glass99 said:
moltenmetal: 17% of GPD is of course appalling. However, in defense of the current mess:
- America subsidizes the rest of the world for practical drug and device development. When America stops overpaying for drugs, Canadians better get used to their generics at whatever level of development they were at the year the US went public.
Prescription drugs are not covered by the Canadian plan, except for the very poor and for drugs given in hospital. But because the governments are a major purchaser and are unafraid to use their purchasing power to negotiate, we all benefit from lower prices. Think of it as a tax on profit. If the US didn't exist, drug companies would still exist, and would still do drug development. What you'd see though is far less peddling of drugs on TV- far less "market building" on the part of drug companies. Those ads you see on US TV- they are absent from Canadian TV entirely. The cost of drugs in Canada also comes with a dramatic reduction in marketing/advertising cost for the drug companies, not by their own choosing I might add.
glass99 said:
- A private system has the possibility of technical innovation, which largely does not exist in single payer systems. If the government just sets the price for commodities, its hard for a young plucky entrepreneur like Elizabeth Holmes to get off the ground.
The public system reduces the maximum profit attainable from such innovation but by no means does it prevent innovation entirely.
glass99 said:
Right now there are gigantic incentives in place for private firms to do better. America was built on techno-capitalism.
- It is not a coincidence that Silicon Valley is in the US and not in France.
All this "innovation" your country is built on isn't making your healthcare cheaper for one simple reason: healthcare is not a market commodity. It's not an IPad you can choose to buy or not buy.
glass99 said:
- Getting 300 million Americans to agree on a single approach is harder than getting 30 million Canadians on board. Even Obamacare is controversial! What would healthcare in the EU look like if it was one system? They can barely manage a currency. The whole structure of government is geared to make central control difficult. The founding fathers baked in the current deadlock with the congress/senate/president/court demarcation.
There are three core reasons your system is screwed:
1) You aren't a totally compassionless country and hence you have a parallel public system- just a totally messed up one which is fragmented into several disparate programs. This fact limits competition- sets a floor for the prices of services etc. But it's impossible to avoid, unless you surgically remove compassion
2) Your political system, like all others but moreso than most, is subject to the power of money. 7% of GDP buys a lot of political power to prevent government "innovation" which might take away private profit
3) You are a nation that from its founding has feared its own government. You don't view government as something you do collectively for each other's benefit- something you can do better together than any of you can do independently. Hence government is always viewed as an evil- by some among you, not even as a necessary evil. You therefore push things onto the private sector that it cannot efficiently provide
glass99 said:
- It could be viewed that the primary problem with US healthcare is its market system is clogged. Market forces are blunted by the structure of insurance.
No, the fundamental problem is that the "commodity" of healthcare isn't a commodity- it's a human right. Accordingly the market cannot function to minimize its cost through competition. The insurance companies are a symptom of this problem- they are private entities set up to intercept the necessary and unavoidable flow of money from people needing care to the care providers, and take away as much of that for themselves as possible. They are, by definition, parasites.
