Short Course on Brain Surgery

[Peter Creasey]

A Short Course on Brain Surgery

A short but poignant independent film on government sponsored health-care systems.

A Particular Case in Canada (http://www.freemarketcure.com/brainsurgery.php)

[earler]

Here in france we have single payer, too, according to michael moore in his film 'sicko' However, the fact is that everyone who is able to do so has a supplemental health insurance policy. Many large companies provide this as a perk. As usual, moore didn't do his homework.

The uk has single payer, too, but using a 3rd party insurance doesn't pay what the nhs doesn't cover. You must choose: Use nhs or private care. The british switch back & forth based on the problem.

The dutch may well have the most effective solution to health care. Faced with mounting costs, the government decided to shut down the national health care, thereby getting rid of the bloated bureaucracy, and mandated health coverage through insurance. The insurance companies may not refuse coverage either. A couple years later the government finds that the health costs per capita have dropped about 40%.

[Lindsey]

Single payer doesn't preclude supplemental policies; Medicare is considered a single-payer system, but most Medicare recipients have supplemental policies.

The bottom line, though, is that there are a number of different ways of achieving universal coverage. The French system, which is said to be the best in the world, wouldn't not be politically possible here at present. Which is why the proposals of John Edwards and Hillary Clinton are closer to the one in the Netherlands. Obama's plan falls a bit short of that by not including mandates. I think that's a serious shortcoming, but I suspect that he has done that to appeal to the younger demographic that is more likely to want to forego the expense of medical insurance. And in a recent column, Paul Krugman cited an MIT study that determined that a plan similar to the Clinton plan covered about twice as many currently uninsured persons at significantly less cost per new person covered than the Obama plan.

--Lindsey

[earler]

The french plans works...........but at a very high cost, one that is increasing each year. The current deficit is about $20 billion for 2007. The system cuts back coverage and this means the supplemental policies cost more and more, too. The system is bankrupt.

The problem is government management, always a poor way of running anything though it is obvious that tasks like the military, the central bank and education must continue that way though terribly inefficient. For that reason the dutch solution is one that is to be preferred. For political reasons this can't be done here in france. But, in the states it is possible.

People forget that healthcare plans aren't really insurance but subsidization. Insurance is used to cover unexpected (and unwanted) untoward events, like fire or theft. With health, everyone has to see a doctor and take medicine or undergo a surgical procedure from time to time. Therefore, a pragmatic system is one that covers people for major medical care. For everyday stuff like a sore throat, well that should be one people's budgets, just as they budget to change a car's tires or replace the tv set. For those below the poverty line, well a safety net would take care of them fully.

[Lindsey]

The french plans works...........but at a very high cost, one that is increasing each year.

You're paying a lot less than we are paying in the US, and you are getting better results.

The problem is government management, always a poor way of running anything

I know that's the conservative mantra, but it just does not happen to be true. The private medical insurance system here in the US spends an enormous amount of money on bureaucratic overhead, money spent largely to try to weed claims out of the system. It's far more costly than the public Medicare system, which spends far less on overhead because when everyone is covered, it doesn't have to spend so much energy trying to weed people out.

...a pragmatic system is one that covers people for major medical care. For everyday stuff like a sore throat, well that should be one people's budgets, just as they budget to change a car's tires or replace the tv set. For those below the poverty line, well a safety net would take care of them fully.

Unfortunately, that "pragmatic" system is one that leads a lot of people into bankruptcy. The vast majority of bankruptcies in this country are at least partly the result of medical expenses, and a large proportion of the people for whom medical expenses contributed to bankruptcy were covered by insurance at the time they filed for bankruptcy. It doesn't take much in the way of uncovered medical expenses, over a period of several years, to bankrupt the average family.

--Lindsey

[earler]

Yes, we do pay much less for health care here in france. But, the statistics hide the fact that the huge deficit of the system are paid out of other tax revenue. Therefore, the statistics as such are misleading. Remember that the french pay much more in taxes than americans, not so much through income tax but through other taxes, especially the high value added tax and the tax on gasoline, 80% of the price at the pump. Further, there are severe shortages of both equipment and specialists in some disciplines. If you live up in lille, a large city close to the belgian border, you have to plan on a 4 to 6 month wait to see a dermatologist. There are far too few mri machines in the country. Count on a month, often much longer and entailing a trip up to paris or a regional city....unless your specialist has an "in" somewhere, as mine did when I needed an mri several years ago. Soon there will be a severe shortage of surgeons because medical students are shunning this discipline because of too long working hours and inadequate compensation.

