Government Intervention in Medicine

[mike777]

To be fair can we agree that all of these countries have a major free market?

 

 

The problem is the free market is stifled to use Winston term

 

"Anyway, patient care seems to work most effectively in countries that have socialised medicine. So I think that one is easy."

 

 

At the very least we need a debate over

 

One huge issue is 99.99 mericans don't underatand uk...Canada health care

 

 

50% simply don't care

[mike777]

Again to say that competition is not the key is just silly....

 

 

Look at the posts that confirm competition is so important.

 

 

the issue is govt inhibits competition

 

 

often in the name of VA or NHS is sacred and holy.

[mike777]

concerning patient care there are stories about VA patient care

 

 

1) Acute patient care

 

2) VA based infection rates.

[helene_t]

Again to say that competition is not the key is just silly....

I wouldn't take it for granted that competition is good in health care.

 

It could be. Maybe the problem with the US health care is lack of competition. Maybe socialized medicine is rubish and just seems OK because nobody has ever implemented a sensible alternative.

 

Who knows. In the absence of evidence I don't believe that competition is the solution. I know from my own experience, both as a patient and as an employee in health care institutions, that the British/Scandinavian socialized system works much better than the Dutch private insurance system. Of course that doesn't prove anything. Just saying: I don't find it plausible that a competition works in health care, and I don't see any evidence for it either.

[hrothgar]

concerning patient care there are stories about VA patient care

 

1) Acute patient care

 

2) VA based infection rates.

 

There are also stories about the Loch Ness monster.

 

FWIW< here's a good article sketching out some of the issues surrounding the VA scandal and why Phoenix seems to be ground zero.

 

http://www.washingtonmonthly.com/political-animal-a/2014_06/va_care_still_the_best_care_an050598.php

[cherdano]

How dare the government get involved in health care for its former soldiers?

[Winstonm]

Again to say that competition is not the key is just silly....

 

 

Look at the posts that confirm competition is so important.

 

 

the issue is govt inhibits competition

 

 

often in the name of VA or NHS is sacred and holy.

 

Asserting it so does not make it so. In fact, closing one's eyes and believing really hard does not even make it so. Like Helene said below: maybe it is so, but it doesn't sound plausible and there is no evidence that it is.

[hrothgar]

Asserting it so does not make it so. In fact, closing one's eyes and believing really hard does not even make it so. Like Helene said below: maybe it is so, but it doesn't sound plausible and there is no evidence that it is.

 

Don't bother trying to use logic on a LaRouchie...

 

Mocking them is fine and dandy, however, they don't engage in intelligent discourse.

[kenberg]

How dare the government get involved in health care for its former soldiers?

 

Details I don't know, but it is what we do.

 

We have friends who are retired military. They get substantial access to medical care through Andrews Air Force base. Actually some of that is changing, I don't know the details.

 

You might or might not agree, but the idea, as far back as I can recall, is that part of the agreement for military service is a commitment to lifetime medical care. Fort Snelliong, near where I grew up, is now, I think, a rest home for aged soldiers.

 

I may say more later, but I am still traveling and just took a quick glance here.

[Winstonm]

One more time into the fray, although likely rendered nugatory by the opposing ideology. Even if competition is the key, competition is not reliant on profit incentives. Profit-driven incentive is only one type of competition. Incentives of pride, curiosity, intellect, good will, and others all play a part in human activities.

 

I feel like I'm playing with a "real" Scotsman. :lol:

[barmar]

I thought Barmar's point was that pharmaceutical research needs money for all the other costs (lab equipment, reembursement of healthy volunteers in phase I trials, etc) rather than that the scientists themselves necesarily need big carrots. But maybe I misunderstood.

That is exactly my point. You put those 100 scientists in a room for 10 years, keeping them fed and clothed, you'll get lots of good ideas, but not a single drug. They won't even know if any of their ideas actually work.

 

Einstein came up with his Theory of Relativity in his spare time while working for the Patent Office, so obviously financial incentives aren't necessary for the thought work that goes into innovation. But turning E=mC^2 into a working nuclear power plant required more innovation and creative work than anyone could do on their own.

[akwoo]

Despite the fact that we tend to lump it in with science, medical research generally looks a lot more like engineering research than science research.

[helene_t]

Despite the fact that we tend to lump it in with science, medical research generally looks a lot more like engineering research than science research.

