To those who oppose mandatory health coverage

[New Mexican Disaster]

I think a program where all MDs and DOs get free med school tuition, in exchange for working for a modest salary for a few years (the military model) could do a lot of good, and probably save everyone some money.

ding, ding, ding-we have a winner. Such a program would take some of the rationale for providing large salaries down.

[Uncle Ted]

When my son was hospitalized and there were $80K of charges, I think maybe $1500 was payments to physicians. My patients have similar ratios for their inpatient care. And you factor in things like prescription drugs and long-term and rehabilitation care and the physician piece of the pie gets even more insignificant.

On prescription drugs I was recently on a business trip in Canada a few weeks ago and got into an interesting conversation with one of the locals over lunch about how Canada's patent laws don't cover drugs. Of course, given that any drug can be copied it makes generic drugs very inexpensive to buy there. He was convinced that the rest of the world should adopt Canada's lack of patent laws on drugs. I asked him how new drug innovation is funded in Canada. After thinking for a moment he said the government created the new drugs. I asked what new and innovative drugs the Canadian government had created recently. Of course, he couldn't think of any but then said the government didn't need to because of all the American drug companies. I speculated that the combined R&D budgets of the American drug companies would be a sizable part of Canada's total budget (I looked it up later and found that it is about $40b. Canada's 2010 budget is $274b.) and proposed that Canadians should be very happy they don't have to fund that as part of their budget.

[jlwalden]

Because it gives you a reason to arrest people that simply can't afford health insurance. I don't have health insurance and I really need it for my meds. I also don't understand American fear of socialism.

[BigFatMeanie]

Because it gives you a reason to arrest people that simply can't afford health insurance. I don't have health insurance and I really need it for my meds. I also don't understand American fear of socialism.

You don't understand my "fear" (not sure I would use that particular word to describe my feelings about socialism but I'll go with it here) because you value other things more than you value freedom.

It's simply a question of what you value more. If you value security, egalitarianism, safety, or a whole host of other things more than you value freedom then I can see how you would be enamored with socialism.

[Uncle Ted]

Because it gives you a reason to arrest people that simply can't afford health insurance. I don't have health insurance and I really need it for my meds. I also don't understand American fear of socialism.

Don't worry... We will all be forced to buy heath insurance by law. If you think about it heath insurance is a form of socialism. Of course, buying into this socialism was optional in the past but is now falling in line with the "gun to the head" forms of socialism that folks enjoy in other parts of the world.

[Goatnapper'96]

You don't understand my "fear" (not sure I would use that particular word to describe my feelings about socialism but I'll go with it here) because you value other things more than you value freedom.

It's simply a question of what you value more. If you value security, egalitarianism, safety, or a whole host of other things more than you value freedom then I can see how you would be enamored with socialism.

Socialism has the appearance of allocating resources/capital more "fairly," but I think market based approaches, i.e. private property owners investing/spending as they view in their best interests, allocate resources more "effeciently." Not only does the centralization of economic control threaten freedom, but it threatens economic vitality and could result in the "fairer" allocation of less and less.

Saying all that I could live with a base level of socialized medicine if I could be convinced it could be maintained at that level. My interpretation of entitlements is that they grow and I don't accept that some folks will ever be content if their are people out there who have more than others. Perhaps that stress between folks like myself wary of the growth of entitlements and those wanting to use entitlements to redistribute more and more wealth is crucial to our way of life and not such a bad thing?

[Clark Addison]

On prescription drugs I was recently on a business trip in Canada a few weeks ago and got into an interesting conversation with one of the locals over lunch about how Canada's patent laws don't cover drugs. Of course, given that any drug can be copied it makes generic drugs very inexpensive to buy there. He was convinced that the rest of the world should adopt Canada's lack of patent laws on drugs. I asked him how new drug innovation is funded in Canada. After thinking for a moment he said the government created the new drugs. I asked what new and innovative drugs the Canadian government had created recently. Of course, he couldn't think of any but then said the government didn't need to because of all the American drug companies. I speculated that the combined R&D budgets of the American drug companies would be a sizable part of Canada's total budget (I looked it up later and found that it is about $40b. Canada's 2010 budget is $274b.) and proposed that Canadians should be very happy they don't have to fund that as part of their budget.

