Dean Kamen: Healthcare Debate "Backward Looking"

by cwan • 17 years ago

48 88 17 years ago

zhyder• 17 years ago

The problem is that the same healthcare service costs a lot more in America than it does anywhere else in the world. It's understandable if the surgery that only 4 surgeons in the world can do costs a lot, but relatively routine/commoditized stuff shouldn't cost more than in other developed countries.

kjn• 17 years ago

The other problem is that despite spending significantly more than any other nation, measures of health care (i.e preventable deaths, access to health care) rank the US well behind other first world nations.

The interview largely ignores that concern, and focuses instead on the strawman of absolute cost.

cwan7• 17 years ago

Unfortunately the debate usually isn't as black and white all the time given that there are a number of metrics like survival rates following heart attacks or cancer detection/treatment where the US is very much ahead of other first world nations.

Absolute cost is far from a strawman in this issue given that the basic argument for reform (as they've proposed - since I think a lot of people are for reform including Dean Kamen), is that the US healthcare system as it is now is too expensive and ergo a significant barrier to access. Others like Kamen make the point that by restricting absolute costs, innovation will drop because the incentives for innovating drop.

kznewman• 17 years ago

This seems intuitive and if its true that the cost is ONLY for that service and not ALSO for the superior research and development, then I would agree.

I don’t know for sure but my hope would be that at least some relatively routine/commoditized stuff is higher in America to pay for things that aren’t being done in other places.

In any case Dean Kamen makes some great points about moving beyond fear based legislation.

mrkurt2• 17 years ago

I've only ever seen statistics that compare the aggregate cost of health care relative to aggregate outcomes in the US vs other countries. Do you have more details on the delta between pricing for specific services?

It's generally very difficult to compare the cost of specific services in any meaningful way. For instance, many countries institute price controls on medication, cutting the cost of some prescriptions to 30% of what they'd cost in the US. However, some of these drugs were developed in the US based on US patent law and with the assumption of a certain amount of profit from US consumers. A price control in Canada is effectively subsidized by US consumers of a given drug, in lots of cases.

A great deal of the costs we pay come as a result of artificial scarcity of both drugs and medical services. The result of legislation, fears of malpractice, and prescription requirements mean that treating a simple sinus infection (which I can diagnose reasonably well myself) costs ~$150 or so after the doctor visit and trip to the pharmacy. There are a great many ways to attack that scarcity, but we're not really considering them (unfortunately).

Dean Kamen has a good point. The level of medical care we can provide to people is both insane and insanely expensive. High prices are rationing. What we need to do is attack the high prices that are artificially inflated.

asmithmd15• 17 years ago

"A price control in Canada is effectively subsidized by US consumers of a given drug" I think that is the crux of his point, if the US didn't have these crazy high prices - then the drug would not have been developed.

I liked this quote: "Every drug that's made is a gift from one generation to the next because, while it may be expensive now, it goes off patent and your kids will have it essentially for free."

The high cost in the US is paying for the R&D that makes the drug possible

ncarlson2• 17 years ago

Health care is just like any other product or service. It will be sold at market prices.

abstractbill2• 17 years ago

Health care is not just like any other product or service.

It's impossible to predict when you'll need it, and how much of it you'll need. When you really need it, you'll pay any price for it, even if that means spending every penny you have and then going heavily into debt.

I can't think of a single other product or service that behaves quite like that.

potatolicious3• 17 years ago

I'm sorry, I know the man is a celebrated inventor and all, but this is hogwash. He's talking about how making health care accessible to all will make it accessible to none - an interesting thesis, but ultimately one that has been soundly disproved by the success of public health systems in most of Europe and Canada.

He is partially right - the lack of extreme-expense health care drives out extreme high-end solutions such as the article's highlighted "Luke" arm, a prosthetic that is almost as good as the real thing.

But really, what do we want as a society? For a two-digit number of extremely wealthy people to have access to the world's best prosthetics, stuff that is in the realm of sci-fi? Or for everyone to have access to "good enough" prosthetic technology that advances more slowly?

