A great article on the urgent need for some kind of US health care reform at http://www.theatlantic.com/business/archive/2013/11/the-singular-waste-of-americas-healthcare-system-in-1-remarkable-chart/281782/ (http://www.theatlantic.com/business/archive/2013/11/the-singular-waste-of-americas-healthcare-system-in-1-remarkable-chart/281782/). It's not pro-ACA, it's just a plain revelation that the status quo isn't working and hasn't been working for more than a decade.
One quote from the article:
QuoteThe problem is everybody wants the system to change, but nobody wants their corner of it to change. Doctors don't want their pay to change. And patients don't want their coverage to change. Obamacare tries to change both at the margins, and even that is politically fraught.
But something has to change.
Or, if you just want to squint to read the chart:
(https://www.grogheads.com/forums/proxy.php?request=http%3A%2F%2Fcdn.theatlantic.com%2Fnewsroom%2Fimg%2Fposts%2FLifeExpectancy.png&hash=dbefe8f7c9eb6b75e22b961fdf5c3885596fc4d8)
There is also the tort reform aspect.
There is a legitimate discussion to be made around whether we should limit the amount of damages people can sue for malpractice.
I'm not saying I know the answer, but the question is worthy of discussion. It's also worth noting that litigation attorneys make strong contributions to the Democratic party, so as a matter of course you can expect the discussion to be partisan from the start, regardless of merit.
Quote from: FarAway Sooner on December 04, 2013, 10:14:43 AM
A great article on the urgent need for some kind of US health care reform at http://www.theatlantic.com/business/archive/2013/11/the-singular-waste-of-americas-healthcare-system-in-1-remarkable-chart/281782/ (http://www.theatlantic.com/business/archive/2013/11/the-singular-waste-of-americas-healthcare-system-in-1-remarkable-chart/281782/). It's not pro-ACA, it's just a plain revelation that the status quo isn't working and hasn't been working for more than a decade.
One quote from the article:
QuoteThe problem is everybody wants the system to change, but nobody wants their corner of it to change. Doctors don't want their pay to change. And patients don't want their coverage to change. Obamacare tries to change both at the margins, and even that is politically fraught.
But something has to change.
Or, if you just want to squint to read the chart:
(https://www.grogheads.com/forums/proxy.php?request=http%3A%2F%2Fcdn.theatlantic.com%2Fnewsroom%2Fimg%2Fposts%2FLifeExpectancy.png&hash=dbefe8f7c9eb6b75e22b961fdf5c3885596fc4d8)
There is a simple reason for that chart. In the US healthcare is about making money first. In other western countries it is an important part of the economy, sure, but that is not primary. The buck is not almighty.
(https://www.grogheads.com/forums/proxy.php?request=http%3A%2F%2Ft2.gstatic.com%2Fimages%3Fq%3Dtbn%3AANd9GcRXNW2EyEl9AJcEHUzaChlLYvQYhJreW23YaxvE6ugzgmXNCvXl&hash=e013d9ee847953192fed26ff9bfd300a26b95fb6)
Quote from: Mr. Bigglesworth on December 04, 2013, 12:45:07 PM
There is a simple reason for that chart. In the US healthcare is about making money first. In other western countries it is an important part of the economy, sure, but that is not primary. The buck is not almighty.
I don't buy that explanation. There are a number of factors which drive our costs differently. Profit is certainly one of them but it's not the only explanation.
You don't have to buy it, it's free. :P
Quote from: Mr. Bigglesworth on December 04, 2013, 01:47:30 PM
You don't have to buy it, it's free. :P
Hey, ma, look: no lines!
Quote from: Mr. Bigglesworth on December 04, 2013, 12:45:07 PM
There is a simple reason for that chart. In the US healthcare is about making money first. In other western countries it is an important part of the economy, sure, but that is not primary. The buck is not almighty.
Yes and no! Lots of spaces in a free-market society are about making money first and foremost, but market incentives and strong competition drive costs down and value out to consumers.
The real take-away here is that the system we have is about making money first, but it doesn't have the sorts of built-in checks and balances that lead to a well-functioning free market economy.
It's kind of funny, but one example of the health care industry where costs have plummeted in the last 15 years even as patient outcomes have soared is LASIK treatments. That also happens to be one of the few areas of health care that generally are not covered by our current system.
As may well be implicit in your point above, the current system contains perverse incentives for everybody:
- Doctors want to maximize treatment costs and optimize patient outcomes.
- Patients want to optimize patient outcomes and don't care about treatment costs but only get to pick from one or two or maybe three insurance policies.
- Insurance companies want to minimize treatment costs and patient reimbursements but maximize premiums.
- Employers want to minimize insurance costs but optimize patient outcomes.
Combine that with a system where lack of information about the value of various medical treatments is virtually impossible for consumers to come by, price comparisons are impossible, insurance payout rules are so opaque as to be inscrutable, and employees can't shop for new insurance plans without changing jobs first, and you begin to see why a purely market-based approach doesn't seem up to reforming our current employer-sponsored health care system.
Good points FAS.
There is a gulf between the talk of free market economics and what actually happens out there. That is old news.
http://fora.tv/2008/10/20/Naomi_Klein_and_Joseph_Stiglitz_on_Economic_Power (http://fora.tv/2008/10/20/Naomi_Klein_and_Joseph_Stiglitz_on_Economic_Power)
What is happening in healthcare is just a small part of what is happening overall.
Interesting topic, as always, but part of the equation is not covered. Healthcare can't help you live longer if your lifestyle choices suck and/or your environment is toxic... even with big bucks being spent.
