Topic: Healthcare

I am a Politician

I am also a math scientist in a statistics related field.


So I have a unique perspective upon the whole.

I have a pre-prepared statement I have created to help those who think Socialized Health Care is good, know the alternatives, and why others may support those alternatives. Please read with an open mind, and I promise in return to try to return here and reply to questions and comments and keep an open mind as well.



First it is important to establish the different venues I will be describing and discussing. These are Hospitals, Pharmacies (separate of Pharmaceuticals), eye glasses, and Dentists.

If you see an inaccuracy please say so, I invite people to find things that are wrong.




Pharmacies

Pharmacies were born in old times by those who would sell tonics, salves, and other items they thought helped with ailments. Some were snake oil salesmen (A term now associated with a con-artist) , some were the herbalists of their day, and some were learned persons seeking their aspect of health and care for others.

This grew until there was an established 'genre' of stores dedicated entirely to, or partially to, medicines (real or imagined). In the early days of the Industrial Age this included Morphine, Cocaine, and other 'hard' drugs. The industry was unregulated in the extreme. Anyone could make drugs, anyone could market drugs, and anyone could buy drugs.

Then the Federal Government of the United States set up regulations about drugs, classified many immediately, and set up a system for pharmaceuticals to make medicines, and for Pharmacies to issue medicines. This is a broad view of the changes of course.

The result was that there was a period of time where less people were qualified to give medicines for a while, and where those that could train others were not in large enough numbers. This lead to prices of medicines to be much higher than they were from the Pharmacies due to lack of supply of the pharmacists.

Over the years it was established at Hospitals there were Pharmacies, and that there were certain drug stores with their own Pharmacists. Prices were still fairly high, but in general everyone could be guaranteed some sort of access to medicines if they could get to one of these and if they had a prescription.

Then the supply of teachers increased enough, and because they were lured by the then very high pay, a stream of new Pharmacists came out in droves. This created a supply side issue. The result was the first pharmacies in super market stores. I know not if it was an Albertsons, Krogers, Safeway, or other store that started this, but I do know the results.


Initially this lead to a substantial increase to access to the medicine. You could be ill enough that you did not wish to drive to a hospital for your medicine, but the store was nearby and you needed something there anyways... Then prices started dropping.

The supply of teachers escalated, especially with private colleges offering courses in targeted venues. This dramatically increased the number of stores with Pharmacies. With the increase came the most powerful dynamic ever. Competition.

Competition lead to prices being dropped. A $20 generic was then $15, then $10, then $5, and now in many places $4. The prices of a generic in production are after all very cheap, and the amount of medicines we use is being increased dramatically, and the transportation costs are very low as well. Competition due to customers being able to choose where to go caused prices to plummet.


Pharmacies are in my mind, one of the ultimate examples of a Free Market that has regulations that do not hinder business in a negative manner.



Eye Glasses
I need to say that I have 20/10 vision, so I do not wear glasses. However my ex-wife did, and when I was a kid I suffered an eye injury and had to wear glasses for a few weeks. That said I watch, I listen, I observe.

What have I seen with my eyes? Binyons, and other big eye glass stores. When I got my care as a child we went to a clinic next to a hospital. This building was the only one for a good distance if I remember correct (I was in 6th grade then) and pre-dated my first observation of an eye glass store.

What is clear though is that over time eye glasses went from having to be ordered from a manufacturing place, to being made at the store itself. It went from bottle bottom thick glasses for some, to refractive lenses capable of providing sight with a much thinner lense.

It lead to, in Oregon at least, a Store in every mall, which makes them easy to find... and with prices that kept dropping steadily downward.

Glasses used to require people with advanced degrees peering into your eyes for a long time to determine flaws. Their accuracy was not so great by the complaints friends and family had back then of their glasses.

Now your in and out in less time than some take in a bathroom.

Glasses have some practical requirements, education and such, but I have not seen any regulations on them except where they might be issued via prescription. Therefore I call it a great example of a free market ideal without regulations.



Dentists
Dentistry has come a long way since I was a kid. Gold and Silver used to cap teeth, now we have other materials, and they can be made to match the color of your (hope they are clean) teeth.

