5 ms·

Italy has a thriving market based private health care industry. You can call in and get prices and everything. Just that it's in addition to the single payer s

by davidw 8y ago

Italy has a thriving market based private health care industry. You can call in and get prices and everything. Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'. As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives. I mention Italy because 1) I lived there and 2) it's not some perfectly run place where everything works. It's not, and yet the health care is still better, overall, than in the US.

conanbatt 8y ago
> Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free' Eek. This is also called crowding out. It means expensive but efficient health services can't survive. It might be a decent compromise but I would call it a success.
dv_dt 8y ago
All other first world nations pay less. On average they pay less than half what the US pays. The fully socialized systems, like the UK, seem to trend lower in cost, as low as one third the cost of the US. But really, the takeaway should be you need universal healthcare with significant government cost controls on drugs and procedures, after that almost any arrangement of public/private administration works (but the caveat that it looks like the more private companies are in the healthcare mix, the higher the costs seem to run).
- aantix 8y ago
  Without the U.S. subsidizing the drug research R&D, who pays for it? You could fill notebooks with worthy, approachable hypotheses for any number of diseases that could show promise if given the funding. But if everyone makes it law to cap prices - fewer scientists, labs, studies are performed. The money has to come from somewhere. I think countries take for granted the progress we've made. No progress is made without incredible intellectual efforts and monetary backings.
  - 8note 8y ago
    Isn't the R&D money for scientists and labs coming from the US government? business drug R&D follows the "which drug patents can we buy and Jack the prices up for extra profit?"
  - antisthenes 8y ago
    > Without the U.S. subsidizing the drug research R&D, who pays for it? I wish we could stop using this tired trope once and for all in debates about medical care. Most medical care is routine and does not require cutting edge drugs. Things like insulin, epinephrine, anesthetics, antibiotics, antihistamines, vaccines, most of those things have been developed in the 1st half of the 20th century. How much do the cutting age drugs account for in the scope of the total health care costs in the US? Even if it was higher than 1% (I'm willing to bet money that it isn't), the marketing budgets for drug companies far exceed their R&D spending.
  - dv_dt 8y ago
    This paper gives pretty interesting breakdown of how private companies are increasingly bad at paying for it. https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-purpose/files/peoples_prescription_report_final_online.pdf https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-p... One quote from the paper: In the last ten years, Pizer has spent US$139 billion on share buybacks and dividends compared to US$82 billion on R&D. Edit: It shouldn't require massive profit margins to make the drug industry work for a basic human need like healthcare. Other sectors for human basics like the grocery industry, run on margins of 1-5%.
    - aantix 8y ago
      Food production is predictable. Finding a safe, effective treatment for Alzheimer’s is not. If you want thin margins, maybe government research wing can take its findings from idea to market (imagine waiting on a cure and that’s your only hope?) But you can’t force a private company to operate on low margins by way of capping prices, you’ll kill them. You can’t taje away their ability to control their risks (cash flow). Drug R&D already has a huge failure rate and now the company can only take a 5% profit on the slight chance they’ve found something effective?
- davidw 8y ago
  The Economist did a nice comparison of different systems a few years back: https://www.economist.com/united-states/2017/08/10/the-fix-for-american-health-care-can-be-found-in-europe https://www.economist.com/united-states/2017/08/10/the-fix-f...
  - js2 8y ago
