And really, even if it wasn't the FDA setting the guidelines for proof of efficacy, the medical professionals (at least ethical ones) would do so, so the companies would still have to spend the money on the research.

I find it very hard to believe that those costs can't be trimmed. I'm absolutely positive that the pharmaceutical companies are passing that along to the consumers.

I don't know that the drug industry or R&D would dry up completely, but it very well could be stifled- or, more likely, I think, a slowing of innovation along with a gradual increase across the board in the drug prices of the export/import products would result. I can't imagine it would take long before the pharmaceutical companies realize that the downward pressure on domestically used drugs from the reimportation from Canada would mean that they need to cover those lost revenues by raising the prices on the Canadian products.

I say that as someone who really does believe that patented drug prices are outrageously high- we see it in our family where we're currently using three prescriptions that are astronomically priced, and even our copayments are $50 a month each. We recently used COBRA for one month (which is a story unto itself- the process to enroll takes longer than the one month period for which we needed coverage, so we had to self pay for the meds and then get reimbursed later) and I realize that a lot of people aren't in the position to even temporarily cover those kinds of costs out of pocket (one prescription was $700 and we had to fill the whole 30 days worth because it's controlled and the pharmacy can't fill part of it and then fill the rest later- and then another couple of scripts we were able to fill partially to the tune of $120 each for a week's worth of meds.)

I see all sides here though. The meds are, in my view, necessary, and I'm thankful that they are available at all. I know this makes us high end consumers of healthcare, getting more out of our insurance policy than we're currently paying in (probably not true over our lifetimes though.) And I know a bit of what goes into the drug research and FDA approval process, so I find it hard to begrudge the profit taking that is necessary to incentivize the investment that went toward creating these products. I do wish it could all be more affordable, but I'm enough of a realist to know that there are no free magical ponies.

The comment sections of many threads on this blog are replete with various conservative and moderate alternatives. For one example, what about the Wyden-Bennett proposal?

HemmD: “One of my favorites is importing drugs from canada. many drugs made in the US, exported to canada, still cost 50% less than what you and I currently pay. “

I don't have the number on the top of my head, but I'm reasonably sure that the profit margin of drug companies is way less than 50%. Therefore assuming your number is correct, if the US implemented the same cost controls as Canada, there would be no more drug industry, at least not one that has the resources to invest in new drug development.

See my comment o this issue in a previous thread: http://themoderatevoice.com/40661/obamas-health…

One you've mentioned before with which I concur, how about medical malpractice reform? I came across a lawyer site that listed won lucrative cases for people who showed up in emergency rooms. It didn't state so explicitly, but their stories had that ring of uninsured. How much is it worth to our discussion if reforms were made that lowered doctor's malpractice insurance costs. Add to that the lessening of extra CYA tests.

One of my favorites is importing drugs from canada. many drugs made in the US, exported to canada, still cost 50% less than what you and I currently pay. No, it may not include all drugs, but who cares, 50% less is a good thing. I brought this up in discussions because both Republicans and blue dogs have gone out of their way to block this saings.. Add that as another savings we currently don't employ.

I hope you see where I'm going here. Drip, drip, drip, and we fill the bucket.

I don't have a problem with those stats, in fact some of it seems to come from this source that I was about to link to. It's just that I'm not disputing the hardships on the working poor who are uninsured and end up with costly health problems. I agree that's a problem- but it doesn't logically follow then that if we provide publicly funded health insurance for them that the public costs will be less than they are now.

If we expand coverage and it's going to cost more, we need to know that upfront and figure out how to cover those increased costs- and at least admit that a reform plan which focuses on the universal coverage aspect is going to bend the cost curve upward instead of downward unless there are some other serious cost reducing measures included to offset the new entitlements.

I understand your point well. I would only say that my example was not to infer that this 3 to 1 cost ratio between emergency room and office visit was somehow the complete solution to our problem. I was contending that much of the existing system has built in inefficiencies that drive costs higher. Please read this example as an example of one of many needed ways to reduce cost and increase care.

There are a bunch of links out there about the effects on uninsured patients, and I include a one below. I do this not to prove any of my contentions, but to share a narrative of how no insurance effects people. for our purposes, some of these details show how late or no treatment results in eventual higher medical costs when they finally do seek medical care. If you find this link biased, let me know, that of course is not my intention.

http://www.nchc.org/facts/coverage.shtml

I did see that last response you gave and quoted above- but hadn't seen it before I wrote my comment here.

Basically though, where I believe you are in error with that example (which seems to be the point you've been stuck on all along in these discussions) is in comparing the cost of ONE visit to ER vs. PCP, and extrapolating as though this proves that universal coverage would lower costs since people who now go to ER would be able to go to PCPs.

