Just in case anyone is interested in where I spend my time now, I wanted to link this article titled "Localizing Health Care". This is the most cogent discussion of the issues we are facing that I've read, and it comes with actionable solutions. Out of the box and outside talking points. One solution: Bring back Guilds.
Posts: 1434 | Registered: Nov 2002
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quote:Rather, we have a Rube Goldberg contraption that combines the worst features of capitalism and socialism.
I like him already. Thanks for this, Kent! I will read it closely (when I'm not exhausted, as now) and return to remark. I would be interested to know what you think of some of the specifics, as well. Of course, that would require you to write more than a couple of sentences at a time, every few months.
Posts: 5277 | Registered: Mar 2005
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I have found at Front Porch Republic the best of conservatism and liberalism, while rejecting statism. I will happily engage anyone here on this topic. I am so sick of the current political dialogue in this country that refuses to take accountability for rent-seeking behavior (as opposed to productive behavior) which lies at the heart of almost all of our ills. Forgive me for my absences, but until my new framework is more developed I can only engage rather modestly.
I am currently reading a book that the author of the linked essay wrote on economics, and I think it is the best thing on the subject I've ever read. I'll post my thoughts on that book at some future time.
Posts: 1434 | Registered: Nov 2002
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quote:What research does require is a reliable funding source, which can come more efficiently from manufacturing licenses than from patents. That is, when a firm develops a new medicine they get the right to license that product to any number of production firms. The licenses should be for a longer term than the current patents, which will provide R&D firms with a much more secure revenue stream from which to fund further research. The license fee would be small relative to the current monopoly profits, but they would continue for a longer period of time, after which the product would enter the public domain and be appropriated by everybody.
Manufacturers, on the other hand, will have to compete on price and service, and will therefore have to find the most efficient ways to manufacture and distribute the medicines. The effect of such a license system would be to divide R&D and manufacturing firms. R&D firms would want as many companies as possible to distribute their product, and would have an incentive to keep the fees low. There may be a role for the government in setting the license fees.
A patent owner can license a current patent to as few or as many manufacturers as they want. They only license it to a single manufacturer, because that provides monopoly profits. Why would extending the length of the patent (license) make them suddenly want to license it to competing manufacturers?
Demand is generally limited for drugs.
He could have instead suggested 1) Mandatory Reasonable and NonDiscrimenatory (RAND) licensing in exchange for a longer patent/licensing period.
That might actually have a chance of accomplishing what he suggested.
His second suggestion, if we don't do his licensing suggestion - then for those companies eliminate patent protection.
"The Problem of Medical Licenses."
quote:I believe that we can drastically increase the supply of medical services—and therefore decrease the price—by providing a range of licenses: midwives, nurse practitioners, medical practitioners, medical doctors, and more advanced doctors of medicine.
Agreed. We already have this in some degree that a P.A. can do care as long as a primary physician is on staff.
He also mentions that this can be used for a stagged learning system where part way through your MD degree you can achieve a lesser license and pay off some of your debt.
I've proposed similar elsewhere, pretty sure this is a common suggestion.
quote:What I propose is that we allow medical professionals to form guilds with the power to grant various licenses. They would be the sole judge of the qualifications required, and they would set the practice standards and prices. But most importantly, the guild would stand surety for its members. That is to say, when a patient had a complaint, he would sue not the doctor but the guild. The guild would be responsible for the competence and good conduct of its members.
I don't object to this per se. I'd suggest though that instead we have comprehensive testing, and allow anyone to take it. With mandatory posting of scores. Have a minimal passing score.
Making the guild the liable body is interesting in theory.
How would one work out transfers between guilds? Spin off guilds? I don't see guilds ever wanting to expand their memberships for many of them, and others wanting to rapidly grow membership and then give them the boot. Or a spin off guild, or can a doctor be his own guild. Or the impact of nepotism.
quote:You might ask, “Why would one doctor stand surety for another?” But in fact, this is what already happens in malpractice insurance. Insurance is merely cost averaging. If the losses go up for one doctor, the rates for every other doctor in that insurance pool go up.
Groups of doctors can already 'self insure' and other arrangements where they can have only specific doctors in their risk pool.
quote:I have no way to judge whether such things as acupuncture or Chinese herbalism are medically valid. But when joined in a guild and required to stand surety for each of their members, practices which do have some value would likely thrive, even if conventional medicine does not, as yet, recognize their value. And if they have no value, it is likely that such practices would simply disappear because the insurance claims would bankrupt them.
That is ignorance speaking. Unless an illness is likely to be life threating using any useless but not particular dangerous treatment should 'work'. Also quack medicine is usually felt to work 'better' because the individual usually gets sicker then gets better so the 'effects' are more dramatic even though it is just the immune system running its course.
His talk about guilds I think points to an lack of knowledge of how medical businesses are set up and done now.
I think his early analysis of the potential problems are pretty spot on, solutions are a mixed bag between well known proposals and one I feel is a bit poorly thought out.