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What amazes me is how few people value the value of profits in our system. The US is responsible for ~40% of the world's output in terms of medical research, wh

What amazes me is how few people value the value of profits in our system. The US is responsible for ~40% of the world's output in terms of medical research, which is 10x the country with the second largest amount of output, England. Profits provides the impetus for many of the medical advances invented here in the US, and many of these advances find their way to other countries. Because of profits, the US is essentially the medical R&D powerhouse for the world and every human in the world benefits. We help make more care options available to more people are lower prices sooner. In a way, the US is providing socialized medical care over time beyond its borders and for more people instead of having it just be socialized in the present. Until I hear solutions that acknowledge this very important detail, I'm going to remain skeptical of all comparisons with countries with socialized medicine and attempts to take the US in that direction. I learned long ago to be skeptical of anyone criticizing any system where they can't point out the value of that system versus the others they prefer. Making the US healthcare system function like the socialized medical systems seen in Europe risks destroying the profit motive and therefore jeopardizes improvements in medical care quality, speed, options, etc. for everyone everywhere. I far prefer a system where some lose out in the present in favor of a system where far fewer people lose out in the future. This is essentially the trolley problem. We can provide care for X people in the US who don't have care in the present or we can provide care for several times X people in the US and elsewhere in the world in the future. [1] https://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/#507bcef81a71 https://www.forbes.com/sites/matthewherper/2011/03/23/the-mo...

