.

[Hawker]

...snip...

Most of those references I've looked at them in the past and been quite dubious about their methodology and interpretations.  I basically do not believe assertions by governments or operations such as the IMF, WHO, or any other operation which exists to push it's agendas.  PBS is always pushing political agendas.

...snip...

Well its a basic problem if _all_ organisations that come up when you search on Google say the US spends twice as much as the UK on healthcare for inferior results and your response is "I've looked at them in the past and been quite dubious about their methodology and interpretations."  Really if you are dubious about facts, how can you possibly have an opinion on policy?  Or is your political view independent of al contact with facts?

It's not a basic problem if I distrust governments and their  numbers.  It's a basic SOLUTION.

And your method is open to question - you are actually saying "I read it on the Internet so it must be true."

Really?

With the greatest respect, if you have decided that all the facts available on the subject are bogus, then I can't see how your policy ideas have value.  

I didn't say that all facts were bogus.  I just pointed out the rather obvious problem that a google search can present seriously flawed results.  Your use of google is illustrative of that.   Suppose you were interested in the functioning of milk secretion in the female breast.  Try googling 'breast'.

Good luck with that one!

The problem is that US healthcare costs have been analysed.  The drivers are well understood.  Your response is "Those facts are on Google - I refuse to accept them."  

Can you see why that might seem an odd basis for arguing your position?  I can't debate a policy with you because, sadly, I do rely on facts.

[1715041825]

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[1715041825]

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[1715041825]

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[scarsbergholden]

so i haven't really looked into this. i am a contractor and dont have insurance currently. if i continue this way, does that mean i will be fined some amount? if so, how much will i be fined?

 

[Littleshop]

so i haven't really looked into this. i am a contractor and dont have insurance currently. if i continue this way, does that mean i will be fined some amount? if so, how much will i be fined?

 

If you don’t qualify for an exemption to the Affordable Care Act’s mandate to purchase qualifying health coverage, then you will be subject to a tax penalty.

In 2014, the penalty will be the greater of 1.0% of taxable income or $95 per adult and $47.50 per child (up to $285 per family).
In 2015, the penalty will be the greater of 2.0% of taxable income or $325 per adult and $162.50 per child (up to $975 per family).
In 2016, the penalty will be at the greater of 2.5% of taxable income or $695 per adult and $347.50 per child (up to $$2,085 per family).

from:
https://www.ehealthinsurance.com/affordable-care-act/faqs/how-much-are-the-tax-penalties-for-not-having-health-insurance-and-when-do-they-apply

[Sword Smith]

I am surprised to not see any discussion here about US health care mandate (Obamacare). I am guessing it is because there is a pretty large international user base here. I usually lurk but I guess I have to make my own thread this time.

Why is it the best thing since sliced bread?
Why will it cause the world to end?

So lets discuss in hopefully less extreme manner than the two above questions.

I am against the individual mandate but you can't pay for it without the individual mandate. Since you can't have the good without the bad in this case, I would rather not have it at all.

The reason that it is not being discussed is probably that if you have come to the conclusion that government should stay out of money creation and banking then you also think that government should stay out of most other things.

[MoonShadow]

Sorry to hear about your condition.

I didn't tell that story looking for pity.  I told that story to highlight the point that everyone has their own issues, whether they are presently aware of them or not.  I am aware, and in some ways that's a huge advantage that my grandmother (and more) did not have.  I can either hope that medicine solves the mystery, or I can arrange my life to better fit my most likely future.  Like all things, I hope for the best but plan for the worst.  My assets are almost all set up to benefit my wife and children should I suddenly drop, which can happen.  I'm presently three years older than my grandmother was when she passed away, but 20 years younger than my father.

What you are proposing is essentially a market based system which is great for controlling costs if done properly.  It works well in many European countries with Belgium and Switzerland often offered as examples of well run systems.

A market based health care system would be great for controlling value of service, not necessarily overall costs.  In fact, I'd doubt it would work that way at all.  The medical industry is far from the only one that the US is, by a wide margin, the most expensive in the world.

However, I don't see how that can work if you grant patents to the drug makers and the medical device manufacturers and give them freedom to charge whatever they want.    

The obvious answer there is to reform the medical patent schedule.  I don't believe that a government created monopoly shourd exist at all, but that is the world we live in.

[MoonShadow]

The problem is that US healthcare costs have been analysed.  The drivers are well understood.  Your response is "Those facts are on Google - I refuse to accept them."  

Can you see why that might seem an odd basis for arguing your position?  I can't debate a policy with you because, sadly, I do rely on facts.

Could you post some of these facts you refer to?  Please show your sources.

[Spendulus]

The problem is that US healthcare costs have been analysed.  The drivers are well understood.  Your response is "Those facts are on Google - I refuse to accept them."  

Can you see why that might seem an odd basis for arguing your position?  I can't debate a policy with you because, sadly, I do rely on facts.

Could you post some of these facts you refer to?  Please show your sources.

To be fair, he did provide a series of links, and as it happens I was familiar with, had read or had debated the first half dozen or so of his links. 

Also to be fair, my response was along the lines of "don't please say that you read it on the internet so it must be true."

[Littleshop]

The obvious answer there is to reform the medical patent schedule.  I don't believe that a government created monopoly shourd exist at all, but that is the world we live in.