"if talented people are given resources they're going to keep driving us to having better, simpler, cheaper solutions to problems"

Absolutely false, and proven by his own highest-profile project; the Segway hasn't gotten significantly cheaper or more accessible despite years of R&D, and is unlikely to become affordable anytime soon. This man's own business is a textbook case of the lie behind this claim. In order for solutions to get cheaper there must be market pressure to reduce cost: this is something that doesn't exist in America's current health care system.

Health care providers don't care about cost - it's passed along to insurance companies and consumers anyway. Insurance companies care about cost, but not really - it's easily passed to sponsoring employers or individual buyers anyway. Really, the only people that truly want cost reduced are the endpoint patients and their employers, who generally lack the clout and influence to push for real cost reductions. The entire system is broken. Costs have not lowered for health care, and will not lower, until the system is reorganized such that cost reduction becomes advantageous to all stakeholders.

He does make a cogent point in the end: more R&D will lead to better solutions and lower costs (given the right structure and incentives). But this argument is really independent of the affordability issue that plagues America today. Where I come from (Canada) we do a huge amount of pharmaceutical research (in fact, we invented the insulin injection) on government funds. I personally know very talented people working every day on cancer research.

Yet we can still afford to give everyone health care. Imagine that. A person can still get a major disease without going broke. Imagine that.

I really do think Dean Kamen is conflating two unrelated issues. The lack of R&D funding is an issue, but increasing R&D need not come from the pockets of consumers. Just look at the existing private system - a third of every health care dollar spent is just on administrative costs. Imagine if we took this money and threw it into R&D.

lutorm2• 17 years ago

Well said. He makes an argument that people are trying to "instill fear in ordinary Americans" and seems to think the system is working perfectly, without giving those that have no access to health care today even a token sentence.

The argument that those that can afford it should just continue spending loads of money on health care and eventually, through some unspecified process, this will make life better for all those who don't have access to health care at all sounds like a variant of "trickle-down" voodoo economics to me.

blhack5• 17 years ago

Who in the United States doesn't have access to healthcare?

Quite honestly, I don't see why this is such a massive issue with everyone right now...

Medical innovation (in it's current state, meaning building things on a molecular level) is prohibitively expensive. Gone are the days when a guy in his basement can hack out (or stumble upon) some great new wonderdrug like penicillin.

These things are not cheap to do...

Also, how does the US Gov't plan on getting the cost of healthcare down? If there is some magic wand that they can wave and make everything cheaper, then why don't they do it? Why do they want control over this so badly?

sp332• 17 years ago

"But really, what do we want as a society? For a two-digit number of extremely wealthy people to have access to the world's best prosthetics, stuff that is in the realm of sci-fi? Or for everyone to have access to "good enough" prosthetic technology that advances more slowly?"

I don't see this as an either-or situation; don't we have both right now? Especially if you look at legs instead of arms.

"... his own highest-profile project; the Segway hasn't gotten significantly cheaper or more accessible despite years of R&D,"

That doesn't make any sense at all. The Segway is the cheaper, more-accessible version of the IBOT, a mobility system. Besides, http://web.mit.edu/first/segway/ is one of many <$1000, DIY Segway projects, so this tech is getting cheaper and more accessible.

potatolicious3• 17 years ago

"I don't see this as an either-or situation; don't we have both right now? Especially if you look at legs instead of arms."

We don't have this right now, that's the point. Yes, there are super-high-end prosthetics available to the uber-rich, and there is the regular stuff. But even the "regular stuff" is out of reach of most Americans, especially the millions that are uninsured (or underinsured by the employer) and thus SOL.

The USA currently has the full range of medical technology commensurate with how much you can afford - but the problem is that much of the really critical care (surgeries, etc) is completely out of reach of the average individual. It truly is a system where the rich receive the absolute best and the poor (or even middle class) can just crawl into a corner and die.

