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Next entry: No, seriously, they want this to be the Republic of Gilead Previous entry: Labor and feminism really don’t belong in different silos

Bieber vs. Townhall: Point, Bieber

Thank you, Whiskey Fire, for digging up this piece of outstanding wingnuttery from Austin Hill at Townhall, who was apparently so shaken by Justin Bieber cutting through the crap* and describing Canada’s health services how Canadians usually do—-as if they were just common sense, which they are—-that he lost his mind and decided to argue against the existence of public services through the heavy use of scare quotes.

Here’s what Bieber said:

You guys are evil,” Bieber joked to the American magazine writers, “Canada’s the best country in the world….We go to the doctor and we don’t need to worry about paying him, but here (in the United States), your whole life, you’re broke because of medical bills.” He continued, “My bodyguard’s baby was premature, and now he has to pay for it. In Canada, if your baby’s premature, he stays in the hospital as long as he needs to, and then you go home.”

That’s quoted from Hill’s article, and he’s going to show his contempt for Rolling Stone and the kids these days with their filthy Rock and Roll music by refusing to name it.  This is Hill’s response, and it’s beautiful in its inanity:

What a wonderful little fantasy, wouldn’t you say? America is so “evil” that when one goes to “see the Doctor,” one has to fuss with something so trivial as “paying him.” How terrible it is that a highly trained professional like a Medical Doctor must be compensated for his or her work.

Yes, he just suggested that Canadian doctors don’t get paid, because anyone in a government-funded system must work for free.  He must be crapping his pants for real about Wisconsin.  “What is this ‘pay the teachers’ crap? I thought everyone who in the public sector did it for free!”  Actually, that would explain a lot of the wingnut reaction.

But this is where his piece gets really amazing:

Yet how beautiful it is that in Canada, “the Doctor” just provides services, the patient just receives those services – as much as he or she needs – and the Doctor apparently doesn’t need to be paid. Or at least the patient doesn’t have to worry about it, right? Isn’t that the way it goes in Canada? Somehow, because of the magic of government, Doctors and nurses and everyone “at the hospital” in Canada just simply perform their jobs, patients just simply “get” what they need, and everybody’s happy. And Canadians don’t have to face that devastating threat of long-term medical bills.

I expect such childlike silliness from, well, children.

Between the words “childlike” and “fantasy”, I get the strong impression that Hill thinks Canada, with its national health care system, isn’t a real place, but a fictional land in a sci-fi novel written by socialists as propaganda.  I hate to break it to him, but Bieber wasn’t talking about some mythical land he read about in a fantasy book, but an actual nation state called “Canada”, and they are really close to the U.S., so if you’re still skeptical, you can go visit and satisfy yourself that they really exist.  They’re as real as Obama’s birth certificate. 

But I think my favorite part of it is that he describes a system where everyone gets what they need and no one is ruined forever just because they get sick, and just assumes you’ll be horrified at the idea. Which is kind of amusing, like writing, “Boston is a land where people just walk by old ladies laying in the street in need of help, and instead of kicking them, they pick them up and get them help,” and expecting your audience to clutch their pearls and vow never to set foot in that dystopia Boston.  But I thought it would be fun to play his game with social services that Americans are more familiar and fond of, just to drive home how weird he’s being. 

Yet how beautiful it is that in America, “the Teacher” just provides services, the student just receives those services – as much as he or she needs – and the Teacher apparently doesn’t need to be paid. Or at least the student doesn’t have to worry about it, right? Isn’t that the way it goes in America? Somehow, because of the magic of government, Teachers and principals and everyone “at the school” in America just simply perform their jobs, students just simply “get” what they need, and everybody’s happy. And Americans don’t have to face that devastating threat of widespread illiteracy.

Or:

Yet how beautiful it is that in America, “the Policeman” just provides services, the crime victim just receives those services – as much as he or she needs – and the Policeman apparently doesn’t need to be paid. Or at least the crime victim doesn’t have to worry about it, right? Isn’t that the way it goes in America? Somehow, because of the magic of government, Policemen and firefighters and everyone “in the city” in America just simply perform their jobs, citizens just simply “get” what they need, and everybody’s happy. And Americans don’t have to face that devastating threat of out of control crime.

Or:

Yet how beautiful it is that in America, “the Construction Worker” just provides services, the car driver just drives on the road – as much as he or she needs – and the Construction Worker apparently doesn’t need to be paid. Or at least the driver doesn’t have to worry about it, right? Isn’t that the way it goes in America? Somehow, because of the magic of government, Road Pavers and bridge builders and everyone “on the roads” in America just simply perform their jobs, drivers just simply “get” what they need, and everybody’s happy. And Americans don’t have to face that devastating threat of not being able to get around when they need to.

Or, and my favorite because it touches on a social spending program Republicans just discovered they need to pretend to love:

Yet how beautiful it is that in America, “the Doctor” just provides services, the Medicare patient just receives those services – as much as he or she needs – and the Doctor apparently doesn’t need to be paid. Or at least the patient doesn’t have to worry about it, right? Isn’t that the way it goes in America? Somehow, because of the magic of government, Doctors and nurses and everyone “at the hospital” in America just simply perform their jobs, Medicare patients just simply “get” what they need, and everybody’s happy. And Medicare patients don’t have to face that devastating threat of long-term medical bills.

Of course, in all these cases, the people actually doing the work do get paid, and it all goes back to taxes, even if there’s intermediaries involved, as I do believe there are in Canadian health care, as there are with paying construction workers to build our roads.  In fact, as the protests in Wisconsin demonstrate, when it comes to putting boots on the ground, it’s liberals who argue that work should be compensated fairly, and conservatives who are demanding that anyone outside of the millionaire class toils in poverty.  The problem that Hill and all conservatives are facing is that people mind taxes a lot less when they see that they’re getting their money’s worth in services, which is absolutely the case with single payer health care systems, which are untouchable politically in the countries that have them in the same way Social Security and our single payer system Medicare are here.  And so they’re left flailing around, implying that doctors in Canada don’t get paid in order to convince ignorant Americans that hospitals in Canada are crap zones where they shoot you full of morphine (if you’re lucky) and leave you to die.  Hill panicked, because Bieber, dumb as he is, produced the kind of anecdote that can often wake people up to the realities, especially if they’ve known someone who had to cease medical treatment too early because of bills, which a lot of Americans do. 

