OT: Ray, how's your Bitcoin investment going?

[1centaur]

Originally Posted by fuzzalow

@ 1centaur: As noted in my post #101, I was not taking a position that health care services should be provided on a non-profit basis. That will not be feasible within the culture and traditions of US society.

I do not understand where you are going with your post on for-profit versus non-profit and the consequence of spending limit caps on health care coverage. There is no controversy that there are finite resources available to anyone.

It is consistent that if health care were enabled to leverage government pricing power such as found with the Medicaid/Medicare programs, health care costs would be decreased considerably as compared to what an individual patient is forced to pay under their own coverage. Under this scenario the extent and duration of heath care might be extended for a given spending limit given the pricing structure advantages the patient rather than corporate margins.

Prescription drugs are expensive relative to other modern, industrialized nations because the US leaves prices to market competition among pharmaceutical companies. Allowing this however opens up all manner of manipulations.

I was responding directly to your words in 101 below my copied in quote, both as to what constitutes speculation or not and to the death panel reference, lest my words be viewed henceforth as simply in that vein.

Further to the quote from you above, but in the same vein as my last one, I want to reiterate what I and perhaps you view as a simple point but one that is clearly not viewed thus in mainstream discussions: the current system does both good and bad things for both outcomes and costs, as would single payer. The devil is not in corporate margins related to health care in the aggregate, though surely that is the case in some specific instances. The bads of margin can be calculated and observed quite easily; the bads of bureaucratic indifference, political trade offs, and systematic constipation are not so clearly visible and are harder to demagogue in a sound bite, but their implications for suboptimal health and unfair outcomes are no less real.

As simply a giant buyer, even if not the only buyer, the government could squeeze margin out of any business through threats implied and stated as well as purchasing power. With margins shattered, outcomes, products and services would change, not just cost less. Good and bad changes would occur. Probably, and this is speculation, the easy stuff would get cheaper and be more available and the harder stuff would go away or only be available to the rich, if the law allowed that outcome. As for pharmaceuticals, the makers logically base their pipeline development on what they can earn, and that earning stream is a mix of the regulated costs overseas and the much less regulated costs elsewhere. Thus US buyers subsidize foreign drug consumption. If there were coordinated efforts to minimize drug profits across all major buying nations, many drugs would not be developed, which might be good for societal health care costs (more people dying sooner is great for affordability). Win win, in a sense.

The fascinating thing about the health care payment structure debate is that even the best informed, best intentioned, most intellectually honest people would end up making both informed and uninformed decisions that would harm a lot of people. It is not a solvable problem, it is a barely manageable problem, which is why it is tempting to let the anonymous market make lots of hard decisions. If we were going with single payer, having an awesome executive run the program would be incredibly important. Somebody that awesome would be wise to do something else.