The simplest thing to do is pick out the best healthcare system in the world, and then replicate it exactly. So bring in the top officials from Singapore, put them on an independent commission to redesign the healthcare system, and force Congress to pass exactly the plan they come up with.
But coming back to Earth, such a plan could never happen. If you approach the problem from the perspective of a hypothetical policy advisor, there is very little that is both a) politically possible and b) would actually improve the system. Raising the caps on medical school enrollment is an obvious fix that would reduce costs without costing taxpayers anything, but the doctors will try their hardest to block it. A mandate to buy insurance makes sense in theory, but in practice the required level of healthcare to buy gets set way, way, too high, and so a mandate ends up being a huge transfer from citizens to the healthcare industry. There are dozens of other examples. Our system is f*ed up for a reason, and until the political system is reformed, policy reform is impossible.
In reality, healthcare spending will continue to rise until it simply cannot rise further. The spending will be distributed according to political power.
> The simplest thing to do is pick out the best healthcare system in the world, and then replicate it exactly. So bring in the top officials from Singapore, put them on an independent commission to redesign the healthcare system, and force Congress to pass exactly the plan they come up with.
You'd have to also replicate the covered population and make sure that there's a "USA" outside paying for drug development and the like.
As much as people speak of the drug development problem, how many copies of Viagra do we need? How many more statins? The drugs don't even seem to get better, they just are finding ways to extend patents!
Past that, most of the competition is not in innovation, but rather in marketing.
"The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion." -- http://www.sciencedaily.com/releases/2008/01/080105140107.ht...
Finally, the NIH is picking up most of the tab for fundamental research, and as such, it isn't the drug company that is leading innovation. As such, I find the drug development argument hollow.
Are you claiming that the existing statins address all relevant cases?
> which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion
That's a non sequitor.
> Finally, the NIH is picking up most of the tab for fundamental research
"fundamental research" isn't a significant fraction of the cost of drug development, aka "getting a drug into the pharmacy".
Added the link to my list of reading. Looks very interesting. I do share your cynicism that we have no tolerance for real change politically. The charge of socialism meets every single proposal that involves a little more government involvement.
Lack of government involvement is not the problem with U.S. healthcare. There is government intervention everywhere. My rule of thumb for determining whether an industry is a free market or not, is that I ask the question, "Can I start a business to solve the problem? Or am I legally prevented or constrained from doing so?" In the U.S. I am legally barred from implementing most of my business ideas that would fix the healthcare system, so I do not consider it a free market.
The problem with U.S. politics in general is that it is fractured. Policy is determined by the interplay of powerful, organized factions. Any government intervention gets captured by these factions, and the policy ends up hurting the general interest rather than making things better.
NO ONE WANTS A FREE MARKET SOLUTION FOR HEALTHCARE.
get over it.
a free market solution means dying baby gets turned away when parent has no money. otherwise it is not a market solution. no one wants this. no one. move to somalia, you can implement your plan there, life is cheap.
healthcare is not a business. no civil society is going to let you decline cusomters who cannot pay when it comes to keeping the baby alive.
Reputation-based consumer feedback isn't a desirable mechanism in an industry where unsatisfied customers are dead customers (as opposed to e.g. dead batteries).
Comments
The simplest thing to do is pick out the best healthcare system in the world, and then replicate it exactly. So bring in the top officials from Singapore, put them on an independent commission to redesign the healthcare system, and force Congress to pass exactly the plan they come up with.
Read more about Singapore's healthcare system here: http://econlog.econlib.org/archives/2008/01/singapores_heal.... http://www.american.com/archive/2008/may-june-magazine-conte...
But coming back to Earth, such a plan could never happen. If you approach the problem from the perspective of a hypothetical policy advisor, there is very little that is both a) politically possible and b) would actually improve the system. Raising the caps on medical school enrollment is an obvious fix that would reduce costs without costing taxpayers anything, but the doctors will try their hardest to block it. A mandate to buy insurance makes sense in theory, but in practice the required level of healthcare to buy gets set way, way, too high, and so a mandate ends up being a huge transfer from citizens to the healthcare industry. There are dozens of other examples. Our system is f*ed up for a reason, and until the political system is reformed, policy reform is impossible.
In reality, healthcare spending will continue to rise until it simply cannot rise further. The spending will be distributed according to political power.
> The simplest thing to do is pick out the best healthcare system in the world, and then replicate it exactly. So bring in the top officials from Singapore, put them on an independent commission to redesign the healthcare system, and force Congress to pass exactly the plan they come up with.
You'd have to also replicate the covered population and make sure that there's a "USA" outside paying for drug development and the like.
As much as people speak of the drug development problem, how many copies of Viagra do we need? How many more statins? The drugs don't even seem to get better, they just are finding ways to extend patents!
Past that, most of the competition is not in innovation, but rather in marketing.
"The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion." -- http://www.sciencedaily.com/releases/2008/01/080105140107.ht...
Finally, the NIH is picking up most of the tab for fundamental research, and as such, it isn't the drug company that is leading innovation. As such, I find the drug development argument hollow.
> How many more statins?
Are you claiming that the existing statins address all relevant cases?
> which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion
That's a non sequitor.
> Finally, the NIH is picking up most of the tab for fundamental research
"fundamental research" isn't a significant fraction of the cost of drug development, aka "getting a drug into the pharmacy".
Added the link to my list of reading. Looks very interesting. I do share your cynicism that we have no tolerance for real change politically. The charge of socialism meets every single proposal that involves a little more government involvement.
Lack of government involvement is not the problem with U.S. healthcare. There is government intervention everywhere. My rule of thumb for determining whether an industry is a free market or not, is that I ask the question, "Can I start a business to solve the problem? Or am I legally prevented or constrained from doing so?" In the U.S. I am legally barred from implementing most of my business ideas that would fix the healthcare system, so I do not consider it a free market.
The problem with U.S. politics in general is that it is fractured. Policy is determined by the interplay of powerful, organized factions. Any government intervention gets captured by these factions, and the policy ends up hurting the general interest rather than making things better.
Here is a comment I made a while ago where I explain how American politics works in practice: http://news.ycombinator.com/item?id=557298
NO ONE WANTS A FREE MARKET SOLUTION FOR HEALTHCARE.
get over it.
a free market solution means dying baby gets turned away when parent has no money. otherwise it is not a market solution. no one wants this. no one. move to somalia, you can implement your plan there, life is cheap.
healthcare is not a business. no civil society is going to let you decline cusomters who cannot pay when it comes to keeping the baby alive.
I would think that not killing babies would be the kind of publicity advantage that really sets a business apart from its competition.
Reputation-based consumer feedback isn't a desirable mechanism in an industry where unsatisfied customers are dead customers (as opposed to e.g. dead batteries).
Only when it's a paid customer's baby.