OBAMA/TRUMPCARE MEGATHREAD

[Y2HH]

While I'm not particularly optimistic for single-payer in this country any time soon, there's no reason to stop advocating for and discussing it.

 

Yes, there is. It's a great system so long as there is a massive system out there innovating for it. That's what we do. Most medical innovations, and drug innovations come from here. If we also had a single payer system, things would change right along with it. Of course this is something people won't talk about, or they'll post thin evidence stating that a free market system is no more innovative...when it is.

 

That and the other unsaid system in place that basically allows these governments to have a single payer system...since the US is 90% of the defense, they can run a skeleton military.

 

I fully expect you to respond now as to how we haven't innovated the medical/drug system for the entire world...when we have.

 

We've had this conversation already. I know, the us sucks balls, and everywhere else rules. But here you still are.

[Jake]

Yes, there is. It's a great system so long as there is a massive system out there innovating for it. That's what we do. Most medical innovations, and drug innovations come from here. If we also had a single payer system, things would change right along with it. Of course this is something people won't talk about, or they'll post thin evidence stating that a free market system is no more innovative...when it is.

 

That and the other unsaid system in place that basically allows these governments to have a single payer system...since the US is 90% of the defense, they can run a skeleton military.

 

I fully expect you to respond now as to how we haven't innovated the medical/drug system for the entire world...when we have.

 

We've had this conversation already. I know, the us sucks balls, and everywhere else rules. But here you still are.

 

I'm certainly interested in the idea of us "innovating for all" so to speak...but I'm not sure if we should all be penalized with an inferior healthcare system for it to happen. It is hard to say whether we come up with medical discoveries and such just because of our free market healthcare system or if it just happens to be true because our country has excellent researchers (perhaps because we have far and away the best higher education system). I'm sure there is a mix of both, but the question is how much of each is responsible. Would an innovative researcher do as much good if he was working at a university and receiving federal research grants rather than in a private lab for a pharmaceutical company? More good? Less good? I suppose that's a loaded question...how much can pharmaceutical companies spend on research, what do they want to research, how available can we make federal grants for medical research, etc.

 

I like that you mention our massive defense budget because it sticks out like a sore thumb when you look at our federal budget and when you look at the rest of the world's defense spending. Maybe we should put some of the burden for all these things like defense, scientific research, etc back on the rest of the world. We don't have to mortgage our own country because we're insecure about the entire world turning on us or failing to do as good of a job with the same resources.

 

I'm also now imagining a federal grant leading to the discovery of some kind of cancer cure/remedy...and some of the people involved in that allocation campaigning on the "I cured cancer" premise

[Y2HH]

I'm certainly interested in the idea of us "innovating for all" so to speak...but I'm not sure if we should all be penalized with an inferior healthcare system for it to happen. It is hard to say whether we come up with medical discoveries and such just because of our free market healthcare system or if it just happens to be true because our country has excellent researchers (perhaps because we have far and away the best higher education system). I'm sure there is a mix of both, but the question is how much of each is responsible. Would an innovative researcher do as much good if he was working at a university and receiving federal research grants rather than in a private lab for a pharmaceutical company? More good? Less good? I suppose that's a loaded question...how much can pharmaceutical companies spend on research, what do they want to research, how available can we make federal grants for medical research, etc.

 

I like that you mention our massive defense budget because it sticks out like a sore thumb when you look at our federal budget and when you look at the rest of the world's defense spending. Maybe we should put some of the burden for all these things like defense, scientific research, etc back on the rest of the world. We don't have to mortgage our own country because we're insecure about the entire world turning on us or failing to do as good of a job with the same resources.

 

I'm also now imagining a federal grant leading to the discovery of some kind of cancer cure/remedy...and some of the people involved in that allocation campaigning on the "I cured cancer" premise

 

This is an excellent post. I'd love to discuss this further when I have some time to put some thoughts in order, but great points.

[kapkomet]

BCBS is a franchise...not all of them are the same.

 

The problem with insurance, as is the problem with anything...is people don't care to know the details...and as they say, the devil is the details. Ask most anyone you know what type of insurance they have, and you'd be lucky if they knew if it was a PPO or an HMO. Most people don't even know the core difference between a PPO/HMO, because having to research that might cut into their reality TV watching time. If by some chance they do happen to know that, ask them what their deductibles/max expense are...or what's covered...odds are they have no idea, because they don't/won't care until it's too late and they suddenly have to care.

 

People are lazy...even when it comes to knowing what their insurance covers.

