3 ms·

1. If the government is guaranteeing it'll pay, why give them a price break? 2. If the reason is passing laws saying you have to give them a price break (as yo

by dlss 12y ago

1. If the government is guaranteeing it'll pay, why give them a price break? 2. If the reason is passing laws saying you have to give them a price break (as you imply in paragraph 2), how is that not price fixing?

gradstudent 12y ago
> If the government is guaranteeing it'll pay, why give them a price break? Because you want to stay in business and there are other healthcare providers the government could use instead? Including those providers that are publicly funded? In the case of expensive drugs, there are a myriad things the government could do including taxpayer subsidies, government health loans and placing limits on the length of the period a private company can exercise monopoly control over substances deemed necessary for universal health.
- msandford 12y ago
  > Because you want to stay in business and there are other healthcare providers the government could use instead? Okay, now suppose that you have a patent on a particular drug or device or procedure and as a result are the monopoly provider of it. Where does the government go to get the lower cost alternative? Where is the downward pressure on your prices?
  - gradstudent 12y ago
    Please refer to my points re subsides, loans and limits. These are not insurmountable problems. Many other countries have figured how to make universal health achievable. IMO it is time America did the same.
    - msandford 12y ago
      >>>> If the government is guaranteeing it'll pay, why give them a price break? >>> Because you want to stay in business and there are other healthcare providers the government could use instead? >> Okay, now suppose that you have a patent on a particular drug or device or procedure and as a result are the monopoly provider of it. Where does the government go to get the lower cost alternative? Where is the downward pressure on your prices? > Please refer to my points re subsides, loans and limits. These are not insurmountable problems. So first you say that market forces will still be in play because the government could always go elsewhere. Then when provided with an example of a situation where market forces cannot come into play, you suggest that legislation can fix it. That is EXACTLY what tptacek was the problem, the loss of MARKET incentives and information. > I'm not sure I follow. Price signals are based on demand. No, no they're not. They're based on supply AND demand. This is literally econ 101. http://en.wikipedia.org/wiki/Supply_and_demand http://en.wikipedia.org/wiki/Supply_and_demand Normally demand goes down as price goes up because more and more entities get priced out of the market. With the government as the sole (or very nearly sole) buyer demand is constant because the government quite literally has a mandate to supply healthcare to the citizens. That means that suppliers have no incentive (short of avoiding legislative action aimed at them which they can cheaply and easily dodge through lobbying) to bring prices down. It's in their interests (read profit motive) to supply as much as they can at as high of a price as they can. This is the problem that people are talking about. > 1. If the government is guaranteeing it'll pay, why give them a price break? Why indeed? The threat of legislative action? See my comments above re: lobbying. Got a way around that? Most of the population of the US would be VERY interested to hear how you circumvent it. So far the only halfway viable strategy is what Lawrence Lessig is doing with mayday.us and that's a long way from making it a solved problem. 2. If the reason is passing laws saying you have to give them a price break (as you imply in paragraph 2), how is that not price fixing? Again, see comments re: lobbying. Unless there is no possible way to circumvent the lobbying problem you're simply proposing that we replace one broken system which you dislike -- and rightly so, it's not that great -- with another broken system which you like. Sure you like it better but others do not. We're at the point of arguing about opinions. "But other countries do it just fine!" you say. Okay sure, but which other countries with single payer systems have the kind of demographics that we do here in the US? Answer: none. They're all relatively small countries (relative to 310mm people) with rather homogeneous demographics (again at least compared to the US). It MIGHT work OK and it MIGHT not be more broken than the system we have now but those aren't guarantees.
