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Universal health care bill ratified in California

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The California state legislature is set to send Governor Schwarzenegger a bill that would replace private insurance in California with government coverage for all Californians, according to the San Francisco Chronicle.

The bill is supposed to "guarantee choice of doctors and hospitals." The DOCTOR'S choices, of course, don't matter in this socialist scheme.

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The California state legislature is set to send Governor Schwarzenegger a bill that would replace private insurance in California with government coverage for all Californians, according to the San Francisco Chronicle.

The bill is supposed to "guarantee choice of doctors and hospitals." The DOCTOR'S choices, of course, don't matter in this socialist scheme.

I know there's nothing funny about this, but I couldn't help but think of the following quote when I read this:
I'm so glad there's California. It's kind of like a big petri dish for the rest of the nation. Every time someone has a stupid idea, California tries it out, mercifully sparing the rest of us.
Maybe we'll get lucky and it will be such a disaster the rest of the country will recoil from socialized medicine in horror.

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I'm interested in knowing more about what contributes to the high cost of healthcare in the US - apart from the high value it provides. Is it:

1) The FDA & the cost of producing a drug, including legal liability for side effects

2) Malpractice lawsuits & associated insurance costs for med practitioners

3) Legislation burdening how insurances set their prices

4) Obligation for emergency rooms to treat patients, with or without coverage

5) Obligation to have an MD perform even routine medical acts, when a cheaper alternative (nurses, etc) would do

6) Absence of a free market for blood and organs

etc, etc?

I just wonder what would be the best steps someone like Schwarzeneger (who doesn't have a coherent, pro-life philosophy) could take.

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I'm interested in knowing more about what contributes to the high cost of healthcare in the US - apart from the high value it provides.

A good place to start is Americans for Free Choice in Medicine, which has a lot of information.

I just wonder what would be the best steps someone like Schwarzeneger (who doesn't have a coherent, pro-life philosophy) could take.

The best step for the governor to take is to veto the bill.

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I'm interested in knowing more about what contributes to the high cost of healthcare in the US - apart from the high value it provides. Is it:

1) The FDA & the cost of producing a drug, including legal liability for side effects

2) Malpractice lawsuits & associated insurance costs for med practitioners

3) Legislation burdening how insurances set their prices

4) Obligation for emergency rooms to treat patients, with or without coverage

5) Obligation to have an MD perform even routine medical acts, when a cheaper alternative (nurses, etc) would do

6) Absence of a free market for blood and organs

etc, etc?

I just wonder what would be the best steps someone like Schwarzeneger (who doesn't have a coherent, pro-life philosophy) could take.

I think all of the factors you named contribute to the high cost of drugs. To elaborate on #1, the cost of producing a drug comes in large part from the FDA's requirement that every drug be proven with one or more clinical trials. Trials take years to conduct -- sometimes decades. During that time, the company producing the drug may not sell the drug, and must give the drug away for free to those participating in the trials (and may have to pay for testing, patient questionnaires, doctor visits related to the trials, etc. as well). This can be anywhere from hundreds of patients (for cancer drugs) to tens of thousands of patients (for heart disease). The company needs to recoup those costs somehow, so the drug becomes exorbitantly priced for those who receive it after the trials are over and FDA approval has been granted. Plus, the FDA usually grants approvals very narrowly. For example, if a clinical trial of a new chemotherapy drug is done in colon cancer, the FDA will approve that drug only in colon cancer (and probably only as part of a specific combination). If the drug company wants to be able to advertise for other disease types (even another type of cancer) or as part of a different drug cocktail, it must conduct additional clinical trials and submit even more paperwork. Since obtaining new FDA approvals is one way that pharma companies can get patent extensions, it's frequently done, at a large cost.

I believe the short patent life of drugs compared to other inventions also contributes to the high cost. Although drug patents are 20 years in length, just like any other invention, the drugmaker usually obtains a patent well before the drug is FDA approved. As a result, the patent may only be good for 10 years or so of actual selling. So the company has a very short amount of time in which to recoup its investment before generics appear on the market (unless they extend the patent with expensive new clinical trials, as mentioned above).

I also think that the prescription drug system contributes to the high cost of drugs -- because the decision maker, the doctor, is not the person paying for the drug. A doctor may prescribe Drug X, which is slightly more effective but considerably more expensive than Drug Y, when the patient (who is probably also insulated from caring about the cost by mandatory health insurance), if he were spending his own money, would sacrifice a little efficacy in exchange for more money in the bank.

And, of course, health insurance not paid for directly by the insured, increases the cost of health care by artificially inflating demand.

