Health Care Thread

Vaclav_sl said:

None were buying a black president for one thing? Gay marriage?

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I give you a B- for effort. There is a separate category at Opensecret for single issue donations.

Did you learn something today you are having trouble coming to grips with?

Rescorla_sl said:

I give you a B- for effort. There is a separate category at Opensecret for single issue donations.

Did you learn something today you are having trouble coming to grips with?

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Then why don't you provide the one for the ACA/Obamacare that should so succinctly prove you're right? Since if they have it - that should evidence your theorem PERFECTLY.

Since you said it was single issue those folks were paying for after all.

I dub you king of circular logic.

Cad_sl said:

It's your assertion that if we get single payer we have to pass tort reform, so by all means, provide the proof of your assertion.

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I see the point went completely over your head. You asked why the Democrat did not pass single payer with they had a filibuster proof majority. I just explained it to you. Are you not willing to admit the Democrats did exactly what the trial lawyers wanted?

Vaclav_sl said:

Then why don't you provide the one for the ACA/Obamacare that should so succinctly prove you're right? Since if they have it - that should evidence your theorem PERFECTLY.

Since you said it was single issue those folks were paying for after all.

I dub you king of circular logic.

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It would appear the answer to my question was Yes.

Wikipedia has a nice summary of studies estimating the cost of malpractice payouts and defensive medicine to the health care system:Medical malpractice in the United States - Wikipedia, the free encyclopedia

If you look at recent studies, it's anywhere between 0% (for defensive medicine) and 4% (for damages & awards). Health care expenses grow by about 5% per year. So at best eliminating all malpractice lawsuits (including all justified ones) would keep premiums fixed for one year before they continue to grow again.

You cannot meaningfully reduce health care spending with anything that provides a level-adjustment (i.e. a one-time shift down). You need something that slows down the speed at which expenses grow.

Incidentally, many liberals talking about health insurance company profits don't seem to get that either. Not only are most insurers non-profits, even if they weren't, you could at best lower costs one time by 5% or so. That buys you another year of no growth.

Now you have a single government insurer with no options to switch if they screw up, no recourse if doctors screw up and you lose your ability to earn a living -- and your premiums are growing at the same rate as if you had not changed anything. Which is to say, you're nowhere closer to a solution than today.

Soriak_sl said:

Wikipedia has a nice summary of studies estimating the cost of malpractice payouts and defensive medicine to the health care system:Medical malpractice in the United States - Wikipedia, the free encyclopedia

If you look at recent studies, it's anywhere between 0% (for defensive medicine) and 4% (for damages & awards). Health care expenses grow by about 5% per year. So at best eliminating all malpractice lawsuits (including all justified ones) would keep premiums fixed for one year before they continue to grow again.

You cannot meaningfully reduce health care spending with anything that provides a level-adjustment (i.e. a one-time shift down). You need something that slows down the speed at which expenses grow.

Incidentally, many liberals talking about health insurance company profits don't seem to get that either. Not only are most insurers non-profits, even if they weren't, you could at best lower costs one time by 5% or so. That buys you another year of no growth.

Now you have a single government insurer with no options to switch if they screw up, no recourse if doctors screw up and you lose your ability to earn a living -- and your premiums are growing at the same rate as if you had not changed anything. Which is to say, you're nowhere closer to a solution than today.

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FYI some global warming skeptics did a test on Wikipedia. They went to popular wiki article that promoted AGW and made an edit to it that presented the skeptics opinion. It was removed from the wiki within 5 minutes.

The point is using Wikipedia for any highly partisan political issue most likely means contrarian points are removed. I've read multiple articles and spoke to a few doctors I know (my wife works at a hospital and we are friends with several of them) and they all say the cost of medical malpractice insurance is passed on to patients and that they routinely engage in defensive medicine to cover their ass. It's a no brainier costs would go down significantly if there was tort reform. It's just a question of how much.

How much, but obviously significantly.

I hear holocaust skeptics did a test on wikipedia too and that same thing happened.

Cad_sl said:

I don't think insurance company profits per se are a big issue, but their overhead, administrative and marketing costs are.

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Marketing costs are pretty low.McKinsey estimates$6bn. So that's 0.2% of health care expenses. Administrative/overhead is difficult to estimate and compare, because it can accrue on so many levels. e.g. Medicare claims can be costly for doctors to process, but that doesn't factor into Medicare's administrative expenses. But the best estimate for billing and insurance related administrative claims (BIR) for private insurance is $200bn/year (Source). Best case that's one year of no growth. Not insignificant, but nothing that will bend the cost curve.

By the way: Medicare on its own is really shitty insurance. You pay 20% of all coverage out of pocket (including treatment in hospitals) with no out-of-pocket maximum, there's no coverage for long-term care, and there are fairly stringent caps on days of hospitalization (including lifetime limits on coverage). What makes it bearable is Medicare Plan C (aka Medicare Advantage), which you have to sign up for. When you do that, the government takes your Medicare premium ($650/month) and gives it to whichever insurer you pick. They will offer the plan either at no charge or for a small monthly premium. It's basically a roundabout way of introducing a $650/month subsidy if you find your own plan, using a system that is absurdly more complex than the health insurance exchanges.

Rescorla_sl said:

FYI some global warming skeptics did a test on Wikipedia. They went to popular wiki article that promoted AGW and made an edit to it that presented the skeptics opinion. It was removed from the wiki within 5 minutes.

