.

[Rassah]

Bump your head overseas and you are checked by a doctor manually (but thoroughly) for severity and if it looks minor you are done.  If it is major then you are scanned if available.  Bump your head in the USA and more often then not you will be scanned costing nearly $1000 because if anything happens are you were not scanned it is the basis for a lawsuit.  

I'd say the problem here is more with the costs being hidden in insurance, and moreso by employer-covered insurance portion, than with lawsuits. If, instead of doctors being worried about being sued and doing whatever they can to an unwitting patient whose insurance is willing to pay for whatever, the doctor actually gave the patient a direct option to either bill them $50 for a check, or $1,000 for a scan, the patient would take their own risks into consideration, and may forgo the more expensive option on their own, in which case the doctor's liability will also be limited, since it was the patient who made that decision.

[Rassah]

Interestingly, from an economic point of view, this is an internal transfer so its harmless.  Wealth is being transferred within the US population and a huge chunk of the US deficit is a simple subsidy going to the drug and device patent holders.

If the patent system is the problem, why not reform that? 

Agree but that is not on the agenda.  The mandate vs. a single payer system are the only 2 options that are politically possible.

What about mandate, with a ban on employee provided insurance? Make everyone pay for the entire coverage directly I.e. instead of employer paying for $500 of your insurance without you even knowing, have them give you a $500 raise, and let you go out and pick something. If we go in this direction, we may even end up moving into a more free-market health coverage system, and really drive down costs, which are mostly hidden from view now.

[Spendulus]

....

What about mandate, with a ban on employee provided insurance? Make everyone pay for the entire coverage directly I.e. instead of employer paying for $500 of your insurance without you even knowing, have them give you a $500 raise, and let you go out and pick something. If we go in this direction, we may even end up moving into a more free-market health coverage system, and really drive down costs, which are mostly hidden from view now.

That's not an acceptable solution, because insufficient potential for graft and corruption exists.

....If, instead of doctors being worried about being sued and doing whatever they can to an unwitting patient whose insurance is willing to pay for whatever, the doctor actually gave the patient a direct option to either bill them $50 for a check, or $1,000 for a scan, the patient would take their own risks into consideration, and may forgo the more expensive option on their own, in which case the doctor's liability will also be limited, since it was the patient who made that decision.

I know several people who have recently done just that, walked right out instead of doing the MRI.

[Spendulus]

...snip...

Interestingly, from an economic point of view, this is an internal transfer so its harmless.  Wealth is being transferred within the US population and a huge chunk of the US deficit is a simple subsidy going to the drug and device patent holders.

First, the article is by Erza Klein, whom is simply an obama/obamacare shill.

Second, it doesn't say or imply what you say it does.  It does not prove the problem is patents, and neither does it disprove (or can it be disproven) that lawyer costs drive medical costs.  Neither does it present data that in any way supports a single payer system.  

It just shows the costs of a doctor visit, a sample procedure, and a drug - in the US versus other countries.  Arguably, you could say that the Lipitor price difference is patents.  But there is another problem there.  I buy Lipitor, both internationally and in the USA, and I do not agree with his quoted numbers.  Buying through Canada Liptor manufactured in India, the price is about 60% of the US pharmacy price.  That ratio is roughly accurate for other drugs.  The chart implies a five to one differential.

The politics of the author are immaterial if the facts he bases it on are accurate.

As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same -- the volume of procedures, the days we spend in the hospital, the number of surgeries we need -- but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.

I really don't see how you can read that and think that tort reform is the answer.  The US pays more for the drugs and the devices.  Your Lipitor example proves that.

Actually, the Lipitor example proves the reverse and disproves your assertion about price gorging of patents.  I pay about half for Lipitor by buying 'the cheap way'.  That's no different than you or I buying through Ebay to get the same thing cheaper.  We can thus assume that the differential is 'retail markup', not price gorging.  Retail markup doesn't go to the patent holder.

Having said that, I am certain that one could show certain drugs to be vastly overpriced in the US and prove that it was due to a patent holder pricing it one way in the US and differently overseas.  However, that is pricing to cater to the local market and it's supply/demand characteristics.  Yet again, all one needs for a correction is to purchase competitively from the low bidder and the markets will adjust accordingly.

Regarding Klein, you note:


The politics of the author are immaterial if the facts he bases it on are accurate.

That's only true if the author does not cherry pick facts or engage in various logical fallacies in asserting a conclusion.  Klein is not known for this sort of impartial presentation, quite the opposite.

 

Lipitor is out of patent protection and has been since mid 2012.  If it was patent protected, the differential between the US and abroad would be way higher.

