How long before Kevin's sarcastic quips about France will get picked up and related as gospel on some right wing website?

That's just the free market working, Kevin. In this economic transaction between customer and insurance company, the cost of the MRI accrues to the participant willing to pay more; Charles was willing to pay $2,480, which exceeded the amount the insurance company was willing to pay ($0). Simple economics.

I guess he should have called every MRI shop in town to check prices, while his doctor tapped his fingers impatiently. That's why God created HSAs.

I'm not good at sarcasm.

It proves the Reagan/Bush point, you can spend your money better than the Government can spend your money. Same for Insurance companies.

France also gives out "special" free pills to all its citizens. They induce a cowardly reaction to Muslim terrorism and a Nancy-boy reaction to aggression in general.

KD: ...And nobody knows how to operate it anyway because the instructions are in English and no one in France speaks English?...

...And to get to it, you have to walk uphill, through snow, both coming and going?...

There's probably recourse for him to try and get reimbursed. "Medical emergencies" do not need to be pre-approved. It was probably billed, by the dr.s and the hospital/facility, with "non-emergency" diagnosis or procedure codes.

The claim can often be resubmitted, with different billing codes. It all depends on the plan type - PPO, POS, or HMO. If he was "directed" by his dr., to have this procedure, and the dr. was in his network (or he had a referral to him) then the patient was following dr's orders, and the procedure should be covered at the "in network" rate.

If he was not under direct orders from a primary care dr., or a specialist with a valid referral, then the patient WAS directing his own care, and is probably being "covered" at the "out-of-network" rate - and the charges are applying to his deductible, or not at all with an HMO. And in a non-emergency, this would be correct.

The patient should contact his state department of insurance, for the info on appealing it, as a last resort. Anyway, the system is ridiculous, of course - nationalized health care will be here in 20 years or so. (This kind of thing could also happen under a nationalized system though).

The last time I had an MRI the capital equipment was owned by the Dr. who prescribed it. I had to sign a waiver stating I was aware of that. Too bad French doctors cannot find such lucrative investments. I guess they have to spend most of their time helping patients heal.

Story from Canada: 2 weeks ago I had to take my 3 year old to emergency. It was about 4 in the afternoon. They had her in an examination room before I could even finish the paperwork! Total time of visit was about 45 minutes. This involved seeing 2 doctors, 3 nurses and filling out forms to participate in a survey. We may have our problems but all in all it seems to work well.

Oh, by the way, my daughter is as good as new.

Oh, by the way - I don't mean to give you the complete medical history of my family, but my father just had to go to the Ottawa Civic because an x-ray showed something in his brain. Total wait time for the MRI was 2 days (it was a weekend). So take that Al.

Good grief.

Al is still as dumb as a rock.

And why the hell would it take 3 days to get an approval?

Well, sure, John, but that just means that some other sap had to wait 298 days....

And why the hell would it take 3 days to get an approval?

To incentivize the patient to self-insure that procedure....

Al -

Ever notice how every time someone talks about waiting lists in "Canada and Europe," that person inevitably only quotes a statistic from Canada? The simple reason for this is that Canada is the only country where waiting lists for a few procedures tend to be longer than in the United States. Why? Canada spends a fraction of what we spend on health care.

Waiting lists are a result of how much we spend on health care, not how we pay for it. This explains why our waiting lists are shorter for things like hip replacements, when both Canadian and U.S. hip replacements are provided almost entirely by the gov't (medicare in the latter case).

Link to the National Review?!?!?!?!?

Multifuckingmillionaire Wall Streeter Andrew Tobias and his multifuckingmillionaire fashion designer partner Charles Nolan got stung with a $2500 MRI bill!! Oh Noes! This is teh OUTRAGE!!11!

Boo Fucking Hoo. I had an MRI a few weeks ago, I'm insured, but I still ended up paying $1400 after what Blue Cross covered. At least I had my MRI within 1 hour of the doctor's order. Unfortunately the MRI showed nothing, so it was all a waste of money. The doctor was just covering his ass, in case he missed something. Dammit.

Al's 1998 data are surely significant, given that's the year they stopped building MRI machines.

In related news, the National Review reports that Canadians can get a government-subsidized igloo after a mere three-week wait, compared to an 18-month average wait in the States (and even longer for Katrina victims). So let's call it a draw, shall we Al? Oh, that's right. You're instructed to never post twice to the same thread.

On my way to work I see an equal number of MRI clinics as I do Starbucks. Why are they still so expensive?

Though I strongly agree that the US healthcare system is broken, this little story captures why actual reform of the system will require acceptance of changes that will inevitably displease many people.

Back pain is indeed very often excruciating, but only in rare circumstances will getting an early MRI has any effect whatsoever on care. (Primarily, this occurs when sciatic-type pain is of such severity that emergency surgery is warranted.) For back pain as such, no matter how severe, there is no difference in outcome or course of care between an early MRI or getting one in six weeks.

The only benefit to the early MRI, in fact, is peace of mind of value for the patient is peace of mind. That's a value, certainly, but one that must be weighed against other uses of health care dollars.

At various times, independent medical commissions have set out guidelines for when an MRI is actually indicated in back pain -- and the answer is "almost never." In a rational health care system, the answer to most requests for an MRI would be "no."

Again, I do think our system needs to be massively overhauled. I do think a single payer system is a viable option. But this is not going to solve the problem addressed by this story: because, unless costs are going to continue to rise exponentially, someone has to ration care. The doctor and the patient have no interest in doing so -- rather the opposite. So, whether it's a bureaucrat, a health insurance employee or a Medicare reviewer, someone living in an undisclosed location will be making decisions like these. And people won't like it.

Steven Bratman, MD

On my way to work I see an equal number of MRI clinics as I do Starbucks. Why are they still so expensive?

I donno... why are Starbucks still so expensive?

I think Dr. Bratman makes a good point. Many of the people who are now receiving MRI's do not need them and they do not contribute to better healthcare, but these same people are in the politically influential ecomonic brackets that inspires most American politicians. These people do not want to give up their privileged status, whether it contributes to their well being or not, and the politicians are going to care more about their concerns than the needs of the other 80% of the population. That is one reason why our healthcare system resists change.

Steven Bratman: Back pain is indeed very often excruciating, but only in rare circumstances will getting an early MRI has any effect whatsoever on care.

Then his doctor should have explained that to him.

unless costs are going to continue to rise exponentially, someone has to ration care. The doctor and the patient have no interest in doing so -- rather the opposite. So, whether it's a bureaucrat, a health insurance employee or a Medicare reviewer, someone living in an undisclosed location will be making decisions like these. And people won't like it.

People don't like it now. I don't know why the rationing has to be done by "someone living in an undisclosed location" though. I would think it better if doctors made some of the rationing decisions on their patients, rather than an undisclosed location person (Dick Cheney?) who gets brownie points for nixing X procedures, without real regard to their importance.

Of course doctors would need an incentive to do this, and I realize it puts extra pressure on them. And no, unfortunately, I don't have solid ideas about how this would work. Maybe standard guidelines with some wiggle room for the doctor so they can order occasional non-guideline stuff, without having to explain themselves, so long as they don't do it for 90% of their patients.

We have rationing now.

Perhaps, I wasn't clear.

