8 ms·

The Problem with Tying Health Care to Trade

51 points by mrjaeger 11y ago

AdeptusAquinas 11y ago
Big fear in NZ, however unfounded, is that TPPA will somehow try and reduce us to the health care standard in the US :(
- pasbesoin 11y ago
  Hmm, a new spin on "race to the bottom." (Spoken as one who is watching the quality health insurance plans disappear from the Affordable Care Act (Obamacare) for the coming year.)
  - marincounty 11y ago
    I'll take your word that Afordable Care Act is eroding "quality health insurance plans". I have seen the rates, and they all seem outrageously expensive. What I have seen is Insurance companies just finding loopholes, and doing what "for profit" insurance companies do; make money. I don't know how the Affordable Care Act is making things worse. The insurance companies were greedy, selfish bastards before the act? I don't think health care would have magically gotten better with time? As to Obamacare. No it's not what he originally wanted. Politically, he needed to amend his original bill. At the time the Rebublicans pressure was palatable. He knew it was this, or nothing. An election was comming up, and he knew he wouldn't be able to get anything through next congress. I'm not a fan of Obamacare, but we were cornered. It was this, or nothing. I do believe we need to document our complaints about individual Insurance companies, but that will probally never happen. Why--because it's one of those subjects we don't like to think about. I don't have an answer to the problem of horrid insurance companies, and medical institutions/individuals that overcharge us. I would be the first one pulling the cord on Obamacare if someone could get a better alternative through congress. I don't see that day comming soon. (To the Doctors/Institutions that don't abuse their power; you have my highest regard. To the ones that accept a medi-cal patient every blue moon; you have my highest regard. To the ones who are just in it for the money, or blame everything on the Insurance companies; some of us see right through the lie.)
    - anonymous854 11y ago
      According to this article, if you look at the prices insurance companies are actually paying (after negotiations), they're still way higher than in other countries: http://www.washingtonpost.com/news/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/ http://www.washingtonpost.com/news/wonkblog/wp/2013/03/26/21... This suggests that the providers of medical care are actually the biggest culprits for our out of control healthcare spending and lack of access to affordable care, not the insurance companies, yet your post only passingly blames the former.
      - ddingus 11y ago
        It's both. Private insurers need to make a profit for distributing risk, and due to there being a lot of them, those risk distributions are much smaller than they could be. Adding a public, non profit "cost + x percent" type plan, say Medicare part E for everyone, would very significantly improve this, particularly if it were allowed to bargain for bulk pricing. (that we don't allow Medicare to do this is just nuts!) Private entities also need to make a profit, and there is no meaningful check on this at present. A similar, public non-profit type delivery entity would reduce prices on most common treatments and maintenance activities. Those wanting to profit on primary care could add value, such as home service, etc... and do it that way, rather than mark up common, mass delivered treatments. Secondly, niche specialization could remain high profit, high value add and more people would be able to afford those services. Doing something like this would carve a big hole into much of the profit inherent in the US system, which would bring our national costs closer to those found in the rest of the world, while leaving high profit, high value on the table. Some of us would not be able to afford those high value offerings, but would definitely benefit from much improved access to preventative and or more common, well proven health care. This is all a compromise. The US could make much better choices and improve both access and outcomes.
