4 ms·

"So "better care for people who can pay more" is a better system?" Don't phrase this as an alternative - those able to pay more can still buy themselves better

"So "better care for people who can pay more" is a better system?" Don't phrase this as an alternative - those able to pay more can still buy themselves better care, they're being denied nothing except to watch the poor die of illness: https://en.wikipedia.org/wiki/Private_medicine_in_the_UK https://en.wikipedia.org/wiki/Private_medicine_in_the_UK

smt88 9y ago
You're right. A better way to phrase it is this: "Health-care quality in proportion to wealth" -- the poor get worse care because they can't afford to pay for gold-standard care.
- zip1234 9y ago
  This is OK as long as there is a sufficiently high floor on the quality of service that the poor receive. Someone has to pay for the advanced treatments, drugs, machinery, and training.
  - chimeracoder 9y ago
    > This is OK as long as there is a sufficiently high floor on the quality of service that the poor receive. Someone has to pay for the advanced treatments, drugs, machinery, and training. Yes, and that "somebody" is the US. Drug prices are high in the US because the US is responsible for funding the the majority of medical and pharmaceutical research for the entire world. Countries like the UK benefit from the research that is being paid by the US, while not actually having to find the R&D that goes into it.
    - jessaustin 9y ago
      In a time when it is seriously proposed by high-ranking elected officials that e.g. South Korea pay for its own military defense, I think we can consider UK paying for its own drug research.
      - smt88 9y ago
        > consider UK paying for its own drug research Because the UK is single-payer, they have enormous negotiating power -- and they use it[1]. They force drug companies to give them low prices, which means the US indirectly pays some of the costs of the research. However, drugs can be very profitable, so you could just as easily say that all the countries share the cost of the research, and the US subsidizes the profits of the private companies. 1. https://qz.com/509344/the-way-to-fix-outrageous-drug-pricing-in-the-us-is-simply-to-do-what-all-other-rich-countries-do/ https://qz.com/509344/the-way-to-fix-outrageous-drug-pricing...
        chimeracoder 9y ago
        > However, drugs can be very profitable, so you could just as easily say that all the countries share the cost of the research, and the US subsidizes the profits of the private companies. Sure, though only if you assume that the companies would pursue the same research and achieve the same results without a profit incentive. Except, we have pretty clear empirical evidence that that isn't the case. The overwhelming majority of both medical research spending and clinical medical discoveries come out of organizations that pursue a profit motive. That's true globally - it's true in the US, in Europe, and in China and India. And even then, you can't say that companies "share the cost of research equally", because there is literally no objective metric under which European countries pay an amount of research proportional to how much they consume. Even European pharmaceutical companies obtain the bulk of their research funds from the US market.
        vilmosi 9y ago
        >>> Even European pharmaceutical companies obtain the bulk of their research funds from the US market. Stop spreading nonsense. This is easily verifiable information and very easy to disprove. Take Norvatis for example: https://www.statista.com/statistics/294631/novartis-revenue-by-region/ https://www.statista.com/statistics/294631/novartis-revenue-... The US is definitely not the "bulk" of revenue for these companies. A big market? Sure. But nothing special when compared to other rich countries if you take into account population and wealth.
    - smt88 9y ago
      > US is responsible for funding the the majority of medical and pharmaceutical research for the entire world I believed this until very recently. I had a long discussion on Facebook with some friends in medical research and public policy. I learned that only a fraction of drug costs are due to this issue. Furthermore, slightly less than 10% of all health-care spending in the US is on drugs. It's an issue, but it's a relatively smaller one than I'd thought, and it's not as clear as "the US subsidizes other countries."
      - chimeracoder 9y ago
