Socialism in healthcare brings rationing, waiting lists, supply shortages and all the kinds of things you don't want when dealing with people's lives.
This isn't always true. The UK is single-payer, and their wait times are lower than in the US[1].
Even if that were true, those things are acceptable on average as long as outcomes improve. Australia, the UK, and France (all single-payer) have longer life expectancy[2] than the US.
In fact, the UK is doing better than the US in nearly every health-related metric[3]
> and all the kinds of things you don't want when dealing with people's lives.
So "better care for people who can pay more" is a better system? That's what we want when dealing with people's lives?
If anything should be socialized, it's health care. No one should die because they weren't born with the opportunity to work a high-paying job or accumulate wealth.
1. https://www.theguardian.com/society/2015/aug/25/gp-appointme...
2. https://data.oecd.org/healthstat/life-expectancy-at-birth.ht...
3. http://www.commonwealthfund.org/publications/fund-reports/20...
Don't phrase this as an alternative - those able to pay more can still buy themselves better care, they're being denied nothing except to watch the poor die of illness: https://en.wikipedia.org/wiki/Private_medicine_in_the_UK
"Health-care quality in proportion to wealth" -- the poor get worse care because they can't afford to pay for gold-standard care.
Yes, and that "somebody" is the US. Drug prices are high in the US because the US is responsible for funding the the majority of medical and pharmaceutical research for the entire world. Countries like the UK benefit from the research that is being paid by the US, while not actually having to find the R&D that goes into it.
A statement entirely unsupported by data. If pharmaceutical companies spent on R&D only the money earned due the inflation of US prices, they'd still have plenty left over: http://healthaffairs.org/blog/2017/03/07/rd-costs-for-pharma...
You could just as well say the US funds the majority of drug advertising for the entire world - they spend more on ads than R&D: http://www.bbc.com/news/business-28212223
Not to mention everything from vital new medicine, to reproducing generics of other companies, and drug reformulations to prolong patents, gets thrown under R&D. If you only count the R&D spending that's not done solely to steal market share from other companies, the ads vs. R&D ratio is even more dire.
So given they post more profits and more ad spending each than R&D spending, at what point would it be okay to stop raising drug prices? When profits are >10x their R&D?
But that's not equivalent to the statement "The US provides the funding for the majority of R&D that the rest of the world benefits from".
If you think that pharmaceutical companies should spend less of their money on R&D, or more on it, that's not really relevant. Whatever research pharmaceutical companies are doing, that's being disproportionately funded by the US market. That's a plainly evident statement; it's right there in their financial sheets.
> You could just as well say the US funds the majority of drug advertising for the entire world
No, because research is a wholly non-excusable good in the global market. Advertising is not.
> they spend more on ads than R&D
Again, not really the point.
Again you're looking at the wrong denominator (fraction of spending spent on R&D, rather than fraction of R&D spending that's funded by the US).
Furthermore, I never made any claims about "good and necessary". It looks like you're interested in having a discussion about a different topic altogether, rather than the original statement.
I believed this until very recently. I had a long discussion on Facebook with some friends in medical research and public policy. I learned that only a fraction of drug costs are due to this issue.
Furthermore, slightly less than 10% of all health-care spending in the US is on drugs.
It's an issue, but it's a relatively smaller one than I'd thought, and it's not as clear as "the US subsidizes other countries."
Literally 50% of medical research in the world happens in the US, and even more is funded (indirectly) by the US market. In the last two years, that number has dropped slightly below 50%, but only because of rapid growth in China and India.
This is all medical research, not just pharmaceutical research. But yes, it is actually responsible for the bulk of drug prices in the US, through a combination of both direct and indirect effects. Even pharmaceutical companies based in Europe still use the US as the primary source of funding their research.
Pharmaceutical companies reap their profits from the US because that's where it's easiest to do so, and because the US is the largest non-developing country. If, overnight, the US capped drug costs[0], a combination of two things would happen: pharmaceutical research would drop dramatically (some would move to China and India, but some would just exit the industry) and drug costs in other developing countries would skyrocket.