  - cryoshon 11y ago
    Yeah, look up the whole "high deductible plan" fiasco which is being expanded to mainstream right now. More expensive recurring costs per plan, then larger out of pocket cost for the consumer after they visit the doctor, which they are economically discouraged to do. Then, when they absolutely have to go to the doctor, they are bankrupted. I thought the ACA was supposed to help us away from this shitty system? Seems to have made it much worse... we should have pushed harder for universal healthcare.
- girvo 11y ago
  Yeah. I don't know how likely it is, but I can't pretend it hasn't crossed my mind; with introducing provisions that make "sense" (in a cruel sort of way) in the US market to other countries that have proper nationalised health care, one would expect those provisions to move the needle at least somewhat towards the "health as a commodity" side...
- pjc50 11y ago
  And in the UK; it's a risk to free, universal health coverage, or will somehow result in mandatory contracting out of services for an increase in cost and reduction in accountability. The NHS isn't perfect, but the US system is a nightmare that must be defended against.
  - ionised 11y ago
    I'm pretty sure a fully privatised, insurance-based healthcare system is exactly what the Tories want. The assault on NHS funding at all levels is clearly an attempt to gradually have it sold off. I'm always deeply depressed and even angry at how many people genuinely believe the free market will solve all of our problems.
    - deleted 11y ago
      [deleted]
    - jedrek 11y ago
      One thing I found funny was that when Obama was pushing through the Affordable Care Act in the US, the GOP was scaring their voters with visions of nationalized hospitals. Around the same time, here in Poland, the right-wing-ish PiS party was scaring its voters with visions of privatized health care.
    - PlzSnow 11y ago
      Don't be depressed and angry. The NHS isn't going to be sold off. No-one thinks that, outside a few extremists on the fringes of the political spectrum.
      - pjc50 11y ago
        'Extremists' like the BMJ? http://www.bmj.com/content/342/bmj.d2996.full http://www.bmj.com/content/342/bmj.d2996.full
        anonymous854 11y ago
        I hope the irony of such an article being published in a pay-walled journal wasn't lost on its authors.
athenot 11y ago
The word "patent" always sounds better than "guaranteed monopoly", yet there is no fundamental difference. With respect to drug patents, I think the French system has a good system: - Option 1: you sell the drug at whatever market price you want but no patent will be granted and anyone is free to copy the drug. - Option 2: you receive a patent protection for you drug but you must defend the price at which you want to sell in a bargaining round with the government. In essence, it's a compromise where you as a drug manufacturer can recoup your costs, and where the people don't overly get taken advantage of in life-or-death situations. Disclaimer: my Dad worked in a major French pharma company.
- pkaye 11y ago
  Which option do the drug manufacturers typically take? The second option would require a government that actually cares more about society in general vs special interests. How has it worked out in practice?
  - ddingus 11y ago
    Seconded. I am very interested in learning more about this question.
    - refurb 11y ago
      I'm in the biotech business and I've never heard of the first option in France at all. That said, individual countries regulations can be quite complex, so it might be true. As for the second option, France, Germany and the UK all have a system where an independent body evaluates a drug in order to determine it's value. They do this by comparing the new drug against what's currently available and provide a rating. In France it's an ASMR rating, but I think that's changing. Once the drug receives a rating (Important, moderate, mild and insufficient improvement over current agents, ASMR I-IV), the company and gov't enter negotiations over the price.[1] [1] http://www.has-sante.fr/portail/upload/docs/application/pdf/2014-03/pricing_reimbursement_of_drugs_and_hta_policies_in_france.pdf http://www.has-sante.fr/portail/upload/docs/application/pdf/...