      - gradstudent 12y ago
        Way to miss my point. Well done guy. Fight that good fight for unfettered capitalism. Americans don't need no stinking commie health system, amirite? Once again: universal health doesn't mean price regulation. Like any private insurer the government can negotiate for lower prices when multiple providers exist and subsidise the cost when they do not. I also see no problem with limiting monopoly control over life saving substances. That's why we have governments. To act in the best collective interest.
        tptacek 12y ago
        Nothing in this comment thread warranted personal attacks.
        gradstudent 12y ago
        That's a bit unfair. I wasn't making a personal attack; just posting a sardonic rebuttal to a poster who seems to me more interested in pushing a specific ideology than posting a considered response to what I have been saying.
        msandford 12y ago
        > Way to miss my point. Well done guy. Fight that good fight for unfettered capitalism. Americans don't need no stinking commie health system, amirite? This is what bugs me. You're arguing against what you THINK I'm arguing, not against what I'm ACTUALLY arguing. I'm not saying that American healthcare is a paragon of efficiency and low cost. Nor am I arguing against "commie health system" but instead that the idea that having a SINGLE purchaser of medical care will quite likely result in less good information about prices and as a result less efficiency. Right now in the US we have a problem where not enough price information is known: almost no doctors list prices anywhere that a person can find PRIOR to going to a doctor. How could that be remotely efficient? Wanna buy some Microsoft stock? OK just call up a million people who may or may not tell you how much they want for their shares. Depressed yet? That's how terrible the price information is in the medical world. It's no wonder everything is so damn expensive. http://well.blogs.nytimes.com/2014/08/05/why-we-should-know-the-price-of-medical-tests/?_php=true&_type=blogs&partner=rss&emc=rss&_r=0 http://well.blogs.nytimes.com/2014/08/05/why-we-should-know-... http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?pagewanted=all http://www.nytimes.com/2013/05/08/business/hospital-billing-... Yes you can trot out the tired old trope about "but medical care isn't something you can't shop around for!" which is true really only in trauma cases where minutes are the difference between life and death. Got a cold? You've got time. The flu? You can check around. Broken bone? Uncomfortable yes but realistically you could spend 15 minutes on doctor-yelp so long as it's not a blood-gushing compound fracture. Mess up a joint like say an ACL? They're not going to operate on you the same day anyhow so might as well spend an hour reading reviews. Having a kid? Guess what, there's a roughly 9 month lead time on that one. You could spend a week shopping around. > Once again: universal health doesn't mean price regulation. If the government is the only buyer of medical care and they "negotiate" for discounts and don't do business with people who "charge too much" then that's EFFECTIVELY regulation. It might not be in the technical sense; there might be no law saying "an ACL surgery costs $4200" but if the sole purchaser of ACL surgeries says it's not willing to pay more than $4200 that kinda-sorta sets the price. You can argue 'til you're blue in the face on technicalities and whatnot but if it walks like a duck and quacks like a duck most people will agree that its a duck.
  - pgeorgi 12y ago
    compulsory licensing of critical patents with non-cooperative license holders is in the law.

