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  • Advanced Member
Posted

So as a proponent for a public healthcare option, I have been listening to some libertarian views on healthcare and what they attribute to problems in the US healthcare system. So they suggest a few things that are wrong with the healthcare system;

(1) Monopoly of the insurance industry - Basically insurance companies are exempt from federal regulation and federal anti-trust laws, which means they don't compete across state lines and hence are unable to diversify their risk pools. This inherently enables a system of cartels among few insurance companies, and especially in smaller states where there isn't a lot of competition among them. Additionally, unlike when you go see a doctor and when you have choices over different doctors you can go to to get whatever treatment you need, insurance companies aren't really selling you a product, they are gambling on a person hedging against risk, and since people are fairly risk averse, they will pay higher premiums to avoid paying higher medical emergency costs in the event that they don't have insurance. Doctors can choose not to take insurance, but then they will lose a pool of customers, most of whom do have insurance. Then you have additional incentives that aid the insurance companies like tax-breaks on insurance premiums have enabled employers to provide insurance to their employees, adding another middleman into the picture. All of this gives the insurance industry an incredible amount of influence and control. A libertarian solution it would seem then would be to eliminate this industry entirely since it runs contrary to the free-market principles of incentives and disincentives. It gambles on risk.

(2) Pharma - I think this is a fairly common critique, but basically patents handed out by governments to pharma, and using copyright laws to protect them from competition. Additionally, elongated time limits to come up with generic drugs for example has created a monopoly on non-generic drugs allowing pharmaceutical companies to charge more for them. I think this is pretty much agreed upon by elements on the right and the left.

(3) Collusion between government and AMA (American Medical Association) - Apparently there has been attempts by the AMA lobbying the government to prevent new healthcare facilities from opening up within a certain locality without the consent of other hospitals in that area. Not to mention the amount of time it takes to become a physician let alone a specialist in the US and the monetary cost is already a huge barrier to entry. The additional lobbying and the redtape and bureaucracy required in order to license people to practice is another issue.

(4) This was a bit of a reach for me but libertarians argue that medicare and medicaid increase demand. I'm not exactly sure how since you don't just go to a doctor if you're feeling like it, you go if you have a problem, perhaps what they mean is people are less likely to take care of themselves if they have a free public option. 

My counterarguments to each of these claims;

(1) Why wouldn't healthcare costs be low in states like NY or CA where there is a lot of competition between insurance industries, such that if one tries to overcharge, others will just undercut and take over the market? I know there is a different risk pool for each insurance company, but if we're talking about operations within state lines, and a good number of insurance companies in the state, then wouldn't this even out anyway? If there is cartel like behaviour wouldn't this happen anyway at the national level even if you enabled insurance companies to compete across states and nationwide? If you eliminate insurance all together then you rely on doctors and patients setting a price in a competitive market. The problem with healthcare is it is has a very inelastic demand and even supply. There is no choice of treatment, if you have a certain condition, you need a certain treatment, you can't treat it like loaves of bread, or types of coffee. It is a necessity. You can go to a different doctor, but again here there are barriers to entry, people can't just become doctors overnight, it takes a long time and if its a specialist, then it takes even longer. So it's not like you can just choose to go to a different seller. So how is it that then the competitive market will yield a better outcome than what you have?

(2) No real disagreement here, big pharma is a big problem, but again surely shrinking the state will mean you won't have publicly funded research, and again you can argue that without patents and copyright laws, people aren't protected and monopolies aren't created, but again this is a specialized industry, there are barriers to entry, it takes pharmacologists, statisticians, doctors etc. to do a clinical trial and pass off a drug as safe and effective. How much competition can you really even achieve here?

(3) This is mostly to protect doctors from losing their ability to charge more to people but bear in mind that there are already huge barriers to entry, and doctors often go into large amounts of debt to become doctors, it only makes sense that they would engage in this type of behaviour. So I'm not too sure how much of an impact the AMA lobbying has, because even if the state wasn't involved, no one would go to a doctor that's not qualified, and it takes a while to be qualified. So would this really help lower costs?

(4) Countries with single-payer options and in some cases, multi-payer like Switzerland have a healthier population than the US with the system that it does have, which isn't fully privatized but is significantly more privatized than a single-payer system or even a multi-payer system.