Quote from: Windigo on December 05, 2013, 01:09:06 AM
Interesting topic, as always, but part of the equation is not covered. Healthcare can't help you live longer if your lifestyle choices suck and/or your environment is toxic... even with big bucks being spent.
We're also leaving out litigation.
Quote from: LongBlade on December 05, 2013, 10:49:32 AM
Quote from: Windigo on December 05, 2013, 01:09:06 AM
Interesting topic, as always, but part of the equation is not covered. Healthcare can't help you live longer if your lifestyle choices suck and/or your environment is toxic... even with big bucks being spent.
We're also leaving out litigation.
And personal responsibility and not assume someone else will pay the bill
Quote from: OJsDad on December 05, 2013, 10:59:36 AM
Quote from: LongBlade on December 05, 2013, 10:49:32 AM
Quote from: Windigo on December 05, 2013, 01:09:06 AM
Interesting topic, as always, but part of the equation is not covered. Healthcare can't help you live longer if your lifestyle choices suck and/or your environment is toxic... even with big bucks being spent.
We're also leaving out litigation.
And personal responsibility and not assume someone else will pay the bill
The personal responsibility angle isn't exactly a free ride. Modern science can do wonders to correct a bad lifestyle but I imagine the trade-off of having to undergo surgery, radiation, and chemo for cancer offsets the some of the joy of knowing you're going to live longer. It's not like you pop a pill and the headache is gone.
Quote from: LongBlade on December 05, 2013, 11:13:04 AM
Quote from: OJsDad on December 05, 2013, 10:59:36 AM
Quote from: LongBlade on December 05, 2013, 10:49:32 AM
Quote from: Windigo on December 05, 2013, 01:09:06 AM
Interesting topic, as always, but part of the equation is not covered. Healthcare can't help you live longer if your lifestyle choices suck and/or your environment is toxic... even with big bucks being spent.
We're also leaving out litigation.
And personal responsibility and not assume someone else will pay the bill
The personal responsibility angle isn't exactly a free ride. Modern science can do wonders to correct a bad lifestyle but I imagine the trade-off of having to undergo surgery, radiation, and chemo for cancer offsets the some of the joy of knowing you're going to live longer. It's not like you pop a pill and the headache is gone.
M. Night Shyamalan was on CNBC yesterday and was talking about education. He pointed out on those international tests that everyone points to and says that the US education system is so bad, that if you take out the inner city school districts that the US rises to the top.
I'm thinking the samething will apply to healthcare. If you take out the worst of the inner cities that costs will go down and life expectancy will go up.
If you give those same people health insurance, I don't think they will use it. I think they will ignore issues and doctors orders until it becomes an emergency.
That's what I meant my personnel responsibility.
Quote from: OJsDad on December 05, 2013, 06:57:26 PM
M. Night Shyamalan was on CNBC yesterday and was talking about education. He pointed out on those international tests that everyone points to and says that the US education system is so bad, that if you take out the inner city school districts that the US rises to the top.
That is very interesting. If true it would explain a lot.
Link to the video.
http://video.cnbc.com/gallery/?video=3000222527
i am skeptical about the personal responsibility. i am currently heavily involved in building an elderly home and therefore have some interest in the topic.
costs are foremost exploding because of two facts: higher life expectancy and a ratio between old and young people that will soon make everything even worse.
Switzerland has about the second most expensive health care system in the world, just after the us. our system is a mix of a general and europe wise very basic insurance that everyone gets. and a market driven private insurance for what is above basic needs. the system sucks money wise. doctors are spending more and more time filling out forms and fighting with insurance companies about how many minutes of their service belongs to the basic insurance and how much belongs to the private insurance.
in contrast to this France, Sweden, Denmark and Norway have non profit oriented, governmental run health care systems that achieve a lot more health per buck. i tend to think we should move in this direction, giving up on this half market - half solidarity driven system.
:) i marked the important part for the us participants in this thread 8)
Quote from: LongBlade on December 05, 2013, 09:12:01 PM
Quote from: OJsDad on December 05, 2013, 06:57:26 PM
M. Night Shyamalan was on CNBC yesterday and was talking about education. He pointed out on those international tests that everyone points to and says that the US education system is so bad, that if you take out the inner city school districts that the US rises to the top.
That is very interesting. If true it would explain a lot.
It's one of those things that can be bent to mean anything. The US has very good prep schools that could well be at the top of the world. What % of the population gets that education? The same for the universities, the best in the world. At least for a couple thousand students at each of the top ones. What happens to the rest?
Quote from: Keunert on December 06, 2013, 03:52:25 AM
i am skeptical about the personal responsibility. i am currently heavily involved in building an elderly home and therefore have some interest in the topic.
costs are foremost exploding because of two facts: higher life expectancy and a ratio between old and young people that will soon make everything even worse.
Switzerland has about the second most expensive health care system in the world, just after the us. our system is a mix of a general and europe wise very basic insurance that everyone gets. and a market driven private insurance for what is above basic needs. the system sucks money wise. doctors are spending more and more time filling out forms and fighting with insurance companies about how many minutes of their service belongs to the basic insurance and how much belongs to the private insurance.
in contrast to this France, Sweden, Denmark and Norway have non profit oriented, governmental run health care systems that achieve a lot more health per buck. i tend to think we should move in this direction, giving up on this half market - half solidarity driven system.
