

Dean Kamen: Healthcare Debate "Backward Looking" - cwan
http://www.popularmechanics.com/science/health_medicine/4327012.html

======
potatolicious
I'm sorry, I know the man is a celebrated inventor and all, but this is
hogwash. He's talking about how making health care accessible to all will make
it accessible to none - an interesting thesis, but ultimately one that has
been soundly disproved by the success of public health systems in most of
Europe and Canada.

He is partially right - the lack of extreme-expense health care drives out
extreme high-end solutions such as the article's highlighted "Luke" arm, a
prosthetic that is almost as good as the real thing.

But really, what do we want as a society? For a two-digit number of extremely
wealthy people to have access to the world's best prosthetics, stuff that is
in the realm of sci-fi? Or for _everyone_ to have access to "good enough"
prosthetic technology that advances more slowly?

"if talented people are given resources they're going to keep driving us to
having better, simpler, cheaper solutions to problems"

Absolutely false, and proven by his own highest-profile project; the Segway
hasn't gotten significantly cheaper or more accessible despite years of R&D,
and is unlikely to become affordable anytime soon. This man's own business is
a textbook case of the lie behind this claim. In order for solutions to get
cheaper there must be market pressure to reduce cost: this is something that
doesn't exist in America's current health care system.

Health care providers don't care about cost - it's passed along to insurance
companies and consumers anyway. Insurance companies care about cost, but not
really - it's easily passed to sponsoring employers or individual buyers
anyway. Really, the only people that truly want cost reduced are the endpoint
patients and their employers, who generally lack the clout and influence to
push for real cost reductions. The entire system is broken. Costs have not
lowered for health care, and will not lower, until the system is reorganized
such that cost reduction becomes advantageous to all stakeholders.

He does make a cogent point in the end: more R&D will lead to better solutions
and lower costs (given the right structure and incentives). But this argument
is really independent of the affordability issue that plagues America today.
Where I come from (Canada) we do a huge amount of pharmaceutical research (in
fact, we invented the insulin injection) on government funds. I personally
know very talented people working every day on cancer research.

Yet we can still afford to give everyone health care. Imagine that. A person
can still get a major disease without going broke. Imagine that.

I really do think Dean Kamen is conflating two unrelated issues. The lack of
R&D funding is an issue, but increasing R&D need not come from the pockets of
consumers. Just look at the existing private system - a third of every health
care dollar spent is just on administrative costs. Imagine if we took this
money and threw it into R&D.

~~~
ncarlson
>but ultimately one that has been soundly disproved by the success of public
health systems in most of Europe and Canada.

Yes, but the success of those systems is dependent upon the (semi) free-market
health system in the United States.

~~~
abstractbill
I've heard this argument a bunch recently. You're suggesting the rest of the
developed world has somehow made the US its bitch as far as medical research
and development goes - the US does all the hard work, and everyone else with a
public health system reaps the rewards.

I don't buy it.

~~~
vidarh
It also ignores the fact that even _if_ we accept his premise and _if_ we
assume that every single cent of the R&D money put up by the US comes in via
high health care payments (it doesn't - a bunch of it is government funded
and/or funded through charitable organizations), then if the US going to a
universal healthcare system somehow halved the cost (bringing it down to the
French level, while extending coverage to all), and this price cut somehow
only came out of the money that'd get pumped into R&D and thus cut it to the
bone, nothing would be stopping America from taking the savings and putting
them right back into R&D.

In other words: Money doesn't magically disappear just because the way it is
distributed changes.

~~~
asmithmd1
"Money doesn't magically disappear just because the way it is distributed
changes." Sure it does. Do you think these private groups would be making
multi-million dollar bets if the prize of huge profits weren't out there?

<http://www.xconomy.com/tag/Life-Sciences>

Not all the cash is redistributed taxes - there is tons of private investment
going to develop treatment

------
run4yourlives
Disclaimer: I'm Canadian, and I shouldn't be wading into this debate...

You do realize though that the rest of the modern world looks at the US in
this one issue the same way we looked at you when you had legalized
segregation?

The rest of us can't even understand why this is a debate. How is it that
someone can argue _in favour_ of people not having the ability to access a
doctor? Would you also argue that people shouldn't have access to fire-
fighters unless they pay the fire-fighter's tax? Police? The protection of an
Army?

