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"Health care providers don't care about cost - it's passed along to insurance companies and consumers anyway. Insurance companies care about cost, but not really - it's easily passed to sponsoring employers or individual buyers anyway. Really, the only people that truly want cost reduced are the endpoint patients and their employers, who generally lack the clout and influence to push for real cost reductions. The entire system is broken. Costs have not lowered for health care, and will not lower, until the system is reorganized such that cost reduction becomes advantageous to all stakeholders."

I'm not sure if we really agree all that much or not, but I do agree with this. There's no way to keep from ballooning costs when the people paying are insulated from what they're paying for.

Unfortunately, it's largely broken as a result of some really strange incentives and a belief that employers should be responsible for their employees health care (rather than just paying employees and letting them deal with it). HMOs, tax incentives to employers to provide health care, tax incentives to employees to take it, are all terrible, terrible things.

Fixing it will require that people "pay" for what they don't feel they're paying for right now. I dunno about everyone else, but I'd rather be getting the extra $1200/yr my employer contributes to my health care and dealing in an actual free market than what we have now. I think we'd all be paying a lot less, and getting better service.

"But really, what do we want as a society? For a two-digit number of extremely wealthy people to have access to the world's best prosthetics, stuff that is in the realm of sci-fi? Or for everyone to have access to "good enough" prosthetic technology that advances more slowly?"

I don't see this as an either-or situation; don't we have both right now? Especially if you look at legs instead of arms.

"... his own highest-profile project; the Segway hasn't gotten significantly cheaper or more accessible despite years of R&D,"

That doesn't make any sense at all. The Segway is the cheaper, more-accessible version of the IBOT, a mobility system. Besides, http://web.mit.edu/first/segway/ is one of many <$1000, DIY Segway projects, so this tech is getting cheaper and more accessible.

"I don't see this as an either-or situation; don't we have both right now? Especially if you look at legs instead of arms."

We don't have this right now, that's the point. Yes, there are super-high-end prosthetics available to the uber-rich, and there is the regular stuff. But even the "regular stuff" is out of reach of most Americans, especially the millions that are uninsured (or underinsured by the employer) and thus SOL.

The USA currently has the full range of medical technology commensurate with how much you can afford - but the problem is that much of the really critical care (surgeries, etc) is completely out of reach of the average individual. It truly is a system where the rich receive the absolute best and the poor (or even middle class) can just crawl into a corner and die.

"Besides, http://web.mit.edu/first/segway/ is one of many <$1000, DIY Segway projects, so this tech is getting cheaper and more accessible."

This only proves my point. DIY geek projects aside, there is no low-cost Segway competitor on the market, likely due to patent issues (I have not looked into this myself, so correct me if I'm wrong). This is the same situation for pharmaceuticals - there is no incentive to reduce drug costs when your patients must buy from you and only you, due to patent law. So yeah, there are a bunch of DIY solutions, but still no competition on the open market, and thus prices stay up.

Well said. He makes an argument that people are trying to "instill fear in ordinary Americans" and seems to think the system is working perfectly, without giving those that have no access to health care today even a token sentence.

The argument that those that can afford it should just continue spending loads of money on health care and eventually, through some unspecified process, this will make life better for all those who don't have access to health care at all sounds like a variant of "trickle-down" voodoo economics to me.

Who in the United States doesn't have access to healthcare?

Quite honestly, I don't see why this is such a massive issue with everyone right now...

Medical innovation (in it's current state, meaning building things on a molecular level) is prohibitively expensive. Gone are the days when a guy in his basement can hack out (or stumble upon) some great new wonderdrug like penicillin.

These things are not cheap to do...

Also, how does the US Gov't plan on getting the cost of healthcare down? If there is some magic wand that they can wave and make everything cheaper, then why don't they do it? Why do they want control over this so badly?

"Who in the United States doesn't have access to healthcare?"

I took the liberty of looking up some numbers, because clearly you haven't. The answer to your question is over 46.6 million Americans(1) (you have 300 million total), the ones without health insurance.