:) i marked the important part for the us participants in this thread 8)
A mix of public and private is the best system. What needs to be shut down is the people attempting to game it, or present it as broken to game it.
Quote from: Keunert on December 06, 2013, 03:52:25 AM
i am skeptical about the personal responsibility. i am currently heavily involved in building an elderly home and therefore have some interest in the topic.
costs are foremost exploding because of two facts: higher life expectancy and a ratio between old and young people that will soon make everything even worse.
Switzerland has about the second most expensive health care system in the world, just after the us. our system is a mix of a general and europe wise very basic insurance that everyone gets. and a market driven private insurance for what is above basic needs. the system sucks money wise. doctors are spending more and more time filling out forms and fighting with insurance companies about how many minutes of their service belongs to the basic insurance and how much belongs to the private insurance.
in contrast to this France, Sweden, Denmark and Norway have non profit oriented, governmental run health care systems that achieve a lot more health per buck. i tend to think we should move in this direction, giving up on this half market - half solidarity driven system.
:) i marked the important part for the us participants in this thread 8)
My teams former HR manager is a single parent and has a daughter with some health issues. Instead of taking some time off to take her to the doctor, she would wait and take her to Urgent Care after work. She did this until salary employees were switched from a traditional health care plan to an health savings account with a higher deductible. Then she realized that urgent care cost about the same as an ER visit. She started taking the time to schedule a doctors appoint after that she started to actually look at the bill and had to write the check our of her own account.
Quote from: Mr. Bigglesworth on December 06, 2013, 05:02:30 AM
Quote from: LongBlade on December 05, 2013, 09:12:01 PM
Quote from: OJsDad on December 05, 2013, 06:57:26 PM
M. Night Shyamalan was on CNBC yesterday and was talking about education. He pointed out on those international tests that everyone points to and says that the US education system is so bad, that if you take out the inner city school districts that the US rises to the top.
That is very interesting. If true it would explain a lot.
It's one of those things that can be bent to mean anything. The US has very good prep schools that could well be at the top of the world. What % of the population gets that education? The same for the universities, the best in the world. At least for a couple thousand students at each of the top ones. What happens to the rest?
Actually, everyone does get access to this level of education. In fact, if you look at the large city schools in Ohio, they're spending a lot more money per pupil and not getting the results;
School District Enrollment $ per Student State Report Card Grade
Cleveland 40803 $14551 D
Akron 21984 $13627 C
Toledo 21642 $14912 F
Columbus 49424 $14614 D
Cincinnati 28670 $14720 C
Dayton 13934 $14375 D
Deer Park 1255 $10936 B
Arcadia 583 $9385 B
Kenton 1876 $9156 B
Delaware 4932 $9681 B
Olentangy 16754 $9599 B
Delphos 1098 $7673 B
Westerville 14187 $10720 B
Quote from: Mr. Bigglesworth on December 06, 2013, 05:05:09 AM
Quote from: Keunert on December 06, 2013, 03:52:25 AM
i am skeptical about the personal responsibility. i am currently heavily involved in building an elderly home and therefore have some interest in the topic.
costs are foremost exploding because of two facts: higher life expectancy and a ratio between old and young people that will soon make everything even worse.
Switzerland has about the second most expensive health care system in the world, just after the us. our system is a mix of a general and europe wise very basic insurance that everyone gets. and a market driven private insurance for what is above basic needs. the system sucks money wise. doctors are spending more and more time filling out forms and fighting with insurance companies about how many minutes of their service belongs to the basic insurance and how much belongs to the private insurance.
in contrast to this France, Sweden, Denmark and Norway have non profit oriented, governmental run health care systems that achieve a lot more health per buck. i tend to think we should move in this direction, giving up on this half market - half solidarity driven system.
:) i marked the important part for the us participants in this thread 8)
A mix of public and private is the best system. What needs to be shut down is the people attempting to game it, or present it as broken to game it.
+ fucking 69!!!
Quote from: OJsDad on December 06, 2013, 09:52:43 AM
Quote from: Mr. Bigglesworth on December 06, 2013, 05:02:30 AM
Quote from: LongBlade on December 05, 2013, 09:12:01 PM
Quote from: OJsDad on December 05, 2013, 06:57:26 PM
M. Night Shyamalan was on CNBC yesterday and was talking about education. He pointed out on those international tests that everyone points to and says that the US education system is so bad, that if you take out the inner city school districts that the US rises to the top.
That is very interesting. If true it would explain a lot.
It's one of those things that can be bent to mean anything. The US has very good prep schools that could well be at the top of the world. What % of the population gets that education? The same for the universities, the best in the world. At least for a couple thousand students at each of the top ones. What happens to the rest?
Actually, everyone does get access to this level of education. In fact, if you look at the large city schools in Ohio, they're spending a lot more money per pupil and not getting the results;
School District Enrollment $ per Student State Report Card Grade
Cleveland 40803 $14551 D
Akron 21984 $13627 C
Toledo 21642 $14912 F
Columbus 49424 $14614 D
Cincinnati 28670 $14720 C
Dayton 13934 $14375 D
Deer Park 1255 $10936 B
Arcadia 583 $9385 B
Kenton 1876 $9156 B
Delaware 4932 $9681 B
Olentangy 16754 $9599 B
Delphos 1098 $7673 B
Westerville 14187 $10720 B
You have to explain what you mean. I am talking about a few schools that do anything to get the Profs they want. Clearly everyone does not have access to those people.