"Besides, http://web.mit.edu/first/segway/ is one of many <$1000, DIY Segway projects, so this tech is getting cheaper and more accessible."

This only proves my point. DIY geek projects aside, there is no low-cost Segway competitor on the market, likely due to patent issues (I have not looked into this myself, so correct me if I'm wrong). This is the same situation for pharmaceuticals - there is no incentive to reduce drug costs when your patients must buy from you and only you, due to patent law. So yeah, there are a bunch of DIY solutions, but still no competition on the open market, and thus prices stay up.

mrkurt2• 17 years ago

"Health care providers don't care about cost - it's passed along to insurance companies and consumers anyway. Insurance companies care about cost, but not really - it's easily passed to sponsoring employers or individual buyers anyway. Really, the only people that truly want cost reduced are the endpoint patients and their employers, who generally lack the clout and influence to push for real cost reductions. The entire system is broken. Costs have not lowered for health care, and will not lower, until the system is reorganized such that cost reduction becomes advantageous to all stakeholders."

I'm not sure if we really agree all that much or not, but I do agree with this. There's no way to keep from ballooning costs when the people paying are insulated from what they're paying for.

Unfortunately, it's largely broken as a result of some really strange incentives and a belief that employers should be responsible for their employees health care (rather than just paying employees and letting them deal with it). HMOs, tax incentives to employers to provide health care, tax incentives to employees to take it, are all terrible, terrible things.

Fixing it will require that people "pay" for what they don't feel they're paying for right now. I dunno about everyone else, but I'd rather be getting the extra $1200/yr my employer contributes to my health care and dealing in an actual free market than what we have now. I think we'd all be paying a lot less, and getting better service.

ncarlson2• 17 years ago

>but ultimately one that has been soundly disproved by the success of public health systems in most of Europe and Canada.

Yes, but the success of those systems is dependent upon the (semi) free-market health system in the United States.

run4yourlives11• 17 years ago

How so?

You seem to be suggesting that if the US went to the same model as the rest of the world, we would all collectively implode? You need to explain that position a little deeper.

octover• 17 years ago

Here is an anecdote from an expat American here living in Sweden. I require immunoglobulin as my body doesn't produce it naturally like it should. In Sweden I'm on a subcutaneous treatment that greatly improves my quality of life. I can take and do the drugs myself without having to at least get an IV line started like in the US. The subcutaneous treatments are starting in America, but slowly and not as widely as they are relied in Sweden. The benefits are increased independence for patients, safer since it is absorbed through the fat instead of straight into the blood stream, and perhaps most importantly it costs less than half of the IV treatment. This subcutaneous treatment was pioneered, tested and deployed in Europe.

That pharmaceuticals in the US are going to stop R&D is BS. I bet there are many 'hacker' scientists that would happily keep doing their job as long as someone employees them. So maybe it won't be Wall St. but there is still money in it, job satisfaction and they aren't going to trade in their lab coats for McDonald's uniforms. Look at stem cell research, private companies could still fund it all they wanted, but once the federal government's teat was shut off research died. Public healthcare wouldn't diminish the government's interest in funding research. Sweden still has many notable things in the field of medical research, and all from a country with a GDP roughly that of North Carolina.

abstractbill2• 17 years ago

I've heard this argument a bunch recently. You're suggesting the rest of the developed world has somehow made the US its bitch as far as medical research and development goes - the US does all the hard work, and everyone else with a public health system reaps the rewards.

I don't buy it.

vidarh2• 17 years ago

> He is partially right - the lack of extreme-expense health care drives out extreme high-end solutions such as the article's highlighted "Luke" arm, a prosthetic that is almost as good as the real thing.

But this isn't even a discussion point in most countries with socialized health-care: Only a handful of countries worldwide prevent private treatments and/or private health insurance on top of the government provided options.

In the UK for example, the two work fine side by side. Everyone has access to the NHS, for "free" (i.e. for their portion of taxes, possibly 0), while people who want to pay extra can pay for the fancy extras that are deemed too expensive or unnecessary.

