The "Costs" of Medical Care
The "Costs" of Medical Care
Thomas Sowell
www.creators.com/opinion/thomas-sowell/the-costs-of-medical-care.html">www.creators.com/opinion/thomas-sowell/the-costs-of-medical-care.html
We are incessantly being told that the cost of medical care is "too high"— either absolutely or as a growing percentage of our incomes. But nothing that is being proposed by the government is likely to lower those costs, and much that is being proposed is almost certain to increase the costs.
There is a fundamental difference between reducing costs and simply shifting costs around, like a pea in a shell game at a carnival. Costs are not reduced simply because you pay less at a doctor's office and more in taxes— or more in insurance premiums, or more in higher prices for other goods and services that you buy, because the government has put the costs on businesses that pass those costs on to you.
Costs are not reduced simply because you don't pay them. It would undoubtedly be cheaper for me to do without the medications that keep me alive and more vigorous in my old age than people of a similar age were in generations past.
Letting old people die would undoubtedly be cheaper than keeping them alive— but that does not mean that the costs have gone down. It just means that we refuse to pay the costs. Instead, we pay the consequences. There is no free lunch.
Providing free lunches to people who go to hospital emergency rooms is one of the reasons for the current high costs of medical care for others. Politicians mandating what insurance companies must cover is another free lunch that leads to higher premiums for medical insurance— and fewer people who can afford it.
Despite all the demonizing of insurance companies, pharmaceutical companies or doctors for what they charge, the fundamental costs of goods and services are the costs of producing them.
If highly paid chief executives of insurance companies or pharmaceutical companies agreed to work free of charge, it would make very little difference in the cost of insurance or medications. If doctors' incomes were cut in half, that would not lower the cost of producing doctors through years of expensive training in medical schools and hospitals, nor the overhead costs of running doctors' offices.
What it would do is reduce the number of very able people who are willing to take on the high costs of a medical education when the return on that investment is greatly reduced and the aggravations of dealing with government bureaucrats are added to the burdens of the work.
Britain has had a government-run medical system for more than half a century and it has to import doctors, including some from Third World countries where the medical training may not be the best.
In short, reducing doctors' income is not reducing the cost of medical care, it is refusing to pay those costs. Like other ways of refusing to pay costs, it has consequences.
Any one of us can reduce medical costs by refusing to pay them. In our own lives, we recognize the consequences. But when someone with a gift for rhetoric tells us that the government can reduce the costs without consequences, we are ready to believe in such political miracles.
There are some ways in which the real costs of medical care can be reduced but the people who are leading the charge for a government takeover of medical care are not the least bit interested in actually reducing those costs, as distinguished from shifting the costs around or just refusing to pay them.
The high costs of "defensive medicine"— expensive tests, medications and procedures required to protect doctors and hospitals from ruinous lawsuits, rather than to help the patients— could be reduced by not letting lawyers get away with filing frivolous lawsuits.
If a court of law determines that the claims made in such lawsuits are bogus, then those who filed those claims could be forced to reimburse those who have been sued for all their expenses, including their attorneys' fees and the lost time of people who have other things to do. But politicians who get huge campaign contributions from lawyers are not about to pass laws to do this.
Why should they, when it is so much easier just to start a political stampede with fiery rhetoric and glittering promises?
To find out more about Thomas Sowell and read features by other Creators Syndicate columnists and cartoonists, visit the Creators Syndicate web page at www.creators.com. Thomas Sowell is a senior fellow at the Hoover Institution, Stanford University, Stanford, CA 94305. His Web site is www.tsowell.com.
By esanch36 on Nov 5, 2009, 13:48 in Off Topic.
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ronaldo says on Nov 5, 2009, 17:12:
The "Costs" of Medical Care By Thomas Sowell
Thomas Sowell talks a lot about "shifting costs, high costs of medical education, doctor costs" and a lot of other "costs" and rhetoric of others who would claim to be able to lower these "costs", but what Mr. Sowell does not talk about is the actual value of his own rhetoric in terms of dollars. Lets have some examples showing the real COST of medical care and the revenue generated by providers. Without these factual dollar numbers the rest is all just, if I may borrow the term from Thomas Sowell "rhetoric".
