KSB and jerry

[DankNuggs 305]

The exchanges increase competition: http://m.csmonitor.com/USA/2013/0530/Obamacare-starts-soon-Choices-will-increase-but-will-premiums

why

[drobeski 3,061]

Ain't nobody claiming "mission accomplished" on this thing, Hare Lip

Dumbo ....read, learn ...get educated on facts.

Dumb dumb dumb

[IGotWorms 4,058]

why

It's set forth in the article linked to. It has allowed more insurance companies to come in and compete on the marketplace, whereas before each individual state was dominated by one or two insurance carriers.

[penultimatestraw 473]

The costa are what is killing our health care system. I believe the quality of our system is better overall. My god in Canada if you screw up an ankle the doctor makes the best guess about what is wrong and treats it because the waiting list for an MRI for a non-critical problem is 9 months.

 

 

The biggest problem with Obamacare other than the tremendously expensive and massive government bureaucracy it created is that it does nothing to control costs.

Even if your wait time was remotely accurate (it isn't), non-critical ankle problems don't require an MRI, as the vast majority can be diagnosed by physical exam and treated without surgery. American expectations for rapid diagnostic testing of little clinical benefit is one of many things driving up our healthcare costs. Cardiac stress tests are the classic example, but there are many others.

 

Agree that not addressing cost appropriately is the major downfall of the ACA.

[penultimatestraw 473]

By the time the true cost of the ACA comes to fruition I believe that we could have outright paid for the uninsured 15% and saved money. I'm not naive enough to think that would be sustainable either but, I do believe putting our heads together we could have come up with something better.

This problem didn't pop up overnight; I remember taking a healthcare economics class in college 20+ years ago which pointed out our obscene healthcare expenditures relative to other countries. Our current system has failed, and special interest groups have resisted change for decades.

 

What is the better solution?

[penultimatestraw 473]

I do wonder if those physicians would answer those survey questions as similarly today as they did in 2009.

Most physicians I know do not like the ACA. But all of them think healthcare needs major changes. One component many of them agree upon is universal coverage.

[penultimatestraw 473]

As I said earlier, a lot of Drs are not seeing any Medicare patients because of the lower payouts.

 

These basic market forces are beyond Worms' cognitive abilities. He has no idea people actually react to things in the marketplace.

Those doctors are practicing unethically IMO. An interesting editorial from the New England Journal of Medicine regarding Medicaid (even lower payout than Medicare):

Medicaid is an important federal–state partnership that provides health insurance for more than one fifth of the U.S. population — 73 million low-income people in 2012. The Affordable Care Act will expand Medicaid coverage to millions more. But 30% of office-based physicians do not accept new Medicaid patients, and in some specialties, the rate of nonacceptance is much higher — for example, 40% in orthopedics, 44% in general internal medicine, 45% in dermatology, and 56% in psychiatry.1Physicians practicing in higher-income areas are less likely to accept new Medicaid patients.2 Physicians who do accept new Medicaid patients may use various techniques to severely limit their number — for example, one study of 289 pediatric specialty clinics showed that in the 34% of these clinics that accepted new Medicaid patients, the average waiting time for an appointment was 22 days longer for children on Medicaid than for privately insured children.3

Physicians have good reasons for not accepting Medicaid patients, as I learned from direct experience as a member of a nine-physician primary care practice in California. We accepted Medicaid patients, but it was difficult. Medicaid's payment rate was very low — we lost money on each Medicaid visit. When referrals were necessary, we often had to personally ask specialists to accept our patient. Administratively, it was not simple to obtain payment from Medicaid for our services, in part because some patients frequently moved between eligibility and ineligibility for the program. In addition, it was time-consuming for our physicians and staff to deal with the Medicaid pharmaceutical formulary and to obtain prior authorization for Medicaid patients to see specialists and obtain imaging studies.

There are additional reasons — beyond low payment rates, administrative complexity, and problems obtaining specialist care — why physicians may be reluctant to see Medicaid patients. Medicaid patients often have complicated behavioral health, transportation, and social service needs that require physician and staff time.4 Some physicians believe that Medicaid patients are more likely to initiate malpractice suits, although data suggest that this belief may be incorrect.5

Nevertheless, there is a fundamental reason why physicians should strongly consider providing care for at least a reasonable number of Medicaid patients. It is a core professional principle that physicians should put the patient's interest first; refusing to care for vulnerable, socioeconomically disadvantaged Medicaid patients seems incompatible with this principle. Many medical schools ask their students to accept the World Health Organization's Declaration of Geneva (a modified version of the Hippocratic Oath), which states in part that “I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.”

Willingness to care for Medicaid patients would be a service to a physician's colleagues as well as to patients. Emergency departments and physicians who care for Medicaid patients would not have to spend time trying to obtain specialist care for patients who need it. Patients would not have to endure long and potentially dangerous waits for care. And if all physicians cared for Medicaid patients, all would have a reason to care about the Medicaid program, so that more pressure could be brought to bear on the program to provide reasonable payment rates and reduce administrative burdens.