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I'm interested in knowing more about what contributes to the high cost of healthcare in the US - apart from the high value it provides. Is it:

1) The FDA & the cost of producing a drug, including legal liability for side effects

2) Malpractice lawsuits & associated insurance costs for med practitioners

3) Legislation burdening how insurances set their prices

4) Obligation for emergency rooms to treat patients, with or without coverage

5) Obligation to have an MD perform even routine medical acts, when a cheaper alternative (nurses, etc) would do

6) Absence of a free market for blood and organs

etc, etc?

I just wonder what would be the best steps someone like Schwarzeneger (who doesn't have a coherent, pro-life philosophy) could take.

As I understand it, medicare/medicaid patients make up over 50% of health care spending. Because they are legislated prices, hospitals and doctors have to make up costs with private payers...especially cash people.

Another factor which might contribute is the high cost of getting a medical degree. $250,000 in student loans is not unusual at graduation. If they defer their loans through residency then it can be as high as $500,000.

Add those loan payments to the average $8000/month in malpractice insurance premiums and doctors have a pretty serious nut to crack before including a mortgage payment and putting their kids through college. All of those costs have been experiencing double digit % increases for years which they of course have to pass on to the consumer.

Not to worry though. California will fix all that with socialized medicine. ;)

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I'm interested in knowing more about what contributes to the high cost of healthcare in the US - apart from the high value it provides....

Another reason besides the ones you enumerated is that the government has increased the demand for medical services by paying for so many people's medical care (i.e., through Medicare). Because of the government-paid services, there is more demand than there would be, which drives up prices.

(Another way of looking at this is that when a person who is paying his own money goes to the doctor, he has to compete with people who get their bills paid by the government. These subsidized people are also more likely to go to a doctor than they'd be if they had to pay for the services, either directly or indirectly through private insurance.)

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Thanks all for the useful info and links.

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Another big source of high bills is that so many people who don't pay and don't have insurance show up at hospital emergency rooms for free care, even for relatively minor ailments which are less than "emergency". This includes a lot of illegal immigrants. The hospitals recover the cost by passing it on to paying customers. This was supposedly one of the main motivations for Gov. Romney to require that everyone in Mass. have insurance -- with the state providing it if someone meets the eligibility requirements and with a new tax on business to partially pay for it.

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I can sum it all up in one word: middlemen. There are too many middlemen between the doctor and patient. For every middleman, you have paper for someone to fill out. The papers all say the same thing, but each middleman insists on having his own paper. You pay somebody, or several somebodies to fill out, and otherwise fiddle with each piece of paper. You are paying for everyone's copy of every piece of paper, and all the overhead that goes with it. You would be stunned at all the pieces of paper that have nothing to do with what is actually wrong with you. ;)

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The California state legislature is set to send Governor Schwarzenegger a bill that would replace private insurance in California with government coverage for all Californians [...]

A question for people living in California: Are there any legal or other political advantages to living in California?

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I can sum it all up in one word: middlemen.

I am not an economist, but I wonder: In a free, not mixed, economy would middlemen tend to raise prices or lower them? For example, is the most efficient market always the one in which farmers sell directly to the customers who buy and eat the farmer's produce?

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I am not an economist, but I wonder: In a free, not mixed, economy would middlemen tend to raise prices or lower them? For example, is the most efficient market always the one in which farmers sell directly to the customers who buy and eat the farmer's produce?

Definitely not. Some "middlemen" do the work of buying products and then distributing them to where they are wanted. A farmer may not have the time or inclination to peddle his wares at a market -- so he sells them to a wholesaler who then distributes the goods to supermarkets. The farmer can focus on what he's good at -- farming, rather than distribution. The distributor can do what he is good at -- lowering his costs of distribution so that both he AND the farmer make a profit -- but the consumer ultimately pays less than if the farmer had tried to be both farmer and distributor.

While the bureaucracy of healthcare as it is (much of that bureaucracy government-caused) definitely creates unnecessary middlemen who do add cost without adding value, middlemen sometimes add value rather than subtracting it.

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A question for people living in California: Are there any legal or other political advantages to living in California?

I'm not sure what you mean by "legal or other political advantages." Do you mean "advantages" in California at the expense of other states? Perhaps an example might help.

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I'm not sure what you mean by "legal or other political advantages." Do you mean "advantages" in California at the expense of other states? Perhaps an example might help.

Not to put words in Burgess' mouth, but I think the meaning here is advantages over other states, rather than against them. For example, I would call the lack of an income tax an "advantage" to living in Texas, even though it does not come at the expense of other states.

