Health insurance in the United States is a shit show. The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue.
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.
Italy has a thriving market based private health care industry. You can call in and get prices and everything.
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.
All other first world nations pay less. On average they pay less than half what the US pays. The fully socialized systems, like the UK, seem to trend lower in cost, as low as one third the cost of the US. But really, the takeaway should be you need universal healthcare with significant government cost controls on drugs and procedures, after that almost any arrangement of public/private administration works (but the caveat that it looks like the more private companies are in the healthcare mix, the higher the costs seem to run).
> the more private companies are in the healthcare mix, the higher the costs seem to run
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.
It might be hard to find... unless you take a gander up north, Canadian public health care is a recent thing and the transition was flow and began with regional efforts. This[1] is a nice little rough timeline of things that happened. And, to be honest, it's not done yet, Canada lacks national pharma coverage (most places having provincial coverage of a sort) and entirely lacks dental & vision coverage, the later is a bit arguable but poor dental care has been strongly linked to heart disease.
Medicare for all plans a two year transition. There are already mechanisms to expand to set payment costs for procedures in Medicare. We would have to extend those to cover a system of setting fairer prices for drugs - as medicare is legally prohibited from negotiating drug prices currently. That's a legal precedent, not a cultural one.
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.
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
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
Of course it does. Because people don’t buy and use the drug if they don’t know about it..?
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.
Making sure doctors are well informed about treatment options are one thing... egging patients on to request a possibly mismatched medication and taking doctors out to lunch to encourage the prescription of a possibly mismatched medication is entirely different.
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.
Unless someone has a medical degree they're not an informed patient - they're someone who has been fed information through pharma PR campaigns to believe they're informed about a topic while only knowing information that would contribute to a private corporation's profit.
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.
Using that argument millions of Americans have refused to let their children be vaccinated because they know more about medicine - even themselves. If your medical decision will endanger others it is a matter for The Great Protector, and, it's my opinion, that the great American habit of second guessing experts is what has let groups that oppose vaccinations, a round earth and the dangers of CO2 infiltrate modern society at such a large level.
Considering cancer, heart disease, or dementia aren't contagious, my individual treatment decision does not threaten those surrounding me.
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".
I'll admit I have no evidence advertising to patients increases drug sales. But, considering how often I see drug commercials on television explicitly targeting patients, it seems the drug companies have evidence it works.
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%.
Food production is predictable. Finding a safe, effective treatment for Alzheimer’s is not.
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?
If you look at the paper, private drug discovery is creating drugs at a declining rate. I would suggest this is because those private efforts are much less research than development, and it's actually the public system that drives much fundamental research. And the drugs to market rate is in serious decline because of a the widespread application of increasingly austure public funding budgets for medical research causing an early pipeline bottleneck.
When you dump a link to a 60 page pdf and you’re going to reference it, please list the page number and/graph you’re referring to. I don’t want to guess.
Sorry, Fig 1, page 15 is the data on drugs discovered per billion. Table 1, pg 18 shows some sample breakdowns of drug investments broken down between basic research and commercial development.
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.
Does the "huge margins of the healthcare industry" include all the money spent on failed pharma startups? If you spend $1bn on a drug then make $1bn profit but the other 9 drugs failed (after someone having spent $1bn for each) the margin isn't 100%, it's 10%.
> Without the U.S. subsidizing the drug research R&D, who pays for it?
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.
i'm keen on the idea that such a model of a government entity (or two) in competition with an open market would provide the most favorable outcome, because a truly free and fair market (one where competition leads to efficiency and low prices) seems mythically distant at this point.
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.
> a government entity (or two) in competition with an open market
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.
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.
> Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'
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 no market based approach that can "fix" healthcare. Market self regulates around substitute goods, but healthcare is in the business of health and there's no substitute for that. Very few humans will say "all considered, the ROI/statistical likelhood of this procedure is not positive so I will pick death instead", it just doesn't happen. Single payer is the only way to go.
Even with single payer, there's a large thriving market. Vendors, suppliers, manufacturers, contractors, auditors, etc. Bandages need to be made, hospitals need to be cleaned, nurses need to be trained, etc.
You can make things and get paid in a non-market economy like the one connected to single payer healthcare. What you don't get is maximization of profits.
> but healthcare is in the business of health and there's no substitute for that
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.
All the inefficiencies are either profit or jobs for them. US health insurance companies are the worst bureaucracies I have ever seen. They have power over people's lives and almost zero accountability. They can do pretty much whatever they want and you are helpless if you can't afford the time and money to constantly call them or hire lawyers.
> The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue.
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.
> ... inability of Congress to meaningfully fix the issue.
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.
Its definitely a boon for the cause, but I would be surprised if it passed the senate.
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?
After Obama ran on hope and change and won, one thing he did was shut down his very capable campaign organization without transitioning it to something else. It was maybe one tactical reason that later midterms became a mess for Democrats.
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.
> as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up,
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.
I doubt your data. Just one counter example, in Orange County CA, Katie Porter, a democrat, won a competitive seat in a district that has been Republican for a long time (maybe 30+ years?).
From what I understand, she wasn't endorsed by Our Revolution (I'm strictly talking about the Bernie-aligned groups). She was endorsed by lots of other progressive groups that are more effective at this sort of thing.
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.
Does it matter if it's a Bernie aligned group? In CA-25, Our revolution endorsed one candidate, Justice Democrats another candidate, and a third Democratic candidate actually won yet another historically Republican district. They were helped (but not endorsed) by also progressive, but not as closely aligned to Bernie, Indivisible, by loose Bernie inspired independents, etc. I think it's a mistake to only look at strict boundaries of support by candidate name. I would consider CA-25s win with Katie Hill another progressive win in an contentious 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.
I don't mean this to be snarky, but if what you are saying is true (Congress can't do anything), why do you think the governmental disfunction will not carry over to an expanded medicare-for-all program? Medicare is not without issue and is wrought with fraud that needs decisive congressional action to help fix, yet they have shown inability there as well.
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.