Universal health care sounds good doesn’t it? But somebody got to pay who?
By Melvin J. Howard
As the US welcomes a new era in politics in the next few days I am pondering what will the health care system have in store for us Americans. As President elect-Obama has campaigned for some type of universal care for Americans I am somewhat reluctant of what will this look like. We here over and over about the greedy pharmaceutical companies, insurance companies and doctors. Will this lead to some health care scheme cobbled together by bureaucrats that will hide its true costs in taxes, discourage innovation and ultimately run up against the same laws of economics that trip up state-run medicine elsewhere. I have a unique perspective on this issue my mother was a RDN/ nurse and after that she became a pharmaceutical rep. My uncle owns and operates seniors’ homes. My sister a health care aid worker my first stepfather a surgical tech. My two best friends a Neurosurgeon and a Primary Physician I have known since college. On the other side of that my Canadian family, Physicians friends and business associates. I have more insight then one can imagine on both issues. I am not talking from an academic ivory tower standpoint but on the front lines of the delivery, cost and financing of health care. Universal health care is not a panacea as some in the US would think and I am ready to prove that. Although it is a noble and human condition to want free health care for all it is the most complicated task to carry out. We Americans have no concept of waiting in a queue for health care. Case in point when I invited some top investment bankers to Canada to do their due diligence on a project I was doing. They were stunned they could not believe you had to wait. When we hurt or need an operation we want it now and if you are rude you never see us again. Americans are not one to sit still and let the status quo continue to go on remember the Boston tea party. So it is with this I leave with you Mr. Daschle hopefully you will not go to far into trying to bring the United States Of America under a 100% Government run mandated universal health care system. There are some pretty strong views on this as quoted from Jon Irenicus.
The Washington Post reported the sad case of Dolly Sweet, who says she's not taking her cancer medicine because it costs $35,000 a year.
You know, I'm sorry to hear that Ms. Sweet was priced out of that expensive drug, but I'm at a loss for a viable alternative. Medicines cost money in terms of research, development and the approval process. Seven years ago, the Tufts Center for the Study of Drug Development pegged the cost of developing a new prescription drug at $802 million. Two years ago, the same group put the cost of a new bio-tech product at $1.2 billion. If it's a new painkiller that's going to reach a vast number of users, the cost can be spread out over millions of people. But a new cancer drug -- particularly if it's targeted at specific types of cancer -- is going to cost fewer users a lot of money.
Somebody has to pay those costs, and resources are finite for all possible candidates. Ms. Sweet says she's unable to pay. She apparently doesn't have private coverage that will pick up the tab, and Medicare (she's 77), budget-busting prescription drug coverage be damned, clearly isn't champing at the bit to foot the bill.
Well, honestly, it's a difficult situation for whoever is holding the checkbook.
But somebody always blames the people who accept the check for being greedy bastards. From the same article:
Jill King had her own theory about why her friend's cancer medicine was so expensive: Drug companies spend too much money buying meals for doctors.
And with that sort of brilliance on the loose, this is inevitable:
The group that met in the Las Vegas home of Ruby Waller concluded that a single-payer system similar to the Canadian approach might make better sense. "There's too much profit in health care," said Waller, 53, who has diabetes.
Actually, Ms. Waller might do all right under just about any health care system, assuming she doesn't suffer from complications; diabetes is pretty easy to control with inexpensive treatments which even an inept system could probably manage.
But poor Ms. Sweet's plight would get worse, not better, up north. Two years ago, the Globe and Mail ran an editorial lamenting the Canadian single-payer system's traditional means of allocating expensive cancer treatments: making patients wait, and wait and wait ...
Canada's health system can't seem to cast off the built-in complacency that is the mark of the second-rate. Take waiting times for prostate-cancer patients. Canada's health ministers set a goal of four weeks wait for radiation treatment for cancer. But 70 per cent of hospitals surveyed don't meet that goal for prostate patients. Apparently the hospitals have decided the waits won't kill them. ...
Canadians have told their governments that the number-one problem in health care is the wait for crucial care. The Supreme Court of Canada has put governments across the land on notice that if the waits persist, medicare's constitutional foundation could be brought crashing down.
Canadians of means can't even choose to shoulder the expenses that Ms. Sweet finds excessive, since their government makes it illegal to pay privately for services covered by the public system (except in Quebec, where the Supreme Court ruled the state-run system was so bad private medicine had to be allowed). Canadian politicians are familiar with the complaints and have responded -- by coming to the U.S to pay out of pocket for their own cancer care.
The U.K. goes a step beyond Canada. Forget waiting lists -- you just can't get up-to-date treatments through the National Health Service. It's a way of controlling costs that wouldn't put Ms. Sweet any closer to her expensive cancer drugs (Britain has miserable cancer-survival rates).
At least Canadians have the U.S. Where would Americans turn if we followed Ms. Waller's advice by emulating our northern neighbors in getting the profit out of medicine?
That antipathy to profit is one of the weirder aspects of the discussion of such important services as the provision of health care. Nicholas Kristof penned a navel-gazer for the New York Times last week that actually began with the question: "Here’s a question for the holiday season: If a businessman rakes in a hefty profit while doing good works, is that charity or greed? Do we applaud or hiss?"
Umm ... what? Are we actually at the point that we'd rather that people suffer than that somebody earn a buck by making the world a better place? Who do we think will shoulder the billion or so dollar cost (plus regulatory grief and liability risk) of developing new drugs and bio-tech products if we strip away monetary rewards for making the effort? Where will the brilliant minds go if years of medical education aren't rewarded by lucrative careers?
And is it really morally preferable to keep medical providers that cater to the needy on an umbilical cord that can be severed at any time, rather than to turn them, as The HealthStore Foundation does, into for-profit franchised clinics that earn tidy incomes for their owner-operators in the third World?
To his credit, Kristof finally allowed that "by frowning on aid groups that pay high salaries, advertise extensively and even turn a profit, we end up hurting the world’s neediest."
But what about the rest of us? Aren't we all entitled to medicine and medical providers spurred to excellence by the potential for monetary reward?
Well, Mr. Daschle doesn't seem to think so. As Sally C. Pipes points out in the Wall Street Journal:
In his book, Mr. Daschle proposes a National Health Board to regulate the way health care is provided. This board would have vast powers in regulating the massive federal health-care system -- a system that includes Medicare, Medicaid, and other programs. Under Mr. Obama, it is likely that that system will be expanded and that new government insurance for the nonelderly, nonpoor will be created.
That new government insurance will likely expand and push out much of the private competition -- especially if the government responds to differences in quality of care by imposing greater mandates on private coverage so as to hide the disparity.
In the end, we'll likely get some muddled amalgam that reduces the ability to make a profit and lards the health care system with yet more mandates and regulations -- which will make matters even worse.
But we won't really ever know how much worse, because the next expensive drug that Ms. Sweet would have agonized over won't even be developed, and the top-notch medical talent that might have helped her find alternatives will have gone into another field instead.
