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one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls (please no anecdotes). The US essentially fun

one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls (please no anecdotes). The US essentially funds medical innovation for the entire rest of the world. If the US goes socialized you will see almost a complete halt to medical innovation over time. Here are 3 (not evidence based) reasons why medical care costs more in the US: 1) more administration (too many rules/regulations) 2) higher costs for the base goods (people get paid more, pharma, medical devices, etc) due to lack of price controls 3) people get more care, potentially even when it isnt going to help https://www.pbs.org/newshour/nation/why-does-health-care-cost-so-much-in-america-ask-harvards-david-cutler https://www.pbs.org/newshour/nation/why-does-health-care-cos...

acdha 9y ago
Do you not consider the billions of dollars which the U.S. government puts into basic medical research socialized innovation? It was only last year that the U.S. government spending dropped below 50% of the total following years of federal cuts: http://www.sciencemag.org/news/2017/03/data-check-us-government-share-basic-research-funding-falls-below-50 http://www.sciencemag.org/news/2017/03/data-check-us-governm... Your starting assumption that price controls are incompatible with innovation is a political belief, not a fact. There's no reason why that precludes funding bounties for improvements / cost reductions (e.g. why Japan's MRIs are so much cheaper than the U.S.), using different funding models for R&D than manufacturing, etc. Individual systems could choose not to fund research but that's a choice rather than a universal truth.
freddie_mercury 9y ago
> one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls This is a strong claim presented with no evidence. It is clear that the US is, by far, the global leader in this area. But to say there is no other innovation at all is going a bit far. Indeed, it is easy to see that communist China is the world's second in this area, whether you go by papers published, clinical trials, or whatnot. Even the libertarian Cato Institute doesn't go so far as to say that no one but the US innovates. https://www.cato.org/publications/policy-analysis/bending-productivity-curve-why-america-leads-world-medical-innovation https://www.cato.org/publications/policy-analysis/bending-pr...
UseStrict 9y ago
I strongly disagree with your first statement. The US definitely has a high rate of innovation in medical procedures, but by no means is it Atlas, carrying the world on its shoulders. Canada which is just a single socialized healthcare system has systematically produced fantastic innovations in drugs and therapy over the last 100 years. We have dozens of research hospitals who innovate regularly. I don't have the time to spend researching every single innovation, but a small sample is included below. There is a lot of donor money and government grant money in medical research around the world. Research Hospitals (off the top of my head) - The Ottawa Hospital - SickKids - Sunnybrook Health Sciences Centre - Sinai Health System - Kingston General Hospital Innovation [1] http://innovativemedicines.ca/medicines/timeline/ http://innovativemedicines.ca/medicines/timeline/ [2] https://legionmagazine.com/en/2009/08/eight-great-canadian-medical-breakthroughs/ https://legionmagazine.com/en/2009/08/eight-great-canadian-m...
- caseymarquis 9y ago
  This is even untrue in the US. My SO works at a system of donation/endowment funded US charity hospitals where they have a history of inventing new more effective methods of treatment. Some doctors will take less money to work in an environment focused on positive patient outcomes instead of performance metrics tied to profit.
- Scoundreller 9y ago
  > Canada which is just a single socialized healthcare system I wouldn't say single. Each province runs its own system. Each province can't decide how many sub health regions it wants (SK just merged theirs, ON collapsed their community care regions into their health integration regions). GP practices are basically private for-profit companies. Hospitals operate like independent charities with wildly different processes, costs and outcomes.
