Wiki: health care in the United States

[Thiebear]

I was reading some GOOD things in healthcare in the US and thought to share....

http://en.wikipedia.org/wiki/Health_care_in_the_United_States

However, the revenues generated from these high healthcare costs have encouraged substantial investment: the United States dominates the biopharmaceutical field, accounting for three quarters of the world’s biotechnology revenues and spending in research and development.[7] In addition, the U.S. produces more new pharmaceuticals, medical devices, and affiliated biotechnology than any other country, or the Western European nations combined.[7][8][9][10]

Medical products, research and development

The United States is a leader in medical innovation. In 2004, the health care industry spent three times as much as Europe per capita on biomedical research.[10] Companies provide medical products such as pharmaceuticals and medical devices. In 2006, the United States accounted for three quarters of the world’s biotechnology revenues and 82% of world R&D spending in biotechnology. [7][9]. The amount of financing by private industry has increased 102% from 1994 to 2003.[20] Most medical research is privately funded. As of 2003, the NIH was responsible for 28%—about $28 billion—of the total biomedical research funding spent annually in the U.S., with most of the rest coming from industry.[20] The National Institutes of Health play a larger role in funding basic research.[citation needed]

The top five U.S. hospitals carry out more clinical trials than all the hospitals in any other country. Between 1975 and 2008, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In 29 of the 34 years between 1975 and 2008, a scientist living in the U.S. either won or shared in the prize.[21]

[JMS]

I was reading some GOOD things in healthcare in the US and thought to share....

http://en.wikipedia.org/wiki/Health_care_in_the_United_States

So the problem I have with the statements is the implied relationship between the huge healthcare costs the American consumer is forced to pay and the research done in pharmaceuticals, biomedicine, and medical engineering. That's a very misleading assumption. The facts are the United States Government underwirtes most research for pharmaceuticals and biomedicine in this country and its pateints are used for free by the industries when they bring new products to market.

The federal government does this because they want new ideas to get into products faster, which paying for research and giving away the work product of that research to the drug companies does. Good things. But it also releaves the industries from having to pay for most of the research they benifit from.

I would argue our "productivity" in these feilds has everything to do with our federally underwritten industry friendly research policies and less to do with the American consumers of that industry getting raped on cost...

Big business gets the money coming and going, it's what happens when they get to write all the laws govering their industry for three decades.

[stevenaa]

So the problem I have with the statements is the implied relationship between the huge healthcare costs the American consumer is forced to pay and the research done in pharmaceuticals, biomedicine, and medical engineering. That's a very misleading assumption. The facts are the United States Government underwirtes most research for pharmaceuticals and biomedicine in this country and its pateints are used for free by the industries when they bring new products to market.

The federal government does this because they want new ideas to get into products faster, which paying for research and giving away the work product of that research to the drug companies does. Good things. But it also releaves the industries from having to pay for most of the research they benifit from.

I would argue our "productivity" in these feilds has everything to do with our federally underwritten industry friendly research policies and less to do with the American consumers of that industry getting raped on cost...

Big business gets the money coming and going, it's what happens when they get to write all the laws govering their industry for three decades.

How about providing some factual data to back up your assertion. Maybe you're assumption is fairly accurate. But this is the problem with this debate. People throwing out spin as if it is fact to bolster their opinion.

[HailYeah]

Its difficult to characterize the exact relationship between govt R&D spending and pharma profits. Govt used to spend 10x more on R&D than the private sector. As the companies have gotten bigger and more international (able to export R&D services to cheaper areas) their spending has gone up. One thing is for sure: govt funded basic research lays almost all the scientific ground work for private, for-profit, research. This is just a fact. Here is an older, but still relevant, CBO report that verifies this:

http://74.125.47.132/search?q=cache:hBmJAYmwIV4J:www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf+federal+r%26d+spending+pharmac&cd=4&hl=en&ct=clnk&gl=us

I think the market plays a crucial role for innovation, sure. But the fact remains that none of it would happen without the govt kick-start. Pharma corps have no incentive to do basic research. If there is a market solution to that, I'd like to hear about it.

[JMS]

How about providing some factual data to back up your assertion. Maybe you're assumption is fairly accurate. But this is the problem with this debate. People throwing out spin as if it is fact to bolster their opinion.

In 2003 the NIH and NASA spent 22.8 billion on health R&D. about 25% of all federally funded research went to healthcare R&D, more money and a higher percentage of total research dollars than any other country on earth.