Add another 25 million Americans(2) who are underinsured and the number is scarier. Underinsured is defined as people who have insurance but end up spending >10% of their income on health care expenses.

The same source (2) indicates that 42% of working adults (19 to 64 years-old) are uninsured or underinsured.

So in short, who in the US doesn't have access to health care? Apparently 42% of them.

"Quite honestly, I don't see why this is such a massive issue with everyone right now..."

You don't see an issue with someone breaking a leg and going bankrupt because of it? You don't see an issue with a population going broke just to keep themselves hobbling along?

Here's some more fun. 50% of bankruptcies in the US today are due to health care costs (5). In fact, 68% of those who declare bankruptcy due to unaffordable health care costs have health insurance (4).

You don't see a problem here?

"Medical innovation (in it's current state, meaning building things on a molecular level) is prohibitively expensive."

Yet Europe and Canada (and other first-world nations with public health care) are doing fine at their own medical research. It's s till expensive, but it's being funded by the government, and the people still get great health care (some of it is better than the US...).

Your thesis is one that is trotted out a lot by proponents of the private system, but it simply holds no water. We have many cases of massive medical R&D being done in countries where every single person receives free health care.

"Also, how does the US Gov't plan on getting the cost of healthcare down?"

Easy. By going public. You asked if there is a magic wand, and I'm here to tell you it doesn't get more magic-wand-y than this. Right now 25% of every health care dollar spent is going towards administrative expenses (2), compared to 1% to 5% for public health systems around the world (2).

By cutting out the private insurance companies you instantly gain a 26-32% efficiency on your health care dollars. Imagine the number of people you can cover with that massive amount of money (some $400 billion per year as of 2003).

(1) http://www.cbpp.org/cms/?fa=view&id=628

(2) http://health.usnews.com/articles/health/healthday/2008/06/1...

(3) http://www.medicalnewstoday.com/articles/8800.php

(4) http://www.nchc.org/facts/cost.shtml

(5) http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf

The answer to your question is over 46.6 million Americans(1) (you have 300 million total), the ones without health insurance.

Lacking health insurance (i.e., a financial services product) is not the same thing as lacking medical services.

But lets ignore that and look more closely at your numbers. Of the 46.6 million uninsured, 14 million are eligible for medicaid/SCHIP, but haven't bothered to sign up. 27 million make at least $50,000/year and simply choose to spend money on other things. Another fun fact: excluding people eligible for medicaid, 70% are uninsured 4 months or less.

http://www.washingtontimes.com/news/2009/jun/25/who-are-the-...

That leaves about 5.6 million people. I expect we could solve the problem of those 5.6 simply by enforcing our immigration laws.

I am sorry you answered the wrong question. This is why politics stink. He is right, everyone has access to healthcare in America. And you are right not everyone has insurance.

These are two different things.

The answer to your question is over 46.6 million Americans..., the ones without health insurance

As the sibling replies noted, everyone in America does have access to at least basic healthcare. If a homeless person is brought into the emergency room after being hit by a car, he won't be denied treatment. The Medicaid program in America reimburses hospitals (and other providers) for charity and bad debt expenses.

Right now 25% of every health care dollar spent is going towards administrative expenses

I've got an unusually close view of this, as my wife is the manager of budget and reimbursement at a largish urban hospital. Most of her job is dealing with Medicaid and Medicare, getting the hospital reimbursed for caring for these people. The reason that she spends most of her (and her department's) time on this is because of the illusion that M&M have efficient administration.

In reality, Medicare and Medicaid account for a huge portion of cases in an urban hospital. They're an 800-lb gorilla: since they account for so much of the hospital's business, the hospitals have little choice but to provide whatever administrative functions that M&M demand. For example, every year my wife must submit the dreaded "Medicare Cost Report". This is literally a crate of documents that my wife's team creates (it takes the team weeks) to document their Medicare charges over the past year. Some time later, the government audits them on this entire crate.

What I'm trying to illustrate is that the actual administrative expenses of Medicare and Medicaid are not really lower than our traditional model. It's just that the regulators force the participants to run it in such a way that the providers bear a large portion of the administrative burden. Since it's on the providers, the costs don't show up on M&M's reports as admin expenses. Instead, they contribute to higher prices billed for the underlying services.