by dlss 12y ago

gradstudent 12y ago

> If the government is guaranteeing it'll pay, why give them a price break? Because you want to stay in business and there are other healthcare providers the government could use instead? Including those providers that are publicly funded? In the case of expensive drugs, there are a myriad things the government could do including taxpayer subsidies, government health loans and placing limits on the length of the period a private company can exercise monopoly control over substances deemed necessary for universal health.

msandford 12y ago
> Because you want to stay in business and there are other healthcare providers the government could use instead? Okay, now suppose that you have a patent on a particular drug or device or procedure and as a result are the monopoly provider of it. Where does the government go to get the lower cost alternative? Where is the downward pressure on your prices?
- gradstudent 12y ago
  Please refer to my points re subsides, loans and limits. These are not insurmountable problems. Many other countries have figured how to make universal health achievable. IMO it is time America did the same.
  - msandford 12y ago
    >>>> If the government is guaranteeing it'll pay, why give them a price break? >>> Because you want to stay in business and there are other healthcare providers the government could use instead? >> Okay, now suppose that you have a patent on a particular drug or device or procedure and as a result are the monopoly provider of it. Where does the government go to get the lower cost alternative? Where is the downward pressure on your prices? > Please refer to my points re subsides, loans and limits. These are not insurmountable problems. So first you say that market forces will still be in play because the government could always go elsewhere. Then when provided with an example of a situation where market forces cannot come into play, you suggest that legislation can fix it. That is EXACTLY what tptacek was the problem, the loss of MARKET incentives and information. > I'm not sure I follow. Price signals are based on demand. No, no they're not. They're based on supply AND demand. This is literally econ 101. http://en.wikipedia.org/wiki/Supply_and_demand http://en.wikipedia.org/wiki/Supply_and_demand Normally demand goes down as price goes up because more and more entities get priced out of the market. With the government as the sole (or very nearly sole) buyer demand is constant because the government quite literally has a mandate to supply healthcare to the citizens. That means that suppliers have no incentive (short of avoiding legislative action aimed at them which they can cheaply and easily dodge through lobbying) to bring prices down. It's in their interests (read profit motive) to supply as much as they can at as high of a price as they can. This is the problem that people are talking about. > 1. If the government is guaranteeing it'll pay, why give them a price break? Why indeed? The threat of legislative action? See my comments above re: lobbying. Got a way around that? Most of the population of the US would be VERY interested to hear how you circumvent it. So far the only halfway viable strategy is what Lawrence Lessig is doing with mayday.us and that's a long way from making it a solved problem. 2. If the reason is passing laws saying you have to give them a price break (as you imply in paragraph 2), how is that not price fixing? Again, see comments re: lobbying. Unless there is no possible way to circumvent the lobbying problem you're simply proposing that we replace one broken system which you dislike -- and rightly so, it's not that great -- with another broken system which you like. Sure you like it better but others do not. We're at the point of arguing about opinions. "But other countries do it just fine!" you say. Okay sure, but which other countries with single payer systems have the kind of demographics that we do here in the US? Answer: none. They're all relatively small countries (relative to 310mm people) with rather homogeneous demographics (again at least compared to the US). It MIGHT work OK and it MIGHT not be more broken than the system we have now but those aren't guarantees.
    - gradstudent 12y ago
      Way to miss my point. Well done guy. Fight that good fight for unfettered capitalism. Americans don't need no stinking commie health system, amirite? Once again: universal health doesn't mean price regulation. Like any private insurer the government can negotiate for lower prices when multiple providers exist and subsidise the cost when they do not. I also see no problem with limiting monopoly control over life saving substances. That's why we have governments. To act in the best collective interest.
      - tptacek 12y ago
        Nothing in this comment thread warranted personal attacks.
        gradstudent 12y ago
        That's a bit unfair. I wasn't making a personal attack; just posting a sardonic rebuttal to a poster who seems to me more interested in pushing a specific ideology than posting a considered response to what I have been saying.
      - msandford 12y ago
        > Way to miss my point. Well done guy. Fight that good fight for unfettered capitalism. Americans don't need no stinking commie health system, amirite? This is what bugs me. You're arguing against what you THINK I'm arguing, not against what I'm ACTUALLY arguing. I'm not saying that American healthcare is a paragon of efficiency and low cost. Nor am I arguing against "commie health system" but instead that the idea that having a SINGLE purchaser of medical care will quite likely result in less good information about prices and as a result less efficiency. Right now in the US we have a problem where not enough price information is known: almost no doctors list prices anywhere that a person can find PRIOR to going to a doctor. How could that be remotely efficient? Wanna buy some Microsoft stock? OK just call up a million people who may or may not tell you how much they want for their shares. Depressed yet? That's how terrible the price information is in the medical world. It's no wonder everything is so damn expensive. http://well.blogs.nytimes.com/2014/08/05/why-we-should-know-the-price-of-medical-tests/?_php=true&_type=blogs&partner=rss&emc=rss&_r=0 http://well.blogs.nytimes.com/2014/08/05/why-we-should-know-... http://www.nytimes.com/2013/05/08/business/hospital-billing-varies-wildly-us-data-shows.html?pagewanted=all http://www.nytimes.com/2013/05/08/business/hospital-billing-... Yes you can trot out the tired old trope about "but medical care isn't something you can't shop around for!" which is true really only in trauma cases where minutes are the difference between life and death. Got a cold? You've got time. The flu? You can check around. Broken bone? Uncomfortable yes but realistically you could spend 15 minutes on doctor-yelp so long as it's not a blood-gushing compound fracture. Mess up a joint like say an ACL? They're not going to operate on you the same day anyhow so might as well spend an hour reading reviews. Having a kid? Guess what, there's a roughly 9 month lead time on that one. You could spend a week shopping around. > Once again: universal health doesn't mean price regulation. If the government is the only buyer of medical care and they "negotiate" for discounts and don't do business with people who "charge too much" then that's EFFECTIVELY regulation. It might not be in the technical sense; there might be no law saying "an ACL surgery costs $4200" but if the sole purchaser of ACL surgeries says it's not willing to pay more than $4200 that kinda-sorta sets the price. You can argue 'til you're blue in the face on technicalities and whatnot but if it walks like a duck and quacks like a duck most people will agree that its a duck.
- pgeorgi 12y ago
  compulsory licensing of critical patents with non-cooperative license holders is in the law.