But it's the sheer number of the visits in each case which would make that assumption false. If I can find any data, I'll come back and post it, but it belies belief that people who are uninsured currently end up in ERs even 33% as often for illnesses (not trauma, or true emergencies which can happen to the insured as well as uninsured) as they would end up in PCP offices or specialists to recieve routine care if they were insured. So even if your cost differential estimate is correct, that it's three times as costly to get care in ER as it is through a PCP, the overall costs still will not be lowered if everyone has insurance and the access that that buys them.

Whether or not you agree with that (which I realize depends on whether the data will support my assumptions about the frequency of visits), can you let me know if I've made the point clear, in terms of the cost implications for numerous routine care visits as compared to a much lesser number of ER visits?

“Hemm, I spent the better part of a day (yesterday I believe it was) discussing this point with you, explaining that we don't in fact pay as much currently for reimbursing care for the uninsured as we will pay to insure all of them– and in addition, the current plans will only insure a portion of the uninsured so we'll still have some of those ER costs to cover.”

So, on first blush, the uninsured are a drag on the system unless they're not….

I sure wish you'd re-read that of other comment thread. Your response to me yesterday came at the very end of a thread of 130+ comments where I was one of the first responders. Your response above implies that I know you think you've addressed my points, but when was the last time you thought you lost a debate

I will just restate the fact that a solution must be found to the current costs we all pay now “off the books:” My example quoted below is an example of how we can begin to accomplish that critical requirement.

” Let's take a simple example of my present insurance. A regular doctor's office visit requires a $25 co-pay on my part. For an emergency room visit, my part is $75. Now either emergency room visits cost three times as much or the insurance company merely charges me three times more simply to lower their exposure.
Thus, either we could provide three times the number of doctor/patient interviews by providing office visits or else the current pricing structure is arbitrarily designed to maximize profit. As I said, we already pay for these uninsured visits, so if the pricing structure is profit driven, it confirms that reducing costs can be accomplished by removing private incentives.

At no point did I say my proposal would solve all aspects of the uninsured health care costs. I merely pointed to the fact that the way we do things now is totally inefficient and costs you and me money. I'm the first person for lowering everybody's cost. I thought that was the point being discussed.

As hard as it may be to believe, I'm not trying to win a debate, I'm trying to find any way possible to give care to everybody at the lowest price possible. My example demonstrates an inherent inefficiency in the present system.

Hemm, I spent the better part of a day (yesterday I believe it was) discussing this point with you, explaining that we don't in fact pay as much currently for reimbursing care for the uninsured as we will pay to insure all of them– and in addition, the current plans will only insure a portion of the uninsured so we'll still have some of those ER costs to cover.

You either ignored everything I said or didn't understand the point. Getting to universal coverage is not a cost saving mechanism or even revenue neutral- it costs money. Again I'll suggest that you look at how things are working out in MA.

http://www.healthcarefinancenews.com/news/gao-h…

We now pay for the uninsured, but we just don't put it in any column when calculating the cost. It's similar to running a war without showing it in the budget as GWB did. When Obama accounted for the cost of conflict in a fiscal manner, many hammered his budget as being expansive. Where the “government expansion” meme is great rhetoric, it sure doesn't address the reality we all face.

“Despite the best that has been done by everyone . . . the war situation has developed not necessarily to our advantage.” Hirohito

Having said that — I think you may be confusing fiscal conservatives with Republicans, or perhaps partisans. You further seem to be forgetting that, for all the millions protesting, the majority of the country supported the escalation / redirection into Iraq. Whether everyone had all the correct information at the time is, as we know, highly questionable. But skating right past all the history surrounding those years to lump everyone into groups is, imho, both unfair and far too overly simplified.

For myself — I was screeching at the top of my lungs (often literally) as we geared up for Iraq, though it had less to do at the time with $$ and more to do with my understanding of the middle east and my realized fears about Bush's foreign policy team's ideology. (Can you say PNAC?) Yes, the war expenses are an enormous part of our current problems with expanding government programs generally — a problem that is not being generally acknowledged, I agree. You are, however, incorrect with the generalizations.

Very easily…

Historical Debt Outstanding – Annual 2000 – 2008

September 2000 – $ 5,674,178,209,886.86
September 2008 – $10,024,724,896,912.49

I remember the millions of Conservatives marching down the streets protesting… Oh sorry those were Liberals and they were protesting Bush's rush to war…

As easy as that, the largest entitlement program since the 1960's is dismissed as a “data point”.

There's also funding of the Iraq War.

Don't forget that Republican party leaders like John Boehner and Eric Castor voted for the Medicare Part D bill. They're still in office. They're still in leadership positions. So I don't see how anyone can claim Republicans paid any price for their fiscal irresponsibility. And I don't see how anyone can claim that “conservative VOTERS” got what they wanted in the elections of 2006 and 2008.

In case you missed it though, we had elections in 2006 and 2008 where conservative VOTERS expressed their displeasure with the fiscal irresponsibility (among other things.) As is often the case, party leaders weren't abiding by the wishes of their constituents and they paid the price for it.