8 ms·

UBI is probably a bit too far in one direction to be a palatable solution. However Healthcare not being a financial concern for an individual or family is a ver

UBI is probably a bit too far in one direction to be a palatable solution. However Healthcare not being a financial concern for an individual or family is a very compelling idea. But can a universal healthcare system resolve many of the emerging rent-seeking behavior costs peripheral to the actual hospital costs? Things like medical supplies that, in the U.S. are significantly more expensive than elsewhere. Would a universal healthcare system only further subsidize that kind of exploitative pricing?

paulddraper 8y ago
Healthcare is expensive largely because the decision-maker does not foot most of the bill. If you have a universal healthcare system that would require mandatory prices.
- dragonwriter 8y ago
  > Healthcare is expensive largely because the decision-maker does not foot most of the bill. No, it's not, at least that's not the reason it's uniquely high cost in the US compared to the rest of the developed world, because that's not a differentiating factor.
  - paulddraper 8y ago
    Kindly help me understand my error. Is there anywhere where (1) prices aren't fixed (2) one party decides which healthcare services to receive (3) a different party pays the bills and (4) cost is significantly less than in the US?
zrail 8y ago
> can a universal healthcare system resolve many of the emerging rent-seeking behavior costs peripheral to the actual hospital costs? Yes. Universal healthcare systems almost all (with some notable exceptions) can and will negotiate with providers and suppliers to control costs. They are typically the largest buyer, so of course they have a lot of negotiating power. Notable exceptions include Medicare in the US being legally forbidden from negotiating drug prices.
- dragonwriter 8y ago
  As Medicare is not a universal healthcare system, it is not an exception to a generality about what universal healthcare systems do.
- refurb 8y ago
  Notable exceptions include Medicare in the US being legally forbidden from negotiating drug prices. That's not really accurate. Medicare doesn't negotiate, they just defacto tell drug companies what they'll pay. Plus on the outpatient side, it's the private insurers who negotiation on behalf of Medicare. At any rate, drugs are ~10% of all Medical costs. Why hasn't Medicare negotiated down the other 90%?
athenot 8y ago
In France, they solve that for Drugs with downward pressure by the government. Basically a company that wants to put out a drug has 2 options: - 1. Sell a whatever price they want. But then they don't get a patent and anybody is free to legally copy it. - 2. Get a patent. But then they must enter the cost negotiation process with the government and prove why they require a particular cost. This is the option that is almost always chosen. Sitting in the US, it's then sickening to see the same drug developped in France go for 5x the price, just because they can sell it here for whatever the market will bear.
- refurb 8y ago
  But then they don't get a patent and anybody is free to legally copy it. Do you have a source for that? There are drug covered by patent in France that the gov't doesn't cover.
  - athenot 8y ago
    Did some digging... you are right (I thought there was a patent exclusion for "prix libre" drugs but I guess I was wrong). There's no reimbursement but still a patent. But in that system, no reimbursement kinda kills the market for a dug.
- wahern 8y ago
  The book Against Intellectual Monopoly explains that the reason American and (especially) German pharmaceutical science advanced more quickly than in the U.K. and France in the early part of the 20th century is because it was more difficult to obtain patents on drugs. In Germany in particular IIRC you could obtain a patent on a manufacturing method only, not on a medical use.
grey-area 8y ago
Things like medical supplies that, in the U.S. are significantly more expensive than elsewhere Yes, because a single buyer has enormous purchasing power. The insurance-based system is the reason these costs are so high in the US and lower elsewhere. Would a universal healthcare system only further subsidize that kind of exploitative pricing? It has not in any other country which offers universal healthcare. I have no idea why people in the US are so averse to this idea - you can still have great private healthcare if you wish and can afford it, but public healthcare provides far better healthcare to the poor, lifts people out of poverty, and it's cheaper for everyone too (public expenditure per capita is dramatically lower). Everybody wins.
- dragonwriter 8y ago
  > The insurance-based system is the reason these costs are so high in the US and lower elsewhere. No, that can't explain it, because it's also lower in other places that use a mixed public/private system with mandatory insurance purchase and public fallback for the medically indigent, instead of a single buyer.
  - dasil003 8y ago
    It’s because most people get insurance through their employer so the costs are less visible up and down the line.
    - thfuran 8y ago
      A pretty large portion of the population doesn't get it through employment or does but sees the price because they're paying part of it.
  - beat 8y ago
    Food for thought... Japan also has private insurance/providers, mostly through employers, just like the US. But they have half our cost, universal coverage, and better outcomes. Why? The big difference is that Japan has strict price controls. Insurers and providers don't negotiate with each other (in network vs out of network in the US). Prices are set to make sure providers and insurers are both profitable but not profiteering. Of course, such an idea here would be seen as straight-up Marxism.
mhb 8y ago
Universal doesn't have to mean single payer. Almost all the comments here are conflating them and addressing single payer.