For the record, I decided to compare the average doctor’s salary in Canada to the United States.  According to this website, the average American family doctor makes about $136,000 a year. And the average Canadian family doctor, if you adjust for currency conversion, makes around $105,000 a year.  It’s less, but it’s not peanuts.  And it’s worth remembering that their jobs are a lot easier, because they can devote more of their time to actually seeing patients, instead of dealing with one of the major small business headaches that make doctors miserable in the U.S.: keeping track of insurance claims and following up repeatedly to make sure they’re getting paid.  Plus, American doctors, like all small business owners, struggle to obtain and keep good staff because paying benefits as a small business owner can be really hard.  In Canada, that’s not as much an issue because the most important benefit—-health care—-isn’t their responsibility to cover.  Consider that half of American physicians report that they’d like to change careers simply because of the hassle of dealing with the intricate bureaucracy of health care, and how much that would change if you billed a single payer for all patients.  Job satisfaction is an underrated aspect of what makes a career worth undertaking in these discussions, especially once someone makes a comfortable living, which Canadian doctors most definitely do.  Especially compared to teachers, who conservatives are currently screaming don’t deserve the money they do get.

*Yes,  I also realized he made exceedingly ignorant remarks about abortion.  But that just goes to show that Bieber is a dumb kid, and that even dumb kids can see through wingnut crap on the health care issue.

 

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Posted by Amanda Marcotte on 10:03 AM • (92) Comments

I love how he capitalizes “the Doctor” throughout.  Now that I know Time Lords handle health care in Canada, I’m definitely moving there!

Comment #1: bomberE  on  02/22  at  11:08 AM

It’s weird, b/c it sounds like he’s calling Bieber a child for not understanding how things work, when that’s EXACTLY how it works.

People who need health care get it, regardless of ability to pay.  Really.  Works that way in all other “civilized” nations.

And it’s cheaper overall than for-profit health care.

Comment #2: Caren-Sun-blocking Creator of Animorphic Pancakes  on  02/22  at  11:14 AM

No, no, the Doctor works for the NHS.

Comment #3: geeoharee  on  02/22  at  11:14 AM

Nice piece, and let’s be clear: Hill and his Teabagging ilk don’t give a tinker’s damn about the poor beleagured Doctor. While they’ll never admit it, their real concerns are for Big Insurance Corps, Big Pharma Corps, and BigCorps in general that use fear of revocation of healthcare benefits to keep the good little consumer/employees in line. They may hate big public bureaucracies, but they love big private ones that work in the interest of the shareholder class.

Comment #4: Gracchus.  on  02/22  at  11:19 AM

Gracchus, that’ll sure be the effect.

But asking whether the fiscal conservative (except in case of wars) Republican believes his nonsense is like asking how many governments have to stay out of my Medicare while dancing on the head of a pin.

Comment #5: witless chum  on  02/22  at  11:38 AM

Yet how beautiful it is that in Canada, “the Doctor” just provides services, the patient just receives those services – as much as he or she needs – and the Doctor apparently doesn’t need to be paid. Or at least the patient doesn’t have to worry about it, right? Isn’t that the way it goes in Canada? Somehow, because of the magic of government, Doctors and nurses and everyone “at the hospital” in Canada just simply perform their jobs, patients just simply “get” what they need, and everybody’s happy. And Canadians don’t have to face that devastating threat of long-term medical bills.

Uh…yeah, that’s…pretty much it, actually.  Not sure how this is supposed to work as devastating sarcasm.  Makes me wonder what it is HE thinks is going on up here…

Comment #6: AmiB  on  02/22  at  11:40 AM

You know, that was more scary than funny.  The writer’s living in his own world, and he believes that there are many people who’ll nod their heads.  I don’t think he’s wrong, and I resent being reminded of that fact.

Comment #7: shah8  on  02/22  at  11:47 AM

I wish this fantasy was strange to me, but alas. My mother clutches her pearls at the idea of having to wait a month for an MRI, when she hasn’t got health insurance and would die before getting an MRI here. It’s astonishing how irrational ideology can be.

Comment #8: katydid  on  02/22  at  11:52 AM

It is amazing how much more efficient a centrally managed system can be…  Beiber should have asked why the costs for the same treatments are so much higher in the US when they are less effective.

Comment #9: James  on  02/22  at  12:02 PM

I wish this fantasy was strange to me, but alas. My mother clutches her pearls at the idea of having to wait a month for an MRI, when she hasn’t got health insurance and would die before getting an MRI here. It’s astonishing how irrational ideology can be.

My mother had to wait 8 months for a hip replacement—in New Jersey because of delays with her insurance saying it wasn’t medically necessary for her to walk.

Here’s a right-wing vocabulary update for you:  If outside the US:  “wait-list.”  If inside the US:  “scheduling.”

Even things like when my father had a pacemaker, it was “scheduled” as the device had to be delivered to the local hospital, the surgeon booked, the surgery and recovery room booked—and can be bumped for emergencies—but overseas, I’m sure that would be decried as a “wait list” for pacemakers.

Comment #10: James  on  02/22  at  12:10 PM

That’s just…weird.  I mean, really? It was difficult not to read it in a Homer Simpson voice. “Ooh, look at me! I’m making people happy! I’m the Magical Man from Happy-Land, in a gumdrop house on Lollipop Lane!”

It’s the incomprehensible magic of everybody clubbing together to pay for nurses and doctors and medical supplies and drugs at a relatively predictable rate instead of everybody having to pay all of those wages and fees individually whenever something happens.

