6 ms·

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 c

by 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?
    - dv_dt 8y ago
      If you look at the paper, private drug discovery is creating drugs at a declining rate. I would suggest this is because those private efforts are much less research than development, and it's actually the public system that drives much fundamental research. And the drugs to market rate is in serious decline because of a the widespread application of increasingly austure public funding budgets for medical research causing an early pipeline bottleneck.
      - aantix 8y ago
        When you dump a link to a 60 page pdf and you’re going to reference it, please list the page number and/graph you’re referring to. I don’t want to guess.
- munk-a 8y ago
  Ha! This is a silly talking point that lots of companies bounce around - you know how insulin costs money because it was so expensive to develop... Except no, it was invented in Canada and the researchers released the formula for free[1] as a "benefit to humanity" thing... then a few US companies acquired rights to produce it and proceeded to establish market control in the US - the fact that insulin isn't being sold at cost is just pure greed. And this happens a lot, very often drugs are innovated using public funds and then sold to private companies to produce which milk the consumers for profit - this whole "it pays for R&D" is a pharmaceutical PR line, just like when McDonalds buried their hot coffee lawsuit under "well, if people weren't such klutzes". The US isn't the great innovator here to save us all and a huge proportion of your drug prices cycles back into marketing to sell more of the drug. [1] Technically, they sold it for a dollar to the University of Toronto
  - aantix 8y ago
    Of course it does. Because people don’t buy and use the drug if they don’t know about it..? Money matters. Marketing to recoup costs matters. Piles of cash to get every dollar of return on an investment matters. That allows the company to turn around and invest in future promising drugs, trials, other companies, marketing to bring awareness to the solution and hopefully get people to buy and use it.
    - munk-a 8y ago
      Making sure doctors are well informed about treatment options are one thing... egging patients on to request a possibly mismatched medication and taking doctors out to lunch to encourage the prescription of a possibly mismatched medication is entirely different. The ideal case for drugs is that no one actually needs them so no one takes them - this is a large contributor as to why this market should be heavily nationalized.
      - aantix 8y ago
        The patient can egg on all they want - it’s still the doctor’s (expert) decision whether to prescribe. And as an informed patient, I want to know my options. My doctor and I will discuss trade offs, he’ll sign off if he thinks it’s appropriate.
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...

by dv_dt 8y ago

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?
  - dv_dt 8y ago
    If you look at the paper, private drug discovery is creating drugs at a declining rate. I would suggest this is because those private efforts are much less research than development, and it's actually the public system that drives much fundamental research. And the drugs to market rate is in serious decline because of a the widespread application of increasingly austure public funding budgets for medical research causing an early pipeline bottleneck.
    - aantix 8y ago
      When you dump a link to a 60 page pdf and you’re going to reference it, please list the page number and/graph you’re referring to. I don’t want to guess.
munk-a 8y ago
Ha! This is a silly talking point that lots of companies bounce around - you know how insulin costs money because it was so expensive to develop... Except no, it was invented in Canada and the researchers released the formula for free[1] as a "benefit to humanity" thing... then a few US companies acquired rights to produce it and proceeded to establish market control in the US - the fact that insulin isn't being sold at cost is just pure greed. And this happens a lot, very often drugs are innovated using public funds and then sold to private companies to produce which milk the consumers for profit - this whole "it pays for R&D" is a pharmaceutical PR line, just like when McDonalds buried their hot coffee lawsuit under "well, if people weren't such klutzes". The US isn't the great innovator here to save us all and a huge proportion of your drug prices cycles back into marketing to sell more of the drug. [1] Technically, they sold it for a dollar to the University of Toronto
- aantix 8y ago
  Of course it does. Because people don’t buy and use the drug if they don’t know about it..? Money matters. Marketing to recoup costs matters. Piles of cash to get every dollar of return on an investment matters. That allows the company to turn around and invest in future promising drugs, trials, other companies, marketing to bring awareness to the solution and hopefully get people to buy and use it.
  - munk-a 8y ago
    Making sure doctors are well informed about treatment options are one thing... egging patients on to request a possibly mismatched medication and taking doctors out to lunch to encourage the prescription of a possibly mismatched medication is entirely different. The ideal case for drugs is that no one actually needs them so no one takes them - this is a large contributor as to why this market should be heavily nationalized.
    - aantix 8y ago
      The patient can egg on all they want - it’s still the doctor’s (expert) decision whether to prescribe. And as an informed patient, I want to know my options. My doctor and I will discuss trade offs, he’ll sign off if he thinks it’s appropriate.

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...