Certainly one factor that is influencing (and will continue to influence) USA medical spend is the aging baby-boomer generation. I believe that the US is somewhat unique in that the post-war baby boom was greatest in the USA, resulting in record population growth. That demographic is now getting old, and like most old people everywhere, their health care costs are higher. Couple that with other problems like choices about diet and excercise and you get higher-than-average demands for healthcare.
And it's probably going to get worse. Over the next 20 years, we are going to be experiencing the greatest "wave of death" in history as those baby-boomers approach end-of-life Further, financial evaluations of health care service will show that about 70% of the money that will be spent on individual healthcare in a person's life occurs within the last 8 months before death.
Maybe Logan's Run got it right. I mean about the whole "random sex-partner transporter" thing, not the "carousel of death".
There are several other things about the US medical system where the entire rest of the world (almost) are free riders.
1] In the USA if you develop a new drug, medical device, etc..... you can actually sell it at a price which allows you to recoup the investment costs and to make money. You can also make enough money to cover all of the failures of drug/device trials that did not work out.
For the rest of the world, they impose massive drug price caps or simply don't allow their citizens to purchase drugs (or use medical devices) that are considerably better until the patent protection expires.
Effectively, the USA is the only country left where the private sector does medical research. Almost all of the drug/equipment advances in the last 15-20 over the entire world have almost all been for USA companies or international firms who are selling their drugs for a profit in the USA. As the USA nationalizes their health care, private sector health research will drop to almost nothing. This is a huge long run cost to humanity.
2] US Health Care spending is concentrated in the last 12 months of life. A huge amount of spending goes to those who are dying in an effort to prolong life. What is interesting is how many US doctors refuse treatment of dramatic end of life care. They see first hand what the suffering is like and choose not to take part. US end of life care is almost totally paid by the US government and many, many people will choose any hope if someone else pays the bill. [Before anyone goes nuts about their parent/loved one at the end of life my parents died a horrible lingering death so I've experienced this first hand].
3] Another free rider problem we have is people who simply refuse to buy simple preventative care. This floods emergency rooms. We have the exact same problem in the USA for car insurance. A lot of people simply will not pay if they think they can get away with it for insurance.
4] I agree with Longblade that medical malpractice & ambulance chasing lawyers are a problem - but it is only say 5-10% of the issue.
5] Last, the graph shows life expectancy vs. health care spending. This has been examined by public health researchers. A significant part of the problem (not all, but a large part) is due to very unhealthy lifestyles that are controllable such as obesity, smoking and lack of exercise. The other part is lack of basic preventative care. A huge part in the US is deaths at or close to birth by moms who are drug addled and don't take care of themselves and effectively kill their children. Statistically, if you have a disproportionate number of people die in year 0 to year 1 it really changes the statistical distribution. As a stats guy this is very easy to see in the data and has been written about in the literature.
6] Really last point - I'm not disagreeing with the earlier comments or the data presented. I just think that the issue is much more complicated than "people are greedy and game the system." Remember, people are always look out for their best interests and will try to game the system. Even on this website we have people alerting themselves to sales, giving away games, and discussing price trends for games. We do the exact same thing everywhere. It is called self interest.
Quote from: airboy on December 07, 2013, 08:12:13 AM
There are several other things about the US medical system where the entire rest of the world (almost) are free riders.
1] In the USA if you develop a new drug, medical device, etc..... you can actually sell it at a price which allows you to recoup the investment costs and to make money. You can also make enough money to cover all of the failures of drug/device trials that did not work out.
For the rest of the world, they impose massive drug price caps or simply don't allow their citizens to purchase drugs (or use medical devices) that are considerably better until the patent protection expires.
Effectively, the USA is the only country left where the private sector does medical research. Almost all of the drug/equipment advances in the last 15-20 over the entire world have almost all been for USA companies or international firms who are selling their drugs for a profit in the USA. As the USA nationalizes their health care, private sector health research will drop to almost nothing. This is a huge long run cost to humanity.
2] US Health Care spending is concentrated in the last 12 months of life. A huge amount of spending goes to those who are dying in an effort to prolong life. What is interesting is how many US doctors refuse treatment of dramatic end of life care. They see first hand what the suffering is like and choose not to take part. US end of life care is almost totally paid by the US government and many, many people will choose any hope if someone else pays the bill. [Before anyone goes nuts about their parent/loved one at the end of life my parents died a horrible lingering death so I've experienced this first hand].
3] Another free rider problem we have is people who simply refuse to buy simple preventative care. This floods emergency rooms. We have the exact same problem in the USA for car insurance. A lot of people simply will not pay if they think they can get away with it for insurance.
4] I agree with Longblade that medical malpractice & ambulance chasing lawyers are a problem - but it is only say 5-10% of the issue.
5] Last, the graph shows life expectancy vs. health care spending. This has been examined by public health researchers. A significant part of the problem (not all, but a large part) is due to very unhealthy lifestyles that are controllable such as obesity, smoking and lack of exercise. The other part is lack of basic preventative care. A huge part in the US is deaths at or close to birth by moms who are drug addled and don't take care of themselves and effectively kill their children. Statistically, if you have a disproportionate number of people die in year 0 to year 1 it really changes the statistical distribution. As a stats guy this is very easy to see in the data and has been written about in the literature.
6] Really last point - I'm not disagreeing with the earlier comments or the data presented. I just think that the issue is much more complicated than "people are greedy and game the system." Remember, people are always look out for their best interests and will try to game the system. Even on this website we have people alerting themselves to sales, giving away games, and discussing price trends for games. We do the exact same thing everywhere. It is called self interest.
