Health Care 10.06.07 And The Pandora Prescription

[genocidal]

1) People can still invent drugs for money. We pay money for drugs. We have basic drugs which are free for the poor, but generally everyone pays for their own drugs in Canada. As well, we offer basic services for free. If you want to pay for a more expensive service, you can as well. An example is cataracts. You can get the old style glass replacement lens for free in British Columbia, or you can pay $1000 and get new ones which tint to sunlight and so on. The the procedure to get the cataract replaced is still free.

Our system guarantees that medically necessarily procedures are done, but it also allows those who want something extra or cosmetic to pay for it.

Yes, people still make money inventing drugs. You pay money for drugs but where do you get them? Either the US or generic companies that use US patents to make their own drugs (usually the latter). I'm not talking about fucking name-brand drugs - everyone knows generic is basically the same. I'm talking about the intellectual capital it takes to invent the original drugs that the generics are based on.

2) Most medical research in the US is actually funded by the National Institutes of Health and by universities. It is funded from foundations, and private donations (think Bill Gates' foundation), and things like 'walk for cancer' and so on. This is the same in Canada. Most researchers in medicine work at universities.

Are you fucking kidding me? Bill Gates Foundation funds maybe 3% of medical research in the US. Most is from pharmaceutical companies and biotechnological companies because IT MAKES THEM MONEY. Don't just spout shit and expect people to believe it. Here's a source for you to ponder (if you have access to JSTOR or this journal you can see the rest but that should do).

Yes some of their research is also funded by drug companies,

No, most of it.

and guess what?

What?

Even in Canada there's PLENTY of medical research. In fact the University of Toronto Medical School is the 2nd most cited medical school in the world, if you take an aggragate of all journal articles related to medicine in the entire world.

I won't argue that your nation's top institute has some pretty good research going on but they aren't developing new drugs at the rate in the US. Name me the last drug to come out of there.

3) Most new medical processes and drugs developed are basically 'me too' drugs and processes that rarely show any real improvement over old processes.

Yeah, they're generics using US patents. Why do you think US drugs are named after people and your drugs are named after what's in them?

Even when they do, it's in the matter of single digit percentiles. Without going into very complex scientific arguments about why that doesn't really matter in the grand scheme of things, you'll just have to believe me. Or you can become a well informed medical researcher and then we can have a legitimate argument on that. Just because a drug/process is well marketed doesn't truly make it any better than what's already out there.

Jesus fuck dude you're arguing to me why generics are the same as marketed drugs. I know it's the same, it's the same technology. I'm talking about patents - just cheating and making your drugs cheaper because your country doesn't respect US intellectual property rights.

Capitalism guarantees that all of these copies will be made, aggressively marketed even if their claims of improvement are dubious (i.e. purely sponsored by the companies that mde them). Many people buy into this, and we have spectacular cases like the entire Vioxx debacle that shows us how aggressive and unethical drug companies and the such can actually be if you let them go too far.

Vioxx is a debate on its own. I personally don't think it's necessarily a harmful drug but that's another argument for another day. The reason the companies got fucked is the US legal system.

So would medicine still progress even in the public system? Absolutely.

Here's what you should ask: would medicine progress in the public system at nearly the same rate? No. Why do you think the overwhelming majority of new drugs come out of the US?

The idea isn't that medicine would stagnate - it's that top intellectuals would choose other fields that are more financially lucrative. Smart people are smart people. If someone is going to make more money doing tummy tucks than drug invention guess what they're going to choose. It's the quality that I'm talking about.

[Cops]

Almost as silly as someone (not you) insinuating that I don't care that millions of people are dying

Just so you know, it wasn't directed at you, it was directed at Jerome. I understand that you think your current system doesn't work and that something needs to be done about it. Jerome however feels that financially it's not affordable, basically leaving millions to fend for themselves.

[Epinephrine]

Yeah, they're generics using US patents. Why do you think US drugs are named after people and your drugs are named after what's in them?[

Jesus fuck dude you're arguing to me why generics are the same as marketed drugs. I know it's the same, it's the same technology. I'm talking about patents - just cheating and making your drugs cheaper because your country doesn't respect US intellectual property rights.

I wasn't talking about generics at all. I'm talking about multiple drugs which are all in the same class. For instance, there's about 9 different types of statins ( http://en.wikipedia.org/wiki/Statin ), tons of different types of beta blockers and so on. These are all brand name drugs, and the reason there's so many of them is because of parallel research. Each drug company basically makes their own version of what they think will be a hot drug in the future. The basic science research on which this is based on is generally from public research, and then the drug companies all create almost identical drugs which have only enough difference so that they can be patented drugs. They then run their own private studies, highlight any differences and market accordingly. But because marketing is all about selling something, they will basically just talk about what's good, and cherry pick the trial which came with the most positive results. This is misleading to both patients and physicians who might not have all the time in the world to read every trial out there to be 100% super informed.

The fact that so many drugs which basically do the exact same thing, with basically the exact drug profile which are completely interchangable between one another means that a lot of the money to develop drugs is actually used for wasted parallel development. As well, since these companies usually spend lavishly on new labs and so on, their budgets are likely to be much higher for doing a similar thing than a university.

Here's what you should ask: would medicine progress in the public system at nearly the same rate? No. Why do you think the overwhelming majority of new drugs come out of the US?

That is only assuming that there are actually huge gains to be made from using certain drugs and certain processes. While I don't argue that drugs overall can be very useful in decreasing mortality and morbidity, the basic things that we can do in healthcare generally matter FAR MORE than what drug to use. Basic things such as no smoking, no drugs, eating healthy, having immunizations, having proper care for pregnancies/birth, preventing hospital borne infections, and so on are very important, but are never stressed because they don't really make much money. Instead we end up spending $12 billion/year on Lipitor because it lowers your cholesterol. Unfortunately while it does work for that, the actual benefit to long-term health for most people with just elevated cholesterol and no significant risk factors (i.e. previous stroke, previous MI) is extremely small at best. The numbers needed to treat according to my pharmacist/physician friend (he's both) is over 10,000. This means 10,000 people need to be treated to prevent one bad outcome... sounds like a great way to make money don't you think?

