Will ObamaCare Make Early Retirement More Difficult?

[forummm]

If you look at the healthcare costs by age across the different countries, it's very clear where the healthcare cost increases are coming from. We just need to halt the increases going to those 60+. If only we had a government program that controlled medical costs for that age group...

Medicare has been mostly prohibited from controlling costs. For example, the GOP/Bush Part D forbids negotiating drug prices. Efforts to privatize (Part C) actually cost more. The ACA is the first time I can think of where any cost control has been added to Medicare. And the ACA's cost control provisions are very weak. However they are starting to have some limited impact.

The US costs are also the highest for the other age groups too. What you're probably seeing with the elderly is the very high cost of procedures/treatments in the US relative to the rest of the world. Cancer treatments are more, surgeries are more, medical devices are more, etc. Medicare pays less for those things than private insurers pay.

[forummm]

I thought this talked reasonably well about the effects of regulation on healthcare costs:
https://mises.org/blog/how-government-regulations-made-healthcare-so-expensive

OK. I will look at this later this week.

I read this. Didn't find it persuasive. There's a lot of the spurious correlation that you also repeat (healthcare costs increasing with some kind of government change happening as much as 10 years before). But a lot of that government change was happening because of escalating costs. And the costs were escalating in part because of increased life spans (older people cost more), improvements in technology (we can cure or treat so many things we couldn't before and there are lots of new technologies to diagnose people too), and other factors.

It also states that drug patents and medical licensing are problems but ignores a lot of the other questions that I posed to you (and you continue to ignore) about patents on drugs (if we don't have any patents we won't have any new drugs), medical licensing (do you want just anyone to be able to practice medicine without any vetting?), etc.

And, above all, the piece doesn't address the central question I have posed to you at least a half dozen times. The US has the LEAST government involvement in the industrialized nations. If government is the problem, then why is it the MOST expensive?

Really, really wanting something to be true does not make it so.

[forummm]

You bring up 1 good point.  How does a patient know they need to pay for medical care?  A call center funded by government to ask questions. Followed by inexpensive and easy availability to primary care and clinics.

A few places do this:  Keiser has a setup like this where their members can call or see a representative that will send them to the appropriate medical facility or provider.

This is one option for initiating care. But I just don't think it's that simple once you go in for a visit. Say I go to the doctor and go through all the questions and examinations and they say I need an XYZ test. How will a call center be able to replicate this advice without also replicating the visit? Isn't that almost twice as costly? The duplicate visit could be a little cheaper because you could just read the BP #s and such instead of replicating it.

[Gin1984]

You bring up 1 good point.  How does a patient know they need to pay for medical care?  A call center funded by government to ask questions. Followed by inexpensive and easy availability to primary care and clinics.

A few places do this:  Keiser has a setup like this where their members can call or see a representative that will send them to the appropriate medical facility or provider.

This is one option for initiating care. But I just don't think it's that simple once you go in for a visit. Say I go to the doctor and go through all the questions and examinations and they say I need an XYZ test. How will a call center be able to replicate this advice without also replicating the visit? Isn't that almost twice as costly? The duplicate visit could be a little cheaper because you could just read the BP #s and such instead of replicating it.

I had kaiser and on occasion called the advice nurse.  Though it could occasionally get you in to see your doctor quicker, it otherwise was useless.

[Yaeger]

It also states that drug patents and medical licensing are problems but ignores a lot of the other questions that I posed to you (and you continue to ignore) about patents on drugs (if we don't have any patents we won't have any new drugs), medical licensing (do you want just anyone to be able to practice medicine without any vetting?), etc.

And, above all, the piece doesn't address the central question I have posed to you at least a half dozen times. The US has the LEAST government involvement in the industrialized nations. If government is the problem, then why is it the MOST expensive?

Really, really wanting something to be true does not make it so.

I could say the same about your stance. Really, really wanting government to be efficient and providing low cost healthcare doesn't make it so. Levying blame for cost increases upon private institutions really shows a disconnect from how competitive private enterprise works and doesn't explain trends in healthcare outside of the obvious crony capitalism.

The US has the LEAST government direct involvement via a monopsony or a nationalization of healthcare, however it compensates for that by increasing regulations and burdens upon private entities. Moreso than those other industrialized nations. You give people the illusion of private enterprise, continually narrow the field in which these entities are able to operate in, and blame the effects on 'greedy insurers'. Our current system lends itself towards MORE inefficiency than a purely government-run system because politicians and taxpayers can push the cost of inefficiencies to the private market via market distortions.

I've addressed those in other posts. Patents on drugs need to be respected, but we need to reduce the costs associated with developing drugs by changing the tax structure surrounding R&D, streamlining the FDA drug approval process, and make our drug manufacturers more competitive on a global market. Repeal Medicare Part D and push the costs onto the customers, the people making the decision to purchase the drug.

Licencing needs to be relaxed, from physicians all the way down to nursing aids, insurers, IT professionals, hospitals, etc. Licencing creep is partly responsible for the restriction of supply of medical professionals and contributes to the healthcare higher cost. It'll make it more feasible for private clinics to operate and help revitalize private practices by making it easier for these physicians to operate, hire and train staff, and reduce overhead.

I'm not sure why you say things like "do you want just anyone to be able to practice medicine without any vetting?", as if people like me want to eliminate ALL standards from the gamut of controls within the healthcare industry. Yes, draconian incremental licencing creep IS a problem, NO eliminating all standards is not an acceptable solution. We need to meet halfway here, and we need to put more trust into our medical professionals.

[EnjoyIt]

Lastly, insurance companies follow suit of CMS because CMS constantly is trying to cut costs and decrease payments.  private insurance wants to pay out less so they follow whatever CMS does.

So if both CMS and private insurers think XYZ will save money--why are you against it? I get that it could be personally bothersome as a physician. But I mean from a societal perspective.

If you think everything the government does is good, then we have a much bigger discussion. Either way medicaid pays out about 80% of what it costs to provide care. Medicare pays better.  Also, the way CMS works on cutting cost is by creating regulatory hurdles making it more difficult to bill. These hurdles require increased personnel. Insurances follow these same hurdles as well.

Believe me red tape is not the answer to cutting health care costs.

It is this burden which makes me want to work less and just stop being a doctor. I love practicing medicine and taking care of patients, I am sick and tired of the ever increasing beurocracy.

If our healthcare turned into what the VA does, I would quite immediately.

[forummm]

Lastly, insurance companies follow suit of CMS because CMS constantly is trying to cut costs and decrease payments.  private insurance wants to pay out less so they follow whatever CMS does.

So if both CMS and private insurers think XYZ will save money--why are you against it? I get that it could be personally bothersome as a physician. But I mean from a societal perspective.

If you think everything the government does is good, then we have a much bigger discussion. Either way medicaid pays out about 80% of what it costs to provide care. Medicare pays better.  Also, the way CMS works on cutting cost is by creating regulatory hurdles making it more difficult to bill. These hurdles require increased personnel. Insurances follow these same hurdles as well.

Believe me red tape is not the answer to cutting health care costs.

It is this burden which makes me want to work less and just stop being a doctor. I love practicing medicine and taking care of patients, I am sick and tired of the ever increasing beurocracy.

If our healthcare turned into what the VA does, I would quite immediately.

The government works well for some things and less well for others. Same with the private sector. They are just groups of people. It's the incentives and human nature and other things that determine whether one or the other is likely to succeed at some particular kind of task.

I think your characterization of CMS is myopic. Yes, it makes it harder for you to bill--I get that that is irritating. But they are also trying to discourage or pick out fraud, unnecessary procedures, etc. They may or may not be doing a bad job of that. But, again, if the private sector endorses and also uses those practices (as you have stated), then I'm not sure why you are highlighting CMS as being the problem.

My understanding is that in other countries with universal healthcare systems, there isn't so much red tape. That's one of many reasons why those systems work better. I would like to go in that direction. It sounds like you do too--except you also are against insurance generally. I don't know if you have any thoughts on what I said about why I don't think that an insurance-free system is workable.

[forummm]

It also states that drug patents and medical licensing are problems but ignores a lot of the other questions that I posed to you (and you continue to ignore) about patents on drugs (if we don't have any patents we won't have any new drugs), medical licensing (do you want just anyone to be able to practice medicine without any vetting?), etc.

And, above all, the piece doesn't address the central question I have posed to you at least a half dozen times. The US has the LEAST government involvement in the industrialized nations. If government is the problem, then why is it the MOST expensive?

Really, really wanting something to be true does not make it so.

I could say the same about your stance. Really, really wanting government to be efficient and providing low cost healthcare doesn't make it so. Levying blame for cost increases upon private institutions really shows a disconnect from how competitive private enterprise works and doesn't explain trends in healthcare outside of the obvious crony capitalism.