I used to work for an EU multi-national medical company. I used to get their detailed financials which showed quite a large investment in R&D. In fact most of their debt, which was significant, was for investment in R&D. I also happened to run their supply chain for our product. I know the costs to deliver world wide. I know the margins. All I can say is a large part of the world got product. There was profit in those markets. The US market is very different. Margins are huge relative to the rest of the world. Nothing is done about it.
BTW readers should not do the mental spin of trying to believe an EU company was screwing Americans. There were bigger US companies in the market with equivalent tech products. They basically had price power worldwide. Our product was actually cheaper in the US while having equivalent quality outcomes. So if anyone was screwing Americans it was the volume leading US firms.
Quote from: Mr. Bigglesworth on December 07, 2013, 05:09:25 PM
BTW readers should not do the mental spin of trying to believe an EU company was screwing Americans. There were bigger US companies in the market with equivalent tech products. They basically had price power worldwide. Our product was actually cheaper in the US while having equivalent quality outcomes. So if anyone was screwing Americans it was the volume leading US firms.
You actually confirmed the point I was making. In the US, the margins for successful new drugs and medical devices are huge. Rest of the world, they are small. This means that the USA is either the primary or the disproportionate funding mechanism for medical R&D for the world.
Also, it is true that many countries just won't use cutting edge drugs or equipment (or adopt them much later) because their government does not want to pay.
considering how many drugs warn you about bleeding out of your asshole, having the possibility of limbs falling off and heart attacks or strokes I wouldnt be rushing to get the cutting edge drugs either.
That has always been my beef with these drugs, too. Regardless of the side effects, the commercials always show a well adjusted person thanks to the drug. And another thing, I know the pharmaceutical companies are supposed to test these drugs in advance of hitting the market, but, does anyone else feel like they are a guinea pig? I mean, these new drugs come out and the doctors push them and noone REALLY knows the effects for months, sometimes years.
my moms oncologist is a pretty sharp fucker and spends a lot of time looking into new drug therapies. in the end though it was established drugs and concepts that won the day without resorting to drug trial programs (which werent covered by insurance anyway).
I'm not suggesting that we are overtly being used as test subjects, but, it seems to me that some of these doctors handing out free samples of the latest drug are just extensions of the pharma companies and we are being used as extended trial subjects.
Quote from: MetalDog on December 08, 2013, 11:10:29 AM
I'm not suggesting that we are overtly being used as test subjects, but, it seems to me that some of these doctors handing out free samples of the latest drug are just extensions of the pharma companies and we are being used as extended trial subjects.
It's something of a catch-22.
Without a strong profit motive drug companies wouldn't have much incentive to research breakthrough drugs. Yes, that means they are "greedy" and it can cost a lot. But there is also a lot of failure. And yes, we sometimes get used as guinea pigs.
Viagra was not originally researched to make Windy feel like a young man - it was researched as a drug to relieve high blood pressure. On that account it was pretty much a failure. However, the drug had a certain side effect that made that research worth while. The rest is history.
I'm not trying to lionize drug companies here, but if the US was like the rest of the world it's not much of a stretch to suggest that medial research would stagnate. Or worse, be government regulated. And we know how good they are at picking winners and losers. Just look at companies like Solyndra.
just to fine tune the debate... mirth loves graphs
(https://www.grogheads.com/forums/proxy.php?request=http%3A%2F%2Fwww.cdc.gov%2Fnchs%2Fdata%2Fdatabriefs%2Fdb120_fig5.png&hash=2ed5c33269544f55ea2c8de375b2df8eff9e8936)
(https://www.grogheads.com/forums/proxy.php?request=http%3A%2F%2Fwww.cdc.gov%2Fnchs%2Fdata%2Fdatabriefs%2Fdb23_Fig2.png&hash=040ed1ad873ea82e9dba1c886fe827062e886818)
We covered infant mortality earlier in this discussion.
Take out crack babies and there's an interesting change in that graph.
It's weird the England/Wales has exactly the same number as Scotland. ??? Are they actually supposed to be combined?
I would imagine that in Texas and Florida the number of illegals warps the numbers.
Quote from: LongBlade on December 08, 2013, 11:20:49 AM
We covered infant mortality earlier in this discussion.
Take out crack babies and there's an interesting change in that graph.
Lotta crack babies in Oklahoma... who knew?
those would be meth babies.
no joke.
yet drug use deaths seem to not be terribly out of line. 1.5 per 100 000 in US versus 1.1 in Sweden for example..... IMO high infant mortality associated with drug use is a bit of a red herring on life expectancy
I suspect that poor lifestyle choices and limited availability of health care to the poor has more bearing
http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/ (http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/)
Quote from: airboy on December 08, 2013, 10:35:13 AM
Quote from: Mr. Bigglesworth on December 07, 2013, 05:09:25 PM
BTW readers should not do the mental spin of trying to believe an EU company was screwing Americans. There were bigger US companies in the market with equivalent tech products. They basically had price power worldwide. Our product was actually cheaper in the US while having equivalent quality outcomes. So if anyone was screwing Americans it was the volume leading US firms.
You actually confirmed the point I was making. In the US, the margins for successful new drugs and medical devices are huge. Rest of the world, they are small. This means that the USA is either the primary or the disproportionate funding mechanism for medical R&D for the world.
Also, it is true that many countries just won't use cutting edge drugs or equipment (or adopt them much later) because their government does not want to pay.
That R&D would have happened anyway. The only difference is the ROI TIMEFRAME.
