Mitt "No insurance for uninsured with pre-existing conditions"

[Leoreth]

But that's not what I am arguing.

Good that you admit that there's no justification for striving for profit in the healthcare sector, then.

 

[luiz]

Good that you admit that there's no justification for striving for profit in the healthcare sector, then.

I didn't say either way. I only said there's nothing immoral about it, unless one finds the whole concept of profit immoral.

 

[Crezth]

Because the existence of for profit healthcare does not stops the existence of the supposedly more efficient public healthcare. Many (most?) countries have both. So the moral case here is non-existing.

Well, okay then.

It benefits everyone in the long run, the rich more in the short run. My dad benefited from techniques and drugs developed in the US while undergoing an operation in Brazil. The doctor responsible for his procedure had nearly daily exchanges with american institutions. Anyone who denies the fantastic innovation of American healthcare is completely ignorant on the subject.

Except the uninsured, whom we are concerned about in this discussion. Everything else is tangential to that; good for your father, and good for the rich. What of the many millions of uninsured Americans? And those denied coverage due to pre-existing conditions they may or may not be able to help? It's inhumane and ineffective to deny them coverage, and by and large a byproduct of the for-profit sector which benefits from denying them coverage. It is a fundamental problem with profit in healthcare and it is innate in the profit-based healthcare system, because removing for-profit elements or introducing non-profit elements to the system reduces those issues (see: public option).

 

[El_Machinae]

There's public funding, yes, but pharmaceutical companies are private giants by and large market funded. You might ask yourself why most medical innovation comes from the US and not any other country.

This is just not as true as people think. The US is a dynamo of medical research, but many of the Western European countries (incl. UK), Japan, Korea, Canada, etc. are really comparable.

The US has a strict advantage over many countries just due to population. Being 10x bigger than Canada, it's no surprise that they have more innovation. If you were to compare the innovation to the %GDP spent on 'healthcare', then US would do very poorly. If you look at the innovation rate compared to total GDP, it's pretty good. But so are many other developed countries.

The US tends to score better, and part of that is due to being wealthier. And part of that wealth is likely due to their market system.

This is something I'm terribly interested in, and it's actually really hard to unpack. If there is a research benefit due to high healthcare costs, it's actually hard to say that the people are getting much of a premium on that extra cost.

 

[luiz]

This is just not as true as people think. The US is a dynamo of medical research, but many of the Western European countries (incl. UK), Japan, Korea, Canada, etc. are really comparable.

The US has a strict advantage over many countries just due to population. Being 10x bigger than Canada, it's no surprise that they have more innovation. If you were to compare the innovation to the %GDP spent on 'healthcare', then US would do very poorly. If you look at the innovation rate compared to total GDP, it's pretty good. But so are many other developed countries.

The US tends to score better, and part of that is due to being wealthier. And part of that wealth is likely due to their market system.

This is something I'm terribly interested in, and it's actually really hard to unpack. If there is a research benefit due to high healthcare costs, it's actually hard to say that the people are getting much of a premium on that extra cost.

I think you are underestimating the extent of the lead of the US in medical innovation. Of course, the fact they are big and rich is part of the explanation (and as you correctly put it, they are only so rich because of their market-based system). But look at this:

The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country.[14] Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined.[15] In only five of the past 34 years did a scientist living in America not win or share in the prize. Most important recent medical innovations were developed in the United States.[16] [See the table.]

Spoiler :

http://www.ncpa.org/pub/ba649

and

In 2003, research and development expenditures were approximately $95 billion with $40 billion coming from public sources and $55 billion coming from private sources.[22][23] These investments into medical research have made the United States the leader in medical innovation, measured either in terms of revenue or the number of new drugs and devices introduced.[24][25] In 2006, the United States accounted for three quarters of the world’s biotechnology revenues and 82% of world R&D spending in biotechnology.[24][25] According to multiple international pharmaceutical trade groups, the high cost of patented drugs in the U.S. has encouraged substantial reinvestment in such research and development.[24][25][26]

http://en.wikipedia.org/wiki/Health_care_in_the_United_States

 

[peter grimes]

I don't see how the existence of for-profit hospitals prevents the emergence of non-profits or public hospitals. The reverse would be more logical.