throwaway2048 10y ago
Points like this sound a lot better when its not you that are lacking access to medical care. (Presently) Consequent is not the same thing as nessisary.
- malandrew 10y ago
  As someone with an autoimmune illness that is currently incurable, yes, I do lack access to medical care so to speak. No amount of money in the world can buy me a cure right now. The specialist I currently see is considered the best doctor in the world for my illness because he's the foremost researcher in the world studying it. He's French. He's in the US because the system here provides him with the resources to study it and come up with better treatments.
  - arcticbull 10y ago
    I'm very sorry to hear that, and I wish you the best. Think how you'd feel if you were underinsured or uninsured? There'd be no hope at all. In any socialized system I'd be surprised if you didn't have access to the best doctors in the system anyways, as would anyone else in the country regardless of their employment status or net worth. For every one person like you who is able to take advantage and be covered, how many more are left hopeless and isolated because they are deemed unsuitable for coverage due to their net worth -- effectively the luck of the draw? What of them? I have no interest in taking away your access. I want to make sure everyone else can get it too without fear of financial ruin. FWIW, at least in Canada, if the government is unable to get you taken care of at home they'll pay for your coverage abroad which I would can only hope would happen to you if somehow your doctor moved back to France if the system were socialized. The point more broadly is that of Tommy Douglas [1] the guy who brought the Canadian system to being: "I felt that no boy should have to depend either for his leg or his life upon the ability of his parents to raise enough money to bring a first-class surgeon to his bedside." [1] https://en.wikipedia.org/wiki/Tommy_Douglas https://en.wikipedia.org/wiki/Tommy_Douglas
    - malandrew 10y ago
      No hope at all? If I were underinsured or uninsured, I would still have the option of working to get the insurance I need. If I couldn't afford it, I could still ask others to fund me if they were feeling charitable. Overall, there would still be options. Lack of wealth is not an insurmountable barrier. Insofar as the best doctors are concerned, they are pretty much all here in the US. Everyone who matters specializing in my illness is in the US. When I lived abroad, I saw a doctor specializing in my illness and the level of knowledge they had relative to the specialists I've seen in the US was laughable. The only medical care I've had abroad (I've lived on three different continents in my life) that was comparable cost as much as healthcare in the US. There may be a few countries that are exceptions in terms of the socialized medical care available, but I would be surprised if any were as genetically heterogenous as the US or had a population even 1/5 of the US. One of the main problems in the US is that there isn't a clear way to compare health insurance policies. You can't exactly go out and say, I want health insurance that covers the 90% of the most likely issues I'd most likely be afflicted with for one price or choose one that covers 99.99% of the things for another price. That lack of comparability and enforcement of payout is what lacks. If these features existed in the market, it would be possible to find insurance at $50 a month all the way to $500 a month. Transparency and comparability would make the market function much better. Something that covers 90% of the things that could go wrong is already way way way better than whatever the richest could afford 50 years ago. Your point about Canada is only worthwhile if another country exists where you want to be treated. If the US socialized medical care and ended up with a system comparable to Canada, all of a sudden that option wouldn't be all that useful because you've lost the best market in the world for providing care that Canada can't. The US subsidizes everyone research on behalf of all people in other countries. Maybe the rest of the world can find it in their heart to help those in the US that lack healthcare instead of lecturing us on how our system is broken when it already does so much for medical progress for the entirety of humanity. Something like 95% of all drugs developed are developed in the US. I went to a university where many of my colleagues went on to join companies that were creating the most advanced medical textiles available, such as artificial aortas and whatnot.
robbiep 10y ago
This is absolute demonstrable horseshit (he says without providing any references). The cost of a gallbladder surgery does not go around and get funnelled back into research and innovation; it is padding the pockets of coders (an almost unheard of profession in much of the rest of the world), administrators and doctors who are busy paying off student debts the size of most doctors in the western world's mortgages. Drug costs are completely out of control and the bankrupting effect this has on the most vulnerable members of a community is completely outrageous and out of touch with what a reasonable society should be expected to do. The high price of monoclonal antibodies and other treatments is no excuse for the blatant market failure that occurs here. To further expand on this: Healthcare is a price inelastic good. The current situation in the US is one of abject market failure as what should be considered an essential service is made available to only those able to pay for it (or willing to bankrupt their families). The worst instances of this are in cases of cancer, where life-extending therapies (maybe only a few months, maybe many years, and a tiny pay-off of a long future) are only available for tens to hundreds of thousands of dollars. So vulnerable families pay it - middle class families that thought they were doing everything right, sell or re-mortgage the family house in the hope of keeping their loved one around forever. Then they die. Then the hardship begins. This is, in my considered opinion, criminal. Bottom line: I firmly believe there is no excuse for the wastage and high costs that the American system provides. Healthcare should be about innovation; and yes we need to fund it. But in the US as in other countries, significant funding is provided by governments for basic research which goes on to be capitalised by private companies, when this information should be free. Bottom line- this article, and indeed your comment, is a post hoc rationalisation of high healthcare charges, with little recognition of the true drivers, and it does not need to be this way