We have rationing now

We have rationing now and it is done on the basis of ability to pay - the single worst indicator of need one could hope to find. Picking people randomly out of a hat would yield better results. Every person who claims that the problem with single payer health care is that it would lead to rationing is lying.

Just to be clear:

WE HAVE RATIONING NOW

Ah, Kevin.

A few years ago IN AMERICA I was having a pain underneath and so I went to the doctor IN AMERICA and the doctor did the examination and treated me for the condition IN AMERICA and it was quick and the facilities were very clean and spacous and my insurer covered everything and all I had to pay was a $30 colpay IN AMERICA.

By the way, did I mention my EXCELLENT, TOP-NOTCH, CHEAP health care was IN AMERICA?!

I forgot to mention, the proceduce was to have a small piece of brain that had become lodged in my skull removed.

Much better now.

3 years ago, my daughter was in Germany. She fell down and cut her fingers, requiring stiches (10 - 12). In this country, this would have required the ER and a followup, minimum charge probably $1000.

In Germany, they paid out of pocket EU 35. That included the followup.

EU 35 - that's cheapo.

The main problem, as people are beginning to notice, is that physicians are WAY WAY WAY overpaid in this country. That drives the whole system.

We need to cut physician pay in half and then the system would begin to work.

Dr. Bratman, don't attempt to inject rationality into this forum regarding this topic. For many, if not most here, this matter is in the realm of Faith, where trade-offs don't exist, and mention of those nasty little realities will, ironically, be met with accusations of having irrational Faith in markets to deliver perfect results.

Ah Kevin

A few days ago you were having a "pain underneath" - would that be a euphemistic way of saying "a pain in the arse"? (sorry - ass - as you would put it IN AMERICA. So you were treated in premises that were "spacuous" - would that be spacious as we might put it in the rest of the English speaking world beyond AMERICA. AMERICA - is that not two continents that extend fron Tierra del Fuego to Baffin Island, and include Canada and Chile, Brazil and Guyana etc? I daresay you imagine a solipsist is the supporter of a weird political party in some faraway country of no import beyond AMERICA. ditto Euphemism.

Will, do we already have rationing?

"The doctor and the patient have no interest in doing so -- rather the opposite. So, whether it's a bureaucrat, a health insurance employee or a Medicare reviewer, someone living in an undisclosed location will be making decisions like these. And people won't like it."

Geez, another arrogant doctor here telling us stuff and pretending that we need that ol' patronyzing physician stuff. I'm not a physician, but do all the data analysis for them frequently. And there are other people running around who do not need that patronyzing crap either.

When I am in my IRB meetings with the physicians and such, we often discuss the concept of "standard of care." Standard of care is pretty much codified, and will not include experiment off the wall stuff. So, we get a national health insurance that pays standard of care treatment, and the rest is out of pocket.

And of course people won't be happy, but they will get standard of care.

Doctors in the US want to be business owners, not technicians working in a clinic to heal people. I have no problem with doctors earning ten times the median wage, but many want to earn 100 times more. It will be very difficult to change this economic privileged class into healers working for the benefit of all.

Like George W. says, it's better for a child to show up at an emergency room than for the gommint to fund the child's insurance.

I know a guy who always defends the President and had his testicles removed and sent to George Bush for safe-keeping. Now that is a Loyal Republican.

. . . so they could see what was happening and Charles's assistant called his health insurer to get prior approval for the MRI but the health insurer said it would take three days to get approval so. . .

Regardless of how long it took for approval, unless you're wheeled into the emergency room after an accident, you don't get scheduled within hours of a doctor's recommendation for an MRI. You know, even though we have at least two MRI machines in the U.S., someone (or some dozen) might actually have an appointment before you. It's not like they're clearing out the cobwebs every time they use "the tube."

MRIs have pretty much replaced X-ray for internal analysis because they provide pictures of both soft tissue and bone. And though there are more of them per capita in the U.S., they are still exceedingly expensive machines, so you're more likely to find them attached to the radiology department of hospitals of larger clinics.

Since it's unlikely that any insurance company will balk at approving the MRI recommended by an orthopedist, one can at least schedule the appointment as soon as it's been recommended by the doctor. It's not like an MRI is experimental diagnostic equipment for back injuries. The patient in question already has "back surgeon" (as opposed to just an orthopedist). In other words, he's suggesting a history of back problems, though he doesn't bother to tell us whether he's had an MRI or CT scan before nor does he tell us what kind of health insurance he has.

Back pain notwithstanding, his example smacks a bit of I want it and I want it now!

Dr. Bratman;
If the problem is Sciatica, (which is the most common) then, yes, an MRI isn't always necessary up front.

But often, sciatica is a symptom of an underlying, more serious issue, like degeneration of the cartilage, ligaments, bone deformity, arthritis, spondelothesis, pulled muscle, etc. In some of these cases - the condition is cronic, and progressive, and an MRI taken early on is very important in order to establish a baseline, to determine how the condition is progressing over time.

My insurance company had a hard-rule: No MRI unless there was loss of motor function. That is to say - I either had to be unable to walk, or I had to lose bowel or bladder function. A fucking bean-counter made that decision. Not my doctor.

The bean-counter's policy is to wait until you're potentially permanently crippled before they'll pay for medical care.

The anti-Single-Payor people say they don't want a government bureaucrat making medical decisions for them. I'd rather have that than an insurance industry accountant worried about his next quarterly bonus. At least I can vote for the government bureaucrat's boss. With the Insurance company as the gatekeeper, I have zero choice, unless I want to change jobs.

JeffII;
In many cases, an XRay is required prior to having an MRI. If there are any metal bits inside the patient (like, if the patient is a machinist, or mechanic), then an XRay is needed - because metal bits inside the patient can cause tissue damage from the intense magnetic field generated by the MRI equipment.

So both pieces of hardware are necessary, and often, the training to operate the equipment, and interpret the output overlaps.

Back pain is indeed very often excruciating, but only in rare circumstances will getting an early MRI has any effect whatsoever on care. (Primarily, this occurs when sciatic-type pain is of such severity that emergency surgery is warranted.) For back pain as such, no matter how severe, there is no difference in outcome or course of care between an early MRI or getting one in six weeks.

As someone who waited more than six years before a Doctor would give me one of those "useless" MRIs, I'm going to have to call partial BS. And I can due to the two back surgeries and 11 screws I've had inserted into my back.

The problem with the American medical system isn't unnecessary procedures and tests -- it's about RATIONING THROUGH ECONOMICS.

The reason it took so long for me to get an MRI is because the doctors didn't seem to care or listen to what I was telling them. Instead, they listened to the various insurance companies who would tell them it was unnecessary and expensive.

It wasn't until I showed up in the ER unable to move before I got one.

Of course, that ER trip wound up costing much, much more than the initial MRI would have, and surgery was the only option (the first one didn't work).

And all because the doctors I saw (more than a dozen) care more about what the insurance company would pay them than what I actually needed.

And it all it cost everyone involved -- including both surgeries, doctor visits, etc. -- was more than $400,000.

And all because they wouldn't pay for a $3,000 MRI in 1998.

I'm now partially disabled, can't pick up my son any more, and can't even walk around the grocery store or park or zoo due to constant, soul crushing pain.

So fuck the American medical system, any person who tries to claim how great it is, and those who think making sure a diagnosis right is less important than saving a few bucks on a test.