The idea isn't that medicine would stagnate - it's that top intellectuals would choose other fields that are more financially lucrative. Smart people are smart people. If someone is going to make more money doing tummy tucks than drug invention guess what they're going to choose. It's the quality that I'm talking about.

I think this is a bit overstated. It's true that money is important. But I think as long as they can make a good living, there's a huge amount of people in healthcare that do it because they actually WANT to do it, or find it interesting. If you really wanted to make money you'd work for a hedge fund, go into finance or work in the business world. Being a scientist generally doesn't pay that great, I'd say most people do it because they actually like it, and the generally better salaries are a perk. While your uncle might not do it, there's countless others who are just as smart out there who would.

And actually you are correct... there IS far more money to be made from stuff like boob jobs and skin care and diet plans than actually doing real medicine. US doctors also make more than Canadian doctors, but studies have shown that we don't have that big a problem with a brain drain overall. The fact that people still do real medicine in large numbers shows that perhaps money isn't everything.


And for the record drugs aren't everything. There is far more to medical research and progress than having expensive machines and brand new drugs. Things like the heart bypass operation were invented by heart surgeons working at a university (I read an article about the main guy a year ago), and most cutting edge medicine happens there too. It is not necessarily supported by any company but rather by the medical school as a way of improving medicine.


But finally, even if we only look at drugs... again, we use BRAND NAME DRUGS in Canada. Believe or not, we respect patent laws, and we actually don't have more generics than you have in the US. We generally get a better price for drugs because our government negotiates prices with drug companies for our medical system, but obviously there is still tremendous profit to be made in Canada, or else the drug companies wouldn't even bother coming here. You should consider drugs separate from universal healthcare though, because if you are just taking a drug at home, you still pay full price for it. Most people with jobs have drug plans from work, so it's cheaper, but this is basically the same as in the USA.

Finally the most important fact to understand is that it's not like drug companies are really out there creating drugs which 'save lives' all the time. Think about it for a sec. If you were to make a drug, would you try and make new cancer drugs or new antibiotics which have a limited market, or would you try and make a drug that most middle class people could possibly buy? Wouldn't it be even better if that drug didn't actually cure anything, but actually was something which you would have to take every day for the rest of your life, meaning you have to buy a lot of it?

Drug companies are experts at doing this. The largest drugs in the entire world (Viagra, Lipitor) are drugs which are expensive to buy and largely used for little extra benefit in saving lives. They either have huge numbers needed to treat (i.e. statins) or are lifestyle medications (i.e. Viagra). It's not like the big drug companies are out there spending billions on AIDS or billions on cancer drugs... it's the public research labs that focus on such things for the most part, such as the national cancer institute and so on.


So in the end, I do agree that overall, drug companies do make things that probably help us even if just a bit (and for a lot of cost) overall. I also agree things like new MRI machines are also quite useful.

What I don't agree is that somehow universal healthcare, which simply guarantees that people have basic access to healthcare for free, actually changes this. People will still need to pay for new drugs out of their own pocket in our system, and hospitals still buy MRI machines. There is still a need for better technologies, and believe it or not, the public system will pay top dollar for such things. And instead of it being one monolithic system, frequently each hospital will have their own governance and own budgets and spend accordingly, so even for makers of medical supplies, there is a HUGE amount of marketing for individual hospitals to make sure they buy their products. Capitalism is still very much part of our system.

I don't know how much more to stress this, than the fact that I've personally met many drug reps (and seen every doctor's office with cupboards of brand name drug samples) and medical supply reps for everything from syringes to new and very expensive laparoscopy equipment. I even met the sales people from GE who were selling my hospital a new MRI machine. Capitalism definitely exists in our universal system, and it's a complete misnomer that it doesn't.

[Mantra-Slider]

this thread is awesome!

[Jerome Scuggs]

Technically Epi was right when he said "actually mileage in American cars hasn't changed in decades". It's been basically steady for 2 decades.

http://www.epa.gov/otaq/cert/mpg/fetrends/420s06003.htm

I just wanted to point out your economics teacher may in fact be a fraud.

This actually allows me to bring up a point which Epi tends to forget, and here's a sub-lesson, from my economics professor: data is only qualifiable if it can be analyzed and applied logically.

For one, your data is merely the average mileage data. Seeing as most Volkswagen, Honda, and Volvo vehicles get a minimum of 25mpg, your average already misrepresents these companies. You also have to consider other variables: for instance, Honda might release a car with exceptional mileage, and then GM unveils the Hummer. While the average might remain constant, you can't deny that cars are moving in a more fuel-efficient direction. They have been for quite some time.

You are making what is known as a false association of cause and effect. Epinephrine does this many times - like when he asserts that because our overall stats (infant mortality, etc) are pretty bad, that capitalism is not the best way to run the medical market.

His claim is false in that he fails to see other factors - like my more analysis that directly associates that specific failing of the medical sector in america to the onset of social practices and regulation.

What he also fails to see is the fundamental difference which always lends creedence to my argument - that his social policies are based on an idea of how humanity should work - and that my ideas of free market are not an "ideal", but a set of theories and laws derived from watching how humans naturally cooperate and interact.

When I say Socialism will fail, I mean it. Look, it already has - the Canadian Supreme Court had to overturn the ban on private heath care. Why? People weren't getting treatment, and the beauracracy wasn't actively seeking to update the regulations. When your Supreme Court then allowed private care on a quasi-legal ground, the market was able to effectively adjust to try to solve that problem as quickly as it could... throughout this entire thread, no one has criticized the effectiveness of the private hospitals themselves, and so I assume no one doubts their high quality of treatment.

