"Testing, Testing" great article about health care reform in The New Yorker

[Blackjack200]

We don't need to "try a bunch of different things". Other nations have already done that. What we need to do is to examine what other nations have done and then scrap our system and adopt what has proven to be the best system and what would be the best system for us, perhaps the British or French systems.

The problem is that a huge number of wealthy interests stand in the way of that kind of reform--pharmaceutical companies, insurance companies (which would be put out of existence), for-profit hospitals, medical billings specialists, insurance brokers, insurance company employees, and everyone else whose jobs would be eliminated in order to realize the greater efficiency of these other systems.

Gawande points out that other nations have not solved for the cost problems. What's more, we are not England or France, there may be a lot of good things about their systems, but some of them might not work so well here.

They have pharmaceutical companies in europe too...

 

[ebaycj]

Gawande doesn't really get into the question of universal care so much, other than to point out that if we don't get costs under control, UHC could be destroyed.

And the real key here, is to get drug / equipment / materials / malpractice prices under control.

Group negotiation on behalf of the whole population should significantly reduce drug / equipment / materials (bandages, etc.) prices.

"Universal" (nonprofit) Malpractice insurance for doctors would be easy to lump in with universal health insurance. (obviously there would need to be some sort of limiting factor here to prevent doctors from not caring at all).

Also, a law requiring "generic" (public-domain) prescription drugs to be sold for no more than 20% over total cost, applying to both manufacturers and pharmacies.

Also, a simple law limiting the drug companies' ability to market their products:

Marketing to doctors is unlimited $$, but with restrictions (similar to the financial industry now).

Marketing to the common folk is limited to 1/2 the amount spent (or donated to accredited programs) on research and development of NEW drugs. In no way should R&D of "existing" drugs count towards this goal. (i.e. doing research to go from fluticasone propionate -> fluticasone furoate, which are basically the same thing with the same efficacy, just slightly different dosages and shiny fresh patents, does not count. immediate-release -> time-release also does not count, unless it is a whole new process for causing the time-release.)

 

[cubeless]

And the real key here, is to get drug / equipment / materials / malpractice prices under control.

Group negotiation on behalf of the whole population should significantly reduce drug / equipment / materials (bandages, etc.) prices.

"Universal" (nonprofit) Malpractice insurance for doctors would be easy to lump in with universal health insurance. (obviously there would need to be some sort of limiting factor here to prevent doctors from not caring at all).

Also, a law requiring "generic" (public-domain) prescription drugs to be sold for no more than 20% over total cost, applying to both manufacturers and pharmacies.

Also, a simple law limiting the drug companies' ability to market their products:

Marketing to doctors is unlimited $$, but with restrictions (similar to the financial industry now).

Marketing to the common folk is limited to 1/2 the amount spent (or donated to accredited programs) on research and development of NEW drugs. In no way should R&D of "existing" drugs count towards this goal. (i.e. doing research to go from fluticasone propionate -> fluticasone furoate, which are basically the same thing with the same efficacy, just slightly different dosages and shiny fresh patents, does not count. immediate-release -> time-release also does not count, unless it is a whole new process for causing the time-release.)

damn, dude... bo ought to put you in charge of the new, nationalized drug companies so that they can fire all their expensive scientists and chemists... you can probably pull amazing new drugs right out of your ass like you do the stuff you post...

 

[JohnnyGage]

From Wiki about Atul Gawande:

"As a student Gawande was a volunteer for Gary Hart's campaign. As a Rhodes Scholar, he raised money for the African National Congress. After graduation, he joined Al Gore's 1988 presidential campaign. He worked as a health-care researcher for Congressman Jim Cooper (D-TN), who was author of a "managed competition" health care proposal for the Conservative Democratic Forum. After two years he left medical school to become Bill Clinton's health care lieutenant during the 1992 campaign and became a senior adviser in the Department of Health and Human Services after Clinton's inauguration. He directed one of the three committees of the Clinton Health Care Task Force, supervising 75 people and defined the benefits packages for Americans and subsidies and requirements for employers. He returned to medical school in 1993 and earned his M.D in 1995."

So he really is unbiased. The article is decent but the comparison is lacking. The govt came in to give the farmers a new way of doing things at a time when communication was practically still Morse code. The govt. did not in fact come in and buy the small farms one by one only to take them over completely.

 

[charrison]

It was a very interesting read, but I am not sure the analogy between agriculture and healthcare quite fit. While no doubt the government did appear to help move farmers forward, the real labor reduction came from mechanization.

And I agree government can do the same thing with health care as there are many best practices can be implemented that would improve quality of care and reduce costs at the same time. However that is not really the point of the current legislation being shoved though right now.

 

[ebaycj]

damn, dude... bo ought to put you in charge of the new, nationalized drug companies so that they can fire all their expensive scientists and chemists... you can probably pull amazing new drugs right out of your ass like you do the stuff you post...

The government already pays for 80% of the research. Why not push industry to do their part?