/rant

MarkD;
That was exactly my point.

I have a similarly long story I could rant about.
I didn't end up with surgery, (yet) - but I will be in pain for the rest of my life, and it will get progressively worse, because I was not treated for my condition 6 years ago, when some of the damage could have been prevented.

And let me tell y'all this:
When you have lower-back pain, you don't exercise and stay in as good a shape as you should. Which causes other health problems. You'd think this would be profitable for the health care industry, all these fat, sick, crippled people. But fat, sick, crippled people don't work very much, or earn very much - and don't spend a whole lot.

So they found a small bit of brain lodged in Egbert’s skull, who would have thought?

MRI’s are expensive machines, but every major medical center has to have one or they are not keeping up with the rest. The US has a higher density of MRI’s than other countries (and a lower density of rural family care physicians). To make a MRI machine pay, the tendency is to run every patient possible (i.e. every billable patient) through it, even if the additional usefulness is nil.

Look, let's get honest here.

The right wing is coming unhinged over universal healthcare because some form of universal healthcare is IMMINENT. 3 years ago they thought they were going to bag the mother of all government programs--Social Security. They thought they were FINALLY going to wipe it out under the guise of saving it.

Instead, SS is more robust than ever and now it's really looking like some kind of Universal Healthcare is on its way. Harry and Louise won't stop it this time--too many people have (like me) spent too many hours trying not to scream at the poor bastard on the other end of the phone trying to unscrew some moronic billing error or other. And that's with a GOOD plan--bad plans result in actual screaming as some mid-level manager whose yearly bonus depends on his denying you care.

So if they try to run those ads about, "The government trying to get between you and your doctor," the country will come to a halt as we all collectively scream, "As opposed to our INSURER?!?!?" And Al and egbert will have lost their last excuse for not curing their Recto-Cranial Inversion problem...

Similar thing happened to me, but it turned out o.k.. My insurance company had me fill out a (note: I am not making this up) "retro-pre-authorization". Look into it.

I wonder what our savings would be if every doctor were on salary and not allowed to own any test equipment for which he would benefit if it was used? How many doctors are willing to trade some of their high incomes for sensible hours and less paperwork? How many would like to see UnitedHealthcare disappear?

While Kaiser Permanente (and the rest of the real HMOs) and the VA are not perfect, they stand well above others in cost and effectiveness.

When you've got a "good" plan, you get an MRI after one visit to the doctor for a migraine headache. My adolescent son had one, definitely migraine headache (aura, nausea). He had had headaches before, but none were migraine. He had no psychological symptoms, no disability, no loss of consciousness.

We go to the family doctor. We get sent to the radiology center (within days) for his MRI "just to make sure nothing else is going on." The results show he has a tendency toward sinusitis. He ends up with prescriptions for Claritin and advice to take Excedrin for another headache. He's blown off the prescription for Claritin and occasionally takes an ibuprofen for a headache. In maybe five years he's had one or two migraines.

Now, what would have happened to the uninsured person who showed up in the emergency with his history?

I'm not in the medical profession, but I think that was a misuse of an MRI. I wasn't sure enough of myself to refuse it on his behalf, but I would have if it had been me.

And it all it cost everyone involved -- including both surgeries, doctor visits, etc. -- was more than $400,000. And all because they wouldn't pay for a $3,000 MRI in 1998.

What we need is some system of responsibility here. Whoever made the decision to deny you the $3000 treatment should be made to pay the $400k.

Okay ... after reading my post, let me make a preemptive apology to Dr. Bratman. I was not aiming my venom at you specifically.

Also, cowalker brings up a good point -- the cost of unncessary procedures to those without health insurance. Of course, it's a problem that's easily solved:

Change the system to one that doesn't put the emphasis on profit.

Hospitals, doctors, insurance companies, et al, could still make money (non-profit doesn't actually mean you just give everything away for free), but that would no longer be their prime motivation.

Take that away, and I'm guessing a huge chunk of the problems could be solved. Not all of them, to be sure, but a lot of them.

Yes, heavy, rationing occurs in the U.S., because rationing always occurs when there is a finite amount of something that people have demand for. This topic always results in one anecdote after another here, which supposedly "proves" something, just like something is supposedly "proved" when more obese, more sedentary, Americans, who have higher fatal car accident and homicide rates, and who have their premature birth fatalities recorded differently, have a lower life expectancy at birth. Of course, the same folks tend to ignore that elderly non-poor Americans have a higher life expectancy that non-poor elderly in countries with systems they favor.

I suspect they do so because to examine that issue would expose a politically painful fact; in many, many, ways, U.S. Medicare recipients face less rationing than any large demographic group in the world, and it is the most politically powerful demographic group in the U.S.. This has considerable implications on the chances of reform in the U.S. no matter how much one desires it. A lot of people may agree that it is wasteful to spend a quarter million bucks in the last 6 weeks of an eighty-nine year old's life, but those people tend to be less likely to be already older than 65, and Congress monitors the sentiments of people older than 65 very, very, closely.

Of course, the one area where non-poor elderly in the U.S. do face more rationing, or at least very closely similar levels of rationing, is in drug consumption, but this is simply another area where most of those advocating large reforms refuse to face reality. Kevin used to to go so far as to assert that private capital allocation was unimportant to drug innovation, thus meaning that reducing the profitabilty of developing new drugs would have no impact on drug innovation. Of course, if one really believed this, the logical thing to do would be to end all patent protection in regards to drugs. It seems, from posts I've read here recently, that Kevin has now abandoned this position, and now states that the U.S. government could negotiate with drug companies directly, and the drug companies would maintain their profit margin, and the incentive for private capital allocation, by raising prices for drugs sold in other countries.

The inherent assumption seems to be that Congress, along with other governments, won't be so ruthless in negotiating prices downward to greatly reduce private capital allocation for drug innovation, and that other examples of government negotiation, like in the DOD budget, show this.

This thinking unfortunately seems to ignore the fact that there is not a large voting constituency which has a great desire to personally use an aircraft carrier at the lowest possible price, while there is a very large voting constituency which desires to personally use a great many new drugs at the lowest possible price. This doesn't even begin to address the fact that DOD capital use has a long track record of wasting large sums of capital on technology development even years after the particular technology has proven to be a dead end. I've yet to see a rationale to lead one to believe that Trent Lott and Robert Byrd will be better stewards of capital use in the area of drug innovation than what exists today.

I'm no fan of the current method of health care delivery of the U.S.. I just wish that the topic could be discussed without either the obsfuscation that the current regime is wonderful, or the obsfuscation that large reforms won't involve painful tradeoffs, with often large political obstacles that don't simply involve the health insuance or doctors' lobby. The U.S. system does deliver very good results to many, many, citizens, and they tend to be the citizens that are most curried to by Congress, including members of Congress who belong to the Democratic Party.

What we need is some system of responsibility here. Whoever made the decision to deny you the $3000 treatment should be made to pay the $400k. --Posted by: Disputo

A couple of things:

1. This was over the course of four years. The first surgery was $135,00, and the second a bit more than $200K. Just a bit more FYI.

2. What REALLY pisses me off is that the $400K figure is only what they accepted as the negotiated rate. Without insurance, I would've been responsible for nearly 50% more than that. But since the docs, hospitals and insurance companies all have little deals with each other, they give each other a break. Meanwhile, us "regular" folks don't get any such deal.