Oops I upvoted this because I somehow took it as "medical research needs more engineering ...".

 

Medical research would be a lot more productive if it was done by engineers instead of physicians, IMO. But maybe I should write this from an anonymous account .....

[cherdano]

Details I don't know, but it is what we do.

 

We have friends who are retired military. They get substantial access to medical care through Andrews Air Force base. Actually some of that is changing, I don't know the details.

 

You might or might not agree, but the idea, as far back as I can recall, is that part of the agreement for military service is a commitment to lifetime medical care. Fort Snelliong, near where I grew up, is now, I think, a rest home for aged soldiers.

 

I may say more later, but I am still traveling and just took a quick glance here.

 

I guess my sarcasm has gotten a bit too subtle these days...

[Winstonm]

That is exactly my point. You put those 100 scientists in a room for 10 years, keeping them fed and clothed, you'll get lots of good ideas, but not a single drug. They won't even know if any of their ideas actually work.

 

Einstein came up with his Theory of Relativity in his spare time while working for the Patent Office, so obviously financial incentives aren't necessary for the thought work that goes into innovation. But turning E=mC^2 into a working nuclear power plant required more innovation and creative work than anyone could do on their own.

 

Yes, but that is not what Mike777 claims, and it was his point to which I objected. His point is that competition and monetary incentives are the driving force of innovation and that government stifles incentive.

 

You and I are in agreement - it takes money to get things done. That is not the same as saying it requires free markets to get things done.

[FM75]

At this point, I think it would be fair to delete my initial post. It seems like the discussion is just about politics, capitalism, and socialism. I don't see any comments about how bureaucracy can destroy an otherwise fine idea and program. Likewise, apparently, nobody disagrees that the program is broken - perhaps because the highly competent bureaucrats and Congress have done such a fine job designing and funding it.

 

The Title/subtitle as a reminder:

 

Government Intervention in Medicine

What could go wrong?

 

 

 

[PassedOut]

At this point, I think it would be fair to delete my initial post. It seems like the discussion is just about politics, capitalism, and socialism. I don't see any comments about how bureaucracy can destroy an otherwise fine idea and program. Likewise, apparently, nobody disagrees that the program is broken - perhaps because the highly competent bureaucrats and Congress have done such a fine job designing and funding it.

 

The Title/subtitle as a reminder:

 

Government Intervention in Medicine

What could go wrong?

I don't see that the "program is broken." Sure there are long wait times in places where lots of vets have retired and short wait times in the places they have left. The link that Richard gave earlier explained that: VA Care: Still the Best Anywhere?

 

Just what do we know about how crowded VA hospitals are generally? Here’s a key relevant fact that is just the opposite of what most people think. For all the wars we’ve been fighting, the veterans population has been falling sharply. Nationwide, their number fell by 17 percent between 2000 and 2014, primarily due to the passing of the huge cohorts of World War II- and Korea War-era vets. The decline has been particularly steep in California and throughout much of New England, the Mid-Atlantic and industrial Midwest, where the fall off has ranged between 21 percent and 36.7 percent.

 

Reflecting this decline, as well a general trend toward more outpatient services, many VA hospitals in these areas, including flagship facilities, want for nothing except sufficient numbers of patients to maintain their long-term viability. I have visited VA hospitals around the county and often been unnerved by how empty they are. When I visited two of the VA’s four state-of-the-art, breathtakingly advanced polytrauma units, in Palo Alto and Minneapolis, there was hardly a patient to be found.

 

But at the same time there is a comparatively small countertrend that results from large migrations of aging veterans from the Rust Belt and California to lower-cost retirement centers in the Sun Belt. And this flow, combined with more liberal eligibility standards that allow more Vietnam vets to receive VA treatment for such chronic conditions as ischemic heart disease and Parkinson’s, means that in some of these areas, such as, Phoenix, VA capacity is indeed under significant strain.

 

This regional imbalance in capacity relatively to demand makes it very difficult to manage the VA with system-wide performance metrics. Setting a benchmark of 14 days to see a new primary care doc at a VA hospital or clinic in Boston or Northern California may be completely reasonable. But trying to do the same in Phoenix and in a handful of other sunbelt retirement meccas is not workable without Congress ponying up for building more capacity there.

