Free Market
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There is no money in selling the drug my ass.
They certainly are getting kick backs in one way or another.
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@DustinB3403 said:
@scottalanmiller said:
@Dashrender said:
Who determines how much money a doctor is paid?
That depends on the system that you want to use. Nearly always the government in systems that currently work well.
Which also means that the doctor is likely to try and "sell" the most expensive service they can every time.
Just like a car sales man.
Have you used healthcare in countries that have government set doctors pricing? Because this really does not happen there. That most of the developed world works this way, and all the countries with the best healthcare, and this is not a problem in the least suggests that this isn't true.
That the US does the opposite and lets doctors set any price they want AND allows them to sell drugs and results in exactly the situation you describe effectively proves that your theory is backwards.
This isn't some theory that isn't tested. You can witness this in global healthcare every day.
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@scottalanmiller said:
@DustinB3403 said:
Just like a car sales man.
Only in a corrupt world where doctors are drug dealers and don't provide healthcare.
IT pros don't have this problem, that's why we warn people about confusing IT pros with salesmen. Two different roles, two different jobs.
The pharma sales reps, sell to doctors, to promote a specific medicine. If the doctor has patients who could use that medicine, they are prescribing it to their patients.
Which at so many units sold (i know this from working closing with the pharma industry) does the doctor get a kickback of some kind. As well as the rep.
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@DustinB3403 said:
There is no money in selling the drug my ass.
They certainly are getting kick backs in one way or another.
No, they really are not. Where are you getting this? What country have you witnessed this in that has government set doctors' prices?
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@DustinB3403 said:
@scottalanmiller said:
@DustinB3403 said:
Just like a car sales man.
Only in a corrupt world where doctors are drug dealers and don't provide healthcare.
IT pros don't have this problem, that's why we warn people about confusing IT pros with salesmen. Two different roles, two different jobs.
The pharma sales reps, sell to doctors, to promote a specific medicine. If the doctor has patients who could use that medicine, they are prescribing it to their patients.
Which at so many units sold (i know this from working closing with the pharma industry) does the doctor get a kickback of some kind. As well as the rep.
Right, but I think the issue is that you are putting things together. You are looking at a system with corrupt doctors AND corrupt pharma and a government that supports both. You can't just fix one or the other. In countries with working healthcare doctors don't sell medicine AND can't get paid for it. Both things get fixed together and work extremely well. Drugs are dirt cheap, research happens unabated, doctors work for more or less set prices, healthcare is affordable and procedures are not guessed prices after the fact. The concept of pharma reps does not replicate universally. That's an Americanism. Since doctors can't sell drugs in other countries, there is no way for pharma reps to push drugs like that. And since the prices are low, there isn't much money in it.
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@scottalanmiller said:
@Dashrender said:
Scott - so in your utopian healthcare isn't part of the free market situation....
It's not a utopia. I haven't suggested how things should work. I've only explained that conceptually healthcare is not eligible for a free market system. Plain and simple. Neither is air, for example. It's not suggestive that there is a utopia system, it's simply stating what is.
I'm not sure how that's being missed. I'm not arguing that one system is more free market and another is not. Or that healthcare should or shouldn't be free. I'm saying that free market is a concept that can't be applied to healthcare and that's all that there is to it.
I don't think the US is a utopia, but clearly free market and healthcare have no association there.
I was going for dramatic effect - I know you never suggested a solution - but I am asking for what you think a viable solution could be.
I'm not missing what you are saying, you've swayed me significantly, but without a plan of action, I still prefer my own versus the BS we have today.
I'd love to hear a plan that addresses the issues I've raised.
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@scottalanmiller said:
@Dashrender said:
Who decides how much money is spent on research to make new drugs?
Who determines it today? The governments determines what will be bought, sold, allowed, protected, provided, etc. The government effectively already decides completely. The government is always the answer when a free market connect exist. You can hate governments as much as you want, they are the only possible answer. Work to fix them rather than to break systems for best results.
I completely agree that the government needs to exist for certain things - roads, power, water, sewer, etc. of course those, we pay for water, we pay for electricity, we pay for sewer.
I think the only way to get healthcare to be the way you mention is to make it zero cost with no financial incentives to anyone who is in it.
i.e. Doctors only make at max $100K, government funded research labs also have salary caps, etc. I'm not sure you could even allow privately funded medical research labs, unless you could somehow require that all research is open source and all results must be freely shared with anyone who wants them and are able to product any product that is a result of that research at no fee to the researchers.
I'll agree there are plenty of altruistic people out there, probably the Bill Gates of the world would continue to donate millions to such research facilities, but you need to take the corruption out of it, and you do that (as far as I can see) by taking money out of it - i.e. no one can become rich.