Physicians who are reluctant to provide care for Medicaid patients can argue, with justice, that policymakers are trying to make medicine as market-driven as possible, that physicians are increasingly expected to respond to market incentives and market constraints, and that no business in other sectors of the economy is asked to provide a service that loses money year after year. Many physicians, however, earn very high incomes, and some of the highest-paid specialties are the least willing to care for Medicaid patients.1 Would it be reasonable to ask all physicians to commit to providing care for enough Medicaid enrollees so that at least 5% of each physician's practice consisted of Medicaid patients (assuming sufficient demand)? For most office-based physicians, such a commitment would mean seeing, on average, one Medicaid patient per day at most. For most surgeons, it would mean, on average, operating on one Medicaid patient every 1 to 2 weeks.

The model for a 5% commitment proposal could come from the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation. To date, 54 specialty societies participating in this campaign have released lists of more than 150 potentially unnecessary tests and treatments that physicians may want to avoid except in unusual clinical circumstances. Perhaps the ABIM Foundation and other specialty societies could consider making the case for caring for Medicaid patients and asking their members to voluntarily commit to accepting a minimum of 5% (or even 3%?) of Medicaid patients into their practices.

We live in an era in which, for better or for worse, market-based solutions are dominant and policymakers tend to view physicians as self-interested actors. Little or no attention is paid to physician professionalism or to the possible effects of policies on professionalism. Policies that are based on this view may be justifiable if many physicians are indeed seeking to maximize their incomes and refusing to accept even a slight reduction in income as the price for helping to provide care to the most vulnerable patients in our society. A 5%-commitment campaign would be a meaningful, highly visible demonstration of physician professionalism — of putting patients first.

[KSB2424 3,148]

Question: What if we had the individual mandate, yet kept health insurance private. Think car insurance. You have to have it to drive but you buy it on the free market.

 

What would theorhetically happen?

[IGotWorms 4,058]

Question: What if we had the individual mandate, yet kept health insurance private.

 

What would theorhetically happen?

That's what we have now with Obamacare, is it not?

[KSB2424 3,148]

That's what we have now with Obamacare, is it not?

 

No gov't exchanges, no website.

 

Opening up state lines for competition, and individual mandate. Thats it. Maybe reform medicaid a bit to help the truely poor.

 

BTW, I'm just spitballin' here to see if we could bring things that work from both sides together while getting rid of the things that don't work. Know what I mean?

[penultimatestraw 473]

I'm not necessarily convinced one is better than the other. My point is that, like all things gov, there are unintended consequences. Liberal policies rarely consider them, believing we can have our cake and eat it too.

Every policy has unintended consequences. And it isn't just government policies. You just seem to have more faith in the dollar than other motivators. But as I've said numerous times before, healthcare doesn't operate like other "products", as the consumer is vulnerable, and the service often times cannot be withheld when payment isn't forthcoming.

[penultimatestraw 473]

Real doctors don't like it. They get paid less for the beggars, and they know their compensation is next on the chopping block as the insurance companies aren't taking a haircut...

 

Why do you think consierge service is the new thing for every doctor in decent demand? They control patient load and compensation, and they control quality of care and access...

Partially correct. Concierge service is becoming more popular to avoid all insurers, private and government alike.

 

The insurance companies need to be scalped, while the doctors probably just need a trim.

[IGotWorms 4,058]

 

No gov't exchanges, no website.

 

Opening up state lines for competition, and individual mandate. Thats it. Maybe reform medicaid a bit to help the truely poor.

So you basically like Obamacare except for the exchanges?

 

I gotta say, that doesn't make much sense. The exchanges exist so that those who must purchase healthcare on an individual level (because of the individual mandate) can benefit from aggregate buying power and can receive subsidies for the government where they can't afford to purchase insurance w/o assistance. How is that at all objectionable if you're otherwise on board?

 

Also I'm wondering if perhaps you are confused about what is offered on the exchanges? They are still private insurers, it isn't a government-administered plan.

[penultimatestraw 473]

Aggregating buying power = limiting competition = less efficiency = inflated costs.

 

If single buyers and single producers were the most efficient market mechanism, it would mean communism is the idea formation of society.... History has proven that flagrantly wrong.

History has also proven our healthcare system extremely flawed, while others operating centrally work better.

[KSB2424 3,148]

So you basically like Obamacare except for the exchanges?

 

I gotta say, that doesn't make much sense. The exchanges exist so that those who must purchase healthcare on an individual level (because of the individual mandate) can benefit from aggregate buying power and can receive subsidies for the government where they can't afford to purchase insurance w/o assistance. How is that at all objectionable if you're otherwise on board?

 

Because you forget one little item. Gov't focks it up. I'm tyring to think of a way (in theory) of doing what you hope Obamacare will accomplish without gov't plans/subsidies/websites/working with insurance companies (telling them what to do) etc.