Dental costs aren't much covered, other than basic dental work. No coverage for bridges or implants. As for glasses, the reimbursement is about $100 or so when a pair of modern glasses with varilux run about $1200. Since supplemental medical policies' coverage is a percentage of what the social security provides, 100%, 200% or 300% (cost of which goes up as does the percentage) when I must get new glasses, my out of pocket cost is close to 75% of the cost. However, for cancer the social security covers you for 100% of the costs.

Hospitals overall are something of a mess. Most are pretty uncomfortable places, often without tv in the rooms, and staff that is not always friendly. For that reasons the better private clinics are often used, if ones supplemental insurance will cover most of the additional cost.

On the other hand, statistics do show the french system is overall better because infant mortality is much lower than in the usa, the life span of people is several years longer than in the usa. It isn't entirely clear how much credit should be given to health care compared to better diet and much less alcohol consumed. Add the fact that over 1% of the poplulation of america is incarcerated, 10 times the per capita imprisoned anywhere in europe. If you have the misfortune to collapse in the street or are hit by a car, paramedics will be there quickly.

As for government management, an oxymoron if there was one, experience has shown that governments run businesses poorly. Look at the soviet union, central and eastern europe behind the iron curtain, cuba, and now venezuela. Political interference is the first reason, then the immutable aspect of the jobs. The dutch innovation is a splendid example of a feasible method to reduce costs while ensuring coverage, as I have already explained.

You say that a pragmatic system of health care, where important procedures are covered, but not cough drops or nasal sprays, leads to bankruptcy. How so? Do people buy cases of cough drops rather than buy food for the house? I did point out that a safety net would handle those who are too poor even to pay for everyday medical situations. You aren't reading messages carefully. I said that medical insurance is to cover the unexpected, the unusual, not for pimples or botox.

[Lindsey]

Yes, we do pay much less for health care here in france. But, the statistics hide the fact that the huge deficit of the system are paid out of other tax revenue.
No, the statistics do not hide that fact. The studies I have seen quoted include the contribution made from tax revenues. Overall, you still pay considerably less that we do.

Further, there are severe shortages of both equipment and specialists in some disciplines. If you live up in lille, a large city close to the belgian border, you have to plan on a 4 to 6 month wait to see a dermatologist.
It's not all that different here, especially in rural and impoverished areas, where communitites can be hard-pressed to keep even an adequate supply of GPs, let alone specialists. And there is definitely rationing of care here, it's just that the rationing is often based on the size of the patient's bank account rather than on immediacy of need.

Dental costs aren't much covered, other than basic dental work.
No different here. Dental coverage is not part of my basic policy, I have to pay extra for it, and until this year it did not cover anything except routine exams. I paid for 3 crowns 100% out of pocket, the only compensation being that it is possible here to set aside money free of tax for such expenses. The catch is that you have to anticipate them, and anything you set aside that you don't use during the year is lost -- it goes to your employer.

As for glasses, the reimbursement is about $100 or so when a pair of modern glasses with varilux run about $1200.
Well, guess what? My reimbursement is $0.

Hospitals overall are something of a mess. Most are pretty uncomfortable places, often without tv in the rooms, and staff that is not always friendly.
And you think that France is unusual in that?

As for government management, an oxymoron if there was one, experience has shown that governments run businesses poorly. Look at the soviet union, central and eastern europe behind the iron curtain, cuba, and now venezuela.
We're not talking about those countries, we're talking about the US, Canada, Western Europe, and Australia and New Zealand. And we're not talking about running a business, we're talking about managing a bureaucracy, and it is not a given that government does that poorly. If you have people at the head that are committed to making government work, then it can manage such things quite well. If you have people at the head that are more interested in running government to benefit their friends and family (as we have with the current administration in Washington), then yeah, what you get is piss poor performance. But government under Bill Clinton worked very well. Government under Franklin Roosevelt worked very well. It can be done; you just have to have people who have a sincere interest in the idea of "government for the people" rather than "government for my cronies."