Our socialized systems aren't a panacea, but the trade-offs of having someone
wait for knee surgery so that another can get cancer treatment seem pretty
fair to me. Sometimes, I simply don't understand the American perspective.

~~~
CWuestefeld
What makes you believe that there's _anyone_ in America that does not have
access to a doctor?

Hospital emergency rooms are _required_ to take and treat all comers (at least
if they want to participate in the system), and the Medicaid system reimburses
those expenses.

A poor, uninsured person might not be able to get a kidney transplant, but
they'll get some level of basic care. And what Mr. Kamen argues is that the
income generated by those expensive procedures -- not to mention a segment of
the population that is willing to pay for it -- is what will lead to the
breakthroughs in the future that will make (say) kidney transplants
unnecessary in another generation.

What really concerns me is that I know, because I have Crohn's Disease, that I
have a much higher risk of colon cancer. Even at forty years old, I'm trying
to put myself into a position where I'll be able to deal with that should it
happen.

But in the ultimate socialized/rationed model, I'm not _allowed_ to buy myself
additional treatment beyond the lowest common denominator. Canada recently
fought (and lost, thank %deity%) to prevent citizens from getting better
health insurance than the socialist plan. In England and other places you're
allowed to get better care, but only if you pay for every bit of it -- you
can't take the baseline and then pay for the overage. So that's definitely the
direction that "progress" is moving in.

My biggest objection is that this prevents people from having their own
values. I'm not to be allowed to make decisions that balance for or against my
lifespan. I can only get the mix that the regulators have deemed appropriate
for every person, one size fits all.

~~~
run4yourlives
_Canada recently fought_

No, the province of Quebec did... Canada's system is not national, it's
provincial. BC for instance allows for several areas of private care.

 _I'm not to be allowed to make decisions that balance for or against my
lifespan._

You just gave examples in both Canada and the UK that showed that you most
certainly can. You're argument is bullshit and comes from a place of ignorance
- assuming that somehow the rest of the world has some sort of inferior system
simply because we have single payers.

It isn't true. Every health statistic shows that the US is actually lagging
behind. You're fighting each other for a dwindling and ever more expensive
piece of the pie, and the solution is staring you right in the face.

~~~
CWuestefeld
_You're argument is bullshit and comes from a place of ignorance_

You need to learn to argue civilly. Then you might not get down-voted.

 _No, the province of Quebec did..._

Fine, that doesn't affect my argument.

 _You just gave examples in both Canada and the UK that showed that you most
certainly can._

No. There's a difference. The UK system says "we'll give you $X for treatment
A; if you want the more-expensive ($Y) B you get 0". What I'm arguing is
"we're willing to invest $X; if you want B, you'll have to kick in Y-X".

In concrete terms, suppose that my hypothetical colon cancer can be treated
for $50,000 but there's also a $60,000 treatment that's better but the
government doesn't cover. The UK says that I have to "take it or leave it";
they won't let me get the alternative by kicking in the extra $10,000. I'd
have to pay the full $60,000. For practical purposes, that's all but a
prohibition.

 _You're fighting each other for a dwindling and ever more expensive piece of
the pie_

This is wrong. The pie is enlarging; _everyone_ has access to better
healthcare than _anyone_ could get 60-70 years ago. The increasing expense is
due to the availability of additional treatments. As Mr. Kamen said, there are
treatments (e.g., polio) that were in effect _infinitely_ expensive two
generations ago that are now within the reach of literally everyone. The stuff
that's outrageously expensive will be available for our kids.

But not if nobody develops them. If those researching new treatments can't
sell those treatments because the gov't puts a wet blanket on the industry,
then the treatments will never be sought.

Another thread in this page claimed that government funding would prevent
this. There's a little truth in that, but it all revolves around the
politicization of disease. We can already see the effects of that: government
subsidizes AIDS/HIV research at something like 10x the rate of breast cancer,
normalized to the number of people suffering from each. It winds that we help
those with the best lobbyists, not those with the most need. And that's
certainly no better than the Adam Smith's invisible hand could do.

~~~
run4yourlives
_Fine, that doesn't affect my argument._

It does, actually. It shows that the specifics of one particular system aren't
even true across the same country.

 _For practical purposes, that's all but a prohibition._

No, it's a feature of that particular system. You're discounting the entire
idea of single payer health care because one particular version has a
component that you don't agree with. You're being intentionally deceptive in
your argument.

 _everyone has access to better healthcare than anyone could get 60-70 years
ago_

...including those of us in government run systems, moot point.

 _If those researching new treatments can't sell those treatments because the
gov't puts a wet blanket on the industry, then the treatments will never be
sought._

By this logic, there should be effectively no medical research occurring
anywhere else in the world save the US. This isn't the case.

