From the transcript of Charlie Rose interviewing Washington Post health care wonk blogger Ezra Klein on December 15:
EK: This bill is both quite an achievement, but a recognition of ourWith the change in the numbers in the Senate, the reform train slows down a little. But only a little -- Democrats will continue to push for health care reform and I expect a bill to pass by the end of the month. They'll be back for more.
limits. And at some point we are not going to be able to content ourselves
with having picked the low-hanging fruit. We are going to have to sit down
and make hard decisions and hard choices on cost, and there won’t be the
spur and the shining goal of covering the uninsured. There will be a lot
less. And we’re still going to have to do it.
So this bill, it’s a good first step, it will make the next one
easier. But the next one is going to be the harder one and I don’t think
anybody looking at this process should be very confident that we will be
able to take it.
CHARLIE ROSE: What’s the next one?
EZRA KLEIN: In a very hard way, cost control. Not just starting the
procedures and the pilot programs, but telling doctors and hospitals and
device manufacturers and Pharma "You are going to make less money next year
than you made this year," or "You are going to make a lot less money in ten
years than you expect to be making now." That’s going to be very hard.
Just remember that their long-term plan is "You are going to make a lot less money in ten years than you expect to be making now."
4 comments:
Jim,
I have always appreciated your approach to the health care issue. Maybe its because you concentrated how to get it done and not on whether or not it should be done.
This post, however, seems to converge the two. The argument should be limited to; are profits in the current system controlled by market forces?
I had dinner with the astrophysicist Mario Livio the other night and he relayed an interesting story about his wife, lost luggage, and the need to buy a particular prescription drug while in Greece last year. No problem but they would have to pay full price which was LESS than the co-pay in the States.
Thanks, Rich.
To answer your question in one word, no.
While some parts of health care are indeed directly subject to market forces (LASIK, plastic surgery), most of it is not. I'm not quite sure how bad that is; I'm guessing that we don't mind some of the guild-like aspects of high-end medicine (e.g. brain surgery.) The insurance market also distorts the field, as it introduces a 3rd party that doesn't apply the pain directly to the patient (sometimes.)
I keep harping on this because I think it's key to the progressive narrative on HCR: the government pays for a good portion of health care. Much of that spending is wasted. Also, health care costs are going up too much. Therefore, we will cut down on the growth of health care spending.
It is very rarely (i.e. this particular case) where progressives will come right out and say it: we want doctors, nurses and scientists to make less money in the future. If that is true, many of us will be slowly pushed out of (broadly speaking) the health care field, as it transitions from being a high-end innovation field to being a lower-end commodity/utility-like field.
Is this a bad thing? Many progressives have a problem (clearly) with the 17% of GDP aimed at health care. They think the money should be spent on other things, e.g. "clean" energy, better social services, etc.
While I disagree, I don't mind the argument. What I do have a real problem with is the insistence that there is no tradeoff: that you can have European-style prices without European-style levels of health R&D (and the attendant jobs).
Jim,
I had the same argument with my cousin 6 months ago; I took (more or less) the same position you have stated (wrt the compensation of the scientists, broadly speaking). If there is no trade-off,in your opinion, is there a reasonable compromise in which science takes a minimal hit? While I don't necessarily agree with this, perhaps this compromise will involve decreasing FDA testing/approval policies. One thing KC reminded me of this morning was Dr. Miller's favorite anecdote about the difficulty with today FDA approval process: if aspirin needed to gain FDA approval according to today's standards, it wouldn't pass. Just because a pharmaceutical company can run a test or can find out about a given biological interaction, does not mean that that information is crucial to the patient populous as a whole. Again, it's a double-edged sword: reduce FDA standard and there is the risk that someone, somewhere is harmed by that drug. The entire issue begs the question: is the potential of the science we can achieve, the diseases we can treat or cure entirely, more or less important that protecting the patients that these therapeutics are supposed to help. It is a conundrum for which our politicians will have to formulate a concrete opinion. Furthermore, while a more extraneous connection to your original argument, one obvious way to help reduce the costs of health care in this country is to put a cap on monetary compensation in malpractice law suits, thereby reducing the amount of coverage that doctors, nurses, and health care associates need to carry.
As to whether there is a tradeoff, my answer (as always) has been that there is indeed a tradeoff. The relatively high prices that pharma charges in the US allows them to hire R&D scientists, who mostly are in the US. I think it's clear, however, that both variables in this equation are going to change. We (scientists) may be stuck in the middle. Besides, nobody owes us a job.
Re FDA: I would be all for FDA to back off of its seeming "zero risk" policy for approving drugs. Such a libertarian stance would warm the cockles of my cold, cold heart.
That being said, I think that FDA does the same cost-benefit analysis that we all do. To steal a phrase from Derek Lowe, if we were to come up with a compound that gave pancreatic cancer patients 5 more years, we'd be allowed to dose it on the point of a sword. If you're Pfizer and you're trying for a compound that every overweight 55 year old is going to take for twenty years, the general public (through FDA) is going to insist that it's pretty darn safe.
It's also worth noting that the general public really wants to have its cake and eat it too -- they want cheap, safe, effective drugs and they don't want to pay a lot for it. That's tough, too.
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