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Old 07-17-2016, 08:43 AM   #21
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Just about every industrialized western country has a universal health care system of one sort or another. Most single payer. They spend less of their GDP on health care, the costs are not rising as quickly and certainly not at multiples of the country's inflation rate. Nor do they threaten to pass the level of 18 percent of GDP which is deemed by many economists to be unsustainable in the long run and a drain on a country's financial well being. Their health outcomes are as good, and often better.


Nor has the so called threat of 'socialized medicine' turned their countries away from capitalism or caused other terrible results that the fear mongers and special interest groups have preached for so long. If anything, it will make their economies more competitive in the long run.

It really comes down to whether one believes that the provision of healthcare, like fire, police, clean water etc, is a basic need or if it should be rationed based upon ability to pay.


We have considered purchasing retirement property in the US. We decided some time ago that the healthcare situation, the gun control issue, and to a lesser extent the tax provisions precluded us from moving forward with a purchase. Just our opinion.
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Old 07-17-2016, 09:13 AM   #22
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One of the wild cards, I think, is that drug costs may be out of control in the US at least **in part** because of cost controls in most other nations. It creates a form of cost-shifting where the US health care system has to eat untold billions of dollars a year in extra drug costs compared to the rest of the world. It's not unlike Medicare creating cost shifting on private insurance plans, and even more on the uninsured, because of lower Medicare reimbursement rates.

Could the US create similar cost caps as many other nations, and still have these blockbuster drugs be economically feasible to develop? Hard to say.
Thinking about that question, I took a look at Pfizer's 2015 financial statement (here). Just one company, only three years of data and just browsing over the data. Still, a couple of things jump out:

Gross profit margins are 80%, while R&D cost is only 15%. Over the past 3 years they invested roughly the same amount of cash in research as they did buying back stock. The high drug prices aren't funding product development, they are funding the high sales expense and shareholder return. The bombardment of tv commercials to generate demand would seem to support that view.
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Old 07-17-2016, 09:38 AM   #23
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Thinking about that question, I took a look at Pfizer's 2015 financial statement (here). Just one company, only three years of data and just browsing over the data. Still, a couple of things jump out:

Gross profit margins are 80%, while R&D cost is only 15%. Over the past 3 years they invested roughly the same amount of cash in research as they did buying back stock. The high drug prices aren't funding product development, they are funding the high sales expense and shareholder return. The bombardment of tv commercials to generate demand would seem to support that view.
I guess the lesson is to buy drug company stocks in order to be able to afford their drugs.
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Old 07-17-2016, 09:44 AM   #24
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Thinking about that question, I took a look at Pfizer's 2015 financial statement (here). Just one company, only three years of data and just browsing over the data. Still, a couple of things jump out:

Gross profit margins are 80%, while R&D cost is only 15%. Over the past 3 years they invested roughly the same amount of cash in research as they did buying back stock. The high drug prices aren't funding product development, they are funding the high sales expense and shareholder return. The bombardment of tv commercials to generate demand would seem to support that view.
I seem to remember that some countries do not allow ads for Drugs.
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Old 07-17-2016, 09:55 AM   #25
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I seem to remember that some countries do not allow ads for Drugs.
Good point, it looks like only 2 or 3 countries allow Direct To Consumer marketing of drugs.

https://en.wikipedia.org/wiki/Direct...permitting_DTC

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All Western nations, with the exception of New Zealand and the United States, have historically (since the 1940s for Australasia, North America, and Europe) banned direct advertising of pharmaceuticals to consumers
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Old 07-17-2016, 11:34 AM   #26
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I am grateful that my husband will be going on the single payer system that is available in the US - Medicare - this January. It will save us significant money compared to the ACA. His doctor is available through both a medicare advantage plan and a medigap plan.

I've read some, in the past, about how medicare changed doctors compensation significantly. Doctors actively supported medicare because it meant they would *get* compensated for providing care to seniors who otherwise couldn't afford it. The uncompensated care provided previously was written off... it was given for moral reasons, rather than financial reasons.

Here in the US we have the highest paid general practitioners in the world. Yes there are annoying insurance forms to fill out - but I would think this extra pay would take the sting out of the paperwork annoyance. But given the trend to doctors not taking insurance, perhaps I'm wrong.

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The United States has the highest paid general practitioners in the world.[5] The US has the second-highest paid specialists in the world behind the Netherlands.[5] Public and private payers pay higher fees to US primary care physicians for office visits (overall 27 percent more for public and 70 percent more for private) than in Australia, Canada, France, Germany and the United Kingdom.[6] US primary care physicians also earn more (overall earning $186,000 yearly) than the foreign counterparts, with even higher numbers for physician compensation for medical specialists.[6] Higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, mainly drive higher US spending.[6]
https://en.wikipedia.org/wiki/Physic..._United_States
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Old 07-17-2016, 01:18 PM   #27
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We have considered purchasing retirement property in the US. We decided some time ago that the healthcare situation, the gun control issue, and to a lesser extent the tax provisions precluded us from moving forward with a purchase. Just our opinion.
Glad to hear you avoided that mistake brett! Some folks just don't seem to be able to come to grips with the fact that they're better off where they are and move anyway only to regret it later. Since you're already in a superior location, why downgrade yourself by moving?