3. I still owe nearly $15K just from copays, deductibles, expenses that were magically declared "out of network" even though, when I asked before this all started, I was assured they were in network. You have no idea how hard this has made our life.

4. The worst part? I'm worse now than I was before all this shit started!!! Seriously ... I wake up feeling like I'm being skewered through the hips, have a pain down my legs that feels like a red hot knife slicing me open from the inside out, and have days where I can't even move.

Okay ... sheesh. Ain't I a whiny little baby? Maybe I should see a therapist. Although I doubt that's covered under my policy.

Just in case, are all you folks here in-network ... ?

;-) :-)

osama_been_forgotten: fat, sick, crippled people don't work very much, or earn very much - and don't spend a whole lot

They also don't have private insurance very often, so the insurance companies don't give a shit. Become disabled, and likely loose your private insurance (though not if it's through your spouse).

The incentives are all wrong. What you and Mark D described isn't just bad medicine, it's bad economics - but only if your insurer is stuck with you for life. That's the beauty of a UHC system, and one reason the VA system is economical.

Of course wingnut heads explode if exposed to any economics more complicated that genuflecting before the "free" market or lowering taxes, but that's beyond my control.

"For many, if not most here, this matter is in the realm of Faith, where trade-offs don't exist"

ROFL... I do so love Will, who'd much rather issue random silly ad hominem attacks than actually debate an issue. This attack is particularly lame, since every single thread of this type here at WashingtonMonthly.com includes, wait for it, a discussion of rationing and trade-offs.

"Back pain notwithstanding, his example smacks a bit of I want it and I want it now!"

Since the issue was about the delay for an approval, not the delay for an MRI, I'm afraid your point is mostly moot.

Now, Will, that you have admitted that rationing occurs. Let's ask the obvious follow-up. Is the current rationing scheme based on need?

I'm not in the medical profession, but I think that was a misuse of an MRI. I wasn't sure enough of myself to refuse it on his behalf, but I would have if it had been me. Posted by: cowalker

Except, of course, if it had been an operable brain tumor. How else do you expect a doctor to determine what is going on inside someone's skull without an MRI or CT scan, use a divining rod?

heavy, that depends on how you define "need", which is entirely dependent, much like "fairness", on the vantage point of the observer.

Paul B., as you normally do, you are lying. Kevin has written in this forum specifically, in support of a Washington Montly piece, for instance, that any change in private capital allocation for drug technology development is unimportant, because rates of innovation aren't affected by private capital allocation. In other words, there is no trade off between reducing drug profitability and drug innovation.

Try to write one post without lying, will you?

Irony alert:

Will Allen said: Try to write one post without lying, will you?

Kevin has written in this forum specifically... [that] rates of innovation aren't affected by private capital allocation.

I'd like to see Will Allen cite where Drum said this. If he can't, I'd like Will Allen to ban his own lying ass from this forum.

Will, answer the question. Is medical care rationed here on the basis of need? This isn't some kind of quantum physics question. It is actually very simple. Two patients have exactly the same condition, that is, the same exact level of medical need. Are they treated equally under our system?

Well, Disputo, there's this post.....

http://www.washingtonmonthly.com/archives/individual/2006_11/010249.php

....where Kevin writes....

"But wait. If the feds negotiate prices, then prices will go down. And if prices go down, pharmaceutical companies might make less money. And if pharmaceutical companies make less money, they'll do less basic research and churn out fewer lifesaving drugs. As Jonathan Cohn says in The New Republic, this is "a potent argument." It's also probably wrong:"

""The most important basic medical and scientific research that leads to major medical breakthroughs usually takes place under government auspices — typically, through grants from the National Institutes of Health. In other words, taxpayers — not drug companies — are the ones financing the most important drug research today. So, even if the pharmaceutical industry did reduce its research and development investment because of declining revenues, what we'd lose probably wouldn't be the next cure for cancer — it would be the next treatment for seasonal allergies, and likely no better than the ones we have already.""

...thus Kevin favorably quotes a piece (my apologies for saying it was from Washington Monthly and not New Republic) which states that there is no tradeoff between reducing private capital allocation and drug technology development, at least for life-saving drugs.

Look, Disputo, you are an ignorant person and demonstrate that quality regularly. I really do have better things to do than use google to educate you, however.

MarkD

I'm really sorry for your pain and loss.

I don't understand how an operation can cost $135k. Call me naive. A relative had a triple bypass (Canada) and I really doubt it cost that.

A surgeon, a team, 2hrs 15 minutes in the operating room. OK I can see how that would be $30k. 5 days in hospital. Physio, drugs etc. Maybe $135k all up.

As I say, call me naive about medical costs. It seems to me the US system is full of rake-offs to healthcare providers.

That they would land you with $15k of 'uncovered' costs is morally offensive. What if you had had cancer? What if you had died?

The problem in the UK, which really does have rationing, is that you might never have been treated. But when they do get to treatment, they tend to be pretty good.

We've been very bad in the UK about MRI scans (this is also a problem in Ontario): equipment sitting unused because of ridiculous costing systems (which amortise the capital cost over each usage: hence, if you don't use it much, each MRI scan costs a fortune. Actually, once you have the machine, you might as well run it 24/7, as additional scans are cheap).

However I believe things have gotten much better of late.

I don't know if you have tried alternative therapies, but I can recommend acupuncture for chronic pain. Meditation can also be effective.

No, heavy they often aren't, but then again, it would be an error to state that two identical patients would definitely receive identical care in France, for instance, and certainly not in Great Britain or Canada.

Will, if you could read, you might notice that Kevin's point is far different from your wild mischaracterization. Kevin's point is that the drug compaines aren't using the money they take in to do the research and therefore changing how much money they make will have little effect on drug technology development. Not even vaguely similar to your distortion.

Let's try again Will. When answering my questions try not to imagine that you are making a point when you talk about errors I have not made.

You have admitted that there is rationing under our current system. This was underscored by the your agreement that two patients are likely to receive different levels of care even if they have the same pathology.

Now, what is the basis for rationing in our system?

Heavy, I didn't "admit" anything, since I had never contended that anything of value on this planet ever avoids rationing. Furthermore, Kevin's point, via a favorable teatment of a quote, was explicitly that there was no trade-off between reducing revenues in the drug industry, and thus reduced capital devoted to development, and rates of innovation in drug technology. Hell, the quote even claims that private capital is unlikely to ever help deliver better seasonal allergy drugs.

Nice dodge Will, but you haven't answer the question. Are you afraid that the answer won't fit the template you have for all of your health care threads? As for your continued distortion of Kevin's point, I won't argue because it distracts from the more important point:

What is the basis for rationing in our system?

heavy, I'm not here to answer your questions regarding the current delivery system, especially since I've not defended the current system. I'm sorry you can't read, too.

Well, Will, you've demonstrated that you aren't here to have an intelligent discussion. You misrepresent Kevin's views, you harp about how there will be rationing under a single payer system but can't explain how rationing is done now - which is a basic requirement for discussing the issue, and you demonstrate a level of arrogance unwarranted for someone with your fundamental ineptitude.

So, you can answer the question and take part in an intelligent discussion, or you can flame away and demonstrate that you are simply a troll.

