Author Topic: Questions for those living in nations with universal health coverage  (Read 20961 times)

Daleth

  • Handlebar Stache
  • *****
  • Posts: 1201
Re: Questions for those living in nations with universal health coverage
« Reply #50 on: November 05, 2013, 06:35:03 PM »
How much of the innovation in medicine happens in situations where single payer healthcare would make a difference?
The US currently does substantially all of the world's medical research because it's profitable here and not really profitable anywhere else.

Wow. Where did you get the idea that almost all the world's medical research is done in the US?!

Here, tell you what, go here: http://www.ncbi.nlm.nih.gov/pubmed
That's PubMed, a database containing millions of articles or abstracts (summaries) published in medical journals. Run a search on anything you please, and start looking at the articles. They all say, directly or indirectly, where the researchers are--either it'll name the institution or provide a tell-tale email (e.g. one that ends with a country code: .fr for France and such). You'll see research happening all over the world.

grantmeaname

  • CM*MW 2023 Attendees
  • Walrus Stache
  • *
  • Posts: 5566
  • Age: 30
  • Location: Middle West
  • Cast me away from yesterday's things
Re: Questions for those living in nations with universal health coverage
« Reply #51 on: November 05, 2013, 07:22:09 PM »
Thanks for the condescension, but I know what PubMed is. I was referring to private-sector expenditures on research, not arguing that no academics in countries other than the US publish. For example, we do more than four fifths of the world's biotech research, and make 90% of the world's pharmaceutical discoveries. A vast majority of the medical research spending today is private in nature (probably two thirds, but it's hard to pin down an authoritative source). So do you have anything more substantial than a handwave to suggest that this isn't an issue worth exploring?

gooki

  • Magnum Stache
  • ******
  • Posts: 2897
  • Location: NZ
    • My FIRE journal
Re: Questions for those living in nations with universal health coverage
« Reply #52 on: November 05, 2013, 08:05:42 PM »
grantmeaname, seriously you're quoting FDA approval stats from three decades ago as proof?

From your document you linked to specifically relating to the 90% claim:

Quote
A 1993 study published in the Journal of Clinical Pharmacology found that between
1981 and 1990, the research-based pharmaceutical industry was the source for 181 of the 196 new drugs
approved by the Food and Drug Administration (FDA) (92.4 percent), academia was the source of 7 of
the drugs (3.6 percent), and the government was the source of 2 of the drugs (1 percent). See Kaitin, et al,
The Role of the Research-Based Pharmaceutical Industry in Medical Progress in the United States, 33 J.
Clin. Pharmacol. 412-14 (1993)

By all means post something that's current and global.
« Last Edit: November 05, 2013, 08:15:09 PM by gooki »

grantmeaname

  • CM*MW 2023 Attendees
  • Walrus Stache
  • *
  • Posts: 5566
  • Age: 30
  • Location: Middle West
  • Cast me away from yesterday's things
Re: Questions for those living in nations with universal health coverage
« Reply #53 on: November 05, 2013, 08:23:11 PM »
I'm not quoting anything as proof, I'm marshalling a white paper from 2002 and several other more recent sources as evidence to support my position. As I said in my post, it seems to be hard to come across good evidence that speaks this, but I think the general trend is relatively clear: private funding is a clear and growing majority of all medical research funding, and the largest portion, by far, of both private and public funding is available in the United States.

If you've got more recent evidence that suggests something different, I'd love to hear it - this certainly isn't an issue I've made my mind up on. But I didn't expect to piss people off and get nothing valuable back when I raised this issue that was previously ignored when somebody else brought it up last month. Surely somebody has thought about this.

gooki

  • Magnum Stache
  • ******
  • Posts: 2897
  • Location: NZ
    • My FIRE journal
Re: Questions for those living in nations with universal health coverage
« Reply #54 on: November 05, 2013, 11:41:28 PM »
According to this study comparing the USA to Europe, November 2009
http://object.cato.org/sites/cato.org/files/pubs/pdf/pa654.pdf

The split is 60/40 in the USAs favour for medical innovations.

And pretty much 50/50 for Pharmaceutical innovations.

Add remember this is just USA vs Europe. There's plenty more countries not even included such as Japan, India, or even your neighbours Canada...

So no it's not all innovations, it's not over 90%. But it is an amount to be proud off.

beltim

  • Magnum Stache
  • ******
  • Posts: 2957
Re: Questions for those living in nations with universal health coverage
« Reply #55 on: November 06, 2013, 12:27:25 AM »
According to this study comparing the USA to Europe, November 2009
http://object.cato.org/sites/cato.org/files/pubs/pdf/pa654.pdf

The split is 60/40 in the USAs favour for medical innovations.