The implication is that you are seeing facts that you don't like and trying to pretend they are not real.

Here are more examples: http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html

That is price gouging - plain and simple.  People have to choose between allowing their child to die and paying well over the market rate for drugs.

The thing that puzzles me is that you want to defend this price gouging.  Do you own a patent yourself that means it would cost you money if prices were controlled.  I don't get where you are coming from here.

Well, so I disproved your assertion about Lipitor and price gorging, but noted that one could find examples of price gorging.  Then you respond:

The thing that puzzles me is that you want to defend this price gouging.  

which makes no sense, does it?

What I've defended is the ability to purchase medicines in the free market both in and between countries, in order to get the best price.  And that rather destroys the foundation of your pro-socialist argument that the state must be in control of prices, doesn't it?

I suggest you look again at the concept of 'price-gorging' and ask how it could exist except with the active assistance of the state in restricting competition, then ask why, if the state created the problem, would further regulation and market restrictions be a necessary solution.

As for this...

As Halvorson explained, and academics and consultancies have repeatedly confirmed, if you leave everything else the same -- the volume of procedures, the days we spend in the hospital, the number of surgeries we need -- but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.

You realize you are quoting a newspaper reporter who is quoting from an interview he made?  These are not 'facts'.  You've been told by several persons in this thread some of the details on how medical procedures differ between the US and other countries which accounts, whether rightly or wrongly, for the price differences.  How are you not ignoring that?  I know why Klein ignores it, let's leave that aside for the moment.

[Hawker]

What all the research and your own experience shows is that there is no free market in drugs because the US has patent laws and regulations to prevent it.

http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html

Again, why are you defending this?  Americans are forced to pay more for inhalers than anyone else in the world.  Why do you think that is a good thing?

BTW, the Holvereson article includes source research.  You just have not looked.

[Spendulus]

...BTW, the Holvereson article includes source research.  You just have not looked.

Yes, I did see the footnotes, to the end of the Klein article in which he quotes Holverseson, for whom he admits he has no transcript.

What all the research and your own experience shows is that there is no free market in drugs because the US has patent laws and regulations to prevent it....

If there is no free market, then how is it that I buy things cheaply and have them promptly shipped to my door? 

http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html

Again, why are you defending this?  Americans are forced to pay more for inhalers than anyone else in the world.  Why do you think that is a good thing?

A 30 second check of my current Canadian pharmacy shows that they do stock the inhalers, and will sell and ship them to me.  Nobody is forcing Americans to pay more for inhalers as you claim.

Please stop these ridiculous claims.

[Beans]

My insurance policy will no longer be available. Next year I will be paying $300 a month to the pharmacy, $200 a month for doctor bills and $270 for insurance. That's $770 a month. No coverage for visits or prescriptions unless I hit some huge deductible.

Compare to this year, I pay $220 for insurance and $15 co-pays for visits and prescriptions. So far I've had every visit and prescription covered by my insurance, and I've gone in twice a month.

I can't believe how naive and clueless people in this country have become. We are in serious trouble here. The loss of pharmacy coverage and these high deductibles is not going to work. I'm only 30 years old, I'm not paying $770 a month for medical bills. At least not the $250 for insurance that only covers me in the event that I get some seriously problem.

Maybe if I get cancer I will sign up for obamacare. With no pre-condition rules I can just hop on the train when it suits me. At least until this country wakes up and gives me my coverage back.

[MoonShadow]

Because there is a difference between health care and health insurance.  The health insurance system in the US is broken.  However, if you do have insurance, or can otherwise pay the costs yourself, the US has the highest rate of health care access and the highest health care quality for the middle class of any nation in the world.  The proof is in the pudding, as the wealthy still come to the US to get care when things get serious; although that's probably going to change.  Can I get cheaper care for common problems in other nations?  Yes, that's provablely true.  But for cutting edge care, historically speaking, that's the US. 

Another way of saying that is that the US is the best place to be ill if you are rich.
It you aren't rich, you would be much better off being ill in Europe instead.

Okay, but I can also make the argument that every American is rich by any historical or global standard.  I'm upper middle class, by American standards; but I can still afford to pay my medical costs directly.  That's what I do, too.  I do not take a dime out of my health savings account in a normal year, and have only taken $1K out of it in the entire time that I've had it.  Because I'm saving for a time when I really need it.  I have a major medical plan that is attached to the medical savings account, with an annual deductable of $6500.  I've not yet hit this mark in a year, but then I also don't pay for expensive testing that's not likely to tell me something about my condition that I can't guess.  Eventually, my condition is going to be very expensive.  That's not your problem.  It's mine. 