 

The true private sector.

[Voltaire 5,317]

The exchanges will not control the costs of health care. How is taxing people with good insurance controlling health care costs?

The main goals of the ACA was in it's name : afforable health care. This was mostly going to benefit people who couldn't afford it. Another goal was to make The ACA pay for itself. This was going to be expensive as the system doesn't sh*t magic money, it eats money. A lot of it. They had to find pools of cash to make the numbers work. That's one thing I respect most about the Dems, unlike some other prominent national parties I could mention, when the Dems want to take on massive new expenses, they actually put on their big boy pants and include unpopular funding mechanisms to pay for the sh*t they want to do.

 

This tax on Cadillac plans was one that they chose. Not popular. don't like it. Another unpopular one was the tax on medical devices. Oh terrible horrible. If you don't like those taxes, that's understandable nobody does. How about find another source of cash more to your liking as a replacement so the system can make up the lost funding?

[Recliner Pilot 61]

 

Also I'm wondering if perhaps you are confused about what is offered on the exchanges? They are still private insurers, it isn't a government-administered plan.

The IRS will be shocked to hear this.

[KSB2424 3,148]

So you basically like Obamacare except for the exchanges?

 

I gotta say, that doesn't make much sense. The exchanges exist so that those who must purchase healthcare on an individual level (because of the individual mandate) can benefit from aggregate buying power and can receive subsidies for the government where they can't afford to purchase insurance w/o assistance. How is that at all objectionable if you're otherwise on board?

 

Also I'm wondering if perhaps you are confused about what is offered on the exchanges? They are still private insurers, it isn't a government-administered plan.

 

When the puppet dances, its because the puppet master is pulling the strings. HTH

[penultimatestraw 473]

 

No gov't exchanges, no website.

 

Opening up state lines for competition, and individual mandate. Thats it. Maybe reform medicaid a bit to help the truely poor.

 

BTW, I'm just spitballin' here to see if we could bring things that work from both sides together while getting rid of the things that don't work. Know what I mean?

My guess: Predatory insurers would charge egregious rates for those with pre-existing conditions. Others would provide insurance that would be inadequate for the patient's needs. The already onerous amount of paperwork piled on providers would increase, as more middle people who provide no actual medical service staff the bazillion insurance/coding/billing companies that would pop up.

[IGotWorms 4,058]

 

Because you forget one little item. Gov't focks it up. I'm tyring to think of a way (in theory) of doing what you hope Obamacare will accomplish without gov't plans/subsidies/websites etc. In the private sector.

But it pretty much IS in the private sector. Yes the exchanges are set up by the government but the plans sold on the exchanges are private plans.

 

The problem with doing away with the exchange and subsidies is that privately purchased health insurance can be very expensive, especially when there is a minimum standard of coverage dictated by the law (as there must be or else the individual mandate would be largely meaningless). So if you don't have the exchanges to aggregate buying power, and you don't have subsidies for some people, then you have a situation where people who are struggling yet aren't "poor enough" for Medicaid will have to spend an exorbitant amount of money to comply with the individual mandate. Even though they aren't dirt poor they probably still can't purchase decent health insurance completely on their own and still be able to pay for food, housing, and other necessities.

 

Let's take a guy who owns his own landscaping business. It's just him, a truck, and a couple lawn

mowers, basically. Now he works his ass off so he is lower middle class rather than dirt poor. How is that guy supposed to go out on his own and purchase health insurance for him, his wife and his kids without any premium assistance at all and without the power of aggregate buying?

[jerryskids 6,829]

Every policy has unintended consequences. And it isn't just government policies. You just seem to have more faith in the dollar than other motivators. But as I've said numerous times before, healthcare doesn't operate like other "products", as the consumer is vulnerable, and the service often times cannot be withheld when payment isn't forthcoming.

I have more faith in the dollar to drive medical advances.

 

Anyway, another question: of all of these countries with far superior centralized care, are any as large as us?

[MedStudent 56]

I have more faith in the dollar to drive medical advances.

 

Anyway, another question: of all of these countries with far superior centralized care, are any as large as us?

I don't agree. More advances are driven by researchers who are working under government grants or are government employees. They are not profit driven. The profit drivers take it to market but don't drive the initial research and innovation.

 

Here is an article about the process:

 

Megan McArdle, Business Editor of The Atlantic and one of the most prolific free-market bloggers out there, had an interesting and lengthy post yesterday about her reasons for opposing national health care. Its worth reading, and several of her points are well-made which is probably why it was linked far and wide today, and is currently the top read story at RealClearPolitics. But McArdle also bases a portion of her argument on a surprisingly inaccurate depiction of the way medical research happens, one that needs rebutting if were going to keep the debate about reform of both the industry and the insurance side of health care based on facts about how the current system works, not polemics.