rbehrends 10y ago
> The US is responsible for ~40% of the world's output in terms of medical research, which is 10x the country with the second largest amount of output, England. These seem to be academic publications and according to this Quora post [1], it's primarily driven by American universities and research institutes. It is not entirely clear to me how profits within the US would be a major factor here: I would have thought that NIH spending is more important in this context. While it's sort of true that NIH spending is more relevant for the R in medical R&D and industry spending for the D in R&D, the Forbes article seems to be only about peer-reviewed published research. [1] https://www.quora.com/What-countries-have-lead-the-world-in-medical-research-and-innovation-in-the-past-20-years https://www.quora.com/What-countries-have-lead-the-world-in-...
- malandrew 10y ago
  What percent of new medicines and treatments developed are developed in the UK? How does that compare to the US?
  - rbehrends 10y ago
    I don't know, and the UK may not even take a dominant role here (as the commercial research infrastructure is very likely to be different). We'd also have to account for the fact that a lot of drug development goes into drugs that do not provide any novel treatments, but merely exist because somebody wants a share out of a big market (e.g., Viagra alternatives) or to find a replacement drug that can be patented to sell in lieu of a drug where patent protection is running out (which doesn't work too well in countries with reference pricing, but reference pricing is still uncommon in the US, and the US practice of prescription drug advertising doesn't help, either). In any event, if you want to make such a claim, it's up to you to support it. I was merely pointing out that your argument is fairly incomplete as it stands. It doesn't even address the question whether it may be due to economic clustering effects or a superior bioscience infrastructure in America; after all, if selling drugs in the US were so profitable and that was the cause of research, that would also spark research in other countries.
white-flame 10y ago
How much medical R&D spending is based on government grants, government-funded university research, and tax incentives, versus reinvesting those profits?
- malandrew 10y ago
  How many of those contributors to medical R&D have actually brought new drugs and new treatments all the way to market? The D in R&D dwarfs the R.
  - anonymousDan 10y ago
    Oh give over, without the R there is no D.
deleted 10y ago
[deleted]
arcticbull 10y ago
First, not everything needs a direct and unrestricted profit motive, and I draw the line on that where people don't have a choice whether to engage in a service or not and whether providing that service provides in general a good above and beyond the person in question. Fire: it's to everyones' benefit if a persons' house catches fire to prevent burning down the neighborhood. Education: all society benefits from more educated youth. Prison: all society benefits from remediation of people with criminal tendencies (not punishment, btw, but preventing it from happening again) Police: everyone benefits from lower crime rates. Health: everyone benefits when people who are sick are treated to prevent infecting those around them, and people tend not to have a choice in whether they get sick, it's something that happens to them beyond their control. It's strange to me that people tend to draw the line just before they get to health. They see the benefits to society of everything else on the list being socialized (most do, anyways) but they don't map it to health. There's no risk of demolishing a profit motive. Canadian doctors get paid upwards of $300,000 per year. Nobody there is suffering. Patents ensure that even when realistically negotiated, drug companies can secure a healthy profit for novel drugs. Drug reasearch often funded by public money. It's also strange to me that your argument for not covering many Americans is that doing so hurts people beyond the border. You should look out for the broader good but why not look out for yourself and your neighbors first? As much as I'm a globalist I don't think it's worth sacrificing American lives to the nebulous goal of trickle-down healthcare to people outside America. Can you cite some evidence of the effectiveness? I'm not an American, by the way, and I'm all in favor of exporting surplus healthcare, and I feel like you should make sure you've got your house in order first.
- malandrew 10y ago
  What percent of new medicines and treatments developed are developed in Canada? How does that compare to the US?
  - arcticbull 10y ago
    Based on conversations in other threads, it has been posited that it isn't the profit motive pushing that but rather the US governments' heavy investment in drug research [1], [2]. Canada doesn't have a big drug sector to the best of my knowledge though playing along, plenty of countries with socialized medicine do: Denmark has Novo Nordisk. Germany has Boeringer Ingelheim and Bayer. Switzerland has Roche. Astra/Zeneca is Swedish/British. GlaxoSmithKlein is British. Sanofi is French. Novartis is Swiss. Actually, of the top 10 by revenue, only two (Johnson and Johnson, and Pfizer, #1 and #3 respectively) are American. All the rest are European. Assuming based on the references that development has more to do with funding, I'm willing to bet the EU spends an awful lot. [1] http://abcnews.go.com/WNT/YourMoney/story?id=129651 http://abcnews.go.com/WNT/YourMoney/story?id=129651 [2] http://undsci.berkeley.edu/article/who_pays http://undsci.berkeley.edu/article/who_pays