Ronaldo
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scumbuster says on Nov 5, 2009, 17:28:
Rising costs are also attributed to the vast improvement in our medical technology. I remember back about 1977 when I had a kidney stone. They made a 10”long incision to remove it. Some that have seen the scar and asked if I had a kidney transplant it is so large. 3 years ago I was unfortunate enough to have one but instead of surgery they put me in a tub of water and used sound waves to disintegrate it. Walked out of the hospital about 1 hour later. Laser surgery and many other medical inventions make surgery less invasive and painful. Do we think someone built these in there garages? Unfortunately the citizens of the USA pay for all innovation in medicine. Drugs are developed and tested here. We pay for R&D through high drug prices. Then places like china copy them and sell them for a fraction of the price because they only had raw material costs to recover. Not years of research and studying on mice and drug trials. FDA approval exc. The same with all modern medical equipment. It took probably 100s of millions to make the first MRI. But all it takes is for another country to buy one and take it back to there own country to be reverse engineered and have them rolling off there assembly lines. We have all cutting edge technology here and wonder why we pay more than every other country? If we waited for others to develop these things to copy we would still be using whisky for anesthesia. Let the government get involved and there will be no new innovation or drugs. Our system will begin to slide as we get less competent people. We have the best treatment in the world so there is no place to go but down if the government gets involved. Does anyone else but me notice that every time there is a head of state from another country with cancer or a major health problem it is always the USA they come to for treatment?
Tomas Jefferson “When the people fear their government, there is tyranny; when the government fears the people, there is liberty.”
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esanch36 says on Nov 6, 2009, 05:46:
Anytime you get government interference the price of something goes up.
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ronaldo says on Nov 7, 2009, 05:53:
scumbuster post Nov 5, 2009, 17:28
You have claimed in your post that the Citizens of the USA pay for all innovation in medicine and have the USA has "all the cutting edge of technology" and "the best treatment in the world".
In responce to your post of the above noted date and time, I would like to inform you of a few facts. This is not intended as a put down, just facts.
You mentioned advancement of treatment in your kidney stone, of shock waves to break up your kidney stones. This procedure is called Extracorporeal Shock Wave Lithotripsy or ESWL. This procedure was not developed in the USA, but in fact developed in 1980 in Germany by Domier Medizintechnik GmbH. So you can thank the Germans for the invention of the treatment of your kidney stone.
You also mentioned Magnetic Resonance Imaging, MRI and implied that the USA developed ALL modern medical equipment in the world. The FATHERS of Magnetic Resonance Imaging or MRI, are Paul Lauterbur, a Professor of Chemistry at the Mellon Institute in Pittsburgh, Pennsylvania and Sir Peter Mansfield, a British Physicist at the University of Noddingham in the UK. The Mellon Institute is a nonprofit Foundation and the University of Noddingham is a Royal Chartered University, meaning it belongs to the people of the UK (which is a "socialist" institution). So the modern MRI was created by a nonprofit Foundation and a foreign "socialist institution" and not by the American Medical Community. Paul Lauterbur and Sir Peter Mansfield both shared the NOBEL PRIZE for MEDICINE in 2003 for their joint contributions to the development of the modern MRI.
There are a number of countries throughout the world who contribute through R&D to the well being of all of us and not just the USA. On a global scale the USA is not the biggest contributor as you have suggested.
Now as far as having "all the cutting edge technology" and "the best treatment in the world" you might try to explain with all this advantage over other countries why the USA has 45 other countries that are ahead of you, as the USA is number 46 on the list of countries for Infant Mortality Rates*? Why with "all the cutting edge" and "best treatment in the world" does the USA slide to 46 place. Even Cuba who has a dreaded "socialist medical system", a country that the USA has been trying to destroy for the last 50 years through economic and material sanctions (no fuel, no fertilizer, no pesticides, no medical equipment, no drugs etc) and even failed attempts of assassination of its leader (illegal by the way under USA law) is ahead of the USA?
