

A thought occurred to me while I was watching Rachel Maddow just now, and it's about the individual mandate and how it could be framed.

The way the mandate works is that if you don't have a health insurance plan, you're going to have to pay an increased amount of taxes, and this is seen as a bad/unconstitutional thing by the Republicans.

But here's the thing, it's not "forcing" you to buy insurance, as the republicans claim. To illustrate, there is a tax-exemption given to people who have land for animal grazing. That doesn't mean that the entire country is being "forced" to let cattle graze on their back/front yards. This is a precedent.

I realize there are some differences, but the argument for the constitutionality of the mandate could be framed that way.

Very big Daydream Believer. "That's not knowledge, that's a crapshoot!" -Al Murray "Welcome to QI" -Stephen Fry

If the "mandate" was instead a universal tax increase, where everyone who had insurance got a tax subsidy of the amount equal to that increase, there'd be no hope of calling it unconstitutional-but that's not the way it's organized (largely because such a thing wouldn't have been able to pass through congress).

Makes sense. I just wanted to get that thought written down, and it didn't occur to me like that.

Very big Daydream Believer. "That's not knowledge, that's a crapshoot!" -Al Murray "Welcome to QI" -Stephen Fry

Hmmm... can you condense the key points of this "Obamacare" to us? It seems intriguing how controversial this Bill seems.

The biggest, most controversial point of the Affordable Care and Patient Protection Act, is the Individual Mandate, which means that you must have private or government insurance by 2014, or your taxes will go up by a certain amount, and this is to reduce premiums and lower costs.

Other portions are protections for people with pre-existing conditions, so that they aren't crippled with debt due to having to buy everything at marked up, pay for it all yourself prices. It also extends how long you're covered under your parent's insurance plan from age 22 to age 29, since that was when most people had no insurance due to not making enough money, as well as setting up things called Exchanges, where you will hopefully be matched with the insurance plan that is right for you in your state, as insurance companies can only offer insurance to people within the state they operate in, for very specific reasons.

EDIT: it also closes a specific loophole in Medicare Part D, a prescription loophole, but I don't know much about that.

edited 27th Mar '12 2:01:24 PM by Enkufka

Very big Daydream Believer. "That's not knowledge, that's a crapshoot!" -Al Murray "Welcome to QI" -Stephen Fry

@Choobeh: actually, you proved our point for us.

Yes. Blockbuster couldnt adapt. Therefore its dying.

This is how capitalism is SUPPOSED to work.

This is why horse and buggy vendors are by and large long out of business. T His is why blacksmiths are also basically a curiosity for ren fairs now.

Id the market quite literally runs your business model out of town completely, then it is your fate to die and let someone with a betteridea take your place with a model that does work.

Exactly, creating jobs and businesses should never be the goal. Jobs are the enemy, the service is the part that matters.

Fight smart, not fair.

I wouldn't say jobs are the enemy, but creating more jobs should never be a reason for inefficency.

Laws are made to be broken. You're next, thermodynamics.

That's just semantics.

Fight smart, not fair.

If the mandate or even the whole law gets struck down

I say: GOOD!

In 10 years time when costs are unmanagable maybe pople wil be willing to accept the Universal System....

I will always cherish the chance of a new beggining.

I'm not sure it's worth it... the stitch in time is almost always the better way to go. Let's let some bridges fall down and kill people so people take the need to maintain them seriously? Let's let some terrorists destroy the World Trade Center so people start taking security seriously?

Political myopia is not something we want to be encouraging, necessarily, even if it ends up happening regardless.

edited 28th Mar '12 6:38:25 AM by Fighteer

"It's Occam's Shuriken! If the answer is elusive, never rule out ninjas!"

Harsh as it might sound...

If the midler version is "unconstitutional" then we might as well get the real deal.

And meanwhile have thousands of people die unnecesarly besides those who go banckrupt...

Either way, good job! Republican Party....

edited 28th Mar '12 8:11:47 AM by Baff

I will always cherish the chance of a new beggining.

Baff, are you seriously suggesting that Obamacare failing will mean people will think universal healthcare is the answer?

I have a feeling the mods might look upon me harshly were I to link the "Wrong wrong wrong" clip from Scrubs but the sentiment applies. There is no way on earth, in Hell, or in any form of reality whatsoever in which that scenario is realistic. The repubs want the private model extended, not reduced, and if Obama's inbetween version fails, they'll take it as justification for their POV. I.e. it failed because it was too socialist, cost too much, and other bullshit fallacies.

It's the same effect as happened in the UK last year - we had a referendum on replacing the First Past The Post voting system with Alternative Voting (AV), which is slightly better, though nowhere near as good as Proportional Representation. It crashed and burned for several reasons, one of the major ones being that a lot of PR supporters thought that if they voted No, the Government (which wanted to keep FPTP as it benefits them) might let them have a vote on getting PR (which would hurt them hugely). Needless to say, Reality Ensues and the result was seen as an endorsement of FPTP, even though the facts indicate it was only a No vote to AV, not yes to FPTP.

Sanity indicates that exactly the same thing will happen with healthcare in the US if UHC supporters oppose Obamacare.

My name is Addy. Please call me that instead of my username.

Postan this here because I don't know where else to put it:

Paul Ryan tried to use Politifact's 2011 Lie of the Year decision to defend his Medicare proposition. Naturally, he got it wrong, but here's my question: Has anyone actually tried to do this before?

You can't even write racist abuse in excrement on somebody's car without the politically correct brigade jumping down your throat!

Bachmann tried something similar, though a bit ballsier.

@Deboss: I'd argue jobs are the goal. But artifically propping up dying industries to "save jobs" inevitably destroys other jobs or makes it so some jobs never come about.

It depends. I mean, I think the auto-bailout was probably a good idea. But that's because the failings of the auto industry aren't about how "no one drives cars anymore" for instance.

One of the GOP attourney generals is suing the ACA because he actually wants Single Payer. He does use the "This is a government intrusion upon our lives" line, but he also acknowledges that a single payer health system is not necessarily run the same way that an insurance company is.

[1]

Very big Daydream Believer. "That's not knowledge, that's a crapshoot!" -Al Murray "Welcome to QI" -Stephen Fry

It is true that ACA is a bastardized halfway measure between the current system and single-payer. Ironically, it was the GOP's idea in the first place, an irony that they now vehemently deny with all the fury of people for whom no truth shall stand in the way.

"It's Occam's Shuriken! If the answer is elusive, never rule out ninjas!"