 

Starting at the sixth paragraph of her piece, McArdle launches into a description of the drug research process that is based on contrasting the tasks and goals of the National Institutes of Health and Pharma, starting from her premise that Monopolies are not innovative, whether they are public or private.

 

McCardle:

 

Advocates of this policy have a number of rejoinders to this, notably that NIH funding is responsible for a lot of innovation. This is true, but theoretical innovation is not the same thing as product innovation. We tend to think of innovation as a matter of a mad scientist somewhere making a Brilliant Discovery!!! but in fact, innovation is more often a matter of small steps towards perfection. Wal-Marts revolution in supply chain management has been one of the most powerful factors influencing American productivity in recent decades. Yes, it was enabled by the computer revolutionbut computers, by themselves, did not give Wal-Mart the idea of treating trucks like mobile warehouses, much less the expertise to do it.

 

In the case of pharma, what an NIH or academic researcher does is very, very different from what a pharma researcher does. They are no more interchangeable than theoretical physicists and civil engineers. An academic identifies targets. A pharma researcher finds out whether those targets can be activated with a molecule. Then he finds out whether that molecule can be made to reach the target. Is it small enough to be orally dosed? (Unless the disease youre after is fairly fatal, inability to orally dose is pretty much a drug-killer). Can it be made reliably? Can it be made cost-effectively? Can you scale production? Its not a viable drug if it takes one guy three weeks with a bunsen burner to knock out 3 doses.

End mccardle

 

 

She goes on at length from there, and Id encourage you to read it all for contexts sake. But needless to say, this passage and the ones following it surprised me a great deal. Working at the Department of Health and Human Services provided me the opportunity to learn a good deal about the workings of the NIH, and I happen to have multiple friends who still work there and their shocked reaction to McArdles description was stronger than mine, to say the least.

 

McArdle clearly doesnt understand what shes writing about, one former NIH colleague said today. Where does she think Nobel prize winners in biomedical research originate, academic researchers or in Pharma? Our academic researchers run clinical trials and develop drugs. Im not trying to talk down Pharma, which Im a big fan of, but I dont think anyone in the field could read what she wrote without laughing.

 

To understand how research is divided overall, consider it as three tranches: basic, translational, and clinical. Basic is research at the molecular level to understand how things work; translational research takes basic findings and tries to find applications for those findings in a clinical setting; and clinical research takes the translational findings and produces procedures, drugs, and equipment for use by and on patients.

 

Pharma operates under a great deal of pressure these days, and not just from the political side everyone wants to avoid being left holding the next Vioxx. But as a matter of focus, their only area of interest is that last category: clinical research. Whats more, theyre only really interested in clinical research into areas that hold the promise of recouping the cost of their investment, and more. They are a business, and they perform as one.

 

As a side note: If you want to understand why in 1998 the medical community suddenly decided that you were overweight at a body mass index of 25 instead of 27.8, taking the WHO view (based on the BMIs of Africa and other developing nations as opposed to the long-held U.S. definition) and suddenly making 30 million Americans fat, just look at the makeup of the advisory panel Pharma pushed this decision through, which had the effect of instantly adding millions of customers. But again, its nothing personal, just business.

 

So Pharma is interested in making money as their primary goal that should surprise no one. But theyre also interested in avoiding litigation. Suppose for a moment that Pharma produces a drug to treat one non-life threatening condition, and its a monetary success, earning profits measured in billions of dollars. But then one of their researchers discovers it might have other applications, including life-saving ones. Instead of starting on research, Pharma will stand pat. Why? Because it doesnt make any business sense to go through an entire FDA approval process and a round of clinical trials all over again, and at the end of the day, they could just be needlessly jeopardizing the success of a multi-billion dollar drug. It makes business sense to just stand with what works perfectly fine for the larger population, not try to cure a more focused and more deadly condition.

 

The truth, as anyone knowledgeable within the system will tell you, is that private companies just dont do basic research. They do productization research, and only for well-known medical conditions that have a lot of commercial value to solve. The government funds nearly everything else, whether its done by government scientists or by academic scientists whose work is funded overwhelmingly by government grants.

 

Its just simple math: if you have a condition that has a relatively small number of patients, theres just no market incentive to sink a great deal of time and money into researching it. This is why youll usually find that 100% not a majority, the entirety of the research into a cure is done either via taxpayer-funded grants to academic researchers or, more frequently, its entirely found on the NIH campus.

 

Organ transplantation? Just about 100% is funded by NIH. Low prevalence cancers, or cancers with low survival rates? Just about 100% of all three phases is funded by NIH. You start to understand how this works.

 

The innovation argument McArdle makes is silly because it presupposes that the government actually controls the research direction, says my NIH friend. The overwhelming majority of our money is devoted to RO1 research. A scientist in a lab has an idea he wants to pursue and writes a grant application. A few times a year the various institutes at NIH convene panels of academic researchers to evaluate the ideas and rank order them. We then issue grants based on the rank order.