There is even a way to grow back partially broken teeth that I read about last year. I have lost track of the progress of that innovation, but watch for it in the coming years.

Dentistry has come far enough that x-ray imaging of our mouths is common place. New tools do not even need to use the 'original' X-ray but instead can use a form of Cat-Scan to examine your teeth. The devices have shrunk in size, and tools and training have grown more capable.

And braces... Ok I admit I have a braces fetish, I like a gal with braces, I do not know why... but besides that... They used to be so clunky, and awkward to use. I remember my sister using rubber-bands so often as well for the proper tightening of her teeth in place. They were a steel of some sort as well I think.

Modern braces though.... They can be plastics, they can be metals, they can be a synthetic of different sorts. They can be made smaller than they used to be, and they can be hidden behind the teeth for those worried about their image (or for those with a need to have them back there due to tooth placement)

More and more dentist offices are opening, and options on where to go increase.

This also has resulted in a price drop on the services. While this drop has been offset with some regulations mandating certain aspects of dentistry, in general the effect has been more access for less cost.


Why at my last dentist visit the poor girl had issues aiming the X-Ray camera correctly at the tooth I had an issue with, so I aimed it for her while she monitored the screen. When devices are that easy to use, there should only be monitoring of how much a person has been 'scanned' by them for radiation purposes, and no longer a license requirement for general usage. But this is neither here nor there enough to bother right now.

What the point is, is that the Free Market has allowed for more dentist offices to be opened by anyone with the required degree and licenses. They can get the equipment needed and open anywhere.


This is an example of a free market mechanism with some interfering regulations.




Hospitals
Hospitals are to me, the epitome example of Socialism in health care. I will describe why I feel this.

Hospitals get their money from two major sources (not withstanding co-pays and those who pay themselves, which does NOT add up to a significant enough amount for most hospitals). These two sources are Insurance Companies and various Government sources.

A hospital is very tightly regulated, with many requirements upon them to treat all people in danger of their life (And I agree that saving lives is NECESSARY, do not read me wrong here), to keep certain staff in ER rooms, to do this, to do that. We all should realize they are regulated very strongly.

They are also not so numerous. There are enough that access is usually available, but you may need to drive a bit to reach one (I myself am 4 miles from the nearest, 6 miles from the next nearest, and so forth).

I am going to admit I do not know the full history of hospitals. I however also do not think it is worth worrying about in this context.


What I do know is that opening a hospital is hard. Generally they require certain sizes to get started. Then they also seek other significant requirements on top of this. Then you have different hospitals for different insurance companies. Kaiser, Good Samaritan, Emanuel, Blue Cross, Blue Shield... Many different requirements may exist on where you can go, and not go.

And I know their prices keep rising. Faster than Inflation even.


Now I wont go into Tort Reform here, it is not needed in the context I am writing upon. What I am writing about is Free Market principles.


Hospitals violate the free market. They are a Socialist design. If a free market was allowed.... Then hospitals with 500 beds would cease to exist, and hospitals with 50 beds would exist everywhere. With the increase in technology it would be easy to use a 'bed finder' in a smaller hospital for seriously injured persons for an ambulance. With a free market with not so much regulation, emergency beds could also double as other beds if there is no current need.

In a free market you would drive 2 miles to get to one of several small hospitals instead of many more miles to a larger one.


In short, by trying to make hospitals with regulations designed to help everyone, and to fund the fewer hospitals, we are escalating prices in my view, instead of letting the free market make innovation required.

In a free market with less regulation, the newer X-Ray devices, which are not harmful to a person, could be trained to anyone with a couple of days training most. And those persons could be a nurse, a paramedic, a doctor, or anyone on the staff... Not just a specific person who has no other applicable duties there.

Waste would be reduced, including wasted man hours, and productivity would be up. Access to doctors would increase, and prices with competition would go down.


Part of the problem is how hospitals get their funding. If a consumer were allowed to choose where to go, and told what amount they could spend on what per a year, they would make choices based upon free market principles, including value, location, and service. This alone would cause some overpriced hospitals to drop their prices to entice people back after they lose out in a big way.


Changing our insurance system to one where the consumer makes more choices than the insurance companies/Government makes would be a big game changer.