What is the basis for rationing in our system?

"Paul B., as you normally do, you are lying."

LOL... No, dear, I'm not, which is why you cannot support your original assertion nor identify a single lie I have ever told. Thanks for acknowledging that you aren't serious, dear.

As for your single "example," not only are you wrong on the substance of what Kevin has posted and believes, it does nothing to support your supremely silly assertion that, "For many, if not most here, this matter is in the realm of Faith, where trade-offs don't exist..."

In short, dear heart, if anyone is lying, it's you.

"Well, Will, you've demonstrated that you aren't here to have an intelligent discussion.

LOL... He never is. It's funny watching him, particularly when he's in full attack mode, which he usually is.

Mark D, the pain doctor I see for my phantom-limb pain, has used a spinal stimulator with some success. It's an implantable battery that sends electrical signals to the nerves it's attached to. Didn't work for me, but maybe you could ask about it.
Acupuncture and meditation didn't work for me either, or shiatsu, deep massage or anything else. Oxycontin and methadone help, though. Better living through chemistry.
You also said,Without insurance, I would've been responsible for nearly 50% more than that. But since the docs, hospitals and insurance companies all have little deals with each other, they give each other a break. Meanwhile, us "regular" folks don't get any such deal.
Actually, the hospital has no idea what your stay would have cost. The price they charge the uninsured is higher than any deal w/ an insurer but that's the only relationship to cost the hospital is aware of. Try calling a hospital beforehand and tell them you are price shopping, they won't even know which department to send you to.

I'm going to have to leave the poor thing in your capable hands. You know that he can't resist having the last word - no matter how stupid that word has to be. I can't really understand why he thinks he's the only person who realizes that rationing will exist under a new system. It's a stupid point.

Yes, there will be rationing and yes, if you incessantly repeat the blindingly obvious as if it were some kind of revelation from God people will mock you. One eagerly anticipates the breathless post from Will telling us all that "water is going to be wet in the future."

I'm no fan of the current method of health care delivery of the U.S.. I just wish that the topic could be discussed without either the obsfuscation that the current regime is wonderful, or the obsfuscation that large reforms won't involve painful tradeoffs...

I have a related wish. Since most people here honestly admit that tradeoffs will occur, while you virtually never criticize the current system in even the most general (much less specific) terms, I just wish that you could discuss the topic without going into contortions to ignore the first problem and fabricating the extent of the second.

But then, as people here are always pointing out, that's just you: a crotchety superreactionary trying to convince himself he's an independent thinker.

Heavy and Paul, I'll simply note that you have not demonstrated how my characterization of Kevin's post, which I reproduced, is inaccurate. In other words, you are both being typically dishonest in this regard, as heavy is being when he implies that I ever stated only I realize that rationing will exist in some sort of reformed system. "Trade-off" is not a synonym for "rationing", nitwit.

Actually, dave, the operator of this forum quite often refuses to acknowledge such trade-offs exist, like when he quotes favorably from a piece which asserts......

" So, even if the pharmaceutical industry did reduce its research and development investment because of declining revenues, what we'd lose probably wouldn't be the next cure for cancer — it would be the next treatment for seasonal allergies, and likely no better than the ones we have already."

....which is an assertion so stupidly devoid of of awareness of the reality of tradeoffs that Kevin should be ashamed he posted it in his forum. Also, dave, you are lying when you state I virtually never criticize the current system, given I have stated a few dozen times here that our system in many instances produces the worst of all worlds; the sclerosis of central planning and the denial of life giving service based on price. The fact that you are compelled to lie about what I've written here is unsurprising, given the typical participant in this forum; desperate to attack anyone who strikes a discordant note in the echo chamber, while laughably calling any who do reactionary. You, like many here, have the soul of an apparatchik, finding loyalty to the group to be the highest calling.

I don't understand how an operation can cost $135k. Call me naive. --Valuethinker

First, thank you for the kind words before this sentence. 'Preciate that.

You're not naive -- probably just unaware of how the system here works (I'm guessing you're not here in the U.S.).

Short version: The doctor charged $85,000. Four-day hospital stay: $30K. Physical therapy—which was about $3K ... just to have someone walk with me around the hall ... seriously ... it was literally 15 minutes—for $3,000.

Add in tests, medications, and BOOM! Huge bill.

As I've noted, and TJM expanded upon, it would've cost more had I not had insurance.

Here's what I truly don't get about our current system:

If I go to, say, a car shop, the prices are listed. Sure, there's some variation due to the make and model, parts, etc., but you usually know what it will cost up front.

But in health care? Heaven f***ing forbid.

Our system can have different costs for the exact same procedure. If those differences were based on the person having the procedure—much like a make and model of car—I'd understand. It'd still be stupid, but I'd understand.

But cost differences in our system are dependent on the type of insurance and nothing else.

Why the holy hell is that? How does that make any sense whatsoever?

I guess some folks don't mind that some of us suffer from failures in the system. For them, the only important things are free market theories and corporate profits.

About 12 or so years ago a group of consumers here won a class action lawsuit against Blue Cross .At the time, an 80/20 split existed for major medical. Blue Cross would charge the consumer 20% of the hospitals ordinary charges. BC had negotiated lower rates for procedures so the actual %age paid was much larger than 20% of the real charges.
How the people who worked there could, in good conscience, go along with this is truly disturbing but the mentality that the company comes first is symptomatic of health care practices in the US.
To quote Charlie Brown: Good Grief!

which is an assertion so stupidly devoid of of awareness of the reality of tradeoffs that Kevin should be ashamed he posted it in his forum. --Will Allen

But yet you haven't proven that assertion incorrect with any evidence whatsoever. Just your opinion.

I also don't think you understand the nature of what people are saying here (or typing, in this case):

* You say that people don't realize that "trade-offs" exist in this debate.

* Numerous people have, however, mentioned the one big trade-off offered by the right: rationing.

* Thus, the specific trade-off people are discussing is rationing, while you keep blathering about some sort of general, amorphous trade-off you have yet to define.

So no one is lying about what you've written here. You just fail to comprehend and/or acknowledge (whether willfully or not is anyone's guess) what others have written in response.

It's really not that hard to follow.

Perhaps crayon and a Big Chief tablet are in order ... ?

Perhaps for yourself, Mark D. I stated that many people in this forum pretend as if trade offs don't exist, and produced a specific, nonamorphous, tradeoff, which was denied by the host of this forum, namely that a reduction in revenues from selling drugs would reult in less private capital devoted to drug development, thus resulting in slower rates of innovation. Paul and heavy then lied in stating that I had misrepresented Kevin's position.

Are you typically so obtuse? Or do you join the New Republic author in believing that private capital plays a trivial role in drug development, in which case "obtuse" is a gross understatement?

Will-
I don't pretend to know anything about how drugs are produced, since I don't work in the industry nor follow it that closely.

The topic of this thread, however, is delays in medical care, costs, etc. No drugs mentioned.

In fact, in your second comment, you referenced the drug discussion but actually posted this:

I'm no fan of the current method of health care delivery of the U.S.. I just wish that the topic could be discussed without either the obsfuscation that the current regime is wonderful, or the obsfuscation that large reforms won't involve painful tradeoffs ...

Again, I haven't seen anyone here post that reforming our health system won't involve trade-offs, yet you accused people of such.

