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Disclaimer: I'm Canadian, and I shouldn't be wading into this debate...

You do realize though that the rest of the modern world looks at the US in this one issue the same way we looked at you when you had legalized segregation?

The rest of us can't even understand why this is a debate. How is it that someone can argue in favour of people not having the ability to access a doctor? Would you also argue that people shouldn't have access to fire-fighters unless they pay the fire-fighter's tax? Police? The protection of an Army?

Our socialized systems aren't a panacea, but the trade-offs of having someone wait for knee surgery so that another can get cancer treatment seem pretty fair to me. Sometimes, I simply don't understand the American perspective.

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What makes you believe that there's anyone in America that does not have access to a doctor?

Hospital emergency rooms are required to take and treat all comers (at least if they want to participate in the system), and the Medicaid system reimburses those expenses.

A poor, uninsured person might not be able to get a kidney transplant, but they'll get some level of basic care. And what Mr. Kamen argues is that the income generated by those expensive procedures -- not to mention a segment of the population that is willing to pay for it -- is what will lead to the breakthroughs in the future that will make (say) kidney transplants unnecessary in another generation.

What really concerns me is that I know, because I have Crohn's Disease, that I have a much higher risk of colon cancer. Even at forty years old, I'm trying to put myself into a position where I'll be able to deal with that should it happen.

But in the ultimate socialized/rationed model, I'm not allowed to buy myself additional treatment beyond the lowest common denominator. Canada recently fought (and lost, thank %deity%) to prevent citizens from getting better health insurance than the socialist plan. In England and other places you're allowed to get better care, but only if you pay for every bit of it -- you can't take the baseline and then pay for the overage. So that's definitely the direction that "progress" is moving in.

My biggest objection is that this prevents people from having their own values. I'm not to be allowed to make decisions that balance for or against my lifespan. I can only get the mix that the regulators have deemed appropriate for every person, one size fits all.

Canada recently fought

No, the province of Quebec did... Canada's system is not national, it's provincial. BC for instance allows for several areas of private care.

I'm not to be allowed to make decisions that balance for or against my lifespan.

You just gave examples in both Canada and the UK that showed that you most certainly can. You're argument is bullshit and comes from a place of ignorance - assuming that somehow the rest of the world has some sort of inferior system simply because we have single payers.

It isn't true. Every health statistic shows that the US is actually lagging behind. You're fighting each other for a dwindling and ever more expensive piece of the pie, and the solution is staring you right in the face.

You're argument is bullshit and comes from a place of ignorance

You need to learn to argue civilly. Then you might not get down-voted.

No, the province of Quebec did...

Fine, that doesn't affect my argument.

You just gave examples in both Canada and the UK that showed that you most certainly can.

No. There's a difference. The UK system says "we'll give you $X for treatment A; if you want the more-expensive ($Y) B you get 0". What I'm arguing is "we're willing to invest $X; if you want B, you'll have to kick in Y-X".

In concrete terms, suppose that my hypothetical colon cancer can be treated for $50,000 but there's also a $60,000 treatment that's better but the government doesn't cover. The UK says that I have to "take it or leave it"; they won't let me get the alternative by kicking in the extra $10,000. I'd have to pay the full $60,000. For practical purposes, that's all but a prohibition.

You're fighting each other for a dwindling and ever more expensive piece of the pie

This is wrong. The pie is enlarging; everyone has access to better healthcare than anyone could get 60-70 years ago. The increasing expense is due to the availability of additional treatments. As Mr. Kamen said, there are treatments (e.g., polio) that were in effect infinitely expensive two generations ago that are now within the reach of literally everyone. The stuff that's outrageously expensive will be available for our kids.

But not if nobody develops them. If those researching new treatments can't sell those treatments because the gov't puts a wet blanket on the industry, then the treatments will never be sought.

Another thread in this page claimed that government funding would prevent this. There's a little truth in that, but it all revolves around the politicization of disease. We can already see the effects of that: government subsidizes AIDS/HIV research at something like 10x the rate of breast cancer, normalized to the number of people suffering from each. It winds that we help those with the best lobbyists, not those with the most need. And that's certainly no better than the Adam Smith's invisible hand could do.

Fine, that doesn't affect my argument.