The Law of Supply - a valid, proven, predictable law - states that if Price of a product goes up, ceteris paribus, then so will Supply. Even the Diamond cartels generally obey this rule - they do increase supply, no matter how slowly they choose to do it.

Your medical sector needs the money of the wealthy to survive as an efficient, innovative entity. Genocidal brought that point to bear: that, quite frankly, when you look at history, people produce better shit when they stand to make a profit. The wealthy invest their money into the medical business, overtly (purchasing means of production to market a product or service) or through exchange itself (paying an expensive doctor alot of money to fix them up). This money doesn't go directly to the doctor's profits. Revenue has to be sunk back in to the business itself.

You make the claim that businesses profit when they roll out medicine after medicine, regardless of the side-effects. Once again, you fail to consider ceteris paribus, "other things constant" - because your scenario completely ignores the "other things". There are two general ways to profit. One is the commonly held way: create or market a product whose price is more than the cost. One way is to just reduce cost itself, so the product, even if its price doesn't rise, actually makes them more profit. One way this is done is by improving previous recipes for products, which is as big a field in the medicine industry as the creation of new medicine itself. Easier, cheaper ways to distribute, package, and administer medicine, new flavors and things like chewable tablets and even sugar cubes.

The way you're looking at the problem, you want equality by eradicating better heath care. Shouldn't you be looking at the problem and aiming for equality by eradicating worse health care? The free market is a constant evolution in that direction - a process that will always try to achieve the best prices for the best products, and if failing that, alternatives that are affordable as well.

Had I been the guy with the arbitrary power of force over my fellow men, I would have cut a better deal. I would tax everyone, as you do, create a massive pool of money, as you do, except then use that massive pool of money to invest in new hospitals, the hiring of doctors, et cetera. That way, people would be free to choose their medical care. The wealthy can hire their family physicians, and the poor can have their state-maintained hospitals. The wealthy still contribute to the poor in the form of taxes, while not having to attend that hospital if they feel they can afford better. It's obvious that you value equality before freedom, and that's exactly what this plan would do. But it's equally obvious that if this plan were to be enacted, the private hospitals would begin to pull away and above in terms of quality and efficiency - because they would be competing to draw customers in from the public health care sector. In that case, socialism is very much a social expirement - one that concludes in favor of the capitalist system. Even if it doesn't, and you argue that with this plan would actually work... then you still concede that it would be a better policy option than the current system.

Epinephrine also makes a good point about why social medicine is a bad idea, whether he makes the argument or not. He makes a good case for people who do not treat their bodies well, and can merely take Lipitor instead of doing something truly beneficial, like deciding to stop smoking. But you fail to ask: why is it that people are becoming more and more careless as to the maintenance of their body? It's because the public viewpoint has become precisely what Epi believes: that health care is a right, not a choice. When you know that ten years from now you can just swipe your healthcard and get your drugs, why bother about watching your own body? Why bother teaching your kid manners when you can just stuff him or her with Ritalin? That's what happens when you replace "calculating" with "compassion", and turn a once private resource into a public one. Look at what's happened with public education, public parks, public anything. People don't have direct control over it, and thus, less of an incentive to maintain it.

edit: oh, check out what's happened because of beauracratic oversight due to failures to predict variables in a market economy. It's actually about the EPA. They sure sound like compassionate beauracracts, completely out of the sphere of private "special interests".

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Epinephrine also makes a good point about why social medicine is a bad idea, whether he makes the argument or not. He makes a good case for people who do not treat their bodies well, and can merely take Lipitor instead of doing something truly beneficial, like deciding to stop smoking. But you fail to ask: why is it that people are becoming more and more careless as to the maintenance of their body? It's because the public viewpoint has become precisely what Epi believes: that health care is a right, not a choice. When you know that ten years from now you can just swipe your healthcard and get your drugs, why bother about watching your own body? Why bother teaching your kid manners when you can just stuff him or her with Ritalin? That's what happens when you replace "calculating" with "compassion", and turn a once private resource into a public one. Look at what's happened with public education, public parks, public anything. People don't have direct control over it, and thus, less of an incentive to maintain it.

In todays health Care, when an Insurance Company can dictate to a Dr. & Hospital that the patient that should be medically supervised, needs to be discharged from the hospital...there is a problem. Some desk jockey with zero med background can make such decisions. So in regards to the above quote....it notes

why bother about watching your own body? Some Dr. is going to precribe a pill anyway. Doctors rarely seem to want and prescribe a healthy lifestyle. That wouldn't allow them to reap the benefits of the Pharmacutical companies...nice lunches, vacations, golf outings and so on. It is up to the individual to take care of themselves, just as it is our choice on what car we would like to buy and what we see on a dinner menu that we would like to eat. There is no self control to some of these people that need to up-size their meals and get giant soft drinks feeling iot is ok as long as it's diet. Same goes for the idiot fatty that buys the enormous breakfast muffins with his coffee. It is only one muffin, yet the label notes that it is 4 servings.

People need to be viogolant upon themselves and stop wanting society and the government to deal with it, at least when it comes to healthy living. How many time will you see some asswipe drive around a parking lot hoping to get that close to the store spot...god forbid they walk an extra 20 yards.

Why bother teaching your kid manners when you can just stuff him or her with Ritalin? Society it would seem, as well as a TV are what kids learn manners from. This is one of the reasons I hate Malls. Always some whining ass kid crying for this or that and the mother usually caves in to shut them up. My mother used to smack the shit out of us kids, noting that if we carried on and cried because we didnt get what we wanted, she always said "here smack now you have something to cry about".

When was the last time you saw a playground or street with kids playing street hockey, football or whatever...nah...everything is based upon 3 things, X-Box, Wii & PS. Outside....exercise...sunlite....no wonder kids are so f'd up. Last thing I ever wanted to do was sit at home and be near my parents. Hard to get a kid outta the house period today...no wonder there are so many fat ass diabetic kids. On top of this notation...why should I be responsible to pay for these kids too and their insurance through a mandated social program? I say let them get sick and die...would help with the population problems in this world....natural selection from human idiots syndrome.