 

This is one of the many reasons that, when it comes to real innovation, most of it originates in the academic labs, funded by the taxpayers. Its also one of the reasons that the boards of biotech start up companies are heavily populated with top NIH funded researchers. The bright line between public and private efforts on the research front exists only as a very dim separation in some areas, if at all.

 

While I consider myself a pro-market and pro-consumer conservative, specialized medical research is one area where government funding is still needed. And to be honest, I see no inconsistency between holding that view and also holding the view that a government takeover of our health insurance system is a bad idea. McArdle intends for the point of her post to be about the nationalized health care system, but talking about government-funded advanced medical research is an entirely different arena, and it just doesnt have anything to do with how our health insurance system is run. Its a red herring, and whats more, its one still slick from the water.

 

http://thisisanadventure.com/2009/07/how-medical-breakthroughs-happen-a-response-to-megan-mcardle/

[Voltaire 5,317]

I don't agree. More advances are driven by researchers who are working under government grants or are government employees. They are not profit driven. The profit drivers take it to market but don't drive the initial research and innovation.

 

Here is an article about the process:

 

Megan McArdle, Business Editor of The Atlantic and one of the most prolific free-market bloggers out there, had an interesting and lengthy post yesterday about her reasons for opposing national health care. Its worth reading, and several of her points are well-made which is probably why it was linked far and wide today, and is currently the top read story at RealClearPolitics. But McArdle also bases a portion of her argument on a surprisingly inaccurate depiction of the way medical research happens, one that needs rebutting if were going to keep the debate about reform of both the industry and the insurance side of health care based on facts about how the current system works, not polemics.

 

Starting at the sixth paragraph of her piece, McArdle launches into a description of the drug research process that is based on contrasting the tasks and goals of the National Institutes of Health and Pharma, starting from her premise that Monopolies are not innovative, whether they are public or private.

 

McCardle:

 

Advocates of this policy have a number of rejoinders to this, notably that NIH funding is responsible for a lot of innovation. This is true, but theoretical innovation is not the same thing as product innovation. We tend to think of innovation as a matter of a mad scientist somewhere making a Brilliant Discovery!!! but in fact, innovation is more often a matter of small steps towards perfection. Wal-Marts revolution in supply chain management has been one of the most powerful factors influencing American productivity in recent decades. Yes, it was enabled by the computer revolutionbut computers, by themselves, did not give Wal-Mart the idea of treating trucks like mobile warehouses, much less the expertise to do it.

 

In the case of pharma, what an NIH or academic researcher does is very, very different from what a pharma researcher does. They are no more interchangeable than theoretical physicists and civil engineers. An academic identifies targets. A pharma researcher finds out whether those targets can be activated with a molecule. Then he finds out whether that molecule can be made to reach the target. Is it small enough to be orally dosed? (Unless the disease youre after is fairly fatal, inability to orally dose is pretty much a drug-killer). Can it be made reliably? Can it be made cost-effectively? Can you scale production? Its not a viable drug if it takes one guy three weeks with a bunsen burner to knock out 3 doses.

End mccardle

 

 

She goes on at length from there, and Id encourage you to read it all for contexts sake. But needless to say, this passage and the ones following it surprised me a great deal. Working at the Department of Health and Human Services provided me the opportunity to learn a good deal about the workings of the NIH, and I happen to have multiple friends who still work there and their shocked reaction to McArdles description was stronger than mine, to say the least.

 

McArdle clearly doesnt understand what shes writing about, one former NIH colleague said today. Where does she think Nobel prize winners in biomedical research originate, academic researchers or in Pharma? Our academic researchers run clinical trials and develop drugs. Im not trying to talk down Pharma, which Im a big fan of, but I dont think anyone in the field could read what she wrote without laughing.

 

To understand how research is divided overall, consider it as three tranches: basic, translational, and clinical. Basic is research at the molecular level to understand how things work; translational research takes basic findings and tries to find applications for those findings in a clinical setting; and clinical research takes the translational findings and produces procedures, drugs, and equipment for use by and on patients.

 

Pharma operates under a great deal of pressure these days, and not just from the political side everyone wants to avoid being left holding the next Vioxx. But as a matter of focus, their only area of interest is that last category: clinical research. Whats more, theyre only really interested in clinical research into areas that hold the promise of recouping the cost of their investment, and more. They are a business, and they perform as one.

 

As a side note: If you want to understand why in 1998 the medical community suddenly decided that you were overweight at a body mass index of 25 instead of 27.8, taking the WHO view (based on the BMIs of Africa and other developing nations as opposed to the long-held U.S. definition) and suddenly making 30 million Americans fat, just look at the makeup of the advisory panel Pharma pushed this decision through, which had the effect of instantly adding millions of customers. But again, its nothing personal, just business.