If you can afford your own care, shouldn't you be expected to pay for it?  Either directly or via taxation?  But if you can't afford it, who then is responsible for your bad luck?  Other taxpayers? 

[Spendulus]

Because there is a difference between health care and health insurance.  The health insurance system in the US is broken.  However, if you do have insurance, or can otherwise pay the costs yourself, the US has the highest rate of health care access and the highest health care quality for the middle class of any nation in the world.  The proof is in the pudding, as the wealthy still come to the US to get care when things get serious; although that's probably going to change.  Can I get cheaper care for common problems in other nations?  Yes, that's provablely true.  But for cutting edge care, historically speaking, that's the US. 

Another way of saying that is that the US is the best place to be ill if you are rich.
It you aren't rich, you would be much better off being ill in Europe instead.

....I do not take a dime out of my health savings account in a normal year, and have only taken $1K out of it in the entire time that I've had it.  Because I'm saving for a time when I really need it.  I have a major medical plan that is attached to the medical savings account, with an annual deductable of $6500.  I've not yet hit this mark in a year, but then I also don't pay for expensive testing that's not likely to tell me something about my condition that I can't guess.  Eventually, my condition is going to be very expensive.  That's not your problem.  It's mine. ....

They don't want you to do this.  This is a way for you to be independent and not to be sucking up to the rulers of subjects like you.  You are doing some thinking.  You need to stop that and get with the program.  Here is what is going to happen to the HSA/MSA:

http://floppingaces.net/2012/07/08/obamacare-killing-health-savings-accounts-reader-post/

HHS has decided, despite repeated petitions to amend their rule, to simply not count any of the monies paid by HSA insured towards their deductible. HHS will only count monies paid by insurers. So, if you have a $5,000 deductible, and pay $3,000 in health expenses to meet your deductible, for the purposes of HHS’s rigged rule, none of that money counts – because you paid it, not the insurer. Given that only roughly 6% of the HSA insured population will hit their $5,000 deductible, it is just about mathematically impossible for the HSA qualified insurance to meet the MLR regulation. HHS knows this, they have been told for just about two years by HSA policyholders and advocates.

Since HHS is in full “let’s just not count it” mode, HSA qualified health plans in the individual and small group market can not comply with the combined rigged rule effect of both the MLR and AV regulations. This means the 5.4 million Americans in these two markets who now have an HSA will not be able to find HSA qualified health plans. Poof – forty percent of Americans with an HSA just won’t be able to have one.

[murraypaul]

If you can afford your own care, shouldn't you be expected to pay for it?  Either directly or via taxation?  But if you can't afford it, who then is responsible for your bad luck?  Other taxpayers?  

In the European model, yes to both.
You pay through general taxation, so the more you can afford, the more you pay.
And the entire country forms one huge insurance pool, so everybody pays for everybody else's bad luck.
(Actually it is more than just the one country, as in general membership of a socialised medical system in one European country also qualifies you for treatment in any other one.)
Healthcare is simply viewed differently here, it is the third emergency service alongside the police and fire service. We wouldn't consider making people pay for using those services, either, they are all considered part of the basic set of services provided by the state.
I realise that that is not the American view of things.
And, at least where I am, it works. I can go and see my GP whenever I need, get referred for specialist consultations as needed, get whatever tests I need, and pay a single fixed price for any prescription medicine, regardless of what it actually costs.
I realise that the largest part of the leftpondian objection is on philosophical, rather than practical grounds, you have a much smaller view of government than on this side, but on a practical level, I wouldn't want to swap what I have for what you have, especially when there is also a parallel private healthcare sector for non-urgent issues, or for if you just want nicer surroundings, a private room, and so on. And for that private heathcare cover, which my work provides, I'm taxed as though it cost me about 100 dollars a month. That is for myself and my wife, including all existing conditions. So either way, public or private, it seems better over here.

[Littleshop]

Overtesting is in the eye of the beholder.  Again, the US is the most expensive medical care industry on Earth for many reasons, but some of those are contributions to the high quality of care.  Sure, odds are good that if you get a good bump on the head, and the doctor sees no ready signs of a concussion, you'll be fine.  But what about the times those odds don't pan out?  Going with the greatest odds is cheaper overall, but if you're the guy that caught brain cancer early because the emergency room insisted on an MRI after your head injury; odds are better you would be thankful for wasteful uses of medical testing.

Outcomes are important here.  Test too many people with MRI and you get cancer caused by MRI.  I am NOT saying MRI is bad, but if you are trying to find something with a 1 in 100,000 shot and you make 2 in 100,000 more people have cancer you are NOT AHEAD even ignoring the massive cost. 

[Rassah]

Healthcare is simply viewed differently here, it is the third emergency service alongside the police and fire service.