Comment #11: preying mantis  on  02/22  at  12:12 PM

Before we start lauding Bieber for his great insight into the Canadian healthcare system (which, yes, he did pretty much describe exactly how it works and it is somewhat horrifying that the wingnuts seem to think that such a system is an impossible fantasy), please note that in the exact same interview, a few lines later, he infers that rape happens “for a reason” and that abortion is “killing a baby”.

Comment #12: Arianna  on  02/22  at  12:19 PM

Here’s a right-wing vocabulary update for you:  If outside the US:  “wait-list.” If inside the US:  “scheduling.”

While we’re busy translating from Wingnut to English, I’m just curious…if the public sector ‘rations’ cares, what is it called when the private sector does so?

Comment #13: Jayn Newell  on  02/22  at  12:23 PM

My brother lives in a particulary wingnuttery area of Canada.  While people there legitimately complain that they have difficulty sometimes getting specialty services when there is no emergency but they can’t work due to pain or impairment, they WILL NOT TRADE THIS FOR A US SYSTEM - particularly, the farmers who know damn well that their counterparts in the US are SOL if they so much as break a leg on the range.

These are very conservative biblist “god squadders”, yet they are sufficiently educated to understand something this basic.

Comment #14: Ms Kate  on  02/22  at  12:23 PM

Ms Kate, I suppose that actually does apply to Bieber as well.  His mom’s about as huge a “god squadder” as you can get, his film was pre-screened for Christian groups, she keeps a pastor on staff on his tour, and he’s always talking about how much he loves Jesus, but somehow in Canada this does not translate into anti-healthcare batshittery the way it does in the US.

Comment #15: Arianna  on  02/22  at  12:27 PM

For the record, I decided to compare the average doctor’s salary in Canada to the United States.  According to this website, the average American family doctor makes about $136,000 a year. And the average Canadian family doctor, if you adjust for currency conversion, makes around $105,000 a year.  It’s less, but it’s not peanuts.  And it’s worth remembering that their jobs are a lot easier, because they can devote more of their time to actually seeing patients, instead of dealing with one of the major small business headaches that make doctors miserable in the U.S.: keeping track of insurance claims and following up repeatedly to make sure they’re getting paid.

Exactly. That difference in salary is NOT attributable to a difference in hours per week, or number of patients. That’s just their total income. A single-payer system means the doc works as many hours as he needs to care for his patients, and not much more. American doctors have to spend hellish amounts of time on the phone with insurance companies, which adds up to a lot more hours per week at the office, and a much higher ratio of time spent at work to patient care. That’s time they could be spending with their families.

Comment #16: Alyson Miers  on  02/22  at  12:30 PM

“Before we start lauding Bieber for his great insight into the Canadian healthcare system”

I don’t know that anyone is lauding Bieber for any great insight.  He’s just providing a fairly accurate description of what happens if you need a doctor in Canada.  The great insight is provided by the guy who flips out and acts like the somewhat dim-seeming kid just described a magical land administered by pixies and unicorns.

Comment #17: preying mantis  on  02/22  at  12:31 PM

If it weren’t at a well known conservative forum (Townhall), I’d swear that was a rather clumsy parody of right-wing rhetoric.  Right down to the “extra” scare quotes.  Seriously, tell me how you could read this line if posted by a commenter here and not think it was either a bad parody or an actual endorsement of a Canadian style system, “And Canadians don’t have to face that devastating threat of long-term medical bills.”

Comment #18: libdevil  on  02/22  at  12:35 PM

@Comment #4: Gracchus on 02/22 at 09:19 AM

While they’ll never admit it, their real concerns are for Big Insurance Corps, Big Pharma Corps, and BigCorps in general that use fear of revocation of healthcare benefits to keep the good little consumer/employees in line.

I think you’re giving most conservatives too much credit. There’s far more authoritarian followers than there are authoritarian leaders. The followers have no such coherent plans as you describe, they just resent people less miserable than themselves.

Comment #19: atheist  on  02/22  at  12:41 PM

It was difficult not to read it in a Homer Simpson voice.

Indeed.  It made me think of this exchange:

“(Lisa) “I’m going to become a vegetarian.”
(Homer) “Does that mean you’re not going to eat any pork?”
“Yes.”
“Bacon?”
“Yes Dad.”
“Ham?”
“Dad, all those meats come from the same animal.”
“Right Lisa, some wonderful, magical animal!””

While they’ll never admit it, their real concerns are for Big Insurance Corps, Big Pharma Corps, and BigCorps in general that use fear of revocation of healthcare benefits to keep the good little consumer/employees in line.

For many wingnuts it’s simpler than that.  They just don’t want their tax money going to lazy minori…uh, undeserving people.  Or even simpler: Better Dead than Red.

Comment #20: Sour Kraut  on  02/22  at  12:52 PM

I think you’re giving most conservatives too much credit. There’s far more authoritarian followers than there are authoritarian leaders.

I was talking about leaders (though I’m hesitant to associate someone like Hill with the term “leadership”)—the pundits and politicians and think-tankers who acts as mouthpieces for the Kochs and the like. Wingnut welfare recipients like Hill are the “thought leaders,” if you’ll make the stretch, who set the agenda and the talking points that trickles down to the mouth-breathing base.

Roy Edroso’s Stupid-to-Evil Ratio aside, the main reason that Hill’s “argument” in this case seems follower-level feeble is that this is really all he has—empty sarcasm and a reliance on the ignorance of his audience. If he made the real agenda plain, or suggested other ways to relieve the burden for physicians (e.g. subsidising medical education), he would lose most of the Know-Nothing marks who crowd around Clownhall’s 3-Card Monte table.

Comment #21: Gracchus.  on  02/22  at  01:02 PM

For many wingnuts it’s simpler than that.  They just don’t want their tax money going to lazy minori…uh, undeserving people.  Or even simpler: Better Dead than Red.