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@Dashrender said:
@scottalanmiller said:
@Dashrender said:
Scott - so in your utopian healthcare isn't part of the free market situation....
It's not a utopia. I haven't suggested how things should work. I've only explained that conceptually healthcare is not eligible for a free market system. Plain and simple. Neither is air, for example. It's not suggestive that there is a utopia system, it's simply stating what is.
I'm not sure how that's being missed. I'm not arguing that one system is more free market and another is not. Or that healthcare should or shouldn't be free. I'm saying that free market is a concept that can't be applied to healthcare and that's all that there is to it.
I don't think the US is a utopia, but clearly free market and healthcare have no association there.
I was going for dramatic effect - I know you never suggested a solution - but I am asking for what you think a viable solution could be.
I'm not missing what you are saying, you've swayed me significantly, but without a plan of action, I still prefer my own versus the BS we have today.
I'd love to hear a plan that addresses the issues I've raised.
I don't think that there is much challenge in having a plan that works. The problem is in having a plan to get from where we are to where we should be.
Since we lack a populace that prioritizes this and thinks that healthcare is important, it isn't going to happen as there is no incentive. It's nice to want good healthcare, but if it isn't broadly desired, it's just not something to deliver.
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@scottalanmiller said:
@DustinB3403 said:
@scottalanmiller said:
@Dashrender said:
Who determines how much money a doctor is paid?
That depends on the system that you want to use. Nearly always the government in systems that currently work well.
Which also means that the doctor is likely to try and "sell" the most expensive service they can every time.
Just like a car sales man.
Have you used healthcare in countries that have government set doctors pricing? Because this really does not happen there. That most of the developed world works this way, and all the countries with the best healthcare, and this is not a problem in the least suggests that this isn't true.
That the US does the opposite and lets doctors set any price they want AND allows them to sell drugs and results in exactly the situation you describe effectively proves that your theory is backwards.
This isn't some theory that isn't tested. You can witness this in global healthcare every day.
The caveat to that is, if you get some type of rare disease or cancer, etc - you'll probably die before you get treatment. But the general populous is probably more healthy and taken care of.
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@Dashrender said:
@scottalanmiller said:
@Dashrender said:
Who decides how much money is spent on research to make new drugs?
Who determines it today? The governments determines what will be bought, sold, allowed, protected, provided, etc. The government effectively already decides completely. The government is always the answer when a free market connect exist. You can hate governments as much as you want, they are the only possible answer. Work to fix them rather than to break systems for best results.
I completely agree that the government needs to exist for certain things - roads, power, water, sewer, etc. of course those, we pay for water, we pay for electricity, we pay for sewer.
I think the only way to get healthcare to be the way you mention is to make it zero cost with no financial incentives to anyone who is in it.
i.e. Doctors only make at max $100K, government funded research labs also have salary caps, etc. I'm not sure you could even allow privately funded medical research labs, unless you could somehow require that all research is open source and all results must be freely shared with anyone who wants them and are able to product any product that is a result of that research at no fee to the researchers.
I'll agree there are plenty of altruistic people out there, probably the Bill Gates of the world would continue to donate millions to such research facilities, but you need to take the corruption out of it, and you do that (as far as I can see) by taking money out of it - i.e. no one can become rich.
Exactly, what that's what most of the developed world has done. There is very little money in healthcare. You can pay your bills. Being a French doctor lets you have a nice house and live in a nice neighbourhood but it does not make you rich. Healthcare systems that are working today have, by and large, effectively no financial incentives outside of relatively basic and limited ones. Similar to teaching jobs in Finland. They pay well, but there is no way to get rich off of it, it just is what it is.
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@Dashrender said:
@scottalanmiller said:
@DustinB3403 said:
@scottalanmiller said:
@Dashrender said:
Who determines how much money a doctor is paid?
That depends on the system that you want to use. Nearly always the government in systems that currently work well.
Which also means that the doctor is likely to try and "sell" the most expensive service they can every time.
Just like a car sales man.
Have you used healthcare in countries that have government set doctors pricing? Because this really does not happen there. That most of the developed world works this way, and all the countries with the best healthcare, and this is not a problem in the least suggests that this isn't true.
That the US does the opposite and lets doctors set any price they want AND allows them to sell drugs and results in exactly the situation you describe effectively proves that your theory is backwards.
This isn't some theory that isn't tested. You can witness this in global healthcare every day.
The caveat to that is, if you get some type of rare disease or cancer, etc - you'll probably die before you get treatment. But the general populous is probably more healthy and taken care of.
Nope, not a caveat as those systems don't have those problems to the same degree that those not using those systems have. The issues of having to wait for healthcare are less, not more. Just look at the worst ones like Canada and the UK, still no waits even where the system works the worst.
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A great example is ebola. You can get ebola treatment for a very life threatening disease faster in west African countries than you can in the US. They both diagnose and treat it faster because their labs respond so much faster.