Sorry for bit off-topic, but reading this, while reading some other stuff I'm researching, I wonder if eventually Europe will have to add a fourth emergency service that deals with grey goo or nanomachine outbreaks, and a fifth one that deals with 3D micro-printed designer viruses. Maybe even a sixths one that deals with relativity and physics related issues, such as from some dumb kid accidentally creating a black hole or some dangerous time dialation event...

[Spendulus]

If you can afford your own care, shouldn't you be expected to pay for it?  Either directly or via taxation?  But if you can't afford it, who then is responsible for your bad luck?  Other taxpayers?  

In the European model, yes to both.
You pay through general taxation, so the more you can afford, the more you pay.
And the entire country forms one huge insurance pool, so everybody pays for everybody else's bad luck.
(Actually it is more than just the one country, as in general membership of a socialised medical system in one European country also qualifies you for treatment in any other one.)
Healthcare is simply viewed differently here, it is the third emergency service alongside the police and fire service. We wouldn't consider making people pay for using those services, either, they are all considered part of the basic set of services provided by the state.
I realise that that is not the American view of things.
And, at least where I am, it works. I can go and see my GP whenever I need, get referred for specialist consultations as needed, get whatever tests I need, and pay a single fixed price for any prescription medicine, regardless of what it actually costs.
I realise that the largest part of the leftpondian objection is on philosophical, rather than practical grounds, you have a much smaller view of government than on this side, but on a practical level, I wouldn't want to swap what I have for what you have, especially when there is also a parallel private healthcare sector for non-urgent issues, or for if you just want nicer surroundings, a private room, and so on. And for that private heathcare cover, which my work provides, I'm taxed as though it cost me about 100 dollars a month. That is for myself and my wife, including all existing conditions. So either way, public or private, it seems better over here.

But under the Euro, your country cannot inflate it's currency to pay for votes it wants to buy by giving people free stuff.   So is your country going further into debt to provide these services, or does it have a balanced budget?

Because there is nothing wrong with a country choosing to spend excess wealth on medical, space, museums, or free tennis shoes for everybody.

What is wrong is creating and spending excess debt on such things.

[romerun]

The whole system is rigged. I think the problem is health care in US cost way too much. I know American want the best, so it's costly. But I know many ppl do not really need the best all the time. Most basic medical service should be affordable without health insurance. Say the water gets in my ear, I just want to visit a hospital, have a doctor to take a quick 10 minutes look for $20 which is a lot if money for 10 minute desk job.

[Hawker]

...BTW, the Holvereson article includes source research.  You just have not looked.

Yes, I did see the footnotes, to the end of the Klein article in which he quotes Holverseson, for whom he admits he has no transcript.

What all the research and your own experience shows is that there is no free market in drugs because the US has patent laws and regulations to prevent it....

If there is no free market, then how is it that I buy things cheaply and have them promptly shipped to my door?  

http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html

Again, why are you defending this?  Americans are forced to pay more for inhalers than anyone else in the world.  Why do you think that is a good thing?

A 30 second check of my current Canadian pharmacy shows that they do stock the inhalers, and will sell and ship them to me.  Nobody is forcing Americans to pay more for inhalers as you claim.

Please stop these ridiculous claims.

Really?

http://www.nytimes.com/2013/10/23/health/as-drug-costs-rise-bending-the-law-is-one-remedy.html?ref=us

So why is this woman having her Vagifen that she paid for impounded?

http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194904.htm Is the FDA making a ridiculous claim here?

These facts show there is no "free market" in drugs in the US which needs to be defended.  In fact, you are the first person I have ever heard asserting there was one.  Not only are you delusional - you have no idea of what a "free market" looks like.

[Hawker]

Because there is a difference between health care and health insurance.  The health insurance system in the US is broken.  However, if you do have insurance, or can otherwise pay the costs yourself, the US has the highest rate of health care access and the highest health care quality for the middle class of any nation in the world.  The proof is in the pudding, as the wealthy still come to the US to get care when things get serious; although that's probably going to change.  Can I get cheaper care for common problems in other nations?  Yes, that's provablely true.  But for cutting edge care, historically speaking, that's the US. 

Another way of saying that is that the US is the best place to be ill if you are rich.
It you aren't rich, you would be much better off being ill in Europe instead.

Okay, but I can also make the argument that every American is rich by any historical or global standard.  I'm upper middle class, by American standards; but I can still afford to pay my medical costs directly.  That's what I do, too.  I do not take a dime out of my health savings account in a normal year, and have only taken $1K out of it in the entire time that I've had it.  Because I'm saving for a time when I really need it.  I have a major medical plan that is attached to the medical savings account, with an annual deductable of $6500.  I've not yet hit this mark in a year, but then I also don't pay for expensive testing that's not likely to tell me something about my condition that I can't guess.  Eventually, my condition is going to be very expensive.  That's not your problem.  It's mine. 