throwaway2048 10y ago

Points like this sound a lot better when its not you that are lacking access to medical care. (Presently) Consequent is not the same thing as nessisary.

malandrew 10y ago
As someone with an autoimmune illness that is currently incurable, yes, I do lack access to medical care so to speak. No amount of money in the world can buy me a cure right now. The specialist I currently see is considered the best doctor in the world for my illness because he's the foremost researcher in the world studying it. He's French. He's in the US because the system here provides him with the resources to study it and come up with better treatments.
- arcticbull 10y ago
  I'm very sorry to hear that, and I wish you the best. Think how you'd feel if you were underinsured or uninsured? There'd be no hope at all. In any socialized system I'd be surprised if you didn't have access to the best doctors in the system anyways, as would anyone else in the country regardless of their employment status or net worth. For every one person like you who is able to take advantage and be covered, how many more are left hopeless and isolated because they are deemed unsuitable for coverage due to their net worth -- effectively the luck of the draw? What of them? I have no interest in taking away your access. I want to make sure everyone else can get it too without fear of financial ruin. FWIW, at least in Canada, if the government is unable to get you taken care of at home they'll pay for your coverage abroad which I would can only hope would happen to you if somehow your doctor moved back to France if the system were socialized. The point more broadly is that of Tommy Douglas [1] the guy who brought the Canadian system to being: "I felt that no boy should have to depend either for his leg or his life upon the ability of his parents to raise enough money to bring a first-class surgeon to his bedside." [1] https://en.wikipedia.org/wiki/Tommy_Douglas https://en.wikipedia.org/wiki/Tommy_Douglas
  - malandrew 10y ago
    No hope at all? If I were underinsured or uninsured, I would still have the option of working to get the insurance I need. If I couldn't afford it, I could still ask others to fund me if they were feeling charitable. Overall, there would still be options. Lack of wealth is not an insurmountable barrier. Insofar as the best doctors are concerned, they are pretty much all here in the US. Everyone who matters specializing in my illness is in the US. When I lived abroad, I saw a doctor specializing in my illness and the level of knowledge they had relative to the specialists I've seen in the US was laughable. The only medical care I've had abroad (I've lived on three different continents in my life) that was comparable cost as much as healthcare in the US. There may be a few countries that are exceptions in terms of the socialized medical care available, but I would be surprised if any were as genetically heterogenous as the US or had a population even 1/5 of the US. One of the main problems in the US is that there isn't a clear way to compare health insurance policies. You can't exactly go out and say, I want health insurance that covers the 90% of the most likely issues I'd most likely be afflicted with for one price or choose one that covers 99.99% of the things for another price. That lack of comparability and enforcement of payout is what lacks. If these features existed in the market, it would be possible to find insurance at $50 a month all the way to $500 a month. Transparency and comparability would make the market function much better. Something that covers 90% of the things that could go wrong is already way way way better than whatever the richest could afford 50 years ago. Your point about Canada is only worthwhile if another country exists where you want to be treated. If the US socialized medical care and ended up with a system comparable to Canada, all of a sudden that option wouldn't be all that useful because you've lost the best market in the world for providing care that Canada can't. The US subsidizes everyone research on behalf of all people in other countries. Maybe the rest of the world can find it in their heart to help those in the US that lack healthcare instead of lecturing us on how our system is broken when it already does so much for medical progress for the entirety of humanity. Something like 95% of all drugs developed are developed in the US. I went to a university where many of my colleagues went on to join companies that were creating the most advanced medical textiles available, such as artificial aortas and whatnot.

robbiep 10y ago

This is absolute demonstrable horseshit (he says without providing any references). The cost of a gallbladder surgery does not go around and get funnelled back into research and innovation; it is padding the pockets of coders (an almost unheard of profession in much of the rest of the world), administrators and doctors who are busy paying off student debts the size of most doctors in the western world's mortgages. Drug costs are completely out of control and the bankrupting effect this has on the most vulnerable members of a community is completely outrageous and out of touch with what a reasonable society should be expected to do. The high price of monoclonal antibodies and other treatments is no excuse for the blatant market failure that occurs here. To further expand on this: Healthcare is a price inelastic good. The current situation in the US is one of abject market failure as what should be considered an essential service is made available to only those able to pay for it (or willing to bankrupt their families). The worst instances of this are in cases of cancer, where life-extending therapies (maybe only a few months, maybe many years, and a tiny pay-off of a long future) are only available for tens to hundreds of thousands of dollars. So vulnerable families pay it - middle class families that thought they were doing everything right, sell or re-mortgage the family house in the hope of keeping their loved one around forever. Then they die. Then the hardship begins. This is, in my considered opinion, criminal. Bottom line: I firmly believe there is no excuse for the wastage and high costs that the American system provides. Healthcare should be about innovation; and yes we need to fund it. But in the US as in other countries, significant funding is provided by governments for basic research which goes on to be capitalised by private companies, when this information should be free. Bottom line- this article, and indeed your comment, is a post hoc rationalisation of high healthcare charges, with little recognition of the true drivers, and it does not need to be this way

rbehrends 10y ago

> The US is responsible for ~40% of the world's output in terms of medical research, which is 10x the country with the second largest amount of output, England. These seem to be academic publications and according to this Quora post [1], it's primarily driven by American universities and research institutes. It is not entirely clear to me how profits within the US would be a major factor here: I would have thought that NIH spending is more important in this context. While it's sort of true that NIH spending is more relevant for the R in medical R&D and industry spending for the D in R&D, the Forbes article seems to be only about peer-reviewed published research. [1] https://www.quora.com/What-countries-have-lead-the-world-in-medical-research-and-innovation-in-the-past-20-years https://www.quora.com/What-countries-have-lead-the-world-in-...