When you look at the big picture, Medicare and Medicaid are certainly no more efficient than conventional providers, and possibly less so.

For example, one of the concerns in rising costs is unnecessary tests. However, M&M regulations tend to cause this. They will refuse to cover the costs associated with various types of infections (e.g., urinary infections) unless the provider can prove that the infection was already present when the patient was admitted. This effectively forces the hospital to test all patients for UTI at the time they're admitted, which is completely unnecessary for actual medical reasons.

Any expectation that total costs would go down due to some miracle of government administration is pure fantasy. Seriously: have you ever been to the DMV, or seen an Immigration office? Why would you believe that a private insurer, given the opportunity to increase profits by lowering their own admin expenses, would not do so? The idea that government-provided healthcare, or government-single-payer, would lower costs really is magic. Just like a belief in the magic of Tinkerbell and Harry Potter.

(Note: I lumped Medicare and Medicaid together for simplicity. While these are related, they're separate entities and anybody who knows the details will probably object. But there's only so much space here.)

Who in the United States doesn't have access to healthcare?

You're joking, right?

>but ultimately one that has been soundly disproved by the success of public health systems in most of Europe and Canada.

Yes, but the success of those systems is dependent upon the (semi) free-market health system in the United States.

How so?

You seem to be suggesting that if the US went to the same model as the rest of the world, we would all collectively implode? You need to explain that position a little deeper.

Here is an anecdote from an expat American here living in Sweden. I require immunoglobulin as my body doesn't produce it naturally like it should. In Sweden I'm on a subcutaneous treatment that greatly improves my quality of life. I can take and do the drugs myself without having to at least get an IV line started like in the US. The subcutaneous treatments are starting in America, but slowly and not as widely as they are relied in Sweden. The benefits are increased independence for patients, safer since it is absorbed through the fat instead of straight into the blood stream, and perhaps most importantly it costs less than half of the IV treatment. This subcutaneous treatment was pioneered, tested and deployed in Europe.

That pharmaceuticals in the US are going to stop R&D is BS. I bet there are many 'hacker' scientists that would happily keep doing their job as long as someone employees them. So maybe it won't be Wall St. but there is still money in it, job satisfaction and they aren't going to trade in their lab coats for McDonald's uniforms. Look at stem cell research, private companies could still fund it all they wanted, but once the federal government's teat was shut off research died. Public healthcare wouldn't diminish the government's interest in funding research. Sweden still has many notable things in the field of medical research, and all from a country with a GDP roughly that of North Carolina.

I've heard this argument a bunch recently. You're suggesting the rest of the developed world has somehow made the US its bitch as far as medical research and development goes - the US does all the hard work, and everyone else with a public health system reaps the rewards.

I don't buy it.

It also ignores the fact that even if we accept his premise and if we assume that every single cent of the R&D money put up by the US comes in via high health care payments (it doesn't - a bunch of it is government funded and/or funded through charitable organizations), then if the US going to a universal healthcare system somehow halved the cost (bringing it down to the French level, while extending coverage to all), and this price cut somehow only came out of the money that'd get pumped into R&D and thus cut it to the bone, nothing would be stopping America from taking the savings and putting them right back into R&D.

In other words: Money doesn't magically disappear just because the way it is distributed changes.

"Money doesn't magically disappear just because the way it is distributed changes." Sure it does. Do you think these private groups would be making multi-million dollar bets if the prize of huge profits weren't out there?

http://www.xconomy.com/tag/Life-Sciences

Not all the cash is redistributed taxes - there is tons of private investment going to develop treatment

"(in fact, we invented the insulin injection) on government funds."

Easily found on the internet: Insulin injections developed in the 1920's, socialization of Canadian medicine began in the 1950's. No link between the two events, not clear in your post if you are arguing this or not.

According to: http://www.canadianaconnection.com/cca/banting.htm, funding during the summer of 1921 was from his family. Not sure as to the accuracy of this website nor do I know of other sources as to funds for the research.