Apart from dental (which is poorly covered) and purely elective procedure, like most cosmetic surgery, most people show little to no interest in going beyond the NHS - only about 10% have private insurance.

modeless• 17 years ago

If you choose the latter then you are short-sighted, because in the future everyone will be worse off.

pyre• 17 years ago

It's a stupid argument in the first place. If there was a social healthcare system in the US, then do rich people somehow have less money? Do people really believe that there won't be better 'cutting edge' techniques that are expensive, but you can only pay for 'out of pocket' or with a private insurance company?

It's not like private insurance doesn't exist in Canada (for example). You're just guaranteed a certain base-level of medical care by the government. You still have to pay for things like prescriptions unless you have private insurance. Things -- like dental work -- are not covered either unless you have private insurance plan that covers it.

{edit} You have to pay for non-life threatening prescriptions, like anti-depressants or antibiotics. Just thought that I should clarify that IIRC, things like insulin which a person needs to stay alive are covered by the government {/edit}

jwhitlark• 17 years ago

see http://accounting.suite101.com/article.cfm/fixed_and_variabl... for an explanation for fixed/variable costs, and why companies will charge less than the average cost to produce something as long as they can get more than the marginal cost per item.

Most people know that drugs have high fixed and low variable costs, but that also is frequently true of new treatments/techniques; it costs far more to develop it than it does to apply it once it exists.

Other countries get low prices by paying the marginal costs, while the US ends up paying most of the fixed cost.

bavcyc• 17 years ago

"(in fact, we invented the insulin injection) on government funds."

Easily found on the internet: Insulin injections developed in the 1920's, socialization of Canadian medicine began in the 1950's. No link between the two events, not clear in your post if you are arguing this or not.

According to: http://www.canadianaconnection.com/cca/banting.htm, funding during the summer of 1921 was from his family. Not sure as to the accuracy of this website nor do I know of other sources as to funds for the research.

If you would like to supply references as to the funding of the insulin research and development being government funded then please do so. Just because research is performed at a university does not mean the funds are from the government.

Your point and others in this forum is that socialism is better, Kamen and others disagree.

Personally I think US Medicare is a good example of why government programs are not the best. Doctors do not want to accept new Medicare patients due to lack of money, one article I recently read had a doctor state the cost for one supply was as much as could be billed by the doctor.

The US system is quasi-socialism at the very least. Since government is partially controlling costs via one program (if you consider Medicare and Medicaid the same) and access via other programs/legislation including the tax laws.

One item to consider in this debate is that in the US at least since Hamilton, influence has enabled legislation to be enacted to favor your point of view, aka a mercantile economy. Such that you can not in the least bit consider the US Health system as non-government influenced.

The only expensive medical procedure I've undergone was paid by the insurance company at around $.50 to the dollar amount billed by the doctor and hospital. I paid around $.10 to the dollar. This raises the question as to how much of the cost is actually price inflation by the medical establishment to ensure they can pay their actual costs. Some items when price compared to the local pharmacy had a mark up of 200-500%, this was only for a couple of items I remembered while waiting for an order to be filled and is not a rigorous assertion on my part.

http://content.healthaffairs.org/cgi/reprint/17/1/225.pdf has some interesting data regarding Canadians visiting the US medical system. The point I saw is that when the northern system reduced the amount paid in Oct 91 (page 226 of the article) the subsequent amount spent was significantly less, chart on page 229. Not sure the data would allow analysis as to how much voluntary/elective payments were reduced as my quick read suggest some of this was transferred to private insurance. And this particular study indicates only 3% of expenditures in the Canadian system are to out of province providers.