By the way I am a Conservative, but I feel that a 'form' of Socialism, where all have equal opportunity (not equal outcomes), equal access to everything most could dream of, and more, is possible under a free market system. In a free market system (which the United States does not approach yet, though we are the closest), the poorest can afford what is now expensive stuff, and the value of life for all is increased.

Everything bad in the economy is now Obama's fault. Every job lost, all the debt, all the lost retirement funds. All Obama. Are you happy now? We all get to blame Obama!
Kemp currently not being responded to until he makes CONCISE posts.
Avogardo and Noir ignored by me for life so people know why I do not respond to them. (Informational)

Re: Healthcare

Yes 1 problem... hospital equipment cost tons. literally. There is no way that a small hospital can afford all of the equipment a regular hospital is supposed to have. Even now we see that only a limited amount of hospitals can provide certain, newer, more technologically advanced treatments, people having to travel across countries to get the best treatment available. Downscaling hospitals will only lead to more hospitals not being able to provide you with the full package, more hospitals not being able to get the best equipment, crippling those hospitals and ensuring lower quality.

High costs aren't only due to hospitals being socialized or any of that nonsense. It is also due to equipment cost and the salary of the doctor. Equipment cost is  something that cannot be cut on: you want the newest equipment, this equipment is only being produced by certain companies as other companies do not have the expertise/recourses to build this equipment, therefore these companies can ask almost anythign they want (hey, a negative side to the free market!). Salary of doctors isn't outrageous either considering all the years of studying, internship, and then specializing.

"Then you have different hospitals for different insurance companies. Kaiser, Good Samaritan, Emanuel, Blue Cross, Blue Shield..."
isn't this a result of your free market? Another negative effect caused by the free market! Perhaps a bit of socialism could help here: a government funded program that allows access to all hospitals or some laws to prevent insurance companies from only allowing their costumers to go to certain hospitals....
oh wait that's you're hated obamacare and more restriction of the free market!

Maar doodslaan deed hij niet, want tussen droom en daad,
Staan wetten in de weg en praktische bezwaren,
En ook weemoedigheid, die niemand kan verklaren,
En die des avonds komt, wanneer men slapen gaat.

Re: Healthcare

Actually the insurance end is very tight. Only certain ones allowed per each state, limitations on what they can cover, they are so regulated, and choices so actually few that it is anti-free market.


Granted there is an equipment expense issue. A full blow MRI machine is expensive.

So is the F-35 fighter, which while the actual cost to make one is 1/50th of the final cost, the lack of demand has kept the price high due to initial research costs. An increase in the customer base by 100x will actually bring costs dramatically down (Probably to 1/20th the current costs) over time. Meanwhile the hospitals that do have the larger equipment would be subject to free market principles, if someone needs it, and they have it, but the other one does not, who has the customer for that use?

Everything bad in the economy is now Obama's fault. Every job lost, all the debt, all the lost retirement funds. All Obama. Are you happy now? We all get to blame Obama!
Kemp currently not being responded to until he makes CONCISE posts.
Avogardo and Noir ignored by me for life so people know why I do not respond to them. (Informational)

4 (edited by Little Paul 24-May-2011 20:11:32)

Re: Healthcare

@rising down:
the problem is...with obama's healthcare, the only ones gaining are loby's with intrests. Salary of doctors is fair to certain point, but obamacare increases these loans for some sorts of doctors if you take a closer look.

Many democratic voters supported it because they liked the idea everybody should have affordable healthcare but this is just not the case. Only the waste has gone up. That is why even many who where first pro know think its a complete disaster.

/Off topic/ Obama hasn't done anything good yet. He's a complete failure.

5 (edited by Justinian I 24-May-2011 22:54:32)

Re: Healthcare

Although I am not certain, it sounds like hospitals are subject to the principle of economies of scale. Sometimes "perfect competition" is simply not the most efficient, Flint. Especially in the case when it is cost prohibitive for a new supplier to enter the market, and/or where one or a few giant firms already own the essential infrastructure (provided that infrastructure is expensive) to service the public. In such cases, the government enforces price ceilings to increase efficiency. Considering that companies want to maximize their profits, and that competition does not compel a monopoly or oligopoly to drop their prices, price ceilings force the said companies to improve their efficiency to increase their profits.