ThomPete 11y ago
The fundamental truth about health care is that no amount of taxation or insurance can live up to the demand. Even if you taxed every citizen a 100% there still wouldn't be enough to pay for healthcare. And so every society find themselves in one of the most complex paradoxes of modern times. If you tax your way to healthcare and provide everyone with free healthcare like in ex. Denmark, then access to treatment is equal but it's always a cost center and your will always mostly lag behind access to the latest treatments. The only way to be able to pay for new equipment or new medicine is either through higher taxes or by budget cuts somewhere else. If you go the insurance way of the US and try to let market forces rule then you end up with highly inflated prices and a younger generation that don't insure themselves and therefore don't pay for the healthcare system until they need it which drives up the prices of the insurance (hence Affordable Care Act). Here the access isn't equal but you have some of the best specialists in the world and always the latest treatments. Then there are countries in the middle trying to find a balance like Switzerland, Germany, the UK and France but even here I fear that no one have found a perfect system either. So no matter how you try and pay for it whether trough trade agreements or NGO etcs that problem still applies. Someone always have to pick up the bill and the bill is potentially infinitely big. Edit: For clarification
- laotzu 11y ago
  So if the problem is too much demand, lets look at how to lower the demand? The answer to lowering demand is clearly to encourage preventative medicine over reaction medicine. Most of the cash cows in the US for sickness profiteering are preventable, heart disease being number one. I know that's not profitable for sickness profiteers but until we start to value health and well-being over institutionalized greed well never have enough money to take care of our health. >He sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived. -DL
  - orangecat 11y ago
    The answer to lowering demand is clearly to encourage preventative medicine over reaction medicine. Not really: http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129 http://www.reuters.com/article/2013/01/29/us-preventive-econ...
anonymous854 11y ago
Tying healthcare to trade would be wonderful for the US, provided the trade were free trade, because it would mean we could finally legally import dirt cheap drugs and medical supplies from abroad and allow cheaper foreign doctors and nurses to practice medicine in the US. Instead, it apparently means stuff like this: >He detailed the many ways in which U.S. law prohibits competition for pharmaceuticals that Peruvian law doesn’t, including granting new patents to old drugs for relatively small changes
evanpw 11y ago
> In recent decades, the majority of new drugs brought to market have been of little real therapeutic benefit. If drug companies are trying to charge ridiculous high prices for drugs with "little therapeutic benefit", wouldn't it be easier just to not buy those drugs than to re-work the patent system?
- zeveb 11y ago
  > If drug companies are trying to charge ridiculous high prices for drugs with "little therapeutic benefit", wouldn't it be easier just to not buy those drugs than to re-work the patent system? But that would involve physicians making recommendations in the best interests of their patients, and patients making decisions for themselves, and we certainly can't have that! I recall a surgeon friend of mine complaining about the decisions made by the physician overseeing his child's care, and how hard it was to stand by and see the wrong thing done. He's internalised the model of 'doctor knows best' so much that even where his child was concerned he couldn't overcome that conditioning! This has analogies, I think, to the ideas of software users who don't develop or people who rely on the police to protect them.