It does, actually. It shows that the specifics of one particular system aren't even true across the same country.

For practical purposes, that's all but a prohibition.

No, it's a feature of that particular system. You're discounting the entire idea of single payer health care because one particular version has a component that you don't agree with. You're being intentionally deceptive in your argument.

everyone has access to better healthcare than anyone could get 60-70 years ago

...including those of us in government run systems, moot point.

If those researching new treatments can't sell those treatments because the gov't puts a wet blanket on the industry, then the treatments will never be sought.

By this logic, there should be effectively no medical research occurring anywhere else in the world save the US. This isn't the case.

And that's certainly no better than the Adam Smith's invisible hand could do.

Except of course for the however many millions that can't actually access any of this medical treatment. That's the whole crux of things: For those able, the trade-offs between a government run system and the US system are trivial overall. The major downsides in the US system have no equivalent in other systems.

No, it's a feature of that particular system. You're discounting the entire idea of single payer health care because one particular version

You're misunderstanding. I'm not saying that all are bad because (at least) a few have a particular feature. I'm citing two examples to show that the "progressive" movement in healthcare shows a trend toward that bad feature. This should be a warning to us about a) the motivations of those pushing this; and b) should we really decide that "reform" is necessary, we ought to guard against this.

Except of course for the however many millions that can't actually access any of this medical treatment. That's the whole crux of things

If that's the crux of this, then you've lost the argument. The premise that you're working from is simply erroneous. It is untrue that many millions cannot access any of these treatments. In the USA, anyone can walk into the emergency room and get treated. While it's true that esoteric treatments having sky-high prices (say, heart transplant) won't be provided, all of the basic services will be provided even to those unable to pay on their own.

FWIW, my wife is the Manager of Budget and Reimbursement at a largish urban hospital. She spends a fair amount of her time coordinating with Medicaid to get the hospital reimbursed for the cost of treating charity and bad debt cases. You seem to be saying that this is all a figment of her imagination, that the hospital is actually turning away all of these people. That ain't so: even the homeless get treatment in America, with the system we have today.

Sorry, every health statistic doesn't show the US is lagging behind. Look at cancer detection and treatment and survival rates from heart attacks. I think that you can get a system that works with a single payer system - but it's tough to find one that also innovates and is sustainable - there's a good case to be made here that the US actually subsidizes the rest of the world with developments in drugs and medical technologies/techniques.

Please point me to these stats, they seem interesting but I can't locate them.

Here's a start:

On cancer: http://www.ncpa.org/pub/ba596 and http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080716...

On heart attacks: http://www.circ.ahajournals.org/cgi/content/abstract/01.CIR....

On access to medical technologies: http://content.healthaffairs.org/cgi/reprint/13/4/113.pdf

The United States is subsidizing the medical expenses of the rest of the planet.

Who do you think pays for medical research and why?

Prove this.

This is nothing more than conjecture and PR taken to laughing stock levels (outside of the US at least).

Even in the US, the largest research funder is in fact the US government, just like every other country.

This is common knowledge to anybody that works in medical research.

I don't know of a way to prove other than telling you to go to a medical research laboratory and ask some of the people that work there.

Most of them are going to chuckle a bit at your suggestion that I'm wrong.

I would also suggest looking at the Mayo Clinic and Johns Hopkins, which are the premier medical research institutions in the world. (I'm sorry, this is also common knowledge...I can't offer you any 'proof' of it other than...look).

This is common knowledge to anybody that works in medical research.

Then it should be easy to support. Let's talk fact here, common knowledge is often wrong.

For reference, the largest medical research funder in the world is actually NIH; an arm of the US government.

Then it should be easy to support. Let's talk fact here, common knowledge is often wrong.

Sure! In 2003 the United States spent about $94 Billion Dollars on medical reseearch. About 28% of this came from the National Institute of health. Yes, you are technically correct, this makes them the largest "single" contributor. (http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/...)

In 2002/2003 the UK (the largest EU contributor to health research) spent about $480 Million (400 Million Euro) on cancer research. (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=15...)

In this same period, the United States spent about $1.9 Billion. (http://www.cancer.gov/cancertopics/factsheet/NCI/research-fu...)