 

I don't wish to sound like an insurance company shill here, despite full disclosure that I presently work for one. Insurance companies do a lot of things I disagree with, a lot of things the ACA actually corrected for the better. But it takes more than insurance companies to mess this up...the doctors/hospitals/drug companies share a majority of the blame, but haven't been touched. Remember, they're the ones that send the arbitrary and exorbitant bills...but nobody seems to care about that. It's all the insurance companies fault.

 

The problem I have with your post (and being a CPA that has worked in health care for a while) is that the doctors/hospitals/drug companies do not share the majority of the blame because what is usual and customary set upon? A medicare rate, most often. And what is the basis of that? The federal government.

 

You want to bend the cost curves? Take out the medicare * XXXX rate to come up with a usual and customary charge that create the basis of the contracts for insurance companies and you solve a lot of problems, because these cost curves are set on an inflationary revenue curve, and it's very on purpose.

 

However, on the flip side, and this is the part I will agree with on the blame that doctors/hospitals/drug companies DO share the blame in is that they are lobbying the hell of out of the government to establish those same medicare rates higher and higher and higher with really no real cost justification.

 

Insurance coverage isn't a lot of the problem, contrary to the spouting of the lefty loons. It's the method of which the accounting of the health care system as a whole is based.

[kapkomet]

Medicare is also partially responsible for why you pay 3x as much. Private insurers are what hospitals use to make up for what they lose to Medicare negotiations.

 

 

Oh, well I should have read further. But I think the point you miss is that usual and customary IS set by medicare rates. And I wouldn't agree that private insurance us what they make up for medicare negotiations... because the cost is set on that rate.

[Y2HH]

I'm certainly interested in the idea of us "innovating for all" so to speak...but I'm not sure if we should all be penalized with an inferior healthcare system for it to happen. It is hard to say whether we come up with medical discoveries and such just because of our free market healthcare system or if it just happens to be true because our country has excellent researchers (perhaps because we have far and away the best higher education system). I'm sure there is a mix of both, but the question is how much of each is responsible. Would an innovative researcher do as much good if he was working at a university and receiving federal research grants rather than in a private lab for a pharmaceutical company? More good? Less good? I suppose that's a loaded question...how much can pharmaceutical companies spend on research, what do they want to research, how available can we make federal grants for medical research, etc.

 

I like that you mention our massive defense budget because it sticks out like a sore thumb when you look at our federal budget and when you look at the rest of the world's defense spending. Maybe we should put some of the burden for all these things like defense, scientific research, etc back on the rest of the world. We don't have to mortgage our own country because we're insecure about the entire world turning on us or failing to do as good of a job with the same resources.

 

I'm also now imagining a federal grant leading to the discovery of some kind of cancer cure/remedy...and some of the people involved in that allocation campaigning on the "I cured cancer" premise

 

Ok, getting back to this...like I said before, you raise some excellent points here.

 

It's unfair to give sole credit to the private market when the other points you raise have merit and have made obvious contributions in the form of R&D over the years. It's not to say innovation doesn't come from elsewhere, but what free market companies tend to spend on R&D far outreaches most anything else, especially government, of course, there are exceptions to every rule. I don't think it's a stretch to say that if you start telling the medical industry what people can/should be making, interest in the market will decline rapidly. A lot of people enter that market knowing the sacrifices they make now will be rewarded huge on the back end. Again, there are those that enter the market because they actually want to help people, and would do so whether the back end pay is high or not, but I'd have to say a majority of them wouldn't bother.

 

Pfizer, as a simple example, spends billions on R&D for a single drug, which more often than not fails in trial and the money is lost. When they do hit upon a winner, think Lipitor, they have to make their money back from all the other failed research, not to mention the research that went into the successful one...hence you get a period of high prices to recuperate those losses and move into profit. If you removed their ability to charge high prices by controlling the drug market...these companies wouldn't risk billions knowing they will never make it back. Whether people want to admit it or not, innovation would fall off a cliff. This principal can be applied to almost any market. Look around you, wherever you are sitting right now...90% of everything you see was brought to you by innovation of people/companies looking to make a profit. That's reality, whether people choose to accept that or not.

 

On the flip side of this is a lost argument people *always* fail to mention, and it is -- by far -- the majority reason why our country is in the financial mess it's in. Defense spending. To an absurd degree. The fact that the US basically subsidizes 90% of the free worlds military/defense spending...for free, is something nobody talks about. We always hear about these great "free" health care systems from countries that have a annual defense budget if 14 dollars and 37 cents, giving them tons of money to budget for their health care systems. If we weren't subsidizing that defense budget...we'd probably have more than enough money to pay for "free" healthcare for our own citizens...but reality is what it is. Let me be clear: I don't agree with us being the worlds police...but we are. And while the world loves to "pretend b****" about it...they also rely on us to enable them to do everything else it is they do.