And pretty much 50/50 for Pharmaceutical innovations.

Add remember this is just USA vs Europe. There's plenty more countries not even included such as Japan, India, or even your neighbours Canada...

So no it's not all innovations, it's not over 90%. But it is an amount to be proud off.

20/27 and 9/10 is 60% ? Those numbers are from figure 2 of your citation. 

And those figures are for all innovations, not just the US and Europe.

gooki

  • Magnum Stache
  • ******
  • Posts: 2897
  • Location: NZ
    • My FIRE journal
Re: Questions for those living in nations with universal health coverage
« Reply #56 on: November 06, 2013, 01:47:57 AM »
No their not.

Figure 2
Top Medical Innovations by Country of Origin, 1975–2000
14 Europe
20 USA

« Last Edit: November 06, 2013, 01:51:40 AM by gooki »

beltim

  • Magnum Stache
  • ******
  • Posts: 2957
Re: Questions for those living in nations with universal health coverage
« Reply #57 on: November 06, 2013, 10:28:38 AM »
Directly from your figure: 20 out of the top 27 "Medical Innovations" originated in the US.  9 out of the top 10 Medical Innovations originated in the U.S.  That's what your figure says.  Perhaps you're confused because the article lists more than one country of origin?

Mega

  • Stubble
  • **
  • Posts: 176
  • Location: Burlington, Ontario
Re: Questions for those living in nations with universal health coverage
« Reply #58 on: November 06, 2013, 12:57:54 PM »
Why wouldn't we expect the majority of medical breakthroughs to come from the USA? The US has the 44 of the top 100 universities in the world. (Just Google it) This is unlikely to change.

It is also incredibly unlikely that medical breakthroughs will suddenly disappear because of single payer healthcare.

The big money costs you are likely thinking of are for drug research. These costs are amlost exclusively driven by regulatory requirements. If all of a sudden innovation drops, the governemnt will change the regs.

gooki

  • Magnum Stache
  • ******
  • Posts: 2897
  • Location: NZ
    • My FIRE journal
Re: Questions for those living in nations with universal health coverage
« Reply #59 on: November 06, 2013, 02:40:36 PM »
Directly from your figure: 20 out of the top 27 "Medical Innovations" originated in the US.  9 out of the top 10 Medical Innovations originated in the U.S.  That's what your figure says.  Perhaps you're confused because the article lists more than one country of origin?


Directly from the figure: 14 out of the top 27 "Medical Innovations" originated in Europe.  5 out of the top 10 Medical Innovations originated in Europe.  That's what the figure says.  Perhaps we're confused because 14 + 20 = 34 not 27, and 5+ 9 = 14 not 10.
« Last Edit: November 06, 2013, 02:42:23 PM by gooki »

beltim

  • Magnum Stache
  • ******
  • Posts: 2957
Re: Questions for those living in nations with universal health coverage
« Reply #60 on: November 06, 2013, 03:20:23 PM »
Directly from your figure: 20 out of the top 27 "Medical Innovations" originated in the US.  9 out of the top 10 Medical Innovations originated in the U.S.  That's what your figure says.  Perhaps you're confused because the article lists more than one country of origin?


Directly from the figure: 14 out of the top 27 "Medical Innovations" originated in Europe.  5 out of the top 10 Medical Innovations originated in Europe.  That's what the figure says.  Perhaps we're confused because 14 + 20 = 34 not 27, and 5+ 9 = 14 not 10.

Right, so a minimum of (20+14-27) 7 of the top 27 medical innovations came out of both Europe and the US.  That doesn't mean that 20 out of 27, and 9 out of 10, didn't come out of the US.

The point is, you're using the wrong denominator.  That's all.

StarswirlTheMustached

  • Bristles
  • ***
  • Posts: 475
Re: Questions for those living in nations with universal health coverage
« Reply #61 on: November 06, 2013, 05:51:34 PM »
How much of the innovation in medicine happens in situations where single payer healthcare would make a difference?
The US currently does substantially all of the world's medical research because it's profitable here and not really profitable anywhere else. As discussed elsewhere, if we introduce a monopsony, that's a market inefficiency just as surely as a monopoly would be. Without an opportunity to profit, why will firms continue to conduct and fund medical research?