Enjoy your life "Up Nort!"
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Old 07-17-2016, 05:07 PM   #28
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. . . .the fear mongers and special interest groups have preached for so long.
Is this characterization of opponents compatible with a reasoned discussion of this issue?

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It really comes down to whether one believes that the provision of healthcare, like fire, police, clean water etc, is a basic need or if it should be rationed based upon ability to pay.
Health care is rationed according to ability to pay in >every< system, yours included. Neither governments, corporations, nor individuals have the resources to provide unlimited healthcare. So, let's just be above board about that.

As far as what "it really comes down to"--at least in the US, I think it's more basic and also more complex than what you are portraying. In this country, there's no basic right to a house, to food, to health care, etc. From a technical standpoint, our Constitution largely lays out "negative rights" (protections from the government in various areas, etc, often known as "natural rights") rather than "positive rights" (to goods/services). By degrees we have established public policies that shift resources toward these areas, but there is no fundamental source document that says the federal government is empowered to seize resources (by force) from some people to give them to other people to meet these requirements. If we had a national discussion that led to amending our Constitution to enumerate these transfers and new "rights," I suppose things would be a lot more clear and there could be a more straightforward discussion of what we are attempting to do, and by what authority.
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Old 07-17-2016, 05:30 PM   #29
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I am not yet eligible for Medicare, but find it very confusing (and I like to think I am somewhat educated). Parts A - N and Advantage Plans? I will probably need to get some advice when the time comes.
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Old 07-17-2016, 07:15 PM   #30
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Nothing in the constitution about Medicare or Social Security either.

No way men in the 18th century could anticipate how the country would develope over 200 years later.

And the ACA was declared constitutional by the Roberts Court. It's not inconceivable the Court could rule future laws regarding health care constitutional as well.
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Old 07-17-2016, 07:45 PM   #31
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Nothing in the constitution about Medicare or Social Security either.
Yes, but these are (nominally) structured as insurance programs that require at least some payment by the recipient. But Medicaid would be a better example. Positing that people have a "right" to this or that benefit (food, housing, medical care, any education they desire, etc), and that other members of the public should be forced to pay for it, is a significant expansion on the "rights" enumerated in the Constitution. So, let's have the up-front national discussion and use the well-established procedure for enshrining new rights, rather than asking SCOTUS to simply read something into the Constitution that is not expressly provided. That seems a very honest way to approach this.

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No way men in the 18th century could anticipate how the country would develope over 200 years later.
That's why they provided a means to amend the Constitution. Let people make their case--if it's really what "people want," then prove it. Define these "new rights" and their limits. While we are are at it, perhaps we can define some type of limit on just how much property can be seized from any citizen to be given to others.
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Old 07-17-2016, 07:49 PM   #32
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Health care is rationed according to ability to pay in >every< system, yours included. Neither governments, corporations, nor individuals have the resources to provide unlimited healthcare. So, let's just be above board about that.
Broadly speaking, you are correct. But there is a fundamental difference between a system in which healthcare is rationed based on the ability of an individual to pay, and one where the total amount of healthcare provided to the population as a whole is limited by the amount of taxation that the population as a whole is willing to pay. in the first example, healthcare is viewed as the responsibility of the individual, while in the second, it is considered a public good.
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Old 07-17-2016, 08:14 PM   #33
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Broadly speaking, you are correct. But there is a fundamental difference between a system in which healthcare is rationed based on the ability of an individual to pay, and one where the total amount of healthcare provided to the population as a whole is limited by the amount of taxation that the population as a whole is willing to pay. in the first example, healthcare is viewed as the responsibility of the individual, while in the second, it is considered a public good.
Yes. But, as a practical matter, in the US we are well beyond the point where people are limited to the health care they can buy with their own resources, so the original stipulation was not an accurate one, either. We have Medicaid for the indigent, the ACA and its subsidies for both insurance premiums and medical costs and its stipulations regarding the "affordability" of premiums, etc. And, of course, Medicare. In addition to this we also have a less-than-tight network of public clinics and the requirement that ERs provide stabilizing care without regard to ability to pay.
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Old 07-18-2016, 05:24 AM   #34
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The idea of a national healthcare program is indeed noble in my opinion.

However, there are potential serious drawbacks. I just returned from overseas and the subject of healthcare came up with local family.

We were told one of our relatives would need to wait 2 years for cataract surgery if done through the national system. Additionally another relative was having to wait 7 years for a knee replacement.
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Old 07-18-2016, 06:58 AM   #35
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The idea of a national healthcare program is indeed noble in my opinion.