You say that a pragmatic system of health care, where important procedures are covered, but not cough drops or nasal sprays, leads to bankruptcy.
No, that is not what I said. I can read just fine, thank you very much; it is you who seem to be having trouble along that line. You said "a pragmatic system is one that covers people for major medical care." "Major medical (http://www.medicalonline.com.au/medical/insurance/major-medical-insurance.htm)" here normally means hospital coverage, or perhaps specific covered illnesses, like cancer, after the patient meets deductibles and co-insurance (normally 20% of the expense). Major medical policies do not cover prescription drugs, routine preventive care, diagnostic tests, etc. It is the sum of those myriad uncovered expenses, including deductibles and coinsurance, that bankrupts people, especially when you consider that people who suffer a catastrophic medical emergency like cancer, heart attack, or stroke, will often end up either jobless or on prolonged disability, which means greatly reduced income (and, quite often, the loss of their medical insurance when they need it most).

No policy I know of covers cough drops or non-prescription nasal sprays; to suggest that "major medical" covers everything short of that is just silly.

--Lindsey

[ndebord]

Lindsey,

"government for my cronies."

For and BY my cronies and with the goal of drowning the government in the bathtub.

This generation of Christian Republicans have taken the hatred of FDR to illogical lengths that are harmful to the very survival of the Republic.

[earler]

There a multitude of ways to hide the real costs of the french medical system. Your argument doesn't hold water. No responsible french commentator backs it, be he right or left.

There may be shortages of diagnostic equipment like mri's in some parts of the the usa, but the number is something 40 times more. Given that the french population is about 1/5 of the american population, that comes to 8 times more mri machines.

Most people I know in the states who are insured through employer plans have dental and eyeglass coverage. Clearly, you are an exception. You also didn't pay attention to the fact that supplemental insurance in france covers an additional 100% to 300% of what the state social security pays out. You have a poor policy. Is it employer paid? Or did you choose it yourself.

American hospitals in major cities like nyc, los angeles, houston, etc. are all more modern, certainly more comfortable places. Have you ever been in french hospitals? Sure, the american hospital in neuilly is very well organized today, the reason so many french use it when possible. Many of the leading surgeons operate there as well as in the hospitals where they teach. Don't rely on michael moore for your knowledge.

You said, "We're not talking about those countries, we're talking about the US, Canada, Western Europe, and Australia and New Zealand". No, we are talking about how poorly governments manage business. As it happens governments in those countries don't run all businesses, though in the recent past western european countries did. Happily, those were privatized and now are run with fewer employees, lower prices and profits where before they relied on governments to make up the shortfall. Alas, countries like cuba still do run everything and the result is poverty. Chavez is trying to catch up with cuba. In spite of massive oil revenues inflation is running near 100% annually and the poor, whom chavez claimed he was going to help, remain poor.

I must admit that the phrase 'major medical' was ill chosen. I should have said 'serious medical'. The example of what happened in britain, then in france, which followed the same reckless course is instructive. After the war the national health service (nhs) was created. Everything was free, including all prescription drugs. The result was huge costs, unnecessary visits to doctors and much enhanced profitability for the world's pharmaceutical firms. So the government imposed a co-pay system to reduce this profligacy. Alas, the french weren't paying attention and made the same mistake as the british. Even today, french drug consumption is the highest in the world, especially tranquilizers and anti-anxiety pills.

Alas, the problem is to educated people to take prophylatic measures before illness becomes serious, just as one lubricates and changees oil on a car to forestall more serious problems, or replaces tires before they become completely bald of any tread. You speak of middle class people being beggared by serious illness. Of course, that is the case in the states among those without insurance, the reason a mandated plan of insurance is the solution. The exception would be those too poor to buy insurance, which would be provided by government.

As for clinton and fdr, well clinton has been called the best republican president of recent years. Things worked well because the economy was recovering when bush sr was defeated. So, it was the inheritance of the years of reagan and bush that buoyed the clinton period. Fdr was another matter. The usa remained stubbornly in depression throughout the 1930s and only exited because of the war. Roosevelt had long desired the entry of the country into the war but public opinion was against.....until pearl harbor. Nearly all of what roosevelt did during his presidency until the war was ineffectual against the depressed economy. The wpa was of no value, as were other schemes.

[ndebord]

A Short Course on Brain Surgery

A short but poignant independent film on government sponsored health-care systems.