I think you would see problems with medicare in terms of how long it would take to see a doctor and especially a specialist, it would be costly and with an ageing population, it would be harder to generate enough tax revenue to fund it. But given that countries that do have it seem to be doing okay what would be the counterargument to having a free-market system over a medicare for all option? Countries that have public options far outweigh countries that have a free-market system like say India, where its fairly cheap for people to get treatment but I;m speaking from a person earning an American salary, it probably isn't cheap for the working class that live there.

What are your thoughts? @hasanhh @Sumerian @King @notme 

  • Veteran Member
Posted
27 minutes ago, Mohamed1993 said:

(4) This was a bit of a reach for me but libertarians argue that medicare and medicaid increase demand. I'm not exactly sure how

Back in the 60s and from an interview of one of the men who did the estimates for Congress, based on the data they accumulated they told Congress the cost for a Medicare program would be $3 Billion per year. When the first year bill came in, it was "$6 Billion". The reason was that once the gov't started paying for most of it, people, especially the old women, started going to the doctors which in most cases were for no reason at all. Before, they went when they needed to.

  • Moderators
Posted
1 hour ago, hasanhh said:

people, especially the old women, started going to the doctors which in most cases were for no reason at all. Before, they went when they needed to.

So they went in for their recommended annual checkup? That's a good thing, not unnecessary at all. 

What kind of psychopath would go to a doctor other than due to illness or general health maintenance recommendations? 

  • Veteran Member
Posted
1 hour ago, notme said:

So they went in for their recommended annual checkup? That's a good thing, not unnecessary at all. 

What kind of psychopath would go to a doctor other than due to illness or general health maintenance recommendations? 

An example is a woman in our town. Her son or daughter kept driving her to doctor appointments and did not think it was anything unusual for an old woman. She never got any better. Finally, one doctor asked her -how he guessed another doctor would know- who else was she seeing. After answering she then volunteered the name of a third. So after phone consultations, it was determined that she was going to three doctors for the same thing and each doctor had proscribed a different course of treatment and medication. Her daughter had drove her that day and l heard her telling it somewhere. She later asked her why she did this and her mother said she just wanted to be sure.

Add into this filling up waiting rooms for the air conditioning or in some cases warm-ups. My ex was good at this dumb stuff. She was always going to some doctor over something --until she had to pay for it as l wasn't.

In Japan with national health insurance, you know you pay 20% every time not matter what it costs. They have a very good system.

  • Moderators
Posted
4 hours ago, hasanhh said:

Add into this filling up waiting rooms for the air conditioning or in some cases warm-ups. My ex was good at this dumb stuff. She was always going to some doctor over something --until she had to pay for it as l wasn't.

Insanity! 

Libraries have heat and AC, and they are so much less intrusive. 

Surely this must be a tiny minority, only hypochondriacs. 

  • Veteran Member
Posted
5 minutes ago, notme said:

Insanity! 

Libraries have heat and AC, and they are so much less intrusive. 

Surely this must be a tiny minority, only hypochondriacs. 

ln July or August this year, one American nework ran a story about how this clogs up hospital admissions, then the bums wait in the waiting room until a doctor looks at them and then sends them home until the next day.

  • Advanced Member
Posted

@hasanhh maybe you can explain this; why are inpatient visits so expensive that people are forced to buy insurance to cover them? If you let the market do the job and eliminate the insurance industry, won't the costs of inpatient visits be what they are right now without the insurance industry getting involved? 

  • Veteran Member
Posted
11 minutes ago, Mohamed1993 said:

@hasanhh maybe you can explain this; why are inpatient visits so expensive that people are forced to buy insurance to cover them? If you let the market do the job and eliminate the insurance industry, won't the costs of inpatient visits be what they are right now without the insurance industry getting involved? 

You'll have to look this number up, but a couple of years ago when answering this question, one of the things reported was 40% or 60% of these people do not pay their bill, so we have to make up the difference. Plus, none of the illegal entries pay anything and bankrupted hospitals to the point that Congress started and funded a program to pay illegal bills  --but not ours.

