Chou Toshio
Over9000
So in the midst of this election year, it's no surprise that health care is once again a central topic in American politics. But this thread is about a topic that concerns more than the US.
Now, I'll comment that I'm bringing up this topic without being an expert, and an outsider to health care. I hope that more informed opinions and sources come up in this thread!
The topic is this: Is the fact that the US is a for profit health sector important to the world's medicine?
Now, we all know that in terms of delivered goods and services, as well as the performance in health statistics, the US basically fails terribly compared to other developed countries. We spend exorbitant amounts per capita for medicine in exchange for shorter life spans, and poorer public health. While no one source is perfect, I really like Frontline's documentary comparing the sick around the world:
http://www.pbs.org/wgbh/frontline/film/sickaroundtheworld/
However, this thread is not about the performance of the system, but about contribution to medical/scientific advancement. If there's one thing positive about the healthcare system in the US that gets repeatedly mentioned in the documentary, is the comparative financial soundness of the institutions.
For instance, take the Japanese system, with basically universally set prices for every medicine and service throughout the country-- despite the obvious differences in logistics and demand that would typically demand the guidance of a market-- a lot of Japanese hospitals are perpetually in the red, and would never make it without government support. This price system ultimately means that basically any role in the industry-- doctors, nurses, insurance, farma, everyone is grossly underpaid compared to their US counterparts.
Now don't get me wrong-- I love the fact that as a married man with a kid living in Japan I can pay 17% of my income to cover ALL my fed, local taxes, social security, and health insurance for the whole family while still getting care (and short wait times by the way) that totally stomp on the US's. Can you believe it?? And I don't even have to file a stupid tax return because my company and the tax collection agency take care of all that stuff w/o me filing paper work!! it's incredible!!!!!
But, that's not what this thread is about.
This thread's about the fact that compared to the US, Japan's research output would be laughably small-- even when you account for population (and remember, Japan has half the US's population, making it a relative giant amongst 1st world countries).
I couldn't easily Google sources, but here's a Forbes article about published papers:
http://www.forbes.com/sites/matthew...untries-in-biology-and-medicine/#63efaf64115d
So in that (somewhat old) study, the US alone accounted for 40% of the world's publications.
Furthermore, here's a source on new substance productions:
http://www.xconomy.com/seattle/2014...-excel-in-creating-new-drugs-its-complicated/
Now the author gives us some interesting and well outlined arguments for a more international view of contributions to drug advancement, and why it's hard to just split # of drugs / country (where is the drug made? where is the company run from? where did the scientists come from?), but I think he's trying to ignore the simple fact that the numbers he's working with point at a VERY big contribution from the US-- whether its in brains, investment, or creating environments for research. Taking into account what he's saying with an OR statement, a great percentage of new drugs are developed inside the US (possibly by foreign pharma) or developed by US companies (possibly abroad).
One statement I feel you can pretty safely infer from that OR statement is that the economic incentive created by the US's for-profit health industry is a big driver for drug development.
And it's not just in drugs and research papers-- the IT industry is also having it's own health innovation boom. From every new app and gadget--coming out of Silicon valley, Nor Cal-- to the super doctor that will potentially level the playing field and put every doc at the forefront of healthcare knowledge, IBM Watson (hey, a New Yorker!).
Let's see how quickly "smart" healthcare based around cloud, mobile, AI, and deep analytics gets rolled out into the US market compared to Japan's.
Now it's not fair or true to say that the US is at the forefront of all health tech advancements, but I think it'd be naive to ignore its impact. I think it's also unwise as a world citizenry to ignore the fact that US citizens aren't the only ones to benefit from US consumption. Sure, every tech innovation and drug comes with patents and initial high prices-- but pharma companies aren't about to walk away from profits in new markets (even comparatively lower profits), and Universal Health Care systems excel because they are better at negotiating cheaper prices. Between countries, I'm almost free to do price discrimination as an international company.