A Particular Case in Canada (http://www.freemarketcure.com/brainsurgery.php)

Pete,

The bigger the pool, the lower the costs. Spreading the risk around is a dictum that has been forgotten in the rush to profit which is the singular characteristic of our current system which no longer insures 50 million Americans and fails to provide comprehensive coverage to God knows how many million more. Last time I looked, we were 300 million bodies. At least 1/6th of us not covered? And more so poorly covered they are lining up wherever they can find charity care?

http://www.cbsnews.com/stories/2008/02/28/60minutes/main3889496.shtml

The following article talks to that idea of universality.

http://www.prospect.org/cs/articles?article=why_health_insurance_doesnt_work

[Lindsey]

For and BY my cronies and with the goal of drowning the government in the bathtub.
Yeah, that, too. :mad:

--Lindsey

[Lindsey]

There a multitude of ways to hide the real costs of the french medical system. Your argument doesn't hold water. No responsible french commentator backs it, be he right or left.
I suspect I know what your definition of "responsible" is, so I won't bother to ask; but if you'd care to explain just precisely why it is incorrect to say that Americans spend considerably more for health care than the French, I am all ears.

Most people I know in the states who are insured through employer plans have dental and eyeglass coverage. Clearly, you are an exception.
Maybe the people that you know, but that doesn't make it true of most people in the US. And if I am an exception, it is only that my policy happens to be a relatively good one. And it is insurance that I get through my employer's cafeteria plan. I get a monthly allowance, and I can choose from among the plans their benefits package offers. It's not the Cadillac plan on the menu, but it's not the cheapest one, either. Dental insurance is an add-on, and I have that as well, but it didn't cover anything but routine care until this past year. Eye care is an add-on, too, but the list of covered providers is extremly limited, and since mine is not one of them, it wasn't worth taking.

You also didn't pay attention to the fact that supplemental insurance in france covers an additional 100% to 300% of what the state social security pays out. You have a poor policy. Is it employer paid? Or did you choose it yourself.
Well, I'm sorry you think my coverage is so poor, but I think you are making my case for me, because what I have is actually pretty good by American standards, even if it is not up to French ones.

American hospitals in major cities like nyc, los angeles, houston, etc. are all more modern, certainly more comfortable places. Have you ever been in french hospitals?
No, I've never been in a French hospital, but I have been in American ones. In fact, I spent nearly a month in one some years ago after an automobile accident. It was not exactly a comfortable experience. The nurses were competent, but with a couple of exceptions, they were rough as pig iron. On more than one occasion, the person in charge of the floor forgot to order clean linens for the weekend, and when you are completely confined to bed, that is a little like having to wear the same underwear all weekend. Nobody on the nursing staff (or among the hospital volunteers) was interested in washing my hair (wasn't considered medically necessary), and had my mother (a former nurse herself) not taken it on herself to gather up the equipment she needed and done it herself, I'd have had to go the entire month without a shampoo. Wouldn't have killed me, but it would have added considerably to my already considerable discomfort. And this was a university teaching hospital, not some tiny backwater outfit. (Actually, I might have gotten more TLC at one of those smaller hospitals.) There was, admittedly, a TV in the room, but it would have been no great hardship had it not been there. I got far more enjoyment out of a small radio that a friend brought me while I was there, and a good book that another friend brought to me.

You said, "We're not talking about those countries, we're talking about the US, Canada, Western Europe, and Australia and New Zealand". No, we are talking about how poorly governments manage business.
Actually, no, we weren't, but nice try at changing the subject.

You speak of middle class people being beggared by serious illness. Of course, that is the case in the states among those without insurance
Actually, a distressingly large percentage of people who find themselves in bankruptcy as a result of medical expenses were covered by insurance when they became ill; many were even still covered at the time they filed for bankruptcy. But, as I said before, uncovered medical expenses can amount to a considerable sum, even with a pretty good insurance policy.

--Lindsey

[Judy G. Russell]

Most people I know in the states who are insured through employer plans have dental and eyeglass coverage. Clearly, you are an exception.No, in fact, the vast majority of Americans have neither. The big workforce here these days is not mega-corporations with wonderful benefits; it's small businesses, and small businesses do NOT offer those kinds of coverages. And even where those coverages are offered, they are usually offered as extra-cost options and not as part of the normal package.