For the followers, no doubt. But a significant portion of them are a bit embarrassed by displaying their bigotry or an outdated Bircher mentality. Hill’s evocation of the poor ol’ country doctor gives them what they foolishly think is cover (although even this goes out the window when they wax rhapsodic about the “good old days” when you paid the stogie-puffing doc with chickens).

Comment #22: Gracchus.  on  02/22  at  01:08 PM

As one of Justin Bieber’s fellow Canadians - I’m perfectly happy to live in my little fantasy land of single payer universally available health care.

Comment #23: carswell  on  02/22  at  01:11 PM

@12 yes, Arianna - you are the only one here that read Amanda’s earlier post, so none of us were aware of that bit, either.

Comment #24: Ms Kate  on  02/22  at  01:14 PM

I wish this fantasy was strange to me, but alas. My mother clutches her pearls at the idea of having to wait a month for an MRI, when she hasn’t got health insurance and would die before getting an MRI here. It’s astonishing how irrational ideology can be.

And unless your MRI is considered to be an emergency, it’s quite possible your standard MRI in the US is going to be scheduled 4-5 weeks out. I needed to see an endocrinologist for an non-emergent issue, and all the ones I called could find me an appointment in 3-4 months. When I was having chronic digestive problems and needed an CAT of my abdomen, my CAT was about 8 weeks after I scheduled it.

But when I was having breathing problems and my doc wrote STAT on the script, I had a lung scan within 12 hours and they were upset with me not getting into the radiology lab faster.

Comment #25: hp  on  02/22  at  01:24 PM

“For many wingnuts it’s simpler than that.  They just don’t want their tax money going to lazy minori…uh, undeserving people.  Or even simpler: Better Dead than Red.”

Many Americans seem to have the idea that Canada is some socialist (which is a polite word for “Communist”) dystopia where people are living one notch up from how people lived in the USSR.  That is, if they ever bother to think about Canada.  Which is really weird because Canada seems about 90+% the same as the US, but with single-payor healthcare and a slight accent.

”...the main reason that Hill’s “argument” in this case seems follower-level feeble is that this is really all he has—empty sarcasm and a reliance on the ignorance of his audience.”

...and people like my dad eat it up.  He is is absolutely convinced that every day there are millions of Canadians crossing the border into the US to get healthcare because the Canadian healthcare system is so terrible.  He doesn’t need proof, it’s just received wisdom, gathered from Faux, CNBC and MSNBC, and listening virtually non-stop to rightwing talk radio.

My dad would very likely be dead if not merely sick and homeless if it wasn’t for Social Security and Medicare.  And part of him knows this.  But he really doesn’t want to admit it to himself.  He’s old enough that he’s reached the “I don’t give a fuck” stage and just wants to get his before he dies, and screw anyone else who comes along after him (including his three children and his three grandchildren).  Sad…

Comment #26: MikeEss  on  02/22  at  01:35 PM

Canada seems about 90+% the same as the US, but with single-payor healthcare and a slight accent.

But WHAT about what they do to the poor french fries!?!?!?! wink

Comment #27: hp  on  02/22  at  01:47 PM

Many Americans seem to have the idea that Canada is some socialist (which is a polite word for “Communist”) dystopia where people are living one notch up from how people lived in the USSR.

That’s fair, since I’d be rich if I had a dollar for every mean-spirited fellow Canadian I’ve heard say “The US is just like Canada, only shittier.”

On a serious note: these people need to be confronted with standard-of-living, longevity, infant mortality, recidivism, graduate degree, and income numbers. But we know that would be asking entirely too much of them.

Comment #28: Ranylt  on  02/22  at  01:55 PM

Jayn Newell, I’m pretty sure when the private sector does it, it’s “shareholder interest protection” and “efficiency.” Because as we all know, short-term profits are the most important consideration in provision of public goods.

Comment #29: katydid  on  02/22  at  01:59 PM

“I expect such childlike silliness from, well, children.” I don’t claim to know too much about the young Bieber but I thought he WAS a child? I thought the some of the questions asked of the kid in the article were stupid because he’s, you know, a kid. Who expects anything but a childlike answer from a child? Oh I forgot, repugs don’t see children once they stop being fetus’.

Comment #30: Michelle the Red  on  02/22  at  02:00 PM

That’s fair, since I’d be rich if I had a dollar for every mean-spirited fellow Canadian I’ve heard say “The US is just like Canada, only shittier.”

That seems like a fair assessment to me.  Except that we have better weather here in the US (not me, personally, since I’m in NW Ohio and have essentially the same winter as southern Ontario—i.e., winter sucks—but the vast majority of the US does have much nicer winters than the vast majority of Canada).  But otherwise, yeah.

Comment #31: ks  on  02/22  at  02:01 PM

He’s old enough that he’s reached the “I don’t give a fuck” stage and just wants to get his before he dies, and screw anyone else who comes along after him (including his three children and his three grandchildren).  Sad…

But… but… he’d get MORE before he kicks if there were better health care???

It seems more just like “fuck all y’all, I don’t want to have to think.”

Comment #32: Eric_RoM  on  02/22  at  02:05 PM

@23: I’ve got some good news for you then, carswell.  Given the current political realities in the US (and China, and India), you can probably expect Canada to boast a warmer climate to go with your affordable health care sometime in your lifetime.

Comment #33: libdevil  on  02/22  at  02:06 PM

The odd thing is that I’ve felt like I was living in the USSR since the Bush takeover. I was always appalled that Soviet scholar Condi Rice decided to turn us into the USSR. It’s like that Star Trek episode where the scientist uses Nazism to unite a planet thinking he can use just the ‘good’ parts of fascism, but then it all goes to hell because Nazis Are Always Nazis.

Did I just geek and Godwin?

Comment #34: Caren-Sun-blocking Creator of Animorphic Pancakes  on  02/22  at  02:07 PM

Caren, yes, but that’s understandable.

Comment #35: helen w. h.  on  02/22  at  02:11 PM

“I don’t claim to know too much about the young Bieber but I thought he WAS a child?”