[Epinephrine]

I think the inherent problem in Jerome's views is that is ignores a lot of the actual realities. I think Jerome still can't get it out of his head that universal healthcare isn't 'make everything about medicine communism'.

Secondly, I still don't really know what Jerome is arguing FOR. It's very easy to argue against something. You can basically argue against anything there is in the world, but unless you actually propose a better and thought out solution, you cannot compare and contrast and truly say that you have a better way. If you have no better way, then while pointing flaws can be useful for making something better, it doesn't really give you an alternate solution. Jermone makes the mistake of saying 'well just let it be capitalist', without really presenting a REAL solution. In the absense of a real solution, I'll assume that he doesn't mean to make the system ACTUALLY capitalistic (i.e. take away all regulation, take away all insurance plans, make people pay each time for everything) and in fact he much likes the status quo. It appears in his last post that finally he's for something like 'public healthcare for all, and if you want you can pay for private care'. I'll go point out the problems with that a bit later on in my post.


So why don't we compare and contrast the two systems:
1) Overall indicators of mortality:

Canada does better in every single indicator there is. Considering our societies are so amazingly similar it's a fair comparison. We eat the same fast food you guys do, we live on the same continent and are exposed to the same pollutants you do, and we drive just as much as Americans do and exercise just as little. Yet we still do better. Why is this? Simply put, everyone in our country gets medicare. We don't have 1/6 of the country with no medicare. Which means when people get really sick who aren't rich, they can actually get treated and get better instead of dying early.

I really do not understand why an overall indicator of mortality is unfair or pointless to point out. If you're not going to use the most obvious statistic there is, what facts exactly are you using? Perhaps I can use population pyramids to show that more people live to older ages in our country, although that is not the best indicator (although we sent similar amounts of people per capita to fight in WWI, WWII and the Korean War).

http://www.census.gov/ipc/www/idb/pyramids.html

If capitalism isn't delivering a longer life expectancy for the country, then what good is it doing for the country as a whole?

The fact is, our system saves more lives. We do not have 1/6 of the population without any real treatment because they can't afford it (if you can't afford private insurance, you probably can't pay $10,000 for an operation either). Yes some people die, but we don't simply and easily leave 1/6 of the population to just fend for themselves.

The biggest reason for the difference in mortality rates though is most likely due to the availability of primary care. Simply put, if you have a family doctor, you're going to get your shots, you're going to get yourself checked often. If you have to go to the ER every time, you're basically not going to get any of that.

2) Choice in the system:
For some reason Jerome thinks that the American system allows for greater choice in choosing one's doctors and so on. Here's some news for him... you can only choose within the doctors who are registered within your insurance plan. If you choose from outside the plan, you have to pay the full fee as it won't be covered by insurance. How many people can actually afford the full $150,000 for a heart bypass operation?

In Canada, you can absolutely choose ANY doctor you want, with absolutely no hassle. If you don't like your current doctor, you can get another one. Simple as that. Basically you can be a patient of any doctor there is if you are willing to navigate the system.

The only limit in the Canadian system in choosing is simply, you have to either wait till there's appointment space for you to get seen. The Canadian system generally works by doctors figuring out who the sickest people are by their own criteria and see those people first. I guess it's a philosophical thing to say whether you believe the sickest should be seen first, or the people who pay the doctor the most money. Obviously in America if you pay enough, you could probably bypass any waiting list. But is this actually helping the overall health of a country? It might make it more convenient for those at the top, but it doesn't actually help the country as a whole and it's pretty hard to argue against that.

3) 'We have better doctors in the USA':
I'm not really sure what this means. I think it's really more of a local boosterism than anything else, just like anyone would say that their country is better at something, Americans are usually louder than most about this.

I want to point out that while I agree that there are some centres of absolute excellence in America (i.e. Johns Hopkins, Harvard, Mayo Clinic, etc), overall, American doctors are less qualified than Canadian ones. In some specialty programs, the number of years training is less (i.e. 4 years for ophthalmology in America vs 5 years in Canada). If you take a simple look at entrance requirements using the MCAT test, about half of American schools have lower requirements than Canadian schools which generally uniformly have exactly the same high standards.

Canadian residency training programs are all affiliated with our high quality medical schools. Meanwhile many American programs are local hospital based, with very few standards.

So yes, you have some of the best doctors in the world in America, but overall the quality is probably lower.

4) 'We have better doctors, and we can also choose them in America!'
Again this is a misnomer. I've already shown how Canadians can basically choose any doctor they want, and how Americans don't exactly have better doctors. But then let's delve deeper into this issue.

What really makes someone a better doctor? The fact that they have written up some research papers? The fact that they work for a prestigious institution? Having actually worked with some of the so called 'top doctors' (i.e. top university professors and chiefs of staff), I can say that just because someone is 'top' really means nothing. Better is almost impossible to quantify properly, when you are talking about how the doctor actually helps the patient. I've seen 'top' doctors just take 5 seconds to see a patient and not really help the person with their real concerns, and I've seen non-famous people take a long time to really sort out a person's issues.

All doctors have a certain level of training so that for basically 99% of problems, as long as you are seeing the right specialist you will get treated properly, in that you will have a similar outcome with any doctor. The reason this is so is because the profession self regulates and regularly posts guidelines. Everyone treats according to established guidelines depending on the outcome of established standardized tests. The real differences in quality of care is that, the actually good doctors will spend more time with patients, listen to more of their concerns, go the extra mile for their patients, and try extra hard to make sure they can help the person with their problems.

People usually end up mistaking nicer looking hospital rooms, newer looking equiptment and so on as actually better care, but they couldn't be further from the truth.

5) 'We use the newest technology in America. You don't'
Actually we use the same technologies in Canada. There are worldwide standards for these things. Generally, while the Europeans use different guidelines, you can basically expect similar processes and medications in all of the developed world. That's just how medicine works. Our system pays for the new machines just as well as your system.

