by evilgenius » Sat 11 Feb 2017, 12:20:37
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')What you are saying looks as if it could come with a high probability of undesirable unintended consequences. Imagine, for instance, some bacterial development that required us to kick antibiotic research up a few notches, but we couldn't meet the challenge because of the financial condition of pharmaceutical companies after a Trump industry shakeup? Imagine the wars within those companies for control, in the wake of the opportunity to seize power manifesting itself due to extreme volatility of stock prices? Those wars would be certain to come with obstruction of both vision and long term decision making. People within an organization act differently when they can't be certain a governing regime will retain power more than a short time. They don't necessarily change everything they do to match the new vision, wondering if they oughtn't to stay ready for a change of plans when the next CEO comes in.
You are sounding like a corporate lobbyist for the pharmaceutical industry who is basically saying that state of the art drugs are only possible if Uncle Sam subsidizes our industry which is what is actually happening with the price protections in place that cause US citizens to pay sometimes 10 - 20 times the prices for drugs than you see in other countries.
And your hypothetical example of an urgently needed anti-biotic actually is good to point out another strategic marketing decision that pharmaceutical companies took years ago when they failed to develop new antibiotics because these drugs actually cure you of disease. That makes their research and development a low priority for drug companies because you can only sell a single dose. Much better to develop anti-statins and spend hundreds of millions on marketing and creating incentives for doctors to prescribe them because these are pills that you take for decades. Chronic medication is the principal area of R&D for drug companies, not actually curing you of illness. It is only after 3 decades of drugs like Zocor and Lipitor that suddenly the truth comes out that these anti-statins where marginal in as a control of cholestrol and heart disease in most cases.
How about cancer drugs and the billions of dollars that the industry makes in prescribing chemo-therapies long past their effectiveness in terminal patients. How the industry plays on the desperate hope of loved ones who spend billions and billions when these patients should be given morphine and made comfortable instead of milked for the last dollar.
It is a deeply cynical industry, sick to the core in the way profits drive R&D and the way procedures and drugs are prescribed. Most folks still see the doctor in the white coat or watch the advertisements and actually believing that there still exists this hippocratic oath that drives the health care industry. That is long gone. It is a money game, cynical and driven by greed and profit. It's a sick industry. I was in it for 25 years and know what I am talking about.
Nobody wants to open this can of worms.
It is a metaphor actually for much of what we discuss here. To cure the problem requires a short term correction and financial hit. Long term solutions require this to happen but you wont find a politician with the integrity to confront this.
Same applies to energy, climate change, our deeply indebted financial system... Everyone is afraid of the short term pain required to reform sick industries.
No, what I'm telling you is that is the wrong way to go about doing it. Like Cog says, there isn't any price discovery. This is a market based problem. There is simply too much money chasing healthcare. The reason for that is that pre-tax deductions for health insurance distort the picture. They remove people from the ability to make economic decisions. Perversely, pre-tax contributions increase the amount of money available to run after healthcare services, but they separate both people and employers from choosing where those dollars will go. Employers hand wring and bewail the choice of which plan to pick and then they turn the money over in one huge transfer of power. They place it in the hands of the insurer as agent. The insurers are not good agents.
The supply of money is so great because employers are more than happy to pay people more if it means they don't have to pay matching taxes. Employees are happy to get paid more, since healthcare is so important to them. They would rather not pay taxes on it either. Taxes are for their 'real income' over which they want to maintain some power over decision making. Fear of paying taxes lies at the heart of this, as well as an unwillingness to categorize a thing like money spent on healthcare as real income. That fear has placed the dollars available into a place where choice is derailed. But you only pay taxes on a positive thing. By moving the costs into the taxed realm you move the money involved into a place where people do have power over how it is spent. They have a stronger connection to 'their money' in that place.
That's where you need to introduce pricing options because that's who the healthcare providers would then have to appeal to. Those options could still arrive under the auspices of some sort of employer based source, but they wouldn't really have to. You could go with public exchanges, even down to specifics. Wrapping costs up in agency is also a problem, even though we will probably never be able to completely eliminate it. Having instituted a means to exchange, however, you've got to make the costs hurt those who pay them such that they are compelled to control them. Pre-tax doesn't cost people enough pain. Competition should begin to sort things out from there. It might not solve everything, but it would be a start. It would be far better than using the government hammer to break something most people don't understand, and at a far quicker pace than critical industries can survive.