On top of that, from 1998 to 2003, the U.S. government more than doubled the National Institutes of Health's annual R&D budget, from $13.1 billion to $26.4 billion. Meanwhile, NASA's R&D budget grew from $9.7 billion to just $10.7 billion, barely keeping pace with inflation. According to numbers compiled by the National Science Foundation, the U.S. government spent nearly 25 percent of its total R&D investment on health, compared with 18 percent by the United Kingdom; 16 percent by Canada; 12 percent by Italy; 7 percent each by Germany, France, and South Korea; and just 6 percent by Japan.

http://www.spectrum.ieee.org/computing/hardware/rd-100

[PeterMP]

Its difficult to characterize the exact relationship between govt R&D spending and pharma profits. Govt used to spend 10x more on R&D than the private sector. As the companies have gotten bigger and more international (able to export R&D services to cheaper areas) their spending has gone up. One thing is for sure: govt funded basic research lays almost all the scientific ground work for private, for-profit, research. This is just a fact. Here is an older, but still relevant, CBO report that verifies this:

http://74.125.47.132/search?q=cache:hBmJAYmwIV4J:www.cbo.gov/ftpdocs/76xx/doc7615/10-02-DrugR-D.pdf+federal+r%26d+spending+pharmac&cd=4&hl=en&ct=clnk&gl=us

I think the market plays a crucial role for innovation, sure. But the fact remains that none of it would happen without the govt kick-start. Pharma corps have no incentive to do basic research. If there is a market solution to that, I'd like to hear about it.

A couple of points:

1. Private industry does help defer some of those costs long term. Institutions (in many cases public ones that are funded in some manner by tax payers) patent discoveries made as a result of work. Those patents are then frequently sold or licensed to private industry. This obviously doesn't totally pay the costs because you are only benefiting from successful research, but there is certainly a contribution.

2. There are other economic considerations w/ respect to employment. There are employment restrictions on companies using patents developed through federal funding (i.e. you have to employee people in the US that are doing work based on those patents). This obviously has a positive affect on the US economy.

3. The notion of drugs costs are really an issue is a bit misplaced:

http://www.nytimes.com/2007/09/21/business/21generic.html

"Annual inflation in drug costs is at the lowest rate in the three decades since the Labor Department began using its current method of tracking prescription prices. The rate over the last 12 months is 1 percent, according to the government’s latest data, released Wednesday."

We WERE paying a lot for drugs because there had been a lot of recent innovation in the industry. Essentially, that's what patent laws allow and most people that have looked at the issue have agreed patent laws (to at least some extant) are good. As the innovation in the industry has decreased, drug prices have come down. (The innovation was driven by other technologies, including computers and other biotech advances. We will now be in a lull until there is the next real advance in some related technology.)

There is an issue w/ drug use though:

"Despite the slowed inflation recorded by the index, overall spending for pharmaceuticals is still on the rise, up 8.3 percent in 2006, according to IMS. And that is unlikely to diminish anytime soon, as an aging population faces increasing health problems. According to Medicare, there have been great increases in the use of drugs for the cardiovascular and central nervous systems and for Type 2 diabetes."

If there is really an issue with respect to drug costs (which I'm dubious of), then the way to address it is by changing patent laws, not by inventing some sort of new scheme to create new government regulation/involvement.

Simply making patents more specific (they've been becoming more and more general), more focused, and/or shorter can achieve whatever cost/benefit ratio that is desired. Just remember, industry NEEDS good profits during high innovative periods (like we had in Pharma from about 1985-2000) to pay for and attract investors through periods with low innovation.

[PeterMP]

In 2003 the NIH and NASA spent 22.8 billion on health R&D. about 25% of all federally funded research went to healthcare R&D, more money and a higher percentage of total research dollars than any other country on earth.

That doesn't actually address a single point that you made really. You'd need to compare that to how much money was spent on R&D by private industry (and I'm not saying you are wrong, just that this reply doesn't actually back up what you said).

It does raise the question if we should slow down our health related research because we can't even afford what we have now and shift that money to other things.

**EDIT**

Of course, I'd love to see a politician stand up and say they were stopping fuding research on Alzhemiers because it isn't cost effective and that money could be better spent.