6) 'You discourage new medications to be developed'
Universal medicare has NOTHING to do with medications. It's a completely different thing. It's like saying if mechanics were free, that would lower the quality of car parts. It's completely unrelated. We use the same full-price and brand name drugs you do. Companies are still free to develop drugs. Once the science is there to prove the drugs work and they pass by our version of the FDA, we use them. It's that simple. Up to date clinical guidelines are honoured.

The big difference is that Health Canada is generally more cautious than the FDA, which means we spend more time in the testing process. While you might think this blocks 'new and better drugs', in fact it helps block out using untested drugs too early with unknown side effects.

In Canada ultimately our government with advice from doctors dictates what drugs on the master formulary, and then hospitals will pick between these via their pharmacy departments. Similarly health insurance plans in the USA and individual hospitals will make these choices. It's not like private insurance will fund anything... they have their limits too on what they are willing to pay for.

[Epinephrine]

7) 'Universal healthcare discourages progress in medicine'
I've already shown that for drugs it really doesn't matter. Well for most technology is also doesn't matter. Our hospitals all have their own budget (and are free to raise more money via fundraising if they wanted) and own boards. They decide what things to buy for the hospital. Similarily hospitals in the US also have their own budget and decide what to buy. We buy new MRI machines, you buy new MRI machines. We use the same technologies.

Secondly, it's important to know that most medical advances have nothing to do with new drugs or new machines. Rather they usually involve new ways of treatment (differently using existing drugs, new processes like new ways of doing a surgery) or tweaking the way we already do things to make it better. These are things which university hospitals specialize in with studies (publicly and university funded) and with their own doctors. The private sector has very little to do with this. Findings are published in journals, and this information is relayed around the entire world. It's a complete misnomer that America does all the research. In fact the world's 2nd most cited medical journal is the British Medical Journal with the Canadian Medical Association Journal at #3, both based in countries with public healthcare systems.

8) 'But we can pay and get the best treatment possible!'
I really have to wonder about this sometimes. I've already pointed out that a lot of extra services in Canada aren't public, stuff like cosmetic surgery, in vitro fertilization and laser eye surgery, nor would they ever be as they simply aren't completely necessary. Therefore it's pretty much equal for you and us in that respect.

For services which ARE necessary, it's true that in the US you can pay money to get care. But what really is there to guarantee that the care is actually any better? Either the doctors there are using the gold standard of care (which would be scientifically advisible), or they are using a new method which is probably published in the literature and thus you can get anywhere where the doctors are more informed before it becomes a guideline (i.e. at a university hospital). Or they are using a completely novel method, that they made up themselves that no one else uses. If it's the latter, you have absolutely no guarantee that their method is any good at all aside from whatever claim they want to make that you have absolutely no way to measure. Is that actually better?

Secondly, yes you could get surgery at the Mayo clinic I guess, but are these surgeons actually that much technically better than surgeons elsewhere? Perhaps for the weirdest and most exotic things, some people can be better because they see it more often. But go to any university center and there will be specialists on par. For more routine stuff, there really is very little difference between skilled and certified professionals, unless your standards suck.

Finally, who can actually afford this care? It would be only the very rich, and thus everyone else (the other 99.5% of the population) doesn't really benefit as their private insurance doesn't cover it.

9) 'Capitalism makes the rich seek the best, so new processes are developed specifically for the rich, and then eventually everyone benefits.'

While this may hold true for such things as cars and computers, medicine is really very different. Just because doctors offer top new services for the rich, doesn't really mean they could actually benefit society. I've already stated how medical advances are published in journals distributed worldwide. Without getting into a full statistical analysis of exactly how much America contributes to the worldwide literature, I can say that the contributions of capitalism to it are extremely overblown. Medical advances come from everywhere around the world, and definately comes extensively from countries with public systems as well (basically the entire developed world except America and Japan).

And of course, if you really think about my previous point, if you are paying for something that someone invented that they are charging more for that is totally novel, what reason would they have to actually publish their data and tell other people? Much like corporate secrets, they would likely keep their ideas to themselves. By not making ideas as 'open source' as possible, you slow down the passage of knowledge and slow down helping people. Unlike a corporation, doctors are just one person who can't really be replicated, and who at most can teach only so many people. Unlike manufacturing a product, if someone doesn't publish, they simply cannot spread the information faster than person-to-person transfer which could take centuries to pass information. If they publish, they give up their 'competitive advantage' and thus they wouldn't make as much money. So in fact capitalism gives incentives for doctors to horde knowledge if they really do find out something novel, and thus the public really isn't better served as a whole.

10) 'We pay better, that's why people actually want to make advances. You pay less, less people in your country cares about research and thus you would advance slower if it weren't for us'.

Again a complete misrepresentation of facts. America is 10x the size of Canada. It's expected that you produce 10x as much. Yet we still produce an amazing amount of research for what we have.

11) 'I read about this one horror story about Canada...'
That's nice. I hear horror stories about the American system too all the time. All those people without coverage. All those people WITH coverage, who the insurance company refuses to pay. Insurance companies are generally in the business of not paying. If they paid out all the time, they'd make less money. So they have legions of people making sure that they have to pay as little as possible. So if you have a real problem, a lot of the time your insurance company may not pay your bills, or pull the plug or whatever. This is a REAL concern, and you'd have to be blind to not acknowledge that it doesn't exist as it happens very often in the USA. Didn't someone on this forum just have a story about this not too long ago?

In Canada, insurance exists for the people, by the people. It is funded by the people, administered by the people, and the rules are made by the people, not stockholders. Therefore, it ensures that no matter what, benefit of the doubt is given to doctors. Doctors aren't prevented from doing necessary procedures. Patients aren't prevented from getting help because the money is cut off and so on.

