
The Problem with Tying Health Care to Trade - mrjaeger
http://fivethirtyeight.com/features/the-problem-with-tying-health-care-to-trade/
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athenot
The word "patent" always sounds better than "guaranteed monopoly", yet there
is no fundamental difference. With respect to drug patents, I think the French
system has a good system:

\- Option 1: you sell the drug at whatever market price you want but no patent
will be granted and anyone is free to copy the drug.

\- Option 2: you receive a patent protection for you drug but you must defend
the price at which you want to sell in a bargaining round with the government.
In essence, it's a compromise where you as a drug manufacturer can recoup your
costs, and where the people don't overly get taken advantage of in life-or-
death situations.

Disclaimer: my Dad worked in a major French pharma company.

~~~
pkaye
Which option do the drug manufacturers typically take? The second option would
require a government that actually cares more about society in general vs
special interests. How has it worked out in practice?

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ddingus
Seconded. I am very interested in learning more about this question.

~~~
refurb
I'm in the biotech business and I've never heard of the first option in France
at all. That said, individual countries regulations can be quite complex, so
it might be true.

As for the second option, France, Germany and the UK all have a system where
an independent body evaluates a drug in order to determine it's value. They do
this by comparing the new drug against what's currently available and provide
a rating. In France it's an ASMR rating, but I think that's changing.

Once the drug receives a rating (Important, moderate, mild and insufficient
improvement over current agents, ASMR I-IV), the company and gov't enter
negotiations over the price.[1]

[1] [http://www.has-
sante.fr/portail/upload/docs/application/pdf/...](http://www.has-
sante.fr/portail/upload/docs/application/pdf/2014-03/pricing_reimbursement_of_drugs_and_hta_policies_in_france.pdf)

~~~
pjc50
The UK system is called NICE. It attracts hostility for not approving drugs
that grant a very marginal improvement to some late-stage cancer patients at
extreme expense.

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AdeptusAquinas
Big fear in NZ, however unfounded, is that TPPA will somehow try and reduce us
to the health care standard in the US :(

~~~
pasbesoin
Hmm, a new spin on "race to the bottom."

(Spoken as one who is watching the quality health insurance plans disappear
from the Affordable Care Act (Obamacare) for the coming year.)

~~~
marincounty
I'll take your word that Afordable Care Act is eroding "quality health
insurance plans". I have seen the rates, and they all seem outrageously
expensive.

What I have seen is Insurance companies just finding loopholes, and doing what
"for profit" insurance companies do; make money.

I don't know how the Affordable Care Act is making things worse.

The insurance companies were greedy, selfish bastards before the act? I don't
think health care would have magically gotten better with time?

As to Obamacare. No it's not what he originally wanted. Politically, he needed
to amend his original bill. At the time the Rebublicans pressure was
palatable. He knew it was this, or nothing. An election was comming up, and he
knew he wouldn't be able to get anything through next congress.

I'm not a fan of Obamacare, but we were cornered. It was this, or nothing.

I do believe we need to document our complaints about individual Insurance
companies, but that will probally never happen. Why--because it's one of those
subjects we don't like to think about.

I don't have an answer to the problem of horrid insurance companies, and
medical institutions/individuals that overcharge us. I would be the first one
pulling the cord on Obamacare if someone could get a better alternative
through congress. I don't see that day comming soon.

(To the Doctors/Institutions that don't abuse their power; you have my highest
regard. To the ones that accept a medi-cal patient every blue moon; you have
my highest regard. To the ones who are just in it for the money, or blame
everything on the Insurance companies; some of us see right through the lie.)

~~~
anonymous854
According to this article, if you look at the prices insurance companies are
actually paying (after negotiations), they're still way higher than in other
countries:
[http://www.washingtonpost.com/news/wonkblog/wp/2013/03/26/21...](http://www.washingtonpost.com/news/wonkblog/wp/2013/03/26/21-graphs-
that-show-americas-health-care-prices-are-ludicrous/)