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Do you mean "advantages" in California at the expense of other states? Perhaps an example might help.

- Are taxes lower in California compared to other states?

- If you are involved in a lawsuit, will you receive speedier or more objective adjudication?

- Do you have more control over your property than you would in other states?

- Are you better protected from crimes of aggression or fraud because of a superior penal system?

- Is the cost of living lower because of the nature of state laws than it would be, all other factors being equal, in other states?

Of course, some issues are affected mostly by local politics, but state laws do affect the quality of life -- taxes, land use, and perhaps the handling of civil court cases being three issues that affect many people as individuals.

In another topic, Betsy explained that you all were able to improve your living conditions by moving from one city to another (LA to Thousand Oaks?). I am wondering about state conditions that would affect both locations -- in comparison to other states.

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I am wondering about state conditions that would affect both locations -- in comparison to other states.

Okay. I think I better understand what you are after. I'm probably not the best person to answer your questions. The only place I can compare was my life in New York City, and California is an improvement in each of the categories you mention, and more. The taxes and cost of living are less, and Proposition 13 limits what they can steal of the property I own. The difference in bureaucracy is astounding: Here we get people who actually talk to you and try to help, and I have much greater confidence in and admiration for the police and court system. I certainly feel more safe and secure all around.

But, for me, it's the whole way of life out here. I love the warm weather, the beautiful surroundings, and the freedom of movement.

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I agree with Stephen's comments on California. And, I intend on moving back to California as soon as possible because of the benfits/values that California has to offer. I have lived in many places, from Iceland to Japan and about 20 places in between. There is not a better place, in my value system, than California to live.

I live in Nevada now because I moved here while awaiting a job oppourtunity that never fully came through. When the job did not come through I had already begun plans to start Progressive Exercise. If I had it to do again, knowing what I know now, I would have started Progressive Exercise in California.

To me the positives outweigh the negatives that the politicans put on the residents. I have also learned how with a good accountant to overcome a lot of the political situations. I have also learned not to let the bad or evil control my life by pushing me out of an area that brings a positive to my life.

On a different note, I find it very insightful that where there is production the looters always follow. Some examples. New York City, probably the most productive city in the world, now has a statist type of governement. Detroit and Chicago in the late part of the 19th century and early 20th century were very productive, now very unionized and statist. Southern California has produced enough wealth that if it was its own country would be the 6th or 7th wealthiest country in the world. Now, the looters have followed and made it statist. What is need is productive people that will stop allowing the statist people to convince them that their production is sinful, and stand up proudly and claim their rights, to their life and wealth.

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I'm interested in knowing more about what contributes to the high cost of healthcare in the US - apart from the high value it provides.

On the subject of the high value of American healthcare, I did want to mention -- since most people are unaware of it -- the HUGE boom in radiology in recent years. When my husband was in his radiology residency, the field was considered a pretty dead. (That was in the mid-90s.) Now it's super-hot: radiologists are more in demand than ever before. That's mostly because researchers and doctors have found all kinds of ways of using radiology not just for very reliable and basically non-invasive diagnosis, but also for treatment. (Radiologists don't do cancer treatment radiation, but interventional radiologists do amazingly delicate work busting clots in the brain and whatnot. Paul doesn't do that, but he does lots of spine injections for pain management and other cool stuff.)

Of course, due to government invervention in healthcare (and the resulting wierdo insurance market), these fancy new techniques are regarded as the right of every person. And that raises costs beyond what they would otherwise be. And some doctors use them rather than just physical exam to cover their asses in malpractice. Still, even a free market, people would be clamoring for these new services; many would be willing to pay more for them.

In any case, they are really quite awesome. People who watch Paul work -- even just something so simple as dictating a case -- are routinely awed. (I'm still awed too!)

On another note (yes, I know this post is rather disorganized), when I had all my students in my ethics class introduce themselves by telling one interesting and unique thing about them, a couple of them told me of rather serious injuries from snowboarding and the like. (Two had broken jaws.) My impression is that people are taking more risks in sports these days -- and part of that is because they know that they'll be pretty well patched up from most injuries, including ones that would have been regarded as far more serious in recent decades. That's pretty cool, I think.

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Schwarzenegger commended the Democratic lawmaker who advanced the health care bill, but said California could not afford a state-run health system.

I have read old interviews where Arnold expressed his abhorrence of socialism.

It is truly disgusting when politicans "commend" ideas they regard as false and evil.

But still........ God, I love that man! ;)

He's been an inspiration ever since I was a kid. Still is in many ways.

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