12) 'we have no waiting lists'.
Of course there's waiting lists in America. Yes you can bypass them if you have money or good plans. And yes overall your lists are shorter. The reason is simple, you have more doctors. This is an acknowledged problem with Canada. It's not that we pay doctors so little no one wants to do it (just look at all the people who apply to medical school). It's just that the schools aren't training enough, and yes this is due to the government not providing enough training.

This has a double effect. #1, because we have less doctors, our doctors are generally of higher quality because we can pick more qualified candidates. #2 we have less doctors.

Is this a problem? Yes it is, everyone in Canada knows it's a problem. But I don't think it's an inherent problem with the system as much as will. Americans spend per capita 2x as much on healthcare than we do. If we were willing to spend more money on it, we'd have better care. It's really that simple. This is a real problem and it needs to be addressed and I agree something must be done. Completely doing away with our system though when we beat you on so many other points, is pretty silly as our system is still much better overall for our populace.

13) 'Wow, everyone can use it? so communist!'
So are roads, so is public school, so are sewer systems, so is garbage pickup. Unless you Jerome never walk on public roads, pay to independently dispose of garbage, hire your own security guards so you don't have to rely on the police, never pour anything down the drain and have never known public school, calling healthcare 'communist' and making it sound so evil is pretty silly. There are certain things which once society passes a certain point should be provided as a public good, because hey the public is really better at doing it. Paving roads and educating kids is one of those. Healthcare is another.

[Epinephrine]

14) Expensive medical advances are completely overstated.
The fact is, simple things which don't require expensive drugs, machines or expensive new processes do FAR FAR more to help health than something expensive. Simple things can be promoted by public health, laws and of course primary care. New vaccines would come even from countries with public systems (in fact one of the largest vaccine companies in the world is Sanofi Pasteur, a French company). Maternal suppliments, and having someone there to actually deliver a baby help hugely. Eating better, promoting smoking cessation, drinking less and drug rehab programs are similarly important. Antibiotics (which are so generally used that really the infinitesimal market of rich people who need them won't actually make advances faster) save tons of lives as well and our system does not hinder their speedy development. Finally simple things like good hygene, clean water and air and so on are massively important. Even the Greeks and Romans who were well taken care of easily lived to over 70 (Socrates was 70 when they killed him). Most of all these super expensive things we've invented, have added very little to our lifespans, and it's arguable that public systems have really slowed their development down very much anyway.

15) By it's very nature, the private system wastes a lot of money.
Capitalism is supposed to be more efficient at providing services, but really when it comes to medical care (where people generally are willing to pay anything they can to not die), the laws of economics don't so easily apply. Americans spend 2x as much per capita on healthcare, not simply because you have 'better and more expensive machines and medicines' or that you 'subsidize research for the rest of the world'. In fact you pay so much more because of middlemen. Insurance companies are there by definition to make money. The employ hundreds of thousands of people whose job it is to deny healthcare, by finding loopholes, 'health reasons' and so on to deny insurance to people. This includes the people, their buildings, their secretaries, etc. We don't employ these people. Just these people alone account for most of the discrepancies.

But I didn't make this up, I read it from Paul Krugman's articles in the New York Times. I know it's probably not ultra-fundamentalist-conservative enough for you Jerome, but facts are facts (more than your economics teacher who thinks that somehow 'average mileage' doesn't actually mean AVERAGE).

17) 'We spend more on research cause we pay more for drugs'
I can't deny Americans do spend a lot of money on research. The budget for the NIH is much higher per capita than Health Canada. That's sad for us, I wish things were different. But most of the extra money spent on drugs and machines isn't towards research, it's towards... marketing and profits. Even the actual R&D budgets in corporations cannot be directly compared with public budgets. Corporate budgets include everything from building fancy buildings to paying for people to upkeep these fancy buildings and so on. Public budgets give money for researchers to directly spend as buildings are paid for separately by universities and hospitals unrelated to research grants.

It was made fun of how the Gates foundation 'only' supports 3% of research. Actually I thought this was a pretty funny comment, as 3% of research for just ONE foundation in such a massive country is pretty frickin amazing. Considering how many more foundations there are out there, and how much governments give out and so on, 3% is amazing.

18) And finally... why can't we just have a fully public system, and a private system on top of that if you want.

Well that's probably what is going to happen in Canada in the next 10 years unless people are willing to raise taxes. That's also what all the Democratic candidates for president in the USA are sort of proposing. This would basically mirror the system of private school and public school. There's no problem with this system and it's fine in principle, but only if it actually is forever and unchanging. The real problem with allowing such a system is that, eventually if the wealthy are only using private hospitals (cause they have 500 thread count hospital sheets, LCD TVs and prettier nurses or something) they will force political change so that they don't have to pay taxes to run the public system. Without their money, the public system would fall apart, and thus you'd have no public system or a system that works so bad, it almost fails for most people. In fact this already happens in the education system with poor districts having by far crappier schools, because the rich have redrawn the districts and the funding rules.

Actually though, the recent supreme court ruling in Canada, has already changed things here. Things are now actually opened up to competition between private vs public. How it will play out, I don't know, but I really think there is no place to abandon the public system.

But one thing I do find funny about this entire point is that, Jerome basically is saying that he supports the current Canadian system (public for all, private on top to provide next level). Funny that.



In the end, I think the real big difference is worldview. The 'capitalistic' worldview in terms of medical care, is simply that, it is absolutely okay that a great number of people have to suffer needlessly (I say needlessly because we easily have the resources to help them, as shown by the fact that the entire world aside from America does it) if those at the top get the treatment they want. This is sort of justified by the thought that 'well eventually if the rich are constantly treated, then the stuff that they want will be cheap enough for everyone'. Unfortunately because medical care is literally life and death, this means that a GREAT NUMBER of people have to die needlessly to achieve these aims far in the future. As well, as I have already shown by how our system doesn't affect drugs or machines and how a huge amount of research comes from countries with public systems as well, means that the actual tangible benefits of a capitalistic medical system are probably far overstated.