He’s 16.  So, young adult.  Old enough to know better than a lot of his answers in that interview, old enough to have grown out of the “Healthcare—how the fuck does it work?” stage, and young enough that some pass can be given for saying stupid shit.  So it’s basically like Bieber 2, Hill 0.

Comment #36: preying mantis  on  02/22  at  02:13 PM

Caren, you side-geeked, since you entered Godwin territory thru the USSR.  Well played!

Comment #37: Eric_RoM  on  02/22  at  02:16 PM

Or even simpler: Better Dead than <strike>Red</strike> Brown.

Comment #20: Sour Kraut

FTFY

Comment #38: cynickal  on  02/22  at  02:31 PM

While we’re busy translating from Wingnut to English, I’m just curious…if the public sector ‘rations’ cares, what is it called when the private sector does so?
Comment #13: Jayn Newell on 02/22 at 11:23 AM

It’s not rationing, it’s the customer making a decision.  Empowerful!

That the decision might be “no care” because the customer has no money is sort of skipped over.

Comment #39: oldfeminist  on  02/22  at  02:48 PM

I had no idea I was living in Justin Bieber’s fantasy all this time until Hill pointed it out to me. Too bad the Bieb couldn’t have imagined someplace warmer, though.

In all seriousness though: I had no idea how bad the situation in the US is until all of the debate over the healthcare bill happened. Some of you folks pay more in a month for healthcare than I do for rent. It really made me realize how lucky we are here that we have what little social safety net that we do. I was unemployed all of last summer and it was a minor inconvenience (I was starting school again in september and had a bit of money saved up), but without public healthcare it would’ve been a gamble with my life.

Comment #40: HonestB  on  02/22  at  02:58 PM

Somehow, because of the magic of government, Doctors and nurses and everyone “at the hospital” in Canada just simply perform their jobs, patients just simply “get” what they need, and everybody’s happy.

Well, yes, that’s the ideal.  Government and money are just a way of organising to reach towards that happy ideal - not an ends in themselves.

Except in the USA…

Comment #41: Phoenician in a time of Romans  on  02/22  at  03:37 PM

While we’re busy translating from Wingnut to English, I’m just curious…if the public sector ‘rations’ cares, what is it called when the private sector does so?

The earlier efforts are so close, but not quite there…

The right-wing term is “free market allocation” wink

You’ve got to have the paen to the free market to be a true right-winger.  (As taught by my Chicago-school macroeconomics teacher.)

Comment #42: James  on  02/22  at  03:39 PM

He’s 16.  So, <strike>young adult</strike> barely up from an amoeba.

Fixed that for you.  No-one under 30 can think.

And get off my damned lawn, too.

Comment #43: Phoenician in a time of Romans  on  02/22  at  03:47 PM

I’m wondering how Canada pays for medical education.  The young people I know here in the US are facing about $500,000 in student loans when they finish, so $136,000 a year will take awhile to make a dent it it.  That explains why they want to go for higher-paying specialties rather than primary care.

Comment #44: gretchen  on  02/22  at  03:49 PM

He put “at the hospital” in scare quotes? What? Is there not really a hospital? Is the doctor not really there? Is it all an ELABORATE CHARADE? The mind boggles.

Comment #45: MissPrism  on  02/22  at  03:50 PM

For the record, I decided to compare the average doctor’s salary in Canada to the United States.  According to this website, the average American family doctor makes about $136,000 a year. And the average Canadian family doctor, if you adjust for currency conversion, makes around $105,000 a year.  It’s less, but it’s not peanuts.  And it’s worth remembering that their jobs are a lot easier, because they can devote more of their time to actually seeing patients, instead of dealing with one of the major small business headaches that make doctors miserable in the U.S.: keeping track of insurance claims and following up repeatedly to make sure they’re getting paid.

I’m betting they’re then going to complain about how Canadians have much less take-home pay because of higher income and sales taxes/duties they have to pay.  It’s a rant I’ve heard from a few Canadian engineers who said they came to the states to work because they get higher salaries and lower taxes compared to Canada and yet, plan to go back there when they retire for their health benefits. 

Not too different from arguments I hear from many freshly graduated biglaw lawyers complaining about how their $160K starting salaries won’t go very far in “high tax” cities like NYC whereas it would be great in lower tax regions like Austin, Texas because the much lower taxes would mean more net income to pay off law school debt and/or live larger.

Comment #46: exholt  on  02/22  at  03:54 PM

Gretchen—education in Canada is subsidized, or was last time I checked.

Comment #47: Well, what?  on  02/22  at  03:55 PM

I tell you, I’ll be looking veeeery carefully at the NHS “hospital” I cycle past on my way home.

I thought, until today, that when I went there for five days with a DVT I got excellent prompt treatment from highly trained and courteous staff for the grand sum of one pound forty five pence including a Crunchie bar and a book of Sudoku. But now I see it is only a “hospital” with “doctors”. Made out of that polystyrene shit they use on film sets, like as not.

Comment #48: MissPrism  on  02/22  at  03:57 PM

Canadian medical school profiles:  http://www.oxfordseminars.ca/MCAT/mcat_profiles.php

Average cost of tuition per year is just shy of $13,000.

Comment #49: wondering  on  02/22  at  04:05 PM

Another factor to consider in the pay differential -

Tuition per semester at McGill: $4,825.10 [Quebec residents], $13,224.40 [out-of-province residents], $37,705.50 [International residents]

Most seem to be in the $10k - to $20k per year range, though there are a couple of outliers.

Comment #50: brenda  on  02/22  at  04:06 PM

Or, what wondering said.

Comment #51: brenda  on  02/22  at  04:07 PM

@46 (exholt), People like those engineers are among the absolute worst people in the world.  They want a free ride, and they aren’t even shy about admitting it.  At least they could have some shame!

