Off-topic: Government healthcare proposals

You are probably right. At least the government provides grants to universities for basic research. As I understand it, a problem with the drug companies is that they do not research drugs for rare and little-publicized conditions and diseases that are not likely be in demand and be big money makers. I guess an analogue of the "public option" insurance idea would be an entire government-operated drug company that competes with the private companies in not only finding the drugs but also distributing them and getting them to market.

Unfortunately that should not and probably will not change a lot. There will always be limited resources and the resources that are available should be applied to help the greatest number of people.

The utilitarian concept makes good sense under the assumption of fixed resources. But perhaps there are enough resources to help both many people with common diseases and the few with rare diseases, provided there is efficient allocation of those resources. For example, maybe it is not really necessary to produce five different drugs to combat cholesterol. Maybe one or two would be enough, and the savings could then be applied to find something for other conditions you don't hear much about in the news. Also, new information gained from research into rare and unusual conditions could eventually lead to better understanding of more common conditions.

Great example except... There are some people who develop severe muscle pain caused by destruction of the muscle tissue when they take statins and it can be a serious problem. I happen to be one of those people. My cardiologist tried four (of the five available) statins before finding one I could tolerate. When I was first put on statins my LDL was not extremely high and when I developed myalgia and high CPK the solution was to stop the statin. Eighteen months later I had a heart attack and now have a stint in one of my coronary arteries so tatking a statin is important to my survival. Like I said, great example. You just picked te wrong guy to use it on.

If there are tens of millions of people who have high blood pressure, producing 15 drugs that each work a little differently, and may be better for a few hundred thousand people each, is better than developing a drug for a disease that affects on a few thousand people a year globally. Twenty years ago, I could not take any of the medications on the market without getting some pretty nasty side effects. Now I have a couple of choices. I am sure I did a lot of damage to my cardiovascular system during the fifteen years that I was not treated consistently. This may or may not knock years off my life (maybe I will be hit by a bus) but across the millions who are like me, I am sure the newer meds are going to add millions of years of life.

Sorry about that! Lets substitute "pain relievers" for "statins" in the example. But we could expect stil more savings if we could completely eradicate smoking, excessive alcohol consumption, and obesity. (My apologies in advance if you are an obese smoker and drinker.) Come to think of it, there are a whole lot of stop-smoking remedies on the market. Wouldn't one or two suffice? And the number of weight-loss programs must be astronomical.

We have a winner! I am not obese, do not drink and quit smoking 41 years ago.

I agree with you whole heartedly. I recently read an artilcle that estimated the cost of excessive salt consumption, alcohol consumption, smoking and obesity at almost $900 million annually.

On reflection I think the cost was almost $900 billion, not million.

I get a kick out of this part of the thread in particular. Imagine if the whole country could be talking the way you (and also my hero(!), Safeway CEO Steve Burd) are here. Helping people "get" that our national problem with health care, and people's personal problems with it, could largely be helped by taking specific measures involving smoking, obesity and drinking should be a national theme. Ideally I think translating it to bucks per individual, and giving them specific financial incentive, the way Burd does with his employees with he reports a fabulous quantifiable return on investment dollars, would be compelling.

I am sure it is something some lofty (and so deprived IMO) minds might guffaw at, but to me one of the most exciting and important TV shows on the air today is "The Biggest Loser." It is a glimpse of some of the most downtrodden (meant a few ways) of America. It is uplifting, too. I know the show's producers are about money. But for gosh sake, they also seem to get that for the show to continue to be successful, its contestants must not only lose weight, quit smoking etc., but keep it off and never take another cigarette. There is amazing emphasis on strategies for contestants to take the show's lessons and make them last for the rest of their lives.

Smokers and drinkers pay taxes. Taxes are a high percentage of the cost of alcohol and tobacco. Taxes that go to fund health care in Canada. We need more smokers and more alcoholics to help pay for this public health system.

Unfortunately Canada has a public health insurance plan. This needs to be paid for by tax revenue. Income and corporate taxes plus various user fees cannot cover all the costs that government agencies are burdened by. So taxes on smoking, gambling, alcohol, and one hopefully one day soon sex and drugs, will go far in making sure the funds will be available to cover the great costs associated with public health insurance.

Smokers and alcoholics die younger saving our pension systems and health care dollars. Taxing salty and fatty snacks and restaurant foods is fine by me. The people that consume these product choose to live shorter lives while quite willingly choosing to pay far more in taxes.

What needs to be discussed in this thread is how much revenue health care will be REQUIRED from smokers and salty food eaters. Healthy people don't exactly provide a reliable tax base.

I would say the health of ALL the people, including smokers, drinkers, and obese people, comes first, and the question of how much tax revenue is needed to provide health care and where it comes from should be considered later. Not only Canada, but also other responsible industrialized nations in Europe and elsewhere seem to get along quite well with their public programs, and they don't fuss about taxes. The people in those enlightened nations will opt for a USA-style health care system when hell freezes over.

I have quite a number of Canadian friends and the majority of them are not enamoured of their health care system. A typical example of many stories they tell is the wife of a friend of mine who herniated a lumbar disc and was in extreme pain. The pain was so severe that it could not be completely suppressed by narcotic pain killers. The wait for an operating room was nine months. Fortunately, they could afford to venue shop and by checking operating room backlogs in some smaller communities in the prairie provinces they got the wait down to four months. I recently had the same problem in the U.S. and the time from onset of symptoms to surgery was four weeks.