[earler]

I never said that the amount spent per capita in the states isn't much higher than in france. One of the principal reasons is the high cost of malpractice insurance, thanks to your friends in washington, who refuse to cap jury awards. Another reason is that too many american doctors run an analysis business, too, from x-ray to cat scans, even blood tests from what I hear.

Thank you for the clarification (and by judy in another message) as concerns dental and eyeglass coverage. I have to pay extra to my supplemental insurance company for dental care, too, by the way. As for eyeglasses, happily the leading manufacturer of sophisticated lenses is french. That's the good news. The bad news is one has to pay the normal 20% value added tax when buying them.

As for hospitals, the ones I've seen in nyc and los angeles are more comfortable places than public hospitals in paris.

As concerns governments being poor managers of businesses, well yes it was and remains under discussion. I've already pointed out the most interesting initiative the dutch have done, remove government bureaucracy and have insurance companies compete. No refusal of coverage possible. Taxpayers must buy insurance those who are economically weak are covered by the government, which pays for the insurance.

I've heard horror stories about middle class people being beggared, usually because they were refused insurance coverage, or, most stupidly, self-insured when they were perfectly capable of subscribing for insurance. A system analogous to the dutch one would handle all problems of this nature.

[ktinkel]

Dental coverage is not part of my basic policy, I have to pay extra for it, and until this year it did not cover anything except routine exams. I paid for 3 crowns 100% out of pocket …When Jack was still at Sikorsky, we had dental coverage. But the rates had not been increased for more than a decade when he left there in 2002. They reimbursed $60 for a molar crown, less for the smaller teeth. (At the time we were paying several hundred dollars.) They did not cover dental implants at all (they barely existed when they established the reimbursement rates. (I had 10 implants over an 8-year period, and paid for all of them myself, at $1,100 to $1,500 apiece; and then there were the inevitable crowns.) Even the reimbursement for regular checkups (charged at $75 ten years ago, $115 now) was way out of line (they paid $35).

If it had not been thrown in with the regular medical coverage, we would never have paid for it, but we had no choice.

Because I had cataract surgery and am what they call a glaucoma suspect, my annual eye checkups are covered as medical treatment, but the part where they check my vision is cash ($40) on the barrelhead.

Obviously regular medical care is more crucial (though both teeth and eyes are related to it). But it is pretty pathetic.

Earl: You should come here to have your glasses made. I get Verilux in good frames with an anti-reflective coating for closer to $600 or $700, and I am in Fairfield County, CT, where they just assume we are all made of money! That $1,200 is astonishing!

[Lindsey]

I never said that the amount spent per capita in the states isn't much higher than in france. One of the principal reasons is the high cost of malpractice insurance, thanks to your friends in washington, who refuse to cap jury awards.
Nope, not the case. That's the Republican argument, but the facts don't bear it out. The price of malpractice insurance (and the costs involved in "defensive medicine") are very minor factors in the rising cost of medical care in the US.

--Lindsey

[Lindsey]

When Jack was still at Sikorsky, we had dental coverage. But the rates had not been increased for more than a decade when he left there in 2002. They reimbursed $60 for a molar crown, less for the smaller teeth. (At the time we were paying several hundred dollars.)
Oh, my word. Yeah, $60 is barely more than a regular dental exam costs. Seems to me that the last time I had a molar crown (about a year ago), it was $600, and that was with a slight discount for paying ahead of time.

--Lindsey

[earler]

>Earl: You should come here to have your glasses made. I get Verilux in good frames with an anti-reflective coating for closer to $600 or $700, and I am in Fairfield County, CT, where they just assume we are all made of money! That $1,200 is astonishing!

The problem is the latest technology is here. A very good friend of mine lives in brooklyn but gets his glasses done here in paris. He also gets his dental work done here. We have the same dentist.

[earler]

>Nope, not the case. That's the Republican argument, but the facts don't bear it out. The price of malpractice insurance (and the costs involved in "defensive medicine") are very minor factors in the rising cost of medical care in the US.

I realize plaintiff's lawyers all claim that, and they are faithfully supported by their acolytes, most democratic congressmen, who by pure coincidence also receive generous campaign contributions, but the fact is that the revenue of doctors is amputated by the cost of insurance, and that certainly increases costs to the public. This is exacerbated by other factors, too, as I'll readily admit, including pharmaceuticals. Europe thanks american consumers for subsidizing its costs for drugs.