So to prove your point, you bring up another thread while ignoring the topic of this one, which is the one everyone else seems to be discussing.

That was kind of my point.

Kevin: "But did you know that in France they're so impoverished that they only have one MRI machine for the whole country? And the waiting list is 15 years? And nobody knows how to operate it anyway because the instructions are in English and no one in France speaks English?"

Mon Dieu! Talk about meddling with the free market system! Thank God we live in America, where I can charge my daughter's emergency appendectomy and hospitalization on my VISA card and ask my doctor about Celebrex, without worrying about any government interference.

Mark D: "But yet you haven't proven that assertion incorrect with any evidence whatsoever. Just your opinion."/i>

I think Will is saying that sometimes you just have to rely on what your gut tells you, just like Homeland Security Secretary Michael Chertoff does.

But when you do, you must also accept that 99% of the time, it's probably just gas.

Will finds it too difficult to argue against the points made, so he creates positions, assigns them to his opponents and then calls them dishonest for denying those positions.

He contributes less than nothing. He's a troll.

Oh, yes, reproducing a post from the person who runs this forum, when asked to produce an example of people in this forum denying the inevitability of trade-offs, is known as "creating a position". Good gravy, you are stupid, as well as heavy and dishonest. Yes, yes, I know, anybody who disagrees with you is "a troll"....

mark, you seem to be unaware that drug production and distribution is very closely tied to health care costs. Endeavor to acquire a clue.

TJM

I can't remember the exact quote, I think it was HL Menken, and it's often quoted with regard to scientists in the fossil fuel industry (and global warming)

but basically

'the best way to get a man to fervently belief a falshehood, is to have his job depend on it'.

Hence Blue Cross. People aren't evil, they just come to evil ends.

TJM

I guess my concern with oxycontin is the side effects? Obviously there is Rush Limbaugh's deafness.

I've used Robaxin (Robaxacet) to ease muscle tension pain (nothing like what you are having, I am sure). It makes me a bit foggy, but is otherwise OK.

My doctor has also used low doses of antidepressant (the tricyclic imimpramine ie not the Prozac/SSRI family) for some kinds of chronic pain.

steve duncan

I know you are kidding, but if you saw how the French Surete dealt with the Parisian terror bombers in the early 90s (Algerian) you would not think that the French were namby-boys.

They play rough. And they play rough in collaboration with the Algerian and Syrian secret police. The mention of Syrian security makes grown men turn white.

The head of French counterterrorism gives conferences to the British and US intelligence chiefs on how to beat Islamic terror. He is quite critical of the Anglo-Saxon legal system (the absence of an investigating prosecutor).

Honestly, Will, what's the source of your expertise on this issue? My father worked in medical research, funded almost entirely by government grants. In his case, this was work on diabetes. Likewise, basic research on heart disease, cancer, and the other major killers relies heavily (almost entirely), on federal funding of university research laboratories. As a result, Kevin is largely correct that reducing private capital allocation would probably have relatively little effect on the basic research underlying life-saving drugs. Put another way, no one is funneling venture capital to Judah Folkman's lab at MGH.

Now, it is true that pharmceutical companies take the research done at research labs and develop drugs from it, but in this case, they are not bearing the cost of basic research part of the R&D costs. So your argument (which is mainly tangential to this discussion, as has been pointed out over, and over, and over again), rests on the assumption that a system that lowers the costs paid for drugs will drive private capital investment from the development of drugs for which the basic research has already been done. Kevin's argument, on the other hand, was that we would still have enough funding for the D half of R&D, but that things like "the newest seasonal allergy drug" -- for which both the research and the development are carried out by pharmaceutical companies, and from which they make large profits, especially after advertising these new drugs heavily -- might lose some of that private investment.

Now, aside from the fact that this is not a denial that tradeoffs exist, I suspect that it is fundamentally correct. I know plenty of people who do basic medical research, including my father and my best friend from college. So while I'm not directly involved in this, neither am I talking out of my ass. You, however, describe this as "an assertion... stupidly devoid of of awareness of the reality of tradeoffs," but offer neither evidence nor analysis to show why your opinion is correct; in fact, I think you're simply wrong about there. In any case, no one has "lied" about your citation, they simply disagree with your reading of what Kevin said. Believe it or not, people are allowed to have opinions other that yours, without automatically becoming liars.

Finally, in case you don't recall your opening salvo, I'm pasting it in below. What you said is that the people here, as a rule, don't believe that trade-offs exist. That's simply untrue, as many of the posts are quite specifically about trade-offs, while not a single one seems to meet the characterization you provided.

Dr. Bratman, don't attempt to inject rationality into this forum regarding this topic. For many, if not most here, this matter is in the realm of Faith, where trade-offs don't exist, and mention of those nasty little realities will, ironically, be met with accusations of having irrational Faith in markets to deliver perfect results.
Posted by: Will Allen on July 31, 2007 at 2:26 PM |

Oh, yes, reproducing a post from the person who runs this forum, when asked to produce an example of people in this forum denying the inevitability of trade-offs, is known as "creating a position".

Oh no, reproducing a post from the person who runs this forum that has NOTHING TO DO WITH YOUR ORIGINAL ASSERTION. is known as "fishing for proof when proven you have none."

Good gravy, you are stupid, as well as heavy and dishonest. Yes, yes, I know, anybody who disagrees with you is "a troll"....

Good gravy, you are stupid since you completely ignore what you yourself actually posted. keith did a great job above of reiterating what you started out with -- that many people here don't think there are trade offs in the debate on universal health care. You accused most people here of believing there are none and, as evidence, posted a single entry by Kevin.

That's it. No evidence of "most people" here believing any such thing.

Nor has a single person said any other country has a system that delivers "perfect results." Not. A. Single. One.

Oh, and you're not a troll because I disagree with you -- you're a troll because you make tangential arguments in an effort to prove you're not a dumbass, while ignoring the actual topic.

mark, you seem to be unaware that drug production and distribution is very closely tied to health care costs.

will, you seem to be unaware that moving the goal posts in the middle of a discussion proves you have no basis for your first two assertions on this thread. Get over yourself, admit it, and move on.

Endeavor to acquire a clue.

Endeavor to learn the definition of "irony."

keith, in conflating "basic research" with "bringing life saving drugs to patients", or pretending that reducing private capital would only affect the speed in which non-essential drugs are brought to market, you reveal such an entirely ignorant or dishonest approach to discussing the issue that you add evidence to my point that many here pretend as if tradeoffs don't exist. Thanks for the illustration.

You are talking out of your ass. Hell, even Kevin has now backed off that nonsensical position, now asserting that having U.S. Government negotiate lower drug prices would merely result in drug companies raising prices for the other governments they deal with. Of course, this still entails a childish unwillingness to acknowledge trade-offs, in that it assumes that the same political dynamic which results in the price of an M-1 tank would apply to the price of a drug which 20 million reliable voters use. If you are going to defend a pundit's silly position, you may want to check to see if the pundit still adheres to it. Also, what more accurate description is there of a knowingly factually untrue statement than that it was made by a liar? Thus, if a person states that every discussion of universal health care in this forum includes a discussion of trade-offs, which ignores the simple fact that many here, including the person who runs this forum, specifically deny trade-offs in many instances, "liar" is a pretty accurate description, unless he is referring to the fact that the threads usually have at least one person who isn't willing to be part of the mindless chorus, which would render the liar's dispute with my chracterization pointless.