FURTHER, there are 49 other countries who's citizens could dance on your grave as the USA is in 50 place for Life Expectancy*
in the world. Is it not logical that with "the cutting edge technology" and "the best treatment in the world" that your life expectancy would place you as number ONE?
*CIA World Factbooks, 2009 Edition.
Ronaldo
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scumbuster says on Nov 7, 2009, 10:23:
renaldo.... You raised interesting points.
I don’t have the time to properly respond now but several quick points. Just because it the MRI was developed in a non profit doesn’t mean it was free... You may be right as I never researched the lithotripter... But it’s a great device ;))
Drugs are notorious for being copied after 100s of millions of costs R&D and FDA Approval.
Life expectancy... You site infant mortality... Very poor statistic to use to show the quality of care.. Much of the US infant mortality is no prenatal care.. Its lack of using the medical technology. Drug use by poor intercity women also increases infant mortality. Its a behavioral issue in the US not a medical issue. Cancer survival rates are the best in the world for almost every type of cancer. Our lifestyle here also puts our medical system to a larger challenge than others, by the obesity rate in the US as compared to all other countries... Got to run now but I will do a little research tonight... jajajaja
Tomas Jefferson “When the people fear their government, there is tyranny; when the government fears the people, there is liberty.”
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ronaldo says on Nov 11, 2009, 15:20:
scumbuster:
I hope you are doing your research.
Here is another couple of great discoveries:
Canada
Sir Frederick Grant Banting and Dr. Charles Best
Nobel Prize for Medicine 1923
Discovery of Insulin
Has saved countless millions of lives worldwide.
Scotland
Sir Alexander Fleming
Nobel Prize for Medicine 1945
Discovery of Penicillin
This man has saved more lives with penicillin than all the other drugs put together.
AND NONE OF THEM DID IT FOR PROFIT.
Ronaldo
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ronaldo says on Nov 11, 2009, 15:36:
scumbuster:
I did some of your research for you.
Cancer survival rates for ALL CANCERS in USA for women is 61%
Cancer survival rates for ALL CANCERS in CANADA for women is 58%
Cancer survival rates for ALL CANCERS in USA for men is 57%
Cancer survival rates for ALL CANCERS in CANADA for men is 53%
USA leads the way with 3% better for women and 4% better for men.
You were absolutely correct.
.
Ronaldo
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Chriscan (☼Travelguide writer) says on Nov 11, 2009, 17:22:
Well, 3% less for cancer. In Canada you are likely to live 3.8% longer.
Canada 81.2 years, USA, 78.1 years
The cost of living in the United States is a shorter life than similar GDP/Capita countries.
Health care in the U.S is great by world standards and slightly sub par by developed world standards.
Administrative costs associated with private care much higher and doctors spend more time with paper work.
One thing I hate about the debate is the use of the word socialist. I believe in markets but when it comes to roads, military, schools, the elderly and health, almost every county in the world has agreed that those are the things that government are for. There is some grand illusion out there that the U.S.A is less socialist than other countries. It's only health where the government plays a lesser role. Corporate tax breaks and hand outs are one of the biggest parts of American success - entirely socialist programs.
Beam me up Scotty; No intelligent life here.
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ronaldo says on Nov 11, 2009, 18:28:
Chriscan
You are correct the USA spends just 1% less on social programs than does Canada, yet some people in the USA think that Canada is what they call a "socialist country".
Most people think that the USA is the home of Capitalism, but the USA is also home of the largest "social program' on this planet. Its called the Education System. No where on earth is there more transfer of wealth from one person to another than in the education system in the USA.
Ronaldo
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Man Tequila says on Nov 11, 2009, 18:45:
I agree with many of Escanch´s points, but disagree with others.
Ultimately, I think government intervention can lower costs substantially, but can also raise them depending on how things are done. Doctors incomes in the US were substantially lowered by the rise of HMOs, I know some American doctors who make more money in Canada. But defensive medicine is a huge cost, one that goes hand in hand with improved technology. I think it is hard to argue the US system is so efficient that there is not ample scope for improvement.
