Quote:Part of the challenge with Health insurers is lack of true competition.  If there are only 5-10 options in a given state for an HR department to choose from then its hard to find a deal that far outside the mean average.  We need to incentivize capital moving into the arena of insuring the risk of health care. 


 

Until we get price transparency we will never have true competition. Also, I presume that the HR example was just the way things currently work, or are you suggesting that we need to keep insurance coupled with your employer? Personally I would be in favor of eliminating the whole FICA and company matching thing altogether.


 

<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;">The high cost of Medical school is not just a line item.  It's a deterrent for intellectual capital.  The people that eventually make it through undergrad, med school, and residency could generally be considered Geniuses.  It requires the highest level of STEM aptitude and a work ethic that transcends most people.  If you were someone in the top 5% in Math and you had a choice between half a million dollars in student debt and an additional 10 years of education or getting your series 7 heading to wall street, making as much money as you can and never having to buy mal practice insurance which one would you choose.  The underlying scarcity of Medical Talent is the true driver of a lot of the costs in Medicine today. 

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<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;">While I get your point, and believe that the high cost is definitely a problem, I think there are a few potential solutions. First, make a determination as to how much of the cost/training bottleneck is for quality and how much is a gatekeeper function. I have no problem with working to ensure quality, but loather artificial barriers on licensing to promote exclusivity and increase cost. Second, decrease barriers to foreign students to allow greater competition from those without the barrier of high school costs. Third, provide some cost relief through scholarships or other training avenues with an offset of government service. Given that other countries seem to be managing to provide much better service at lower cost and having lower doctor salaries, I also question your premise that doctor scarcity is a big part of the problem. If anything, the increased pay here should be causing more of a problem for those countries that pay their doctors less.


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<p style="color:rgb(40,40,40);font-family:helvetica, arial, sans-serif;">I think that part of this can be traced to k-12 education.  There is very little deviation between the path of a student in 2017 as 1917.  The top students may get to calc 1 upon graduating from high school.  In the 12 years that they are part of the traditional school system we will waste roughly 3 years of time on vacations, and a lot more telling them which bathroom to use and studying aspects of literature and the like that will not develop anything resembling a marketable skill let alone advance their natural aptitude for STEM.  We need to have a system by which the advanced students in our society are put on the fast track to absorb as much as they can while they are in k-12 so that we can mitigate the cost of under and post graduate education to make medicine more attractive. 

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No argument that K-12 education is lacking, and I would love to participate in a thread about that, but I think we can find plenty of doctors, even if they are not U.S.-educated ones.


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Tort reform could theoretically help. 

Agreed


 

Also, its important to remember that in most cases regulation INCREASES COST efficiency and innovation generally DECREASES COST.  As an example, one of the challenges mentioned in this thread has been the inordinate cost of some medications.  We have already talked about the fact that Drug companies base their business models on belonging to a network of customers that don't really see a bill.  They don't have to compete solely on a cost basis or produce a product that the average person can afford.  This is also compounded by the fact that it takes 10 years in some cases and tens of millions of dollars for the FDA to approve a new Drug. To make matters worse, the current incentive for domestic pharma companies to traverse this maze is a market insulated from foreign competition!!!  Safety is great, I am not advocating that we just let some kid with gasoline and a pacifier sell drugs to kids.  I am stating that the inordinate cost of bringing a new drug to market creates an artificial truncation of supply and thus limitless inflation in the marketplace.  That's why you see companies being sold as soon as a drug is approved and the new owners jacking up the price 900%.

If your premise is correct, then why are all of the other countries with far greater regulation spending far less per procedure and per pill? I disagree totally. It is the regulation that is allowing the price to be so low. And I have absolutely no concern about over-regulation in the pharma field at this point. When pharma companies start closing their doors rather than posting record profits I might reconsider. 


 

We need to simplify and streamline the process by which drugs are brought to market and if scarcity exists in a sector of the pharmaceutical  industry we should allow foreign drug makers to directly compete in our markets, in addition, we should have open deals with countries that inherently share our commitment to drug safety and similar standards so that they can sell their drugs in our markets to bring down overall cost to the consumer. 

This sounds interesting. I presume that you are talking about some sort of common licensing. As long as standards are the same, I think this sounds appealing. However, to use an example from a different industry, I have read that one of the main problems with imports into Japan for automobiles is that we allow self-certification and Japan dies not. So we would need to make sure it is an apples to apples thing. 


 

<div>I would also ask you a similar question to the one I posed to Rob. How is it that all of these other countries, with much greater regulation, have better health care for most citizens and a much lower cost? 

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