This suggests that the providers of medical care are actually the biggest
culprits for our out of control healthcare spending and lack of access to
affordable care, not the insurance companies, yet your post only passingly
blames the former.

~~~
ddingus
It's both.

Private insurers need to make a profit for distributing risk, and due to there
being a lot of them, those risk distributions are much smaller than they could
be. Adding a public, non profit "cost + x percent" type plan, say Medicare
part E for everyone, would very significantly improve this, particularly if it
were allowed to bargain for bulk pricing.

(that we don't allow Medicare to do this is just nuts!)

Private entities also need to make a profit, and there is no meaningful check
on this at present. A similar, public non-profit type delivery entity would
reduce prices on most common treatments and maintenance activities.

Those wanting to profit on primary care could add value, such as home service,
etc... and do it that way, rather than mark up common, mass delivered
treatments. Secondly, niche specialization could remain high profit, high
value add and more people would be able to afford those services.

Doing something like this would carve a big hole into much of the profit
inherent in the US system, which would bring our national costs closer to
those found in the rest of the world, while leaving high profit, high value on
the table.

Some of us would not be able to afford those high value offerings, but would
definitely benefit from much improved access to preventative and or more
common, well proven health care.

This is all a compromise. The US could make much better choices and improve
both access and outcomes.

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ThomPete
The fundamental truth about health care is that no amount of taxation or
insurance can live up to the demand. Even if you taxed every citizen a 100%
there still wouldn't be enough to pay for healthcare.

And so every society find themselves in one of the most complex paradoxes of
modern times.

If you tax your way to healthcare and provide everyone with free healthcare
like in ex. Denmark, then access to treatment is equal but it's always a cost
center and your will always mostly lag behind access to the latest treatments.

The only way to be able to pay for new equipment or new medicine is either
through higher taxes or by budget cuts somewhere else.

If you go the insurance way of the US and try to let market forces rule then
you end up with highly inflated prices and a younger generation that don't
insure themselves and therefore don't pay for the healthcare system until they
need it which drives up the prices of the insurance (hence Affordable Care
Act).

Here the access isn't equal but you have some of the best specialists in the
world and always the latest treatments.

Then there are countries in the middle trying to find a balance like
Switzerland, Germany, the UK and France but even here I fear that no one have
found a perfect system either.

So no matter how you try and pay for it whether trough trade agreements or NGO
etcs that problem still applies. Someone always have to pick up the bill and
the bill is potentially infinitely big.

Edit: For clarification

~~~
laotzu
So if the problem is too much demand, lets look at how to lower the demand?
The answer to lowering demand is clearly to encourage preventative medicine
over reaction medicine. Most of the cash cows in the US for sickness
profiteering are preventable, heart disease being number one. I know that's
not profitable for sickness profiteers but until we start to value health and
well-being over institutionalized greed well never have enough money to take
care of our health.

>He sacrifices his health in order to make money. Then he sacrifices money to
recuperate his health. And then he is so anxious about the future that he does
not enjoy the present; the result being that he does not live in the present
or the future; he lives as if he is never going to die, and then dies having
never really lived. -DL

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orangecat
_The answer to lowering demand is clearly to encourage preventative medicine
over reaction medicine._

Not really: [http://www.reuters.com/article/2013/01/29/us-preventive-
econ...](http://www.reuters.com/article/2013/01/29/us-preventive-economics-
idUSBRE90S05M20130129)

~~~
laotzu
The article fails to convince. Mentions studies but does not cite them.
Doesn't even mention the words "exercise" or "healthy diet", the two best and
cheapest forms of preventative medicine. Narrowly defines preventative
medicine as "low- or no-benefit measures include annual physicals".

~~~
ThomPete
Do you know how few people have the energy or money to exercise and eat
healthy? It sounds easy but it's a lot of work.

It's not just a rational choice, people aren't rational. It's kind of like
saying that the solution to overpopulation is to get less children.

Thats not how things work.

~~~
laotzu
I'm not saying at all that it would be easy to get people to do what is in
their best interest; though once they are properly educated, it would create a
positive feedback loop. The more you exercise the more energy you have to
exercise. The healthier you eat the less you have to spend on preventable
diseases like heart disease and diabetes and so the more money you have to
spend on healthy food.

The solution to overpopulation, as evidenced by the Demographic-Economic
Paradox, is clearly to raise the standard of living by successfully
distributing the renewable surplus of food, water, and shelter that is
available but wasted every year. This is also an example of turning a negative
feedback loop into a positive feedback loop which in turn pays for itself.

[https://en.wikipedia.org/wiki/Demographic-
economic_paradox](https://en.wikipedia.org/wiki/Demographic-economic_paradox)

The issues of poverty, disease, and overpopulation are closely interrelated
indeed.

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anonymous854
Tying healthcare to trade would be wonderful for the US, provided the trade
were free trade, because it would mean we could finally legally import dirt
cheap drugs and medical supplies from abroad and allow cheaper foreign doctors
and nurses to practice medicine in the US.

Instead, it apparently means stuff like this:

>He detailed the many ways in which U.S. law prohibits competition for
pharmaceuticals that Peruvian law doesn’t, including granting new patents to
old drugs for relatively small changes

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evanpw
> In recent decades, the majority of new drugs brought to market have been of
> little real therapeutic benefit.

If drug companies are trying to charge ridiculous high prices for drugs with
"little therapeutic benefit", wouldn't it be easier just to _not buy those
drugs_ than to re-work the patent system?

~~~
zeveb
> If drug companies are trying to charge ridiculous high prices for drugs with
> "little therapeutic benefit", wouldn't it be easier just to not buy those
> drugs than to re-work the patent system?

But that would involve physicians making recommendations in the best interests
of their patients, and patients making decisions for themselves, and we
certainly can't have that!

I recall a surgeon friend of mine complaining about the decisions made by the
physician overseeing his child's care, and how hard it was to stand by and see
the wrong thing done. He's internalised the model of 'doctor knows best' so
much that even where his child was concerned he couldn't overcome that
conditioning!

This has analogies, I think, to the ideas of software users who don't develop
or people who rely on the police to protect them.