Comment #52: libdevil  on  02/22  at  04:15 PM

Another thing that conservatives don’t understand is that sometimes government intervention can increase competition. The most obvious examples are the anti-trust rules, but healthcare is another one. Canada actually has a higher percent of private practice doctors (as opposed to those connected to a big organization—I forget where I saw this, so sorry about the lack of a link). So, in some sense, there is more competition in Canada than the US in healthcare.

Comment #53: JohnL  on  02/22  at  04:22 PM

Not too different from arguments I hear from many freshly graduated biglaw lawyers complaining about how their $160K starting salaries won’t go very far in “high tax” cities like NYC whereas it would be great in lower tax regions like Austin, Texas because the much lower taxes would mean more net income to pay off law school debt and/or live larger.

Except that biglaw firms aren’t hiring people at those salaries to go to Austin… Much like doctors and engineers who complain about taxes in the USA should realize that the only reason they make so much money in the first place is because the USA creates a structure to allow them to command higher salaries than they could get elsewhere.

Comment #54: Tyro  on  02/22  at  04:26 PM

“Canada actually has a higher percent of private practice doctors (as opposed to those connected to a big organization—I forget where I saw this, so sorry about the lack of a link). So, in some sense, there is more competition in Canada than the US in healthcare.”

They don’t have to band together to handle billing and insurance negotiations if it’s single-payer, so there’s less drive to join larger practices.

Comment #55: preying mantis  on  02/22  at  04:36 PM

Hahaha!  Oh gosh, this is making me laugh so much.  I can just imagine him putting on one of those over-the-top storyteller voices too… “In a maaaagical land called Canada, lives a myyyystical tribe…”

I hope they talk about this on The Bugle soon, I’d love to hear John Oliver’s take

Comment #56: alicefairy  on  02/22  at  04:57 PM

What’s very interesting about this quote is how it completely takes the wheels off of the “let the private sector and charity handle social issues.”  The Biebs has a ton of money and it’s clear he know the value of free healthcare.  But when a member of his own staff has a family health issue the biebs doesn’t chip in to pay those bills.

Comment #57: verucaamish  on  02/22  at  05:06 PM

Verucaamish, to be fair, he’s 16 and doesn’t legally control the money.

Comment #58: Ms Kate  on  02/22  at  05:25 PM

“*Yes, I also realized he made exceedingly ignorant remarks about abortion.”

Actually, he didn’t.  The next sentence, which was not included, went to the effect of “I’ve never been there, so I don’t know what I’d do.”  Which is in fact a very well-balanced thing to hear a 16 year old say.

Comment #59: vileseagulls  on  02/22  at  05:26 PM

“Actually, he didn’t.”

Expressing the opinion that abortion is killing a baby and then turning around and saying “Well, I don’t know what I’d do” in the case of a pregnancy resulting from rape does not betray a whole lot of thought on the topic.  Unless, you know, there are a ton of Canadian fundies running around who think it’d be okay to smother an infant in its crib so long as its mother said no to the sex that produced it.

Comment #60: preying mantis  on  02/22  at  05:37 PM

@#52

Those engineers are going to NEED those Canadian health benefits after working in US company conditions for a couple of years.  Canada’s safety standards are stricter - and more expensive - than the US in at least part because it helps save on healthcare costs.  I’d bet my life savings that if we instituted a single-payer system in the US, worker safety would magically become better regulated.

Me, I can’t even secure an appointment with the part-time IH at my company for a badly-needed erganomic evaluation.  Which is why one day I’m just going to say fuck it and move to Finland.

Comment #61: Caelan Aegana  on  02/22  at  05:43 PM

As for the lawyers who want to go to Texas because their salaries would be taxed at a lower rate, I’d have to ask “What salaries?”

I have an old friend in Texas whose daughter graduated from law school two years ago, a top student. And two years later, that daughter is still out of work.

There are no jobs for young lawyers, and nowhere else will hire her because she’s “overqualified.”

She can’t leave Texas for Manhattan jobs because her husband finally got a job as a teacher in Texas.

The best they can hope for at the moment is that he doesn’t lose his job to more “budget cuts” that will come inevitably because Texas—well, it’s in debt, no enough revenue from taxes coming in, ya know.

Comment #62: judybrowni  on  02/22  at  05:48 PM

@27 I have no taste for poutine, but considering Canada taught me about vinegar on fries—freaking WHITE vinegar, sprayed with some kind of spray gun like for fountain drinks at a bar, and sold out of a chip wagon under a bridge!—I am willing to forgive them for poutine.

I am in full agreement re: the Homer voice as well.  I finished reading the paragraph in question and was in awe of the obvious mental gymnastics involved in making that sound like a bad thing. “At the hospital” indeed.

Comment #63: twg_  on  02/22  at  06:04 PM

This is part of their sum-zero ideology on the right.  For some reason they think economics work on a limited supply of money and thus they must hoard it lest they be left behind.  Which was arguably true when we were just getting out of the barter system but hasn’t been true since early-modern Europe start exploring the world.  The fact he attacks Bieber for actually explaining the government’s role in health care in laymen terms is just hilarious and proves how simple he is.

Comment #64: Xeranar  on  02/22  at  06:26 PM

Comment #42: James on 02/22 at 02:39 PM

The earlier efforts are so close, but not quite there…  The right-wing term is “free market allocation” You’ve got to have the paen to the free market to be a true right-winger.  (As taught by my Chicago-school macroeconomics teacher.)

I like oldfeminist@39’s “customer making a decision” better.  It kind of ties in with the dogma about the allocations of a truly free market being completely “voluntary.”  I keep saying this: these health care problems would never happen in a truly free market because the market would eventually instantaneously correct them if they did happen, and who are you to question the market’s Panglossian wisdom anyway when it does happen.

And poutine is delish.

Comment #65: sacundim  on  02/22  at  06:35 PM

Canada actually has a higher percent of private practice doctors (as opposed to those connected to a big organization—I forget where I saw this, so sorry about the lack of a link). So, in some sense, there is more competition in Canada than the US in healthcare.