I understand that these sorts of things are inconvenient, and I apologize for not citing sources earlier. Like I said, this is pretty much common knowledge to anybody even remotely familiar with medical research.

In the future, I suggest using this website: http://www.google.com .. it is really great for helping you find things that support "common" knowledge.

I have to laugh at the misplaced smugness of your reply.

With your own quoted figures:

$480 million / 60 million population = $8 per person in the UK

$1.9 billion / 300 million population = $6.33 per person in the US

Nice try!

How does any of this bantering disporve my statement that the United States is doing the overwhelming majority of the medical research in the world?

The United States is responsible for 4x as much medical research as the United Kingdom is. How can you in any way misunderstand this to mean something other than "The United States does more Research than anybody else. This is common knowledge".

Are you illiterate?

No, and I think you're retreating from your argument because you can't defend it.

You asked: "Who do you think pays for medical research and why?"

It appears everyone, including the US, pays for medical research via taxation and government directed research and this dwarfs private investment on a global scale (absolute or per capita), even in the only first world nation to avoid socialized medicine (i.e. the US).

You didn't challenge this interpretation when the other poster said:

"Even in the US, the largest research funder is in fact the US government, just like every other country."

Yet, you suddenly suggest that you meant:

"The US pays for a lot of medical research because it is a populous first world country" which is true but utterly facile.

Why don't you answer your own question? Who pays and why? Maybe then we'll be able to figure what you're actually trying to say and how it relates to the topic being discussed.

Luckily, research isn't done per capita. Find a cure, it's applicable to (pretty much) everyone.

You might say that other, smaller governments spend at a comparable per-capita rate. But that doesn't change the fact that the USA is still spending much more and accomplishing more research.

So we've gone from "The US not having socialised medicine makes it a reseach powerhouse that the rest of the world has to leech off because of their backwards programs" to "The US has more citizens than other 1st world countries".

Hardly a great argument, but at least the latter actually is "common knowledge".

The original claim was "The United States is subsidizing the medical expenses of the rest of the planet."

When some evidence was provided, you stated that per capita they're only doing 1/3 more than the UK.

The thing is, that original claim that others were arguing with had nothing to do with per capita. The proposition is based on absolute numbers.

And for the larger argument about what current proposals would do to innovation in medical treatments, what we're really talking about is the total amount of research, not per capita -- the latter is a red herring.

The fear is that, if the USA clamps down on healthcare spending, then much of the research that's done in the USA won't continue. And if that's the case, then the pace of improvements in healthcare will slow, and in the long run that's a very bad thing.

That proposition is certainly open to debate. But decomposing the facts into per capita data is a red herring that does nothing to resolve the question one way or another.

The original claim was about private medicine leading to greater investment. That's why it was pointed out that the largest single investor was a US government agency.

Showing that other nations with socialised medicine have higher per capita investment is entirely germane since the point is at what level the US could be investing if it chose another approach. It's evidence that directly contradicts assumptions in this thread.

I don't know about other statistics off-hand, but there has been a debate about this off and on for months on Megan McArdle's blog - one thing that has been well established is that cancer survival rates are substantially higher in the US than any other country.

I would be interested to know if this takes in account people who die of cancer who cannot afford to see a Dr. in the US.

I live in a place with a very good public health care system. I always go private so I can choose my doctors and get the best care. I pay medical insurance for this privilege by choice.

I see your slippery slope argument of "the ultimate socialized/rationed model". But aren't you concerned that without any type of public option that no insurance company will insure you at any price given your current condition? It seems that an insurance company would lose money by insuring you. Unless they charge exorbitant prices. Ultimately, your insurance company is going to decide what care you get.

"you can't take the baseline and then pay for the overage"

If that was allowed, there'd be a fuckton of nickel-and-diming going on where it'd be very difficult to avoid being forced to pay overages.

I'm a Canadian as well - most of my friends in my town don't have access to a family doctor and are on waiting lists. And that's family doctors - try getting an appointment with a specialist.

This isn't Kamen's point though. If the US can continue to accelerate innovation, being the biggest medical innovator in the world, costs for older technologies will also fall improving access. Restrict what technology companies and healthcare firms who use these technologies can charge however, and you reduce the incentive to innovate. Improvements in technology in every other industry results in lower not higher costs. One thing he doesn't talk about as much which is a hurdle is the system of third party payers - but I think he at least discusses a more sustainable solution and the threats that the current and proposed regulations pose.

