[kenberg]

VSP=Very Sick Person?


I have been very lucky with my health but perfection is only for the gods so I recently got some generic medication. Price to me: $20. Actual price: $500. Well, I say "actual price" but of course I haven't a clue about what the actual price is. I have a piece of paper saying the actual price is $500. I do not know who gives what to whom, I just fork over $20 and get my medicine. There are a lot of us Medicares out there and believe me, I am very far from being the most in need of meds. I can see how this might run up a bill.


I have more health insurance than I can understand, I just give them some plastic, so I am not at all sure that the remaining $480 is totally picked up by Medicare. But that may not be the main point. Part of the problem must be that because it gets almost entirely paid for by some someone somewhere somehow, I have no motivation to ask if the charge is reasonable. I would like to think someone is motivated to do so, but I am at a loss to say who that might be.

[phil_20686]

In a shockingly mundane twist, respected economist continues to bang on about the blindingly obvious, while politicians insist that with only a little more persuasion, reality will take their side.

[mike777]

The concern is and has always been that central govts cannot be trusted when it comes to medical innovation if you take away free capitalist markets in health care.


It looks like Western Europe does not share this concern.

[dwar0123]

 mike777, on 2012-December-03, 17:38, said:

The concern is and has always been that central govts cannot be trusted when it comes to medical innovation if you take away free capitalist markets in health care.


It looks like Western Europe does not share this concern.

It will take a lot more then central government oversight to overcomes people desire to innovate how not to die.

[mike777]

 dwar0123, on 2012-December-03, 18:13, said:

It will take a lot more then central government oversight to overcomes people desire to innovate how not to die.

ok it sounds like you are not concerned if there are not free capital markets in the health care industry when it comes to innovation.

What do you propose if anything?

---


btw just to be clear the concern is not that innovation will drop to zero.

[awm]

 mike777, on 2012-December-03, 18:24, said:

ok it sounds like you are not concerned if there are not free capital markets in the health care industry when it comes to innovation.

What do you propose if anything?

---


btw just to be clear the concern is not that innovation will drop to zero.

It's important to keep in mind that these four are actually different industries:

(1) Drug Industry
(2) Medical Technology
(3) Health/Medical Insurance

Innovation in the first two of these is really critical and what leads to improved lifespans and quality of life. No one is seriously suggesting nationalizing these industries; government has some role in protecting patent rights in a reasonable way and measuring/testing product safety, but otherwise the free market should rule.

Innovation in the third of these is almost always detrimental to the citizens, because it generally involves finding legal loopholes to deny paying for life/health services to people who really need them. Further, economies of scale are hugely important in the insurance business, such that a very large organization (typically a government) can do a better job than a private insurer. A "free market" doesn't even really work here, because small "innovative" startups cannot compete (due to economy of scale) with large monopolies. Virtually every "civilized" country has acted to nationalize this industry.

[kenberg]

It seems that one thing, perhaps the only thing, that gets widespread agreement is that we simply cannot afford the ever increasing costs of health care. I think this inevitably leads to some really tough choices. We now can do many really good things for patients but these really good things cost a lot of money.

I'll spare you the details, but the $500 prescription I refer to above is really important to my health. I don't take $500 out of the petty cash drawer, but if I had to pay it myself, and it will be repeated every three months, I would do so and I would not need to take out a loan or cut back on wine. But some people are financially worse off, and medically they are much worse off. The expenses are far higher, and they do not have it.

If anyone thinks the answers are obvious, I think that they need to think a little harder. Meanwhile, I am pleased to be paying $20.

[phil_20686]

 kenberg, on 2012-December-04, 09:25, said:

If anyone thinks the answers are obvious, I think that they need to think a little harder. Meanwhile, I am pleased to be paying $20.

If you come to western Europe you will discover that the obvious solution really does work pretty well.....

Nationalising healthcare does not mean nationalising the pharma industry - it just means there is a little more discretion in deciding which drugs one actually buys.

Its true that in a National Healthcare there are limits on what care you can receive, but the reality is that you will almost never come up against them before you are in the last year of life. Paying £100,000 a month to extend the life of a 80 year old for six more months really doesn't make sense.

Paying £100,000 a month to extend the life of a thirty year old parent with young kids really does make sense.