    Similarly, a Frontline episode: https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ An excellent book on the subject ("The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care"): https://www.amazon.com/Healing-America-Global-Better-Cheaper/dp/0143118218 https://www.amazon.com/Healing-America-Global-Better-Cheaper... And a comparison by The Commonwealth Fund: http://international.commonwealthfund.org/ http://international.commonwealthfund.org/ And just a reminder how long the U.S. has been having this argument: https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_1993 https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_19... And a quote from that page: The long-term political effects of a successful... health care bill will be even worse—much worse.... It will revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government. — William Kristol, "Defeating President Clinton's Healthcare Proposal", December 1993
- btown 8y ago
  > the more private companies are in the healthcare mix, the higher the costs seem to run One worrying thing about single-payer healthcare in America is that we can look at other countries with a _rich history_ of single-payer healthcare from before the modern era [0] and see that they have developed efficient public healthcare systems, but it does not follow that our system, with its similarly rich history of for-profit entities developing methods to thrive in the weird world of American health insurance, can be immediately brought to a level of cost efficiency that is comparable. Consider, for instance, how much ownership of the healthcare space is held by private equity firms in the U.S. I'd love to see a great transition plan towards single payer, but it would need to be one that takes into account that the operators have no inherent incentive to reduce costs. [0] http://www.euro.who.int/__data/assets/pdf_file/0020/96410/E73430.pdf http://www.euro.who.int/__data/assets/pdf_file/0020/96410/E7...
  - dv_dt 8y ago
    Medicare for all plans a two year transition. There are already mechanisms to expand to set payment costs for procedures in Medicare. We would have to extend those to cover a system of setting fairer prices for drugs - as medicare is legally prohibited from negotiating drug prices currently. That's a legal precedent, not a cultural one. But basically, future history begins today. I don't see why because we historically have an ineffective system, we shouldn't strive to build a working system.
  - munk-a 8y ago
    It might be hard to find... unless you take a gander up north, Canadian public health care is a recent thing and the transition was flow and began with regional efforts. This[1] is a nice little rough timeline of things that happened. And, to be honest, it's not done yet, Canada lacks national pharma coverage (most places having provincial coverage of a sort) and entirely lacks dental & vision coverage, the later is a bit arguable but poor dental care has been strongly linked to heart disease. [1] https://www.healthcoalition.ca/tools-and-resources/history-of-canadas-public-health-care/ https://www.healthcoalition.ca/tools-and-resources/history-o...
clairity 8y ago
i'm keen on the idea that such a model of a government entity (or two) in competition with an open market would provide the most favorable outcome, because a truly free and fair market (one where competition leads to efficiency and low prices) seems mythically distant at this point. government entities can get subsumed by politics and bureaucracy, while private markets can get distorted by poor regulations and anti-competitive practices. if bureaucrats can get thrown out for not being competitive with the private companies, and private companies can go out of business for not being efficient and serving customers well, we might get decent service-oriented entities in the market. many goods that don't fit the simple paradigm of commerce (e.g., housing) can benefit from such a model.
- davidw 8y ago
  > politics and bureaucracy Health care was way less bureaucratic in Italy. Every time you go to the doctor in the US, you fill out forms. And then hand them to the person in the office who spends their days doing insurance stuff. In Italy - you just go to the doctor.
- nybble41 8y ago
  > a government entity (or two) in competition with an open market Meaningful competition cannot exist between tax-funded and voluntarily-funded service providers. Anyone who chooses the private provider ends up paying for both. The only way to ensure a level playing field is for the "government" entity to be limited to essentially a co-op, receiving no government funding or special influence and adhering to all the same rules which apply to private providers, in which case it might as well not be a government entity in the first place. Even then there is an obvious conflict of interest since the organization that makes and enforces the rules is also backing one of the competitors.