  • Advanced Member
Posted
1 minute ago, hasanhh said:

You'll have to look this number up, but a couple of years ago when answering this question, one of the things reported was 40% or 60% of these people do not pay their bill, so we have to make up the difference. Plus, none of the illegal entries pay anything and bankrupted hospitals to the point that Congress started and funded a program to pay illegal bills  --but not ours.

I don't get it so hospitals can't deny you treatment if you're undocumented? 

  • Moderators
Posted
4 minutes ago, Mohamed1993 said:

I don't get it so hospitals can't deny you treatment if you're undocumented? 

Public hospital emergency rooms won't (I'm not sure about can't) deny anyone necessary treatment, but they will bill you for the rest of your life if you can't pay. At least once I've filled forms to have a portion of my expense covered by grants or charities, and my children and I have needed the emergency room few enough times that I can count on one hand. I believe these grant and charity programs are more available than Medicaid or other government health subsidies. 

  • Veteran Member
Posted
49 minutes ago, Mohamed1993 said:

I don't get it so hospitals can't deny you treatment if you're undocumented? 

That is the law. For them or anyone else.

See why Trump wants proof of health insurance for visas?

  • Veteran Member
Posted
42 minutes ago, notme said:

I have needed the emergency room f

We have a clinic around here. l go, pay $100 and the doc sees me. lf l want to see my primary care physician it is 3 months out. The last time l went to a hospital emergency room in the 90s, the price to walk through the door had jumped from $160 to $190 plus the cost of treatment.

l saw in 2017 or 2018 that hospitals in many cities had started to sponsor clinics.

  • Moderators
Posted
9 hours ago, hasanhh said:

We have a clinic around here.

We have urgent care clinics too, but if they can't deal with a condition, they will send the patient to the emergency room, like the time my son stepped on a broken (sewing) needle and it was very stuck in his foot. 

Posted

There is truth to the fact that the only reason why other countries can afford nationalised healthcare in comparison with the US is because they don't have to spend the billions of dollars that US pharma companies already spend on research and innovation for them.

  • Advanced Member
Posted
9 minutes ago, Sumerian said:

There is truth to the fact that the only reason why other countries can afford nationalised healthcare in comparison with the US is because they don't have to spend the billions of dollars that US pharma companies already spend on research and innovation for them.

That's not the reason why. They are raising prices on drugs that already exist (see article below)..so that's just an excuse made by the pharmaceutical industry. Also that is only part of it as healthcare is not only about pharmaceuticals but this is about comprehensive health care coverage. In short, these companies are ripping people off. We spend so much on military budget (more than the 7 countries after us on the list combined) but refuse to treat healthcare as a human right. The whole thing against Medicare for All is just companies trying to continue to rip people off. Unfortunately, I don't think Bernie Sanders will win because many of the Americans that vote are ignorant boomers that will likely vote for the Orange man. 

https://www.cnbc.com/2019/01/10/why-prescription-drugs-in-the-us-cost-so-much.html

Posted (edited)
57 minutes ago, tri-star said:

That's not the reason why. They are raising prices on drugs that already exist (see article below)..so that's just an excuse made by the pharmaceutical industry. Also that is only part of it as healthcare is not only about pharmaceuticals but this is about comprehensive health care coverage. In short, these companies are ripping people off. We spend so much on military budget (more than the 7 countries after us on the list combined) but refuse to treat healthcare as a human right. The whole thing against Medicare for All is just companies trying to continue to rip people off. Unfortunately, I don't think Bernie Sanders will win because many of the Americans that vote are ignorant boomers that will likely vote for the Orange man. 

https://www.cnbc.com/2019/01/10/why-prescription-drugs-in-the-us-cost-so-much.html

Yes, they raise prices. What is your solution? At the end of the day society needs them to create new drugs and lead medical research, so who will fill that part if they go bust? The government? lol.

US spends more on military budget than the next seven countries combined simply because it has a larger budget than them. It is a bigger economy (largest) and spends more overall on anything compared to any other country. 

https://data.worldbank.org/indicator/MS.MIL.XPND.ZS?most_recent_value_desc=true

The better statistic to measure by is % of GDP, to which the US is even behind Russia in military spending in that regard.