As I stated, the rules of capitalism cannot so easily be applied to health care. Not only does our system support private companies that make drugs and that make new machines, a lot of research has absolutely nothing to do with private enterprise as no one can really make any money out of most medical research, especially if it's telling you to do less of something (i.e. smoke less, eat less fatty food). As well, since doctors already publish their findings publicly, and publicly sharing your processes more or less infringes upon your competitive advantage (or else why else would we have patents?), if doctors really do have a novel way of doing things that really is better and more money making, they will keep it to themselves. And since they can only physically train so many people in their process, unlike a manufacturing process capitalism doesn't so easily allow for it's spread. Not to mention that the basic idea of science is to spread ideas which can then be debated, tested, and improved upon by all which certainly is better than having a haphazard way of approaching things.

Even if capitalism does allow for SOME advances to be faster, without a doubt I'd take a bit slower advance but not needlessly letting millions of people die for no reason, rather than the opposite. There simply is no excuse for willingly and knowingly letting people die when you could easily help them.



Ideally what system do I want? I want extra things to be private (i.e. cosmetics, laser eye surgery, etc). I want the public system to be better funded or at least as well funded as it was in the early 90s before money was cut to lower taxes. I want more funding to be given for public research. And I'd like governments to focus more on primary care and prevention than on expensive specialist care which sounds more impressive but has smaller returns on actually helping the health of the nation. All this could be done for far less cost than the American system per capita.

[Cops]

Even if capitalism does allow for SOME advances to be faster, without a doubt I'd take a bit slower advance but not needlessly letting millions of people die for no reason, rather than the opposite. There simply is no excuse for willingly and knowingly letting people die when you could easily help them.

That's why they have military campaigns all around the globe but people are still dying of simple health related issues in the U.S, I don't think this will ever change. I especially don't think this will change when you have people like Jerome who think that some people just don't deserve health care. America in this respect is the biggest hypocrite in the world, and it's as clear as day. I'm not attacking America for any other reason and I definitely think Americans get way more shit than they deserve, it's not the people I have a problem with it's the policies.

Help yourself before you try to help others.

[Jerome Scuggs]

Epinephrine, please, check your premises.

You make the assumption that Canada and America are the exact same, except you guys have medicare, and thus are better off mortality-wise. This is the exact sort of thinking that ushered in your failed system in the first place.

I am arguing for the seperation of government and economy, and the health sector is one of the most urgent systems in need of re-thinking.

You keep claiming that I have ambiguous goals, so let me re-iterate them:

-I do not believe that universal health care works. On face, I do not believe this because your intended goal of "equality" has not been met.

-I do not believe it will ever work. Policy, at this point, is nothing more than patchwork regulation meant to keep comprehensive healthcare existing, with no plans or even regard to the future.

-Since my arguments are based on economic, testable, and real theories and laws; and socialism is a social expirement for a certain code of morality, I must defend my ideas not only by virtue of their accomplishment, but also on an ethical plane. I contend that your code of ethics is contradictory, arbitrary, and biologically impossible.

-I also criticise the concept of "putting equality before freedom", which is the core axiom of the type of policy you support.

-Since most of your counter-argumentation relies on status quo misinterpretations of reality - i.e. assuming that the status quo US medical sector is "capitalist" - I also levy criticism at the institution of "state" and "government" itself, perceptions of "free market", and other counterpragmatic positions.

-Lastly, and to make this clear, I do not disagree with your objectives, only the means by which you achieve them. I am completely in favor of healthcare. I am not in favor of government regulation.

To put it bluntly, the healthcare debate is only the first thing that's wrong with your views. You're looking for a patchwork solution to a crisis which is incredibly real to thousands of people, but you do not consider the steps that caused the crisis to happen in the first place.

To start, let me point these facts out:

In 49 states, insurance companies are forced to cover treatment against alcoholism, which is obviously something that can be individually affected (or even if we say it cannot be individually effected, we would have to say it does not affect all people in the same way).

In 27 states, they must cover treatment against drug addiction. In other words, people who know that they will never use any addictive drugs nonetheless have to pay through their premiums.

The coverage of chiropractors is mandatory in 45 states.

Podiatrists in 37 states.

Psychologists are covered by mandate in 36 of the states. Again, it should be perfectly clear that the desire to go or not to go to a shrink can be individually affected.

In 22 states, the services of social workers have to be included in the coverage and of course are reflected then in the premium.

Georgia requires coverage for heart transplants. Now again, heart transplants might certainly be a risk that can be insured against, but it should be perfectly clear that this risk is different for different groups.

In Illinois, liver transplants have to be included. In Minnesota, hairpieces have to be included.

Marriage counseling has to be included in California.

Pastoral counseling in Vermont,

And sperm banking in Massachusetts.

In more than a dozen states, insurance may not ask any AIDS related questions. And in Washington DC, any HIV testing is prohibited for all insurers.

In California there can be no discrimination between any genetic traits that distinguish people. With the advances we make in genetic research, these types of differentiations would become finer and finer as scientific progress is made, but insurance companies are barred from recognizing this type of progress.

Insurance is the free-market equivalent of your lofty "universal healthcare". Insurance is literally a pooling of healthcare resources: if we all pitch in and form a big supply of money, then in the event that injury occurs to someone, he will have adequate money to have the best healthcare possible.

If one insurance company insured everyone, it would have maximum profit and thus tons of cash and resources to provide the best healthcare to EVERYONE. Had the company risen to the top of a free market, the only obvious way, economically, would by being the best: providing top treatment, cheap rates, comprehensive care, individualized quotes, and other, less important things like "no shortages or waiting lists".

But it would be "destructive" and "monopolistic", and even thought we provided "equality" to all consumers of health care, we didn't provide "equality" to other competitors. Isn't it wonderful to be a businessman, always breaking a law when you finally figure out how to obey another one? The contradictions are endless, but that is to be expected of government interests. (I would definitely take some time to read that article. It's actually pretty fucking sad.)

