[FM75]

At this point, I think it would be fair to delete my initial post. It seems like the discussion is just about politics, capitalism, and socialism. I don't see any comments about how bureaucracy can destroy an otherwise fine idea and program. Likewise, apparently, nobody disagrees that the program is broken - perhaps because the highly competent bureaucrats and Congress have done such a fine job designing and funding it.

The Title/subtitle as a reminder:

Government Intervention in Medicine
What could go wrong?

[PassedOut]

FM75, on 2014-June-04, 18:06, said:

At this point, I think it would be fair to delete my initial post. It seems like the discussion is just about politics, capitalism, and socialism. I don't see any comments about how bureaucracy can destroy an otherwise fine idea and program. Likewise, apparently, nobody disagrees that the program is broken - perhaps because the highly competent bureaucrats and Congress have done such a fine job designing and funding it.

The Title/subtitle as a reminder:

Government Intervention in Medicine
What could go wrong?

I don't see that the "program is broken." Sure there are long wait times in places where lots of vets have retired and short wait times in the places they have left. The link that Richard gave earlier explained that: VA Care: Still the Best Anywhere?

Quote

Just what do we know about how crowded VA hospitals are generally? Here’s a key relevant fact that is just the opposite of what most people think. For all the wars we’ve been fighting, the veterans population has been falling sharply. Nationwide, their number fell by 17 percent between 2000 and 2014, primarily due to the passing of the huge cohorts of World War II- and Korea War-era vets. The decline has been particularly steep in California and throughout much of New England, the Mid-Atlantic and industrial Midwest, where the fall off has ranged between 21 percent and 36.7 percent.

Reflecting this decline, as well a general trend toward more outpatient services, many VA hospitals in these areas, including flagship facilities, want for nothing except sufficient numbers of patients to maintain their long-term viability. I have visited VA hospitals around the county and often been unnerved by how empty they are. When I visited two of the VA’s four state-of-the-art, breathtakingly advanced polytrauma units, in Palo Alto and Minneapolis, there was hardly a patient to be found.

But at the same time there is a comparatively small countertrend that results from large migrations of aging veterans from the Rust Belt and California to lower-cost retirement centers in the Sun Belt. And this flow, combined with more liberal eligibility standards that allow more Vietnam vets to receive VA treatment for such chronic conditions as ischemic heart disease and Parkinson’s, means that in some of these areas, such as, Phoenix, VA capacity is indeed under significant strain.

This regional imbalance in capacity relatively to demand makes it very difficult to manage the VA with system-wide performance metrics. Setting a benchmark of 14 days to see a new primary care doc at a VA hospital or clinic in Boston or Northern California may be completely reasonable. But trying to do the same in Phoenix and in a handful of other sunbelt retirement meccas is not workable without Congress ponying up for building more capacity there.

Once you have this background, it becomes easy to understand certain anomalies in this scandal. If care is really so bad, for example, why did all the major veterans services remain unanimous in recent testimony before Congress in their long-stranding praise for the quality of VA health care? And why have they remained stalwart in defending the VA against its many ideological enemies who want to see it privatized? It’s because, by and large, VA care is as good, if not better than what vets can find outside the system, including by such metrics as wait times.

Similarly, if VA care were not generally very good, the VA would not continue to rank extraordinarily high in independent surveys of patient satisfaction. Recently discharged VA hospital patients for example, rate their experience 4 points higher than the average for the health care industry as a whole. Fully 96 percent say they would turn to VA inpatient care again.

Yes, the wait times need to be fixed by getting more doctors where the demand has spiked. But how does this situation qualify as an example of "how bureaucracy can destroy an otherwise fine idea and program?"

Considering the poor quality of US medical care in general, why would one want to dump veterans into an inferior system? We owe it to our veterans to beef up the VA where the demand has spiked. But we don't want to throw out the baby with the bathwater...

[blackshoe]

barmar, on 2014-June-04, 11:21, said:

That is exactly my point. You put those 100 scientists in a room for 10 years, keeping them fed and clothed, you'll get lots of good ideas, but not a single drug. They won't even know if any of their ideas actually work.

Einstein came up with his Theory of Relativity in his spare time while working for the Patent Office, so obviously financial incentives aren't necessary for the thought work that goes into innovation. But turning E=mC^2 into a working nuclear power plant required more innovation and creative work than anyone could do on their own.

Yes, it did. It started with The Manhattan Project.

"If it were ever found possible to control at will the rate of disintegration of the radio-elements, an enormous amount of energy could be obtained from a small quantity of matter." -- Ernest Rutherford, 1904. (Einstein published "On the Electrodynamics of Moving Bodies" in 1905).