Mark, you apparently are too dim to grasp that the person who runs this forum is part of the set known as "people in this forum", and that the manner in which patients acquire drugs is part of the debate pertaining to universal health care. Really, just how stupid are you?

Mark, you apparently are too dim to grasp that the person who runs this forum is part of the set known as "people in this forum", and that the manner in which patients acquire drugs is part of the debate pertaining to universal health care. Really, just how stupid are you?

So "one person" now equals "most people"? Sweet fucking lord ...

And nice job ignoring the rest of my post.

You truly are the most intellectually corrupt person I've ever met. Seriously. You are comically pathetic.

I've never understood that pre-approval BS. You get pre-approval for a procedure as medically necessary. You get the same procedure, but ask for approval afterwards. It's the same procedure. It's the same medical situation. The procedure is still medically necessary, whether you get the approval beforehand or afterwards.

If payment for the procedure depends on whether it is medically necessary, why should it make any difference at all to the insurance company whether it is pre-approved or post-approved?

Oh right, it's just another way to deny payment and wear the patients down, so less money goes out the door.

No, mark, I never said that one person was synonymous with many people, to say nothing of most people. I merely noted that you were too stupid to grasp that a post from the person who runs this forum does, in fact, have, in your words "something to do" with the set known as, in my words, "many people in this forum" especially since it was a post that was largely agreed with by the people in this forum. I can't say that you are intellectually corrupt, however, for that would entail the logical implication that you are in possession of an intellect, an implication which appears to be more fantastic with every sentence you write.

Blah blah blah spin spin spin blah blah blah I posted "most people" and was discussing this issue but instead decided that one post from one person on a different topic is proof of my original assertion blah blah blah some other sentence that proves I'm a pedantic asshat as well as clinically fucking retarded blah blah ... --Will Allen

I was wrong -- you are not intellectually corrupt.

You are morally corrupt.

Blah blah blah spin spin spin blah blah blah I posted "most people" and was discussing this issue but instead decided that one post from one person on a different topic is proof of my original assertion blah blah blah some other sentence that proves I'm a pedantic asshat as well as clinically fucking retarded blah blah ... --Will Allen

I was wrong -- you are not intellectually corrupt, you're morally corrupt.

My fault ...

Yes, Mark, I understand that you are such an idiot that you cannot grasp that drug distribution is an integral aspect to universal health care, and not a different topic, nor that a post by the person who runs this forum, and is largely agreed with in response by people in this forum, is an example of many people in this forum, but I won't say you are morally corrupt, because a mollusk lacks moral agency.

I never said that one person was synonymous...

Speaking of barking mad...oops, that's one thread down.

Woof woof, Will.

Did Will just try to insult me by calling me a ... mollusk?

Really? That's the best you can do?

I guess all those mental gymnastics you're doing in a vain effort to prove you're not a complete dipshit has sapped all of your energy.

Go take a nap and try again later. Seriously ... you're embarrassing yourself.

Mark, I see no point in attempting to insult one who often lacks the mental capacity to grasp the meaning of common words. I was merely making a descrpitive, and only mildly hyperbolic, statement.

"Heavy and Paul, I'll simply note that you have not demonstrated how my characterization of Kevin's post, which I reproduced, is inaccurate."

Dear heart, we prefer to let Kevin's words, and yours, speak for themselves; no further effort on our part was required. Nor was any effort required to point out that even were you correct about Kevin's views, it still does not support your silly assertion, an assertion that you cannot support because it is manifestly false. Nice try at changing the subject, though.

"In other words, you are both being typically dishonest in this regard"

ROFL.... Whatever, dear.

"The fact that you are compelled to lie about what I've written here is unsurprising, given the typical participant in this forum"

ROFLMAO.... What a drama queen. It couldn't possibly have anything to do with what Will writes or the way he writes it, could it? Nope, we all are "liars," every one of us, because we reject the wit and wisdom of one Will Allen. I do so love this guy.

No, Paul, I never said everyone is a liar here. I said you and a few others were. You really can't write a post without a lie, can you?

As to theatrics, Paul, is this the place where you regale the crowd with your account of your years-long track record of on-line debating? It really is oh so impressive! How many years has it been! Oh, do tell us!

One of Will's funniest tics is his habit of completely re-writing someone's post in his head and responding to that. But if you respond to the clear implications of his post he insists that he "never said that."

Arguing with someone with Will's level of dishonesty ensures that no one wins - least of all Will.

Will,

Basic research is the foundation on which "bringing life saving drugs to patients" rests. Those drugs aren't simply the result of a development process, they depend on research. This isn't a conflation, as should be immediately evident to anyone who carefully read what I wrote, especially since I specifically mentioned this more than once. You will note that I was careful to discuss both research and development, two different aspects which you, yourself fail to mention. Thus, if anyone is guilty of conflation on this issue, that person would be you.

Again, I will point out that basic research is often both time-consuming and expensive. However, unlike seasonal allergy medicines, the drugs that are used for things like diabetes, cancer, and heart disease don't have major basic research costs for most pharmaceutical companies, because the research is done for them by scientists and doctors who receive public funds. As a result, there's no intuitively obvious reason why private capital would not flow to the manufacturers of ACE inhibitors, even under a federal procurement regime, when a significant portion of the R&D costs for those drugs are not borne by the drug companies. The same, obviously, is not true for seasonal allergy medications.

As for "the speed at which non-essential drugs are brought to the market," I said nothing about that, and I don't recall that I was "pretending" anything at all. As for "evidence" that people think tradeoffs don't exist, it is in fact your so-called evidence that is non-existent. But go ahead and pretend otherwise; it's your own credibility that you're undermining.

Now, what's the basis for labeling me "ignorant and dishonest" when you're the one who has said nothing about the importance of research costs (perhaps you were ignorant of them?), and you're the one who is criticizing me for statements that I never made?

Perhaps you feel that I'm "ignorant" because I don't know anything about medical research of the process of bringing drugs to market. That's false, but I wonder what the source of your own expertise might be. What's your evidence for me "talking out of my ass," other than the fact that you disagree with me... but offer not a single piece of evidence in support of your own opinion?

I actually know people who do basic medical research, and I know their opinions on this matter. You, on the other hand, appear to be someone who is happy to offer opinions, insult those who disagree with you, and operate under the assumption that your pronouncements are inherently correct simply because they are your own. Do you have anything other than that to offer in your support? Do you know anything at all about the basic research that underlies drug development, or about the development path? Do you have any experience in either the research end or the development end of pharmaceutical R&D? If not, what makes your opinion on this matter any more valid than that of my eight-year-old son (from whom you could learn a few lessons in good manners)?

I'm aware that your basic m.o. all but demands that you make ad hominem attacks on others, often prefaced by falsely accusing those very people of making ad hominem attacks on you, but really, if you wish to convince people that you've got a valid point to make, you might want to, you know, speak reasonably and use actual facts to make your point, rather than shifting the goal posts, insulting those with whom you disagree, mischaracterizing the points made by others, and refusing to answer questions about statements you yourself have made. However, if you merely wish to stir up disagreement, in a misguided attempt to prove that you're a clever independent thinker, or perhaps simply to roil the waters (a.k.a. trolling), then by all means, continue.