As for hospitals, I think the case for economies of scale is strongly established with the high cost of certain equipment. However, our health care system is broken and inefficient beyond repair. It needs full structural reform. Obama Care is a laughable attempt to treat the branches of the tree, but the fact is the tree is sick at the roots. It needs to be cut down.

Re: Healthcare

> Einstein wrote:

> So is the F-35 fighter, which while the actual cost to make one is 1/50th of the final cost, the lack of demand has kept the price high due to initial research costs. An increase in the customer base by 100x will actually bring costs dramatically down (Probably to 1/20th the current costs) over time.


I don't care how cheap it will be... I'm not going to support letting F-35s be sold at Walmart!

Make Eyes Great Again!

The Great Eye is watching you... when there's nothing good on TV...

Re: Healthcare

tbh i didn't necessarily mean obamacare. it was just an easy bridge to make to a socialist package that seems to be hated by everyone. although i do believe the american insurance market is flawed to the point where it is necessary for the government to step in and make changes. i guess obamacare was a change for the worse, but this free market will have to be restricted somehow, otherwise insurance companies will just keep refusing to give insurance to people with disabilities or a slightly higher chance of some hereditary disease because one of  their ancestors had it. What are they gonna do next, refuse to give insurance to obese people? now that'd be funny, 3 out of 10 americans without insurance just because of that.

Back to the point: do you think that when hospitals get downsized to the point where they cannot afford the newest equipment any longer, that the companies selling this equipment will think "herp derp they can't buy it in this country, even though other countries in the world can still afford it, let's bring down our price". You say you drive up demand by having a multitude of small hospitals compared to a couple larger hospitals, which will make the companies producing this equipment to lower their price. I say this goes completely against what a free market is. The basic rules of supply/demand surely tell us that when demand goes up, and supply stays the same, then the price goes up?

Plus, actually, the demand for new equipment is there: not all large hospitals have the newest, best equipment, yet they require this equipment to perform certain types of operations. As you said, to attract costumers (patients), they require this equipment. So, according to you, the companies should be able to lower the price of the new equipment, since the demand is already there. But they don't, at least not for the time being. New equipment is always expensive, due to research costs and companies wanting to start making revenue as soon as possible. Now your system would work if technology were stagnant and there were no new innovations: after some time, prices would drop. However, in reality, a new product is brought out before/at the time that the older product starts dropping in price. This newer product has to pay for its research costs in an as short time as possible, so the price still stays higher than production price. It doesn't have as much to do with demand as it has to do with innovation and companies wanting to make profits as soon as they can.

Also, if large hospitals can't pay for the equipment even if they want to, then how are smaller hospitals with smaller budgets going to buy that same piece of equipment?

Your examples of pharmacies, opticians, and dentists all have one thing in common: none of them are on the same scale as hospitals. Hell, all of them could even be part of a hospital if it were financially profitable. You even said so in one of your own examples: pharmacies incorporated in hospitals.
You cannot these successes to hospitals, just because they all have to do with human health.

Maar doodslaan deed hij niet, want tussen droom en daad,
Staan wetten in de weg en praktische bezwaren,
En ook weemoedigheid, die niemand kan verklaren,
En die des avonds komt, wanneer men slapen gaat.

Re: Healthcare

FLIIIINT!! hi smile

"Heh heh heh heh heh heh!"

Metrex

Re: Healthcare

As someone who has socialized healthcare (Canada) I have to say I like it.  I pay my taxes and get covered under OHIP (Ontario Health Insurance Plan) for insurance.  I find this better than private insurance because I have private insurance with my car and whenever I make a claim they try to weasel out of paying on it (it's what they do and how they make their money).  With OHIP I know what's covered, what isn't, and never have to worry about getting screwed out of what I'm owed because of some technicality.