[Elianna]

cherdano, on 2014-June-04, 15:42, said:

I guess my sarcasm has gotten a bit too subtle these days...

I upvoted it before I saw Ken's reply, and then was going to reply to him to say that I think that you were being sarcastic, but I see that you've beat me to it.

[kenberg]

cherdano, on 2014-June-04, 15:42, said:

I guess my sarcasm has gotten a bit too subtle these days...

I didn't read it closely or I might have understood, but I easily miss such things.I had planned not to contribute to this thread, I slipped up, I sincerely regret this impulsive choice.

[Winstonm]

There is no doubt that fine private health care is available in the U.S. The problem is that it is only affordable for the top earners. Case in point is the drug Abilify. Abilify is one of the better antipsychotic medications with few side effects - it is now a tier 5 medication on Medicare meaning that the co-pay for this drug is over $1000 per month. The well-to-do can afford this drug; others, not so much.

[helene_t]

Winstonm, on 2014-June-05, 06:27, said:

There is no doubt that fine private health care is available in the U.S. The problem is that it is only affordable for the top earners. Case in point is the drug Abilify. Abilify is one of the better antipsychotic medications with few side effects - it is now a tier 5 medication on Medicare meaning that the co-pay for this drug is over $1000 per month. The well-to-do can afford this drug; others, not so much.

69 pencecents per 30 mg tablet according to https://www.pharmacy...ole/30+mg/cpp/. Are you telling me that a patient needs 50 times 30 mg per day?

This post has been edited by helene_t: 2014-June-05, 09:01

[Winstonm]

helene_t, on 2014-June-05, 06:38, said:

69 pence per 30 mg tablet according to https://www.pharmacy...ole/30+mg/cpp/. Are you telling me that a patient needs 50 times 30 mg per day?

No. That is the cost of a daily dose of Abilify.

Here is a result from a really quick Google search:

Quote

Dr O.

Depending on the strength, 30 tablets of Abilify can cost from $700 to $1000 out of pocket, even with a discount. If covered by your insurance, it’s likely to fall under your highest co-pay. In contrast, generic atypical antipsychotics like olanzapine (Zyprexa) and risperidone (Risperdal) can be found for under $20 out of pocket with a discount. They are also covered under most insurance plans as Tier 1 drugs, meaning you’ll pay only your lowest co-pay

.

Here is the U.S., private healthcare is terrific for the 1% and maybe on down to the 5%. For the rest of us, not so much.

[helene_t]

So a tablet that costs 25 dollars in the US costs 69 cents in Canada? Are US tourists allowed to shop in Canadian pharmacies?

[WellSpyder]

helene_t, on 2014-June-05, 09:00, said:

So a tablet that costs 25 dollars in the US costs 69 cents in Canada? Are US tourists allowed to shop in Canadian pharmacies?

I thought all forms of competition were welcomed with open arms in the land of the free...

[hrothgar]

helene_t, on 2014-June-05, 09:00, said:

So a tablet that costs 25 dollars in the US costs 69 cents in Canada? Are US tourists allowed to shop in Canadian pharmacies?

Comment 1: You are only looking at the patient's out of pocket expense. The insurance carrier also pays a hefty sum

Comment 2: I believe that it is against the law to purchase drugs from Canada, which is not to say that there isn't a thriving business doing so.

[barmar]

Winstonm, on 2014-June-04, 17:21, said:

You and I are in agreement - it takes money to get things done. That is not the same as saying it requires free markets to get things done.

OK, now I think I get it.

I think the reason people think that government-funded research is stifled compared to free market research is because the government grants often come with hefty restrictions and requirements.

This hasn't always been true. In earlier decades, there was lots of government money funding basic research, and scientists had plenty of freedom in what they worked on. The Internet came out of that type of funding from DARPA, for instance. But as government budgets have tightened, and the amount spent on funding R&D has dwindled, they've become more selective about what they fund. So the grant recipients can't be as creative as they might be if they were working in private industry.

As an analogy, consider the days when artists generally required patronage. Would Bach have been able to produce such great masterpieces if his patron placed the restriction that he be able to play the pieces that Bach composed for him?

[Winstonm]

helene_t, on 2014-June-05, 09:00, said:

So a tablet that costs 25 dollars in the US costs 69 cents in Canada? Are US tourists allowed to shop in Canadian pharmacies?

George Bush implemented a Medicare change that disallowed the government from buying from non-U.S. sources.

[blackshoe]

WellSpyder, on 2014-June-05, 09:16, said:

I thought all forms of competition were welcomed with open arms in the land of the free...

