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Your example of the cost of medication is an odd one. Most (all?) states in the US have mandatory generic substitution. That means the pharmacy must fill your Rx with the generic unless the doctor wrote "Dispense as Written" on the Rx.

Now, if the generic was not available in the US that is a different story. Patents don't all end at the same time, so the drug may already be off patent in the UK, but not in the US.

Finally, to say "there is no profitability" in generics is laughable. The US has lower generic prices that most of the EU due to fierce competition for the US market.

And finally, although the US may not have a single payer system, we do have public health for the old (Medicare) and the poor (Medicaid). In addition, if you are sick and you go to a hospital, you must be treated regardless of your ability to pay.

>The US has lower generic prices that most of the EU due to fierce competition for the US market

This is not the case.

From direct person experience I can attest that:

Betaserc is 1/25 the price in Spain as the generic in the US

Nebivolol is 1/10

Lovastatin is 1/5

Enalapril is 1/2

I quote the parent poster: "The US has lower generic prices that most of the EU"

Emphasis mine. Perhaps, if they were consistently "cheaper" than the US, fine. But your singular example doesn't quite contradict the person you're responding to. So it actually is the case, unless you prove your findings for other EU countries.

I have no idea if that's the case, just pointing out the obvious flaw in your logic. Perhaps a little too-quick to look for contradictions if you disagree with the general point?

Quite correct: I have no idea what the price is in Lichtenstein. Nor have I compared the price of every drug manufactured. Nor even a majority of those thousands.

I have, however bought a dozen or so different drugs and have done so in France, Italy, Croatia, Spain, Portugal and the Netherlands. All of which were tiny fraction of the price in the US.

So given two hypothesis: the US is cheaper vs the EU is cheaper, and a bunch of data points all pointing that same way, a little bit of Bayesian statistics shows us which hypothesis is over overwhelmingly more likely doesn't it? We can agree to use Bayesian statistics even though there's no entry in the conservapedia can't we?

Contrast, for example, with the parent poster's hypothesis which comes form no more data than a.m. radio infotainment, I think there's only one rational tentative conclusion don't you?

I'd take a Commonwealth Fund analysis over your "Bayesian statistical analysis".

http://managinghealthcarecosts.blogspot.com/2012/03/united-s...

Ah yes that is obviously much better than extrapolating from anecdotes.

But of the few European countries compared, at least two have deregulated pricing for generics which is exactly the point we're talking about isn't it? The others may or may not (I don't know). But why were Norway, Sweden and Denmark omitted from that comparison when they are in every other comparison on the original page? It's a strange omission because generics in Scandinavia are lower than western Europe. Inside of Europe, countries that have deregulated their generics simply have higher prices.

I have no doubt there are examples of cheaper generics in the EU than US, but overall, US generics are cheaper.[1]

[1]http://www.gabionline.net/Reports/Are-generic-medicines-too-...

Where in the article are the US prices compared to EU prices? It seems that it compares EU prices to production prices (in India and China). It also states:

"We also see that in countries that have free market pricing of medicines (where companies can decide for themselves the price of a new medicine), such as Germany, the price of generic medicines tend to be higher than in countries which regulate medicine prices."

This seems to contradict the claim as well.

Here is the article I was thinking of....

http://managinghealthcarecosts.blogspot.com/2012/03/united-s...

The US payers more for brand name drugs, but less than nearly every other OECD country (with the exception of NZ).

Hospitals are not required to treat people regardless of ability to pay. Hospitals are merely required to stabilize a patient before dumping them.

The U.S. spends around 16% GDP on healthcare. This is by far the most of any industrialized nations. Americans have among the worst health care outcomes of the industrialized nations. Americans spend far more for procedures than citizens of other countries. Medicaid only kicks in for the extremely poor. Medicare kicks in for the old because it is unprofitable for insurance companies to insure elderly. Medicare is a subsidy for the health insurance industry. It allows that industry to dump unprofitable people and socialize their care.

That a person in the U.S. can go bankrupt and lose their home due to medical bills is obscene. The U.S. has an uncivilized health care system.

You've made several erroneous claims, so I'll comment on a few of them:

Hospitals are not required to treat, but most do. It is general knowledge in the industry that if you can't afford treatment for your cancer you go to a local hospital where you will be treated regardless of ability to pay.