A hybrid healthcare plan, like Germany, or a private insurance mandatory system like Switzerland, would work better in the US than a single-payer like Canada or the UK. And in fact those two countries have better healthcare than both.

Edited by Sumerian
  • Advanced Member
Posted
1 hour ago, Sumerian said:

Yes, they raise prices. What is your solution? At the end of the day society needs them to create new drugs and lead medical research, so who will fill that part if they go bust? The government? lol.

US spends more on military budget than the next seven countries combined simply because it has a larger budget than them. It is a bigger economy (largest) and spends more overall on anything compared to any other country. 

https://data.worldbank.org/indicator/MS.MIL.XPND.ZS?most_recent_value_desc=true

The better statistic to measure by is % of GDP, to which the US is even behind Russia in military spending in that regard.

A hybrid healthcare plan, like Germany, or a private insurance mandatory system like Switzerland, would work better in the US than a single-payer like Canada or the UK. And in fact those two countries have better healthcare than both.

Lack of regulation and competition is what allows them to raise the prices that much in fact like the article I quoted stated that only 17% of their costs are for research and development. After the FDA approves a drug there are minimal research and development costs if any (most of the time there isn't any). So Americans are just supposed to take the beating just because these companies are working on research? They are not going to magically stop their research just because medicare for all is enacted because it benefits them too. 

The military budget is outrageously large (close to how large it was during the Iraq war) and just because the economy grows in America, does mean that the US is required to spend more money on national security. Security is at the base of order of necessities so it has to be funded sufficiently regardless of the size of the economy. So as the economy grows, more resources should be accessible to spend on things higher up the hierarchy rank order, things that should improve the quality of life for Americans such as healthcare and education. Likewise, just because Congress has determinedto spend more on healthcare or education or any social safety net and hence increasing the size of the federal budget in general, it does not mean that defense spending should grow evenly. That makes no sense. 

Posted (edited)

Whether you like it or not, pharma companies do have alot of leverage. If your solution is to price-fix certain drugs, the pharma companies may simply stop making them because there is no incentive to make them anymore because they will lose profit. And that "17%" of R&D is what causes the highest quality rate of new drug creation not just for the US, but for the entire world. The rest of the world's drug creation and innovation does not compare at all to the US.

The US will spend more on the military than anyone even if it only spent 2% of their GDP on it. The US actually spends less on their military than during the Iraq war, because it was a smaller economy in 2003. My point is spending on anything - social security, healthcare, and other services all across the board will rise as long as an economy grows.

Edited by Sumerian
  • Advanced Member
Posted
1 hour ago, Sumerian said:

Whether you like it or not, pharma companies do have alot of leverage. If your solution is to price-fix certain drugs, the pharma companies may simply stop making them because there is no incentive to make them anymore because they will lose profit. And that "17%" of R&D is what causes the highest quality rate of new drug creation not just for the US, but for the entire world. The rest of the world's drug creation and innovation does not compare at all to the US.

The US will spend more on the military than anyone even if it only spent 2% of their GDP on it. The US actually spends less on their military than during the Iraq war, because it was a smaller economy in 2003. My point is spending on anything - social security, healthcare, and other services all across the board will rise as long as an economy grows.

% of GDP is a really bad way to measure spending. The government does not collect the GDP,they collect a portion through taxes, and they always rant about the debt and the deficit, so it doesn't even really make sense to be looking at GDP. It's like when you buy a house, they look at the amount you pocket.

I don't really think big pharma will stop functioning if they're forced to control prices, because its either make nothing or make something, albeit less than what they're making now. The same arguments are used to defend lower minimum wages, yet when they're raised, you don't see massive waves of unemployment. And I also wonder, if their argument for overcharging is that the research costs money, etc. etc., well then how much of the drugs they do research on are really beneficial to the average person in all these countries the drugs benefit? If drugs are going to be massively overpriced as a result of R&D costs then most people wouldn't be able to afford them, in which case what is the point of the research? In any case, a lot of research is done by public institutions, non-profits and universities, and big pharma often uses research funded by the NIH, but then they get copyright protections, which enables them to build a monopoly and overcharge. It's worth looking at to what extent this research is beneficial to  the average person relative to drugs created through other sources of research.

