I found this post interesting with a lot of the little subtle realities highlighted.

But I am not sure that there's actually a real difference between a pure single-payer system, and market-based competition within social insurance.

the big difference I see is that a single payer plan embraces the reality that the people have a democratic say about the delivery of medicine whereas, with a market based system, the public is blocked from critiquing the system because they lose to "shareholders" and/or other corporate interests.

corporations like socialism on the business side (i.e. a monopoly) but markets on the demand side since it fragments the power of the consumer.

as an example of this, consider the medicare drug bill: the government cannot use it's purchasing power to negotiate or critique price... under single-payer, this negotiation, I assumed, is possible and actually ensures that the market (read innovation) works.

update: as I understand it, the market works when the market keeps turning products into commodities that cost less; obviously, some businesses don't like this, and try to artificially keep their prices high instead of using innovation to create products that have more value-- either because they have less side effects, produce better results, do less damage to the environment, etc...

If incrementalism is dead, health care reform is dead. Deal with it.

Health care reform elected Bill Clinton - with robust Democratic majorities in both houses - but even in limited form it never made it through the sausage factory. SP Now advocates played an indispensible role in killing it.

The argument whose conclusion you don't like (not that it's the main argument contra reform) is "nonsense"? How so? (You don't say.)

The options we face are:
1. No reform.
2. An increment in the direction of a desirable solution (i.e., single payer).
3. An increment in some direction off the critical path, e.g., mandates and subsidies to aggrandize the private insurance sector.

Progressives' inability to comprehend intermediate steps is the conservative's most valuable advantage.

alternatively, the single payer system could make investments in developing better solutions.

It depends on the details of the single payer system doesn’t it?

I assume that the agency responsible for negotiating drug prices will have some level of political accountability to the public and will be under pressure to provide access to any new drugs at low price. On the other side of the table the drug company will argue for more profit to fund development of new drugs. The public will easily win that political debate.

As the drug companies become essentially public utilities efficiently manufacturing commodity drugs, I don’t see any incentive for a research only companies since the manufactures, operating on thin margins will not be able to afford to license new drugs.

As you suggest, that leaves the single payer to take over the R&D for new drugs, funded out of tax dollars. How much will the the government be willing to allocate to R&D for new drugs given other budget needs? Who knows?

Yes. They would assume the cost of all the applied research required to develop a practical drug and see it through its clinical trials.

Rick, it may be that things have worsened significantly -- significantly enough to change the rules of the game.

But if I recall correctly, public attitude surveys showed broader and more intense interest in h/c reform when Clinton was elected.

Likewise, anxiety over America's competitiveness in world markets was far more intense, with a greater sense of urgency and/or futility.

Hillary may have botched her first turn at-bat, but remember -- nobody else has ever hit that pitch.

And remember also -- single-payer purists were as determined as the Republicans to see her fail, only they got there first.

If you imagine the politics are now so easy we can't learn anyting from history, you are running an obstacle course blindfolded.

And if you think shouting makes your case more compelling, please reconsider.

As you suggest, that leaves the single payer to take over the R&D for new drugs, funded out of tax dollars. How much will the the government be willing to allocate to R&D for new drugs given other budget needs? Who knows?

well, don't the drug companies spend most of their money on marketing and much less on research? at least, that's what i've heard.

in general, I think that we need to make direct investments instead of making indirect investments through higher prices.

if we directly investment, then the public's investment is rewarded but if the public invests indirectlry, through higher prices, there is no reward.

“well, don't the drug companies spend most of their money on marketing and much less on research? at least, that's what i've heard.”

I don’t know…I hear wild claims on all sides of the health care debate.

“if we directly investment, then the public's investment is rewarded but if the public invests indirectlry, through higher prices, there is no reward.”

It really boils down to ideology doesn’t it? Do you trust a central government agency making decisions about which drugs to attempt to develop and how much to spend on it or not? What if that agency is controlled by Republicans?

Well put.

I absolutely agree that incrementalism will not work and we must move to a publicly funded medicare for all type health care system.

Robert Brown

Thanks for your comment on bolding or using caps in blogs

Off health care reform topic but when I observed the birth of USA TODAY I realized that image was competing with small font language for eyeballs for better or worse.

Also note that TPM Cafe uses not only very large font maroon headlines for their stories but photos of writers as well.

The venerable New York Times also has added photos of their Op-Ed Writers

So I dont't feel so bad using bolding or CAPS from time to time in my comments :)

Be Well,

Dr. Rick Lippin
Southampton, Pa