Finally, I'll paste in your response to me, and let others decide whether you have offered a substantial response to what I wrote at 7:05 A.M., or whether you've continue your pattern of obfuscation.

Apologies to the rest of the readers for the length of this post.

keith, in conflating "basic research" with "bringing life saving drugs to patients", or pretending that reducing private capital would only affect the speed in which non-essential drugs are brought to market, you reveal such an entirely ignorant or dishonest approach to discussing the issue that you add evidence to my point that many here pretend as if tradeoffs don't exist. Thanks for the illustration.
Posted by: Will Allen on August 1, 2007 at 10:48 AM |

keith, given that you wrote...

"Kevin's argument, on the other hand, was that we would still have enough funding for the D half of R&D, but that things like "the newest seasonal allergy drug" -- for which both the research and the development are carried out by pharmaceutical companies, and from which they make large profits, especially after advertising these new drugs heavily -- might lose some of that private investment."

.....it can only be concluded that you don't understand the meaning of the words you post. Either that, or you are lying. There is no sense in addressing anything else you have written, since you seem to be unaware of the content.

I'll risk wasting yet more time, and simply note that you semm to think that private capital allocation is dependent on how much basic research the government does, as opposed to profit potential, regardless of how much basic research the government does. If you truly grasp that basic research is only one part of what capital is needed for in order to bring drugs to market, it is a bit of a wonder why you think that merely having the basic research already completed would be enough to guarantee the additonal capital needed to bring a drug to market. Private capital doesn't care if the basic research has been done. What it cares about is what profit can be made in selling a drug. Sure, it's potentially useful if the basic research has been done, but that doesn't matter if the drug can't be sold at sufficient profit, because of price ceilings created by "government negotiation". Private capital allocation is reduced when profit potential is reduced, unless one is arguing that the profit potential for selling life saving drugs, after the government dictates lower prices, is still better than, say, drilling for oil when oil sells at $90/barrel.

As to my hostile tone, please point out one person who has indicated to me a willingness to be civil, and to whom I have responded rudely. Just one. What sort of psychological condition exists which would cause one to expect civility in response to rude behavior?

Well, Will, I'd say that my tone to you -- a person who has written that he "looks for confrontations" -- has been far more civil than your tone to me. So that would be one.

As for the rest of your post, let me make this as clear as I possibly can, since you seem not only to missread what I write, to to also attribute to me things I have never written. Please note that, unlike you, I'm not calling you an idiot, or dishonest, or a liar, or anything of the sort. I'm actually trying to reason with you, on the assumption that you are perhaps reading so quickly, or with such a strong belief that you already know what I'm going to say, that you are simply making mistakes when you read, rather than willfully misrepresenting what I've written.

First, I'm not only aware of the meaning of the words I write, I'm also pretty certain that they are correct. If they are not, that means I'm mistaken, not that I'm a liar. But, since you're such an expert on the meaning of words, you already know that (well, except for that time when you argued that since "assinine" and "silly" are synonyms, there is no difference between you calling someone assinine and someone calling you silly... because, after all, synonymous means identical).

Here we go. Drug companies can produce drugs based on their own R&D, or they can produce drugs for which they have to do little basic research. In the second case, the costs will be relatively less. Private capital investors may still help fund drug development for those drugs that will not only require less research funding, but also serve an enormous potential market when they deal with life-threatening conditions. Why? Because there's an increased likelihood that the drugs will come to market, and profit x on a drug that has a 15% likelihood of reaching the market (especially if it's a large market), is functionally the same as profit 5x on a drug that has only a 3% change of reaching the market. It's not simply the profit potential, it's also the risk of the drug not panning out, the size of the potential market, and other factors. This has nothing to do with the price of oil, unless you can accurately estimate the chance that the well you are investing in will actually yield oil, as well as the chance that the drug you are investing in will actually find a market. If those capital investors are named Will Allen, this will not be the case, but that was't your argument.

How do I know this to be true, at least in some cases? Because both my father and my best friend from college have done some of that basic research, and in the event that they come up with something that indicates a way to arrest the growth of tumors, or ease the production of synthetic insulin, then investors are likely to reward a pharmaceutical company that proposes to develop that research into a marketable drug, regardless of whether those drugs will be purchased by the mechanisms now in place, or by a federal procurement agency.

Now, since you are so certain that you are neither an idiot, nor a liar, nor misinformed, perhaps you can indicate why this is untrue. Note that I'm basing my argument on the views of people who do basic research that drug companies are interested in, so simply dismissing this is not an argument. You might want to indicate what part of your experience or knowledge makes you more qualified to make accurate judgements in this matter. Are you a medical researcher? Do you work in pharmaceutical production? Do you direct large-scale private investment in the pharmaceutical industry? Or are you simply stating personal opinions that you happen to feel are immutable truth?

Finally, you can decide for yourself whether or not there is "sense" in addressing whatever else I've written. I'm not the one who is running away from the statements I've made, I;m not the one who is conflating arguments and then accusing someone of having done so, I'm not the one accusing my opponent of making arguments that he never made, I'm not the one characterizing statements on this list in a manner that is obviously incorrect. and I'm not the one who seems to feel that anyone who disagrees with me is necessarily ignorant or a liar.

Sure, feel free to ignore this, but don't pretend that there's "no sense" in defending your own statements. Just be honest and say that you made a mistake, or that you were writing quickly and didn't mean exactly what you wrote, or that you don't want to talk about it because you just don't feel like it. Fine. But those errors are yours, not mine, and if pointing them out to you is nonsensical, then that says a lot more about the way you conduct yourself in a dispute than it does about my writing skills.

Keith, you've just spent several paragraphs discussing profit potential as a function of capital investment and likelihood of successful development, without referencing the other critical aspect of profitability, namely, the price the good can be sold at. In fact, you write....

"then investors are likely to reward a pharmaceutical company that proposes to develop that research into a marketable drug, regardless of whether those drugs will be purchased by the mechanisms now in place, or by a federal procurement agency."

...thus explicitly denying that the mechanisms by which a drug will be purchased, which in turn helps determine price, will affect investor behavior. I'm sorry, you simply have extremely little comprehension of what you are trying to discuss, as proven by your attempt to advance the notion that investor behavior is not greatly affected by mechanism of purchase. If you truly believe that mechanism of purchase does not greatly influence investor behavior, you are extremely ignorant of investor behavior.

Keith, let it be noted that I didn't call you an idiot. I reserved that invective for people who indicated to me that they desired an invective-filled exchange. I did say you could be lying, because it did not seem likely to me that you would so ignorant as to actually believe that "then investors are likely to reward a pharmaceutical company that proposes to develop that research into a marketable drug, regardless of whether those drugs will be purchased by the mechanisms now in place, or by a federal procurement agency." I withdraw the remark that you may be lying, since you now seem to actually sincerely believe this strange notion.

Also, yes, the estimate of what a barrel of oil can be sold at does have an impact on how much capital will be made available for other purposes.

Finally, why is it you have chastised me with some regualrity regarding the insulting tone I adopt for some posters, and yet I've never read you chastising just as insulting language, if not more so, when employed by people with whom you agree? Is it because you find such language acceptable when employed by people with whom you agree? Why is that?