In Canada, you have STOLEN the free-market solution and, by power of law, created a monopoly. What are the results? You have a monopoly of resources, yet you still have shortages and waiting lists. You have a monopoly of power, yet people willfully disobey and break the law to find their own, more efficient solution.

In a market economy, your "monopoly" would go out of business because it was so shitty.

In the United States, we've taken that hazardous route - government intervention - except a different way. We still have legal insurance companies, but we then force them to cover a myriad of things, half of which are uninsurable - alcoholism? Seriously?

It's that sort of thing - covering uninsurable risks - that is raising the premium prices. Of course, dropping out of the insurance market is a risky thing to do, but young healthy people are almost crazy to pay the high premiums that come about from subsidizing all these unhealthy lifestyles and covering risk that they know don't apply to them.

This leads to a shift in the market equilibrium price - it is shifted, against the will of the insurer or the insured - up. As a result, many people simply opt out of insurance alltogether, because they think rationally and economically: "should i really pay that much for insurance? i don't drink alcohol, i don't have a predisposition for sickle cell", etc.

You're looking at the Status Quo and drawing your arguments from it. I have been saying, this whole time, that the type of system you advocate is the cause of the very problems you're claiming to solve. Because of your overwhelming desire to put "immediate equality" before such things as "practicality", "realism", and "rational decisionmaking", beauracrats with your line of thinking have actually forced people to choose between excessive insurance, or none at all. (Cops, does wanting to get rid of a system that forces poor people to not be able to afford insurance make me a bad person?)

Anyways, when insurance becomes too expensive thanks to your beauracrats, their next "surefire" solution are price controls.

Through this entire debate, my arguments have been called "Complex" and "Unrealistic", so I'll keep trying to explain it as best as I can - seriously, if you don't understand, Epi, just tell me - don't write a three-post rant that completely ignores everything I've said.

With that in mind, let me re-re-re-re-re-explain something: resources are finite. That means that they are not inexhaustibile - at a certain point, amount of Resource X will be zero.

At any given time, only certain amount of Resource X (in this case: health care) is avaliable. At one point, it was cheap and affordable for the masses, even those with no insurance. Thanks to regulations that raised the price of health care and then insurance, prices rose - even though the actual supply of it never really changed in relation to that price.

So what Canada has done, (and what America will, at this pace, inevitably do), is enact price controls and mandatory insurance.

MAndatory insurance will cause premiums to skyrocket, which results in the obvious government reaction of price control. Price controls will merely create shortages, because certain procedures cost more in reality than what Canada says they do. It becomes unprofitable to do such services, which either leads to the service not being offered as a treatment (assuming a less effective but cheaper substitute is avaliable) or, if that doesn't happen, shortages. Epi makes the claim that I am not very engaged in reality, is he saying that these "waiting lists" that Canadians have to wait on, sometimes in excess of years, are not real?

As I stated before, I argue that not only is your system flawed, but it created the very thing it has to increasingly try to fix.

To quote Cowperthwaite:

"In the long run, the aggregate of decisions of individual businessmen, exercising individual judgment in a free economy, even if often mistaken, is less likely to do harm than the centralised decisions of a government, and certainly the harm is likely to be counteracted faster."

[Cops]

reviving dead threads? Welcome back.

I want to pledge allegiance to the country I live, I don't want to be ashamed to be American, but opportunity no it don't exist it's the opiate of the populace. We need some harder shit now, the truth's getting round'. Each public school is a half-way house, where huddled masses sober up and up. it's not enough to fatten all the cows and feed all of us, it's just irrationally unlucky.

[Cops]

You're looking at the Status Quo and drawing your arguments from it. I have been saying, this whole time, that the type of system you advocate is the cause of the very problems you're claiming to solve. Because of your overwhelming desire to put "immediate equality" before such things as "practicality", "realism", and "rational decisionmaking", beauracrats with your line of thinking have actually forced people to choose between excessive insurance, or none at all. (Cops, does wanting to get rid of a system that forces poor people to not be able to afford insurance make me a bad person?)

Reason, rational, all things that you profess yet you don't understand that a lakc of social programs, which are usually the adjustments to societies who are financial trouble result in the deaths of Millions. When I'm standing in a hospital and I refuse to help someone who has been stabbed because my purely capitalist society says that unless he can help himself by affording it or having health insurance then there's something wrong with that scenario. Do you have the heart to turn to this person and say I'd like to help you but unfortunately helping you isn't "practical".

American Insurance Companies are useless, that said I don't think there's anything wrong with a person wanting to choose between coverage that they feel is necessary, but there has to be some basic level provided for the masses who can't afford it. That is unethical to let your people die over basic health care related issues. If Insurance companies made things cheaper per capita or made getting coverage easy I'd agree that it was worth it to convert to that system but currently it's not and Americans pay about the same as Canadians and it's available to everyone.

[Jerome Scuggs]

American Insurance Companies are useless, that said I don't think there's anything wrong with a person wanting to choose between coverage that they feel is necessary, but there has to be some basic level provided for the masses who can't afford it.

A basic level that could be provided had the government not felt it necessary to provide it. Ironic, huh?

That is unethical to let your people die over basic health care related issues. If Insurance companies made things cheaper per capita or made getting coverage easy I'd agree that it was worth it to convert to that system but currently it's not and Americans pay about the same as Canadians and it's available to everyone.

I don't see why you're still blaming the companies, when you obviously don't argue my point that what is causing all this is the government. And you also don't see something else - there is no "conversion" necessary. You literally have to repeal laws and let the market do the rest - as it has been, as it's trying to do, and how it will do.

[Facetious]

Ha, I banned him for double posting, then you call him out on reviving dead threads (a week isn't a dead thread) but double post yourself.

Jerome, how can you prove it's regulations that are raising the price of health insurance?