Most insurance policies in the US have much worse limits than the NHS in practice, either because of diseases that they will not treat, or because of high excesses, which can essentially prevent poorish people with health insurance from receiving relatively cheap care.

Look down the world life expectancy charts:

1)Japan: universal healthcare
2)Israel: universal healthcare
3)Italy: universal healthcare
4)Australia: universal healthcare
5)Spain: National Health Service

In fact, ignoring small countries (less than 1 million persons), every country in the top fifteen has universal healthcare funded by the government, now, there is some variety among how you actually do it. For example, israel still has a private insurance sector, it is just compulsory to have health insurance, but most of them are just single payer systems. Sometimes with some copay.

Single payer systems are just better, and in life, just keep aiming for better, and leave perfection to those poor fools who think it is achievable........

[phil_20686]

 mike777, on 2012-December-03, 18:24, said:

ok it sounds like you are not concerned if there are not free capital markets in the health care industry when it comes to innovation.


btw just to be clear the concern is not that innovation will drop to zero.

There is very little evidence that capital markets are any better at allocating capital to R&D projects than governments. There is quit a lot of evidence that capital markets are better at taking a functioning idea and turning it into a consumer product.

I mean, can you imagine a modern corporation funding basic research at all? Real game changing inventions have always come out of the blue, and almost never from corporations.

I am going to list a bunch of inventions, and you pick the one whose invention was funded by the capital markets:

(1) The transistor
(2) LED
(3) Light bulb
(4) Electricity generators
(5) Touchscreen
(6) The internet
(7) Universal Logic Engine (i.e. a computer)
(8) Pneumatic tyre
(9) Universal Joint
(10) Superconductors
(11) Nuclear Fission
(12) Nuclear Fusion
(13) Lasers

Its a trick question, these were all inventions that came out of publicly funded research. Pretty much the only exception was the telephone. And that was really only an incremental improvement over the radio. Capital markets are great for making incremental improvements to existing tech, but terrible for funding speculative research.

[Winstonm]

 phil_20686, on 2012-December-04, 11:07, said:

There is very little evidence that capital markets are any better at allocating capital to R&D projects than governments. There is quit a lot of evidence that capital markets are better at taking a functioning idea and turning it into a consumer product.

I mean, can you imagine a modern corporation funding basic research at all? Real game changing inventions have always come out of the blue, and almost never from corporations.

I am going to list a bunch of inventions, and you pick the one whose invention was funded by the capital markets:

(1) The transistor
(2) LED
(3) Light bulb
(4) Electricity generators
(5) Touchscreen
(6) The internet
(7) Universal Logic Engine (i.e. a computer)
(8) Pneumatic tyre
(9) Universal Joint
(10) Superconductors
(11) Nuclear Fission
(12) Nuclear Fusion
(13) Lasers

Its a trick question, these were all inventions that came out of publicly funded research. Pretty much the only exception was the telephone. And that was really only an incremental improvement over the radio. Capital markets are great for making incremental improvements to existing tech, but terrible for funding speculative research.

The old Bell Labs would have a quibble or two with your claims.

[dwar0123]

 phil_20686, on 2012-December-04, 11:07, said:

(3) Light bulb
(4) Electricity generators

Ugh, I agree with you, but I can't help myself.

I think you listed light bulb instead of telephone.

Also, I thought electricity generation was also done by Edison.

[phil_20686]

 dwar0123, on 2012-December-04, 11:31, said:

Ugh, I agree with you, but I can't help myself.

I think you listed light bulb instead of telephone.

Also, I thought electricity generation was also done by Edison.

The light bulb was not invented by Edison, but by the chemist Warren De La Rue, about 1800. Edison turned it into a consumer product forty years later....

The dynamo is normally attributed to Faraday.Supposedly the first dynamo actually built was commissioned by Faraday from his violin maker, but that might just be legend.

Telephone was very definitely a commercial invention, but it was also something that was a relatively small step from radio. It was just about getting it sensitive enough to carry voice rather than just beeps of a telegram.

[dwar0123]

 phil_20686, on 2012-December-04, 12:32, said:

The light bulb was not invented by Edison, but by the chemist Warren De La Rue, about 1800. Edison turned it into a consumer product forty years later....

The dynamo is normally attributed to Faraday.Supposedly the first dynamo actually built was commissioned by Faraday from his violin maker, but that might just be legend.