[JMS]

Its difficult to characterize the exact relationship between govt R&D spending and pharma profits. Govt used to spend 10x more on R&D than the private sector. As the companies have gotten bigger and more international (able to export R&D services to cheaper areas) their spending has gone up. One thing is for sure: govt funded basic research lays almost all the scientific ground work for private, for-profit, research. This is just a fact. Here is an older, but still relevant, CBO report that verifies this:

Right the federal gov funds the basic research. The Drug companies fund best case figuring out how to use those discoveries in marketable drugs.

About 8 years ago the Federal government doubled it's drug R&D budgets. It takes about 10 years to bring new discoveries to market. So one would expect for drug companies to ramp up their R&D efforts to take advantage of all the new discoveries coming out of the twice as large federal base research.....

Two thoughts. The actual growth in private spending has not increased to scale. The best case scenario is not the real scenario. Drug companies typically don't spend most of their R&D budgets on new drugs. It's too risky even with the Government paying for the lions share of the research. They spend their R&D budgets on tweaking old drugs, which allows them to extend patents. A much more lucritive and less risky practice. The actual number of new drugs brought ot market under our system isn't very high if you take out the reworked patent for expiring drugs.

[PeterMP]

Right the federal gov funds the basic research. The Drug companies fund best case figuring out how to use those discoveries in marketable drugs.

About 8 years ago the Federal government doubled it's drug R&D budgets. It takes about 10 years to bring new discoveries to market. So one would expect for drug companies to ramp up their R&D efforts to take advantage of all the new discoveries coming out of the twice as large federal base research.....

You ignore the relation to other technologies. Computers (and other things) changed how drugs are made and found. Lot's of "easy" fruit was picked leaving very hard to get fruit left. An increase in R&D funding does not mean there will be an increase in discoveries.

Two thoughts. The actual growth in private spending has not increased to scale. The best case scenario is not the real scenario. Drug companies typically don't spend most of their R&D budgets on new drugs. It's too risky even with the Government paying for the lions share of the research. They spend their R&D budgets on tweaking old drugs, which allows them to extend patents. A much more lucritive and less risky practice.

Do you have any numbers to back these things up?

Quoting from the CBO report posted:

"In 1980, U.S. companies spent a total of $5.5 billion (in 2005 dollars) on

research and development of pharma-ceuticals and medicines, according to the National Sci-ence Foundation (NSF). By 2003, that figure had grown to more than $17 billion an average increase of 5 per-cent per year in real terms (see Figure 2-1)."

That's a pretty nice increase. Pharma estimates it has even spent more (the report details the differences between the NSF and Pharam numbers).

The actual number of new drugs brought ot market under our system isn't very high if you take out the reworked patent for expiring drugs.

Compared to what?

[JMS]

You ignore the relation to other technologies. Computers (and other things) changed how drugs are made and found. Lot's of "easy" fruit was picked leaving very hard to get fruit left. An increase in R&D funding does not mean there will be an increase in discoveries.

I don't get your logic? Cause the 486 came on the market 10 years ago it and the 8088 allowed the Drug companies to know "the low hanging fruit", but the increases in efficiency since that time with computers doubling in speed every 18 months since that time and the Pentium based I, II, III are not as benificial to drug research? The "low hanging fruit" isn't effected by computers 10 times as powerful costing half as much?

We should 'expect' the same or less research being done for twice the Federal Budget and orders of magnatude better computers?

Makes no sense to me, but you are more familiar with drug research than I am.

Do you have any numbers to back these things up?

Quoting from the CBO report posted:

"In 1980, U.S. companies spent a total of $5.5 billion (in 2005 dollars) on

research and development of pharma-ceuticals and medicines, according to the National Sci-ence Foundation (NSF). By 2003, that figure had grown to more than $17 billion an average increase of 5 per-cent per year in real terms (see Figure 2-1)."

That's a pretty nice increase. Pharma estimates it has even spent more (the report details the differences between the NSF and Pharam numbers).

Compared to what?

In 2003 NASA and NIH spent 37.1 Billion or more than 200% the industries 17 Billion just in those two federal agencies. Not sure if other government agencies besides NIH and NASA sponcor medical research.

Oh and let's also not forget the Bush Federal government gave the Medical Industry including the Drug Companies an 800 Billion dollar subsidy as part of the Medicare Part D plan. That 17 billion dollars they spend on R&D is looking smaller and smaller.