My theory: It's POSSIBLE, that as a pharma company, I may be motivated by the big profits to be had in the US, but still be willing to sell at lower prices (and still profit) in other markets. The US consumer's dollar motivates the innovation, but worldwide we all benefit from new medicine and technology.
In the Frontline documentary, they cited that even after implementing universal healthcare, Switzerland still has pharmaceutical companies in the top 10 worldwide. But they also noted that those companies make a third or more of their profits... in the US.
I'm not saying that this is an issue or that there is something that needs addressing. I'm not even informed enough to know if the greater economic data even confirms this theory of mine. This is what I would surmise.
What I would be curious about though, is that if the US were to move to a truly universal health care system similar to other developed countries, would we see a drastic slow down in healthcare advancements? Fewer drugs, less research, fewer start-ups, less investment?
My gut guess (totally not based on data) would be-- yes, but not significantly. We could (and probably would) just patch it up with additional government subsidies spent on health R&D internationally. But I really am not in a position to say.
By the way, it's not like a for-profit health industry is a golden pinnacle of thought, science, and flawless contribution. Outside the aforementioned failing at public health, we got to look at the failings and snake oils produced by plenty of players in the drug and wider health sector (looking at you, largely unregulated "natural" supplements). All the scandal that again comes from the power of wealthy private sector dollars spent on lobbying and campaigning.
We also have to look at fields of study that for profit fails us in-- like antibiotic production. Everyone in the world would agree that we need to keep ahead of bacterial evolution and continue to create new antibiotics in order to maintain modern civilization. Problem is that the best way to get the most good out of a new antibiotic is to use it as LITTLE as possible, and maintain it's effectiveness for as long as possible. Not exactly the consumption practice a for-profit producer wants to hear when it makes a new product.
Obviously, government subsidies are integral in developing/maintaining a health research market/field/system/environment/machine/thingie that "works for all of us." (in a global community) America plays an interesting and unique role in the one we have now.
What should America's role be? What are your thoughts on our country's contributions, and our health industry's influence in the science? Would universal health care in the US have any impact on the world's health advancements?
Now, I'll comment that I'm bringing up this topic without being an expert, and an outsider to health care. I hope that more informed opinions and sources come up in this thread!
The topic is this: Is the fact that the US is a for profit health sector important to the world's medicine?
Now, we all know that in terms of delivered goods and services, as well as the performance in health statistics, the US basically fails terribly compared to other developed countries. We spend exorbitant amounts per capita for medicine in exchange for shorter life spans, and poorer public health. While no one source is perfect, I really like Frontline's documentary comparing the sick around the world:
http://www.pbs.org/wgbh/frontline/film/sickaroundtheworld/
However, this thread is not about the performance of the system, but about contribution to medical/scientific advancement. If there's one thing positive about the healthcare system in the US that gets repeatedly mentioned in the documentary, is the comparative financial soundness of the institutions.
For instance, take the Japanese system, with basically universally set prices for every medicine and service throughout the country-- despite the obvious differences in logistics and demand that would typically demand the guidance of a market-- a lot of Japanese hospitals are perpetually in the red, and would never make it without government support. This price system ultimately means that basically any role in the industry-- doctors, nurses, insurance, farma, everyone is grossly underpaid compared to their US counterparts.
Now don't get me wrong-- I love the fact that as a married man with a kid living in Japan I can pay 17% of my income to cover ALL my fed, local taxes, social security, and health insurance for the whole family while still getting care (and short wait times by the way) that totally stomp on the US's. Can you believe it?? And I don't even have to file a stupid tax return because my company and the tax collection agency take care of all that stuff w/o me filing paper work!! it's incredible!!!!!
But, that's not what this thread is about.
This thread's about the fact that compared to the US, Japan's research output would be laughably small-- even when you account for population (and remember, Japan has half the US's population, making it a relative giant amongst 1st world countries).