 

So Pharma is interested in making money as their primary goal that should surprise no one. But theyre also interested in avoiding litigation. Suppose for a moment that Pharma produces a drug to treat one non-life threatening condition, and its a monetary success, earning profits measured in billions of dollars. But then one of their researchers discovers it might have other applications, including life-saving ones. Instead of starting on research, Pharma will stand pat. Why? Because it doesnt make any business sense to go through an entire FDA approval process and a round of clinical trials all over again, and at the end of the day, they could just be needlessly jeopardizing the success of a multi-billion dollar drug. It makes business sense to just stand with what works perfectly fine for the larger population, not try to cure a more focused and more deadly condition.

 

The truth, as anyone knowledgeable within the system will tell you, is that private companies just dont do basic research. They do productization research, and only for well-known medical conditions that have a lot of commercial value to solve. The government funds nearly everything else, whether its done by government scientists or by academic scientists whose work is funded overwhelmingly by government grants.

 

Its just simple math: if you have a condition that has a relatively small number of patients, theres just no market incentive to sink a great deal of time and money into researching it. This is why youll usually find that 100% not a majority, the entirety of the research into a cure is done either via taxpayer-funded grants to academic researchers or, more frequently, its entirely found on the NIH campus.

 

Organ transplantation? Just about 100% is funded by NIH. Low prevalence cancers, or cancers with low survival rates? Just about 100% of all three phases is funded by NIH. You start to understand how this works.

 

The innovation argument McArdle makes is silly because it presupposes that the government actually controls the research direction, says my NIH friend. The overwhelming majority of our money is devoted to RO1 research. A scientist in a lab has an idea he wants to pursue and writes a grant application. A few times a year the various institutes at NIH convene panels of academic researchers to evaluate the ideas and rank order them. We then issue grants based on the rank order.

 

This is one of the many reasons that, when it comes to real innovation, most of it originates in the academic labs, funded by the taxpayers. Its also one of the reasons that the boards of biotech start up companies are heavily populated with top NIH funded researchers. The bright line between public and private efforts on the research front exists only as a very dim separation in some areas, if at all.

 

While I consider myself a pro-market and pro-consumer conservative, specialized medical research is one area where government funding is still needed. And to be honest, I see no inconsistency between holding that view and also holding the view that a government takeover of our health insurance system is a bad idea. McArdle intends for the point of her post to be about the nationalized health care system, but talking about government-funded advanced medical research is an entirely different arena, and it just doesnt have anything to do with how our health insurance system is run. Its a red herring, and whats more, its one still slick from the water.

 

http://thisisanadventure.com/2009/07/how-medical-breakthroughs-happen-a-response-to-megan-mcardle/

Thank you. This is beautifully written. I've known this all along but putting it into words ... anyways, I wish I could click "like it" more than one time.

[DankNuggs 305]

It's set forth in the article linked to. It has allowed more insurance companies to come in and compete on the marketplace, whereas before each individual state was dominated by one or two insurance carriers.

What about the law allows more competition the article states it as fact, not why

[penultimatestraw 473]

I have more faith in the dollar to drive medical advances.

 

Anyway, another question: of all of these countries with far superior centralized care, are any as large as us?

Canada is bigger than us.

 

The US is the third most populous country in the world, and numbers one and two are just entering first world status. But Japan is doing pretty well with 1/3 of our population.

 

BTW I never said the care was far superior, but it is better by many metric including cost, so please drop the hyperbole.

[DankNuggs 305]

Canada is bigger than us.

 

The US is the third most populous country in the world, and numbers one and two are just entering first world status. But Japan is doing pretty well with 1/3 of our population.

 

BTW I never said the care was far superior, but it is better by many metric including cost, so please drop the hyperbole.

Health outcomes for the uninsured are about the same as those on Medicaid. Yet there is a moral

Imperative to go bankrupt to get people on Medicaid

[penultimatestraw 473]

Health outcomes for the uninsured are about the same as those on Medicaid. Yet there is a moral

Imperative to go bankrupt to get people on Medicaid

There is a moral imperative to treat all patients in need, regardless of type of insurance or ability to pay.

[jerryskids 6,829]

Canada is bigger than us.

 

The US is the third most populous country in the world, and numbers one and two are just entering first world status. But Japan is doing pretty well with 1/3 of our population.

 

BTW I never said the care was far superior, but it is better by many metric including cost, so please drop the hyperbole.

I actually thought about Canada as I hit the post button, thanks for going there in jest.

 

Anyway, I wasn't trying to use hyperbole. By "far superior" I meant "superior enough to justify a wholesale change," by your definition of superior.

[jerryskids 6,829]

I don't agree. More advances are driven by researchers who are working under government grants or are government employees. They are not profit driven. The profit drivers take it to market but don't drive the initial research and innovation.

 

Here is an article about the process:

 

Megan McArdle, Business Editor of The Atlantic and one of the most prolific free-market bloggers out there, had an interesting and lengthy post yesterday about her reasons for opposing national health care. Its worth reading, and several of her points are well-made which is probably why it was linked far and wide today, and is currently the top read story at RealClearPolitics. But McArdle also bases a portion of her argument on a surprisingly inaccurate depiction of the way medical research happens, one that needs rebutting if were going to keep the debate about reform of both the industry and the insurance side of health care based on facts about how the current system works, not polemics.