On top of that, from 1998 to 2003, the U.S. government more than doubled the National Institutes of Health's annual R&D budget, from $13.1 billion to $26.4 billion. Meanwhile, NASA's R&D budget grew from $9.7 billion to just $10.7 billion

http://www.spectrum.ieee.org/computing/hardware/rd-100/0

The broader point is American Drug companies spend more money on advertising than they do on R&D, and the majority of their R&D is paid for by the federal government and given to them for free. It's hard to claim the American Consumer benifits from paying 200% times what other countries citizens do because the Drug companies put out more porducts. With the Federal governemnt picking up the lions share of research dollars, that alone could explain the difference in bringing new drugs to market.

Again American Drug companies treat R&D as an afterthought. It's less important to them than advertising by nearly 2-1.

[JMS]

Do you have any numbers to back these things up?

Quoting from the CBO report posted:

"In 1980, U.S. companies spent a total of $5.5 billion (in 2005 dollars) on

research and development of pharma-ceuticals and medicines, according to the National Sci-ence Foundation (NSF). By 2003, that figure had grown to more than $17 billion an average increase of 5 per-cent per year in real terms (see Figure 2-1)."

On Drug companies spending more money on reworking existing drugs to extend their patents ( lucritive and more predictable) rather than exploring new drugs for market as the OP suggests..

NEW YORK (CNNMoney.com) -- As Big Pharma faces patent expirations on some of its most lucrative drugs, the industry is trying to reinvigorate sales by finding creative ways to land new patents - but on the same old drugs.

The industry is losing some $16 billion worth of annual sales this year because of patents that will expire; last year it suffered $23 billion in patent losses, according to the research firm IMS Health. And despite clever reformulations of popular patented drugs like Lipitor and Zyrtec, Pfizer (up $0.13 to $25.67, Charts) and other industry leaders are discovering that there is no substitute for the ever-elusive new blockbusters.

But since new blockbusters are hard to find, drug companies are tweaking their existing drugs -- by creating extended release versions for instance -- in order to get new patents on old drugs. Drugmakers are also combining drugs whose patents are set to expire with other drugs to create entirely new products, and new patents. These patent-extension tricks certainly help to cushion the blow of the sales vacuum created by patent expirations, but they're no substitute for new products worth billions.

http://money.cnn.com/2007/03/21/news/companies/drug_patents/index.htm

Big Pharma's battles to extend and protect its drug patents are hard-fought, but they ultimately cannot compensate for a weak research and development pipeline

http://money.cnn.com/2007/03/21/news/companies/drug_patents/index.htm

[ddub52]

We also have 4 MRI machines for every one MRI machine that any other country on the planet has.

[Predicto]

I don't see a think in any of these posts explaining why our huge spending on the noncompetitive private health care INSURANCE industry provides us with any particular side benefits.

Big Pharma is not the same as Big Insurance. Big Pharma provides our society with drug breakthroughs. Big insurance provides our society with... what? Big paperwork? Big profits for its investors?

[PeterMP]

I don't get your logic? Cause the 486 came on the market 10 years ago it and the 8088 allowed the Drug companies to know "the low hanging fruit", but the increases in efficiency since that time with computers doubling in speed every 18 months since that time and the Pentium based I, II, III are not as benificial to drug research? The "low hanging fruit" isn't effected by computers 10 times as powerful costing half as much?

We should 'expect' the same or less research being done for twice the Federal Budget and orders of magnatude better computers?

Makes no sense to me, but you are more familiar with drug research than I am.

They are a benefit, but they don't have the same magnitude of affect (I will point out that I did say there was more than computers).

I have multiple instruments that are being run by a Pentium II (or even less). If I want to measure something that is changing (so I get a plot of x vs. y) and then get the slope of the line, the difference between me having a paper strip chart printout and having to calculate the slope of the line myself and even a Pentium I computer to "record" the data electronically and automatically calculate the slope itself is VERY significant in terms of time (to the point that depending on the other factors involved, I can easily create a situation where more of my time is spent on data analysis (measuring slopes on lines of strip chart recorders) than actually doing experiments in one situation, but the time in the other is very insignificant). The difference between a Pentium I doing it and a Pentium M isn't really significant.

Another example is polymerase chain reaction (PCR) (itself a discovery that greatly helped). To do PCR, you have a tube and on a scheduele the temperature of the tube has to change. This used to consist of somebody setting up a bunch of water baths (and/or heat blocks) at different temperatures and walking around with a timer and at the proper time moving the tubes from one to another. Of course this had to be done during the day, when a researcher was around to keep track of the time and move the tubes around.