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I'm not citing Wikipedia as proof; just pointing toward a number of studies that are linked there. You can hop on Google Scholar and there'll be a whole bunch of papers coming up. At this point, there is simply no evidence that health care expenditures dropped (or grew at a slower rate) in states that enacted tort reform than in those who didn't.

I have no doubt that physicians will say they practice defensive medicine. I also never met a physician who admitted they're prescribing treatments because they get paid for doing so. But when reimbursement rates for doctors change, magically so do the things they prescribe. It's a bit like nobody will say they're not going to buy milk if the price increases by 10 cents per gallon, but the volume of milk sold, across the country, does decrease substantially with such a price increase.

The major reason health care in the United States is so expensive is we're willing to pay it and nobody else is. Take, for example, Sofosbuvir/Sovaldi, the Hepatitis C cure that came out last year and cost $90,000 for a course of treatment. That drug is now being sold in SE Asia for $300 per treatment course. Why does this work? Well, 99% of the drug cost is the R&D, which is intellectual property and thus nobody else really needs to care about respecting it. Every other country just tells Gilead Sciences that they will accept manufacturing costs +5% profit, and if they refuse, well, then we'll just copy your formula and sell our citizens a knockoff and you get nothing. We're subsidizing literally everyone else, and there's nothing we can really do about it either because once the drug is discovered and out there it's pretty trivial to copy the formula and make your own knockoff pills.

Now, someone is going to point out that Gilead Sciences has a profit margin of around 25%. And I would agree that this is excessive. But that still means the break even price for this drug would have been $72k per treatment course. They were able to invest this ridiculous amount of money coming up with a drug because they knew people would pay it. Hell, this example is relatively benign, in that while this drug is insanely expensive, at least that money went to actual R&D. You've got tons of drugs that are simply minor reformulations of existing drugs, which can be sold for huge amounts of money because that minor reformulation means they get a new patent and new 20-year monopoly. This shit isn't going to stop until the government steps in and says, "No, you can't spend $10 billion marketing your "new" time-release formula or researching a cancer drug that improves median survival by three months more than existing drugs. We as a country can't afford this shit."

Xequecal_sl said:

The major reason health care in the United States is so expensive is we're willing to pay it and nobody else is. Take, for example, Sofosbuvir/Sovaldi, the Hepatitis C cure that came out last year and cost $90,000 for a course of treatment. That drug is now being sold in SE Asia for $300 per treatment course. Why does this work? Well, 99% of the drug cost is the R&D, which is intellectual property and thus nobody else really needs to care about respecting it. Every other country just tells Gilead Sciences that they will accept manufacturing costs +5% profit, and if they refuse, well, then we'll just copy your formula and sell our citizens a knockoff and you get nothing. We're subsidizing literally everyone else, and there's nothing we can really do about it either because once the drug is discovered and out there it's pretty trivial to copy the formula and make your own knockoff pills.

Now, someone is going to point out that Gilead Sciences has a profit margin of around 25%. And I would agree that this is excessive. But that still means the break even price for this drug would have been $72k per treatment course. They were able to invest this ridiculous amount of money coming up with a drug because they knew people would pay it. Hell, this example is relatively benign, in that while this drug is insanely expensive, at least that money went to actual R&D. You've got tons of drugs that are simply minor reformulations of existing drugs, which can be sold for huge amounts of money because that minor reformulation means they get a new patent and new 20-year monopoly. This shit isn't going to stop until the government steps in and says, "No, you can't spend $10 billion marketing your "new" time-release formula or researching a cancer drug that improves median survival by three months more than existing drugs. We as a country can't afford this shit."

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There is something we can do about it, use our status as the or one of the largest importers in the world to impose tariffs on the goods of countries who steal from us in that manner. It amazes me how often the US is just willing to take the dick when it comes to trade.

The biggest problem isn't really trade terms with the third world though. It is trade terms with the first world. The fact that northern europe can afford to pay their fair share for all this RnD and instead passes most of the cost on to the US is just insane. The best and easiest solution is to have the US govt negotiate for drug prices the same as every other advanced country does. This will force the EU/GB to increase their payment terms for drugs to something more equitable or see their own domestic researchers and firms go under as well since they currently just export cost to the US and sell cheaply at home.

But we don't do that because our masters tell us that shocking the drug market like that would end research all together and scare grandma into voting herself into bankruptcy.

Big Phoenix_sl said:

Lol tariffs are literally the stupidest thing in economics.

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They work fine to bully little countries into fairer terms. And thinking that they should never be used ever is a big part of the reason the US has seen so much of its industry exported.

But like I said, the little small economies of SE Asia and the like making knockoffs isn't even our big problem. They couldn't afford to pay much high for the treatment anyway.

Big Phoenix_sl said:

Here's a better idea, how about we make it cheaper to produce drugs?

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How about we produce public drug manufacturing plants in the USA instead?

Now Aetna and UHC are gone. So what happens when no companies want to offer anything on the marketplace but people are forced to have insurance? Is there a medicare fallback plan or just 'oh shit we did not think of that'.

Palum_sl said:

Now Aetna and UHC are gone. So what happens when no companies want to offer anything on the marketplace but people are forced to have insurance? Is there a medicare fallback plan or just 'oh shit we did not think of that'.

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There is precisely that - I swear we had this discussion a few years ago when I bothered to read the whole damn thing.