BF2S Forums The devolution of medicine

blisteringsilence wrote:

What? No takers on my inflammatory statements or absurd assertions?

I didn't say they got them from the drug companies, I said they got them from the distributors, and I don't care how many fucking doctors you know, my best friend is a doctor, and it is more common than you think.  Do you think they are going to admit to it!?

Yes, I would agree that most drugs are going to have some side effects.  Headaches, nausea, cramps, etc. are all minimal side effects that are tolerable for a drug that is possibly saving some ones life.  However, when people start having heart failure, kidney failure, liver failure, etc.  These are side effects too drastic to accept regardless of whatever else the drug is supposed to do.

When large groups of people taking a drug start developing the same problems, maybe even life threatening, the drug companies should be responsible.  Doctors should not be liable for these problems, unless they continued to administer the drug knowing their was a problem, otherwise the responsibility should lay firmly at the feet of the drug companies.

blisteringsilence wrote:

Turquoise wrote:

the oligopoly that the AMA promotes in medical education (which keeps our patient to doctor ratio high), and the cartel behavior of the 5 big pharmaceutical companies in America are the main causes of the high cost and slow advancement of medicine.

I don't know about you, but I'm in favor of a centralized organization setting standards for medical education. This might shock you, but being a doctor is actually pretty hard. There's a lot to learn. Letting students from unaccredited med schools become licensed physicians is not a very good idea in my opinion. Also, don't forget that the AOA accredits and licenses DO's not the AMA.

If the military can accredit and license people as medics completely independent of the AOA, then I don't see why letting more schools into the market of medical education is such a bad thing.

If you'd prefer to keep the AOA as a monopoly over this education outside of the military, that's ok as long as they aren't trying to drive up the cost of medical services, but it seems like they are when you consider how high the patient to doctor ratio is in America compared to most other First World nations.  If the AOA was really interested in helping to provide more people with affordable healthcare, they'd let more schools into the field.

blisteringsilence wrote:

And I really don't see cartel-like action on the part of the major pharmaceutical companies. That would imply that they collude with one another to keep prices high, when in fact they are in constant competition with one another.

Oh really?  Why then, were the Hatch-Waxman Amendments to the Food, Drug and Cosmetic Act passed?  Could it not have something to do with collusion?  Afterall, the FTC seemed pretty concerned about it.

Last edited by Turquoise (2007-02-16 15:41:40)

Interesting discussion…

Now I’m not a MD so I can’t and wont argue about the medical system, but I'll gladly give you my thoughts about my American colleagues.

The main reason why the American judicial system is incorrect and creates a sue happy society is the fact that a lawyer can become really rich by winning a lawsuit.

The first problem with the American judicial system is the fact that it is merely a jury based system, meaning that even the smallest courts have a jury which means a verdict is the result of non-legal persons, most of the time based on their guts or their feelings instead of the law, which creates the possibility to receive extensive damages.

The second problem is the fact that the American judicial system uses punitive damages, which means parties – mostly companies - that are claimed to be liable, have to pay a considerable amount of money in excess of the real substantial damage, just to make sure they never do it again. The infamous lady with the hot coffee in her lap is a perfect example of this kind of damages.

The third problem in the American judicial system is the fact that an American lawyer is permitted to work at a ‘no cure no pay’ fee system, which means he doesn’t get paid when he looses the trial, but he takes up to 30+ % if he wins. The result of this is that he demands enormous remunerations, in the hope he can have a personal benefit.

The fourth problem may be the class action system, although I’m undecided on that topic.

Turquoise wrote:

So, again, the doctor to patient ratio in America vs. the ratio in most other First World nations doesn't bother you?  You don't think the AOA is just ensuring that the ratio is high so that services cost more through a controlled supply of doctors?

First of all, I don't know that the doctor:patient ratio in the US IS higher than other countries. I've looked about the internets for a bit, and I can't seem to find any papers documenting that fact.