Computers combined with improved robotics allowed for the creation of machines w/ different temperature controlled blocks. The computer can track and control the temperature and the time. The robotic arm moves the samples based on the control of the computer. So right off the bat, some researcher has less responsibility, but the thing is now you can do your PCR overnight, while you are at home, and come in the morning and start worrying about if it worked.

Again, PCR machines have gotten nicer and more fancy, but the improvement hasn't been as great in terms of real resource management as the first few steps.

Think about it like this. Since the invention of the grocery store scanner, has your experience at the grocery store improved dramatically?

No, they are slightly better, but nothing compared to when somebody had to punch in the numbers for all of the products vs. the scanner. Samething in biomedical research.

The broader point is American Drug companies spend more money on advertising than they do on R&D, and the majority of their R&D is paid for by the federal government and given to them for free. It's hard to claim the American Consumer benifits from paying 200% times what other countries citizens do because the Drug companies put out more porducts. With the Federal governemnt picking up the lions share of research dollars, that alone could explain the difference in bringing new drugs to market.

Again American Drug companies treat R&D as an afterthought. It's less important to them than advertising by nearly 2-1.

1. Do you have a link for 200% more? I see total savings of 20-80% on name brand drugs (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1936287), and generics tend to cost more in Canada so it isn't even that large.

2. I agree. We should tell other developed nations to stop fundamentally altering the market for prescription drugs. I wonder what the Canadians would do if we did the samething w/ respect to their lumber in order to help ensure everybody had lodging.

3. I've already pointed out that the last few years prescription drug prices are rising SLOWER than inflation in the US.

4. As I've already stated above, there are various economic benefits essentially paid by the Pharma industry that would make the conclusion that they paid for none of it incorrect.

[PeterMP]

On Drug companies spending more money on reworking existing drugs to extend their patents ( lucritive and more predictable) rather than exploring new drugs for market as the OP suggests..

I don't see a single dollar figure on how they are spending their money, much less how it has changed.

[stevenaa]

I don't see a think in any of these posts explaining why our huge spending on the noncompetitive private health care INSURANCE industry provides us with any particular side benefits.

Big Pharma is not the same as Big Insurance. Big Pharma provides our society with drug breakthroughs. Big insurance provides our society with... what? Big paperwork? Big profits for its investors?

It think it's a huge stretch to say the health insurance industry hasn't provided benefits. I'm sure you can easily look around in the lives of your own friends and family and find examples of medical expenses covered by insurance. When my nephew had to have his scalp peeled back and his skull reshaped, his parents didn't have to be concerned about costs. He spent the first 2 years of his life in and out of hospitals. They never had to be concerned about it. He sees the leading professionals in the field for his disorder. World reknowned, and they don't have to worry about expense.

My daugher has Scoliosis and gets multiple thousand dollar braces several times a year. Doesn't cost me a dime. If she progresses to needing surgery, it will be fully covered. No worries about it at all.

When my 65 year old father needed a stint in his carodic artery, insurance covered it. He pushing 70 and his insurance covers whatever he needs.

I can go on endlessly with examples from friends and families benefiting, and yet I have no personal knowledge of anyone being denied services. Obviously that's a trivial sampling, but I think there have been tremendous benefits due to healthcare insurance.

[JMS]

They are a benefit, but they don't have the same magnitude of affect (I will point out that I did say there was more than computers).

I have multiple instruments that are being run by a Pentium II (or even less). If I want to measure something that is changing (so I get a plot of x vs. y) and then get the slope of the line, the difference between me having a paper strip chart printout and having to calculate the slope of the line myself and even a Pentium I computer to "record" the data electronically and automatically calculate the slope itself is VERY significant in terms of time (to the point that depending on the other factors involved, I can easily create a situation where more of my time is spent on data analysis (measuring slopes on lines of strip chart recorders) than actually doing experiments in one situation, but the time in the other is very insignificant). The difference between a Pentium I doing it and a Pentium M isn't really significant.

Thanks for taking the time to go over that for me. The article I posted from IEEE says computer hardware and software actually get more R&D money than the medical fields, so maybe you have even more efficiencies to look forward too in the coming future.

1. Do you have a link for 200% more? I see total savings of 20-80% on name brand drugs (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1936287).