Or in other words, for the US to pay less in drug costs, other developed countries have to be ready to pay more, and the world has to be ready to accept a decrease in medical research.
> Furthermore, slightly less than 10% of all health-care spending in the US is on drugs.
That doesn't contradict the original point; that's just looking at a different denominator. And again, this is all medical research, not just pharmaceuticals.
[0] ignoring for the moment the mechanism of doing so
Because the UK is single-payer, they have enormous negotiating power -- and they use it[1]. They force drug companies to give them low prices, which means the US indirectly pays some of the costs of the research.
However, drugs can be very profitable, so you could just as easily say that all the countries share the cost of the research, and the US subsidizes the profits of the private companies.
1. https://qz.com/509344/the-way-to-fix-outrageous-drug-pricing...
Sure, though only if you assume that the companies would pursue the same research and achieve the same results without a profit incentive.
Except, we have pretty clear empirical evidence that that isn't the case. The overwhelming majority of both medical research spending and clinical medical discoveries come out of organizations that pursue a profit motive. That's true globally - it's true in the US, in Europe, and in China and India.
And even then, you can't say that companies "share the cost of research equally", because there is literally no objective metric under which European countries pay an amount of research proportional to how much they consume. Even European pharmaceutical companies obtain the bulk of their research funds from the US market.
Stop spreading nonsense. This is easily verifiable information and very easy to disprove.
Take Norvatis for example:
https://www.statista.com/statistics/294631/novartis-revenue-...
The US is definitely not the "bulk" of revenue for these companies. A big market? Sure. But nothing special when compared to other rich countries if you take into account population and wealth.
Yes, if we normalize by the things we're measuring, we reduce the observed effect... but that's a statistical tautology.
For example, take Western European country prices as a reference point, and assume that the difference in price to the US is entirely an excess premium. That's already a dramatic overestimate, because it assumes that the prices in Europe would still be as low even without the US market, which we already know is not the case.
In that case, Norvartis earned $8.6 billion from inflated prices in the US in 2015. And in 2015, their entire R&D budget was $9.9 billion, on a net income of $6.7 billion.
In other words, if US prices were magically brought down to European levels, Novartis would somehow have to find another way to make up a sum of money that accounts for almost their entire R&D budget.
And even if you assume that the second largest pharmaceutical company in the world would operate the exact same way without an explicit profit motive, without the inflated prices in the US, they would literally be losing money.
> Stop spreading nonsense.
From the Hacker New Guidelines:
> Be civil. Don't say things you wouldn't say in a face-to-face conversation. Avoid gratuitous negativity.
And I do believe people need to have food. Every developed country agrees, which is why there are welfare and food programs. They're inadequate and often leave people behind, but the goal is that no one dies just from being poor.
I disagree. Lifespan, quality of life and health all depend on all those.
> And I do believe people need to have food. Every developed country agrees, which is why there are welfare and food programs. They're inadequate and often leave people behind, but the goal is that no one dies just from being poor.
Sure, but not any kind of food at any price. The equivalent would be basic medical care, not advanced cancer treatment solutions.
I personally resist the idea that any human life is of infinite value, since it conflicts with the basic reality that economically, we trade some lives for others. Reducing cost is fruitful for everyone but the traders and professionals: supporting any cost as a right is fruitful for the traders and professionals and the recipients at the cost of the givers.
And in reality, the givers tend to be the poor more frequently than the rich.
I understand the sentiment but that is simply not true. If someone gets cancer and requires the lifetime work of 10 people to survive, then guaranteeing that treatment for everyone would be have very negative results.
Life does have a value and a cost, and its not worth spending great amounts of achieve little results. 1000,000U$S might save the lives of a lot of people, but 1000,000U$S cancer treatment might just prolong the life of a single one.
1) Living people are taxpayers and consumers. Dead people are not.
2) This is the whole point of insurance. Very few people will be very expensive and most people will be relatively inexpensive. With preventative care and the advancement of research, fewer people should be expensive over time.
Regardless, the US, as a society, has more than enough money. There's no reason for someone to buy his second $50M yacht while someone else dies of the flu because they couldn't afford the $25 vaccine.