It’s not just that: in the vast majority of cases if you want to see a specific doctor in Canada, assuming you fall within their type of practice, you can. The only real limit is on how much time they have available in terms of their patient load. My wife’s gynecologist was her best friend in elementary and high school; she didn’t need any approval from her insurance company to see her, and the territorial health insurance coverage she has doesn’t care that said gynecologist lives and practices (literally) on the other side of the country. They won’t pay for travel, of course (my wife does her visits when she’s, well, visiting), and in the event of an emergency she’d be sent to the closest specialist, but for your routine, non-emergency type things there’s no issue at all: my wife sees who she chooses, the hospital administration files the paperwork with Ontario and gets paid (assuming it’s normal, routine stuff), Ontario bills Nunavut, and Nunavut reimburses Ontario for handling one of its medicare clients for routine things that are covered by the national standards on what the provinces and territories recognize as being covered. The end.

Comment #66: KeithM  on  02/22  at  06:52 PM

For some reason they think economics work on a limited supply of money and thus they must hoard it lest they be left behind.

This idea is still commonly taught in intro college economics courses IME and from how most econ majors I’ve met viewed economics.  If there is unlimited money supply in relation to goods the spectre of hyperinflation is the most often cited consequence…with examples of Weimar Germany, postwar Hungary, and China before the Chinese Communist took over.

Comment #67: exholt  on  02/22  at  07:54 PM

I concede that Health Care is an exception to market economics, along the lines of Kenneth Arrow’s seminal paper on the issue.

The only remaining issue, and I suspect this is the reason Obama was very cautious in his reforms,  is what happens to drug development under socialized medicine or a public option. When the US govt uses its near monopoly status to squeeze pharmaceutical companies, like the Canadians do, odds are, they won’t put as much money at risk if the rewards are no longer there. Michael Milken points out that r&d;declined 40-50% when Clinton tried to reform healthcare along those lines. The bottom line is the vast majority of health are innovation emerges from the US system. So what happens when our system is altered?

The US system is mixed to be sure. Govt finances research at the university level and NIH along with private institutions like Howard Hughes. Then start-up biotechs license the tech and, usually financed by Angels and VC money, develop it towards commercialization, a very expensive process that can eat up like 70 million for a cancer drug for example. Its high risk. Millions have gone into trying to treat chronic wounds like diabetic foot ulcers for example but nothing has proved efficacious. These investor are willing to take the risk b/c if they can pull it off the market and returns are huge. If the start up has good early-stage data in clinic they usually sell themselves to large pharma or IPO. There are about 500 such companies around the US.

So the Canadian system benefits from this process. American drug companies are willing to sell their drugs to Canada b/c something is better than nothing and they always have the US as their main market. It’s a parasitic relationship with the US taxpayer and investors footing the bill for R&D;. So it’s unclear how the effectiveness of the Canadian system should inform us in regards to access to advanced therapies. In other words, if we go to the Canadian route, we have to find a more free-market country than us to develop miracle drugs that we’ll buy at a discount.

Comment #68: Manju  on  02/22  at  09:19 PM

Manju, I’ve seen a study that shows that 50% of US pharmaceutical drug costs are paid for via government funding (university labs, etc) and that marketing pharmaceuticals is by far the greatest expense. I’ll try to find it. In the meantime, I’d argue that the current US model for developing pharmaceuticals may have to change if the US went single payer, but its not like other countries have stopped developing pharma, even with the scary spectre of socialized medicine hanging over their R&D;.

Comment #69: wondering  on  02/22  at  10:00 PM

Screw Bieber. He’s anti-choice-and some weird little boy who has not yet even exited his parents xristian little world. Totally something that should not be on a liberal blog. Its nearly degenerate. Who gives a F about Bieber?

Comment #70: BeanS  on  02/23  at  12:52 AM

Also think its stupid to care about Biebers comments. It wasnt a serious quip about health care and this should only be hilarious because some right winger actually took some 16 year old pop tween idols lax comments THAT seriously. Can we get back to the adult world now? Ewww-I feel like I’m back in high school and everyones debating what GRAND thing N’Sync or Backstreet Boys said like its Gods word.

Comment #71: BeanS  on  02/23  at  12:56 AM

In some more serious ADULT news we have:

http://www.msnbc.msn.com/id/41700270/ns/world_news-africa/

Comment #72: BeanS  on  02/23  at  01:29 AM

Hmm. I’m Canadian, and I have two stories.

In 1995, an American guy living in Chicago; has his Master’s in Rehabilitation. 27 years old. No wife and kids, $70,000/year US, when the US $ was $1.60 Cdn. He ups and moves to Canada, to work for the organization I work for (the Paraplegic Association) at only $50K Cdn. So I ask him why. He said,

“I was working for a big insurance company. And I would go into these meetings where the account managers would spend hours working out exactly how they were going to deny the claims of their injured paying customers. I left these meetings physically ill. So I came here.” (And he’s here now, married, a Canadian citizen.)

#2 - I went in to the doctor today because I had a bad wart on my finger, finger swollen, painful, a bit purple. I had to wait 90 mins for the doctor because I went in without an appointment. He says there’s an abcess until there, and maybe a foreign object. So he writes me a letter for the hospital doctor, and I’ll go in there tomorrow to be seen by the plastic surgeon, have the abcess drained and the wound checked out for anything nastier. But there’ll be one bureaucratic obstacle, dammit! I’ll have to give my medical # when I go into the hospital. 

Cost out of pocket for everything. $0.

Comment #73: Hairhead  on  02/23  at  01:34 AM

I just went to my ortho surgeon today.  Apparently I’ve become a very boring patient, and he doesn’t wanna see me for a year - which is good, as I really really like being a boring patient.  This means that my GP is covering my pain medication, and I have a regular physio check-up.

Net cost - well, about $20 everytime I need the codeine prescription refilled, as the GP has to do that himself.  And bus fare.  Plus I have to motivate myself to do the physio exercises *sigh*.