As for hospitals themselves I like that they're not private because it ensures a few things.  First it ensures that no matter where I go I will get the same quality of care.  In a private system this can't be ensured since we all know some private businesses are better than others (even those that are part of franchise chains).  For example there are 2 McDonalds within walking distance of my house; one of them is well run, food tastes good, and the service is quick; while the other is filthy, foods terrible, servers take forever to get an order, and it's usually wrong (I don't go there).  Now this isn't a problem with McDonalds or specialized medical clinics because I have the time to pick and choose which one I want to go to.  Where it becomes a problem is emergency rooms where I don't have a choice (I need to get to the closest one), because if I go to an unclean ER with sub-standard equipment operated by half trained morons I could die.

Second a for-profit doctor is a mechanic.  When hospitals are privatized and become for-profit organizations one of the problems is that the focus shifts from getting the patient well to getting the patient well enough.  Patients are brought in, patched up, and rushed out because the more patients they get through the more money they make.  Again this is fine for an auto mechanic but it's a bad attitude to take towards medicine (IMO).  When I was a kid I broke my leg and was kept in hospital for 10 weeks in traction to make sure it healed properly.  In a privatized hospital they'd have set the bone, slapped on a cast, and booted me out the door with a bill for my crutches.

Which brings me to another point, return business.  Like mechanics private doctors actually have an incentive not to fix things properly.  A temporary fix, or an improper fix, is cheaper and ensures the customer is going to have to come back.  Using my leg again had I been given a cast and shown the door it wouldn't have healed properly meaning I'd have to go back to the hospital, have my leg re-broken and re-set, and then get charged again for them to do the same thing, or pay an arm and a leg to get them to do it right.

Now I do support private specialized clinics (and we have them here they do quite well), because of the benefits they bring (greater speed of care, shorter waiting times, etc.), but for general care and ER I like to know what I'm getting into (regardless of where I am) and that the doc isn't just gonna patch me up and send me on my merry way but make sure I'm actually well.

There are 10 kinds of people in this world, those who understand binary and those who don't.

Re: Healthcare

Hospitals are a socialist design because they violate free market principles?

well  their primary goal is to treat the sick, not make a profit. But the more people you successfully treat the more people you have buying goods and working which contributes to the economy.

sometimes a little socialism helps capitalism.

Buddugoliaeth neu Marwolaeth

Re: Healthcare

i gotta say i agree with canada boy, they also have much cheaper medicines, without health insurance, any pain killer is going to run you 100 dollars or more per refill, there is a reason why people try to go to canada for their medical needs. thier system works good, and yes i would be willing to pay the tax rates for the proper use of my hard earned money

Re: Healthcare

I see no problem with privitising the front-end of health care. The back-end (revenue collection; purchase of drugs; standards board) needs to be collective as much as possible. I believe that is essentially the system in Holland.

Re: Healthcare

Drugs are cheaper in Canada because their government told foriegn pharmaceuticals that if Canada didnt' get a fat discount, Canada was going to void their patents and allow Canadians to manufacture the drug cheaper.

The core joke of Hitchhiker's Guide to the Galaxy is that of course no civilization would develop personal computers with instant remote database recovery, and then waste this technology to find good drinks.
Steve Jobs has ruined this joke.

Re: Healthcare

so those cannucks are driving the prices up for all the rest of the world, how very American X(

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Re: Healthcare

well if they have the ability to produce the drug cheaper, but have a contract to not produce for that reason, its not canada's fault is it? its the controlling party as of now for making that deal in the first place.

16 (edited by Godwin's Law 02-Jun-2011 14:38:19)

Re: Healthcare

Except the drug market is completely different from most types of markets in that, although pills themselves cost less than a dollar to create en masse, the business is perpetually trying to recoup losses from the research and development, which accounts for millions upon millions of dollars for developing that drug, along with recouping losses from research in other drugs which either didn't prove fruitful or didn't produce research results.  Research is still a cost in producing a drug, except that it's accrued years in advance of the drug actually being produced, without any promise of reward.

It's not a question of them being able to profitably produce drugs cheaper.  If Canada threatened their patents, it's pretty much the equivalent of threatening to shut down the businesses entirely unless they sell their stuff cheaper.

Even if it works for Canada, it's not a sustainable plan to use on a worldwide basis, largely because the companies have to adjust prices in other countries to account for losses there.  If every country has that model... well, you're looking at a much less industrious pharmaceutical industry.

Make Eyes Great Again!

The Great Eye is watching you... when there's nothing good on TV...