51 points by mrjaeger 11y ago

AdeptusAquinas 11y ago

Big fear in NZ, however unfounded, is that TPPA will somehow try and reduce us to the health care standard in the US :(

pasbesoin 11y ago
Hmm, a new spin on "race to the bottom." (Spoken as one who is watching the quality health insurance plans disappear from the Affordable Care Act (Obamacare) for the coming year.)
- marincounty 11y ago
  I'll take your word that Afordable Care Act is eroding "quality health insurance plans". I have seen the rates, and they all seem outrageously expensive. What I have seen is Insurance companies just finding loopholes, and doing what "for profit" insurance companies do; make money. I don't know how the Affordable Care Act is making things worse. The insurance companies were greedy, selfish bastards before the act? I don't think health care would have magically gotten better with time? As to Obamacare. No it's not what he originally wanted. Politically, he needed to amend his original bill. At the time the Rebublicans pressure was palatable. He knew it was this, or nothing. An election was comming up, and he knew he wouldn't be able to get anything through next congress. I'm not a fan of Obamacare, but we were cornered. It was this, or nothing. I do believe we need to document our complaints about individual Insurance companies, but that will probally never happen. Why--because it's one of those subjects we don't like to think about. I don't have an answer to the problem of horrid insurance companies, and medical institutions/individuals that overcharge us. I would be the first one pulling the cord on Obamacare if someone could get a better alternative through congress. I don't see that day comming soon. (To the Doctors/Institutions that don't abuse their power; you have my highest regard. To the ones that accept a medi-cal patient every blue moon; you have my highest regard. To the ones who are just in it for the money, or blame everything on the Insurance companies; some of us see right through the lie.)
  - anonymous854 11y ago
    According to this article, if you look at the prices insurance companies are actually paying (after negotiations), they're still way higher than in other countries: http://www.washingtonpost.com/news/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/ http://www.washingtonpost.com/news/wonkblog/wp/2013/03/26/21... This suggests that the providers of medical care are actually the biggest culprits for our out of control healthcare spending and lack of access to affordable care, not the insurance companies, yet your post only passingly blames the former.
    - ddingus 11y ago
      It's both. Private insurers need to make a profit for distributing risk, and due to there being a lot of them, those risk distributions are much smaller than they could be. Adding a public, non profit "cost + x percent" type plan, say Medicare part E for everyone, would very significantly improve this, particularly if it were allowed to bargain for bulk pricing. (that we don't allow Medicare to do this is just nuts!) Private entities also need to make a profit, and there is no meaningful check on this at present. A similar, public non-profit type delivery entity would reduce prices on most common treatments and maintenance activities. Those wanting to profit on primary care could add value, such as home service, etc... and do it that way, rather than mark up common, mass delivered treatments. Secondly, niche specialization could remain high profit, high value add and more people would be able to afford those services. Doing something like this would carve a big hole into much of the profit inherent in the US system, which would bring our national costs closer to those found in the rest of the world, while leaving high profit, high value on the table. Some of us would not be able to afford those high value offerings, but would definitely benefit from much improved access to preventative and or more common, well proven health care. This is all a compromise. The US could make much better choices and improve both access and outcomes.
- cryoshon 11y ago
  Yeah, look up the whole "high deductible plan" fiasco which is being expanded to mainstream right now. More expensive recurring costs per plan, then larger out of pocket cost for the consumer after they visit the doctor, which they are economically discouraged to do. Then, when they absolutely have to go to the doctor, they are bankrupted. I thought the ACA was supposed to help us away from this shitty system? Seems to have made it much worse... we should have pushed harder for universal healthcare.
girvo 11y ago
Yeah. I don't know how likely it is, but I can't pretend it hasn't crossed my mind; with introducing provisions that make "sense" (in a cruel sort of way) in the US market to other countries that have proper nationalised health care, one would expect those provisions to move the needle at least somewhat towards the "health as a commodity" side...
pjc50 11y ago
And in the UK; it's a risk to free, universal health coverage, or will somehow result in mandatory contracting out of services for an increase in cost and reduction in accountability. The NHS isn't perfect, but the US system is a nightmare that must be defended against.
- ionised 11y ago
  I'm pretty sure a fully privatised, insurance-based healthcare system is exactly what the Tories want. The assault on NHS funding at all levels is clearly an attempt to gradually have it sold off. I'm always deeply depressed and even angry at how many people genuinely believe the free market will solve all of our problems.
  - deleted 11y ago
    [deleted]
  - jedrek 11y ago
    One thing I found funny was that when Obama was pushing through the Affordable Care Act in the US, the GOP was scaring their voters with visions of nationalized hospitals. Around the same time, here in Poland, the right-wing-ish PiS party was scaring its voters with visions of privatized health care.
  - PlzSnow 11y ago
    Don't be depressed and angry. The NHS isn't going to be sold off. No-one thinks that, outside a few extremists on the fringes of the political spectrum.
    - pjc50 11y ago
      'Extremists' like the BMJ? http://www.bmj.com/content/342/bmj.d2996.full http://www.bmj.com/content/342/bmj.d2996.full
      - anonymous854 11y ago
        I hope the irony of such an article being published in a pay-walled journal wasn't lost on its authors.

athenot 11y ago

The word "patent" always sounds better than "guaranteed monopoly", yet there is no fundamental difference. With respect to drug patents, I think the French system has a good system: - Option 1: you sell the drug at whatever market price you want but no patent will be granted and anyone is free to copy the drug. - Option 2: you receive a patent protection for you drug but you must defend the price at which you want to sell in a bargaining round with the government. In essence, it's a compromise where you as a drug manufacturer can recoup your costs, and where the people don't overly get taken advantage of in life-or-death situations. Disclaimer: my Dad worked in a major French pharma company.