Yes the US spends more than any other industrialized nation, but no, health outcomes are not the worst. If you use blunt tools like life expectancy to measure outcomes, the US ranks far behind, but that is only because of other extraneous factors that have nothing to do with quality of care. Check out cancer patient outcomes for colorectal cancer sometime, the US outcomes easily outstrip those of other countries.

Medicaid is not only for the extremely poor. The ACA just bumped up Medicaid income eligibility to 133% of poverty level. That's over $30K for a family, so I wouldn't say that's "extremely poor".

I have no idea where the "Medicare kicks in for the old because it is unprofitable" comes from. It was a social benefit put into place in the 1950's. The insurance industry has nothing to do with it.

No you can't lose your home over medical bills. Your primary residence is protected when you go bankrupt. Also, even in nations with single payer systems patients end up financial difficulties when sick because they can't work.

I suggest you do some more research and educate yourself on these issues rather than repeating what others tell you.

Your last sentence is not warranted and has no place on this site. The Medicaid bump only applies to states that enacted it. It is also a recent thing.

People without healthcare insurance often find out they have cancer far too late. While they may find treatment for free often times it is too late. If the free healthcare that hospitals provide was anywhere near adequate then people with insurance would dump it and save money. The fact that people with health insurance aren't dumping it in droves proves that care without it is inadequate.

Old people are costly to care for. They are unprofitable from the insurance industry perspective. Medicare was enacted because the country at the time was civilized enough to not want millions of elderly to do without health insurance. It is not disputable that this benefits the insurance industry.

You can't directly lose your home due to medical bills. You can lose for not being able to afford payments because medical bills for needed healthcare cost too much. There are lots of examples of this. Medical bills are the number one reason for bankruptcy in the u.s.

It is not known why the U.S. has lower life expectancy but the lower rate is correlated to income and education. I did not say our health outcomes are the worst. I said they are among the worst. In terms of happiness, overall health, life expectancy, etc. we do badly. There are areas where we do well.

Sorry for the last comment, but you're repeating several claims that are untrue and have no basis in fact.

Another example: "Medical bills are the number one reason for bankruptcy in the u.s.", again, not true. The correct statistic is "Unpaid medical bills are the most common debt owed during bankruptcy filings", someone could have a medical debt of $10 and that doesn't mean it caused their bankruptcy.

"Interestingly, it turns out that research commissioned by the Canadian government shows that 15% of people over the age of 55 who declare bankruptcy cite a medical problem as the primary reason. Medical bankruptcies can, as I've been saying for a while, be driven by something other than the lack of free government provided medical care."[1]

http://www.theatlantic.com/business/archive/2009/09/bankrupt...

Instead of reading Megan read the report she cites. The Canada number is self reported by those surveyed and it isn't known if this is from the bills themselves or from loss of income due to illness or a combination of both. If it is from medical bills this would be for care above and beyond what the Medicare system provides. I don't know exactly what Medicare refers to when talking about Canada. I'm quoting the paper that Megan cited. interestingly the paper cites work by Warren and Megan is quite critical of her work in the article you linked too. I've found Megan to be unreliable when interpreting studies.

The fact remains that people in the US do go bankrupt as a result of medical bills. People in Germany, France, etc. don't. As a general matter of affairs. We spend far more per capita than anyone else on care. We don't live longer, aren't more happy, or in better health than people in other countries. Our health outcomes are worse than many industrialized nations. The free care that hospitals provide is not adequate care evidenced by the market.

I certainly won't argue with you about the impact of direct medical costs on Americans. My comment is that statistics are often misleading and you can't draw broad conclusions from a single number.

>Hospitals are not required to treat, but most do. It is general knowledge in the industry that if you can't afford treatment for your cancer you go to a local hospital where you will be treated regardless of ability to pay.

Do you have a source for this? I can only speak from personal experience, but when I was sick and didn't have insurance I had to come up with a pretty significant upfront payment to see a specialist.

You may get to see a doctor, but try seeing a true specialist with insurance. So yeah, I agree with yequalsx, you will be stabilized, and that's pretty much it.

> In addition, if you are sick and you go to a hospital, you must be treated regardless of your ability to pay.

If you'll pardon a second response, I must point out this is only true of emergencies like car accidents and the ever abundance of shootings.