I did the calculation myself. You published a 17billion dollar number for drug research done in 2003. My link quoted NASA and NIH spent 37.1 Billion in 2003. 37 is more than 200% of 17 billion. ( did that in my head too.. so feel free to check it. )..

2. I agree. We should tell other developed nations to stop fundamentally altering the market for prescription drugs. I wonder what the Canadians would do if we did the samething w/ respect to their lumber in order to help ensure everybody had lodging.

Actually I think it works the other way around. They have a better case against us. We are free to not sell the Canadians drugs if we like, nobody can force us to sell them at a lose... Course we aren't loosing on the Canadian sales. The drug companies sell the Canadians and everybody else drugs at 50% cheaper cause it's profitable to do so.

The Canadians on the other hand would have an excellent case against us if they claimed we were unfairly subsidizing our drug companies and dumpting the drugs in their markets to crush competition. Just like we complain when China sells their steal in the US at half what they charge domestic consumers of steal. It's called dumping.

No industry in the world works on the business model you suggest. That they charge twice domestically while getting humonguse subsidies, and benifiting from massive government research; but it's foreign countries fault cause they negotiate better prices oversees.

It's fantasy.

3. I've already pointed out that the last few years prescription drug prices are rising SLOWER than inflation in the US.

Did you add in the 800 billion kiss on the cheak from Bush into your calculation?

4. As I've already stated above, there are various economic benefits essentially paid by the Pharma industry that would make the conclusion that they paid for none of it incorrect.

Yeah In the same way if I got a 1 million dollar grant from the federal government I could claim I had actually contributed to that million with the import tax from the cheese I eat with my imported wine?

The very very generous federal funded environment which benifits the Drug companies in this country is a big sloppy wet kiss to a very sucessful industry which not only doesn't pull its weight, they rape the American consumer too boot; preying upon those least able to be preyed upon.

[Predicto]

It think it's a huge stretch to say the health insurance industry hasn't provided benefits. I'm sure you can easily look around in the lives of your own friends and family and find examples of medical expenses covered by insurance. When my nephew had to have his scalp peeled back and his skull reshaped, his parents didn't have to be concerned about costs. He spent the first 2 years of his life in and out of hospitals. They never had to be concerned about it. He sees the leading professionals in the field for his disorder. World reknowned, and they don't have to worry about expense.

My daugher has Scoliosis and gets multiple thousand dollar braces several times a year. Doesn't cost me a dime. If she progresses to needing surgery, it will be fully covered. No worries about it at all.

When my 65 year old father needed a stint in his carodic artery, insurance covered it. He pushing 70 and his insurance covers whatever he needs.

I can go on endlessly with examples from friends and families benefiting, and yet I have no personal knowledge of anyone being denied services. Obviously that's a trivial sampling, but I think there have been tremendous benefits due to healthcare insurance.

People definitely benefit from having health coverage. That is not what I was saying.

What I was asking is how we, as a society, benefit from having one third of every heath care dollar go into the pockets of private insurance companies (rather than to actual health care)? That is a much larger administrative cost than any other health care system in the world.

At the bottom line, this diversion of health care money to administration is what people seem to be fighting so hard to preserve - and I just don't get it.

[December90]

I don't see a think in any of these posts explaining why our huge spending on the noncompetitive private health care INSURANCE industry provides us with any particular side benefits.

Big Pharma is not the same as Big Insurance. Big Pharma provides our society with drug breakthroughs. Big insurance provides our society with... what? Big paperwork? Big profits for its investors?

If you don't like "Insurance" then don't buy it. Insurance is like any other industry, they try to take a product and figure out how to sell it at a profit. If we prevent insurance companies from making a profit, then why should they be willing to stay in business? They are in the business of reducing your risk for catastrophic expenses in the event you need medical care. If you have large expenses they lose money on you, if you are healthy then they make money on you.

Not necessarily supporting the Insurance companies, but perhaps if we step back a little and try to see what it is that they provide, we won't see that as quite as evil as some would paint them to be.

[PeterMP]

I did the calculation myself. You published a 17billion dollar number for drug research done in 2003. My link quoted NASA and NIH spent 37.1 Billion in 2003. 37 is more than 200% of 17 billion. ( did that in my head too.. so feel free to check it. )..

Ahh. The way you phrased it made it sound like that was the difference in prices to consumers directly between the two countries.