malandrew 10y ago
What percent of new medicines and treatments developed are developed in the UK? How does that compare to the US?
- rbehrends 10y ago
  I don't know, and the UK may not even take a dominant role here (as the commercial research infrastructure is very likely to be different). We'd also have to account for the fact that a lot of drug development goes into drugs that do not provide any novel treatments, but merely exist because somebody wants a share out of a big market (e.g., Viagra alternatives) or to find a replacement drug that can be patented to sell in lieu of a drug where patent protection is running out (which doesn't work too well in countries with reference pricing, but reference pricing is still uncommon in the US, and the US practice of prescription drug advertising doesn't help, either). In any event, if you want to make such a claim, it's up to you to support it. I was merely pointing out that your argument is fairly incomplete as it stands. It doesn't even address the question whether it may be due to economic clustering effects or a superior bioscience infrastructure in America; after all, if selling drugs in the US were so profitable and that was the cause of research, that would also spark research in other countries.

white-flame 10y ago

How much medical R&D spending is based on government grants, government-funded university research, and tax incentives, versus reinvesting those profits?

malandrew 10y ago
How many of those contributors to medical R&D have actually brought new drugs and new treatments all the way to market? The D in R&D dwarfs the R.
- anonymousDan 10y ago
  Oh give over, without the R there is no D.

deleted 10y ago

[deleted]

arcticbull 10y ago

First, not everything needs a direct and unrestricted profit motive, and I draw the line on that where people don't have a choice whether to engage in a service or not and whether providing that service provides in general a good above and beyond the person in question. Fire: it's to everyones' benefit if a persons' house catches fire to prevent burning down the neighborhood. Education: all society benefits from more educated youth. Prison: all society benefits from remediation of people with criminal tendencies (not punishment, btw, but preventing it from happening again) Police: everyone benefits from lower crime rates. Health: everyone benefits when people who are sick are treated to prevent infecting those around them, and people tend not to have a choice in whether they get sick, it's something that happens to them beyond their control. It's strange to me that people tend to draw the line just before they get to health. They see the benefits to society of everything else on the list being socialized (most do, anyways) but they don't map it to health. There's no risk of demolishing a profit motive. Canadian doctors get paid upwards of $300,000 per year. Nobody there is suffering. Patents ensure that even when realistically negotiated, drug companies can secure a healthy profit for novel drugs. Drug reasearch often funded by public money. It's also strange to me that your argument for not covering many Americans is that doing so hurts people beyond the border. You should look out for the broader good but why not look out for yourself and your neighbors first? As much as I'm a globalist I don't think it's worth sacrificing American lives to the nebulous goal of trickle-down healthcare to people outside America. Can you cite some evidence of the effectiveness? I'm not an American, by the way, and I'm all in favor of exporting surplus healthcare, and I feel like you should make sure you've got your house in order first.

malandrew 10y ago
What percent of new medicines and treatments developed are developed in Canada? How does that compare to the US?
- arcticbull 10y ago
  Based on conversations in other threads, it has been posited that it isn't the profit motive pushing that but rather the US governments' heavy investment in drug research [1], [2]. Canada doesn't have a big drug sector to the best of my knowledge though playing along, plenty of countries with socialized medicine do: Denmark has Novo Nordisk. Germany has Boeringer Ingelheim and Bayer. Switzerland has Roche. Astra/Zeneca is Swedish/British. GlaxoSmithKlein is British. Sanofi is French. Novartis is Swiss. Actually, of the top 10 by revenue, only two (Johnson and Johnson, and Pfizer, #1 and #3 respectively) are American. All the rest are European. Assuming based on the references that development has more to do with funding, I'm willing to bet the EU spends an awful lot. [1] http://abcnews.go.com/WNT/YourMoney/story?id=129651 http://abcnews.go.com/WNT/YourMoney/story?id=129651 [2] http://undsci.berkeley.edu/article/who_pays http://undsci.berkeley.edu/article/who_pays