 _And that's certainly no better than the Adam Smith's invisible hand could
do._

Except of course for the however many millions that can't actually access any
of this medical treatment. That's the whole crux of things: For those able,
the trade-offs between a government run system and the US system are trivial
overall. The major downsides in the US system have no equivalent in other
systems.

~~~
CWuestefeld
_No, it's a feature of that particular system. You're discounting the entire
idea of single payer health care because one particular version_

You're misunderstanding. I'm not saying that _all_ are bad because (at least)
a few have a particular feature. I'm citing two examples to show that the
"progressive" movement in healthcare shows a trend toward that bad feature.
This should be a warning to us about a) the motivations of those pushing this;
and b) should we really decide that "reform" is necessary, we ought to guard
against this.

 _Except of course for the however many millions that can't actually access
any of this medical treatment. That's the whole crux of things_

If that's the crux of this, then you've lost the argument. The premise that
you're working from is simply erroneous. It is untrue that many millions
cannot access any of these treatments. In the USA, _anyone_ can walk into the
emergency room and get treated. While it's true that esoteric treatments
having sky-high prices (say, heart transplant) won't be provided, all of the
basic services will be provided even to those unable to pay on their own.

FWIW, my wife is the Manager of Budget and Reimbursement at a largish urban
hospital. She spends a fair amount of her time coordinating with Medicaid to
get the hospital reimbursed for the cost of treating charity and bad debt
cases. You seem to be saying that this is all a figment of her imagination,
that the hospital is actually turning away all of these people. That ain't so:
even the homeless get treatment in America, with the system we have today.

------
zhyder
The problem is that the same healthcare service costs a lot more in America
than it does anywhere else in the world. It's understandable if the surgery
that only 4 surgeons in the world can do costs a lot, but relatively
routine/commoditized stuff shouldn't cost more than in other developed
countries.

~~~
mrkurt
I've only ever seen statistics that compare the aggregate cost of health care
relative to aggregate outcomes in the US vs other countries. Do you have more
details on the delta between pricing for specific services?

It's generally very difficult to compare the cost of specific services in any
meaningful way. For instance, many countries institute price controls on
medication, cutting the cost of some prescriptions to 30% of what they'd cost
in the US. However, some of these drugs were developed in the US based on US
patent law and with the assumption of a certain amount of profit from US
consumers. A price control in Canada is effectively subsidized by US consumers
of a given drug, in lots of cases.

A great deal of the costs we pay come as a result of artificial scarcity of
both drugs and medical services. The result of legislation, fears of
malpractice, and prescription requirements mean that treating a simple sinus
infection (which I can diagnose reasonably well myself) costs ~$150 or so
after the doctor visit and trip to the pharmacy. There are a great many ways
to attack that scarcity, but we're not really considering them
(unfortunately).

Dean Kamen has a good point. The level of medical care we _can_ provide to
people is both insane and insanely expensive. High prices are rationing. What
we need to do is attack the high prices that are artificially inflated.

~~~
asmithmd1
"A price control in Canada is effectively subsidized by US consumers of a
given drug" I think that is the crux of his point, if the US didn't have these
crazy high prices - then the drug would not have been developed.

I liked this quote: "Every drug that's made is a gift from one generation to
the next because, while it may be expensive now, it goes off patent and your
kids will have it essentially for free."

The high cost in the US is paying for the R&D that makes the drug possible

~~~
blasdel
The drug companies spend almost nothing on R&D, not compared to what they
spend on consumer advertising, marketing to doctors, regulatory compliance,
lobbying, civil defense lawyering, and patent lawyering.

~~~
yummyfajitas
Typically 15-20% of their expenses are spent on R&D. The cost of marketing is
also about 15-20%. This is roughly the same as any large tech company. Compare
Merck and Johnson&Johnson to Google or Intel.

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danteembermage
Taking the rationing argument to the extreme, suppose we could take a painless
treatment once a year that would stop all aging and disease but costs $1
million. Would we still innovate in cheaper, less effective methods? We
couldn't possibly pay for the treatments for everyone, but should they be
subsidized for some? Would there be pressure to make the treatments illegal
for those who can afford them? What if for a quarter of the price you get half
the effects, but you can still only take it once a year. What would be the
optimal time to not age/be disease free a month, a week, a day?

~~~
logicalmind
While we're theorizing, what if you knew you could make a pill that would be
"a painless treatment once a year that would stop all aging and disease but
costs $1 million." But it takes a company 50 years to develop and costs $1
trillion in research. Could a company take such a risk? Could the government?

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kqr2
Since Dean Kamen makes medical devices, doesn't he have a conflict of
interest?

Basically, if the government tries to control costs, he will probably earn
less per device.

~~~
billswift
Since the gov't wants more control over all that money, doesn't IT have an
even bigger conflict of interest?

~~~
logicalmind
The government doesn't make money, your government representatives do. I would
think that the government representatives would make more money by keeping the
healthcare lobbyists in place. Then again, maybe this healthcare threat is
simply a shake-down to get the lobbyists to give them more money. Who knows.

~~~
billswift
Who said anything about the gov't making money? They want the POWER from
CONTROLLING it.

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Nwallins
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