Quote from: Mr. Bigglesworth on December 08, 2013, 12:47:38 PM
Quote from: airboy on December 08, 2013, 10:35:13 AM
Quote from: Mr. Bigglesworth on December 07, 2013, 05:09:25 PM
BTW readers should not do the mental spin of trying to believe an EU company was screwing Americans. There were bigger US companies in the market with equivalent tech products. They basically had price power worldwide. Our product was actually cheaper in the US while having equivalent quality outcomes. So if anyone was screwing Americans it was the volume leading US firms.
You actually confirmed the point I was making. In the US, the margins for successful new drugs and medical devices are huge. Rest of the world, they are small. This means that the USA is either the primary or the disproportionate funding mechanism for medical R&D for the world.
Also, it is true that many countries just won't use cutting edge drugs or equipment (or adopt them much later) because their government does not want to pay.
That R&D would have happened anyway. The only difference is the ROI TIMEFRAME.
ahhhh, unbridled greed rears its ugly head
Quote from: Windigo on December 08, 2013, 12:43:20 PM
yet drug use deaths seem to not be terribly out of line. 1.5 per 100 000 in US versus 1.1 in Sweden for example..... IMO high infant mortality associated with drug use is a bit of a red herring on life expectancy
I suspect that poor lifestyle choices and limited availability of health care to the poor has more bearing
http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/ (http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/)
ya nimrod, poor lifestyle choices like crack and meth and limited healthcare because your money goes to drugs.
and to that being impoverished because you cant hold a job because your high.
Quote from: Windigo on December 08, 2013, 12:49:07 PM
Quote from: Mr. Bigglesworth on December 08, 2013, 12:47:38 PM
Quote from: airboy on December 08, 2013, 10:35:13 AM
Quote from: Mr. Bigglesworth on December 07, 2013, 05:09:25 PM
BTW readers should not do the mental spin of trying to believe an EU company was screwing Americans. There were bigger US companies in the market with equivalent tech products. They basically had price power worldwide. Our product was actually cheaper in the US while having equivalent quality outcomes. So if anyone was screwing Americans it was the volume leading US firms.
You actually confirmed the point I was making. In the US, the margins for successful new drugs and medical devices are huge. Rest of the world, they are small. This means that the USA is either the primary or the disproportionate funding mechanism for medical R&D for the world.
Also, it is true that many countries just won't use cutting edge drugs or equipment (or adopt them much later) because their government does not want to pay.
That R&D would have happened anyway. The only difference is the ROI TIMEFRAME.
ahhhh, unbridled greed rears its ugly head
Yes. There is this strange attitude of many people that struggle to become biochem or genetic researchers. They are actually motivated by saving lives far more than making stockholders fabulously rich. Shocking I know. So when they get these jobs, they want to pursue their research no matter what.
Quote from: GDS_Starfury on December 08, 2013, 11:38:56 AM
those would be meth babies.
no joke.
Yeah, meth is big in Oklahoma, sad to say.
Quote from: GDS_Starfury on December 08, 2013, 12:52:33 PM
Quote from: Windigo on December 08, 2013, 12:43:20 PM
yet drug use deaths seem to not be terribly out of line. 1.5 per 100 000 in US versus 1.1 in Sweden for example..... IMO high infant mortality associated with drug use is a bit of a red herring on life expectancy
I suspect that poor lifestyle choices and limited availability of health care to the poor has more bearing
http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/ (http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/)
ya nimrod, poor lifestyle choices like crack and meth and limited healthcare because your money goes to drugs.
and to that being impoverished because you cant hold a job because your high.
drug use rates in the states are not terribly out of line with other western nations so your point is moot - there are other factors at play
Quote from: GDS_Starfury on December 08, 2013, 12:52:33 PM
Quote from: Windigo on December 08, 2013, 12:43:20 PM
yet drug use deaths seem to not be terribly out of line. 1.5 per 100 000 in US versus 1.1 in Sweden for example..... IMO high infant mortality associated with drug use is a bit of a red herring on life expectancy
I suspect that poor lifestyle choices and limited availability of health care to the poor has more bearing
http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/ (http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/)
ya nimrod, poor lifestyle choices like crack and meth and limited healthcare because your money goes to drugs.
and to that being impoverished because you cant hold a job because your high.
Personal responsibility is lacking in a lot of people and their choices. Considering several other factors including environment, opportunity, and mental capacity, to name a few, some of them don't really have a chance. And how do you determine who they are and how far do you go to help them?
Quote from: Windigo on December 08, 2013, 01:31:39 PM
Quote from: GDS_Starfury on December 08, 2013, 12:52:33 PM
Quote from: Windigo on December 08, 2013, 12:43:20 PM
yet drug use deaths seem to not be terribly out of line. 1.5 per 100 000 in US versus 1.1 in Sweden for example..... IMO high infant mortality associated with drug use is a bit of a red herring on life expectancy
I suspect that poor lifestyle choices and limited availability of health care to the poor has more bearing
http://was.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/ (http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/)
ya nimrod, poor lifestyle choices like crack and meth and limited healthcare because your money goes to drugs.
and to that being impoverished because you cant hold a job because your high.
drug use rates in the states are not terribly out of line with other western nations so your point is moot - there are other factors at play
Its the type of drugs in play not over alluseage.
Quote from: GDS_Starfury on December 08, 2013, 02:51:44 PM
Its the type of drugs in play not over alluseage.
There is also the question as to whether each country defines infant mortality identically.
Eh? Dead is dead, no?