        > I believed this until very recently. I had a long discussion on Facebook with some friends in medical research and public policy. I learned that only a fraction of drug costs are due to this issue. Literally 50% of medical research in the world happens in the US, and even more is funded (indirectly) by the US market. In the last two years, that number has dropped slightly below 50%, but only because of rapid growth in China and India. This is all medical research, not just pharmaceutical research. But yes, it is actually responsible for the bulk of drug prices in the US, through a combination of both direct and indirect effects. Even pharmaceutical companies based in Europe still use the US as the primary source of funding their research. Pharmaceutical companies reap their profits from the US because that's where it's easiest to do so, and because the US is the largest non-developing country. If, overnight, the US capped drug costs[0], a combination of two things would happen: pharmaceutical research would drop dramatically (some would move to China and India, but some would just exit the industry) and drug costs in other developing countries would skyrocket. Or in other words, for the US to pay less in drug costs, other developed countries have to be ready to pay more, and the world has to be ready to accept a decrease in medical research. > Furthermore, slightly less than 10% of all health-care spending in the US is on drugs. That doesn't contradict the original point; that's just looking at a different denominator. And again, this is all medical research, not just pharmaceuticals. [0] ignoring for the moment the mechanism of doing so
    - DarkKomunalec 9y ago
      "Drug prices are high in the US because the US is responsible for funding the the majority of medical and pharmaceutical research for the entire world." A statement entirely unsupported by data. If pharmaceutical companies spent on R&D only the money earned due the inflation of US prices, they'd still have plenty left over: http://healthaffairs.org/blog/2017/03/07/rd-costs-for-pharmaceutical-companies-do-not-explain-elevated-us-drug-prices/ http://healthaffairs.org/blog/2017/03/07/rd-costs-for-pharma... You could just as well say the US funds the majority of drug advertising for the entire world - they spend more on ads than R&D: http://www.bbc.com/news/business-28212223 http://www.bbc.com/news/business-28212223 Not to mention everything from vital new medicine, to reproducing generics of other companies, and drug reformulations to prolong patents, gets thrown under R&D. If you only count the R&D spending that's not done solely to steal market share from other companies, the ads vs. R&D ratio is even more dire. So given they post more profits and more ad spending each than R&D spending, at what point would it be okay to stop raising drug prices? When profits are >10x their R&D?
      - chimeracoder 9y ago
        You seem to be interested in arguing the statement "Pharmaceutical companies in the US spend too much on R&D". But that's not equivalent to the statement "The US provides the funding for the majority of R&D that the rest of the world benefits from". If you think that pharmaceutical companies should spend less of their money on R&D, or more on it, that's not really relevant. Whatever research pharmaceutical companies are doing, that's being disproportionately funded by the US market. That's a plainly evident statement; it's right there in their financial sheets. > You could just as well say the US funds the majority of drug advertising for the entire world No, because research is a wholly non-excusable good in the global market. Advertising is not. > they spend more on ads than R&D Again, not really the point.
        DarkKomunalec 9y ago
        Sounds like as long as they spend some portion of their revenue on R&D, you'll argue inflated drug prices are good and necessary.
- conanbatt 9y ago
  That is true for literally anything, from food, education, jobs, lifestyle, etc. Why would just health-care be so different to all those other necessities?
  - smt88 9y ago
    Education, jobs, and lifestyle aren't necessities. That's how health care is different. And I do believe people need to have food. Every developed country agrees, which is why there are welfare and food programs. They're inadequate and often leave people behind, but the goal is that no one dies just from being poor.
    - conanbatt 9y ago
      > Education, jobs, and lifestyle aren't necessities. That's how health care is different. I disagree. Lifespan, quality of life and health all depend on all those. > And I do believe people need to have food. Every developed country agrees, which is why there are welfare and food programs. They're inadequate and often leave people behind, but the goal is that no one dies just from being poor. Sure, but not any kind of food at any price. The equivalent would be basic medical care, not advanced cancer treatment solutions. I personally resist the idea that any human life is of infinite value, since it conflicts with the basic reality that economically, we trade some lives for others. Reducing cost is fruitful for everyone but the traders and professionals: supporting any cost as a right is fruitful for the traders and professionals and the recipients at the cost of the givers. And in reality, the givers tend to be the poor more frequently than the rich.