Another friend who lives in Toronto, when told that the wait for a MRI for his son was six weeks elected to drive to Buffalo and pay for the procedure himself. Once he had the MRI which showed that his son's condition was life threatening he was able to get immediate surgery in Canada but the boy had an anyeurism and if his parents had waited for the national health the anyeurism might have ruptured and the boy would be dead.

Not all other industrialized nations have systems that are better than ours in every way all though quite a few appear to be better than both ours and Canada's. There is a lot of variety between Canada, England, Germany and Sweden as examples. The choice is not as simple as saying, "Everyone does it better than we do so we should just do what everyone else does."

I live in Canada and have heard similar complaints about long waits for operations. However, I have never met a single Canadian who suggests abandoning government insurance and changing over to an American-style system. Serious life-threatening conditions get quick action, and the long waits are mostly for less serious, elective procedures. I guess there are unfortunate exceptions like the one you described, but on the whole I think the record is good. Nobody in Canada goes bankrupt because of illness.

I certainly did not mean to imply that the Canadians I know would like to abandon the national healthcare system, particularly for what we have. I do know many who would like to see some things about the system changed.

The point I was trying to make is that there are not just two systems, the U.S. and the rest of the industrialized world. There are differences country to country and they all have positive benefits and limitations. The decision that the U.S. has to make is more complex (even ignoring the political issues) than just deciding whether or not to go to "the system" used by the rest of the industrialized world which is the way I interpreted your message.

One thing that I do not understand here in the U.S. is why most people seem to be unable to grasp the idea that when it comes to healthcare demand will always exceed supply. Therefore, there will always be some form of rationing. The trick is to design a system that rations healthcare in a way that is least onerous to the citizens.

That is the best concise summary I have ever seen. Thanks.

By the way, with regard to the income difference, it seems like a third of the physicians I have seen in the last 15 years went to medical school at McGill.

Yes, I agree completely. Many Canadians complain and want a better system, but what they usually have in mind are systems like those in places like France, Britain, or Australia, certainly not the USA.

Agreement here too. Another interesting comparison could be made between medical education in the two countries. This is just a personal impression, but it seems to me that medical schools are more selective and more rigorous in their training in the USA than in Canada. Some people get through in Canada who wouldn't make it in the USA. Furthermore, for the very reasons you mention about earnings and wealth, a lot of Canadian doctors find their way South of the border. Despite these diffefences, it is still true that most people needing health care are better off North of the border.

My #1 point of contention is a level playing field for the people which RECEIVE the healthcare.

Level playing field needs to happen in many ways, on many fronts.

Examples:

1) You and I need access to the same insurance plan with the same coverage regardless of employer or pre-existing conditions 2) If you or I go to same city/region to have a given procedure done, that cost must be the same with minor exceptions meaning my MRI costs the same as your MRI. Exceptions could be that if you are a hospital, there might be an additional fee for the orderly or nurse which wheeled you into room. But the most important thing is that if both you and I had the same MRI done at same location, it cost the same whether you or I had insurance, or what insurance we had (standard pricing). 3) I think 60 minutes did something a few months back on areas with high populations and high cost of health care per person did not have lower mortality rates than locations which spent less money per person. This probably gets aligned with some "end of life care" issues, but the point is spending more per person is not the answer, so the "costs of care/ treatment" need to be in line with a level playing field- everyone needing a given service in a pre-defined area should be paying the same cost. **The point of level playing field is to get "true costs" disclosed and then let free markets take control of pricing. Right now, most people could not tell you how much a given service really costs because of markup before insurance companies mark prices down.**

Point #2 for me is that people should expect to pay for the health care they receive. Treating people for free is just bad economics. My personal example is that my wife was pregnant slightly more than 24 months ago. In Feb of 2008 she was admitted to hospital, and in March of 2008 I had twin boys which were born 3 months early. One spent 11 weeks and one spent 13 weeks in one hospital or another. We could tell that about 1/3 to 1/2 of the beds (space) in the NICU were people which probably could not pay for their coverage. Our insurance paid everything after $150 and $50 payments (Wife and each kid paid $50 for admittance to hospital A and baby C paid another $50 when transferred to hospital B). The total "Bill" for all 3 was well in excess of $1 M (400k, 300k, 500k I think for wife, baby R and baby C). Best guess is the hospital has to "mark up" our beds to pay for the free beds we saw in the NICU.

Point #3 if a person cannot pay for the health care they receive, there should NOT be markup for services I receive because I can afford to pay. I think this is the million dollar question (how is this solved?), but bottom line is this for me

1) level playing field for obtaining insurance- allow it to be sold like life insurance or similar, and the insurance must be just as good as that I can get from my employer. How this is done does not matter, but level the playing field for how insurance is obtained so everyone can get access to it. 2) If you receive health care, the expectation is you pay for it. Every american tax payer should be expected to pay $X per year in health coverage (like an HDHP or similar). $X might be $2000, $5000 or $10,000. The government should come up with a number, give tax credits to low income people if the money is spent, and similar incentives in this regard, but the expectation should be you pay for health care, then resolve your tax return to possibly get refunded for money spent. 3) It is not up to the people which can afford to pay to pay more to subsidize the people which refuse to pay.

My rant will read beyond first page of posts now.