If you would like to supply references as to the funding of the insulin research and development being government funded then please do so. Just because research is performed at a university does not mean the funds are from the government.

Your point and others in this forum is that socialism is better, Kamen and others disagree.

Personally I think US Medicare is a good example of why government programs are not the best. Doctors do not want to accept new Medicare patients due to lack of money, one article I recently read had a doctor state the cost for one supply was as much as could be billed by the doctor.

The US system is quasi-socialism at the very least. Since government is partially controlling costs via one program (if you consider Medicare and Medicaid the same) and access via other programs/legislation including the tax laws.

One item to consider in this debate is that in the US at least since Hamilton, influence has enabled legislation to be enacted to favor your point of view, aka a mercantile economy. Such that you can not in the least bit consider the US Health system as non-government influenced.

The only expensive medical procedure I've undergone was paid by the insurance company at around $.50 to the dollar amount billed by the doctor and hospital. I paid around $.10 to the dollar. This raises the question as to how much of the cost is actually price inflation by the medical establishment to ensure they can pay their actual costs. Some items when price compared to the local pharmacy had a mark up of 200-500%, this was only for a couple of items I remembered while waiting for an order to be filled and is not a rigorous assertion on my part.

http://content.healthaffairs.org/cgi/reprint/17/1/225.pdf has some interesting data regarding Canadians visiting the US medical system. The point I saw is that when the northern system reduced the amount paid in Oct 91 (page 226 of the article) the subsequent amount spent was significantly less, chart on page 229. Not sure the data would allow analysis as to how much voluntary/elective payments were reduced as my quick read suggest some of this was transferred to private insurance. And this particular study indicates only 3% of expenditures in the Canadian system are to out of province providers.

Highly recommend that you read 'The Politically Incorrect Guide to Capitalism' if for no other reason than you know what you are arguing against. Free Enterprise is the best solution to any problem unfortunately like pure communism, it is not found in its pure form due to human nature.

> He is partially right - the lack of extreme-expense health care drives out extreme high-end solutions such as the article's highlighted "Luke" arm, a prosthetic that is almost as good as the real thing.

But this isn't even a discussion point in most countries with socialized health-care: Only a handful of countries worldwide prevent private treatments and/or private health insurance on top of the government provided options.

In the UK for example, the two work fine side by side. Everyone has access to the NHS, for "free" (i.e. for their portion of taxes, possibly 0), while people who want to pay extra can pay for the fancy extras that are deemed too expensive or unnecessary.

Apart from dental (which is poorly covered) and purely elective procedure, like most cosmetic surgery, most people show little to no interest in going beyond the NHS - only about 10% have private insurance.

"But really, what do we want as a society? For a two-digit number of extremely wealthy people to have access to the world's best prosthetics, stuff that is in the realm of sci-fi? Or for everyone to have access to "good enough" prosthetic technology that advances more slowly?"

If you choose the latter then you are short-sighted, because in the future everyone will be worse off.

It's a stupid argument in the first place. If there was a social healthcare system in the US, then do rich people somehow have less money? Do people really believe that there won't be better 'cutting edge' techniques that are expensive, but you can only pay for 'out of pocket' or with a private insurance company?

It's not like private insurance doesn't exist in Canada (for example). You're just guaranteed a certain base-level of medical care by the government. You still have to pay for things like prescriptions unless you have private insurance. Things -- like dental work -- are not covered either unless you have private insurance plan that covers it.

{edit} You have to pay for non-life threatening prescriptions, like anti-depressants or antibiotics. Just thought that I should clarify that IIRC, things like insulin which a person needs to stay alive are covered by the government {/edit}

see http://accounting.suite101.com/article.cfm/fixed_and_variabl... for an explanation for fixed/variable costs, and why companies will charge less than the average cost to produce something as long as they can get more than the marginal cost per item.

Most people know that drugs have high fixed and low variable costs, but that also is frequently true of new treatments/techniques; it costs far more to develop it than it does to apply it once it exists.

Other countries get low prices by paying the marginal costs, while the US ends up paying most of the fixed cost.