I'm no expert, but this is why I have always thought that the folks who point to Canada's Prescription Drug system as a model are misguided. It seems this system works best if you happen to have the USA next door to you.

[beefytee]

On prescription drugs I was recently on a business trip in Canada a few weeks ago and got into an interesting conversation with one of the locals over lunch about how Canada's patent laws don't cover drugs.

Sounds like the local had no clue what he was talking about.

http://dsp-psd.pwgsc.gc.ca/Collection-R/LoPBdP/BP/prb9946-e.htm

[CardiacCoug]

On prescription drugs I was recently on a business trip in Canada a few weeks ago and got into an interesting conversation with one of the locals over lunch about how Canada's patent laws don't cover drugs. Of course, given that any drug can be copied it makes generic drugs very inexpensive to buy there. He was convinced that the rest of the world should adopt Canada's lack of patent laws on drugs. I asked him how new drug innovation is funded in Canada. After thinking for a moment he said the government created the new drugs. I asked what new and innovative drugs the Canadian government had created recently. Of course, he couldn't think of any but then said the government didn't need to because of all the American drug companies. I speculated that the combined R&D budgets of the American drug companies would be a sizable part of Canada's total budget (I looked it up later and found that it is about $40b. Canada's 2010 budget is $274b.) and proposed that Canadians should be very happy they don't have to fund that as part of their budget.

Right, the US health care system funds drug and medical device development for not just Canada, but the entire world. Rather than denigrating the US system, that Canadian should be grateful for it.

Here's the thing with drug development, though: There is drug development that is truly revolutionary, things like the first statins, the first ACE inhibitors for blood pressure, and thienopyridines drugs like clopidogrel that enabled coronary stenting to be performed safely.

But there is a lot of drug development that is just testing and the marketing of the 11th different type of a well-established type of medication that really has no proven advantage over older versions.

So Medicare Part D pays millions of dollars for Crestor and Lipitor for patients where generic simvastatin would be just as effective at a fraction of the cost. The same thing happens with use of newer blood pressure medications. And that's not necessary. Most patients will do just fine taking almost entirely older generic medications.

I think the drug patent system should do something to reward the development of entirely new CLASSES of medications in a way that differentiates this type of drug development that really moves medical science forward from the type of drug development that just cynically adds another "me too" medication (or minor variation on an older medication) in a purely profit-driven scheme that really just milks consumers and the government out of money for no proven medical benefit.

[San Juan Sun]

And some of the stuff in that chart is just stupid. Like the line "In the UK, 60% of hernias are treated as inpatient, in the US that number is just 11%."

Uhhh... Outpatient treatment is cheaper than inpatient treatment (even if the profit margin is higher). Are they arguing that the US should keep patients in the hospital unnecessarily for more days so we can be more like the UK? That's something the US is doing right.

That's because there are many fewer elective hernia repairs done in the UK. Obviously, this leads to more acute incarcerations/strangulations/admissions when compared to the US. It's essentially a consequence of rationing.

[snowcat]

I think the drug patent system should do something to reward the development of entirely new CLASSES of medications in a way that differentiates this type of drug development that really moves medical science forward from the type of drug development that just cynically adds another "me too" medication (or minor variation on an older medication) in a purely profit-driven scheme that really just milks consumers and the government out of money for no proven medical benefit.

Eliminating drug advertising would help this.

[San Juan Sun]

I think a program where all MDs and DOs get free med school tuition, in exchange for working for a modest salary for a few years (the military model) could do a lot of good, and probably save everyone some money.

They have this. Its called "residency". Except for the free tuition part.

Sort of TIC.

[Jacob]

I also don't understand American fear of socialism.

It is the sad result of its abject failure every time it has been tried.

[il Padrino Ute]

The doctors on this board are going to love this... They saved the best for last.

Who are these commie bastards?

[il Padrino Ute]

I also don't understand American fear of socialism.

I don't understand why you don't value freedom.