Au contraire. I'd really love it if the private sector was fantastic and efficient and inexpensive regarding healthcare. We'd save trillions per year. Instead, they suck miserably. I'm very upset about that. The private market, when it works really well, is the easiest way to go. It's a shame that it sucks so badly in this area.

The US has the LEAST government direct involvement via a monopsony or a nationalization of healthcare, however it compensates for that by increasing regulations and burdens upon private entities. Moreso than those other industrialized nations. You give people the illusion of private enterprise, continually narrow the field in which these entities are able to operate in, and blame the effects on 'greedy insurers'. Our current system lends itself towards MORE inefficiency than a purely government-run system because politicians and taxpayers can push the cost of inefficiencies to the private market via market distortions.

Do you have evidence for the claim in the first sentence? Or the last?

I've addressed those in other posts. Patents on drugs need to be respected, but we need to reduce the costs associated with developing drugs by changing the tax structure surrounding R&D, streamlining the FDA drug approval process, and make our drug manufacturers more competitive on a global market. Repeal Medicare Part D and push the costs onto the customers, the people making the decision to purchase the drug.

Licencing needs to be relaxed, from physicians all the way down to nursing aids, insurers, IT professionals, hospitals, etc. Licencing creep is partly responsible for the restriction of supply of medical professionals and contributes to the healthcare higher cost. It'll make it more feasible for private clinics to operate and help revitalize private practices by making it easier for these physicians to operate, hire and train staff, and reduce overhead.

I'm not sure why you say things like "do you want just anyone to be able to practice medicine without any vetting?", as if people like me want to eliminate ALL standards from the gamut of controls within the healthcare industry. Yes, draconian incremental licencing creep IS a problem, NO eliminating all standards is not an acceptable solution. We need to meet halfway here, and we need to put more trust into our medical professionals.

I've never seen you say that regulations can be good. You tend to be quite anti that. So it's a nice surprise to see that you think that *some* licensing of physicians is a good thing.

And you've posted (and linked) to things being against patents. So now you're for them. OK good.

"changing the tax structure around R&D". What does that mean? Most drug R&D is totally free to drug companies because it's conducted at nonprofit universities by graduate students and paid for by NIH grants. And most of the R&D done at drug firms is on "me too" drugs to copy what some other drug already does. And I'm pretty sure that's also tax deductible.

I don't know what bearing "make our drug manufacturers more competitive on a global market" has on anything. Drugs owned by US firms are sold everywhere already. It doesn't matter where they are made. Just like it doesn't matter where your socks are made.

[Yaeger]

It also states that drug patents and medical licensing are problems but ignores a lot of the other questions that I posed to you (and you continue to ignore) about patents on drugs (if we don't have any patents we won't have any new drugs), medical licensing (do you want just anyone to be able to practice medicine without any vetting?), etc.

And, above all, the piece doesn't address the central question I have posed to you at least a half dozen times. The US has the LEAST government involvement in the industrialized nations. If government is the problem, then why is it the MOST expensive?

Really, really wanting something to be true does not make it so.

I could say the same about your stance. Really, really wanting government to be efficient and providing low cost healthcare doesn't make it so. Levying blame for cost increases upon private institutions really shows a disconnect from how competitive private enterprise works and doesn't explain trends in healthcare outside of the obvious crony capitalism.

Au contraire. I'd really love it if the private sector was fantastic and efficient and inexpensive regarding healthcare. We'd save trillions per year. Instead, they suck miserably. I'm very upset about that. The private market, when it works really well, is the easiest way to go. It's a shame that it sucks so badly in this area.

I'd love to see evidence of what you're proposing, that government healthcare involvement has no negative effect on private enterprise. You keep asking me for proof yet provide none to support your points, it's hypocritical. I'm also not sure if you're saying that over the last 50 years the private sector has suddenly become grossly incompetent regarding inefficiencies and price, the things private companies actually CARE about. If anything, government-run facilities like the VA seem to be widely acknowledged exemplars of cost overruns, waste, and inefficiency, not private companies. As someone that routinely uses government healthcare, I can attest to the gross inefficiencies of it compared to the private sector.

Convince me.

I've addressed those in other posts. Patents on drugs need to be respected, but we need to reduce the costs associated with developing drugs by changing the tax structure surrounding R&D, streamlining the FDA drug approval process, and make our drug manufacturers more competitive on a global market. Repeal Medicare Part D and push the costs onto the customers, the people making the decision to purchase the drug.

Licencing needs to be relaxed, from physicians all the way down to nursing aids, insurers, IT professionals, hospitals, etc. Licencing creep is partly responsible for the restriction of supply of medical professionals and contributes to the healthcare higher cost. It'll make it more feasible for private clinics to operate and help revitalize private practices by making it easier for these physicians to operate, hire and train staff, and reduce overhead.

I'm not sure why you say things like "do you want just anyone to be able to practice medicine without any vetting?", as if people like me want to eliminate ALL standards from the gamut of controls within the healthcare industry. Yes, draconian incremental licencing creep IS a problem, NO eliminating all standards is not an acceptable solution. We need to meet halfway here, and we need to put more trust into our medical professionals.

I've never seen you say that regulations can be good. You tend to be quite anti that. So it's a nice surprise to see that you think that *some* licensing of physicians is a good thing.

And you've posted (and linked) to things being against patents. So now you're for them. OK good.

"changing the tax structure around R&D". What does that mean? Most drug R&D is totally free to drug companies because it's conducted at nonprofit universities by graduate students and paid for by NIH grants. And most of the R&D done at drug firms is on "me too" drugs to copy what some other drug already does. And I'm pretty sure that's also tax deductible.

I don't know what bearing "make our drug manufacturers more competitive on a global market" has on anything. Drugs owned by US firms are sold everywhere already. It doesn't matter where they are made. Just like it doesn't matter where your socks are made.

This is the problem, you assume that because I think government intervention is on whole bad, that I must therefore oppose EVERYTHING the government does. That's as inane as me assuming that because you support regulations, licencing, and national healthcare that you support everything the government does. Both are bad assumptions, I don't paint you a fool so please do me the same courtesy.

I'm against our patent process leading to excessive drug costs, I'm not against the concept of patent protection. Specifically we should repeal the Research and Development Tax Credit, streamlining the FDA process to become more in line with testing and certifying new drugs similar to other developed countries, and work on reducing drug prices to compete against an increasing market in foreign-development of drugs and patent violations. Art 1 Sec 8 of the Constitution, gives that power explicitly to the government in regards to exclusive property rights of their invention:

"To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries"

[Telecaster]

I've addressed those in other posts. Patents on drugs need to be respected, but we need to reduce the costs associated with developing drugs by changing the tax structure surrounding R&D, streamlining the FDA drug approval process, and make our drug manufacturers more competitive on a global market.

The pharmaceutical sector is one of the most--if not the most---both profitable and consistently profitable industry in the county.  Over the last 20 years, the NYSE Arca Pharmaceutical Index (DRG) has blown the doors off the S&P 500.   

If your goal is to make them even more profitable by lowering taxes, a better plan would be to lower the tax structure around advertising, because American pharmaceutical companies spend far more on advertising than they do on R&D. 

Another part of your plan that I don't understand is that if pharmaceutical companies become more profitable, what would motivate them to share profits with consumers by lowering prices?  Most big pharma companies make their money on patent protected drugs and charge whatever the market will bear.  I don't understand why fiddling with the tax rates would motivate them to change their business model. 

 

[Yaeger]

I've addressed those in other posts. Patents on drugs need to be respected, but we need to reduce the costs associated with developing drugs by changing the tax structure surrounding R&D, streamlining the FDA drug approval process, and make our drug manufacturers more competitive on a global market.

The pharmaceutical sector is one of the most--if not the most---both profitable and consistently profitable industry in the county.  Over the last 20 years, the NYSE Arca Pharmaceutical Index (DRG) has blown the doors off the S&P 500.   

If your goal is to make them even more profitable by lowering taxes, a better plan would be to lower the tax structure around advertising, because American pharmaceutical companies spend far more on advertising than they do on R&D. 

Another part of your plan that I don't understand is that if pharmaceutical companies become more profitable, what would motivate them to share profits with consumers by lowering prices?  Most big pharma companies make their money on patent protected drugs and charge whatever the market will bear.  I don't understand why fiddling with the tax rates would motivate them to change their business model.

I don't want them to become more profitable by granting special incentives, I honestly don't care if they're profitable or not. I DO care if the government has a say as to whether they're profitable by offering special tax breaks and deals behind the curtain. I abhor crony capitalism and think these companies should sink or swim on the merits of their products and serving their customers, period.

I bet most people don't even realize that one of the taxes included in the ACA is a tax on Brand Name drugs that contributed to a 13% rise in the cost of prescription drugs in 2014, the largest increase in a decade. It's things like this, special taxes behind the scenes that a vast majority of Americans aren't aware of, that lend to a general narrative that companies are out to screw you by hiking prices.