 

Once you have this background, it becomes easy to understand certain anomalies in this scandal. If care is really so bad, for example, why did all the major veterans services remain unanimous in recent testimony before Congress in their long-stranding praise for the quality of VA health care? And why have they remained stalwart in defending the VA against its many ideological enemies who want to see it privatized? It’s because, by and large, VA care is as good, if not better than what vets can find outside the system, including by such metrics as wait times.

 

Similarly, if VA care were not generally very good, the VA would not continue to rank extraordinarily high in independent surveys of patient satisfaction. Recently discharged VA hospital patients for example, rate their experience 4 points higher than the average for the health care industry as a whole. Fully 96 percent say they would turn to VA inpatient care again.

Yes, the wait times need to be fixed by getting more doctors where the demand has spiked. But how does this situation qualify as an example of "how bureaucracy can destroy an otherwise fine idea and program?"

 

Considering the poor quality of US medical care in general, why would one want to dump veterans into an inferior system? We owe it to our veterans to beef up the VA where the demand has spiked. But we don't want to throw out the baby with the bathwater...

[blackshoe]

That is exactly my point. You put those 100 scientists in a room for 10 years, keeping them fed and clothed, you'll get lots of good ideas, but not a single drug. They won't even know if any of their ideas actually work.

 

Einstein came up with his Theory of Relativity in his spare time while working for the Patent Office, so obviously financial incentives aren't necessary for the thought work that goes into innovation. But turning E=mC^2 into a working nuclear power plant required more innovation and creative work than anyone could do on their own.

Yes, it did. It started with The Manhattan Project. B-)

 

"If it were ever found possible to control at will the rate of disintegration of the radio-elements, an enormous amount of energy could be obtained from a small quantity of matter." -- Ernest Rutherford, 1904. (Einstein published "On the Electrodynamics of Moving Bodies" in 1905).

[Elianna]

I guess my sarcasm has gotten a bit too subtle these days...

 

I upvoted it before I saw Ken's reply, and then was going to reply to him to say that I think that you were being sarcastic, but I see that you've beat me to it.

[kenberg]

I guess my sarcasm has gotten a bit too subtle these days...

 

I didn't read it closely or I might have understood, but I easily miss such things.I had planned not to contribute to this thread, I slipped up, I sincerely regret this impulsive choice.

[Winstonm]

There is no doubt that fine private health care is available in the U.S. The problem is that it is only affordable for the top earners. Case in point is the drug Abilify. Abilify is one of the better antipsychotic medications with few side effects - it is now a tier 5 medication on Medicare meaning that the co-pay for this drug is over $1000 per month. The well-to-do can afford this drug; others, not so much.

[helene_t]

There is no doubt that fine private health care is available in the U.S. The problem is that it is only affordable for the top earners. Case in point is the drug Abilify. Abilify is one of the better antipsychotic medications with few side effects - it is now a tier 5 medication on Medicare meaning that the co-pay for this drug is over $1000 per month. The well-to-do can afford this drug; others, not so much.

69 pencecents per 30 mg tablet according to https://www.pharmacychecker.com/generic/price-comparison/aripiprazole/30+mg/cpp/. Are you telling me that a patient needs 50 times 30 mg per day?

Edited June 5, 2014 by helene_t

[Winstonm]

69 pence per 30 mg tablet according to https://www.pharmacychecker.com/generic/price-comparison/aripiprazole/30+mg/cpp/. Are you telling me that a patient needs 50 times 30 mg per day?

 

No. That is the cost of a daily dose of Abilify.

 

Here is a result from a really quick Google search:

 

Dr O.

 

Depending on the strength, 30 tablets of Abilify can cost from $700 to $1000 out of pocket, even with a discount. If covered by your insurance, it’s likely to fall under your highest co-pay. In contrast, generic atypical antipsychotics like olanzapine (Zyprexa) and risperidone (Risperdal) can be found for under $20 out of pocket with a discount. They are also covered under most insurance plans as Tier 1 drugs, meaning you’ll pay only your lowest co-pay

.

 

Here is the U.S., private healthcare is terrific for the 1% and maybe on down to the 5%. For the rest of us, not so much.

[helene_t]

So a tablet that costs 25 dollars in the US costs 69 cents in Canada? Are US tourists allowed to shop in Canadian pharmacies?

[WellSpyder]

So a tablet that costs 25 dollars in the US costs 69 cents in Canada? Are US tourists allowed to shop in Canadian pharmacies?

I thought all forms of competition were welcomed with open arms in the land of the free...