Sure that would help and I am all for it, but that is NOT a primary driver of cost.

You could lop off a big amount of cost in the US system by simply not allowing lawsuits against doctors.  Make it so they do not need to buy malpractice insurance.  While the cost of this insurance is only about 2% of the cost of health care, the extra tests doctors do in the name of avoiding lawsuits are much greater.   Overtesting is a major driver of medical costs. 

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. 

[MoonShadow]

The problem is that US healthcare costs have been analysed.  The drivers are well understood.  Your response is "Those facts are on Google - I refuse to accept them."  

Can you see why that might seem an odd basis for arguing your position?  I can't debate a policy with you because, sadly, I do rely on facts.

Could you post some of these facts you refer to?  Please show your sources.

To be fair, he did provide a series of links, and as it happens I was familiar with, had read or had debated the first half dozen or so of his links. 

Also to be fair, my response was along the lines of "don't please say that you read it on the internet so it must be true."

While that is fair of you to say, links to articles are not facts.  They aren't even sources.  I want to know what assertions are being claimed as facts here, and what conclusions he draws from said facts.  I'm predisposed to disbelief whenever someone attempts to use the Internet as support for an argument, and it doesn't even matter if I agreed or not.  The biases, reputation and trustworthiness of sources really do matter; particularly since almost no one who reads such articles can replicate the research methodology in order to check their work.  Most of us have to be able to trust that we're not just being lied to by educated bullshitters. 

[MoonShadow]

The obvious answer there is to reform the medical patent schedule.  I don't believe that a government created monopoly shourd exist at all, but that is the world we live in.

Sure that would help and I am all for it, but that is NOT a primary driver of cost.

Perhaps not. I'm not in a position to make this argument.  Regardless, medical patents really shouldn't exist; and then this issue wouldn't exist either.

You could lop off a big amount of cost in the US system by simply not allowing lawsuits against doctors.  Make it so they do not need to buy malpractice insurance.  While the cost of this insurance is only about 2% of the cost of health care, the extra tests doctors do in the name of avoiding lawsuits are much greater.   Overtesting is a major driver of medical costs. 

Prohibition of lawasuits creates other perverse incentives.  We have a real world example in the case of vaccines for children.  Did you know that you can't sue the manufactuer of your child's vaccine, even if it provablely caused harm, if it's listed on any state or federal vaccine schedule?  You can, however, beg permission to sue the federal government as it has legally assumed all liability for childhood vaccines; but you have to beg such permission from a federal court, and even if you win you're taking funds from taxpayers, not the vaccine manufacter that screwed up your kid.  Artificial limitations on civil liabilites creates it's own issues, is a violation of both the non-aggression principle and 1000 years of common law, and is begging to be taken advantage of by souless corporations.

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. 

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.

[Hawker]

The problem is that US healthcare costs have been analysed.  The drivers are well understood.  Your response is "Those facts are on Google - I refuse to accept them."  

Can you see why that might seem an odd basis for arguing your position?  I can't debate a policy with you because, sadly, I do rely on facts.

Could you post some of these facts you refer to?  Please show your sources.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/

Price comparisons.  

http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html

A specific example of price gouging by patent maker.  

There is a paper out there showing the profit margins in US healthcare.  Its not the professionals, hospitals, lawyers, insurance companies - its the patent holders.  If you ever decide that the system needs its costs brought under control, you are going to have to address that and a single payer system is one way to do it.

EDIT: here it is http://voices.washingtonpost.com/ezra-klein/2009/11/an_insurance_industry_ceo_expl.html

"... 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. "

so all the stuff about lawyers and tort reform should be seen as what it is - a distraction.

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.

[hawkeye]

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? 

[Hawker]

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.

[Spendulus]

The problem is that US healthcare costs have been analysed.  The drivers are well understood.  Your response is "Those facts are on Google - I refuse to accept them."  

Can you see why that might seem an odd basis for arguing your position?  I can't debate a policy with you because, sadly, I do rely on facts.

Could you post some of these facts you refer to?  Please show your sources.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/

Price comparisons.  

http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html

A specific example of price gouging by patent maker.  

There is a paper out there showing the profit margins in US healthcare.  Its not the professionals, hospitals, lawyers, insurance companies - its the patent holders.  If you ever decide that the system needs its costs brought under control, you are going to have to address that and a single payer system is one way to do it.

EDIT: here it is http://voices.washingtonpost.com/ezra-klein/2009/11/an_insurance_industry_ceo_expl.html

"... 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. "

so all the stuff about lawyers and tort reform should be seen as what it is - a distraction.

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.

[hawkeye]

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.

Seems like a clumsy approach to me.  When you only have a hammer everything looks like a nail.  Or I should say everything is made to like a nail even if it's not so it can be hit with the hammer.  Real world results usually don't work too well with this approach though.

[Spendulus]

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.

Seems like a clumsy approach to me.  When you only have a hammer everything looks like a nail.  Or I should say everything is made to like a nail even if it's not so it can be hit with the hammer.  Real world results usually don't work too well with this approach though.

'single payer' is NOT politically possible.

[Hawker]

...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.

[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.

[Hawker]

...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.

I'm sort of sad that you avoid 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.

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.

[murraypaul]

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.