paulddraper 8y ago

Healthcare is expensive largely because the decision-maker does not foot most of the bill. If you have a universal healthcare system that would require mandatory prices.

dragonwriter 8y ago
> Healthcare is expensive largely because the decision-maker does not foot most of the bill. No, it's not, at least that's not the reason it's uniquely high cost in the US compared to the rest of the developed world, because that's not a differentiating factor.
- paulddraper 8y ago
  Kindly help me understand my error. Is there anywhere where (1) prices aren't fixed (2) one party decides which healthcare services to receive (3) a different party pays the bills and (4) cost is significantly less than in the US?

zrail 8y ago

> can a universal healthcare system resolve many of the emerging rent-seeking behavior costs peripheral to the actual hospital costs? Yes. Universal healthcare systems almost all (with some notable exceptions) can and will negotiate with providers and suppliers to control costs. They are typically the largest buyer, so of course they have a lot of negotiating power. Notable exceptions include Medicare in the US being legally forbidden from negotiating drug prices.

dragonwriter 8y ago
As Medicare is not a universal healthcare system, it is not an exception to a generality about what universal healthcare systems do.
refurb 8y ago
Notable exceptions include Medicare in the US being legally forbidden from negotiating drug prices. That's not really accurate. Medicare doesn't negotiate, they just defacto tell drug companies what they'll pay. Plus on the outpatient side, it's the private insurers who negotiation on behalf of Medicare. At any rate, drugs are ~10% of all Medical costs. Why hasn't Medicare negotiated down the other 90%?

athenot 8y ago

In France, they solve that for Drugs with downward pressure by the government. Basically a company that wants to put out a drug has 2 options: - 1. Sell a whatever price they want. But then they don't get a patent and anybody is free to legally copy it. - 2. Get a patent. But then they must enter the cost negotiation process with the government and prove why they require a particular cost. This is the option that is almost always chosen. Sitting in the US, it's then sickening to see the same drug developped in France go for 5x the price, just because they can sell it here for whatever the market will bear.

refurb 8y ago
But then they don't get a patent and anybody is free to legally copy it. Do you have a source for that? There are drug covered by patent in France that the gov't doesn't cover.
- athenot 8y ago
  Did some digging... you are right (I thought there was a patent exclusion for "prix libre" drugs but I guess I was wrong). There's no reimbursement but still a patent. But in that system, no reimbursement kinda kills the market for a dug.
wahern 8y ago
The book Against Intellectual Monopoly explains that the reason American and (especially) German pharmaceutical science advanced more quickly than in the U.K. and France in the early part of the 20th century is because it was more difficult to obtain patents on drugs. In Germany in particular IIRC you could obtain a patent on a manufacturing method only, not on a medical use.

grey-area 8y ago

Things like medical supplies that, in the U.S. are significantly more expensive than elsewhere Yes, because a single buyer has enormous purchasing power. The insurance-based system is the reason these costs are so high in the US and lower elsewhere. Would a universal healthcare system only further subsidize that kind of exploitative pricing? It has not in any other country which offers universal healthcare. I have no idea why people in the US are so averse to this idea - you can still have great private healthcare if you wish and can afford it, but public healthcare provides far better healthcare to the poor, lifts people out of poverty, and it's cheaper for everyone too (public expenditure per capita is dramatically lower). Everybody wins.

dragonwriter 8y ago
> The insurance-based system is the reason these costs are so high in the US and lower elsewhere. No, that can't explain it, because it's also lower in other places that use a mixed public/private system with mandatory insurance purchase and public fallback for the medically indigent, instead of a single buyer.
- dasil003 8y ago
  It’s because most people get insurance through their employer so the costs are less visible up and down the line.
  - thfuran 8y ago
    A pretty large portion of the population doesn't get it through employment or does but sees the price because they're paying part of it.
- beat 8y ago
  Food for thought... Japan also has private insurance/providers, mostly through employers, just like the US. But they have half our cost, universal coverage, and better outcomes. Why? The big difference is that Japan has strict price controls. Insurers and providers don't negotiate with each other (in network vs out of network in the US). Prices are set to make sure providers and insurers are both profitable but not profiteering. Of course, such an idea here would be seen as straight-up Marxism.

mhb 8y ago

Universal doesn't have to mean single payer. Almost all the comments here are conflating them and addressing single payer.