 

Starting at the sixth paragraph of her piece, McArdle launches into a description of the drug research process that is based on contrasting the tasks and goals of the National Institutes of Health and Pharma, starting from her premise that Monopolies are not innovative, whether they are public or private.

 

McCardle:

 

Advocates of this policy have a number of rejoinders to this, notably that NIH funding is responsible for a lot of innovation. This is true, but theoretical innovation is not the same thing as product innovation. We tend to think of innovation as a matter of a mad scientist somewhere making a Brilliant Discovery!!! but in fact, innovation is more often a matter of small steps towards perfection. Wal-Marts revolution in supply chain management has been one of the most powerful factors influencing American productivity in recent decades. Yes, it was enabled by the computer revolutionbut computers, by themselves, did not give Wal-Mart the idea of treating trucks like mobile warehouses, much less the expertise to do it.

 

In the case of pharma, what an NIH or academic researcher does is very, very different from what a pharma researcher does. They are no more interchangeable than theoretical physicists and civil engineers. An academic identifies targets. A pharma researcher finds out whether those targets can be activated with a molecule. Then he finds out whether that molecule can be made to reach the target. Is it small enough to be orally dosed? (Unless the disease youre after is fairly fatal, inability to orally dose is pretty much a drug-killer). Can it be made reliably? Can it be made cost-effectively? Can you scale production? Its not a viable drug if it takes one guy three weeks with a bunsen burner to knock out 3 doses.

End mccardle

 

 

She goes on at length from there, and Id encourage you to read it all for contexts sake. But needless to say, this passage and the ones following it surprised me a great deal. Working at the Department of Health and Human Services provided me the opportunity to learn a good deal about the workings of the NIH, and I happen to have multiple friends who still work there and their shocked reaction to McArdles description was stronger than mine, to say the least.

 

McArdle clearly doesnt understand what shes writing about, one former NIH colleague said today. Where does she think Nobel prize winners in biomedical research originate, academic researchers or in Pharma? Our academic researchers run clinical trials and develop drugs. Im not trying to talk down Pharma, which Im a big fan of, but I dont think anyone in the field could read what she wrote without laughing.

 

To understand how research is divided overall, consider it as three tranches: basic, translational, and clinical. Basic is research at the molecular level to understand how things work; translational research takes basic findings and tries to find applications for those findings in a clinical setting; and clinical research takes the translational findings and produces procedures, drugs, and equipment for use by and on patients.

 

Pharma operates under a great deal of pressure these days, and not just from the political side everyone wants to avoid being left holding the next Vioxx. But as a matter of focus, their only area of interest is that last category: clinical research. Whats more, theyre only really interested in clinical research into areas that hold the promise of recouping the cost of their investment, and more. They are a business, and they perform as one.

 

As a side note: If you want to understand why in 1998 the medical community suddenly decided that you were overweight at a body mass index of 25 instead of 27.8, taking the WHO view (based on the BMIs of Africa and other developing nations as opposed to the long-held U.S. definition) and suddenly making 30 million Americans fat, just look at the makeup of the advisory panel Pharma pushed this decision through, which had the effect of instantly adding millions of customers. But again, its nothing personal, just business.

 

So Pharma is interested in making money as their primary goal that should surprise no one. But theyre also interested in avoiding litigation. Suppose for a moment that Pharma produces a drug to treat one non-life threatening condition, and its a monetary success, earning profits measured in billions of dollars. But then one of their researchers discovers it might have other applications, including life-saving ones. Instead of starting on research, Pharma will stand pat. Why? Because it doesnt make any business sense to go through an entire FDA approval process and a round of clinical trials all over again, and at the end of the day, they could just be needlessly jeopardizing the success of a multi-billion dollar drug. It makes business sense to just stand with what works perfectly fine for the larger population, not try to cure a more focused and more deadly condition.

 

The truth, as anyone knowledgeable within the system will tell you, is that private companies just dont do basic research. They do productization research, and only for well-known medical conditions that have a lot of commercial value to solve. The government funds nearly everything else, whether its done by government scientists or by academic scientists whose work is funded overwhelmingly by government grants.

 

Its just simple math: if you have a condition that has a relatively small number of patients, theres just no market incentive to sink a great deal of time and money into researching it. This is why youll usually find that 100% not a majority, the entirety of the research into a cure is done either via taxpayer-funded grants to academic researchers or, more frequently, its entirely found on the NIH campus.

 

Organ transplantation? Just about 100% is funded by NIH. Low prevalence cancers, or cancers with low survival rates? Just about 100% of all three phases is funded by NIH. You start to understand how this works.