I couldn't easily Google sources, but here's a Forbes article about published papers:
http://www.forbes.com/sites/matthew...untries-in-biology-and-medicine/#63efaf64115d
So in that (somewhat old) study, the US alone accounted for 40% of the world's publications.
Furthermore, here's a source on new substance productions:
http://www.xconomy.com/seattle/2014...-excel-in-creating-new-drugs-its-complicated/
Now the author gives us some interesting and well outlined arguments for a more international view of contributions to drug advancement, and why it's hard to just split # of drugs / country (where is the drug made? where is the company run from? where did the scientists come from?), but I think he's trying to ignore the simple fact that the numbers he's working with point at a VERY big contribution from the US-- whether its in brains, investment, or creating environments for research. Taking into account what he's saying with an OR statement, a great percentage of new drugs are developed inside the US (possibly by foreign pharma) or developed by US companies (possibly abroad).
One statement I feel you can pretty safely infer from that OR statement is that the economic incentive created by the US's for-profit health industry is a big driver for drug development.
And it's not just in drugs and research papers-- the IT industry is also having it's own health innovation boom. From every new app and gadget--coming out of Silicon valley, Nor Cal-- to the super doctor that will potentially level the playing field and put every doc at the forefront of healthcare knowledge, IBM Watson (hey, a New Yorker!).
Let's see how quickly "smart" healthcare based around cloud, mobile, AI, and deep analytics gets rolled out into the US market compared to Japan's.
Now it's not fair or true to say that the US is at the forefront of all health tech advancements, but I think it'd be naive to ignore its impact. I think it's also unwise as a world citizenry to ignore the fact that US citizens aren't the only ones to benefit from US consumption. Sure, every tech innovation and drug comes with patents and initial high prices-- but pharma companies aren't about to walk away from profits in new markets (even comparatively lower profits), and Universal Health Care systems excel because they are better at negotiating cheaper prices. Between countries, I'm almost free to do price discrimination as an international company.
My theory: It's POSSIBLE, that as a pharma company, I may be motivated by the big profits to be had in the US, but still be willing to sell at lower prices (and still profit) in other markets. The US consumer's dollar motivates the innovation, but worldwide we all benefit from new medicine and technology.
In the Frontline documentary, they cited that even after implementing universal healthcare, Switzerland still has pharmaceutical companies in the top 10 worldwide. But they also noted that those companies make a third or more of their profits... in the US.
I'm not saying that this is an issue or that there is something that needs addressing. I'm not even informed enough to know if the greater economic data even confirms this theory of mine. This is what I would surmise.
What I would be curious about though, is that if the US were to move to a truly universal health care system similar to other developed countries, would we see a drastic slow down in healthcare advancements? Fewer drugs, less research, fewer start-ups, less investment?
My gut guess (totally not based on data) would be-- yes, but not significantly. We could (and probably would) just patch it up with additional government subsidies spent on health R&D internationally. But I really am not in a position to say.
By the way, it's not like a for-profit health industry is a golden pinnacle of thought, science, and flawless contribution. Outside the aforementioned failing at public health, we got to look at the failings and snake oils produced by plenty of players in the drug and wider health sector (looking at you, largely unregulated "natural" supplements). All the scandal that again comes from the power of wealthy private sector dollars spent on lobbying and campaigning.
We also have to look at fields of study that for profit fails us in-- like antibiotic production. Everyone in the world would agree that we need to keep ahead of bacterial evolution and continue to create new antibiotics in order to maintain modern civilization. Problem is that the best way to get the most good out of a new antibiotic is to use it as LITTLE as possible, and maintain it's effectiveness for as long as possible. Not exactly the consumption practice a for-profit producer wants to hear when it makes a new product.
Obviously, government subsidies are integral in developing/maintaining a health research market/field/system/environment/machine/thingie that "works for all of us." (in a global community) America plays an interesting and unique role in the one we have now.
What should America's role be? What are your thoughts on our country's contributions, and our health industry's influence in the science? Would universal health care in the US have any impact on the world's health advancements?
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