We've a thriving medical industry in Canada. Why shouldn’t medical innovations be profitable here? Oh, there's a hurdle to entry? You need to prove to a vast, uncaring government bureaucracy that your treatment is worth putting into practice?
Something like... the FDA?
After that, you need to convince insurers to fund the treatment. With single payer, that's just one sell-- one sell that's (supposed to be) based on "will this save more lives than spending the money elsewhere?" rather than selling upteen times based on "will this increase our profit margin?"
I don't see why a multi-payer system ought to automatically favour innovation over a single-payer system. Or that the innovations it selects for will actually benefit patients. See, for example, end-of-life care: thanks to medical innovation, you can now spend millions for an incredibly painful few weeks extra weeks. Those who know what to expect don't want to die like that.

grantmeaname

  • CM*MW 2023 Attendees
  • Walrus Stache
  • *
  • Posts: 5566
  • Age: 30
  • Location: Middle West
  • Cast me away from yesterday's things
Re: Questions for those living in nations with universal health coverage
« Reply #62 on: November 06, 2013, 06:11:01 PM »
We've a thriving medical industry in Canada. Why shouldn’t medical innovations be profitable here? Oh, there's a hurdle to entry? You need to prove to a vast, uncaring government bureaucracy that your treatment is worth putting into practice?
Something like... the FDA?
I gave an explicit argument about the mechanism by which single payer could be harmful. Why even respond if you're going to ignore it?

StarswirlTheMustached

  • Bristles
  • ***
  • Posts: 475
Re: Questions for those living in nations with universal health coverage
« Reply #63 on: November 06, 2013, 06:29:08 PM »
We've a thriving medical industry in Canada. Why shouldn’t medical innovations be profitable here? Oh, there's a hurdle to entry? You need to prove to a vast, uncaring government bureaucracy that your treatment is worth putting into practice?
Something like... the FDA?
I gave an explicit argument about the mechanism by which single payer could be harmful. Why even respond if you're going to ignore it?
I saw that you assert that the hurdle to entry is much larger; I question this assertion. For example, here in Ontario, it is my understanding that ANY treatment which is legal in Canada (i.e., approved by our version of the FDA) and falls into one of the categories covered by OHIP can be covered by the province if the physicians can show that it is a medical necessity. Even if it's been shot down for general use, in some cases. Difficult? Oh, yes. Not every special case is approved, and it's the special cases which you'd imagine drive innovation. Better than squeezing blood from the actuarial stone with a for-profit insurance company? (If you think not, you still have that option. AND you can still pay for drugs out-of-pocket, through the public hospitals, if OHIP says "nyte, comrade" to your treatment.)
Sure, we lag on some of the wizz-bang gizmos up here, but we'd have them too, if we were (collectively, democratically) willing to pay. Remember: Canadians pay only a fraction of what Americans do for health care.

KimPossible

  • Stubble
  • **
  • Posts: 111
Re: Questions for those living in nations with universal health coverage
« Reply #64 on: November 06, 2013, 06:37:45 PM »
Doctors continue to recommend too many tests, except now they do it because government is paying for it, rather than to avoid lawsuits.

Yep.  That's us.  Brainless drones.  (Eyeroll)

grantmeaname

  • CM*MW 2023 Attendees
  • Walrus Stache
  • *
  • Posts: 5566
  • Age: 30
  • Location: Middle West
  • Cast me away from yesterday's things
Re: Questions for those living in nations with universal health coverage
« Reply #65 on: November 06, 2013, 06:50:58 PM »
Not a hurdle to entry, a capital-budgeting style hurdle of required rate of return to new project approval.

Ziw

  • 5 O'Clock Shadow
  • *
  • Posts: 1
Re: Questions for those living in nations with universal health coverage
« Reply #66 on: November 07, 2013, 12:22:50 AM »
In Sweden I think it works pretty good I think, fortunately I have never had any need of long time service or been on a long waiting list. But I guess some people might  have to wait for weeks, depending how serious it is.
 
It is basically all included in our high taxes, you can pay insurance for a private health plan if you want to skip queues.

You may choose your "house doctor" (smaller hospitals) freely.

Random checkup visit: 30$
If you are hospitalized your pay like 15$ a day (highest allowed price).
We also have a high cost protection that means that you do not pay more than 170$ per year in medical bills (I don't think that 15$/day is included).
Same with medicine where you pay maximum 338$ per year.

Within EU we have a card that allows us to get the same treatment in all EU-countries as their citizens for free.
In almost all household insurances there is a travel insurance with the same protection included for the first 45 days outside EU.

This is how it is supposed to work here, but as I have no real experience (worst thing is otitis...) so I can't say for 100%.