Mvandenbergh 9y ago
>one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls (please no anecdotes). Thanks for parenthetically instructing us not to share anecdotes at the end of a statement which isn't even that. https://www.statista.com/statistics/266141/pharmaceutical-spending-per-capita-in-selected-countries/ https://www.statista.com/statistics/266141/pharmaceutical-sp... That's per capital spending on pharmaceuticals. Two things to note from that: 1) The highest by far is in the US, that's absolutely true. 2) Substantial amounts are still spent in other wealthy countries. American healthcare payers - insurance companies and their agents - also impose controls on what they will pay for drugs and for which conditions. They don't seem to be as effective in enforcing them since they haven't got the kind of monopsoninistic power as either single payer systems like Canada or constrained multi-payer insurance markets like the Netherlands. That Americans overpaying for drugs helps to subsidise R&D that everyone benefits from seems like it make intuitive sense. I'd question whether the evidence supports a complete halt to innovation if the US adopted pharmaceutical price controls unless the price control they adopted was to restrict prices to cost of production - something that no government single payer health service does. In the NHS, these decisions are made by the NICE which determines how many quality adjusted life years are gained from the use of a drug and then checks to see if they clear a threshold CBA value. It's worth noting that £100k+ cancer drugs that actually work are still frequently approved under this system. Recently, NICE approved Soliris at £330k/yr for treating aHUS. That's $450k/yr, treatment required for life. I suspect that many American insurance companies wouldn't fund that. Moreover there are goods and services such as fighter jets where there is a single US government buyer and innovation still happens. Conceptually it doesn't appear that this needs to be a barrier to innovation spending.
- Scoundreller 9y ago
  > That's $450k/yr, treatment required for life. I suspect that many American insurance companies wouldn't fund that. The question is, how did NICE arrive at the decision to fund it when it doesn't meet their CBA threshold? Isn't the whole point of a CBA threshold to say: "We should defund really expensive treatments so we can pay for more cheaper treatments and improve aggregate outcomes per GBP"?
lavrov 9y ago
The argument that "if the US goes socialized, you will see almost a complete halt to medical innovation over time," and therefore that private funding of research is preferred, is a bad one. It rests on the premise that the profit motive for pharma companies and the imperative to improve health care outcomes for the greatest number of people are aligned, which they are not. Public funding of drug research is a better driver for the discovery of improved treatments than private pharma investment - under the current model, drug companies aren't incentivized to develop novel treatments (see Nexium), or to develop treatments that would improve outcomes for the greatest number of people (see Pfizer abandoning research into Alzheimer's and Parkinson's treatments). Since the Bayh-Dole Act passed in 1980, pharma companies have profited hugely by purchasing patents held by publicly-funded researchers, and commercializing them with virtually no controls on the resulting drug prices. Even private development of drugs still relies on publicly-funded and publicly-available research. The assertion that the institution of stricter price controls would eliminate innovation seems to be untrue - I don't think that scientists are incentivized to do research solely by the promise of lucrative patents. Stricter price controls would likely mean that the government would have to participate more directly in the clinical trial phase, which would be a good thing, as there are minimal checks against manipulation of clinical trials.
- Scoundreller 9y ago
  On the other hand, streams of interesting new oral Type-2 diabetes medications have been coming out. E.g. Gliptins and gliflozins Unfortunately, Alzheimer's and Parkinson's treatments have been a black-hole for research funding. Many have tried, most have failed.
  - deleted 9y ago
    [deleted]