[StrangeSox]

An awful lot of medical research, especially basic research, is bankrolled by the government, so it's not some sort of free-market innovation paradise in pharma.

Edited August 23, 2012 by StrangeSox

[southsider2k5]

An awful lot of medical research, especially basic research, is bankrolled by the government, so it's not some sort of free-market innovation paradise in pharma.

 

Like research into syphilis for example.

[StrangeSox]

Who Drives Innovation?

 

Government-funded research is a big driver of innovation in the health-care market, doing work private companies aren't interested in and also freeing pharmaceutical firms to do the kind of they're most interested in, because those trials get drugs on the market and highlight their products competitive advantages. As Ian Cockburn and Rebecca Henderson wrote in a 2001 paper for the National Bureau of Economic Research, "The public sector probably plays a more important role in determining private sector productivity in the pharmaceutical industry than in any other industry except defense."

[Y2HH]

Who Drives Innovation?

 

I already said they contribute.

 

Just not nearly as much as you're trying to make it sound like they do. The issue with this is you can apply your logic/point to ANY industry, yes...governments help allow them to exist, but governments taking control of the industry and destroying the ability to compete/profit is what we're talking about here.

 

Nobody here is pretending, or even trying to say that the government isn't in part responsible for helping create an atmosphere for others to drive massive innovation...but let's not jump the shark here. These companies are on their own...if they try and fail, over and over, they'll go bankrupt, and the government won't do anything to stop that...many pharmacutical and medical device companies have gone bankrupt attempting to innovate, and nobody -- including the government -- saved them.

Edited August 23, 2012 by Y2HH

[Jake]

Like research into syphilis for example.

 

lol

 

Who Drives Innovation?

 

"Ian Cockburn"

[StrangeSox]

I already said they contribute.

 

Just not nearly as much as you're trying to make it sound like they do. The issue with this is you can apply your logic/point to ANY industry, yes...governments help allow them to exist, but governments taking control of the industry and destroying the ability to compete/profit is what we're talking about here.

 

Nobody here is pretending, or even trying to say that the government isn't in part responsible for helping create an atmosphere for others to drive massive innovation...but let's not jump the shark here. These companies are on their own...if they try and fail, over and over, they'll go bankrupt, and the government won't do anything to stop that...many pharmacutical and medical device companies have gone bankrupt attempting to innovate, and nobody -- including the government -- saved them.

 

Private companies barely do basic research these days without heavy NIH funding, and it's still mostly done in university labs with heavy NIH funding. Let's not jump the shark and pretend that the government doesn't play a vital role in scientific research and innovation that lays the groundwork for private research and innovation. While pharma companies do take on a lot of risk and expenses bringing a drug to market, it isn't comparable to the decades-if-ever profitable timelines for basic research.

 

My point isn't that pharma companies don't do anything or are only a minor part, just that we wouldn't be anywhere near where we are without government-funded basic research.

[Y2HH]

Private companies barely do basic research these days without heavy NIH funding, and it's still mostly done in university labs with heavy NIH funding. Let's not jump the shark and pretend that the government doesn't play a vital role in scientific research and innovation that lays the groundwork for private research and innovation. While pharma companies do take on a lot of risk and expenses bringing a drug to market, it isn't comparable to the decades-if-ever profitable timelines for basic research.

 

My point isn't that pharma companies don't do anything or are only a minor part, just that we wouldn't be anywhere near where we are without government-funded basic research.

 

Which is conveniently impossible to quantify, or even prove. You're entire post is basically the same "you didn't build that" argument Obama erroneously leaned on. It's a f***ing terrible argument...colorful metaphor included to add meaning.

 

Basic research is done by FAR more than just government funded institutions, always has been, always will be.

 

Again, that's not to say the government doesn't contribute...I've already made it pretty clear they do.

Edited August 23, 2012 by Y2HH

[StrangeSox]

It's not impossible to quantify or prove. Look up NIH funding levels, read the medical-economic papers published on the issue. The government provides fully a third of all medical research funding in this country, much of it going into the basic research that companies do not otherwise perform.

 

It's the same "you didn't build that" argument that Obama correctly leaned on: government provides infrastructure and support necessary for businesses to operate on a regional, national and global level. Highways and bridges are comparable to basic medical (and physics, chemistry, biology, etc. etc.) research that is almost completely funded or performed by government these days.

 

Basic research is simply not really done by private companies on their own these days. For a while, you had places like Bell Labs on the tech side of things, but even those are gone now. Private companies focus on developmental research necessary to bring things to market, but they aren't performing the basic research with 20-30+ year timelines before marketability (if ever) because companies don't invest in that kind of R&D. And without that critical research funded by NIH, private companies don't have anything to developmentally research.