Re: Healthcare

this really does sound like just about every market out there, a newer product is costly to cover new production costs plus thier research costs, then once they are outdated or challenged by a competitor thier prices will drop to try and keep income comingin ect.

and just like other markets,evenin the food market,people who are capable of producing the product cheaper are often paid to not produce in order to keep prices high and the money flowing in the same dirrection. this is commonplace in i think all markets.

it is understandalbe that people want to recover thier research costs, but they dont stop there, they plan to make profits. this is somewhat a flaw of the free market and can slow growth overall. the companies want to generate profit sooner rather then later at the cost of the buyer.

18 (edited by Godwin's Law 03-Jun-2011 01:44:05)

Re: Healthcare

> twosidedeath wrote:

> this really does sound like just about every market out there, a newer product is costly to cover new production costs plus thier research costs, then once they are outdated or challenged by a competitor thier prices will drop to try and keep income comingin ect.

and just like other markets,evenin the food market,people who are capable of producing the product cheaper are often paid to not produce in order to keep prices high and the money flowing in the same dirrection. this is commonplace in i think all markets.

it is understandalbe that people want to recover thier research costs, but they dont stop there, they plan to make profits. this is somewhat a flaw of the free market and can slow growth overall. the companies want to generate profit sooner rather then later at the cost of the buyer.




You're right that most markets do have elements of this problem.  That being said...

1: The proportion between R&D costs for any one drug and manufacturing costs for that drug aren't nearly as proportional in other industries as they are for the pharmaceutical industry.  We're talking about tens of millions of dollars just to produce one pill... which is then used to produce millions of pills.

2: R&D is a unique problem in that, unlike other start-up costs you mention such as manufacturing, the organization which incurs the loss (and actually provided the greatest benefit to society) is the organization that gets punished, outside some sort of protection.  The moment a drug is produced, it's generally relatively easy to reverse engineer the drug to determine how it was produced, then reproduce the drug.  As a result, without patent protection, if business A researches a drug and business B reverse engineers A's drug, A will start off with a mild head start of maybe a couple months production, and $50 million in debt.  Company B will have a few thousand in debt, without doing any sort of scientific advancement.

3: That means the producer of a drug only has a short window of opportunity to actually make profits off their drug.  Once that patent runs out... the company is left to competing with every generic drug company on the planet... which makes it extremely difficult for them to recoup the losses from the R&D.


> it is understandalbe that people want to recover thier research costs, but they dont stop there, they plan to make profits. this is somewhat a flaw of the free market and can slow growth overall.

First of all... seriously, Republicans... what are you all doing on this forum?  This is the land of Flint, The Yell, Avo, LP... and the job of defending the profit motive goes to me?  tongue


If it's bad for a company to obtain profits for their multi-million dollar investment under your interpretation... then why should that company even bother to research new drugs?  For that matter, why would they be producing drugs at all?  Why should a company produce anything if all they can do, at best, is break even, according to those ethical standards?

That's what your equation is forgetting.  Pharmaceutical businesses have incentives for producing what they are producing.  Profits are a way by which society rewards people who do good things for that society.  Without that profit motive, why should a business take the effort to step forward and research new drugs?

Do you go to work 40 hours a week, expecting to be given nothing more than a high five?  Or do you expect payment for your services?  If you believe you should get pay for your service, yet don't like the idea of a pharmaceutical company getting profits, you're a hypocrite.  Pure and simple.

Make Eyes Great Again!

The Great Eye is watching you... when there's nothing good on TV...

19 (edited by twosidedeath 03-Jun-2011 01:50:37)

Re: Healthcare

haha thanks for pegging me as a republican, but im not tongue

and other then saving lives i guess there is no reason to make better drugs hmm ya got me there.

Re: Healthcare

> twosidedeath wrote:

> haha thanks for pegging me as a republican, but im not tongue


Oh, I wasn't pegging you as a Republican.  I was saying that, under normal circumstances, I would have expected Flint, The Yell, or some other hard-right, free market conservative to jump up at the opportunity to defend the idea of profits...

But they didn't.  Slackers.  tongue

Make Eyes Great Again!

The Great Eye is watching you... when there's nothing good on TV...