The land of the free... isn't. Not anymore, if it ever was.

[blackshoe]

hrothgar, on 2014-June-05, 09:42, said:

Comment 1: You are only looking at the patient's out of pocket expense. The insurance carrier also pays a hefty sum

Comment 2: I believe that it is against the law to purchase drugs from Canada, which is not to say that there isn't a thriving business doing so.

I suspect it's not illegal to purchase drugs in Canada. What's illegal is importing them.

[blackshoe]

Winstonm, on 2014-June-05, 17:50, said:

George Bush implemented a Medicare change that disallowed the government from buying from non-U.S. sources.

All by himself, no doubt.

[Winstonm]

blackshoe, on 2014-June-05, 19:05, said:

I suspect it's not illegal to purchase drugs in Canada. What's illegal is importing them.

Precisely:

Quote

Under the Prescription Drug Marketing Act of 1987, it is illegal for anyone other than the original manufacturer to bring prescription drugs into the country

[mike777]

barmar, on 2014-June-05, 16:13, said:

OK, now I think I get it.

I think the reason people think that government-funded research is stifled compared to free market research is because the government grants often come with hefty restrictions and requirements.

This hasn't always been true. In earlier decades, there was lots of government money funding basic research, and scientists had plenty of freedom in what they worked on. The Internet came out of that type of funding from DARPA, for instance. But as government budgets have tightened, and the amount spent on funding R&D has dwindled, they've become more selective about what they fund. So the grant recipients can't be as creative as they might be if they were working in private industry.

As an analogy, consider the days when artists generally required patronage. Would Bach have been able to produce such great masterpieces if his patron placed the restriction that he be able to play the pieces that Bach composed for him?

Given that the money on research will be spent my main objection is that it is spent on a few big projects. I fully expect most of these to be a failure.

I do not know the best way to spend the money so I just ask that it be spread out to many more projects in more tiny amounts. Again I assume the money will be spent in any event.

---

If the patron wants to put restrictions on the money, so be it. They may be forgotten.
--

Please stop with all this talk about darpa and the what we call the internet today.

The free market place created todays's internet....I understand many don't get it.

What darpa did was spread some seed money around and won...that is the whole point

spread the seed around and let competition in and allow for a culture of failure!

Darpa did not I repeat did not create what we call the internet today. Please give it a rest.

Free markets did, I Know many of you hate, really hate that idea.

[Winstonm]

mike777, on 2014-June-05, 21:15, said:

Given that the money on research will be spent my main objection is that it is spent on a few big projects. I fully expect most of these to be a failure.

I do not know the best way to spend the money so I just ask that it be spread out to many more projects in more tiny amounts. Again I assume the money will be spent in any event.

---

If the patron wants to put restrictions on the money, so be it. They may be forgotten.
--

Please stop with all this talk about darpa and the what we call the internet today.

The free market place created todays's internet....I understand many don't get it.

What darpa did was spread some seed money around and won...that is the whole point

spread the seed around and let competition in and allow for a culture of failure!

Darpa did not I repeat did not create what we call the internet today. Please give it a rest.

Free markets did, I Know many of you hate, really hate that idea.

Your total faith in a mythological "free market" is interesting. I suspect you have not thought it all the way through. Robert Reich helps clarify the free market myth.

Quote

In reality, the “free market” is a bunch of rules about (1) what can be owned and traded (the genome? slaves? nuclear materials? babies? votes?); (2) on what terms (equal access to the internet? the right to organize unions? corporate monopolies? the length of patent protections? ); (3) under what conditions (poisonous drugs? unsafe foods? deceptive Ponzi schemes? uninsured derivatives? dangerous workplaces?) (4) what’s private and what’s public (police? roads? clean air and clean water? healthcare? good schools? parks and playgrounds?); (5) how to pay for what (taxes, user fees, individual pricing?). And so on.

These rules don’t exist in nature; they are human creations. Governments don’t “intrude” on free markets; governments organize and maintain them. Markets aren’t “free” of rules; the rules define them.

[barmar]

mike777, on 2014-June-05, 21:15, said:

Darpa did not I repeat did not create what we call the internet today. Please give it a rest.

Free markets did, I Know many of you hate, really hate that idea.

The free market didn't really get involved until most of the critical R&D work was done via public funding. Arpanet was replaced with the Internet in 1983, I think it was at least 5 years later before consumers could purchase Internet connections. And high speed connections for enterprises were still only available from one provider in each region.

I was there, I even worked for one of them for a while, at the time when competition was starting up.