Access to a family doctor has nothing to do with the fact that our system isn't private, it has to do with a well known shortage of doctors.

To the point though: I reject the notion that there is effectively a single country conducting health research that the rest of the world is leaching off of. It's preposterous and unsupported. Further, even in the USA a vast majority of medical research is government funded!

If the US moved to a single payer system, medical research will change, not end. That's the same thing that happens whenever there is a disruption in any industry.

To suggest that we will a reduction in medical innovation because the US suddenly collectively and not individually paying for medical coverage is to spout nothing more than PR that various corporate interests would love to pay for.

Can you provide any links re: "vast majority of medical research is government funded"? As to whether or not we would see less research, markets create greater demand for that research and most of it is developed in the US. I don't believe these are controversial points.

You're right though, the medical research wouldn't go away completely but my suspicion based on the output of countries with single payer systems, and how much less they pay for such things as pharmaceuticals that result in substantial healthcare savings (which is why I think that the US does subsidize much of the world), is that this would be the case. It would definitely change, but when it comes to the issue of innovation and making that technology usable, I doubt it would be for the better.

Also with respect to the doctor and specialist shortage - it has a great deal to do with incentives within a public system. When you restrict the pay that doctors can make, they work less and fewer of them stay in Canada. This is the case for my doctor who chooses to work 4 days a week and where she caps out and for a few of the specialists I know.

Two good links on this page:

http://wiki.idebate.org/index.php/Argument:_Most_investment_...

it has a great deal to do with incentives within a public system. When you restrict the pay that doctors can make, they work less and fewer of them stay in Canada.

Yes, but this is an administrative problem. It's simple math, if you only have x doctors, and their max patient load is y, you should be able to know exactly how many doctors you will need per population.

There's something odd about some of the numbers cited: "The single biggest source of medical research funding, not just in the United States but in the entire world, is the National Institutes of Health (NIH): Last year [2006], it spent more than $28 billion on research, accounting for about one-third of the total dollars spent on medical research and development in this country (and half the money spent at universities)"

Pharmaceutical companies spent $39 billion in 2004 according to the CBO's report (which would ironically have been done by Peter Orszag): http://www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf That doesn't even include the billions spent on other medical technologies. Either way, it doesn't support your claim that "vast majority of medical research is government funded". Further, not all dollars are created equal. Private firms invest capital based on markets and demand and they have a significant incentive to do so whereas it's far easier to find frivolous government research studies.

I'm not exactly clear though how you think that the shortage of doctors are an administrative problem when the problem is that they aren't willing to pay them more for the services they perform so there's a shortage. It's not that they don't hire more, there just aren't enough willing to practice in Canada - and that's directly related to the single payer system because governments here are unwilling to spend more.

The numbers add up if you consider all the other governments, not just the US, and compare that to the $39B for pretty much every pharma company.

As to the shortage of doctors: Doctors in Canada are limited to the amount of patients they can see, not so much by what they can charge. (Although the rates for services are set, the same way they are often set by HMO's in the US.)

The whole reason this is done is to prevent doctor "factories" - doctors that spend 10 minutes with patients and provide poor diagnosis' in order to see as many people as possible.

The shortage is exactly due to the fact that they don't hire more. The number of semi-qualified medical professionals driving cabs in this country is outlandish. The doctoral societies have been not bent in their admission guidelines, and hospitals simply don't have enough space for all the people needed a Canadian residency requirement.

There are tons of people willing to practice in Canada.

re: numbers adding up - re: 39B (not including research in medical equipment and techniques) versus NIH: I'd be curious what you would find if you added it up all other governments as I think you assume erroneously here. All european governments spent 3.7B (2000, the most recent number I was able to find) in medical research. Further, the impact of the pharma industry in the US is disproportionate to other countries in output. And again, not all dollars are equal in efficacy. Again, the US is the dominant innovator in medical technologies and the way that they charge for pharmaceuticals in the US differs than what they charge to the rest of the world.

re: doctor shortages in Canada: When you maximize number of patients and maximize amount charged on a given procedure, it amounts to a pay cap. A direct result is that doctors go elsewhere. The regulatory system is also inefficient as you note in that those who are trained elsewhere encounter barriers here. Further, we don't empower nurses sufficiently instead of allowing patients to choose like in the US (Walmart / Walgreens). This says nothing about specialists who are even harder to find in Canada because incentives are even greater to move elsewhere (again a direct result of caps in the one payer system).