pkaye 11y ago
Which option do the drug manufacturers typically take? The second option would require a government that actually cares more about society in general vs special interests. How has it worked out in practice?
- ddingus 11y ago
  Seconded. I am very interested in learning more about this question.
  - refurb 11y ago
    I'm in the biotech business and I've never heard of the first option in France at all. That said, individual countries regulations can be quite complex, so it might be true. As for the second option, France, Germany and the UK all have a system where an independent body evaluates a drug in order to determine it's value. They do this by comparing the new drug against what's currently available and provide a rating. In France it's an ASMR rating, but I think that's changing. Once the drug receives a rating (Important, moderate, mild and insufficient improvement over current agents, ASMR I-IV), the company and gov't enter negotiations over the price.[1] [1] http://www.has-sante.fr/portail/upload/docs/application/pdf/2014-03/pricing_reimbursement_of_drugs_and_hta_policies_in_france.pdf http://www.has-sante.fr/portail/upload/docs/application/pdf/...

ThomPete 11y ago

The fundamental truth about health care is that no amount of taxation or insurance can live up to the demand. Even if you taxed every citizen a 100% there still wouldn't be enough to pay for healthcare. And so every society find themselves in one of the most complex paradoxes of modern times. If you tax your way to healthcare and provide everyone with free healthcare like in ex. Denmark, then access to treatment is equal but it's always a cost center and your will always mostly lag behind access to the latest treatments. The only way to be able to pay for new equipment or new medicine is either through higher taxes or by budget cuts somewhere else. If you go the insurance way of the US and try to let market forces rule then you end up with highly inflated prices and a younger generation that don't insure themselves and therefore don't pay for the healthcare system until they need it which drives up the prices of the insurance (hence Affordable Care Act). Here the access isn't equal but you have some of the best specialists in the world and always the latest treatments. Then there are countries in the middle trying to find a balance like Switzerland, Germany, the UK and France but even here I fear that no one have found a perfect system either. So no matter how you try and pay for it whether trough trade agreements or NGO etcs that problem still applies. Someone always have to pick up the bill and the bill is potentially infinitely big. Edit: For clarification

laotzu 11y ago
So if the problem is too much demand, lets look at how to lower the demand? The answer to lowering demand is clearly to encourage preventative medicine over reaction medicine. Most of the cash cows in the US for sickness profiteering are preventable, heart disease being number one. I know that's not profitable for sickness profiteers but until we start to value health and well-being over institutionalized greed well never have enough money to take care of our health. >He sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived. -DL
- orangecat 11y ago
  The answer to lowering demand is clearly to encourage preventative medicine over reaction medicine. Not really: http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129 http://www.reuters.com/article/2013/01/29/us-preventive-econ...

anonymous854 11y ago

Tying healthcare to trade would be wonderful for the US, provided the trade were free trade, because it would mean we could finally legally import dirt cheap drugs and medical supplies from abroad and allow cheaper foreign doctors and nurses to practice medicine in the US. Instead, it apparently means stuff like this: >He detailed the many ways in which U.S. law prohibits competition for pharmaceuticals that Peruvian law doesn’t, including granting new patents to old drugs for relatively small changes

evanpw 11y ago

> In recent decades, the majority of new drugs brought to market have been of little real therapeutic benefit. If drug companies are trying to charge ridiculous high prices for drugs with "little therapeutic benefit", wouldn't it be easier just to not buy those drugs than to re-work the patent system?

zeveb 11y ago
> If drug companies are trying to charge ridiculous high prices for drugs with "little therapeutic benefit", wouldn't it be easier just to not buy those drugs than to re-work the patent system? But that would involve physicians making recommendations in the best interests of their patients, and patients making decisions for themselves, and we certainly can't have that! I recall a surgeon friend of mine complaining about the decisions made by the physician overseeing his child's care, and how hard it was to stand by and see the wrong thing done. He's internalised the model of 'doctor knows best' so much that even where his child was concerned he couldn't overcome that conditioning! This has analogies, I think, to the ideas of software users who don't develop or people who rely on the police to protect them.