However, there are potential serious drawbacks. I just returned from overseas and the subject of healthcare came up with local family.

We were told one of our relatives would need to wait 2 years for cataract surgery if done through the national system. Additionally another relative was having to wait 7 years for a knee replacement.
While this is true in some cases. Emergencies and life threatening accidents or illnesses are treated very expediently (At least in Canada and the UK of which I am familiar).

The recipient & Their family does not potentially go bankrupt because a child or family member has a potential catastrophic issue.

Here in the USA for the most part, if a child is born to a middle class family with a complication that impacts a lifetime of medical care, their family is virtually ruined because of the financial hardship. Prior to ACA they could not get insurance at all.

This does not occur in countries with a sensible healthcare for all system.

If you want your cataracts or hip seen to earlier, I am sure one has an option to pay extra for it.

"Noble" and essential IMHO. All we really need is Emergency healthcare for all. We can purchase riders and supplements as needed for everything else.

We do have a kind of single payer system for the select few in this country, like those who cannot pay for example (You cannot get blood out of a stone). it should be expanded to all. Medicare for all may work.
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Old 07-18-2016, 07:08 AM   #36
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Doctors group welcomes national debate on ‘Medicare for All’ | Physicians for a National Health Program

Excerpts:

Myth: A single-payer system would impose an unacceptable financial burden on U.S. households. Reality: Single payer is the only health reform that pays for itself. By replacing hundreds of insurers and thousands of different private health plans, each with their own marketing, enrollment, billing, utilization review, actuary and other departments, with a single, streamlined, tax-financed nonprofit program, more than $400 billion in health spending would be freed up to guarantee coverage to all of the 30 million people who are currently uninsured and to upgrade the coverage of everyone else, including the tens of millions who are underinsured.


What is truly “unrealistic” is believing that we can provide universal and affordable health care, and control costs, in a system dominated by private insurers and Big Pharma.

+100

When you have a battle between heslthcare and Profit, profit will ALWAYS win evennif it means the detriment of healthcare. Insurers bottom line will always be the bottom line

this is such a sore spot for me because my dh died from AML a few years ago. He had to have a Neuprogen shot once a day to battle the cancer, which of course Aetna denied because they wanted him to try a cheaper alternative which almost every Oncologist in NYC and Philly said did not work. Shots were 100/day.

I think of all the energy and time I wasted battling Insurance companies that I could have spent with him and my eyes glaze over and a red haze drops down
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Old 07-18-2016, 07:17 AM   #37
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The idea of a national healthcare program is indeed noble in my opinion.

However, there are potential serious drawbacks. I just returned from overseas and the subject of healthcare came up with local family.

We were told one of our relatives would need to wait 2 years for cataract surgery if done through the national system. Additionally another relative was having to wait 7 years for a knee replacement.
That is so weird to me and I've heard that before. my late husband was Portuegese. We spent a few years in Lisbon when we were first married. We waited for nothing. my late father in law went from diagnosis to heart surgery in under two months.

first let me say I was married over 28 years ago so it probably has changed alot.

Lol, when we decided to come back to the states because we wanted to start a family, my inlaws thought we were insane.
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Old 07-18-2016, 07:33 AM   #38
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We live in Canada. We have had a single payer system for years. It is not perfect. No health care system will ever be perfect.

What is interesting is that every poll taken shows that 80 plus percent of the population supports the current system. Our right wing politicians don't even think of introducing user fees or even discussing for it is a sure fire way for them to end up in political oblivion.

The medical associations in Canada are now recommending, and have been for the past few years, the next step. The inclusion of prescription drugs into the plan.

The discussion is making it's way to the political forum Naturally, the drug companies are against this, as are the insurance companies.

Seems to me that if the drug companies and the insurance companies are against it, it must be to the benefit of the rest of us.
Yes, agree. We Canadians generally are very supportive of our system. Not perfect but very good for the vast majority. It has resulted in doctors making less money, than would be the case otherwise though. Not surprising that the majority of American doctors would want a system that maintains their freedom and earning potential. Single payer never gonna happen though, too bad.
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Old 07-18-2016, 07:44 AM   #39
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We have considered purchasing retirement property in the US. We decided some time ago that the healthcare situation, the gun control issue, and to a lesser extent the tax provisions precluded us from moving forward with a purchase. Just our opinion.
I was with you until you said this. Travel health insurance is easily and fairly cheaply available and you know this because of your current travels. We own a house in Arizona and have never seen a gun in public. The tax issues you speak of are insignificant if you are informed, which I know you are. Unfortunately, your overall argument is weakened by this clearly biased, and unfair description of snowbirding. Furthermore, in other threads you have made it very clear that your decision to not buy a second home was mostly financial and lifestyle in nature.
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Old 07-18-2016, 11:15 AM   #40
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