 

The innovation argument McArdle makes is silly because it presupposes that the government actually controls the research direction, says my NIH friend. The overwhelming majority of our money is devoted to RO1 research. A scientist in a lab has an idea he wants to pursue and writes a grant application. A few times a year the various institutes at NIH convene panels of academic researchers to evaluate the ideas and rank order them. We then issue grants based on the rank order.

 

This is one of the many reasons that, when it comes to real innovation, most of it originates in the academic labs, funded by the taxpayers. Its also one of the reasons that the boards of biotech start up companies are heavily populated with top NIH funded researchers. The bright line between public and private efforts on the research front exists only as a very dim separation in some areas, if at all.

 

While I consider myself a pro-market and pro-consumer conservative, specialized medical research is one area where government funding is still needed. And to be honest, I see no inconsistency between holding that view and also holding the view that a government takeover of our health insurance system is a bad idea. McArdle intends for the point of her post to be about the nationalized health care system, but talking about government-funded advanced medical research is an entirely different arena, and it just doesnt have anything to do with how our health insurance system is run. Its a red herring, and whats more, its one still slick from the water.

 

http://thisisanadventure.com/2009/07/how-medical-breakthroughs-happen-a-response-to-megan-mcardle/

Some thoughts:

 

1. It is well-written, as Voltaire indicated.

2. I don't quite see the distinction that the author is making. McArdle specifically talked about the productization contributions of pharma; she didn't say that pharma comes up with all of the basic ideas. I guess I missed something.

3. Anyway, in this model, how does say... Pfizer vs. Merck get access to the next bazillion-dollar wonder drug that the NIH develops?

[IGotWorms 4,058]

What about the law allows more competition the article states it as fact, not why

 

It allows insurers much easier access to the marketplace, as explained here:

 

 

Right now, it’s not unusual for one health insurance plan to cover the majority of an individual market’s buyers even when there are dozens of smaller health plans in the same market. Seventeen states have health insurance carriers that cover more than two-thirds of the individual insurance market, according to data from the Kaiser Family Foundation.

“It’s not an easy market to enter,” Larry Levitt, vice president at the Kaiser Family Foundation, said. “You need to have to have a lot of systems in place to be an insurance company, like a provider network, and be able to compete against a known brand.”

The new health insurance exchanges, Levitt said, will help smaller insurers gain market share by displaying all insurance plans side-by-side, sorted by the cost of monthly premiums.

“It definitely makes it easier for a small plan to compete,” he said.

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/30/are-obamacares-exchanges-competitive-heres-what-the-experts-say/

[Recliner Pilot 61]

3 of California's largest insurers, AETNA, CIGNA, and United Health have decided to pull out of the exchanges.

 

Good for competition, huh Worms.

[drobeski 3,061]

[IGotWorms 4,058]

3 of California's largest insurers, AETNA, CIGNA, and United Health have decided to pull out of the exchanges.

 

Good for competition, huh Worms.

Interesting you didn't leave a link there. Could it be that you are misrepresenting the facts again?

 

ETA: did a quick little search of my own and apparently there are 11 insurance companies participating in the California exchange

[Recliner Pilot 61]

You need a link to a commonly known fact?

 

Oh, for a second I forgot you are the King of the low information voter.

[IGotWorms 4,058]

And it appears that one of the eleven companies participating in the CA exchange is Coventry Healthcare, which is owned by AETNA

[IGotWorms 4,058]

Also AETNA was never a participant in CA's health exchange so you can't really say that they "pulled out" of the exchange

[IGotWorms 4,058]

Meanwhile, the biggest insurers in the state Kaiser Permanente, Anthem Blue Cross and Blue Shield of California are all expected to participate in the state-run market for individual health coverage.

 

...

 

UnitedHealth, Aetna and Cigna are small players now in California's individual health insurance market. More of their business is focused on large employers, where most Californians receive their health coverage. But the companies signaled a wait-and-see approach on these new government-run marketplaces.

 

Together, in 2011, those three big insurers had 7% of California's individual health insurance market, according to Citigroup research. In contrast, Kaiser, Anthem Blue Cross and Blue Shield had nearly 87%, collectively. Anthem Blue Cross is a unit of WellPoint Inc., the nation's second-largest health insurer.

http://articles.latimes.com/2013/may/22/business/la-fi-health-insure-20130523

 

[Recliner Pilot 61]

None of those 3 companies are in tge exchange.

 

Hth

 

Good job chasing down a bunch of BS that doesn't refute that.

 

[Sho Nuff 720]

None of those 3 companies are in tge exchange.

 

Hth

 

Good job chasing down a bunch of BS that doesn't refute that.

 

 

The 3 biggest that he mentioned...are on there.

https://www.coveredca.com/hbex/insurance-companies/

 

What he did...was show how your "major players" were not major players in California...and those that are, are involved in the exchange...making your point...completely idiotic as usual.

[IGotWorms 4,058]

You got caught with your pants down, again. That'll learn you to really on stupid conservitard sites that don't give you the full story