Highly recommend that you read 'The Politically Incorrect Guide to Capitalism' if for no other reason than you know what you are arguing against. Free Enterprise is the best solution to any problem unfortunately like pure communism, it is not found in its pure form due to human nature.

danteembermage• 17 years ago

Taking the rationing argument to the extreme, suppose we could take a painless treatment once a year that would stop all aging and disease but costs $1 million. Would we still innovate in cheaper, less effective methods? We couldn't possibly pay for the treatments for everyone, but should they be subsidized for some? Would there be pressure to make the treatments illegal for those who can afford them? What if for a quarter of the price you get half the effects, but you can still only take it once a year. What would be the optimal time to not age/be disease free a month, a week, a day?

logicalmind6• 17 years ago

While we're theorizing, what if you knew you could make a pill that would be "a painless treatment once a year that would stop all aging and disease but costs $1 million." But it takes a company 50 years to develop and costs $1 trillion in research. Could a company take such a risk? Could the government?

kqr2• 17 years ago

Since Dean Kamen makes medical devices, doesn't he have a conflict of interest?

Basically, if the government tries to control costs, he will probably earn less per device.

billswift4• 17 years ago

Since the gov't wants more control over all that money, doesn't IT have an even bigger conflict of interest?

logicalmind6• 17 years ago

The government doesn't make money, your government representatives do. I would think that the government representatives would make more money by keeping the healthcare lobbyists in place. Then again, maybe this healthcare threat is simply a shake-down to get the lobbyists to give them more money. Who knows.

Nwallins• 17 years ago

Print Link: http://www.popularmechanics.com/science/health_medicine/4327...

run4yourlives11• 17 years ago

Disclaimer: I'm Canadian, and I shouldn't be wading into this debate...

You do realize though that the rest of the modern world looks at the US in this one issue the same way we looked at you when you had legalized segregation?

The rest of us can't even understand why this is a debate. How is it that someone can argue in favour of people not having the ability to access a doctor? Would you also argue that people shouldn't have access to fire-fighters unless they pay the fire-fighter's tax? Police? The protection of an Army?

Our socialized systems aren't a panacea, but the trade-offs of having someone wait for knee surgery so that another can get cancer treatment seem pretty fair to me. Sometimes, I simply don't understand the American perspective.

_pi• 17 years ago

You have no idea, I recently got into a car accident (look at my history for the story of that). And for all of our "socialist policies" in the US that republicans owuld want you to believe, we're grossly libertarian.

Long story short: Accident happened, cop came out and wrote me a ticket based on the fact that he had to come out, and pretty much told me that. Then today I got a bill from the fire department/EMS for them having to come out. In total these bills/tickets are about 1K in cost. So you'd think there isn't a fire-fighters tax but there is....

jws• 17 years ago

In the 1970's I lived in a small town in Oregon. You paid your fire protection fee and they stuck a little sign in your yard. If your house caught fire and you weren't a customer they would allegedly come and protect your neighbor's houses, but not risk anything to save yours.

CWuestefeld6• 17 years ago

What makes you believe that there's anyone in America that does not have access to a doctor?

Hospital emergency rooms are required to take and treat all comers (at least if they want to participate in the system), and the Medicaid system reimburses those expenses.

A poor, uninsured person might not be able to get a kidney transplant, but they'll get some level of basic care. And what Mr. Kamen argues is that the income generated by those expensive procedures -- not to mention a segment of the population that is willing to pay for it -- is what will lead to the breakthroughs in the future that will make (say) kidney transplants unnecessary in another generation.

What really concerns me is that I know, because I have Crohn's Disease, that I have a much higher risk of colon cancer. Even at forty years old, I'm trying to put myself into a position where I'll be able to deal with that should it happen.

But in the ultimate socialized/rationed model, I'm not allowed to buy myself additional treatment beyond the lowest common denominator. Canada recently fought (and lost, thank %deity%) to prevent citizens from getting better health insurance than the socialist plan. In England and other places you're allowed to get better care, but only if you pay for every bit of it -- you can't take the baseline and then pay for the overage. So that's definitely the direction that "progress" is moving in.