smt88 9y ago

You're right. A better way to phrase it is this: "Health-care quality in proportion to wealth" -- the poor get worse care because they can't afford to pay for gold-standard care.

zip1234 9y ago
This is OK as long as there is a sufficiently high floor on the quality of service that the poor receive. Someone has to pay for the advanced treatments, drugs, machinery, and training.
- chimeracoder 9y ago
  > This is OK as long as there is a sufficiently high floor on the quality of service that the poor receive. Someone has to pay for the advanced treatments, drugs, machinery, and training. Yes, and that "somebody" is the US. Drug prices are high in the US because the US is responsible for funding the the majority of medical and pharmaceutical research for the entire world. Countries like the UK benefit from the research that is being paid by the US, while not actually having to find the R&D that goes into it.
  - jessaustin 9y ago
    In a time when it is seriously proposed by high-ranking elected officials that e.g. South Korea pay for its own military defense, I think we can consider UK paying for its own drug research.
    - smt88 9y ago
      > consider UK paying for its own drug research Because the UK is single-payer, they have enormous negotiating power -- and they use it[1]. They force drug companies to give them low prices, which means the US indirectly pays some of the costs of the research. However, drugs can be very profitable, so you could just as easily say that all the countries share the cost of the research, and the US subsidizes the profits of the private companies. 1. https://qz.com/509344/the-way-to-fix-outrageous-drug-pricing-in-the-us-is-simply-to-do-what-all-other-rich-countries-do/ https://qz.com/509344/the-way-to-fix-outrageous-drug-pricing...
      - chimeracoder 9y ago
        > However, drugs can be very profitable, so you could just as easily say that all the countries share the cost of the research, and the US subsidizes the profits of the private companies. Sure, though only if you assume that the companies would pursue the same research and achieve the same results without a profit incentive. Except, we have pretty clear empirical evidence that that isn't the case. The overwhelming majority of both medical research spending and clinical medical discoveries come out of organizations that pursue a profit motive. That's true globally - it's true in the US, in Europe, and in China and India. And even then, you can't say that companies "share the cost of research equally", because there is literally no objective metric under which European countries pay an amount of research proportional to how much they consume. Even European pharmaceutical companies obtain the bulk of their research funds from the US market.
        vilmosi 9y ago
        >>> Even European pharmaceutical companies obtain the bulk of their research funds from the US market. Stop spreading nonsense. This is easily verifiable information and very easy to disprove. Take Norvatis for example: https://www.statista.com/statistics/294631/novartis-revenue-by-region/ https://www.statista.com/statistics/294631/novartis-revenue-... The US is definitely not the "bulk" of revenue for these companies. A big market? Sure. But nothing special when compared to other rich countries if you take into account population and wealth.
  - smt88 9y ago
    > US is responsible for funding the the majority of medical and pharmaceutical research for the entire world I believed this until very recently. I had a long discussion on Facebook with some friends in medical research and public policy. I learned that only a fraction of drug costs are due to this issue. Furthermore, slightly less than 10% of all health-care spending in the US is on drugs. It's an issue, but it's a relatively smaller one than I'd thought, and it's not as clear as "the US subsidizes other countries."
    - chimeracoder 9y ago
      > I believed this until very recently. I had a long discussion on Facebook with some friends in medical research and public policy. I learned that only a fraction of drug costs are due to this issue. Literally 50% of medical research in the world happens in the US, and even more is funded (indirectly) by the US market. In the last two years, that number has dropped slightly below 50%, but only because of rapid growth in China and India. This is all medical research, not just pharmaceutical research. But yes, it is actually responsible for the bulk of drug prices in the US, through a combination of both direct and indirect effects. Even pharmaceutical companies based in Europe still use the US as the primary source of funding their research. Pharmaceutical companies reap their profits from the US because that's where it's easiest to do so, and because the US is the largest non-developing country. If, overnight, the US capped drug costs[0], a combination of two things would happen: pharmaceutical research would drop dramatically (some would move to China and India, but some would just exit the industry) and drug costs in other developing countries would skyrocket. Or in other words, for the US to pay less in drug costs, other developed countries have to be ready to pay more, and the world has to be ready to accept a decrease in medical research. > Furthermore, slightly less than 10% of all health-care spending in the US is on drugs. That doesn't contradict the original point; that's just looking at a different denominator. And again, this is all medical research, not just pharmaceuticals. [0] ignoring for the moment the mechanism of doing so
  - DarkKomunalec 9y ago
    "Drug prices are high in the US because the US is responsible for funding the the majority of medical and pharmaceutical research for the entire world." A statement entirely unsupported by data. If pharmaceutical companies spent on R&D only the money earned due the inflation of US prices, they'd still have plenty left over: http://healthaffairs.org/blog/2017/03/07/rd-costs-for-pharmaceutical-companies-do-not-explain-elevated-us-drug-prices/ http://healthaffairs.org/blog/2017/03/07/rd-costs-for-pharma... You could just as well say the US funds the majority of drug advertising for the entire world - they spend more on ads than R&D: http://www.bbc.com/news/business-28212223 http://www.bbc.com/news/business-28212223 Not to mention everything from vital new medicine, to reproducing generics of other companies, and drug reformulations to prolong patents, gets thrown under R&D. If you only count the R&D spending that's not done solely to steal market share from other companies, the ads vs. R&D ratio is even more dire. So given they post more profits and more ad spending each than R&D spending, at what point would it be okay to stop raising drug prices? When profits are >10x their R&D?
    - chimeracoder 9y ago
      You seem to be interested in arguing the statement "Pharmaceutical companies in the US spend too much on R&D". But that's not equivalent to the statement "The US provides the funding for the majority of R&D that the rest of the world benefits from". If you think that pharmaceutical companies should spend less of their money on R&D, or more on it, that's not really relevant. Whatever research pharmaceutical companies are doing, that's being disproportionately funded by the US market. That's a plainly evident statement; it's right there in their financial sheets. > You could just as well say the US funds the majority of drug advertising for the entire world No, because research is a wholly non-excusable good in the global market. Advertising is not. > they spend more on ads than R&D Again, not really the point.
      - DarkKomunalec 9y ago
        Sounds like as long as they spend some portion of their revenue on R&D, you'll argue inflated drug prices are good and necessary.
conanbatt 9y ago
That is true for literally anything, from food, education, jobs, lifestyle, etc. Why would just health-care be so different to all those other necessities?
- smt88 9y ago
  Education, jobs, and lifestyle aren't necessities. That's how health care is different. And I do believe people need to have food. Every developed country agrees, which is why there are welfare and food programs. They're inadequate and often leave people behind, but the goal is that no one dies just from being poor.
  - conanbatt 9y ago
    > Education, jobs, and lifestyle aren't necessities. That's how health care is different. I disagree. Lifespan, quality of life and health all depend on all those. > And I do believe people need to have food. Every developed country agrees, which is why there are welfare and food programs. They're inadequate and often leave people behind, but the goal is that no one dies just from being poor. Sure, but not any kind of food at any price. The equivalent would be basic medical care, not advanced cancer treatment solutions. I personally resist the idea that any human life is of infinite value, since it conflicts with the basic reality that economically, we trade some lives for others. Reducing cost is fruitful for everyone but the traders and professionals: supporting any cost as a right is fruitful for the traders and professionals and the recipients at the cost of the givers. And in reality, the givers tend to be the poor more frequently than the rich.