  • Veteran Member
Posted
1 hour ago, Mohamed1993 said:

The government does not collect the GDP,they collect a portion through taxes, and they always rant about the debt and the deficit,

:hahaha:

Most of what you pay iz taxes. Taxes accumulate. Taxes pile up. You pay sales tax on the taxes eveyone before you paid.

Simplistic example: cigarettes. 4 cents a pack to produce and what you pay is a modicum for tranportation and all the rest is taxes.

From the self-employment taxes by the original material producer, fuel taxes to transport, to wage, social security and medicare taxes, then the same until the product you bought is on the shelf . . . and then you pay the sales tax plus whatever fuel taxes on the fuel you used to get to the store --including public transportation. And at every level of production this occurs.

  • Advanced Member
Posted
1 hour ago, hasanhh said:

:hahaha:

Most of what you pay iz taxes. Taxes accumulate. Taxes pile up. You pay sales tax on the taxes eveyone before you paid.

Simplistic example: cigarettes. 4 cents a pack to produce and what you pay is a modicum for tranportation and all the rest is taxes.

From the self-employment taxes by the original material producer, fuel taxes to transport, to wage, social security and medicare taxes, then the same until the product you bought is on the shelf . . . and then you pay the sales tax plus whatever fuel taxes on the fuel you used to get to the store --including public transportation. And at every level of production this occurs.

Yes, there are diff taxes, but still the budget is what? 20-25% of GDP? And, with that you have a deficit so, obviously tax revenue is less than 20% of GDP. 

Posted
15 hours ago, Mohamed1993 said:

% of GDP is a really bad way to measure spending. The government does not collect the GDP,they collect a portion through taxes, and they always rant about the debt and the deficit, so it doesn't even really make sense to be looking at GDP. It's like when you buy a house, they look at the amount you pocket.

Which ever way you go, the US doesn't really spend that much on the military in comparison with their adversaries. The US simply has more money to spend because their budget is bigger. It's a richer and bigger country.

15 hours ago, Mohamed1993 said:

I don't really think big pharma will stop functioning if they're forced to control prices, because its either make nothing or make something, albeit less than what they're making now. 

Big pharma will not stop functioning, they will never stop functioning, but they will reorganise their budget to still maintain healthy profit, and that may mean scrapping certain life-saving or very needed drugs, or their development.

15 hours ago, Mohamed1993 said:

The same arguments are used to defend lower minimum wages, yet when they're raised, you don't see massive waves of unemployment. 

Well it depends on how high you raise it. 

15 hours ago, Mohamed1993 said:

And I also wonder, if their argument for overcharging is that the research costs money, etc. etc., well then how much of the drugs they do research on are really beneficial to the average person in all these countries the drugs benefit? If drugs are going to be massively overpriced as a result of R&D costs then most people wouldn't be able to afford them, in which case what is the point of the research? 

That's a problem with lack of competition and a monopoly, when there are multiple businesses competing on making the same product then it will drive prices down naturally. But when a handful of companies control the market and are granted special status by the government, of course they will overcharge.. because they can. The government then only ends up with two options: price fixing which can harm innovation and research, or subsidising drugs which is using taxpayer money. 

15 hours ago, Mohamed1993 said:

In any case, a lot of research is done by public institutions, non-profits and universities, and big pharma often uses research funded by the NIH, but then they get copyright protections, which enables them to build a monopoly and overcharge. It's worth looking at to what extent this research is beneficial to  the average person relative to drugs created through other sources of research.

When it comes to drugs and medication, the private sector comes out on top easily in terms of research and development.

  • Veteran Member
Posted
9 hours ago, Sumerian said:

, the private sector comes out on top easily in terms of research and development.

There are gov't subsidy programs for this.

  • 4 years later...
  • Forum Administrators
Posted

Life expectancy comparisons

 

Screenshot 2024-08-17 at 21.28.48.png

 

Screenshot 2024-08-17 at 21.29.06.png

 

The author has this conclusion:

Quote

One strong possibility is because the US is the ultimate “individual responsibility” country. Every person for themselves, weaker social safety nets. So, far more people slip through the cracks and find themselves in situations that make obesity, violence and drugs more likely.

https://x.com/jburnmurdoch/status/1641799815074914305

 

  • 4 months later...

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