[forummm]

It also states that drug patents and medical licensing are problems but ignores a lot of the other questions that I posed to you (and you continue to ignore) about patents on drugs (if we don't have any patents we won't have any new drugs), medical licensing (do you want just anyone to be able to practice medicine without any vetting?), etc.

And, above all, the piece doesn't address the central question I have posed to you at least a half dozen times. The US has the LEAST government involvement in the industrialized nations. If government is the problem, then why is it the MOST expensive?

Really, really wanting something to be true does not make it so.

I could say the same about your stance. Really, really wanting government to be efficient and providing low cost healthcare doesn't make it so. Levying blame for cost increases upon private institutions really shows a disconnect from how competitive private enterprise works and doesn't explain trends in healthcare outside of the obvious crony capitalism.

Au contraire. I'd really love it if the private sector was fantastic and efficient and inexpensive regarding healthcare. We'd save trillions per year. Instead, they suck miserably. I'm very upset about that. The private market, when it works really well, is the easiest way to go. It's a shame that it sucks so badly in this area.

I'd love to see evidence of what you're proposing, that government healthcare involvement has no negative effect on private enterprise. You keep asking me for proof yet provide none to support your points, it's hypocritical. I'm also not sure if you're saying that over the last 50 years the private sector has suddenly become grossly incompetent regarding inefficiencies and price, the things private companies actually CARE about. If anything, government-run facilities like the VA seem to be widely acknowledged exemplars of cost overruns, waste, and inefficiency, not private companies. As someone that routinely uses government healthcare, I can attest to the gross inefficiencies of it compared to the private sector.

Convince me.

When did I say the bold? Government has positive and negative effects on the private sector, just like the private sector has positive and negative effects on government sector activities. The point is that the US private sector sucks at providing a great and low cost healthcare system. And partly because we're doing some totally convoluted patchwork of public and private and uninsured, the system has lots of inefficiencies. We should have a single payer system. Or some other similar system to one of the other countries that has better outcomes and lower costs.

I feel like you're a waste of my time. You don't answer direct questions. You put words in my mouth. You don't consider other points of view. You aren't here to have a useful discussion where facts and ideas are shared and the merits are debated using data. You have an ideology (government=bad) and you are blind to anything else. Life is not black and white.

I've addressed those in other posts. Patents on drugs need to be respected, but we need to reduce the costs associated with developing drugs by changing the tax structure surrounding R&D, streamlining the FDA drug approval process, and make our drug manufacturers more competitive on a global market. Repeal Medicare Part D and push the costs onto the customers, the people making the decision to purchase the drug.

Licencing needs to be relaxed, from physicians all the way down to nursing aids, insurers, IT professionals, hospitals, etc. Licencing creep is partly responsible for the restriction of supply of medical professionals and contributes to the healthcare higher cost. It'll make it more feasible for private clinics to operate and help revitalize private practices by making it easier for these physicians to operate, hire and train staff, and reduce overhead.

I'm not sure why you say things like "do you want just anyone to be able to practice medicine without any vetting?", as if people like me want to eliminate ALL standards from the gamut of controls within the healthcare industry. Yes, draconian incremental licencing creep IS a problem, NO eliminating all standards is not an acceptable solution. We need to meet halfway here, and we need to put more trust into our medical professionals.

I've never seen you say that regulations can be good. You tend to be quite anti that. So it's a nice surprise to see that you think that *some* licensing of physicians is a good thing.

And you've posted (and linked) to things being against patents. So now you're for them. OK good.

"changing the tax structure around R&D". What does that mean? Most drug R&D is totally free to drug companies because it's conducted at nonprofit universities by graduate students and paid for by NIH grants. And most of the R&D done at drug firms is on "me too" drugs to copy what some other drug already does. And I'm pretty sure that's also tax deductible.

I don't know what bearing "make our drug manufacturers more competitive on a global market" has on anything. Drugs owned by US firms are sold everywhere already. It doesn't matter where they are made. Just like it doesn't matter where your socks are made.

This is the problem, you assume that because I think government intervention is on whole bad, that I must therefore oppose EVERYTHING the government does. That's as inane as me assuming that because you support regulations, licencing, and national healthcare that you support everything the government does. Both are bad assumptions, I don't paint you a fool so please do me the same courtesy.

I'm against our patent process leading to excessive drug costs, I'm not against the concept of patent protection. Specifically we should repeal the Research and Development Tax Credit, streamlining the FDA process to become more in line with testing and certifying new drugs similar to other developed countries, and work on reducing drug prices to compete against an increasing market in foreign-development of drugs and patent violations. Art 1 Sec 8 of the Constitution, gives that power explicitly to the government in regards to exclusive property rights of their invention:

"To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries"

You had an entire thread about how all regulations were hurting economic growth. And never once admitted that some regulations help growth or increase prosperity. That comes pretty close to being against everything government does.

The patent process has nothing to do with R&D and taxes. Patents allow drug prices to be higher because of no competition. That's the entire point. How are you for patents but against the higher prices they bring?

[Yaeger]

This is the problem, you assume that because I think government intervention is on whole bad, that I must therefore oppose EVERYTHING the government does. That's as inane as me assuming that because you support regulations, licencing, and national healthcare that you support everything the government does. Both are bad assumptions, I don't paint you a fool so please do me the same courtesy.

I'm against our patent process leading to excessive drug costs, I'm not against the concept of patent protection. Specifically we should repeal the Research and Development Tax Credit, streamlining the FDA process to become more in line with testing and certifying new drugs similar to other developed countries, and work on reducing drug prices to compete against an increasing market in foreign-development of drugs and patent violations. Art 1 Sec 8 of the Constitution, gives that power explicitly to the government in regards to exclusive property rights of their invention:

"To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries"

You had an entire thread about how all regulations were hurting economic growth. And never once admitted that some regulations help growth or increase prosperity. That comes pretty close to being against everything government does.

The patent process has nothing to do with R&D and taxes. Patents allow drug prices to be higher because of no competition. That's the entire point. How are you for patents but against the higher prices they bring?

It does. It does. It does. The market drug price is a reflection of the costs required to bring that drug to market. In order for the company to recoup the costs, it needs patent protection to enforce a legal monopoly so the relatively higher price can recoup those costs before competitors move into the market with off-brand goods. You safely lower the costs required to bring it to market and you lower the price you charge to consumers by shortening the patent time. The US enables patents to last around an average of 12 years, far longer than other industrialized countries. It also takes more than 2.5 times the amount today, compared to 2003, to bring a drug to market)

You tend to get more of what you subsidize, in this case the relationship between R&D and taxes ideally would encourage more R&D, but it would also incentivize less optimal R&D efficiency and encourage the maximization of R&D expenses as a tax shelter, but still a valid cost to recoup during the patent period. I think too many people get wrapped around the intent of policies and not actual effects.

My regulation thread started out saying that the economic impact of federal regulation is much more than we thought it was. It's much more than the sum total. You could say that *some* regulations help by addressing externalities or protecting consumer confidence like, Sarbanes Oxley or Frank Dodd (I'd disagree but there ARE some I support), but it'd be a stretch to say that the overall effect lends itself to positive economic growth. We don't talk about economic growth in our Presidential debates, because it's not as important as sacrificing to correct other things in our society (education, racism, social security, medicare). I think the consensus is that economic growth can go screw itself as long as people get things they want, and regulations tend to reflect those priorities.

I understand that we have different opinions as to the legitimate role of government in the US, and the effects of government intervention, but thank you for staying civil.

[EnjoyIt]

Forummm,
Let me adress a few of your items.

1)  Just because private industry copies billing practices of CMS does not make it a benefit to everyone.  It benefits only the insurance companies.  Every couple of years more regulatory burdens are created by CMS for billing requiring increased man/woman hours to accomplish.  This is waste of resources.  It temporarily decreases how much collections a practice brings in because there is a learning curve involved.  It is kinda like playing a game where the rules change on you every few years. 

Today I spend less time with my patients than I did 5 years ago.  This is not a benefit to the patients. 
Today we have more non medical personal costing the practice money which increases the price to the end consumer.
These are inefficiencies of the CMS billing structure.
I suspect in 5 years it will get even worse.

2)  The exact same medicine cost much more in the US as compared to every other country.  Why? I believe it is due to a lack of transparency in cost.  Most people in the US pay an insurance company to pay for their medication.  Did you know that CVS and Walgreens charge as much as 10x the cost of the same medication as compared to a grocery pharmacy?  It is ridiculous.  Pharmaceutical companies will charge whatever the market will bare.  You are completely correct and since the market is a hidden convoluted system the market seams to bear insane markups on drugs.  Also, drug companies do spend much more on FDA approval as compared to foreign country medication approval.  That does increase cost as well in the US.

3)  I never mentioned anything about not having health insurance.  I think people need health insurance, but it needs to be insurance and not a day to day spending account for all health related things.  I should not be able to by $3 tylenol and a $5 blood pressure medication with insurance. It is asinine.