If there's only one hospital in the area and it happens to be a for-profit, that seems to prove the point that they serve a good purpose. If it were not for that hospital there would be no hospital in said region. And if there's plenty of demand in the region, nothing is stopping the emergence of a public or non-profit additional hospital.

I think you and I see things precisely opposite

I would think (but I don't know!) that the existence of a for-profit institution would have exert a downwards pressure on wages and services relative to the non-profit. Plus, hospitals are the sorts of things where excess capacity is a drag on the operating costs - something a for-profit entity would strive to eliminate. The result is that you get the bare minimum of service for the community's needs. The way it is here they try to kick you out the door as fast as possible so they can free up a bed for the next person.

But again - I don't know if this is really how things work. I'm looking into it.

 

[luiz]

I think you and I see things precisely opposite

I would think (but I don't know!) that the existence of a for-profit institution would have exert a downwards pressure on wages and services relative to the non-profit. Plus, hospitals are the sorts of things where excess capacity is a drag on the operating costs - something a for-profit entity would strive to eliminate. The result is that you get the bare minimum of service for the community's needs. The way it is here they try to kick you out the door as fast as possible so they can free up a bed for the next person.

But again - I don't know if this is really how things work. I'm looking into it.

The way I see it, the existence of a non-profit or public hospital, which presumably offers healthcare for a lower cost than a private hospital, would depress the demand for private hospitals. Why would people pay more if they don't have to?

OTOH, if a private hospital is so expensive as to exclude a sizeable proportion of the population, there will be demand for lower cost alternatives, so people choosing the location of a nonprofit or public hospital will still consider the region, as the private hospital is not meeting all demand.

 

[JollyRoger]

OTOH, if a private hospital is so expensive as to exclude a sizeable proportion of the population, there will be demand for lower cost alternatives, so people choosing the location of a nonprofit or public hospital will still consider the region, as the private hospital is not meeting all demand.

The problem in my neck of the woods is free riding. The public hospitals are subsidized by county level tax dollars. The most affluent county in the region free rides by referring its poor to Dallas county instead of providing an in-county alternative for its poor.

 

[El_Machinae]

I think you are underestimating the extent of the lead of the US in medical innovation. Of course, the fact they are big and rich is part of the explanation (and as you correctly put it, they are only so rich because of their market-based system). But look at this:

Spoiler :

http://www.ncpa.org/pub/ba649

and

http://en.wikipedia.org/wiki/Health_care_in_the_United_States

Like I said, the US is a juggernaut. That list you gave is weird, though. SSRIs were discovered in Sweden. The ACE inhibitors weren't discovered in Sweden, but I am quite sure they were Western Europe (I want to say UK, but I was reading about UK drug discoveries eariler today)

 

[luiz]

The problem in my neck of the woods is free riding. The public hospitals are subsidized by county level tax dollars. The most affluent county in the region free rides by referring its poor to Dallas county instead of providing an in-county alternative for its poor.

While that's a valid (and very real) concern, that's actually a problem of implementation of public healthcare, not of private hospitals.

Brazil has a public universal healthcare system, and suffers severely from what you describe. Rio, for instance, has many public hospitals, as it is the state capital and former federal capital, and is also a very wealthy city by Brazilian standards. Many mayors of neighboring cities, instead of building hospitals, simply buy vans and buses to take patients to Rio's hospitals, who have to give free healthcare for any Brazilian. This represents not only a cost of hundreds of millions of dollars for Rio every year, but it also means Rio's public hospitals are always crowded and have to put people in huge lines, where many (literally) die waiting for treatment.

Like I said, the US is a juggernaut. That list you gave is weird, though. SSRIs were discovered in Sweden. The ACE inhibitors weren't discovered in Sweden, but I am quite sure they were Western Europe (I want to say UK, but I was reading about UK drug discoveries eariler today)

The US is huge, but in terms of innovation in medical industry they represent 70% - 85% of the global total, depending on the metric. They're not that huge in GDP or healthcare spending, which does mean that their system is stimulating innovation more than others, as flawed as it may be in other departments.

As for the table, I can't vouch for its precision. It came from an Economic Report of the President, so I'd expect some data-checking, but who knows.