by davidw 8y ago

conanbatt 8y ago

> Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free' Eek. This is also called crowding out. It means expensive but efficient health services can't survive. It might be a decent compromise but I would call it a success.

dv_dt 8y ago

All other first world nations pay less. On average they pay less than half what the US pays. The fully socialized systems, like the UK, seem to trend lower in cost, as low as one third the cost of the US. But really, the takeaway should be you need universal healthcare with significant government cost controls on drugs and procedures, after that almost any arrangement of public/private administration works (but the caveat that it looks like the more private companies are in the healthcare mix, the higher the costs seem to run).

aantix 8y ago
Without the U.S. subsidizing the drug research R&D, who pays for it? You could fill notebooks with worthy, approachable hypotheses for any number of diseases that could show promise if given the funding. But if everyone makes it law to cap prices - fewer scientists, labs, studies are performed. The money has to come from somewhere. I think countries take for granted the progress we've made. No progress is made without incredible intellectual efforts and monetary backings.
- 8note 8y ago
  Isn't the R&D money for scientists and labs coming from the US government? business drug R&D follows the "which drug patents can we buy and Jack the prices up for extra profit?"
- antisthenes 8y ago
  > Without the U.S. subsidizing the drug research R&D, who pays for it? I wish we could stop using this tired trope once and for all in debates about medical care. Most medical care is routine and does not require cutting edge drugs. Things like insulin, epinephrine, anesthetics, antibiotics, antihistamines, vaccines, most of those things have been developed in the 1st half of the 20th century. How much do the cutting age drugs account for in the scope of the total health care costs in the US? Even if it was higher than 1% (I'm willing to bet money that it isn't), the marketing budgets for drug companies far exceed their R&D spending.
- dv_dt 8y ago
  This paper gives pretty interesting breakdown of how private companies are increasingly bad at paying for it. https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-purpose/files/peoples_prescription_report_final_online.pdf https://www.ucl.ac.uk/bartlett/public-purpose/sites/public-p... One quote from the paper: In the last ten years, Pizer has spent US$139 billion on share buybacks and dividends compared to US$82 billion on R&D. Edit: It shouldn't require massive profit margins to make the drug industry work for a basic human need like healthcare. Other sectors for human basics like the grocery industry, run on margins of 1-5%.
  - aantix 8y ago
    Food production is predictable. Finding a safe, effective treatment for Alzheimer’s is not. If you want thin margins, maybe government research wing can take its findings from idea to market (imagine waiting on a cure and that’s your only hope?) But you can’t force a private company to operate on low margins by way of capping prices, you’ll kill them. You can’t taje away their ability to control their risks (cash flow). Drug R&D already has a huge failure rate and now the company can only take a 5% profit on the slight chance they’ve found something effective?
davidw 8y ago
The Economist did a nice comparison of different systems a few years back: https://www.economist.com/united-states/2017/08/10/the-fix-for-american-health-care-can-be-found-in-europe https://www.economist.com/united-states/2017/08/10/the-fix-f...
- js2 8y ago
  Similarly, a Frontline episode: https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/ An excellent book on the subject ("The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care"): https://www.amazon.com/Healing-America-Global-Better-Cheaper/dp/0143118218 https://www.amazon.com/Healing-America-Global-Better-Cheaper... And a comparison by The Commonwealth Fund: http://international.commonwealthfund.org/ http://international.commonwealthfund.org/ And just a reminder how long the U.S. has been having this argument: https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_1993 https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_19... And a quote from that page: The long-term political effects of a successful... health care bill will be even worse—much worse.... It will revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government. — William Kristol, "Defeating President Clinton's Healthcare Proposal", December 1993
btown 8y ago
> the more private companies are in the healthcare mix, the higher the costs seem to run One worrying thing about single-payer healthcare in America is that we can look at other countries with a _rich history_ of single-payer healthcare from before the modern era [0] and see that they have developed efficient public healthcare systems, but it does not follow that our system, with its similarly rich history of for-profit entities developing methods to thrive in the weird world of American health insurance, can be immediately brought to a level of cost efficiency that is comparable. Consider, for instance, how much ownership of the healthcare space is held by private equity firms in the U.S. I'd love to see a great transition plan towards single payer, but it would need to be one that takes into account that the operators have no inherent incentive to reduce costs. [0] http://www.euro.who.int/__data/assets/pdf_file/0020/96410/E73430.pdf http://www.euro.who.int/__data/assets/pdf_file/0020/96410/E7...
- dv_dt 8y ago
  Medicare for all plans a two year transition. There are already mechanisms to expand to set payment costs for procedures in Medicare. We would have to extend those to cover a system of setting fairer prices for drugs - as medicare is legally prohibited from negotiating drug prices currently. That's a legal precedent, not a cultural one. But basically, future history begins today. I don't see why because we historically have an ineffective system, we shouldn't strive to build a working system.
- munk-a 8y ago
  It might be hard to find... unless you take a gander up north, Canadian public health care is a recent thing and the transition was flow and began with regional efforts. This[1] is a nice little rough timeline of things that happened. And, to be honest, it's not done yet, Canada lacks national pharma coverage (most places having provincial coverage of a sort) and entirely lacks dental & vision coverage, the later is a bit arguable but poor dental care has been strongly linked to heart disease. [1] https://www.healthcoalition.ca/tools-and-resources/history-of-canadas-public-health-care/ https://www.healthcoalition.ca/tools-and-resources/history-o...

clairity 8y ago

i'm keen on the idea that such a model of a government entity (or two) in competition with an open market would provide the most favorable outcome, because a truly free and fair market (one where competition leads to efficiency and low prices) seems mythically distant at this point. government entities can get subsumed by politics and bureaucracy, while private markets can get distorted by poor regulations and anti-competitive practices. if bureaucrats can get thrown out for not being competitive with the private companies, and private companies can go out of business for not being efficient and serving customers well, we might get decent service-oriented entities in the market. many goods that don't fit the simple paradigm of commerce (e.g., housing) can benefit from such a model.

davidw 8y ago
> politics and bureaucracy Health care was way less bureaucratic in Italy. Every time you go to the doctor in the US, you fill out forms. And then hand them to the person in the office who spends their days doing insurance stuff. In Italy - you just go to the doctor.
nybble41 8y ago
> a government entity (or two) in competition with an open market Meaningful competition cannot exist between tax-funded and voluntarily-funded service providers. Anyone who chooses the private provider ends up paying for both. The only way to ensure a level playing field is for the "government" entity to be limited to essentially a co-op, receiving no government funding or special influence and adhering to all the same rules which apply to private providers, in which case it might as well not be a government entity in the first place. Even then there is an obvious conflict of interest since the organization that makes and enforces the rules is also backing one of the competitors.