3) You can make these hyper-rationalist arguments, but the vast majority of people are willing to pay a lot of money to live in a society that doesn't just let them die of something curable.
I genuinely believe that people who are uninterested in the social contract of the US or other developed nations should be allowed to "opt out" of society: the citizens of the nation will pay for transport to any border of the country, and then citizenship is permanently lost.
In the example above, you get maybe 5 years + taxpayer+consumer - 10 lifetimes, which is a deficit both for taxpayers and consumers.
> This is the whole point of insurance. Very few people will be very expensive and most people will be relatively inexpensive. With preventative care and the advancement of research, fewer people should be expensive over time.
Basically everyone needs some sort of medical care. True, the most expensive cases are rare and they befit insurance, but medical costs are normally not about insurance. Checkups, dentists, basic clinical appointments, etc are not great cases for insurance.
That is, hard diseases can be convered by life insurance, without the need for socialized healthcare for the rest.
> Regardless, the US, as a society, has more than enough money. There's no reason for someone to buy his second $50M yacht while someone else dies of the flu because they couldn't afford the $25 vaccine.
This is a typical rabbit hole argument where it turns out nobody wants to donate their salary until they reach the lowest percentile of income to make it fair. Because who are you to spend your money on a vegan deluxe burger when people are dying of malnutrition!
Blaming rich people for hardships is akin to blaming immigrants for it, on the other side of the political spectrum. They guy with the 50 million dollars did not make the rest poor, in fact its possibly the exact opposite.
There is a lot of ideology in the mere presentation of that argument, i fear this can take a bad turn :).
> You can make these hyper-rationalist arguments, but the vast majority of people are willing to pay a lot of money to live in a society that doesn't just let them die of something curable
I somehow doubt thats really true, otherwise it wouldnt be a debate at all...
See: Europe. High taxes, strong social safety net. The "debate" is a minority of highly vocal people.
This morning my girlfriend was sick. She called her doc, got an appointment for the very afternoon.
The visit, buying the med and getting a certificate for 3 days off work took us all in all 2 hours.
She paid most of the bills using her health care card, so in total it was less than 50 euros from her pocket.
The day off will be paid in full.
Tell me again how we suffered from "waiting lists, supply shortages and all the kinds of things you don't want when dealing with people's lives".
Cause right now my life is god damn awesome.
It has been for the last 3 decades, including when I got malaria in Africa and the french system refunded me, or when I break my arms multiple times, or got my appendice removed.
I always though that the US system was that bad compared to ours from the people POV because french companies paid a lot more. Now I see it's not even the case.
Maybe, but Le Pen got a lot more interest than she should have. If the economy was roaring and France was "awesome" would that happen?
Le Pen voters are angry for some part, yes. They're the ones with the fewest resources, yes. And you know what? They still get the same health care as anyone else.
One of the consequences of government-provided services, for example, is that it pits native citizens against 'new' and aspiring citizens on the years that everyone decides life is a zero sum game.
Nobody has "everything" figured out, and health care (and paying for it) is a problem everywhere. It's just that comparatively...well, there really is no comparison. In comparison, it is awesome. And I've lived both in the US and in different parts of Europe.
The French voted a 2/3 against Le Pen. The US voted 48:46 against Trump (and got him anyway).
It pits nobody against nobody. It's (almost) universal healthcare, including for non citizens.
What you even mean by "socialism in healthcare" ? Is it a trigger-word for Americans so they switch off their brain ?
Anyway, in most west EU countries, public-run health care works very well. It's more efficient by a vast margin : no marketing cost, no middle-man overhead, no for-profit requirement.
In fact in France we are currently evaluating getting rid of private sector altogether, as recent reports showed it would be much cheaper and better overall.
People with disposable income/high healthcare needs aren't dying in countries with single-payer insurance. Indeed, they're able to purchase private healthcare, while the broader population gets better health than the US population.
Honestly, it looks like this 'socialism' thing works a lot better for peoples' health than what's happening in the US.