My biggest objection is that this prevents people from having their own values. I'm not to be allowed to make decisions that balance for or against my lifespan. I can only get the mix that the regulators have deemed appropriate for every person, one size fits all.

run4yourlives11• 17 years ago

Canada recently fought

No, the province of Quebec did... Canada's system is not national, it's provincial. BC for instance allows for several areas of private care.

I'm not to be allowed to make decisions that balance for or against my lifespan.

You just gave examples in both Canada and the UK that showed that you most certainly can. You're argument is bullshit and comes from a place of ignorance - assuming that somehow the rest of the world has some sort of inferior system simply because we have single payers.

It isn't true. Every health statistic shows that the US is actually lagging behind. You're fighting each other for a dwindling and ever more expensive piece of the pie, and the solution is staring you right in the face.

logicalmind6• 17 years ago

I see your slippery slope argument of "the ultimate socialized/rationed model". But aren't you concerned that without any type of public option that no insurance company will insure you at any price given your current condition? It seems that an insurance company would lose money by insuring you. Unless they charge exorbitant prices. Ultimately, your insurance company is going to decide what care you get.

blasdel2• 17 years ago

"you can't take the baseline and then pay for the overage"

If that was allowed, there'd be a fuckton of nickel-and-diming going on where it'd be very difficult to avoid being forced to pay overages.

trapper• 17 years ago

I live in a place with a very good public health care system. I always go private so I can choose my doctors and get the best care. I pay medical insurance for this privilege by choice.

asmithmd15• 17 years ago

You missed his whole point. Because the US has such high costs we can't afford to give it to everyone. These exorbitant costs also create incentives for innovation. No other countries produce the medical breakthroughs that the US does.

This quote sums-up his thinking: "Every drug that's made is a gift from one generation to the next because, while it may be expensive now, it goes off patent and your kids will have it essentially for free."

You could say the same thing about the US vis-a-vis the rest of the world. Every drug/treatment/device that is developed in the US is a gift to the rest of the world

logicalmind6• 17 years ago

I'd just like to point out that the internet was government-funded innovation. As well as the massive amounts of R&D we do in the military space. Another area in which we lead the world. To assume that government-funded equates to lack of innovation is false.

cwan7• 17 years ago

I'm a Canadian as well - most of my friends in my town don't have access to a family doctor and are on waiting lists. And that's family doctors - try getting an appointment with a specialist.

This isn't Kamen's point though. If the US can continue to accelerate innovation, being the biggest medical innovator in the world, costs for older technologies will also fall improving access. Restrict what technology companies and healthcare firms who use these technologies can charge however, and you reduce the incentive to innovate. Improvements in technology in every other industry results in lower not higher costs. One thing he doesn't talk about as much which is a hurdle is the system of third party payers - but I think he at least discusses a more sustainable solution and the threats that the current and proposed regulations pose.

run4yourlives11• 17 years ago

Access to a family doctor has nothing to do with the fact that our system isn't private, it has to do with a well known shortage of doctors.

To the point though: I reject the notion that there is effectively a single country conducting health research that the rest of the world is leaching off of. It's preposterous and unsupported. Further, even in the USA a vast majority of medical research is government funded!

If the US moved to a single payer system, medical research will change, not end. That's the same thing that happens whenever there is a disruption in any industry.

To suggest that we will a reduction in medical innovation because the US suddenly collectively and not individually paying for medical coverage is to spout nothing more than PR that various corporate interests would love to pay for.

reedlaw2• 17 years ago

Let's take your argument and apply it to other commodities.

"How is it that someone can argue in favor of people not having free groceries? Would you also argue that people shouldn't have access to computers unless they pay the computer tax? Entertainment? The protection of free homes?"

The problem with making everything free is that you create a system where no one wants to work, corrupt officials take more than their fair share, and scarcity becomes the norm.

gnaritas3• 17 years ago

He didn't say make everything free, and healthcare isn't like any other commodity. The world is not so black and white.

Dean Kamen: Healthcare Debate "Backward Looking"

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