Beyond that, no, I don't believe that either the AOA or the AMA is keeping the ratio high to ensure higher salaries. The number of docs that we can graduate in a year is dependent on the number of medical schools times the class size. ALL good medical schools keep class sizes small to ensure the best possible education for their charges. If you want more docs, you need more med schools. And neither the AOA or AMA have any control over the number of medical schools in the country. All they do is accredit them. If every state wanted to open a new medical school next year, and the programs were all of sufficient quality to be accredited, I have no doubt that the AMA and/or AOA would accredit them.

The faulty assumption you're making is that the cost of medical services is tied to the number of physicians, a la the classic supply/demand model. I would aruge that specific model doesn't apply. The vast majority of physicians set their service price points at what the medicare reimbursement rate is. AKA, there's no point in charging more than you're going to get.

Remember, the vast majority of medical expense outlays in the US are absorbed by insurance plans, be they of the private (HMO, PPO, etc.) or public (medicare and medicaid) type. There are very, very few people who pay out of pocket for their medical expenses.

Having more docs does not mean that services would be less expensive. The physician fee, while often making up the majority of an office visit, is but a small part of a hospital stay or outpatient surgical visit.

Turquoise wrote:

Think about what would have happened if it hadn't passed.  Now, think about how 5 major companies running an industry have in their best interests the practice of behaving like a cartel.  I don't see how you can say they aren't colluding when you look at the rising cost of prescriptions.

Again, you are drawing results from faulty assumptions. Rising prescription costs have nothing to do with anti-competetive practices of drug manufacturers.

First of all, I don't see how companies who, by their very nature, must compete with one another for market share would benefit from colluding to keep pharmaceutical prices high. They want their drug to be best, and therefore to have the greatest share. If a competeting drug is almost as good, but half the price, it will get a better initial share, but lose out in the long-term.

Prescription costs are going up for many reasons. Among them:

1. Research and development costs are skyrocking.
2. Ditto for trials for potentitally successful drugs.
3. Costs for FDA approval are also going up.
4. You have to have a huge cash reserve in case you get sued for some unforseen long-term consequence. Ask Merck.

Now, as to what medicine would have been like had the amendments not passed? It would have been more diffifult to get generics to market. The big pharmas would still have competed with one another. Prices might be higher. It's really hard to say. There's one school that believes that the expiration of patents and the easier path to generics inspried the drug companies to work harder at creating newer and better drugs, as they couldn't rest on their laurels and collect on a cash cow.

Turquoise wrote:

blisteringsilence wrote:

Remember, the vast majority of medical expense outlays in the US are absorbed by insurance plans, be they of the private (HMO, PPO, etc.) or public (medicare and medicaid) type. There are very, very few people who pay out of pocket for their medical expenses.

Is that why 40 million Americans are uninsured?

I don't define that as "very, very few people."

I would characterize this as another faulty association. The 40 million uninsured you quote are people who are not, by and large, involved in the medical system. They don't get regular checkups, they ignore disease, and then, when hospitalized, end up defaulting on the debt. This financial burden is then transferred to those who can pay, driving up healthcare costs across the board. I have worked at two non-profit hospitals, and each of them estimates what they call write off patients (those who can't pay, and the hospital writes off the charges) at 20% of their total admissions.

Not to mention, national estimates say that 25% of the 46 million uninsured (that's 11.5 million people) are elegible for either medicare or medicaid.

So, the question is, what percentage of medical costs are actual out of pocket expenses to the patient/consumer? According to the Rand corporation, 15% of the total cost of healthcare is borne by individuals, and the rest by insurers. So, assuming $1.6 trillion in health care costs in 2002, the citizens of the United States spent $240 billion of their dollars on healthcare. Subtracting from that the cost of insurance, the average citizen in the US (who of course doesn't exist) will spend $744 on healthcare. Of that, doctors and clinics will see $164. Hospitals will see $231, and he will spend $74 on pharmaceuticals, both prescription and nonprescription.