Aunque no me creas/ si me lo propongo/ lograre olvidarte/ porque a fin de cuentas/ no soy tan cobarde./ Y termino todo una de estas tardes/ no sera dificil buscar algún sitio donde refugiarme/ donde nunca mas vuelvas a encontrarme. (Polo Montañez)
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esanch36 says on Nov 12, 2009, 13:24:
The "Costs" of Medical Care: Part II
Although it is cheaper to buy a pint of milk than to buy a quart of milk, nobody considers that to be lowering the price of milk. Although it is cheaper to buy a lower quality of all sorts of goods than to buy a higher quality, nobody thinks of that as lowering the price of either lower or higher quality goods.
Yet, when it comes to medical care, there seems to be remarkably little attention paid to questions of both quantity and quality, in the rush to "bring down the cost of medical care."
There is no question that you can reduce the payments for medical care by having either a lower quantity or a lower quality of medical care. That has already been done in countries with government-run medical systems.
In the United States, the government has already reduced payments for patients on Medicare and Medicaid, with the result that some doctors no longer accept new patients with Medicare or Medicaid. That has not reduced the cost of medical care. It has reduced the availability of medical care, just as buying a pint of milk reduces the payment below what a quart of milk would cost.
Letting old people die instead of saving their lives will undoubtedly reduce medical payments considerably. But old people have that option already— and seldom choose to exercise it, despite clever people who talk about a "duty to die."
A government-run system will take that decision out of the hands of the elderly or their families, and thereby "bring down the cost of medical care." A stranger's death is much easier to take, especially if you are a bureaucrat making that decision in Washington.
At one time, in desperately poor societies, living on the edge of starvation, old people might be abandoned to their fate or even go off on their own to face death alone. But, in a society where huge flat-screen TVs are common, along with a thousand gadgets for amusement and entertainment, and where even most people living below the official poverty line own a car or truck, to talk about a "duty to die" so that younger people can live it up is obscene.
You can even save money by cutting down on medications to relieve pain, as is already being done in Britain's government-run medical system.
You can save money by not having as many high-tech medical devices like CAT scans or MRIs, and not using the latest medications. Countries with government-run medical systems have less of all these things than the United States has.
But reducing these things is not "bringing down the cost of medical care." It is simply refusing to pay those costs— and taking the consequences.
For those who live by talking points, one of their biggest talking points is that Americans do not get any longer life span than people in other Western nations by all the additional money we spend on medical care.
Like so many clever things that are said, this argument depends on confusing very different things— namely, "health care" and "medical care." Medical care is a limited part of health care. What we do and don't do in the way we live our lives affects our health and our longevity, in many cases more so than what doctors can do to provide medical care.
Americans have higher rates of obesity, homicide and narcotics addiction than people in many other Western nations. There are severe limits on what doctors and medical care can do about that.
If we are serious about medical care— and we should be serious, since it is a matter of life and death— then we should have no time for clever statements that confuse instead of clarifying.
If we want to compare the effects of medical care, as such, in the United States with that in other countries with government-run medical systems, then we need to compare things where medical care is what matters most, such as survival rates of people with cancer.
The United States has one of the highest rates of cancer survival in the world— and for some cancers, the number one rate of survival.
We also lead the world in creating new life-saving pharmaceutical drugs. But all of this can change— for the worse— if we listen to clever people who think they should be running our lives.
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miamimike says on Nov 14, 2009, 08:45:
Scumbuster--I disagree with you on a various points you make but a big one is your comment about letting the Govt getting involved in healthcare. Let me remind you that due to the Space race and the technology that was developed as a result of it, the New Technology also has(had) dual applications and is being used in Medical Procedures as well. Google this and you will see what I mean.