Quote from: Staggerwing on December 08, 2013, 04:33:02 PM
Eh? Dead is dead, no?
In theory.
QuoteBut infant mortality tells us a lot less about a health care system than one might think. The main problem is inconsistent measurement across nations. The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then "breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles... is considered live-born regardless of gestational age."16 While the U.S. follows that definition, many other nations do not. Demographer Nicholas Eberstadt notes that in Switzerland "an infant must be at least 30 centimeters long at birth to be counted as living."17 This excludes many of the most vulnerable infants from Switzerland's infant mortality measure.
source: http://www.nationalcenter.org/NPA547ComparativeHealth.html
As I think I / we have stated before...admittedly access to primay care in US is a determining factor in higher than expected infant mortality rates. Although I can't quote the study now, I believe one review in 2010 showed that something like 20% of expecting mothers did NOT see a primary care provider for a healthy pregnancy check-up between confirmation of pregnancy and childbirth. So any high-risk preganancies that may have been identified via a check-up are going to get missed and influence that number. It is a sobering reflection that when you consider that approximately 70% of all conceptions miscarry, and another 30% of pregancies end in miscarriage, modern medicine still hasn't addressed the precariousness of a healthy birth / healthy baby.
I am not confident that access to affordable primary care would change that statistic...at least for the short to medium term. I don't know ANY primary care doctors who would refuse service for an expecting mother who couldn't afford the office visit fee, and those very few that might refuse service would almost certainly know of a care provider office that would perform the check-up on a pro-bono basis.
Also fwiw...in general in the health care industy, we don't tend to include crack / oxycodin / meth / heroine addiction etc into the "therapeutic lifestyle choices" category.
Quote from: GDS_Starfury on December 08, 2013, 02:51:44 PM
Quote from: Windigo on December 08, 2013, 01:31:39 PM
Quote from: GDS_Starfury on December 08, 2013, 12:52:33 PM
Quote from: Windigo on December 08, 2013, 12:43:20 PM
yet drug use deaths seem to not be terribly out of line. 1.5 per 100 000 in US versus 1.1 in Sweden for example..... IMO high infant mortality associated with drug use is a bit of a red herring on life expectancy
I suspect that poor lifestyle choices and limited availability of health care to the poor has more bearing
http://was.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/ (http://www.worldlifeexpectancy.com/cause-of-death/drug-use/by-country/)
ya nimrod, poor lifestyle choices like crack and meth and limited healthcare because your money goes to drugs.
and to that being impoverished because you cant hold a job because your high.
drug use rates in the states are not terribly out of line with other western nations so your point is moot - there are other factors at play
Its the type of drugs in play not over alluseage.
fair point... never went that far, did notice that meth use is mentioned as being higher than average in the EU nation of Czechoslovakia
that was where the Blue was going.
So, on the question of US pharma companies' research bankrolling other countries, help me understand something. If pharma companies enjoy very consistent and extremely high profitability margins in the US, then why are they complaining about their extraordinary R&D expenses?
It seems to me like you'd spend R&D money until the anticipated marginal return on that next $$ of investment was < the opportunity cost of doing something better with that money. I get how higher margins on your product would goose more in investment. But if they were in a truly competitive marketplace, wouldn't they have to invest so much in R&D that it ate further into their extremely high profit margins?
I've never seen data on how much US companies plow into R&D versus non-US firms, but the notion that their extraordinary profitability is justified by the extreme R&D layouts they have to maintain misses the point. Investment as a % of Revenue is one metric, but if they're left with plenty of earnings even after R&D, doesn't that indicate that they're getting their great margins somewhere else?
I'm a Finance professional and I always feel like there's some real obvious point I'm missing here, but I'll be danged if I can pinpoint it. Anybody know what I'm missing?
Quote from: FarAway Sooner on December 12, 2013, 08:24:03 PM
So, on the question of US pharma companies' research bankrolling other countries, help me understand something. If pharma companies enjoy very consistent and extremely high profitability margins in the US, then why are they complaining about their extraordinary R&D expenses?
It seems to me like you'd spend R&D money until the anticipated marginal return on that next $$ of investment was < the opportunity cost of doing something better with that money. I get how higher margins on your product would goose more in investment. But if they were in a truly competitive marketplace, wouldn't they have to invest so much in R&D that it ate further into their extremely high profit margins?
I've never seen data on how much US companies plow into R&D versus non-US firms, but the notion that their extraordinary profitability is justified by the extreme R&D layouts they have to maintain misses the point. Investment as a % of Revenue is one metric, but if they're left with plenty of earnings even after R&D, doesn't that indicate that they're getting their great margins somewhere else?
I'm a Finance professional and I always feel like there's some real obvious point I'm missing here, but I'll be danged if I can pinpoint it. Anybody know what I'm missing?
The petulant child will cry that it can't play with all the toys.
Quote from: FarAway Sooner on December 12, 2013, 08:24:03 PM
So, on the question of US pharma companies' research bankrolling other countries, help me understand something. If pharma companies enjoy very consistent and extremely high profitability margins in the US, then why are they complaining about their extraordinary R&D expenses?
It may sound strange but you're going to need to put yourself into something of a sympathetic mind to get the answers.
Not every drug researched pans out. I don't know the statistics but far more drugs fail than succeed. And you don't know a drug will fail until you've spent money looking into it.
How many decades have we been researching a cure for cancer? Life expectancy has gone up for most every form of cancer but we still don't have a cure. Somebody has to pay for that research or it won't be worth doing.