[0] There's a distinction between "public" (gesetzlich) and "private" (privat) health insurance, but neither is run by the government. Public insurers are private organizations. The difference is in what is covered (all public insurers provide essentially the same cover), and how they are funded (the cost of public insurance depends on income, while private insurers can set their own prices). There is an income threshold below which one is required to take public insurance; private insurance is seen by many as kind of a scam. Private insurance is generally cheaper for young people, but one can't easily switch from private to public, so you'd better be sure your income will continue to be high as you get old and premiums go up.
And they do have single payer in a sense. The consumer pays the doctor and is reimbursed by a health insurer. Something that pretty much seems like it might not work well in the US, without very tight reins on the insurer reimbursement timeline and approval.
Well as someone from Canada, living in a provincial capital, who can't get a doctor (for years), I'd say I agree with the OP.
I guess the family doctor waiting list I've been on for two years and counting is simply a "bogeyman".
No, but it's a problem coast to coast, apparently.
>every time I actually try to access healthcare it seems to work much better than my friends led me to believe it would.
You sound healthy. Not everyone is so lucky.
Also, it seems that your condition isn't life-threatening (considering you're posting here and all). While the average, generally healthy, person will likely need to wait longer, they at least have access to care in developed countries outside the US.
The final point I would add is that private healthcare is still available, even if only available in a different country. I think that's a reasonable trade off- most people can get care readily, while those who need more can pay more to get more timely care.
Germany is interesting, depending of your annual income and your work contract, you can either go with a private health insurance and a public health insurance. Only about 10% of the population is going with the private system. Once you decided to go private, you cannot go back to the public insurance. At the moment, a lot of people regret their switch to the private system, because with low interest rates, the insurance costs have been increasing drastically.
In fact, proponent of a total privatization of the German health insurance system are now backtracking and thinking about the reverse, stopping the private system (but if the interest rates rocket again, I suppose the private system will make money again).
For that, Germany is pretty interesting as it allows observation of two parallel systems within the same country with the "best case scenario" for the private system because only rich people and state employees are allowed to go with a fully private health insurance.
My personal opinion is that health insurance like education is a basic "right" but this has nothing to do with the effectiveness of one approach or another, just an opinion.
Wow, it seems there may have been an interesting series of political deals that led to these particular eligibility criteria.
There is no waiting lists or rationing and many countries do well with this setup.
It has been years since Soviet Union collapsed, it is amazing to see same boogeyman yet again.
This is nonsense. Someone has to decide if a procedure is worth the cost. If it's not the patient (who isn't paying) and it's not an insurer (though who wants that?), it's the government.
Deciding a procedure isn't appropriate or worth the cost is rationing. In a bureaucratic system, you have bureaucrats deciding what procedures are for whom and when.
No it isn't.
> Someone has to decide if a procedure is worth the cost. If it's not the patient (who isn't paying)
In Belgium, it is the doctor together with the patient. If a procedure is medically justified, cost doesn't factor into the equation.
> In a bureaucratic system, you have bureaucrats deciding what procedures are for whom and when.
That is simply false.
Of course it does. There are rules saying what procedures are urgent, which ones are legitimate, and which treatments are covered and at what prices. The government doesn't write a blank check for doctors and patients to fill out.
[1] http://www.mloz.be/nl/art/dure-geneesmiddelen-structurele-ma...
In northern Italy I have seen two "simple" (easily removed surgically) cancer cases going through all diagnostic steps in less than 2 months (including ultrasound, biopsies, CT scans), followed by surgery and/or radiotherapy, all at absolutely zero cost for the patient.
If you need heart surgery (valve replacement, coronary stents, stuff like that), your GP can get you an ambulance straight to the ICU, and you can stay there for free until everything is ready for surgery, maybe in a couple days.
Surgical operations are split into 2 groups - planned and unplanned. In planned enter people that could wait a bit.
If there is good medical reason that you cannot wait you get the treatment on the spot.
You only have real waiting lists for transplants.
And in what way is that not a waiting list?
It is best for both the purse of the system and the patient if needed but not urgent stuff is done at time convenient to all parties. This way everybody could be prepared. The hoapitals will stock the right amount of supplies, the bloodbanks will know how much and what kind of blood is needed in advance and so on. The patient will make sure all mission critical projects are taken care of for the rehabilitation time etc.