[earler]

I don't know why cataract surgery should increase the risk of glaucoma. Most people get it before cataracts, as I can attest. While cataracts usually come later in life, glaucoma can occur quite young. In any case, given that the test is so easy and cheap, too, there is no excuse for not having ones eyes tested annually.

[Peter Creasey]

the fact is that the revenue of doctors is amputated by the cost of insurance, and that certainly increases costs to the public.

Earl, The cost of malpractice insurance and the hassle of dealing with the government are the reasons that are most often given by doctors for throwing up their hands and abandoning their practice. Thus, the large influx of foreign, perhaps especially Indian, doctors.

[earler]

Shh! The democrats in congress don't like to hear that. They protect the interest of their masters, plaintiff's attorneys who make their millions (e.g. john edwards) from such suits.

[Lindsey]

I realize plaintiff's lawyers all claim that
I'm not talking about what the plaintiff's lawyers claim, I'm talking about what the data says, and the data says that malpractice claims are a very small factor among those that contribute to the rapid growth in health care costs in the US.

--Lindsey

[earler]

You confuse two things. The current growth in costs and the already high costs. The latter are in no small part due to very high malpractice insurance premiums, which in turn are due to ridiculously high jury awards, which are obtained by plaintiff's attorneys who are cosseted by the democratic contingent in congress who refuse to permit reasonable caps on such jury awards.

The continuing surge in costs today are due in the main to the continuing increase in costs, diagnostic and treatment. While the drug companies bear some of the blame, they argue, not without complete foundation, that new molecules require costly research and development and such costs have increased due to more costly testing required by government. It is easy to blame the drug companies for all the sins and for their rapacity. But, a look at their current earnings show profitability lags if no new molecule appears with regularity.

In other words, the already high cost of health care is largely due to malpractice insurance costs, but the increases today, from that plateau, are imputable to the naturally increasing cost of diagnostics and procedures and some imputable to unjustified increases in costs, such as over implimentations of mri machines. But, legislation that put a reasonable cap on jury awards would permit a significant drop overnight in health costs.

[Lindsey]

[The already high costs] are in no small part due to very high malpractice insurance premiums, which in turn are due to ridiculously high jury awards
The only people I hear making that case are those who have a political agenda (and they are almost always focusing on the rapid increase in costs). Independent studies say otherwise.

While the drug companies bear some of the blame, they argue, not without complete foundation, that new molecules require costly research and development and such costs have increased due to more costly testing required by government.
I do believe I have read that the major drug companies spend more on advertising and promotions than R&D. Maybe they should quit trying to push new medications on TV?

No question that developing new drugs is costly. But I don't think the solution to that is to cut back on testing them for safety, especially not since the same people clamoring to cut back on the safety regulations are also the ones who want to cap damage awards.

--Lindsey

[earler]

Independent studies? By whom? The poltical agenda has been to protect the band of plaintiff attorneys.

While drug companies do spend heavily on promotion, it doesn't come near the amounts spent for r&d. The problem is that only 1 out of a zillion new molecules ever makes it to final trials and approval. As for safety regulations, well that is a big argument. Those with aids in particular were not happy when they were deprived of experimental drugs because they weren't approved by the fda. The real question, for which there is no satisfactory answer, is how much testing is required.

[Lindsey]

Independent studies? By whom? The poltical agenda has been to protect the band of plaintiff attorneys.
No; if there's a political agenda on the Democratic side of the issue, it is to protect the plaintiffs themselves, the people who have been harmed by medical or corporate malpractice.

But there are certainly independent studies on the question of what is driving the cost of health care, such as this one offered by HHS (http://www.ahrq.gov/news/ulp/costs/ulpcosts1.htm) (and note that this is HHS in an adminstration noted for its partisanship on the other side of this issue); this brief (http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358) offered by the Kaiser Family Foundation (note that it points out that while administrative costs overall are 7% of health care expenditures, they are less than 2% of the government operated Medicare program); and this one (http://www.rand.org/pubs/corporate_pubs/2005/RAND_CP484.1.pdf) from the conservative Rand corporation which talks of many things, but never makes any mention of malpractice insurance or the cost of litigation. (BTW, Kaiser is probably not completely independent, but I would expect their interests might lead them to finger trial lawers and malpractice suits if that accusation could be remotely considered to hold water.) And finally, a study by the Congressional Budget Office (http://www.cbo.gov/ftpdoc.cfm?index=4968) concludes:

Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending--private or governmental--because malpractice costs account for less than 2 percent of that spending. Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice "defensive medicine" by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive.