So, each person is handing his doc a check for $164 every year. From that, the doc has to pay the salaries of those in his or her office, rent, utilities, license fees, and (of course) malpractice insurance. Which, for some specialities in states without tort reform, may be more than he or she grosses in a year.

So, there you go. Why is healthcare so expensive? There are literally thousands of reasons. But, think about this:

In the last decade, physican income has risen about 25%. The cost of operating a practice has risen 66%, and malpractice premiums have risen 74%.

So who, exactly, are making out like the bandits here? It's sure as hell not the folks that practice medicine. The docs, nurses, paramedics, techs, we're all making way less money that we could make woking out in the "real" world.

Its a good thing we love what we do. If not, you'd be in pretty deep shit.

blisteringsilence wrote:

Turquoise wrote:

blisteringsilence wrote:

Remember, the vast majority of medical expense outlays in the US are absorbed by insurance plans, be they of the private (HMO, PPO, etc.) or public (medicare and medicaid) type. There are very, very few people who pay out of pocket for their medical expenses.

Is that why 40 million Americans are uninsured?

I don't define that as "very, very few people."

I would characterize this as another faulty association. The 40 million uninsured you quote are people who are not, by and large, involved in the medical system. They don't get regular checkups, they ignore disease, and then, when hospitalized, end up defaulting on the debt. This financial burden is then transferred to those who can pay, driving up healthcare costs across the board. I have worked at two non-profit hospitals, and each of them estimates what they call write off patients (those who can't pay, and the hospital writes off the charges) at 20% of their total admissions.

Not to mention, national estimates say that 25% of the 46 million uninsured (that's 11.5 million people) are elegible for either medicare or medicaid.

So, the question is, what percentage of medical costs are actual out of pocket expenses to the patient/consumer? According to the Rand corporation, 15% of the total cost of healthcare is borne by individuals, and the rest by insurers. So, assuming $1.6 trillion in health care costs in 2002, the citizens of the United States spent $240 billion of their dollars on healthcare. Subtracting from that the cost of insurance, the average citizen in the US (who of course doesn't exist) will spend $744 on healthcare. Of that, doctors and clinics will see $164. Hospitals will see $231, and he will spend $74 on pharmaceuticals, both prescription and nonprescription.

So, each person is handing his doc a check for $164 every year. From that, the doc has to pay the salaries of those in his or her office, rent, utilities, license fees, and (of course) malpractice insurance. Which, for some specialities in states without tort reform, may be more than he or she grosses in a year.

So, there you go. Why is healthcare so expensive? There are literally thousands of reasons. But, think about this:

In the last decade, physican income has risen about 25%. The cost of operating a practice has risen 66%, and malpractice premiums have risen 74%.

So who, exactly, are making out like the bandits here? It's sure as hell not the folks that practice medicine. The docs, nurses, paramedics, techs, we're all making way less money that we could make woking out in the "real" world.

Its a good thing we love what we do. If not, you'd be in pretty deep shit.

I suppose you'd support socializing medicine then, eh?  Without a socialized system, doctors are bound to keep getting stuck with people that don't pay.

But yeah, I agree with tort reform too.

CommieChipmunk wrote:

Kmarion wrote:

In Florida they cap the amount you can make off some of the frivolous lawsuits. It's really the solicitation of the lawyers that has generated this problem. Stop that and it may help. Also, try not to put murderous drugs in the market place. I'm sure if you want I could bombard you with links to the great 'oops' in the pharmaceutical business...lol

Yeah thats the thing.. you can't live with lawsuits, cant live without em.. there has to be a balance somewhere

Well, the same with women, im sure we'll find a balance over the next few million years. Lol

Turquoise wrote:

blisteringsilence wrote:

Turquoise wrote:

I suppose you'd support socializing medicine then, eh?  Without a socialized system, doctors are bound to keep getting stuck with people that don't pay.

But yeah, I agree with tort reform too.

I like the idea of socialized medicine. However, there's no good model to follow. I've yet to see a model that would work on the scale the US requires that also presents all the benefits of our fee-based system.

