Rumble in the health reform jungle

It’s Holt vs Hogberg:

. . . while I agree that there are serious problems with the U.S. health care system, I disagree on the solution. I think we need less government involvement and more freedom in the health care system, thereby letting free markets function properly. Holt would rather have us establish a government single-payer system.
Yet all of the studies I pointed to above compare the U.S. with single-payer systems. Since they show that single-payer systems are inferior in some vital ways, let me end this by asking Holt a question: Why do you want to give the U.S. a health care system that leads to more sickness and death?

Precisely. You will get no argument from me that the US health care system is in sad shape. However, implementing a single-payer, “Medicare-for-all”, pseudo-VA or some other government-run system will exchange the devil we know for something that may be far, far worse.

Comments

Mike
Well, one thing that would help is if we recognize that Pharma is allowed to charge what they want, while docters cannot. So despite the opinion of some congressional members, the govt should be able to bargain for better drug prices. Thats a huge chunk of healthcare dollars right there. This Medicare part D is just a big Pharma giveaway. And meanwhile, its cost doctors, nursiong homes, etc MORE in lost hours of time spent trying to figure out their demented formularies.
David Hogberg
Actually, the biggest expense is hospital costs. That is the area that needs the most competition.
As for drugs, letting government negotiate for programs like Medicare will only result in higher drug prices for the private sector. If we want lower drug prices, we should deregulate–let the FDA only test for safety and not efficacy. Plus, let drugs that have been through the approval process in Europe receive expedited approval here.
Mike
I honestly can’t see how negotiating would drive up prices, but that is the argument the opposition loves to make.
Also, the FDA should be testing for efficacy, not stopping that. And the Ketek fiasco proves that European data is not a substitute for FDA funded studies. What should happen there is Congress should demand that more of PDUFA user fees be used for these studies.
Hospital costs are a big problem also, but the drug issue is more easily addressed.
David Hogberg
The reason that letting Medicare negotiate drug prices will raise the price in the private sector is that when a government program “negotiates” drug prices, it starts by demanding that the drug company gives the government the “average” price in the private sector. The drug company then has the incentive to drive the price as high as it can in the private sector so that the reimbursement it gets from the government is higher. There is that this has happened with Medicaid (Go here: http://www.nber.org/papers/10930).
As for the FDA, it’s a simple trade off. The longer and more cumbersome the approval process, the more drugs are going to cost. I see little harm in letting the market determine efficacy–loads of drugs have “off-label” uses anyway, suggesting that the market is pretty good at figuring out how best to use a drug.
And, sure, the European approval process is not perfect, but then neither is the FDA process. Again, it is trade-off: drugs will continue to cost more if we make them go through the approval process here when they have already been tested in Europe.
If we want lower cost drugs, we need to deregulate.
Anonymous
Those of us who want freedom begin to lose the debate when we allowed our opponents to chose the terms, the first being system. The status quo always loses in comparison to any health care system because it isn’t a system. We have several healthcare systems in the US, but not a system. The VA is a system. Medicare is payment system. FFS medicine can be considered yet another system. The mental health centers-state psych hospitals yet another. Department of defense.
What we should be asking ourselves first and foremost is “Do we want a System? Or we prefer multiple disconnnected systems with the freedom, competetion, and potential for mutual learning which that presents-at the price of the risk of falling in the cracks between them and a certain amount of chaos and ineffeciency?”
I vote for freedom. I vote for continuing to not have a US Healthcare System.

Rumble in the health reform jungle

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