Where does capitalism fit in to health care?

After my recent poll about health care, I began thinking about the role played by capitalism in the health care industry. Capitalism has helped us create a better mousetrap in regards to a lot of medical devices, I don't know if all of those advancements would have happened without the financial incentive, to some degree I think it would have just not to the same degree. I just wonder what the best balance is between what we have right now and providing the best care for the most people. Your thoughts would be appreciated.

David

How about: If you're in it for the money, I don't want you in it.

I want you in it because of your genuine aptitude for the life sciences and a desire to ease the suffering of your fellow human beings.

They largely have been and it's given us some fantastic tools.

David

I don't know what the solution is. I have a child with autism, and only 10 states in the country are required to have insurance coverage for autism treatment. My state is not one of those 10. Our healthcare bills are ridiculous. I need surgery in November, but am probably not going to get it because now our second child is exhibiting problems and may need feeding therapy, which is expensive. I had to quit working when my first son was born, because of his special needs. He simply cannot be in daycare. The same is proving true for my second child.

We paid 11k out of pocket the first year my first son was diagnosed with a special need, and that wasn't even his autism diagnosis.

Yes, our system has lead to advances, and that's great. I'm an RN, so I'm on the front lines. I don't know what the solution is. All I know is that what we've got now isn't working.

Thanks for your input. It's funny I find that people who actually work in the field seem to understand what I'm talking about. SPO2 monitors came up the other day, Masimo's new RAD 57 monitor provides noninvasive measurement of Methemoglobin, Carboxyhemoglobin and Oxyhemoglobin in the blood. I don't think we have it without capitalism.

David

are not in it for money. They are in it for providing succor to people who are ill and in pain. If memory serves, some of the most effective vaccines and treatments were given away by their inventors so that everyone could benefit. To my mind, this is what healing is all about. Money is not a factor. (I work for a non-profit health education foundation which has a demonstration clinic that does not turn people away for lack of funds.)

I'm surely not in my line of work for the money. I'm talking about the companies like GE who do R & D on new imaging devices. How widespread would MRI's and PET scans be without capitalism? I don't know the answer, it seems like a tough balancing act.

David

state supported schools. Those are the real centers of research.

Selling flowers, get well cards and other gifts. Those are things that fit the axioms of a "free market": low barriers to entry for producers, perfect information, buyers and sellers having an equal advantage, etc.

We have some sort of weird hybrid between capitalism and socialism that has just happened because of benign neglect. Unfortunately we have a health care complex that is similar to a military industrial complex, with high paid lobbyists and the whole bit. There's plenty of government money going into health care, and the insurance money paying for health care is "collective." People are not directly paying for it so supply/demand equations simply do not work.

Almost everyone's solutions to the abysmal state of affairs is different--we need more capitalism to make it work, or need less capitalism to make it work. Honestly we have the worst of all worlds now. We have just enough capitalism to allow unneeded treatments, as many as twelve different drugs in the elderly, while there are children dying from not being able to afford dental work. The situation is very Alice in Wonderlandish. I'm not sure how we pluck a workable solution out of it.

One of the worst problems we have is that the poor in our country cannot afford decent food--and when Americans eat indecent food, we are talking BAD FOR YOU. Kids are going to school feeling bad and unhealthy. In terms of the collective good, this is a much more dire situation than the possible disincentive to develop yet another new imaging machine.

Still, I am glad I am not in charge of this mess.

I agree with much of what you said. I'm just using MRI's as an example of a device that has saved a lot of lives, made a lot of exploratory surgery unneccessary and in part has been a result of the free market.

David

When it comes to delivery of care, I don't think capitalism has a place, everyone should get the best care possible IMO, regardless of profit.

On the research and development end, I do think capitalism can be a healthy thing.

What many people don't realize is that competition for research funding is fierce in the non-profit world, you have more people fighting for fewer dollars. A lot of time is wasted, again IMHO, on securing and maintaining that funding (ask anyone writing up a grant how happy they feel about what they are doing, then duck). There's a lot of preliminary work done in the non profit sector that the profit sector then can spend the LARGE amounts of money needed to refine and improve on the basic premise. Most non-profits research institutions just can't afford to spend the money needed to complete the large scale testing, study design, etc that for-profits can. The competition trickles down to non-profit research because money is not the only capital these guys value, respect in the field is also highly valued (it brings in more research $$).

But science doesn't make those choices available, capitalism does.

Science doesn't provide doctors, med schools do.



I could not find consistent numbers on the cost of nursing school, but a BS in Nursing would be roughly the same as any other 4 year BS degree. Currently nurse's wages are pathetically low compared to other BS degree holders, and the hours they have to work are frightening long. One reason for this is that the employers of nurses have capped wages and taken capitalism out of the system. And LO! and Behold! we have a nursing shortage. If the market was allowed to work we would have plenty of nurses who didn't have to work 60+ hrs a week just to keep their job.

People who provide goods and services to this industry deserve to be compensated for their investment in time and money. And they should be compensated comparably to others with the same qualifications and contributions to our standard of living.

When you pay a man $150,000 for his MBA from a Strip-mall University, It is ridiculous to expect an MD from Baylor College Of Medicine to work for less than that.

Bottom line, capitalism ends at the patient's bed side.

and many of the breakthroughs in both drugs and equipment are coming out of NIH funded university research programs, the one socialist part of our feeble medical system. The drugs or devices are then licensed to for profit companies for a laughably low fee, considering what those companies then charge for them.

Many of the real breakthroughs in equipment and technique are now coming from socialized medical systems, systems that are more likely to invest in pure science since there is no need to bleed the maximum profit out of the system to satisfy shareholders. They, too, license the breakthroughs to private companies who must submit to a bidding process to make sure they're not extorting the system.

The profit motive is great when you're considering the large scale manufacture of goods. It just breaks down when investment in research without a clear and immediate reward is needed.

Bell Labs, I think, would be the premiere example of a corporate giant doing pure research for decades with no immediate application to their core business. Of course, the legacy of Bell Labs has come to an end, but just pulling the list of Nobel Prizes awarded to Bell Labs researchers from Wikpedia shows just some of the amazing work to come out of Murray Hill, NJ:

that it's being shut down in the name of profit. The applied research will continue, of course, but the pure research will cease.

Not a great example, IMO.

But the fact is, it did work. For many decades. What's changed is the corporate culture. I think it's a shining example personally of how, sometimes for-profit entities can do fundamental research. But, and this is a big but, how many of them engaged in this kind of basic research? Not many. An even bigger problem is that fewer and fewer companies are doing even applied research these days.

Capitalism has not been awfully helpful in spurring devices that create the best outcomes. A simple and cheap device that saves many lives will probably not get produced, because it can't generate great profits. But an expensive device that has dubious utility will often get produced because it can generate great profit.

Far better to have the government reimburse devices based on some measure of goodness - e.g., $10,000 for each patient-year of life saved.

Portable CPAP's are now being carried on all our ALS fire engines and ambulances. They have improved patient outcomes dramatically.

David

They're so ubiquitous now that Red Cross is including their use as part of their standard CPR course.

"Bottom-line" considerations have no place in the allocation of care. I am a cancer, survivor grateful for the technological advances made under a capitalist system, but take great issue with being denied individual health insurance because of my "pre-existing condition". Access and funding of health-care is really the same thing. You can't receive kidney dialysis, chemotherapy and radiation, or surgery via the ER, you need reliable insurance coverage to pay for chronic or catastrophic treatment.