On Drugs, interference from the Lobbyists connected to the Large US Based Pharmacuetical Giants results in many drugs being let on the Market before they were safe and throughly tested. This shortcoming caused a lot of problems for many users and now many Lawsuits(legitimate) are coming forward. In this case, it was caused as a result of inadequate government involvement and Oversight. Vioxx is but one glaring example of lack of Govt Oversight and undue pressure from the Merck Pharnaceutical to get it on the market without proper vetting.
http://vioxxlawsuit.lawinfo.com/
Cuba vs USA on Life Expectancy: We rank almost Equal and for Infant Mortality, Cuba actually leads the USA in fewer deaths. The Big Difference, Cuba expends around $150 yearly per capita on Govt run healthcare while the US spends around $6500 yearly per Capita. One would think the results should be tilted heavily in favor of the USA as far as longer life expectency but that, by a preponderence of Facts&Figures, shows that is not true. We are pretty much equal so that shoots holes in the Govt vs Privately run Health Care system. ESanchez, you need to check your Facts out first. Personally, in my past employment at a Govt Clinic, I personally examined hundreds of Cubans arriving in Miami and I can personally attest with my own two eyes that they are some of the Healthiest people on the Planet. I say this based on the fact the Cubans arrived without communicable diseases, they are in prime physical condition( lack of dental, respiratory & other chronic health problems like High blood pressure, diabetes ect) The Detainees(cuban) who did arrive with these problems had their problems managed and under control, either with Medication or past surgery. They are very very healthy people and it speaks well of their Health Care system, for whatever other shortcomings their Govt has, their people are healthy.
Bésame, bésame mucho Como si fuera esta noche La última vez Bésame, bésame mucho Que tengo miedo a perderte Perderte después Bésame, bésame mucho Como si fuera esta noche La última vez Bésame, bésame mucho Que tengo miedo a perderte Perderte de
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miamimike says on Nov 14, 2009, 09:07:
Another interesting Fact on Cuba is their booming Biomedical Industry. This is under Govt control in Cuba so one, using the Logic of a few posters here, would expect this Industry to be a disaster. The truth is they are one of leaders in some areas such as Cancer, Hepatitis vaccines to name just a few.
ESanchez, you need to research your posts and facts before putting them up as what you posted on this subject is not backed up factually!
One does not frequently hear of Cuba when discussing today's integrating global economy. Cuba appears isolated, politically and economically, mainly due to trade restrictions placed on it by the US in the 1960's. No wonder, says the author of this Straits Times article, the world is surprised to learn of Cuba's flourishing biotech industry which has contributed much to the field of biotechnology and medicine. *********Since its establishment in the mid-1980's, the Cuban biotech sector has developed a meningitis B vaccine, and today exports the world's most effective hepatitis B vaccine to more than 30 countries.**** Recently, it developed the first synthetic vaccine for the prevention of pneumonia and meningitis, which is much cheaper than what is offered by Western pharmaceutical companies.******** Poised to provide anti-cancer therapies to the European market by 2008, Cuba is also eagerly looking to enter the western market, and many observers are cheering it on. – YaleGlobal
*******Cuba Ailing? Not Its Biomedical Industry**********
MENTION faraway Cuba and most people think of a Caribbean island best known for Havana cigars, rum and the revolutionary exploits of Che Guevara. They probably don't associate it with cutting edge medical research.
*******Yet Cuban biotechnology is now, among other things, leading the way in the development of a new generation of anti-cancer therapies expected to be available to the European market by 2008. *********
Given Cuba's cash-strapped economy, its scientific achievements are all the more surprising. It has long been battered by the United States trade embargo, imposed in the 1960s and still in force today. After the Cold War ended, Washington tightened the economic screws further with resulting shortages of consumer goods.
When Marxist revolutionary Fidel Castro came to power in 1959, most of Cuba's resources were ploughed into developing education and health systems. In the mid-1980s, with aid from the Soviet Union, Cuba started to invest heavily in science and biotechnology.
Although it is a small country with only 11 million people, it now boasts 52 scientific research institutes in the capital and more than 12,000 scientists on the whole island.
