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YC Research: Universal Healthcare

blog.ycombinator.com

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Re: YC Research: Universal Healthcare

#301

Post by spangry »

chimeracoder wrote: post #278
rayiner wrote: post #235

Earlier quoted context omitted.

A complex tango between drug companies that want to maintain their margins, and European governments that want to drive drug prices artificially low to force American payers to make up the difference.

You're getting downvoted, but you're right. Currently, the US is implicitly subsidizing other countries in this regard. If we removed the trade barriers for prescription drugs, US prices would fall and other countries would end up paying more.

An alternative scenario might be that drugs would get cheaper in the US, European drug prices stay the same and pharmaceutical companies somehow scrape by with lower (but still positive) profit levels.

Seriously, if drug companies were making a net loss in European and other countries, they'd just stop supplying in those countries and subsequently enjoy higher profits. Unless you're suggesting companies like Pfizer and Merck & Co do it anyway out of the goodness of their hearts. And prices the US pay are in no way related to what other countries pay: it's simply a function of market power and being in a much weaker bargaining position.

Most of these countries have 'single buyers': essentially a panel of medical practitioners and economists who negotiate prices on the basis of cost-benefit ratio on behalf of the entire country. So the lower drug prices in European countries (and other single buyer/universal insurance countries like Britain, Australia, Canada etc.) is simply drug companies supplying the market at the price it will bear. They are price takers in such countries, because those countries are monoponsy markets.

I realise Pfizer (net income: $7.74 billion) and Merck & Co (net income: $4.44 billion) are really doing it tough, but I think they'll be OK if Americans realise it's insane to pay close to double (>15%) the OECD average (7-8%, medical spending as a % of GDP). Although I hear US medical treatment is top notch if you're rich, otherwise statistically (and conservatively) 25% of the time it will send you bankrupt, assuming you make it out of the waiting room alive (compared to, say, the UK where medical costs account for %5 of households that report 'financial difficulty'). [0]

It truly baffles me when I hear Americans talk about this issue, as they always argue it's actually really a good thing that they're getting rogered by most of the private medical industry in their country (hey, they're nice people, we cuddle afterwards). There's some crazy mental gymnastics going on if you truly believe that paying double the 'rich country club' average on health care costs for basically the same outcomes (apart from the much higher bankruptcy rate) is in some way a good thing.

It's almost like some weird form of buyers' remorse: 'Yeah, but we treat cancer better that anyone. USA #1!'

[0] http://www.snopes.com/643000-bankruptcies-in-the-u-s-every-y...

Re: YC Research: Universal Healthcare

#302

Post by bjshepard »

Thriptic wrote: post #186
Retric wrote: post #155

Earlier quoted context omitted.

Corruption. However, the line is generally described as: If companies can't discount per country then all countries end up paying high prices without discounts. However, if they can discount prices in some countries then that maximizes profits which increasing the customer base.

It's much more complicated than that. Sales in the US where they can charge more are what actually offer pharma companies good ROI. Effectively the US is subsidizing R&D for the rest of the world.

This is a lie.

Re: YC Research: Universal Healthcare

#303

Post by alkonaut »

intrasight wrote: post #123

>Currently, up to 40% of all healthcare funding is wasted on operational inefficiencies Your inefficiencies are someone else's revenue. Or to say another way: Healthcare is ~20% of US GDP Reduce spending by 40% would reduce US GDP by almost 10%. That's a tough sell politically you have to admit.

That's why GDP is a pretty bad yardstick. Spending on inefficiency is spending so it raises GDP, but GDP doesn't indicate whether money was spent making people better off, or just spent.

It's like a natural disaster or oil spill: there is good chance a natural disaster or actually increases GDP short term. People aren't better off for it however, since that money could have been spent better elsewhere.

Re: YC Research: Universal Healthcare

#304

Post by dx034 »

ameister14 wrote: post #189
lumberjack wrote: post #159

Universal healthcare is already much more cost effective than fully or semi-privitised health care. Sorry, I forgot to pretend that all the other developed countries haven't figured out healthcare already. Geez. ---------------- Oh and btw, when you have a universal healthcare system payed by taxes (none of that bullshit insurance crap that only ends up being costly regulation/financial bloat) you can have entire and…

>Universal healthcare is already much more cost effective than fully or semi-privitised health care. That's not true. Most developed countries have some form of privatized system, falling into your 'semi-privatized' definition. It's more cost-effective.

In many countries there is some element of private healthcare, but it only provides luxurious services that are in no way needed to treat health conditions (1-bed rooms in hospitals, choosing any doctor you like, shorter wait times for non-urgent treatments). Good examples here are UK and Germany. In both countries you'll get full coverage of any medical condition with public insurance.