Actually I think it works the other way around. They have a better case against us. We are free to not sell the Canadians drugs if we like, nobody can force us to sell them at a lose... Course we aren't loosing on the Canadian sales. The drug companies sell the Canadians and everybody else drugs at 50% cheaper cause it's profitable to do so.

The Canadians on the other hand would have an excellent case against us if they claimed we were unfairly subsidizing our drug companies and dumpting the drugs in their markets to crush competition. Just like we complain when China sells their steal in the US at half what they charge domestic consumers of steal. It's called dumping.

Except drugs ARE NOT sold here at 1/2 of they are in Canada so by definition isn't dumping.

No industry in the world works on the business model you suggest. That they charge twice domestically while getting humonguse subsidies, and benifiting from massive government research; but it's foreign countries fault cause they negotiate better prices oversees.

It's fantasy.

Well, you are right. It doesn't happen to any other industry, but it isn't a fantasy to the Pharma industry. They are also one of the very few industries where products being cosumed by individuals directly is negotiated at the federal level in many countries.

Did you add in the 800 billion kiss on the cheak from Bush into your calculation?

1. Well, first it isn't a subsidy. The Pharma industry is providing its product at the costs it can get.

2. The number is based on the actual consumer price of the drug so for that number it doesn't really matter. As the NYT piece I quoted stated, the savings is mostly the result of a shift to generics as drugs come off patents.

Yeah In the same way if I got a 1 million dollar grant from the federal government I could claim I had actually contributed to that million with the import tax from the cheese I eat with my imported wine?

The very very generous federal funded environment which benifits the Drug companies in this country is a big sloppy wet kiss to a very sucessful industry which not only doesn't pull its weight, they rape the American consumer too boot; preying upon those least able to be preyed upon.

VERY VERY VERY few of the dollars from the NIH budget are going directly to Pharam. They go to various public and non-profit institutions (e.g colleges and medical shools (I have grants from the NIH and directly have no money coming from Pharma)) that then do research and pay and educate people. Those institutions than patent discoveries/inventions, which they then sell/liscense to Pharma, which makes those institutions money.

***EDIT***

Based on some of your comments, especially the last one, I'm starting to wonder if you understand how NIH and government funding in general works.

More than Pharma the NIH is subsidizing the costs of a science/medical education in the US.

[Predicto]

If you don't like "Insurance" then don't buy it. Insurance is like any other industry, they try to take a product and figure out how to sell it at a profit. If we prevent insurance companies from making a profit, then why should they be willing to stay in business? They are in the business of reducing your risk for catastrophic expenses in the event you need medical care. If you have large expenses they lose money on you, if you are healthy then they make money on you.

Not necessarily supporting the Insurance companies, but perhaps if we step back a little and try to see what it is that they provide, we won't see that as quite as evil as some would paint them to be.

I'm not saying they are evil. They are just businesses.

What I am asking is why we have to preserve a healthcare structure that spends so much money on them, rather than on actual health care costs?

If we change the worker's compensation system so that there are less legal costs, no one starts yelling about how unfair it is to the lawyers who have lost work. But if we talk about how to reduce the insurance company overhead in our healthcare system - bammo - we have just taken a leak on the American Flag.

[PeterMP]

If you don't like "Insurance" then don't buy it. Insurance is like any other industry, they try to take a product and figure out how to sell it at a profit. If we prevent insurance companies from making a profit, then why should they be willing to stay in business? They are in the business of reducing your risk for catastrophic expenses in the event you need medical care. If you have large expenses they lose money on you, if you are healthy then they make money on you.

Not necessarily supporting the Insurance companies, but perhaps if we step back a little and try to see what it is that they provide, we won't see that as quite as evil as some would paint them to be.

The problem is that even if he doesn't have insurance, he has to pay part of the administrative costs for those that do have insurance.

A hosipitial isn't (w/o some negotiation AT LEAST and likely not even w/) going to look at you and say, well, you don't have insurance and are going to pay with cash so we are not going to pass ANY of the costs associated with those that have insurance on to you in your billing.

[Thiebear]

you've take a feel good and turned it into gobblety gook.

nice

[stevenaa]

JMS,

While I appreciate the fervor with which you debate this issue, your argument is pure conjecture on what you think is happening. None of the data you presented gives one iota of credence to your theory. Find some numbers on the total R&D dollars spent by Private industry and then we can see if your assumption has merit. Until then, your spinning like a top.

Regards,

Steven