Quote from: FarAway Sooner on December 12, 2013, 08:24:03 PM
So, on the question of US pharma companies' research bankrolling other countries, help me understand something. If pharma companies enjoy very consistent and extremely high profitability margins in the US, then why are they complaining about their extraordinary R&D expenses?
It seems to me like you'd spend R&D money until the anticipated marginal return on that next $$ of investment was < the opportunity cost of doing something better with that money. I get how higher margins on your product would goose more in investment. But if they were in a truly competitive marketplace, wouldn't they have to invest so much in R&D that it ate further into their extremely high profit margins?
I've never seen data on how much US companies plow into R&D versus non-US firms, but the notion that their extraordinary profitability is justified by the extreme R&D layouts they have to maintain misses the point. Investment as a % of Revenue is one metric, but if they're left with plenty of earnings even after R&D, doesn't that indicate that they're getting their great margins somewhere else?
I'm a Finance professional and I always feel like there's some real obvious point I'm missing here, but I'll be danged if I can pinpoint it. Anybody know what I'm missing?
You are missing the failure rate of drugs in clinical, animal, and human trials. You must pay for all costs as a company or you go bankrupt.
Many drug companies have gone bankrupt or have been merged out of existence for a couple of simple reasons:
1] They had too many failures of drugs in trial
2] They stopped putting money into research (a huge expense) and ran out of new drugs that were under patent protection.
The rate of a drug getting to market is at best one in ten. Even if a drug gets to market, it may end up being withdrawn because of adverse effects that only show up once it is used in a large population. The total number of people used in the clinical trials to develop a drug is usually between 10,000 and 20,000. These numbers are much lower for cancer drugs and orphan drugs.
I'm plenty sympathetic about how it works. Or, at least, I'm plenty clinical about it. In my industry, you kinda got to try to be objective in how you understand firms' behavior.
I've seen the data around drug trial failure rates. I've seen the data around the proliferating expense curve as the failures happen higher up the curve. I understand those challenges.
But everything I've read (and I'll admit, it's not that much, which is one reason I'm asking the question here) says that the sector as a whole is phenomenally profitable. Far above average rates for other industries over any appreciable stretch of time.
A lot of M&A activity might be because of high failure rates. Or it could just be that the biggest fish, sitting on mountains of cash, realize that the industry has sufficiently high barriers to entry (due to the failure rates cited above) that they'll get a better return on investment by using lots of that cash to gobble up the medium-sized fish (who are only sitting on smaller hills of cash) even when their stock is priced reasonably?
I haven't followed the valuations patterns for big pharma companies, but I can imagine that they're pretty volatile over time--and that would leave the best funded firms in a great position to take over the others.
On the other hand, I could also imagine them being a bunch of vampire squids latched onto the face of humanity, growing rich off our suffering and misery and death.
8)
Quote from: airboy on December 07, 2013, 08:12:13 AM
6] Really last point - I'm not disagreeing with the earlier comments or the data presented. I just think that the issue is much more complicated than "people are greedy and game the system." Remember, people are always look out for their best interests and will try to game the system. Even on this website we have people alerting themselves to sales, giving away games, and discussing price trends for games. We do the exact same thing everywhere. It is called self interest.
So, we can say that the American health care cost/high mortality issues are best summarized by saying "people are greedy, whether they're gaming the system or eating too much". I can buy that.
I have some interesting stats I ran across on the state of the educational system in America, but I'll save that for another thread.
Quote from: FarAway Sooner on December 13, 2013, 12:28:03 AM
Quote from: airboy on December 07, 2013, 08:12:13 AM
6] Really last point - I'm not disagreeing with the earlier comments or the data presented. I just think that the issue is much more complicated than "people are greedy and game the system." Remember, people are always look out for their best interests and will try to game the system. Even on this website we have people alerting themselves to sales, giving away games, and discussing price trends for games. We do the exact same thing everywhere. It is called self interest.
So, we can say that the American health care cost/high mortality issues are best summarized by saying "people are greedy, whether they're gaming the system or eating too much". I can buy that.
I have some interesting stats I ran across on the state of the educational system in America, but I'll save that for another thread.
I can agree to that, though I'd say "people act in their own self-interests."
We can create incentives for people to behave differently but we should avoid mandating certain behaviors.
People may think they are acting in their self interest, but the longer I live, the more I believe they have no idea what is really in their self interest.
Quote from: Labbug on December 13, 2013, 11:57:58 AM
People may think they are acting in their self interest, but the longer I live, the more I believe they have no idea what is really in their self interest.
Quoted for truth!!!!!!!!!!!!!!!!!!!!!!!!
short term gain for long term pain my new forum bud!!!!
Quote from: Labbug on December 13, 2013, 11:57:58 AM
People may think they are acting in their self interest, but the longer I live, the more I believe they have no idea what is really in their self interest.
That sounds good on paper but doesn't work so well when someone else starts telling you how to live your life.
Quote from: LongBlade on December 13, 2013, 12:31:49 PM
Quote from: Labbug on December 13, 2013, 11:57:58 AM
People may think they are acting in their self interest, but the longer I live, the more I believe they have no idea what is really in their self interest.
That sounds good on paper but doesn't work so well when someone else starts telling you how to live your life.
I agree with you. But there has to be some boundaries for a civil society to exist. The real debate is what those boundaries are. Some boundaries seem to be obvious: don't murder, don't steal, treat people as you wish to be treated. As for me I don't want someone telling me how to live, I want to be responsible for myself and my actions.