4)  I fear the single payer model.  I fear it for two reasons.  I look at 100% run government healthcare in this country for our vets.  The VA bureaucratic red tape is mind boggling.  The computer system is convoluted, the medical charts are just cutting and pasting of older charts and a ridiculous mess.  No one gives a shit and moves at 1/2 speed, and they don't care about costs.  They will use the most expensive medications and treatments because cost doesn't matter to the providers or the consumers.  This is not what I want for our healthcare.  I told you, I would quit before having to work in a VA hospital. 
I will also admit that my second fear is a drastic decrease in compensation.  Although someone like me who lives well below my means can handle a 20% pay cut, most physicians would go bankrupt in the process or worse, try to see more patients in less time, burning out and making mistakes.  In fact, over the last decade I have witnessed the slow decrease in pay in some specialties and have watched physicians crumble in the process.  They start to work more to be able to pay their bills, burnout, become rude to everyone around them, and eventually start making mistakes. Suicide is very common for physicians. 

1) If we go to a one payer system and it is government run, how do we prevent runaway costs and bureaucratic red tape we see in the VA?
2) How do we keep our doctors from burning out in the process?
3) Currently I spend more than 70-80% of my day in from of a computer.  I actually timed this. CMS regulations has created this, how do you give my time back to the patients where it belongs?
4) Why should health insurance cover simple cheap medications?  Most people can buy their medications for $4-$10 a month. Why should insurance cover a simple $50-$100 office visit to a doctor once or twice a year?  And don't tell me some people can't afford $20/month for they medications.  I have patients tell me that all the time, yet smoke cigarettes and are texting away on their iPhone or galaxy.  When do we make people accountable for their actions and choices, or do you expect the government to take care of everything no matter the cost?

Now that I have addressed your topics, can you please respond to the above and address mine.

[forummm]

This is the problem, you assume that because I think government intervention is on whole bad, that I must therefore oppose EVERYTHING the government does. That's as inane as me assuming that because you support regulations, licencing, and national healthcare that you support everything the government does. Both are bad assumptions, I don't paint you a fool so please do me the same courtesy.

I'm against our patent process leading to excessive drug costs, I'm not against the concept of patent protection. Specifically we should repeal the Research and Development Tax Credit, streamlining the FDA process to become more in line with testing and certifying new drugs similar to other developed countries, and work on reducing drug prices to compete against an increasing market in foreign-development of drugs and patent violations. Art 1 Sec 8 of the Constitution, gives that power explicitly to the government in regards to exclusive property rights of their invention:

"To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries"

You had an entire thread about how all regulations were hurting economic growth. And never once admitted that some regulations help growth or increase prosperity. That comes pretty close to being against everything government does.

The patent process has nothing to do with R&D and taxes. Patents allow drug prices to be higher because of no competition. That's the entire point. How are you for patents but against the higher prices they bring?

It does. It does. It does. The market drug price is a reflection of the costs required to bring that drug to market. In order for the company to recoup the costs, it needs patent protection to enforce a legal monopoly so the relatively higher price can recoup those costs before competitors move into the market with off-brand goods. You safely lower the costs required to bring it to market and you lower the price you charge to consumers by shortening the patent time. The US enables patents to last around an average of 12 years, far longer than other industrialized countries. It also takes more than 2.5 times the amount today, compared to 2003, to bring a drug to market)

You tend to get more of what you subsidize, in this case the relationship between R&D and taxes ideally would encourage more R&D, but it would also incentivize less optimal R&D efficiency and encourage the maximization of R&D expenses as a tax shelter, but still a valid cost to recoup during the patent period. I think too many people get wrapped around the intent of policies and not actual effects.

My regulation thread started out saying that the economic impact of federal regulation is much more than we thought it was. It's much more than the sum total. You could say that *some* regulations help by addressing externalities or protecting consumer confidence like, Sarbanes Oxley or Frank Dodd (I'd disagree but there ARE some I support), but it'd be a stretch to say that the overall effect lends itself to positive economic growth. We don't talk about economic growth in our Presidential debates, because it's not as important as sacrificing to correct other things in our society (education, racism, social security, medicare). I think the consensus is that economic growth can go screw itself as long as people get things they want, and regulations tend to reflect those priorities.

I understand that we have different opinions as to the legitimate role of government in the US, and the effects of government intervention, but thank you for staying civil.

Your arguments don't follow from each other. You mention the "patent process" being why things are expensive. But R&D has nothing to do with the "patent process". Nothing.

And R&D costs are mostly paid for by NIH--not the drug companies. The R&D that drug companies do is frequently for copycat drugs (duplicating existing drugs).

The big items a costly drug pays for are 1) advertising [more than R&D], 2) profit [usually top 3 most profitable industries], 3) compensation for executives, 4) compensation for drug reps that visit dr offices frequently to push the drugs and hand out perks to drs, and 5) clinical trials to get the drug through the FDA.

I think you might benefit from reading more on the subject. I haven't read this book but I've heard interviews with the author. I think you'll find it enlightening.
https://www.amazon.com/Truth-About-Drug-Companies-Deceive/dp/0375760946

[forummm]

Forummm,
Let me adress a few of your items.

1)  Just because private industry copies billing practices of CMS does not make it a benefit to everyone.  It benefits only the insurance companies.  Every couple of years more regulatory burdens are created by CMS for billing requiring increased man/woman hours to accomplish.  This is waste of resources.  It temporarily decreases how much collections a practice brings in because there is a learning curve involved.  It is kinda like playing a game where the rules change on you every few years. 

Today I spend less time with my patients than I did 5 years ago.  This is not a benefit to the patients. 
Today we have more non medical personal costing the practice money which increases the price to the end consumer.
These are inefficiencies of the CMS billing structure.
I suspect in 5 years it will get even worse.

2)  The exact same medicine cost much more in the US as compared to every other country.  Why? I believe it is due to a lack of transparency in cost.  Most people in the US pay an insurance company to pay for their medication.  Did you know that CVS and Walgreens charge as much as 10x the cost of the same medication as compared to a grocery pharmacy?  It is ridiculous.  Pharmaceutical companies will charge whatever the market will bare.  You are completely correct and since the market is a hidden convoluted system the market seams to bear insane markups on drugs.  Also, drug companies do spend much more on FDA approval as compared to foreign country medication approval.  That does increase cost as well in the US.

3)  I never mentioned anything about not having health insurance.  I think people need health insurance, but it needs to be insurance and not a day to day spending account for all health related things.  I should not be able to by $3 tylenol and a $5 blood pressure medication with insurance. It is asinine.

4)  I fear the single payer model.  I fear it for two reasons.  I look at 100% run government healthcare in this country for our vets.  The VA bureaucratic red tape is mind boggling.  The computer system is convoluted, the medical charts are just cutting and pasting of older charts and a ridiculous mess.  No one gives a shit and moves at 1/2 speed, and they don't care about costs.  They will use the most expensive medications and treatments because cost doesn't matter to the providers or the consumers.  This is not what I want for our healthcare.  I told you, I would quit before having to work in a VA hospital. 
I will also admit that my second fear is a drastic decrease in compensation.  Although someone like me who lives well below my means can handle a 20% pay cut, most physicians would go bankrupt in the process or worse, try to see more patients in less time, burning out and making mistakes.  In fact, over the last decade I have witnessed the slow decrease in pay in some specialties and have watched physicians crumble in the process.  They start to work more to be able to pay their bills, burnout, become rude to everyone around them, and eventually start making mistakes. Suicide is very common for physicians. 

1) If we go to a one payer system and it is government run, how do we prevent runaway costs and bureaucratic red tape we see in the VA?
2) How do we keep our doctors from burning out in the process?
3) Currently I spend more than 70-80% of my day in from of a computer.  I actually timed this. CMS regulations has created this, how do you give my time back to the patients where it belongs?
4) Why should health insurance cover simple cheap medications?  Most people can buy their medications for $4-$10 a month. Why should insurance cover a simple $50-$100 office visit to a doctor once or twice a year?  And don't tell me some people can't afford $20/month for they medications.  I have patients tell me that all the time, yet smoke cigarettes and are texting away on their iPhone or galaxy.  When do we make people accountable for their actions and choices, or do you expect the government to take care of everything no matter the cost?

Now that I have addressed your topics, can you please respond to the above and address mine.