acdha 9y ago

Do you not consider the billions of dollars which the U.S. government puts into basic medical research socialized innovation? It was only last year that the U.S. government spending dropped below 50% of the total following years of federal cuts: http://www.sciencemag.org/news/2017/03/data-check-us-government-share-basic-research-funding-falls-below-50 http://www.sciencemag.org/news/2017/03/data-check-us-governm... Your starting assumption that price controls are incompatible with innovation is a political belief, not a fact. There's no reason why that precludes funding bounties for improvements / cost reductions (e.g. why Japan's MRIs are so much cheaper than the U.S.), using different funding models for R&D than manufacturing, etc. Individual systems could choose not to fund research but that's a choice rather than a universal truth.

freddie_mercury 9y ago

> one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls This is a strong claim presented with no evidence. It is clear that the US is, by far, the global leader in this area. But to say there is no other innovation at all is going a bit far. Indeed, it is easy to see that communist China is the world's second in this area, whether you go by papers published, clinical trials, or whatnot. Even the libertarian Cato Institute doesn't go so far as to say that no one but the US innovates. https://www.cato.org/publications/policy-analysis/bending-productivity-curve-why-america-leads-world-medical-innovation https://www.cato.org/publications/policy-analysis/bending-pr...

UseStrict 9y ago

I strongly disagree with your first statement. The US definitely has a high rate of innovation in medical procedures, but by no means is it Atlas, carrying the world on its shoulders. Canada which is just a single socialized healthcare system has systematically produced fantastic innovations in drugs and therapy over the last 100 years. We have dozens of research hospitals who innovate regularly. I don't have the time to spend researching every single innovation, but a small sample is included below. There is a lot of donor money and government grant money in medical research around the world. Research Hospitals (off the top of my head) - The Ottawa Hospital - SickKids - Sunnybrook Health Sciences Centre - Sinai Health System - Kingston General Hospital Innovation [1] http://innovativemedicines.ca/medicines/timeline/ http://innovativemedicines.ca/medicines/timeline/ [2] https://legionmagazine.com/en/2009/08/eight-great-canadian-medical-breakthroughs/ https://legionmagazine.com/en/2009/08/eight-great-canadian-m...

caseymarquis 9y ago
This is even untrue in the US. My SO works at a system of donation/endowment funded US charity hospitals where they have a history of inventing new more effective methods of treatment. Some doctors will take less money to work in an environment focused on positive patient outcomes instead of performance metrics tied to profit.
Scoundreller 9y ago
> Canada which is just a single socialized healthcare system I wouldn't say single. Each province runs its own system. Each province can't decide how many sub health regions it wants (SK just merged theirs, ON collapsed their community care regions into their health integration regions). GP practices are basically private for-profit companies. Hospitals operate like independent charities with wildly different processes, costs and outcomes.

Mvandenbergh 9y ago

>one of the meta challenges with socialized medicine is that there is virtually no innovation due to price controls (please no anecdotes). Thanks for parenthetically instructing us not to share anecdotes at the end of a statement which isn't even that. https://www.statista.com/statistics/266141/pharmaceutical-spending-per-capita-in-selected-countries/ https://www.statista.com/statistics/266141/pharmaceutical-sp... That's per capital spending on pharmaceuticals. Two things to note from that: 1) The highest by far is in the US, that's absolutely true. 2) Substantial amounts are still spent in other wealthy countries. American healthcare payers - insurance companies and their agents - also impose controls on what they will pay for drugs and for which conditions. They don't seem to be as effective in enforcing them since they haven't got the kind of monopsoninistic power as either single payer systems like Canada or constrained multi-payer insurance markets like the Netherlands. That Americans overpaying for drugs helps to subsidise R&D that everyone benefits from seems like it make intuitive sense. I'd question whether the evidence supports a complete halt to innovation if the US adopted pharmaceutical price controls unless the price control they adopted was to restrict prices to cost of production - something that no government single payer health service does. In the NHS, these decisions are made by the NICE which determines how many quality adjusted life years are gained from the use of a drug and then checks to see if they clear a threshold CBA value. It's worth noting that £100k+ cancer drugs that actually work are still frequently approved under this system. Recently, NICE approved Soliris at £330k/yr for treating aHUS. That's $450k/yr, treatment required for life. I suspect that many American insurance companies wouldn't fund that. Moreover there are goods and services such as fighter jets where there is a single US government buyer and innovation still happens. Conceptually it doesn't appear that this needs to be a barrier to innovation spending.

Scoundreller 9y ago
> That's $450k/yr, treatment required for life. I suspect that many American insurance companies wouldn't fund that. The question is, how did NICE arrive at the decision to fund it when it doesn't meet their CBA threshold? Isn't the whole point of a CBA threshold to say: "We should defund really expensive treatments so we can pay for more cheaper treatments and improve aggregate outcomes per GBP"?

lavrov 9y ago

The argument that "if the US goes socialized, you will see almost a complete halt to medical innovation over time," and therefore that private funding of research is preferred, is a bad one. It rests on the premise that the profit motive for pharma companies and the imperative to improve health care outcomes for the greatest number of people are aligned, which they are not. Public funding of drug research is a better driver for the discovery of improved treatments than private pharma investment - under the current model, drug companies aren't incentivized to develop novel treatments (see Nexium), or to develop treatments that would improve outcomes for the greatest number of people (see Pfizer abandoning research into Alzheimer's and Parkinson's treatments). Since the Bayh-Dole Act passed in 1980, pharma companies have profited hugely by purchasing patents held by publicly-funded researchers, and commercializing them with virtually no controls on the resulting drug prices. Even private development of drugs still relies on publicly-funded and publicly-available research. The assertion that the institution of stricter price controls would eliminate innovation seems to be untrue - I don't think that scientists are incentivized to do research solely by the promise of lucrative patents. Stricter price controls would likely mean that the government would have to participate more directly in the clinical trial phase, which would be a good thing, as there are minimal checks against manipulation of clinical trials.

Scoundreller 9y ago
On the other hand, streams of interesting new oral Type-2 diabetes medications have been coming out. E.g. Gliptins and gliflozins Unfortunately, Alzheimer's and Parkinson's treatments have been a black-hole for research funding. Many have tried, most have failed.
- deleted 9y ago
  [deleted]