I personally would prefer a market based approach to fixing the issues with obtaining medical care, but Congress can't do anything because there's just too much money and influence involved.
Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'.
As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives.
I mention Italy because 1) I lived there and 2) it's not some perfectly run place where everything works. It's not, and yet the health care is still better, overall, than in the US.
You could fill notebooks with worthy, approachable hypotheses for any number of diseases that could show promise if given the funding.
But if everyone makes it law to cap prices - fewer scientists, labs, studies are performed.
The money has to come from somewhere.
I think countries take for granted the progress we've made. No progress is made without incredible intellectual efforts and monetary backings.
https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-p...
One quote from the paper: In the last ten years, Pizer has spent US$139 billion on share buybacks and dividends compared to US$82 billion on R&D.
Edit: It shouldn't require massive profit margins to make the drug industry work for a basic human need like healthcare. Other sectors for human basics like the grocery industry, run on margins of 1-5%.
If you want thin margins, maybe government research wing can take its findings from idea to market (imagine waiting on a cure and that’s your only hope?)
But you can’t force a private company to operate on low margins by way of capping prices, you’ll kill them. You can’t taje away their ability to control their risks (cash flow). Drug R&D already has a huge failure rate and now the company can only take a 5% profit on the slight chance they’ve found something effective?
I don't necessarily subscribe to everything in that report, but I do think that modeling drug development in terms of a simple risk-reward model for the private drug industry needs further thought.
This is a silly talking point that lots of companies bounce around - you know how insulin costs money because it was so expensive to develop... Except no, it was invented in Canada and the researchers released the formula for free[1] as a "benefit to humanity" thing... then a few US companies acquired rights to produce it and proceeded to establish market control in the US - the fact that insulin isn't being sold at cost is just pure greed.
And this happens a lot, very often drugs are innovated using public funds and then sold to private companies to produce which milk the consumers for profit - this whole "it pays for R&D" is a pharmaceutical PR line, just like when McDonalds buried their hot coffee lawsuit under "well, if people weren't such klutzes". The US isn't the great innovator here to save us all and a huge proportion of your drug prices cycles back into marketing to sell more of the drug.
[1] Technically, they sold it for a dollar to the University of Toronto
Money matters. Marketing to recoup costs matters. Piles of cash to get every dollar of return on an investment matters. That allows the company to turn around and invest in future promising drugs, trials, other companies, marketing to bring awareness to the solution and hopefully get people to buy and use it.
The ideal case for drugs is that no one actually needs them so no one takes them - this is a large contributor as to why this market should be heavily nationalized.
And as an informed patient, I want to know my options. My doctor and I will discuss trade offs, he’ll sign off if he thinks it’s appropriate.
It is amazingly difficult to find good balanced information on prescriptions in the US - even doctors have issues.
Especially in the case of if/when my life is on the line, I want to know about my options. I'd much rather have information overload, than be blind.
And between my doctor and I, we will discern what is a real option, what is BS, and what tradeoffs I am willing to make in an effort to extend my life.
Stop being The Great Protector.
I want to know as much as possible about treatments, their side effects, and tradeoffs. And if I partially learn about those items from a commercial, who cares? I want more time with my friends and family. I don't care about the source of a potential solution.
And the doctor can still elect to not provide the medication. The treatment decision is expertly gated, regardless of my wishes or insistence that "I know better".
business drug R&D follows the "which drug patents can we buy and Jack the prices up for extra profit?"
I wish we could stop using this tired trope once and for all in debates about medical care.
Most medical care is routine and does not require cutting edge drugs. Things like insulin, epinephrine, anesthetics, antibiotics, antihistamines, vaccines, most of those things have been developed in the 1st half of the 20th century.
How much do the cutting age drugs account for in the scope of the total health care costs in the US? Even if it was higher than 1% (I'm willing to bet money that it isn't), the marketing budgets for drug companies far exceed their R&D spending.
https://www.economist.com/united-states/2017/08/10/the-fix-f...
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
An excellent book on the subject ("The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care"):
https://www.amazon.com/Healing-America-Global-Better-Cheaper...
And a comparison by The Commonwealth Fund:
http://international.commonwealthfund.org/
And just a reminder how long the U.S. has been having this argument:
https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_19...
And a quote from that page:
The long-term political effects of a successful... health care bill will be even worse—much worse.... It will revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.