While drug companies do spend heavily on promotion, it doesn't come near the amounts spent for r&d.
Not according to this (http://www.sciencedaily.com/releases/2008/01/080105140107.htm) and this (http://www.nybooks.com/articles/17244).

ScienceDaily (Jan. 7, 2008) — A new study by two York University researchers estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry’s claim.

The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion.

The research is co-authored by PhD candidate Marc-André Gagnon, who led the study with Joel Lexchin, a long-time researcher of pharmaceutical promotion, Toronto physician, and Associate Chair of York’s School of Health Policy & Management in the Faculty of Health.

In the past two years, we have started to see, for the first time, the beginnings of public resistance to rapacious pricing and other dubious practices of the pharmaceutical industry. It is mainly because of this resistance that drug companies are now blanketing us with public relations messages. And the magic words, repeated over and over like an incantation, are research, innovation, and American. Research. Innovation. American. It makes a great story.

But while the rhetoric is stirring, it has very little to do with reality. First, research and development (R&D) is a relatively small part of the budgets of the big drug companies—dwarfed by their vast expenditures on marketing and administration, and smaller even than profits. In fact, year after year, for over two decades, this industry has been far and away the most profitable in the United States. (In 2003, for the first time, the industry lost its first-place position, coming in third, behind "mining, crude oil production," and "commercial banks.") The prices drug companies charge have little relationship to the costs of making the drugs and could be cut dramatically without coming anywhere close to threatening R&D.

New York Review of Books


--Lindsey

[earler]

Sorry, but that isn't true. I just looked at glaxo's annual report. Seliing, general and administrative expenses were twice those of r & d. But, there are 100,000 employees and administrative exprense are very high indeed. It is clear from those figures that 24% of turnover isn't spent on what is called promotion.

Now, I won't defend pharmaceutical company pricing, which is often exorbitantly high. But, glaxo, for example, has a 25% return on sales, somewhat less of a return than a microsoft or a google. It costs real money to create new molecules. I suppose you think governments should nationalize drug companies!

[earler]

Sorry, but that isn't true. I just looked at glaxo's annual report. Seliing, general and administrative expenses were twice those of r & d. But, there are 100,000 employees and administrative exprense are very high indeed. It is clear from those figures that 24% of turnover isn't spent on what is called promotion.

Now, I won't defend pharmaceutical company pricing, which is often exorbitantly high. But, glaxo, for example, has a 25% return on sales, somewhat less of a return than a microsoft or a google. It costs real money to create new molecules. I suppose you think governments should nationalize drug companies!

[Lindsey]

Sorry, but that isn't true. I just looked at glaxo's annual report.
If I understand what you are saying, the annual report apparently does say that they are spending twice as much for marketing and administrative expenses as they are for R&D. So I am not sure how that is such a clear rebuttal, even if one British pharmaceutical company's annual report for some unspecified year were to be considered a valid rebuttal of an independent report covering the US pharmaceutical industry as a whole for 2004.

I suppose you think governments should nationalize drug companies!
Nope, never said that.

--Lindsey

[ndebord]

Sorry, but that isn't true. I just looked at glaxo's annual report. Seliing, general and administrative expenses were twice those of r & d. But, there are 100,000 employees and administrative exprense are very high indeed. It is clear from those figures that 24% of turnover isn't spent on what is called promotion.

Now, I won't defend pharmaceutical company pricing, which is often exorbitantly high. But, glaxo, for example, has a 25% return on sales, somewhat less of a return than a microsoft or a google. It costs real money to create new molecules. I suppose you think governments should nationalize drug companies!

Earl,

Once upon a time, I edited annual reports for a wall street company, or rather I edited the work a friend did who was their golden pr writer in this specialized field. The link between rosy and reality is tenuous at best, sans outright fraud discovered by some ambitious DA with higher ambiitons.

In other words, I wouldn't invest in a company based on the veracity of their annual report, would you?