I don't have time to get too in depth. But I would say briefly:
1) The VA is such a different system that you really can't compare it to a health system. In the VA, it's episodic care. People frequently have other insurance and choose to go to the VA for some things. It's also given a flat appropriation regardless of how many people want service there. A better model would be one of the many examples of national healthcare systems in other nations.
2) Doctors in other countries seem to like their jobs. And still make a solid upper middle class income. Moving away from FFS and towards capitation--letting them practice actual medicine--seems to be more fulfilling. Doesn't that jibe with you?
3) I think that if you are paid to keep people healthy, a lot of the documentation requirements will no longer be needed. There won't be concern that you're billing for something without justification--because there won't be billing. EHRs will still be part of medicine going forward. But better interfaces are needed. These interfaces are developed by private firms. It's an area where the private sector has done a bad job.
4) I don't know many insurance plans that cover $4 medications (other than prevention drugs like contraception or BP control) or pay for Tylenol. I don't think that's common. And I totally agree that people make bad financial choices. They don't value their blood pressure meds because it doesn't immediately lead to major pain or a heart attack. People are terrible at evaluating things when the potential consequences are uncertain and seem far in the future. Whereas they get a lot of immediate perceived benefit from the cigarettes and the fancy phone. It's a problem that probably relies more on education and care coordination than anything else.

[EnjoyIt]

Forummm,
Let me adress a few of your items.

1)  Just because private industry copies billing practices of CMS does not make it a benefit to everyone.  It benefits only the insurance companies.  Every couple of years more regulatory burdens are created by CMS for billing requiring increased man/woman hours to accomplish.  This is waste of resources.  It temporarily decreases how much collections a practice brings in because there is a learning curve involved.  It is kinda like playing a game where the rules change on you every few years. 

Today I spend less time with my patients than I did 5 years ago.  This is not a benefit to the patients. 
Today we have more non medical personal costing the practice money which increases the price to the end consumer.
These are inefficiencies of the CMS billing structure.
I suspect in 5 years it will get even worse.

2)  The exact same medicine cost much more in the US as compared to every other country.  Why? I believe it is due to a lack of transparency in cost.  Most people in the US pay an insurance company to pay for their medication.  Did you know that CVS and Walgreens charge as much as 10x the cost of the same medication as compared to a grocery pharmacy?  It is ridiculous.  Pharmaceutical companies will charge whatever the market will bare.  You are completely correct and since the market is a hidden convoluted system the market seams to bear insane markups on drugs.  Also, drug companies do spend much more on FDA approval as compared to foreign country medication approval.  That does increase cost as well in the US.

3)  I never mentioned anything about not having health insurance.  I think people need health insurance, but it needs to be insurance and not a day to day spending account for all health related things.  I should not be able to by $3 tylenol and a $5 blood pressure medication with insurance. It is asinine.

4)  I fear the single payer model.  I fear it for two reasons.  I look at 100% run government healthcare in this country for our vets.  The VA bureaucratic red tape is mind boggling.  The computer system is convoluted, the medical charts are just cutting and pasting of older charts and a ridiculous mess.  No one gives a shit and moves at 1/2 speed, and they don't care about costs.  They will use the most expensive medications and treatments because cost doesn't matter to the providers or the consumers.  This is not what I want for our healthcare.  I told you, I would quit before having to work in a VA hospital. 
I will also admit that my second fear is a drastic decrease in compensation.  Although someone like me who lives well below my means can handle a 20% pay cut, most physicians would go bankrupt in the process or worse, try to see more patients in less time, burning out and making mistakes.  In fact, over the last decade I have witnessed the slow decrease in pay in some specialties and have watched physicians crumble in the process.  They start to work more to be able to pay their bills, burnout, become rude to everyone around them, and eventually start making mistakes. Suicide is very common for physicians. 

1) If we go to a one payer system and it is government run, how do we prevent runaway costs and bureaucratic red tape we see in the VA?
2) How do we keep our doctors from burning out in the process?
3) Currently I spend more than 70-80% of my day in from of a computer.  I actually timed this. CMS regulations has created this, how do you give my time back to the patients where it belongs?
4) Why should health insurance cover simple cheap medications?  Most people can buy their medications for $4-$10 a month. Why should insurance cover a simple $50-$100 office visit to a doctor once or twice a year?  And don't tell me some people can't afford $20/month for they medications.  I have patients tell me that all the time, yet smoke cigarettes and are texting away on their iPhone or galaxy.  When do we make people accountable for their actions and choices, or do you expect the government to take care of everything no matter the cost?

Now that I have addressed your topics, can you please respond to the above and address mine.

I don't have time to get too in depth. But I would say briefly:
1) The VA is such a different system that you really can't compare it to a health system. In the VA, it's episodic care. People frequently have other insurance and choose to go to the VA for some things. It's also given a flat appropriation regardless of how many people want service there. A better model would be one of the many examples of national healthcare systems in other nations.
2) Doctors in other countries seem to like their jobs. And still make a solid upper middle class income. Moving away from FFS and towards capitation--letting them practice actual medicine--seems to be more fulfilling. Doesn't that jibe with you?
3) I think that if you are paid to keep people healthy, a lot of the documentation requirements will no longer be needed. There won't be concern that you're billing for something without justification--because there won't be billing. EHRs will still be part of medicine going forward. But better interfaces are needed. These interfaces are developed by private firms. It's an area where the private sector has done a bad job.
4) I don't know many insurance plans that cover $4 medications (other than prevention drugs like contraception or BP control) or pay for Tylenol. I don't think that's common. And I totally agree that people make bad financial choices. They don't value their blood pressure meds because it doesn't immediately lead to major pain or a heart attack. People are terrible at evaluating things when the potential consequences are uncertain and seem far in the future. Whereas they get a lot of immediate perceived benefit from the cigarettes and the fancy phone. It's a problem that probably relies more on education and care coordination than anything else.

[forummm]

This is the problem, you assume that because I think government intervention is on whole bad, that I must therefore oppose EVERYTHING the government does. That's as inane as me assuming that because you support regulations, licencing, and national healthcare that you support everything the government does. Both are bad assumptions, I don't paint you a fool so please do me the same courtesy.

I'm against our patent process leading to excessive drug costs, I'm not against the concept of patent protection. Specifically we should repeal the Research and Development Tax Credit, streamlining the FDA process to become more in line with testing and certifying new drugs similar to other developed countries, and work on reducing drug prices to compete against an increasing market in foreign-development of drugs and patent violations. Art 1 Sec 8 of the Constitution, gives that power explicitly to the government in regards to exclusive property rights of their invention:

"To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries"

You had an entire thread about how all regulations were hurting economic growth. And never once admitted that some regulations help growth or increase prosperity. That comes pretty close to being against everything government does.

The patent process has nothing to do with R&D and taxes. Patents allow drug prices to be higher because of no competition. That's the entire point. How are you for patents but against the higher prices they bring?

It does. It does. It does. The market drug price is a reflection of the costs required to bring that drug to market. In order for the company to recoup the costs, it needs patent protection to enforce a legal monopoly so the relatively higher price can recoup those costs before competitors move into the market with off-brand goods. You safely lower the costs required to bring it to market and you lower the price you charge to consumers by shortening the patent time. The US enables patents to last around an average of 12 years, far longer than other industrialized countries. It also takes more than 2.5 times the amount today, compared to 2003, to bring a drug to market)

You tend to get more of what you subsidize, in this case the relationship between R&D and taxes ideally would encourage more R&D, but it would also incentivize less optimal R&D efficiency and encourage the maximization of R&D expenses as a tax shelter, but still a valid cost to recoup during the patent period. I think too many people get wrapped around the intent of policies and not actual effects.

My regulation thread started out saying that the economic impact of federal regulation is much more than we thought it was. It's much more than the sum total. You could say that *some* regulations help by addressing externalities or protecting consumer confidence like, Sarbanes Oxley or Frank Dodd (I'd disagree but there ARE some I support), but it'd be a stretch to say that the overall effect lends itself to positive economic growth. We don't talk about economic growth in our Presidential debates, because it's not as important as sacrificing to correct other things in our society (education, racism, social security, medicare). I think the consensus is that economic growth can go screw itself as long as people get things they want, and regulations tend to reflect those priorities.

I understand that we have different opinions as to the legitimate role of government in the US, and the effects of government intervention, but thank you for staying civil.

Your arguments don't follow from each other. You mention the "patent process" being why things are expensive. But R&D has nothing to do with the "patent process". Nothing.

And R&D costs are mostly paid for by NIH--not the drug companies. The R&D that drug companies do is frequently for copycat drugs (duplicating existing drugs).

The big items a costly drug pays for are 1) advertising [more than R&D], 2) profit [usually top 3 most profitable industries], 3) compensation for executives, 4) compensation for drug reps that visit dr offices frequently to push the drugs and hand out perks to drs, and 5) clinical trials to get the drug through the FDA.

I think you might benefit from reading more on the subject. I haven't read this book but I've heard interviews with the author. I think you'll find it enlightening.
https://www.amazon.com/Truth-About-Drug-Companies-Deceive/dp/0375760946

Just to be clear, the "patent process" is having your lawyers talk to your scientists about what's novel about the drug, figuring out what IP should be protected, filing some forms with USPTO, etc.

The "drug development process" is another thing entirely.

[monstermonster]

This is the problem, you assume that because I think government intervention is on whole bad, that I must therefore oppose EVERYTHING the government does. That's as inane as me assuming that because you support regulations, licencing, and national healthcare that you support everything the government does. Both are bad assumptions, I don't paint you a fool so please do me the same courtesy.