In most states, if you get cancer without insurance you just die. Period. And not by euthanasia, by the way, because apparently that is mortal sin / slippery-slope to mass murder.

"In most states, if you get cancer without insurance you just die. Period. And not by euthanasia, by the way, because apparently that is mortal sin / slippery-slope to mass murder."

This is patently untrue. Do a google search for "disproportionate share hospitals" and "charity care". In my line of work I've spoken with numerous oncologists and I've asked them "what do you do if your patient can't afford cancer treatment?" and the answer was always "I send them to the local hospital that treats them regardless of ability to pay."

If you have a fashionable cancer then yes there are special programs.

If you do not have the right kind of cancer then there are not.

Which is pretty strange in and of itself.

And if you are utterly indigent then yes there programs in many counties. County or city run hospitals which is of course the exact definition of socialist which I understand is completely objectionable on principle and so something to be zealously eradicated.

But if you are one of the working poor the options evaporate. Especially if you are in the wrong county/state.

If you glance through this pdf

http://action.acscan.org/site/DocServer/cancer-disparities-c...

I think you'll find there is an enormous difference in the fatality rate for uninsured vs insured patients exactly because of the lack of treatment.

But perhaps I'm wrong: what is the name of this hospital run entirely by donation that takes every cancer patient that shows up free of charge?

This "you get care if you have a fashionable cancer" bit does not ring true at all. The source you cited doesn't seem to back it up. Can you cite evidence that indigent care for cancer varies based on the "fashionability" of the specific kind of cancer?

The link above does not speak about different cancer funds. It simply shows that cancer patients without insurance just die.

That is obviously how it works without universal medical care; sick people don't just magically get better with magic money like a sitcom. They die.

But there are large funds for breast and cervical cancer and that is obviously very good. Unfortunately there are not for rectal or colon cancer. Maybe because no one is going to run 10k for rectal cancer, maybe because it's too dirty a word to say on tv.

Either way, if you're poor, be sure to get the right cancer.

Or just fix your medical system.

Now if you'll pardon me I must take a break and let the dittoheads and digg-patriots catch up with downvoting all my posts.

This reply is sophomoric. Its thesis is "sick people don't just magically get better with magic money like a sitcom. They die." But that's self-evidently not true; when an indigent patient has a heart attack and arrives in the emergency room, they are treated. It's not "magic money" that saves them; there is an actual pool of resources that they draw from.

> lack of a safety net?

That's one argument. Here's another:

Cost:

http://healthcarereform.procon.org/view.resource.php?resourc...

vs Quality:

http://www.commonwealthfund.org/publications/press-releases/...

http://www.businessinsider.com/best-healthcare-systems-in-th...

EDIT: not sure if downvotes are because people think I'm saying that cost is less important than the lack of a safety net or because people are butthurt over figures demonstrating that universal health care is also cheaper. Please clarify.

It might help (I didn't downvote, just suggesting) to put an intro to these arguments in the post, instead of just links.

Lack of safety net is why I don't feel comfortable continuing a life of entrepreneurship in the US while I'm building a family; I'll be leaving. I bootstrap and am not going to be getting millions in investment to pay myself ... if there are some lean years, at least I'll have assistance for my children and healthcare! I'm self-employed now, but if I didn't have employer-sponsored healthcare through my spouse, we'd be paying $1,000 per MONTH for a bottom-tier health plan with a $10,000 deductible. My wife staying employed after childbirth isn't an option because her employer expects her back to work after three weeks (yes her coworkers do this). What kind of nonsense life would that be?

Would you mind naming the generic drug? It seems like this is a powerful argument against having (only) for-profit healthcare. I'd like to be able to point to a specific case of what you're describing.

A data point from the USA: I take a very low dose of lamotrigene extended-release (mild epilepsy). The brand-name cost of this was $1200-$1400 per month. The recently available generic version of this costs nearly $400/mo. And this is, again, for a very low dose. For someone with a moderate or severe seizure (or bipolor - it's used for that too) disorder, the cost might be 4-5x this.

While one might argue that the name-brand version costs so much because of high R&D costs (dubious in my opinion), it's difficult to make that argument for the generic. It's expensive because the manufacturer can get away with it -- it's very much needed by the patients but the market is sufficiently limited in size that few potential competitors choose to target it.