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@scottalanmiller said:
@Dashrender said:
@scottalanmiller said:
@DustinB3403 said:
@scottalanmiller said:
@Dashrender said:
Who determines how much money a doctor is paid?
That depends on the system that you want to use. Nearly always the government in systems that currently work well.
Which also means that the doctor is likely to try and "sell" the most expensive service they can every time.
Just like a car sales man.
Have you used healthcare in countries that have government set doctors pricing? Because this really does not happen there. That most of the developed world works this way, and all the countries with the best healthcare, and this is not a problem in the least suggests that this isn't true.
That the US does the opposite and lets doctors set any price they want AND allows them to sell drugs and results in exactly the situation you describe effectively proves that your theory is backwards.
This isn't some theory that isn't tested. You can witness this in global healthcare every day.
The caveat to that is, if you get some type of rare disease or cancer, etc - you'll probably die before you get treatment. But the general populous is probably more healthy and taken care of.
Nope, not a caveat as those systems don't have those problems to the same degree that those not using those systems have. The issues of having to wait for healthcare are less, not more. Just look at the worst ones like Canada and the UK, still no waits even where the system works the worst.
I've heard first hand stories from a few Canadian's who came to the US because of the back log in Canada.
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How do the doctors in those government provided healthcare places get drug so cheap? Why would they be cheaper there in Europe than in the US? I mean besides we are corrupt?
Why wouldn't the drug companies just say no instead of agreeing to a lower price?
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@Dashrender said:
@scottalanmiller said:
@Dashrender said:
@scottalanmiller said:
@DustinB3403 said:
@scottalanmiller said:
@Dashrender said:
Who determines how much money a doctor is paid?
That depends on the system that you want to use. Nearly always the government in systems that currently work well.
Which also means that the doctor is likely to try and "sell" the most expensive service they can every time.
Just like a car sales man.
Have you used healthcare in countries that have government set doctors pricing? Because this really does not happen there. That most of the developed world works this way, and all the countries with the best healthcare, and this is not a problem in the least suggests that this isn't true.
That the US does the opposite and lets doctors set any price they want AND allows them to sell drugs and results in exactly the situation you describe effectively proves that your theory is backwards.
This isn't some theory that isn't tested. You can witness this in global healthcare every day.
The caveat to that is, if you get some type of rare disease or cancer, etc - you'll probably die before you get treatment. But the general populous is probably more healthy and taken care of.
Nope, not a caveat as those systems don't have those problems to the same degree that those not using those systems have. The issues of having to wait for healthcare are less, not more. Just look at the worst ones like Canada and the UK, still no waits even where the system works the worst.
I've heard first hand stories from a few Canadian's who came to the US because of the back log in Canada.
And vice versa. It's not that they never have a back log. It is that they have less of one. Many Americans go to Central America for services too. Doesn't mean that the US is terribly backlogged.
Were those emergency services in Canada or optional ones?
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@Dashrender said:
How do the doctors in those government provided healthcare places get drug so cheap?
Doctors don't get them. They are just for sale. The idea that doctors gate drugs in an Americanism.
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@Dashrender said:
Why would they be cheaper there in Europe than in the US? I mean besides we are corrupt?
That's the only reason. There is no system for raising the prices like there is in the US. In the US there is an unlimited ability to make things expensive due to the lack of open market. In most of the world drugs are sold openly (outside of a few extreme examples) like any normal market product. The question isn't what makes them cheap everywhere else, it is what makes them expensive in the US?
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@Dashrender said:
Why wouldn't the drug companies just say no instead of agreeing to a lower price?
Because someone else will make them and make all of the money from them. -
@scottalanmiller said:
Here is a thought experiment...
What if a single rich person could hire every doctor that there is - this doesn't just give them access to all existing legal healthcare but the right to control the creation of more (only doctors can make more doctors legally.) The market is not free, someone new is not allowed to just become a doctor by knowing doctor stuff, you have to have other doctors and political groups approve you. It's a gated thing. So, in theory, access to healthcare can be controlled by a single person without the ability to have competitors.
In a free market, that situation cannot arise. Someone could always invest the time, effort or money to compete. But in the current framework, it is completely possible although totally impractical, to literally buy up all healthcare and with non-competes literally shut down the healthcare systems totally if one so desired.
We may be closer to that reality than people realize. Around here The Cleveland Clinic owns and runs 90% of the healthcare facilities and has the same amount of doctors under contract. My wife was in their main facility before she passed, and it is larger than most mid-sized cities. Just a small idea of the size, the window in her room looked out over the helicopter landing pads, all 4 of them. To get to her room from the parking lot, you walked 3/4 mile.
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Rochester is like that, UofR owns nearly all of the hospitals in the area.