I'm against our patent process leading to excessive drug costs, I'm not against the concept of patent protection. Specifically we should repeal the Research and Development Tax Credit, streamlining the FDA process to become more in line with testing and certifying new drugs similar to other developed countries, and work on reducing drug prices to compete against an increasing market in foreign-development of drugs and patent violations. Art 1 Sec 8 of the Constitution, gives that power explicitly to the government in regards to exclusive property rights of their invention:

"To promote the progress of science and useful arts, by securing for limited times to authors and inventors the exclusive right to their respective writings and discoveries"

You had an entire thread about how all regulations were hurting economic growth. And never once admitted that some regulations help growth or increase prosperity. That comes pretty close to being against everything government does.

The patent process has nothing to do with R&D and taxes. Patents allow drug prices to be higher because of no competition. That's the entire point. How are you for patents but against the higher prices they bring?

It does. It does. It does. The market drug price is a reflection of the costs required to bring that drug to market. In order for the company to recoup the costs, it needs patent protection to enforce a legal monopoly so the relatively higher price can recoup those costs before competitors move into the market with off-brand goods. You safely lower the costs required to bring it to market and you lower the price you charge to consumers by shortening the patent time. The US enables patents to last around an average of 12 years, far longer than other industrialized countries. It also takes more than 2.5 times the amount today, compared to 2003, to bring a drug to market)

You tend to get more of what you subsidize, in this case the relationship between R&D and taxes ideally would encourage more R&D, but it would also incentivize less optimal R&D efficiency and encourage the maximization of R&D expenses as a tax shelter, but still a valid cost to recoup during the patent period. I think too many people get wrapped around the intent of policies and not actual effects.

My regulation thread started out saying that the economic impact of federal regulation is much more than we thought it was. It's much more than the sum total. You could say that *some* regulations help by addressing externalities or protecting consumer confidence like, Sarbanes Oxley or Frank Dodd (I'd disagree but there ARE some I support), but it'd be a stretch to say that the overall effect lends itself to positive economic growth. We don't talk about economic growth in our Presidential debates, because it's not as important as sacrificing to correct other things in our society (education, racism, social security, medicare). I think the consensus is that economic growth can go screw itself as long as people get things they want, and regulations tend to reflect those priorities.

I understand that we have different opinions as to the legitimate role of government in the US, and the effects of government intervention, but thank you for staying civil.

Your arguments don't follow from each other. You mention the "patent process" being why things are expensive. But R&D has nothing to do with the "patent process". Nothing.

And R&D costs are mostly paid for by NIH--not the drug companies. The R&D that drug companies do is frequently for copycat drugs (duplicating existing drugs).

The big items a costly drug pays for are 1) advertising [more than R&D], 2) profit [usually top 3 most profitable industries], 3) compensation for executives, 4) compensation for drug reps that visit dr offices frequently to push the drugs and hand out perks to drs, and 5) clinical trials to get the drug through the FDA.

I think you might benefit from reading more on the subject. I haven't read this book but I've heard interviews with the author. I think you'll find it enlightening.
https://www.amazon.com/Truth-About-Drug-Companies-Deceive/dp/0375760946

Just to be clear, the "patent process" is having your lawyers talk to your scientists about what's novel about the drug, figuring out what IP should be protected, filing some forms with USPTO, etc.

The "drug development process" is another thing entirely.

Most R&D in the pipeline these days is for biologicals (which is much more costly than chemical compounds), which haven't yet had a patent run out in the US and only one interchangable biosimilar (the equivalent of a generic) has been approved in the US. The ACA actually is what made is possible for biosimilars to be approved in the US (they have been able to do so since 2006 in Europe, 2010 in US since the ACA). The R&D cost for biosimilars is currently about as expensive as the original development process, and thus the generics on the market are only about 15% cheaper right now than the commercial drugs, which are a huge part of the large health care prescription cost increase in the US.

[Daleth]

You safely lower the costs required to bring it to market and you lower the price you charge to consumers by shortening the patent time. The US enables patents to last around an average of 12 years, far longer than other industrialized countries.

That is totally incorrect. The US, like other industrialized countries, grants patents for 20 years. To check how long a given country's patents last, Google "(country name) patent duration" (no parentheses or quotes). Try the EU... France... The U.K.... etc. We are all at 20 years.

But I know first hand that medication, including patented medication, costs on the order of 5 times less in France than in the US, even though we both have 20-year patent terms.

That means it's not the duration of patents that is causing high drug prices in the US.

[jim555]

For those libertarians in the thread, aren't patents against libertarian theory??

[Spork]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

[jim555]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property? 

[Daleth]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

Congress's constitutional mandate is to balance the incentive for artists and inventors to create, on the one hand, and the public good on the other. They protect the incentives by establishing IP rights, and they protect the public good by limiting the duration of IP rights.

Spork, US patent laws are not implemented the way you think.

[jim555]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

Congress's constitutional mandate is to balance the incentive for artists and inventors to create, on the one hand, and the public good on the other. They protect the incentives by establishing IP rights, and they protect the public good by limiting the duration of IP rights.

Spork, US patent laws are not implemented the way you think.

My discussion was not relating to current laws but on political theory of property in libertarianism.  An exclusive monopoly grant by a State for a limited duration has no basis in property theory.  The concept of "protecting incentives" should have no say when it comes to what property is or is not. 

[Schaefer Light]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

I think so.

[MoonShadow]

For those libertarians in the thread, aren't patents against libertarian theory??

Yes.  Intellectual property isn't property, and copying isn't theft.  Patents, copyrights & licensing are just a legal model of a time limited government sponsored monopolies.  That said, it is one that is deliberately included in the US Constitution, with the counter-balancing Library of Congress and associated "fair use" rules.

That said, the ideological problems with IP are so low on the list of problems that most just ignore them.

https://www.youtube.com/watch?v=IeTybKL1pM4

[MoonShadow]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

I think so.

Hell no.

[Schaefer Light]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

I think so.

Hell no.

Should Apple have to give away the design plans for the iPhone?

[Spork]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

Congress's constitutional mandate is to balance the incentive for artists and inventors to create, on the one hand, and the public good on the other. They protect the incentives by establishing IP rights, and they protect the public good by limiting the duration of IP rights.

Spork, US patent laws are not implemented the way you think.

No?
https://en.wikipedia.org/wiki/1-Click
https://www.google.com/patents/US6727830
http://www.zdnet.com/article/microsoft-patents-page-up-and-page-down-5000218626/
(There are tens of thousands of stupid patents.  It's not hard to find them.)

Dumb patents also create dumb patent troll lawsuits.  It's a vicious cycle.

[beltim]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

Congress's constitutional mandate is to balance the incentive for artists and inventors to create, on the one hand, and the public good on the other. They protect the incentives by establishing IP rights, and they protect the public good by limiting the duration of IP rights.

Spork, US patent laws are not implemented the way you think.

No?
https://en.wikipedia.org/wiki/1-Click
https://www.google.com/patents/US6727830
http://www.zdnet.com/article/microsoft-patents-page-up-and-page-down-5000218626/
(There are tens of thousands of stupid patents.  It's not hard to find them.)

Dumb patents also create dumb patent troll lawsuits.  It's a vicious cycle.

I think Daleth was talking about the bolded part.  Looking at it again, I wonder if you meant: "A patent is the legal realization that an original idea can be property" or alternatively that "an inventor can hold property rights for an invention."  Those are accurate statements of our patent system, whereas your is not.

[Spork]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

Congress's constitutional mandate is to balance the incentive for artists and inventors to create, on the one hand, and the public good on the other. They protect the incentives by establishing IP rights, and they protect the public good by limiting the duration of IP rights.

Spork, US patent laws are not implemented the way you think.

No?
https://en.wikipedia.org/wiki/1-Click
https://www.google.com/patents/US6727830
http://www.zdnet.com/article/microsoft-patents-page-up-and-page-down-5000218626/
(There are tens of thousands of stupid patents.  It's not hard to find them.)

Dumb patents also create dumb patent troll lawsuits.  It's a vicious cycle.

I think Daleth was talking about the bolded part.  Looking at it again, I wonder if you meant: "A patent is the legal realization that an original idea can be property" or alternatively that "an inventor can hold property rights for an invention."  Those are accurate statements of our patent system, whereas your is not.

ah, yes, totally.  I in no way meant to use I can has cheeseburger speak.

[Daleth]

If ideas can be a property right then shouldn't it be perpetual like other property?

I think so.

So screw the public good?

And apart from the public good (i.e., letting the public eventually have free use of your ideas after you and your heirs have made money off them), there are major logistical problems with making it perpetual. Say you write a hit song. You die, and the copyright on that song exists for another 70 years ("life plus 70 years" is how long copyright lasts). For those 70 years, your heirs--and then their heirs--will be getting royalties, assuming the song is still selling at all.