If you can afford your own care, shouldn't you be expected to pay for it?  Either directly or via taxation?  But if you can't afford it, who then is responsible for your bad luck?  Other taxpayers? 

If I understand correctly, Americans who try to buy their medicines with their own money get charged more than those who pay for the drugs through an insurance policy who in turn are charged more than those whose drugs are paid for by medicare. And the differences are sometimes over 1000% - price gouging rather than marketing differences.

If the prices you pay for your drugs are negotiated for all taxpayers and roughly the same for all, whats wrong with that?

[Mike Christ]

If I understand correctly, Americans who try to buy their medicines with their own money get charged more than those who pay for the drugs through an insurance policy who in turn are charged more than those whose drugs are paid for by medicare. And the differences are sometimes over 1000% - price gouging rather than marketing differences.

If the prices you pay for your drugs are negotiated for all taxpayers and roughly the same for all, whats wrong with that?

It doesn't acknowledge the underlying problem of why medicine needs a price fix to ensure it's fair; it sounds as though there are protections for the developers of medicine to keep the methods on creating such medicine secret to prevent others from profiting, which sounds inherent in the systems of copyright and patenting.

Instead of controlling the problem through the very methods that created the problem, we should instead move to unravel the problem at its core so we can find a real solution.

[spooderman]

Will ruin the healthcare system in the US.

I am in the crappy UK and the NHS system is seriously messed up here.

It is true : you get what you pay for ! Crap doctors, huge waiting lists, can't do a blood test unless it is "needed" etc.

Healthcare managed by government = total POS; the government ruins everything mate !

I feel sorry for you in the US now you are forced to pay into the public healthcare scam ...

If you really think the NHS is crappy, go private!  Its cheaper to go private here than it is in the US.

You really don't understand ...

NHS is state monopoly on healthcare.

State monopoly on ANYTHING is crappy, including healthcare or money creation.

If NHS did not exist then private healthcare + free market would be much better, cheaper, more effective than crappy taxpayer NHS forced system that is pure FAIL for patients.

Because NHS exists then private can't compete and has to demand 500 GBP for a blood test just to stay in business.

It's not a monopoly. Private healthcare also exists in the UK, in fact most of the NHS is getting contracted out to private firms one by one.

[murraypaul]

You really don't understand ...

Wow, that is a real pot calling the kettle black.

NHS is state monopoly on healthcare.

You don't understand what the word monopoly means.
There are private healthcare providers in the UK. The NHS can therefore not have a monopoly.

State monopoly on ANYTHING is crappy, including healthcare or money creation.

I see, so I should ignore my own actual experiences with the NHS, and instead just accept your blindly parroted philosophical objections?

If NHS did not exist then private healthcare + free market would be much better, cheaper, more effective than crappy taxpayer NHS forced system that is pure FAIL for patients.

Yes, because we can see that has worked so well in the US, can't we?
The US free market approach results in a far higher proportion of GDP spent on healthcare than the socialised systems in Europe.

[Lethn]

If I understand correctly, Americans who try to buy their medicines with their own money get charged more than those who pay for the drugs through an insurance policy who in turn are charged more than those whose drugs are paid for by medicare. And the differences are sometimes over 1000% - price gouging rather than marketing differences.

If the prices you pay for your drugs are negotiated for all taxpayers and roughly the same for all, whats wrong with that?

It doesn't acknowledge the underlying problem of why medicine needs a price fix to ensure it's fair; it sounds as though there are protections for the developers of medicine to keep the methods on creating such medicine secret to prevent others from profiting, which sounds inherent in the systems of copyright and patenting.

Instead of controlling the problem through the very methods that created the problem, we should instead move to unravel the problem at its core so we can find a real solution.

It's very easy to provide free or cheap healthcare and it's something a government doesn't even need to be involved with, stop being assholes, one thing I've noticed with this whole healthcare problem is there are a bunch of selfish scumbags out there who would rather bankrupt entire countries and cling onto their monopoly selling pills and insurance to a select few for ridiculous amounts than give in to the fact that people aren't going to go along with it forever. This is a problem that is to do with humanity, not ideologies or anything else, we have a very similar problem within the UK where there are a few out there lobbying constantly against the government to force everyone to buy car insurance at ridiculous prices and they all do the usual arguments of how it would mean everyone would go around uninsured and no one would be able to afford repairs etc. it's all lies.