In the latest issue of Forbes, Peter Huber points out the hidden cost of efforts to cut prescription-drug costs: the US is currently the only major market supporting research into new drugs. Government efforts to bring down drug costs will no doubt make existing drugs cheaper; but they will also choke off the flow of new drugs, because the money needed to finance the research and development behind them will no longer be there.This points to the flaw in the reasoning of those who point to Canada and say, “Why can’t we do that? It works for them.” The fact is, their system only works as well as it does because of the US, which helps keep their costs down and their waiting lists more tolerable by treating many of their patients, and because the US’ open market effectively subsidizes their drug costs. It will be interesting to see, if the Democrats get their way and move the American health-care system hard left, what the other unintended consequences are for health care in Canada, and Mexico, and elsewhere in the world. I have a hunch they won’t be pretty.
As I’ve mentioned before – they’re not pretty now. It isn’t as if we are considering changing a system which works well for those involved in it. It doesn’t work well. It absolutely must change if we want to be anywhere near just and if we aren’t satisfied with an infant mortality rate commensurate with a third-world country (for example).
Doubtless there will be unintended costs to socialized medicine. The argument is whether it will, in total, be better than the monstrosity we have no which is neither public nor truly private, neither efficient nor affordable, etc.
Maybe we’ll need to change – instead of paying for millions going to the Emergency Room for routine medicine, we’ll have to pay for scientific research into medicine so those people can go to family practitioners instead. That just doesn’t bother me.
The point for me is: our system right now does not work. I don’t think we, as a nation, should tolerate it.
I agree that changes need to be made; it’s just a question of in which direction, because I want changes that make our system better, not worse. Having spent five years living in Canada–as a net beneficiary of the system, being a poor student–and having a pretty fair idea how much the Canadian system needs ours to prop it up, and knowing that it’s not just a matter of people “going to family practitioners instead,” but rather of people suffering and dying on waiting lists . . . well, suffice it to say, I’m quite convinced we won’t be better off going that way.
The problem isn’t really with “health care” per se. The problem is that our insurance system vastly deforms the cost structure. There are, I believe, several things which need to be done to start. First (this is my wife’s big thing), hospital prices need to be as public as the prices in any other industry; people need to know ahead of time what any given hospital is going to charge for any given procedure, for room costs, and so on. Second, we need to uncouple medical insurance from employment compensation; and third, we need to remove the massive incentives in the system for expensive and unnecessary care. The latter two can be partly taken care of by a move to medical savings accounts.
That third one, however, requires one additional step: dealing with the parasitic component of the insurance system–namely, trial lawyers and malpractice insurance. The fact that ATLA is virtually unfettered under rules which encourage unsubstantiated lawsuits designed only to force settlements is a major, major factor in the high cost of medical care. Obviously, in cases of real malpractice, lawsuits are entirely appropriate; but our legal system needs to respond sufficiently punitively to failed lawsuits to discourage those which are not justified.
Fourth, we need to get insurance companies out of the business of trying to make money by weeding people out who need insurance. I could see increasing premiums based on behavioral risk factors (e.g., smoking), but people ought not find themselves unable to buy insurance due to factors beyond their control. Time will tell if the Massachusetts program will work in the details, but the idea there was a sound one, I think.
Also, I should note–what I said “won’t be pretty” will be the consequences for the national health care systems which ours helps prop up (Canada, at the very least) if we do in fact socialize to any significant degree.
Further than that, if we want to make the tradeoff–much cheaper drugs for no new drugs–then so be it; but we need to realize that that’s the tradeoff we’re making.