Even 40, 50, 60+ years from now it can be a bit difficult for people to figure out who they are supposed to pay when they want to record that song, use it in a movie/TV show, etc. How hard would it be 200 years from now? By that point you may well have 150 different descendants in any number of states and foreign countries. Who gets paid? How?

[forummm]

For those libertarians in the thread, aren't patents against libertarian theory??

I don't personally think so.  A patent is the legal realization that an original idea can has property rights.

Now: I think the US implementation of patent law is dumb as a rock.  There seems to be very little common sense applied.  I think they should be more difficult to get.  Patentable ideas need to be truly original, not stupid things like "a button press" or "one click checkout".

If ideas can be a property right then shouldn't it be perpetual like other property?

Congress's constitutional mandate is to balance the incentive for artists and inventors to create, on the one hand, and the public good on the other. They protect the incentives by establishing IP rights, and they protect the public good by limiting the duration of IP rights.

Spork, US patent laws are not implemented the way you think.

No?
https://en.wikipedia.org/wiki/1-Click
https://www.google.com/patents/US6727830
http://www.zdnet.com/article/microsoft-patents-page-up-and-page-down-5000218626/
(There are tens of thousands of stupid patents.  It's not hard to find them.)

Dumb patents also create dumb patent troll lawsuits.  It's a vicious cycle.

Agree that there are a lot of stupid patents--mostly for software. But that's not really related to drug patents. Those are pretty different and substantial contributions to the field.

[Jrr85]

Au contraire. I'd really love it if the private sector was fantastic and efficient and inexpensive regarding healthcare. We'd save trillions per year. Instead, they suck miserably. I'm very upset about that. The private market, when it works really well, is the easiest way to go. It's a shame that it sucks so badly in this area.

The private sector is pretty fantastic and inexpensive with respect to health care where it is allowed to operate, which is basically only cosmetic plastic surgery.  Even with the draconian restrictions on supply of MD's we have in the U.S. and the impact of Baumol's cost disease, the inflation of cosmetic plastic surgery procedures has been reasonably mild. 

[Jrr85]

Europe is not a single country, nor do they have a single way of managing health care. In fact, Switzerland's system sounds very similar to Obamacare: everyone must buy insurance meeting government standards from a private company, the insurance has annual deductibles with coinsurance after that up to an out-of-pocket maximum, and there are income-based subsidies to keep the premiums at a set percentage of a person's income.

Switzerland's is also the 2nd most expensive system in the world (behind US). Private insurance is not the best way to go. Other countries do private insurance better than we do. But it's still inefficient and expensive.

You can't just compare expenses and think you are doing a meaningful analysis.  Most fairly rich countries that spend less than the U.S. per capita on healthcare use a pretty simple trick to do it, and a trick that most voting americans would not be ok with.  They just stop spending more money on healthcare.  Once you've more or less nationalized healthcare, it's a lot easier to ration by just not approving procedures or just having a significant wait times.  This may also help on costs by avoiding market segmentation with respect to facilities.  You don't have fancy, high end hospitals and surgery centers set up more like hotels to go along with hospitals (or even just separate wings within a hospital) that provide more basic, bare bones care.  The facilities tend to be much more uniform across the board, and up to standards that would generally be deemed unacceptable by a lot of U.S. healthcare consumers, even if they functionally were just as good.  These countries can also just stop paying healthcare professionals as much as they are primarily the only game in town (although realistically the U.S. could more or less do this through Medicare and Medicaid, except doctors and nurses are too politically powerful).  And if that ends up with a shortage, well that just helps by naturally rationing healthcare services.  To their credit, most countries at least accompany lower doctor pay with a much shorter track to be a doctor than in the U.S.  And of course you could just start refusing to pay for drugs above a certain price.  This is another thing that the U.S. could more or less accomplish through Medicare and Medicaid, except that it's not politically feasible, and we actually provide a fairly massive subsidy to the rest of the world by not only not doing this, but also prohibiting purchasing drugs overseas at lower prices and importing them into the U.S., which allows drug companies to reap proportionally more profits from the U.S. market while allowing other countries to get prices much closer to the marginal price of producing the drugs. 

[geekette]

I'm an emergency physician, and at the request of friends and family wrote a post about both when to use the emergency department and the costs involved. Our system stinks, but I hope you find this helpful. Please let me know what I forgot to include. There's a link to a great chart from the UK that shows where to seek care for specific symptoms.
http://www.choosebetterlife.com/navigating-emergency-department-visit/

Helpful blog post. I knew that a long wait was good - my DH ended up with very quick help in the ER once after a reaction to my parent's dog (on Christmas Eve, of course). His fingernail beds were blue, and as soon as they saw him someone hollered "We have an S.O.B. out here!"  Now really, he's a nice man (and yes, I now know it means "short of breath").

I struggled with the ER/no ER decision this weekend myself. I had been to an urgent care place Friday night and again Sunday morning for increasing pain, weakness, and numbness in one leg. Probably some sort of back thing (appointment in 2 weeks <sigh>), but if it hadn't started easing up Sunday afternoon, I was considering the ER.  WORST. PAIN. EVER. Unrelenting ugly cry pain.

It wasn't life threatening, but wouldn't the ER have been able to do more than "here are some steroids and some Norco, see your doctor if it doesn't get better in a week?"  Thank goodness for steroids; I don't think opioids do a darn thing for nerve pain.

[MoonShadow]

The most recent EconTalk podcast with guest Jonathan Skinner went into this topic deep.  It's not even fair for me to summarize it, they went so deep.  And wide, too.  They talked about factors such as the N.I.C.E. committee in England, which is the basis for the "death panels" claim by Sarah Palin; as well a life extending medications that cost an average of $200K or more for an additional 6 months, which wouldn't be approved by most or any government sponsored health care systems around the world to start with.

http://www.econtalk.org/

[wenchsenior]

I'm an emergency physician, and at the request of friends and family wrote a post about both when to use the emergency department and the costs involved. Our system stinks, but I hope you find this helpful. Please let me know what I forgot to include. There's a link to a great chart from the UK that shows where to seek care for specific symptoms.
http://www.choosebetterlife.com/navigating-emergency-department-visit/

Helpful blog post. I knew that a long wait was good - my DH ended up with very quick help in the ER once after a reaction to my parent's dog (on Christmas Eve, of course). His fingernail beds were blue, and as soon as they saw him someone hollered "We have an S.O.B. out here!"  Now really, he's a nice man (and yes, I now know it means "short of breath").

I struggled with the ER/no ER decision this weekend myself. I had been to an urgent care place Friday night and again Sunday morning for increasing pain, weakness, and numbness in one leg. Probably some sort of back thing (appointment in 2 weeks <sigh>), but if it hadn't started easing up Sunday afternoon, I was considering the ER.  WORST. PAIN. EVER. Unrelenting ugly cry pain.

It wasn't life threatening, but wouldn't the ER have been able to do more than "here are some steroids and some Norco, see your doctor if it doesn't get better in a week?"  Thank goodness for steroids; I don't think opioids do a darn thing for nerve pain.

geekette, are you aware of piriformis muscle syndrome? You might have that. I have regular flareups in my right lower back, hip, butt cheek, and right leg. There are a number of contributors, but a spasm in my piriformis is usually the primary one for me...and if I don't self massage (by rolling it on a tennis ball) at least every other day, it can quickly spiral to pain and right leg paralysis (because the sciatic nerve runs over under or through that muscle). If you think this might be an issue and you want info, PM me.

[ender]

You can't just compare expenses and think you are doing a meaningful analysis.  Most fairly rich countries that spend less than the U.S. per capita on healthcare use a pretty simple trick to do it, and a trick that most voting americans would not be ok with.  They just stop spending more money on healthcare.  Once you've more or less nationalized healthcare, it's a lot easier to ration by just not approving procedures or just having a significant wait times.

This certainly sounds plausible, particularly with end of life related expenses (someone linked a picture showing how much more the USA spends on age 67+ care than other countries -- the bulk of the difference between US healthcare spending and other countries).

Is there any research into this sort of analysis? Comparison of average procedure wait times for the USA vs countries in Europe, how hospitals/doctors would respond in various scenarios?

[forummm]

Au contraire. I'd really love it if the private sector was fantastic and efficient and inexpensive regarding healthcare. We'd save trillions per year. Instead, they suck miserably. I'm very upset about that. The private market, when it works really well, is the easiest way to go. It's a shame that it sucks so badly in this area.

The private sector is pretty fantastic and inexpensive with respect to health care where it is allowed to operate, which is basically only cosmetic plastic surgery.  Even with the draconian restrictions on supply of MD's we have in the U.S. and the impact of Baumol's cost disease, the inflation of cosmetic plastic surgery procedures has been reasonably mild.