Not to mention, governmental control is never, in my experience, beneficial to those who are controlled. Socializing medicine might guarantee that a doc gets paid for every patient, but it also takes away his incentive to work harder and innovate. Why work to be the best if you're not going to get paid for it?

I guess that's my problem with socialism in general. I'm too cynical to believe that people will work for the common good.

Anyway, I belive that socialized medicine will lead to a decline in salaries across the board, a decline in quality of care, and a general fuckup of all the good things we have going for us here in the US. If someone proposes a system that works, well, let's do it. I just have never seen a system that does.

Here's an idea: state-based socialized healthcare.  Forget the federal government.  Most state governments are better at serving the needs of their people.  Each state could have a different plan, free of federal interference.

The problem with a state based system would be to just call it an extension of Medicaid. And that'll never fly. Medicaid is by and large the most refused insurance in the US. Many, many physicians refuse to accept medicaid patients becuase their reimbursements are so low. In Missouri, for example, for every dollar that Medicare will pay, medicaid pays about 11 cents. There's no financial incentive for physicians to accept it.

Therein lies the rub. There is NO good model of a nationalized healthcare system. In each of them, the drawbacks outweigh the benefits. It would require a whole new model, some real outside the box thinking. I'm not saying its impossible, just difficult.

Turquoise wrote:

blisteringsilence wrote:

Turquoise wrote:

Here's an idea: state-based socialized healthcare.  Forget the federal government.  Most state governments are better at serving the needs of their people.  Each state could have a different plan, free of federal interference.

The problem with a state based system would be to just call it an extension of Medicaid. And that'll never fly. Medicaid is by and large the most refused insurance in the US. Many, many physicians refuse to accept medicaid patients becuase their reimbursements are so low. In Missouri, for example, for every dollar that Medicare will pay, medicaid pays about 11 cents. There's no financial incentive for physicians to accept it.

Therein lies the rub. There is NO good model of a nationalized healthcare system. In each of them, the drawbacks outweigh the benefits. It would require a whole new model, some real outside the box thinking. I'm not saying its impossible, just difficult.

Here's the thing though...  if we shrank the federal government both in spending and in taxes, states could tax more and spend more on a Medicaid like system, so that it would pay doctors sensible amounts.

Which are fine ideas. But then the questions start coming. How do you ensure equal access without ending up like Canada and the UK? How do you provide coverage for experimental treatments (remember, people from all over the world come here for experimental treatments right now)? How do you ensure comparable quality of care to what we have now? What do you do with the private hospitals and clinics that exist now that refuse medicare/medicaid?

Again, its not that I'm against socialized medicine. I just don't see how it could be better than our current system.

Turquoise wrote:

blisteringsilence wrote:

Turquoise wrote:

Here's the thing though...  if we shrank the federal government both in spending and in taxes, states could tax more and spend more on a Medicaid like system, so that it would pay doctors sensible amounts.

Which are fine ideas. But then the questions start coming. How do you ensure equal access without ending up like Canada and the UK? How do you provide coverage for experimental treatments (remember, people from all over the world come here for experimental treatments right now)? How do you ensure comparable quality of care to what we have now? What do you do with the private hospitals and clinics that exist now that refuse medicare/medicaid?

Again, its not that I'm against socialized medicine. I just don't see how it could be better than our current system.

Good points, but I guess my question is this: with the way things are going, not many people will be able to pay for medical care in the near future.  So, what are we going to do when the average person doesn't pay?

I guess that I just don't see it that way. Anyone who wants to get health insurance can get it. It's just a matter of priorities. Many, many jobs offer health insurance. I know that when I worked for GeekSquad in college, Best Buy circulated a memo that stated that less than 20% of those who were elegible for health insurance elected to take the coverage. Now, there are many reasons (wife or husband of employeee has it, covered by parent's policy, etc), but lots of the folks in my stores just didn't want to pay for it. If they gave up cable, they could afford it. It's just a matter of sacrifices.