Telephone was very definitely a commercial invention, but it was also something that was a relatively small step from radio. It was just about getting it sensitive enough to carry voice rather than just beeps of a telegram.

Edison improved both to the point that they became commercially viable. He didn't take an existing commercial product and incrementally improve it. He took a commercial non entity and made them a commercial success.

Regardless, even if we discount Edison, the earlier research and development of both products was not government funded, so far as I know.

[phil_20686]

 Winstonm, on 2012-December-04, 11:25, said:

The old Bell Labs would have a quibble or two with your claims.

Bell labs was a fairly unique place. They closed it down only in 2008 I think, "to focus on more immediately useful research" or some such. A lab that had more nobel prizes than most famous universities (seven Nobel prizes).

[phil_20686]

 dwar0123, on 2012-December-04, 12:41, said:

Edison improved both to the point that they became commercially viable. He didn't take an existing commercial product and incrementally improve it. He took a commercial non entity and made them a commercial success.

Regardless, even if we discount Edison, the earlier research and development of both products was not government funded, so far as I know.

This isnt right. Its not like they had "grants" per se, but warren de la rue, and Faraday were faculty at English universities. Also, Edison's venture to market electric lights (eventually) failed because he based it on DC rather than AC currents. Famously, Edison invented the electric chair as a marketing stunt to show how much safer DC was. lol.

[y66]

Changes in life expectancy between 1960 and 2010: Canada, Cuba, UK and US.

[dwar0123]

 phil_20686, on 2012-December-04, 12:54, said:

This isnt right. Its not like they had "grants" per se, but warren de la rue, and Faraday were faculty at English universities. Also, Edison's venture to market electric lights (eventually) failed because he based it on DC rather than AC currents. Famously, Edison invented the electric chair as a marketing stunt to show how much safer DC was. lol.

You are nitpicking.

Everything fails(eventually) and it was privately funded research and development that led to a commercial product, even if it was incrementally improved and supplanted upon by Westinghouse shortly thereafter.

[phil_20686]

 dwar0123, on 2012-December-04, 13:04, said:

You are nitpicking.

I am nitpicking? You questioned my list claiming the light bulb was invented by Edison, which it wasn't, you also claimed that edison invented electricity generation, which he didn't, then you claimed that earlier work on the lightbulb wasn't government funded, when it was, and then you claimed that edison turned it into a commercial product when his company failed.

Since the first incandescent filaments making better ones has been a product of trial and error to get longer lasting filaments. Its not rocket science! It has continued with marginal improvements right up to the present day. Filament lamps now last tens of thousands of hours, when once they lasted only a few hundred.

Obviously Edison made some pretty huge contributions, but he was not primarily responsible for either the light bulb or electricity. Unlike, say. the duplex telegraph, and the phonograph, which were definitely his almost from scratch. I mean I think he has like 1000 patents or something.

[phil_20686]

 phil_20686, on 2012-December-04, 11:07, said:

There is quit a lot of evidence that capital markets are better at taking a functioning idea and turning it into a consumer product.

 dwar0123, on 2012-December-04, 13:04, said:

it was privately funded research and development that led to a commercial product, even if it was incrementally improved and supplanted upon by Westinghouse shortly thereafter.

It seems like you are saying exactly what I said: remind me again what we are arguing about?

[mike777]

What is the fiscal cliff?

The fiscal cliff is an inapt metaphor for the looming consequences of some very bad congressional decisions.

On or around Jan. 1, about $500 billion in tax increases and $200 billion in spending cuts (see table 1) are scheduled to take effect. That’s equal to about four percent of GDP, which is, according to the Congressional Budget Office, more than enough to throw us into a recession (more on that later).


Data: Economic Policy Institute

Analysts disagree on exactly how quickly the recession would begin. That’s why the “cliff” metaphor is inapt. If financial markets freak out, it might happen very quickly, proving the “cliff” imagery correct. But it might happen gradually, affirming those who’ve argued it’s a “slope.”

Either way, both parties agree it shouldn’t be permitted to happen at all. But that’s the rub. The reason that the fiscal cliff could push us into another recession in 2013 is because it enacts too much deficit reduction upfront, not too little. And yet, deficit reduction is something that most members of Congress support, at least in the abstract. So both sides want to replace the fiscal cliff with…something. The question is, with what?

What is the fiscal cliff in one sentence?

Much too much austerity, much too quickly.



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