A related article from Macleans: http://www.thecanadianencyclopedia.com/index.cfm?PgNm=TCE... (also talks about the spending in attempt to integrate some of the foreign medical practitioners)

Take a look at the VC money invested just this week in US companies:

http://www.xconomy.com/tag/Life-Sciences/

If the huge pay-off for a blockbuster treatment is not out there all that research goes away

In the 1970's I lived in a small town in Oregon. You paid your fire protection fee and they stuck a little sign in your yard. If your house caught fire and you weren't a customer they would allegedly come and protect your neighbor's houses, but not risk anything to save yours.

You missed his whole point. Because the US has such high costs we can't afford to give it to everyone. These exorbitant costs also create incentives for innovation. No other countries produce the medical breakthroughs that the US does.

This quote sums-up his thinking: "Every drug that's made is a gift from one generation to the next because, while it may be expensive now, it goes off patent and your kids will have it essentially for free."

You could say the same thing about the US vis-a-vis the rest of the world. Every drug/treatment/device that is developed in the US is a gift to the rest of the world

I'd just like to point out that the internet was government-funded innovation. As well as the massive amounts of R&D we do in the military space. Another area in which we lead the world. To assume that government-funded equates to lack of innovation is false.

The initial invention was gov't funded, but it wasn't until (decades) later when business began investing in it that it really took off. And became much more than an academic toy.

Companies weren't interested in the internet until they could make a profit. The same way they aren't interested in treatments/medicines/cures unless they can make a profit. What if these decisions were made altruistically based on how many people you can help, regardless of the profits...

Which is why we have 15 different types of erectile dysfunction pills and no HIV vaccine.

It's also why health care should be a government problem rather than a free market problem. They can focus on the right things rather than the profitable things, no business can survive doing that.

I agree. I wouldn't mind trading the private bureaucrat who determines if I get care (and gets rewarded for containing the medical loss ratio * ) for a government bureaucrat who determines if I get care.

The point I agree with is that the very high medical expenses in the US aren't just going up in smoke. Because of those high costs people are directing private investment dollars towards creating new treatments.

* medical loss ratio - the amount of my premium that actually gets handed over for medical care - typically 75%-80% vs. 95% with Medicare.

Yes, but these companies determine what to invest in based on how much profit they presume to make. Should profit be the only motive to creating new treatments?

You have no idea, I recently got into a car accident (look at my history for the story of that). And for all of our "socialist policies" in the US that republicans owuld want you to believe, we're grossly libertarian.

Long story short: Accident happened, cop came out and wrote me a ticket based on the fact that he had to come out, and pretty much told me that. Then today I got a bill from the fire department/EMS for them having to come out. In total these bills/tickets are about 1K in cost. So you'd think there isn't a fire-fighters tax but there is....

Let's take your argument and apply it to other commodities.

"How is it that someone can argue in favor of people not having free groceries? Would you also argue that people shouldn't have access to computers unless they pay the computer tax? Entertainment? The protection of free homes?"

The problem with making everything free is that you create a system where no one wants to work, corrupt officials take more than their fair share, and scarcity becomes the norm.

He didn't say make everything free, and healthcare isn't like any other commodity. The world is not so black and white.

Why is health care so special then? Shouldn't food and water be just as free? Aren't they even more basic necessities?

Because food is predictable, available, and cheap. Healthcare is unpredictable; you don't know when you'll need it and you hope you never do, but if you do, it could completely bankrupt you and since your life could be on the line you'll do anything to get it.

Also unlike food, since we have a massive insurance industry involved to spread the risk of unpredictable and often massive expenses, we've actually created a system that incentivises people to hurt other people by denying claims. Not everyone believes the invisible hand of the market is the correct solution to every problem; I'm all for socialized healthcare.

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