Why do People Hate Obamacare?

[Biblical Anabaptist]

I agree...healthcare is a unique market that needs to be regulated to some degree. It does not exist under normal supply & demand free-market conditions.

Drug patents on the supply side give almost unlimited monopolistic price power to pharmaceutical companies...and medical conditions on the demand side often make the purchase of patented drugs a unavoidable necessity - taking away the consumer's ability to choose. Unregulated, it is a recipe for gouging - and I believe that is much of what has been driving the unreasonable costs in this country. There needs to be some watchdog control placed into the system to keep a lid on unrestrained profiteering.

While I fully understand a companies need to recover their R&D costs, some of the charges seem exorbitant. A year ago I was paying around $275.00 for 30 pills of a certain medication. Yesterday I picked up a generic at the same drugstore. $32.00 for 60 pills.

[Josh]

Some of the worst gouging takes place in the form of providers and hospitals.

$350k salaries? No human being needs to make that much money, especially if they want to pretend they are "helping people".

[Bootstrap]

I would argue that if you totally regulated it and turned it over entirely to the government (drug research that is) that the wastefulness would far out way any of the so called gouging of today. But that is jus my opinion although I think based on most government's track records I think it is a good one.

Nobody is arguing that drug research should be done only by the government. But I do think that government should limit the prices paid for drugs, especially for drugs paid for by the government. Of course, it should pay enough that companies get a reasonable profit.

Socialism is about controlling the means of production. I would rather see doctors, hospitals, and drug companies operating as private regulated entities, where the means of production is privately held.

[MattY]

For bigger, sweeping, long-term reforms, I think the best thing in the long run would be to end the system of employer-provided health care, which creates a bunch of perverse incentives that encourage unnecessary procedures with no incentive to control costs.

I agree with this. Why put the burden on the employer?

But I don't want single payer - that has its own problems, and I don't like socialism; I think it will not be good in the long run either. At least not national single-payer, like the Canadian and British systems. The best single-payer systems are in Sweden and Denmark, but those systems are run mostly by the local governments. Some of the best health care systems overall are Switzerland and Singapore; they have individual markets where everyone buys their own health care. I think we really need to develop a plan modeled after their systems.

The Singapore public healthcare system is a single-payer system, though it allows private medical care on top of it. It has some nice incentives built in - you have to pay for healthcare, what you pay depends on your income. It's like an HSA where funds accumulate if you don't use it, and you can build up quite a bit of money over time. You always have to pay part of the price, so you know that healthcare isn't free. It's built on compulsory savings, subsidies, and price controls.

Singapore is not really a single-payer system. If you have people saving to pay out of pocket, that's not single-payer.
MediShield, the catastrophic health insurance part, is single-payer, but there are also private alternatives. Singapore is a two-tier system.

Definitions of system types:

Single Payer: The government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and coinsurance. Providers may be public, private, or a combination of both.

Two-Tier: The government provides or mandates catastrophic or minimum insurance coverage for all residents (or citizens) while allowing the purchase of additional voluntary insurance or fee-for service care when desired. In Singapore all residents receive a catastrophic policy from the government coupled with a health savings account that they use to pay for routine care. In other countries like Ireland and Israel, the government provides a core policy which the majority of the population supplement with private insurance.

Insurance Mandate: The government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.

https://www.forbes.com/sites/danmunro/2 ... f451cb36ee

[Robert]

While I fully understand a companies need to recover their R&D costs, some of the charges seem exorbitant. A year ago I was paying around $275.00 for 30 pills of a certain medication. Yesterday I picked up a generic at the same drugstore. $32.00 for 60 pills.

That shows the free market does work. I always ask the doctor to prescribe an older less expensive medicine if it will do the same thing. Most doctors have been trained by the pharmaceutical companies to prescribe the newest most expensive drugs.Most times, older ones do as well. All you have to do is ask. If there is nothing else, then the $275 may be worth it, depending on the condition. Even with Medicaid paying, I still ask. Someone is paying for that medicine. If people were really paying out of their own pockets, I think this question would be asked all the time by most others.

$350k salaries? No human being needs to make that much money, especially if they want to pretend they are "helping people".

They make those amounts because there is little competition. I can get an MRI off site of a hospital for the same price as an x-ray at a hospital. The more we ask for prices and seek out better deals, the more the market will adjust. We do not need government to do that. We have to take responsibility and do it. Don't go to the doctor thinking they know it all and you have to do what they say. Have a conversation. Ask for less expensive treatment options. They know their industry. A good doctor will jump right in and help you keep costs down. One that doesn't, well find a better doctor.