Generics can be inexpensive if the drug in question has a very large market - statins for example. But if not, and you don't work for a company that provides health insurance with prescription drug coverage, a drug you need may well be a drug that you cannot get because of its cost.

That's insane. I take the generic lamotrigine, but even at a high dose it's something like $36/month here in Canada. I have a half-decent private insurance policy, but at US prices I'd burn through my yearly prescription rebate limit in a month.

You mean, this "lamotrigene":

http://www2.costco.com/Pharmacy/DrugInfo.aspx?p=1&SearchTerm...

The one that costs $17.22 for 50 100mg tablets? Sounds like you might be getting ripped off wherever you bought your medicine.

You're looking at the non-extended-release tablets, which are reasonably cheap these days.

I just called Costco for you, and the price of 30 generic 200mg extended-release tablets is $397 for members and $408 for non-members.

Edit: spelling

While your point is also good, I really wanted to know the case where the a generic equivalent isn't even available (despite being more effective).

The OP's anecdote seems to imply that there are situations where only inferior proprietary drugs are available. Which, in my opinion, would be impossible to defend, no matter how much of a fan of the free market one might be.

> The thought of people dying in the streets from preventable disease and injury sounds pretty horrendous.

Funny that you raise FUD in your very next sentence, because that is itself FUD. Since the 1980s hospitals have been obliged to treat anyone who shows up.

> And it turns out that this medication is not as effective as the generic that would cost $2 per pill. But because there is no profitability this medication is not currently manufactured in the US.

That doesn't make sense. A generic is the same as the name-brand. You mean a different drug for the same disease, I presume.

And it doesn't make sense that there would be no profitability; by your numbers, a generic drug manufacturer could produce the $2 pill which works better than the $100 pill and sell it for $50, or $25, or whatever it wanted.

> America needs to pull its head out of its ass and realize we are little better than a third-world country for anyone below median income who doesn't have a good group health insurance policy.

Actually, one of the nice things about real third-world countries is that one can just go to the pharmacist and buy pills, instead of having to go through a professional gatekeepers' union (the AMA) to do so.

In theory.

In practice, the active ingredient(s) are required to be the same, but there can be some variation in e.g. binders that can make differences. The characteristics of the generic (bioavailbility, onset time, etc) are only required to be within a certain range compared to the original, not be identical.

See this, for example: http://en.wikipedia.org/wiki/Generic_drug#Efficacy

>> And it turns out that this medication is not as effective as the generic that would cost $2 per pill.

What medication was it, if you don't mind me asking? And why didn't you just ask for the generic?

Many pharmacy chains in the USA offer a large list of generics for the low costs like $10/90 day supply

Therein lies the problem with the US and the mentality of the citizens. Since the proletariat are "temporarily embarrassed millionaires", the safety net is never there. To even take advantage of it is shameful. Perhaps unrelated, but the status of your achievements is reflected by how much you need to pay or put into it such as your job and even that 5-star hotel where you need to pay for breakfast and Wi-Fi.

> The thought of people dying in the streets from preventable disease and injury sounds pretty horrendous.

Doesn't happen in the US unless the person intends to do so. But that's pretty good fear mongering on your behalf.

So you're saying there has always been universal healthcare in the US even before Obama was elected? That everyone has always gotten all the medical care they need?

Or are you saying uninsured people don't get sick?

In fact roughly 45,000 die a year due to lack of medical care.[1]

Why not embrace the society you're creating? Because I'm sure Miss Rand would not be happy with that level of self delusion.

[1] http://news.harvard.edu/gazette/story/2009/09/new-study-find...

Wow, a Rand reference. You must be of such superior intellect that thinking of an original argument is beneath you.

Reread my message. A person will not be kicked out of the hospital to die on the street. Preventative Healthcare is a problem, but immediate is not.

No, not the street: you will be kicked out of the hospital to die at home.

But true, if you're shot in the street, an emergency room will accept you.

But no, there's no chemotherapy in the emergency room.

> You must be of such superior intellect that thinking of an original argument is beneath you.

Wow, an ad hominem attack, what a surprise.

Keep shifting those goalposts. It's interesting that you would point out an ad hominem after you felt it was perfectly acceptable to make an idiot reference to Rand with no connection.

Obamacare argument was inevitable, wasn't it.