The reason that private elements exist at all are NOT because they are more cost efficient. They exist just because some people like to have more comfort and are willing to pay for it. Not sharing a room in a hospital doesn't make you healthier (and is certainly not more efficient), it's just nicer.

I'd agree with your parent-comment that most states have actually figured out that public health care is the most efficient option. Private health-care providing necessary treatments is the more expensive option for society.

Re: YC Research: Universal Healthcare

#305

Post by alkonaut »

Would there be legal issues (apart from political will) with forming a publicly owned health insurance company for the general public in the US, rather than a subset like Medicare etc?

It seems that if you just form a large enough public insurer it could soon start undercutting the prices of the private insures.

Re: YC Research: Universal Healthcare

#306

Post by jclos »

jrowley wrote: post #76
jclos wrote: post #58

Pardon my cynicism, but I don't like the idea of choosing a patient you're going to "spend your money on" as a replacement for a basic universal healthcare. Healthcare shouldn't be a popularity contest. As an addition to a normal "basic" healthcare it's fine, but please don't replace existing systems with this stuff.

I urge you to read the announcement. Watsi is going into a different space than before - integrated healthcare (including preventive action) as opposed to their traditional funding a single patient model.

You're right, I got the bad habit of skipping blog posts and going directly to the main website when the announcement was the actual news.

Re: YC Research: Universal Healthcare

#307

Post by KaiserPro »

refurb wrote: post #281
finnh wrote: post #233

Earlier quoted context omitted.

> Medicare is required to cover a number of classes of drugs. they can't say "no, we're not paying for it." > As a result, Medicare has no negotiating power. Unless you can walk away from the table, why would drug companies budge? Those statements are only true for drugs with no alternatives - which doesn't apply to all (most?) drugs. And, even for those, couldn't the government say "we're not going to pay $(RANSOMPR…

we will not buy any other drugs from you Private payers are free to do that, but don't. The reason why they don't is because they have customers and telling someone "no you can't have this drug" makes people really upset. I'm not sure Medicare would have much more success in that area. I could imagine politicians phones ringing off the hook with call from retirees stating "why won't you pay for my drug"?

Because most patients are not competent to source alternatives.

Lets be honest, apart from generics, are you able to dive through source material to find older, equally effective, but with different side effect drugs?

Re: YC Research: Universal Healthcare

#308

Post by XorNot »

DanBC wrote: post #145
HarryHirsch wrote: post #130

Earlier quoted context omitted.

What's seeing the expenses going to do, what mechanism is supposed to lower cost? When you need healthcare you need healthcare. No one goes to the physician for fun, elective procedures like breast enlargement or Lasik excepted.

The free market argument goes that informed consumers will chose healthcare services, and thus will either drive up quality, or drive down prices. The problem is that the customers cannot see the prices, and thus can't negotiate before hand. This isn't just for emergency care, but for stuff that shouldn't be too hard to get pricing for. There's a nice Vice(?) video about a couple having a baby. They find it impossibl…

How do you account for the cost of a delivery? Do we just assume a totally fine birthing experience? What if there's complications? The emergency blood transfusion sure isn't free. It's also not predictable individually.

Ooh I know we'll calculate the cost across the mean population. Of course almost everyone has children or was a child, or knows someone who will and is invested in their well-being. And we can't account for when births happen so we need to keep facilities staffed in downturns, and account for future expensive deliveries where neonatal care is needed.

So really, the best strategy would be some scheme where we charge everyone a little - and the more people we add in the pool the smaller it'll get.

If only there were a name for such a system...

Re: YC Research: Universal Healthcare

#309

Post by narrator »

The prices in the U.S system are wildly divergent from the rest of the world and enhancing international competition is a good way to remedy this. Thus, one way to implement universal health care is to allow import of any prescribed drug and the government will pay for any medical procedure + plane ticket if that cost is less than it is in the U.S. Perhaps a doctor visa would also help with costs.

Re: YC Research: Universal Healthcare

#310

Post by dandare »

narrator wrote: post #309

The prices in the U.S system are wildly divergent from the rest of the world and enhancing international competition is a good way to remedy this. Thus, one way to implement universal health care is to allow import of any prescribed drug and the government will pay for any medical procedure + plane ticket if that cost is less than it is in the U.S. Perhaps a doctor visa would also help with costs.

doctor visa is a terrible idea, a) it would undermine the salaries of US doctors, b) it would drain doctors from poor countries where they are needed more than in the US.
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