— William Kristol, "Defeating President Clinton's Healthcare Proposal", December 1993
One worrying thing about single-payer healthcare in America is that we can look at other countries with a _rich history_ of single-payer healthcare from before the modern era [0] and see that they have developed efficient public healthcare systems, but it does not follow that our system, with its similarly rich history of for-profit entities developing methods to thrive in the weird world of American health insurance, can be immediately brought to a level of cost efficiency that is comparable. Consider, for instance, how much ownership of the healthcare space is held by private equity firms in the U.S. I'd love to see a great transition plan towards single payer, but it would need to be one that takes into account that the operators have no inherent incentive to reduce costs.
[0] http://www.euro.who.int/__data/assets/pdf_file/0020/96410/E7...
But basically, future history begins today. I don't see why because we historically have an ineffective system, we shouldn't strive to build a working system.
[1] https://www.healthcoalition.ca/tools-and-resources/history-o...
government entities can get subsumed by politics and bureaucracy, while private markets can get distorted by poor regulations and anti-competitive practices. if bureaucrats can get thrown out for not being competitive with the private companies, and private companies can go out of business for not being efficient and serving customers well, we might get decent service-oriented entities in the market.
many goods that don't fit the simple paradigm of commerce (e.g., housing) can benefit from such a model.
Health care was way less bureaucratic in Italy. Every time you go to the doctor in the US, you fill out forms. And then hand them to the person in the office who spends their days doing insurance stuff.
In Italy - you just go to the doctor.
Meaningful competition cannot exist between tax-funded and voluntarily-funded service providers. Anyone who chooses the private provider ends up paying for both. The only way to ensure a level playing field is for the "government" entity to be limited to essentially a co-op, receiving no government funding or special influence and adhering to all the same rules which apply to private providers, in which case it might as well not be a government entity in the first place. Even then there is an obvious conflict of interest since the organization that makes and enforces the rules is also backing one of the competitors.
Eek. This is also called crowding out. It means expensive but efficient health services can't survive. It might be a decent compromise but I would call it a success.
There's plenty of substitutes, and there are plenty of things that have little to no substitutes and don't have these issues (food, clothing..housing does have some of the same issues).
Healthcare is a mess because it is the most regulated market there is.
luckydata: there is no substitute to healthcare services, so whatever you need in healthcare, whoever provides service has absolute leverage to charge whatever they want.
response: there are plenty of substitute effects in healthcare as you can deny getting treatment, or choose cheaper treatments. Moreover, even if you had no substitute effect possible, there are also other examples of markets with "no substitute effects" like food or clothing, but there is no gouging. It is a characteristic of the market but on itself is does not guarantee gouging unless other conditions are met, most typically mononopolies, and most typically gov. granted ones.
Instead they've invested in lobbying to keep the status quo.
[0] https://www.merriam-webster.com/dictionary/he%20who%20pays%2...
Wouldn't expanding Medicare to all also require an act of Congress? Bernie will have the influence of the White House, which is important, but it doesn't change the fact that Congress is still the body that would need to fix this.
I've always felt like the Affordable Care Act was a bandaid almost designed to point out the breaking points in the existing system, and force something like Medicare for All, to come along and "fix" the situation permanently.
OTOH I dont even get how it could be in the table to bankrupt an entire market without compensation. Can the state really just outlaw all private insurances?
It's pretty clear the Bernie's organization, as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, will continue full bore to change congress as well as keep pressure on congress to make, well, progress.
The problem being that none of their candidates won competitive seats. Now, some like Kara Eastman came close..but candidates closer to the Obama/Hillary mold, veterans, and pro-gun control candidates in suburbs made up the bulk of the wins in the midterms.
On the other hand, people like Kendra Horn flipped deep-red Oklahoma 5th with help of Bloomberg's Independence PAC, and Sharice Davids beat Bernie-backed Brent Welder in the primary to win the general by 10 points in a swing district.
My theory is that presidents should try to make big changes only in their second term when they understand how the system works. Obama in his first term was a complete pushover with the banks after 2008 and also during the Obamacare debate. I think he would have done much better in his second term.
They'll never fix it. As long as there is a mentality that the poor are poor because they make bad life choices and thus should receive as little support as possible as a punishment, nothing will change because any change that would give everyone basic healthcare would also mean helping the poor.