Saturday, September 26, 2009

Rule 1: OSG is always right

Rule #2 - if you think right is wrong, you're not paying attention.

Regardless of who pays for it, healthcare is a set of goods and services that must be delivered by others to you.

Like if or not, there is not enough 'healthcare' to go around. Everyone cannot and will not get all the 'healthcare' they need or want.

This is just a reality, not a political statement.

When you let the government pay - the government has to decide who will get how much. Since government represent everyone equally, government payment systems requires 'fairness'. This means the government has to decide who gets treatment and who doesn't.

Some form of the following:

Life expectancy (age) X quality of life (defined how exactly??) X effectiveness of treatment / Cost of treatment

is used to determine whether you (or your kids or your parents) get the treatment.

Hey - wake up - this isn't some philosophical argument. Today - right now - Australia has what so many of you seem to want - nationalized medicine. There aren't enough cancer drugs to go around in Australia - and Australia has a panel of experts called the Pharmaceutical Benefits Advisory Committee who perform this economic analysis on cancer drugs to determine who will get them.

This is a direct quote from their website:

"Users should be encouraged to understand the costs, benefits and risks of medicines, and wherever possible the public benefit of provision of medicines should be achieved through the regulated can be difficult to meet the community’s expectations regarding subsidised access to all available treatments. Both the effectiveness and cost-effectiveness of the treatments need to be considered in making decisions about subsidisation...(we must assure) access to necessary medicines occurs at a cost the community as a whole can afford, particularly in the context of pressures such as the development of new high cost medicines and Australia’s ageing population...."


Cost...effectiveness...regulated...access...decisions about medicine... aging population...

What? Hello?

As I said - healthcare isn't a right, it's a good. Goods must be distributed. In nationalized (socialist) systems the government uses fairness to determine distribution.

Meaning - sick, old people don't get no chemo.

Tell mom that was the hope and change she believed in...

(oops, that was a political statement, sorry, just slipped out...)


Generic Technologist said...

I think you don't quite understand how the PBS works in Australia. It is probably one of the better things about the Australian health care system. Yes it all comes down to money, but a lot less then in the American system.

Firstly a summary of how drugs work in Australia. Drugs have to be approved as safe by an organisation called the Therapeutic Drugs Administration (TGA), I think this has a similar role to the FDA, this has to happen for a drug to be sold.

The TGA decides if a drug gets subsidised. All subsidised drugs cost the patient the same per treatment, pensioners get a much lower rate. The PBS works out how much more effective that drug is when compared to the cheapest drug in that class, and use that to work out the price the government will pay the drug company. The drugs might only be subsidised when used for particular conditions, but they do not decide on a case by case basis who gets treatment and who doesn’t.

If the drug company doesn’t accept the price the government is offering they can still sell directly via normal channels. My allergy medication is not subsidised for example, and I know of anti-nausea medication several times the subsidised rate, and some drugs are available below the subsidies rate anyway. If a drug is only 10% more effective then existing treatments, then the government will only pay 10% more.

There have been some cases where politics seem to have overridden the normal process. A few years ago there was a cancer drug that some people were paying something like $70,000 for treatment and the government put it on the schedule (but only for specific cancers where existing drugs were not very effective). Gardasil was made available free for women under 26, so that seems to be another exception, and the H1N1 vaccine looks to be another one, but in the most part the process seems to be followed without interference.

Under the US system your insurance company seems to decide if they will pay for treatment or not, and bad luck if you lost your coverage with your job, or you failed your medical when starting a new one.

At least in Australia people aren’t bankrupted by medical bills or die because they cannot afford treatment. People in Australia might criticise the medial system, but only because they want it to do better. I think you would be hard pressed to find anyone who wants to dismantle it and go to the chaos of the US system.

Kirby Wadsworth said...

Thanks for the thoughtful comment GenTech - my usual comment is either a japanese porno spammer or a nutjob. Your inputs are helpful.

In the US, most of us are actually very satisfined with our insurance as a benefit of employment. aside from the nonsense spouted by a bias media, there isn't really chaos in healthcare for most of us. The system works well - and has generated the most advanced and innovative healthcare system in the world - we wouldn't trade for usurious tax rates and waiting lines of our nationalized health allies, either.

Most states have regulations prohibiting exclusions for existing conditions when insurance is switched. If you lose your job, the insurance company must allow you to purchase insurance (COBRA) yourself. Insurance companies don't dictate treatment, other than untested or unapproved procedures. Typically edge cases that end up in court anyway.

There is no doubt we need health insurance reform - eliminating state barriers to competition, for instance.

Its probably hard for non-Americans to understand the fervor we have for independence, individual liberties, and the concept of equal opportunity, not equal distribution of goods. These are the tenents of our national DNA - they can't be changed by a president or a single party dominated congress. They have survived 200+ years of attack from all sides. I am pretty confident that won't change anytime soon.

Darwin Capitalist said...

I am not for bailouts, I am not a socialist. I am a registered Repulican with fantastic healthcare. I have a question for you, you write,

"Everyone cannot and will not get all the 'healthcare' they need or want.

You continue...

"In nationalized (socialist) systems the government uses fairness to determine distribution."

What would you use to determine distribution of the chemo? Money???

I am all for letting the markets determine life and deaths of companies. But I do not think an indigent child should struggle or get denied quality care.


Kirby Wadsworth said...

No - you might have missed earlier posts where I reference the fact that we aren't animals. There is a level of socialism - pretty significant really - in our system today. Indigent children get chemo from taxpayers. My point in these posts was to clarify right vs good visavi H/C. I am not advocating for one method of distribution vs another. I am pointing out the flawed thinking that distribution isn't necessary.

It just plain is - never enough docs, drugs, beds ever, ever, ever.

In MA, we have full H/C coverage. State is on verge of bankrupcy, taxes soaring, productive high income individuals fleeing, emergency rooms overun, doctors quitting medicine. It is what it is...reality bites, move on.