We were self pay for over 10 years and always found a way to get treatment and the things we needed. We were fortune not to have major medical expenses, but my wife had a chronic illness all that time. I knew we had the odds on our side. Things can happen, but the odds that a major issue develops are less then the odds that it would not. We had faith that God would help us through whatever we faced, and were never disappointed.

[Robert]

But I do think that government should limit the prices paid for drugs, especially for drugs paid for by the government. Of course, it should pay enough that companies get a reasonable profit.

Reducing regulation for R&D while shortening the time they can patent the medicine would keep their profits balanced, while not regulating price. The Trump Administration is actually working at doing some of this presently.

Without the big money pay off, few companies would spend time developing new drugs. You want to slow R&D, regulate. Fastest way to stop new things.

[Dan Z]

I would argue that if you totally regulated it and turned it over entirely to the government (drug research that is) that the wastefulness would far out way any of the so called gouging of today. But that is jus my opinion although I think based on most government's track records I think it is a good one.

I agree appleman.

The middle ground here (and the historic pattern for US governance) has been a free-market system regulated for excess and abuse, particularly in cases where market forces are prone to manipulation and control. Boot use the utilities as an example. Bank lending is another one.

[Bootstrap]

Actually bootstrap not quite. Even in our extremely socialized system here in Canada there are lots of steps where the market still decides what gets paid out.

There are two main ways to control costs. One is to build in free market mechanisms. The other is to regulate costs. If the government pays but does not regulate costs, that's like creating an artificial customer that doesn't care about price, which really messes up any free market mechanisms. I think we need both mechanisms.

The Singapore model does a good job of building in some free market incentives, making patients care about the real cost of procedures. But they still work hard on cost control.

Here are some examples.
1. Labour costs. (Very powerful unions have made sure that health practitioner labour rates have risen at a rate that is much higher than the average person out there not to mention many of the other benefits that are attached.)

As long as health providers are privately held, they have incentive to control labor costs.

If we want labor costs to be subject to free market mechanisms, we need to stop limiting the number of foreign doctors who come to practice in the United States. That would put pressure on their salaries.

2. Drug costs. Again I am not sure if you took the free market component out of this whether nearly as much research would actually get done.

You definitely don't want to set prices at a level where drug companies don't make a profit. But they make a profit all over the world selling drugs at much lower prices than we have in the United States.

And the free market encourages drug companies to focus on the most profitable drugs, and on encouraging people to take as many drugs as possible. Most Americans would be healthier if they took fewer drugs. It's hard to get companies to develop drugs needed primarily by people who can't pay for them or vaccines that are often not all that profitable.

The free market works well for generic drugs when multiple companies make a given drug.

3. Over all capital costs of building health facilities and equipment. This is one that really falls by the wayside when government is involved. Initial costs as well as overruns simply go way off the rails.

The free market encourages lots of health facilities in cities where they are most profitable. Where I live, three major health conglomerates are building competing facilities not far from each other, and there's no end to the construction. In rural North Carolina, they have difficulty even getting doctors to run family practices.

I agree that we need free market mechanisms in addition to regulation, and that we have to run things in a way that lets private providers be profitable. If you look at utilities, our regulators usually make sure companies are profitable. But the free market has no incentive to avoid selling people healthcare they don't need or provide healthcare for people who cannot pay for it. These are two things our healthcare system needs to do.

[Bootstrap]

Reducing regulation for R&D while shortening the time they can patent the medicine would keep their profits balanced, while not regulating price. The Trump Administration is actually working at doing some of this presently.

I have no idea what the Trump administration is doing in this area, so this is not a comment on that.

But I think you want regulations that:

• Make companies prove that drugs have the benefits they advertise
• Make sure we know the side effects of a drug
• Make sure we understand drug interactions
• Make it easy to evaluate the projected benefit compared to the projected risk

That's what regulations are for. Any overhead that does not contribute to those goals or can be done more efficiently in other ways should be eliminated. The devil's in the details.

Doing that for any given drug is expensive and slow. Clinical trials are not cheap. But if we can find ways to demonstrate the things listed above more efficiently, we should.

[appleman2006]

It is no wonder our systems have so many problems. It is interesting to me how much greed and selfishness is really at the root of almost all of these problems.

Jesus does really hold the key to all of this I believe.