The most convenient time for me for my knee surgery was yesterday the most convenient time for the hospital was in 4-6 month. Guess who's convenience was taken into consideration.
Its always me-me-me. Screw everybody else's needs. If i cant get get what i the second i ask for it then the system muat be horrible.
Would you be able to cut the waiting time in this country by paying more? What would be the waiting time without paying extra (which I'm sure the insurance company would not approve) in the US?
4-6 months worth of other patients with similar needs?
And while I guess knee surgery is technically 'elective' as in I could elect to not be able to carry heavy things and have trouble getting up stairs, I'm not quite sure I'd use that term.
As for using the term "elective", I would use that term, given it has a specific definition: https://en.wikipedia.org/wiki/Elective_surgery
> Elective surgery or elective procedure (from the Latin eligere, meaning to choose) is surgery that is scheduled in advance because it does not involve a medical emergency. Semi-elective surgery is a surgery that must be done to preserve the patient's life, but does not need to be performed immediately.
Call it what you want, but that is literally rationing a scarce resources
On the other hand the people that need lets say hip replacement will get it. The system have enough capacity and budget to serve their medical needs. But it works better if the people are properly spaced.
So (excepting some triage) they put people on a _list_ of people that need hip replacements and make them _wait_ until they get to the front of the list before they get their surgery.
Waiting lists are just a stupid argument, because the US has them too.
We fare badly in particular on getting access to a primary care doctor quickly (or other general care, if you Google articles). We have the highest percentage response for the question "Went to ER for condition that could have been treated by regular doctor if available" of the countries surveyed. And we have the highest response for people unable to get medical care due to cost.
When it comes to specialists and elective surgery, we definitely have much less issues with waiting lists there. IMHO general health care is much more important; this is another indicator of the perverse incentives of the current US health care structure.
Look at Canada, where this stuff is happening in spades. I'm living it.
It's a tried and tested technique. Take a well working system which doesn't generate profits, push to reduce costs, entirely destroying the service then point it out and say "See? It doesn't work. Better privatize it!"
The reason for the waitlists in Canada are complex, but cost control is one of the reasons.
Plus universal access, which is pretty much how you'd judge if a country is civilised or not.
http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com...
Ignoring insurance spending: the US government spends more on healthcare than the UK government, and gets worse outcomes across many (but not all) measures.
Treatment I've known people go through include cancer therapy, orthopedic surgery, eye laser treatment, chronic pain management, casts after accidents, and others.
https://www.svt.se/nyheter/akut-brist-pa-vardplatser-i-hela-...
It seems like healthy people spend a bit of time in wealthy nations with socialized health care and see nothing wrong with the system.
Live it. Have friends and family suffer illness or disability and try to find treatment. There is very little preventative care where I'm from because the doctors have no time. It's emergency after emergency.
So, sure, in Canada you won't break the bank if you dislocate your shoulder and have to go to the ER. But any special procedures and you'll be waiting years sometimes for an appointment.
US problems in health care are not the same as the Swedish problems. Different problems, different solutions.
Disclosure: I live in Sweden and follow the health care debate here.
So basically Sweden is slowly introducing the US system.
https://www.svt.se/nyheter/inrikes/privat-sjukvardsforsakrin...
Health care in US is political regulated system, badly done as well.
Yes, you can have capitalism and government funded health care system.
Constrainted, non-infinite supply, basically infinite demand. What a great business to be in!
While single payer is often a better system, it's not without its problems - in Canada ER wait times are ridiculous, my sister had to wait 10 hours recently and if you want to find a GP? Good luck. Everyone is booked solid.
I thought Obamacare seemed like a good compromise to be honest. Unfortunately it doesn't seem like that's been a miraculous solution. I think some sort of free market solution with a safety net on the low end could do the job, but I don't know what that would look like. And I don't think we've seen any proposals in that direction.
But right now I can see my family doctor with 1 day notice, most times same day, and they have someone on-call for phone 14 hours a day and on weekends. Mostly I can avoid ER and drop-in clinic visits completely.