I don't have any particular insight on cosmetic surgery costs. But I can see how something that's entirely optional would be cheaper. If it were too expensive, people wouldn't get it as much. It's a little different than having an actual health problem and needing to get that taken care of.*

*I'm ignoring the small portion of plastic surgeries that are deemed more medically necessary.

[forummm]

Europe is not a single country, nor do they have a single way of managing health care. In fact, Switzerland's system sounds very similar to Obamacare: everyone must buy insurance meeting government standards from a private company, the insurance has annual deductibles with coinsurance after that up to an out-of-pocket maximum, and there are income-based subsidies to keep the premiums at a set percentage of a person's income.

Switzerland's is also the 2nd most expensive system in the world (behind US). Private insurance is not the best way to go. Other countries do private insurance better than we do. But it's still inefficient and expensive.

You can't just compare expenses and think you are doing a meaningful analysis.  Most fairly rich countries that spend less than the U.S. per capita on healthcare use a pretty simple trick to do it, and a trick that most voting americans would not be ok with.  They just stop spending more money on healthcare.  Once you've more or less nationalized healthcare, it's a lot easier to ration by just not approving procedures or just having a significant wait times.  This may also help on costs by avoiding market segmentation with respect to facilities.  You don't have fancy, high end hospitals and surgery centers set up more like hotels to go along with hospitals (or even just separate wings within a hospital) that provide more basic, bare bones care.  The facilities tend to be much more uniform across the board, and up to standards that would generally be deemed unacceptable by a lot of U.S. healthcare consumers, even if they functionally were just as good.  These countries can also just stop paying healthcare professionals as much as they are primarily the only game in town (although realistically the U.S. could more or less do this through Medicare and Medicaid, except doctors and nurses are too politically powerful).  And if that ends up with a shortage, well that just helps by naturally rationing healthcare services.  To their credit, most countries at least accompany lower doctor pay with a much shorter track to be a doctor than in the U.S.  And of course you could just start refusing to pay for drugs above a certain price.  This is another thing that the U.S. could more or less accomplish through Medicare and Medicaid, except that it's not politically feasible, and we actually provide a fairly massive subsidy to the rest of the world by not only not doing this, but also prohibiting purchasing drugs overseas at lower prices and importing them into the U.S., which allows drug companies to reap proportionally more profits from the U.S. market while allowing other countries to get prices much closer to the marginal price of producing the drugs.

I'm totally fine with having hospitals be no frills. Or having waiting lists for non urgent procedures. If that saves money--fantastic! It would be a problem if health outcomes were worse as a result. But the fact is that these other countries spend less and have the same or better health outcomes as the US.

Who needs their hospital to be a resort? It just needs to provide decent, affordable medical care. What's unacceptable to voting Americans is how #)* expensive healthcare is.

[MoonShadow]

I'm totally fine with having hospitals be no frills. Or having waiting lists for non urgent procedures. If that saves money--fantastic! It would be a problem if health outcomes were worse as a result. But the fact is that these other countries spend less and have the same or better health outcomes as the US.

Source please?  My understanding is that this is not typically the case.

[Shane]

The most recent EconTalk podcast with guest Jonathan Skinner went into this topic deep.  It's not even fair for me to summarize it, they went so deep.  And wide, too.  They talked about factors such as the N.I.C.E. committee in England, which is the basis for the "death panels" claim by Sarah Palin; as well a life extending medications that cost an average of $200K or more for an additional 6 months, which wouldn't be approved by most or any government sponsored health care systems around the world to start with.

http://www.econtalk.org/

Thanks for the link @MoonShadow. That was interesting.

[Choices]

I'm totally fine with having hospitals be no frills. Or having waiting lists for non urgent procedures. If that saves money--fantastic! It would be a problem if health outcomes were worse as a result. But the fact is that these other countries spend less and have the same or better health outcomes as the US.

Source please?  My understanding is that this is not typically the case.

Sad but true. Our healthcare system stinks.

http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

[Yaeger]

I'm totally fine with having hospitals be no frills. Or having waiting lists for non urgent procedures. If that saves money--fantastic! It would be a problem if health outcomes were worse as a result. But the fact is that these other countries spend less and have the same or better health outcomes as the US.

Who needs their hospital to be a resort? It just needs to provide decent, affordable medical care. What's unacceptable to voting Americans is how #)* expensive healthcare is.

I don't think anyone here has argued that our healthcare system is unaffordable for some, and there are things that need to be improved, but what we argue about is why healthcare has become unaffordable. Any solution has to address that underlying cause and I have yet to see how anyone can ultimately attribute that increase to the private sector when arguing for a single payer or national healthcare system.

We've been trying to make healthcare 'affordable' through 50+ years of government healthcare expansions, and look where we're at now. Why should we believe that more of the same will help?

[randymarsh]

We've been trying to make healthcare 'affordable' through 50+ years of government healthcare expansions, and look where we're at now. Why should we believe that more of the same will help?

Because practically every other country in the world has far more government involvement in healthcare and their costs are lower with overall better outcomes.

[Yaeger]

We've been trying to make healthcare 'affordable' through 50+ years of government healthcare expansions, and look where we're at now. Why should we believe that more of the same will help?

Because practically every other country in the world has far more government involvement in healthcare and their costs are lower with overall better outcomes.

You're assuming the same thing will work here, or that we want the same healthcare system? The problem isn't the fact that their costs are lower, but that our costs continue to rise, have been rising for decades, and because of that have become unaffordable.

During his July 12th Dallas Memorial Service speech, President Obama demonstrated this perfectly from a phrase in his speech: "In the end, it’s not about finding policies that work. It’s about forging consensus and fighting cynicism and finding the will to make change." This statement exemplifies EXACTLY why healthcare has becomes so expensive. Things like the Affordable Care Act, Medicaid, Medicare weren't about making healthcare affordable for all, but making healthcare 'affordable' to some by shifting that burden to others. We need policies that work and more politically-driven, demographic-targeted healthcare disasters aren't the answer.

[Jrr85]

I don't have any particular insight on cosmetic surgery costs. But I can see how something that's entirely optional would be cheaper. If it were too expensive, people wouldn't get it as much. It's a little different than having an actual health problem and needing to get that taken care of.*

*I'm ignoring the small portion of plastic surgeries that are deemed more medically necessary.

Yes, there is a difference in the type of demand, but plastic surgeons are not underpaid compared to other doctors.  They do quite well.  Of course their supply probably is more responsive to demand than other specialties as if plastic surgeons were underpaid, you'd see people stop specializing in it, but that doesn't change the fact that it's clear the private market will work, if you let it, even with some pretty ridiculous restrictions on supply. 

The amount of care that cannot be competitively shopped (basically your emergency care, maybe some non-emergency care in very low population density, remote areas) may need to be treated differently from day to day care where the price mechanism can be allowed to work, but it seems pretty clear that we are inflating the cost of healthcare through poorly thought out regulation and too great of a reliance on third party payments. 

[Jrr85]

I'm totally fine with having hospitals be no frills.

As I would be, as it doesn't have a big impact on quality of care.  But the horse is out of the barn on that one.  We already have a hospital infrastructure built up that depends primarily on single occupancy rooms.  We can't save money by building new, but no frills hospitals or by blowing walls out. 

Or having waiting lists for non urgent procedures.

I suspect you would be very unhappy to find out what the government considers non-urgent.  Maybe you'd be fine with the definition of non-urgent for other people, but when it's you or your Great aunt emma or whoever laid up for weeks on end in pain waiting for hip surgery, it will suddenly seem completely unreasonable. 

If that saves money--fantastic! It would be a problem if health outcomes were worse as a result. But the fact is that these other countries spend less and have the same or better health outcomes as the US.

  This is generally not true.  Other countries have the same life expectancy as the U.S., but that's primarily driven by factors other than health care (taking out driving and gun fatalities does away with a substantial portion of the discrepancies).  A lot of the differences can also be controlled out by looking at lifestyle.  We have a much higher rate of "life style" diseases, like diabetes and heart disease, than other rich countries.  And controlling for demographics, which is a lot more difficult (or maybe not more difficult but it's a lot less clear what the justification is) makes a lot of the differences disappear.  For example, Japan has a significantly longer life expectancy than the U.S., but americans of Japanese descent have longer life expectancies than Japanese.  If you compare actual health outcomes, the U.S. does well.  But then you run into problems like, are we treating cancer better, or are we finding it earlier, which results in longer life expectancy after diagnosis?   

The reality is when you look at the numbers, we spend more and in many ways we get better care.  We don't get a ton of bang for our buck and it seems clear that a lot of healthcare costs are wasteful, but it's not easy to identify what was wasteful until after the fact.  The areas where we clearly spend more than other countries it's politically difficult to change (e.g., we politically apparently can't just pay our doctors and nurses less) or would come at a significant social cost (e.g., no longer pumping up the price for prescription drugs bought in the U.S. would make drugs cheaper for people in the U.S., but would significantly change the calculus on how much drug R&D can be justified).