*********Cuba's health indicators - the infant mortality rate is 6.4 per 1,000 and life expectancy is 75 years - put it in the same league, health-wise, as the US and Britain. The quality and efficiency of its comprehensive, and free, health-care system contrasts sharply with the sluggish and inefficient state-controlled economy. ********
********Cuba pulled off its first scientific coup with the discovery of a new vaccine for meningitis B in the late 1980s. The vaccine controlled epidemics at home, and obtained good results abroad especially in Argentina and Brazil. ********
Havana's Carlos J. Finlay Institute has entered into a deal that allows major drug multinational GlaxoSmithKline to license its discovery in order to facilitate the first entry of a Cuban medical product into the more lucrative Western market.
Professor Michael Levin, head of the Paediatric Unit at St Mary's Hospital in London, and who is pioneering a joint UK-Cuban medical research project at the Finlay Institute, told this correspondent that despite its economic problems, 'they have excellent laboratories, and their doctors and scientists have maintained world-class standards'.
Another centre of excellence is the Pedro Kouri Institute of Tropical Medicine (IPK) which works closely with the United Nations World Health Organisation in Geneva. It is currently working on a new cholera vaccine and seeking to match the efforts of Western countries in the race to find the first vaccine against Aids.
'IPK is respected throughout Latin America and beyond,' says Professor Paul Farmer, professor of medical anthropology at Harvard Medical School. 'With a comparatively tiny budget - less than that, say, of a single large research hospital at Harvard - IPK has conducted important basic science research, helped develop novel vaccines, trained thousands of researchers from Cuba and from around the world, and developed ties with researchers in the US, too.'
*******Visiting Western scientists are often surprised by the scale and size of the Cuban Biotechnology Centre (CIGB) which opened its research and development facilities back in 1986. In 1994, this was complemented by the launch of a Centre for Molecular Immunology, which has pioneered the latest research into anti-cancer vaccines. Other scientists are engaged in developing an anti HIV-Aids vaccine.*********
TECHNOLOGY TRANSFER
DR ROLANDO Perez, one of the top scientists at CIM-Centre of Immunology, points out that the Cuban biotechnology model is 'completely different' from the development of Western pharmaceutical products. 'Pure scientific research, innovation and product development, production and marketing are all integrated under the same roof, or at least in the same institution.'
In a country where there are no private hospitals, and all pharmaceuticals are publicly owned, inevitably all investment comes from the state.
*******Orthodox Western economists would tend to dismiss this socialist model of medical innovation and production as a quaint aberration in today's world, clearly out of synch in the globalised economy. But the Cuban record boasts 26 inventions with more than 100 international patents already granted.*********
*******One of the major earners is the successful export of the hepatitis B vaccine to more than 30 countries. Dr Pedro Lopez, who directs the testing of Cuban biotechnology products, said that 'all the clinical trials have shown that it is the most effective vaccine (against hepatitis B) in the world'. ***********
Although the US and France also manufacture a hepatitis B vaccine, there are Western experts who support the Cuban claim. Mr Louis Baretta, head of Aventis Pasteur, a big Canadian pharmaceutical, told The Financial Times in June 2002: 'Their work on hepatitis is likely to become the standard for the rest of the industry.'
*********The first synthetic vaccine for the prevention of pneumonia and meningitis is the latest Cuban breakthrough. Aimed at lowering the cost of immunising children in poor, developing countries, the vaccine was launched late last year before a gathering of world experts at Havana's International Biotechnology Congress. *******
******This vaccine protects against bacteria that cause respiratory infections mainly in children up to five years old, and is touted as much cheaper than the conventional one offered by the multinationals which costs US$3 (S$5.10) a dose.*****
http://yaleglobal.yale.edu/content/cuba-ailing-not-its-biomedical-indu...
Bésame, bésame mucho Como si fuera esta noche La última vez Bésame, bésame mucho Que tengo miedo a perderte Perderte después Bésame, bésame mucho Como si fuera esta noche La última vez Bésame, bésame mucho Que tengo miedo a perderte Perderte de
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