[southsider2k5]

It's not impossible to quantify or prove. Look up NIH funding levels, read the medical-economic papers published on the issue. The government provides fully a third of all medical research funding in this country, much of it going into the basic research that companies do not otherwise perform.

 

It's the same "you didn't build that" argument that Obama correctly leaned on: government provides infrastructure and support necessary for businesses to operate on a regional, national and global level. Highways and bridges are comparable to basic medical (and physics, chemistry, biology, etc. etc.) research that is almost completely funded or performed by government these days.

 

Basic research is simply not really done by private companies on their own these days. For a while, you had places like Bell Labs on the tech side of things, but even those are gone now. Private companies focus on developmental research necessary to bring things to market, but they aren't performing the basic research with 20-30+ year timelines before marketability (if ever) because companies don't invest in that kind of R&D. And without that critical research funded by NIH, private companies don't have anything to developmentally research.

 

By that logic the government didn't do a damned thing. I did it. It is my tax money.

[StrangeSox]

Money you were able to earn because of prior investment in infrastructure and government services, mainly law & order. Absent government, your earnings would likely be far, far less.

 

I have no problem saying that public and private sectors are a symbiotic relationship that strengthen each other.

Edited August 23, 2012 by StrangeSox

[southsider2k5]

Money you were able to earn because of prior investment in infrastructure and government services, mainly law & order. Absent government, your earnings would likely be far, far less.

 

Absent citizens, the government wouldn't exist.

[StrangeSox]

That is a true but meaningless statement.

[southsider2k5]

That is a true but meaningless statement.

 

As is "You didn't build this".

[StrangeSox]

As is "You didn't build this".

 

"there is no government without citizens" is a tautological statement. It doesn't tell me anything.

 

"You didn't build [the infrastructure necessary for the success of your business]" is not tautological and, in the context of the rest of the paragraph, makes a point on the necessity of social organization and cooperation as opposed to the Lone Individual mythos prevalent in this country. You may not agree with the point of his speech, but your statement still have no meaning while his did.

[southsider2k5]

"there is no government without citizens" is a tautological statement. It doesn't tell me anything.

 

"You didn't build [the infrastructure necessary for the success of your business]" is not tautological and, in the context of the rest of the paragraph, makes a point on the necessity of social organization and cooperation as opposed to the Lone Individual mythos prevalent in this country. You may not agree with the point of his speech, but your statement still have no meaning while his did.

 

The only meaning behind his statement was a self-serving load of garbage that literally ignores what the individual citizens have done to improve their stations in their lives in order to take credit for it.

 

It doesn't mean anything. Its like Al Gore "inventing" the internet.

[StrangeSox]

The only meaning behind his statement was a self-serving load of garbage that literally ignores what the individual citizens have done to improve their stations in their lives in order to take credit for it.

 

It doesn't mean anything.

 

You're free to disagree, but it means something. Your statement did not.

 

Its like Al Gore "inventing" the internet.

Al Gore never claimed he invented the internet, that's something conservatives invented and the media uncritically repeated.

 

and actually, the internet is a great example of government-funded R&D that leads to massive economic expansion. So it only makes Obama's point, which is that government plays a critical role in the economy. Always has, always will.

Edited August 23, 2012 by StrangeSox

[southsider2k5]

You're free to disagree, but it means something. Your statement did not.

 

 

Al Gore never claimed he invented the internet, that's something conservatives invented and the media uncritically repeated.

 

and actually, the internet is a great example of government-funded R&D that leads to massive economic expansion. So it only makes Obama's point, which is that government plays a critical role in the economy. Always has, always will.

 

Really, it means nothing, except to the people he just threw under the bus.

[StrangeSox]

It means nothing except the deep philosophical difference between yours and his worldview, got it.

[Jenksismyhero]

You're free to disagree, but it means something. Your statement did not.

 

 

Al Gore never claimed he invented the internet, that's something conservatives invented and the media uncritically repeated.

 

and actually, the internet is a great example of government-funded R&D that leads to massive economic expansion. So it only makes Obama's point, which is that government plays a critical role in the economy. Always has, always will.

 

The problem with his statement was that he ignored 99% of what creates a business and praised the 1% society provides (teachers/roads/etc) all while ignoring that the business owner still pays for that 1%, so it's not like some free service he/she got.

 

The internet is a good example. The government created the "internet" as part of the military, then academia took it over and then capitalism took over. The government has little involvement in 99% of why the internet is what it is.