The ortho guy has had three patients come through from Christchurch after the quake, and expects about 10 others to eventually transfer to his care in Wellington Hospital.

None of these people will be bankrupted by getting care for their injuries.  None of them will have to suffer in pain because they can’t afford care.  None.

People in NZ complain about the health system all the time.  No-one ever suggests “maybe we should move to an American system”.

Comment #74: Phoenician in a time of Romans  on  02/23  at  02:38 AM

What happens if no one gets sick this month?  How does ‘the doctor’ get paid?

Ugh.  This logic hurts my head.

Comment #75: Crissa  on  02/23  at  02:43 AM

The bottom line is the vast majority of health are innovation emerges from the US system.

Prove this assertion. Six of the eight largest pharma companies are non-US. The first heart transplant was performed in South Africa. The first corneal transplant was performed in the Czech Republic. First lung lobe and double-lung transplant, Canada. First hand transplant and partial face transplant, France. First windpipe transplant and first full facial transplant, Spain. First full double arm transplant, Germany. First cardiac surgery under local anesthesia, Soviet fuckin’ Russia. Still, I suppose most medical innovation occurring in America occurs in America.

Comment #76: Anonymous P. Hancock  on  02/23  at  02:45 AM

The hyperinflation that took place after WWII in China was excerbated by the fact that unless one was one of Chancre Jack’s ‘friends’(Chiang kai-Shek, may the old bastard rot in hell forever)(Friends being fellow members of the Green Dragon tong, for example) it was illegal to hold American dollars, or even gold instead of Chinese currency.

That’s why when my mothers’ family came over here from China in 1946, it was an old vaudeville joke come to life:  There was relatively little currency in Grandfather Avengers’ pocketbook, and that, along with the gold that was sewn inside my mothers’ coat was all they had to start with in the New World of America.

Comment #77: Dark Avenger Guardian Chow Mein  on  02/23  at  03:56 AM

You know what, who cares what Bieber said about abortion. Abortion is legal and accessible in all Canada and is free in at least Quebec (I don’t know for the others). So as wrong and dumb as he is, he’s not denying anyone her rights.

Comment #78: sirkowski  on  02/23  at  04:18 AM

Manju, far more funds go into creating slightly modified or “improved” versions of drugs that treat problems there have been effective treatments for for generations, because the patents on the old ones are about to expire. Imagine what would happen in cancer research, or treatment for diabetic foot ulcers, or those rare diseases like malaria that no one bothers to study, if funds were diverted from developing Viagra XLE.

Of course, your assumption that most drug development takes place in the US is flawed anyhow. You might have heard of a few little companies called Roche, GlaxoSmithKline, Novartis, Sanofi-Aventis, AstraZeneca, or Bayer? No? Because they’re 60% of the top ten pharmaceutical companies in the world and none of them are based in the US. Hey, let’s go a little further than Europe. Heard of Takeda Pharmaceutical or Daichi Sankyo? People with high blood pressure and cholesterol might have, not to mention anyone who takes Prevacid. Novo Nordisk, from Denmark? People with diabetes find them pretty important. How about Teva Pharmaceutical, from Israel? You’ve probably got them to thank for half the doses of generic drugs you’ve ever put in your mouth, if not more. Ooh, CSL is a good one. They’re from Australia. You probably don’t care about them yet, but just wait til you get bitten by a black snake. Then you’ll care, because they’re the only company that bothers to make an antivenin. Drug development not only happens outside the US, it thrives outside the US. Americans are just far too removed from the world stage to see it.

Why do you feel compelled to support the abnormal profits of drug companies by “subsidizing” them with vastly overblown prices anyhow? Do you feel you owe corporations something for existing? Hint: economically, profit is maximized at MC = MR - that is, marginal cost is equal to marginal revenue. It shouldn’t cost you any more to buy one more pill than it costs them to make one more pill, and if it does the market is being artificially manipulated. So congrats on being a corporate patsy if you find this situation acceptable. Hey, I’ve got a nice bridge over here, it’s practically got views of the Manhattan skyline…

Comment #79: katydid  on  02/23  at  08:50 AM

“Drug development not only happens outside the US, it thrives outside the US. Americans are just far too removed from the world stage to see it.”

This is just one of many things an embarrassingly large number of my fellow Americans fail to understand:  Not everything is invented/designed/developed in the US.  In fact, there are smart and talented people all over this planet (imagine that!).

The days of presumed American dominance in all “important” areas of science and industry as a American birthright are over.  If our drug manufacturers “go Galt”, others elsewhere will fill any gaps they aren’t already filling.  If Boeing goes under, Airbus or some nascent Chinese or Japanese company will step up.  If Intel fails, there are other microprocessor companies that will become dominant.  (This has already happened in automobiles, for those who haven’t been paying attention over the last decade.)

One area (that I can name off the top of my head) where American firms still dominate is computer software.  How much of this is because of a generous head start and the fact software tends to be English-oriented is unclear.  What is clear is that the dominance of American software can’t be assumed to last forever.  There are many talented operating system and application designers/programmers out there.  (One small example: Linus Torvalds, Finnish developer of the Linux operating system.)

So, wave the flag all you want, my fellow Americans, but remember this:  Nearly every culture on Earth has at one time or other considered itself an exception to the laws of history.  And yet every one of them has had its moment in the sun and then faded.  America is no exception.  We’ve already climbed into the handbasket, and we’re rocketing toward hell, and that fall will not be stopped simply because we’re “exceptional”...

Comment #80: MikeEss  on  02/23  at  11:01 AM

The hyperinflation that took place after WWII in China was excerbated by the fact that unless one was one of Chancre Jack’s ‘friends’(Chiang kai-Shek, may the old bastard rot in hell forever)(Friends being fellow members of the Green Dragon tong, for example) it was illegal to hold American dollars, or even gold instead of Chinese currency.

That’s why when my mothers’ family came over here from China in 1946, it was an old vaudeville joke come to life:  There was relatively little currency in Grandfather Avengers’ pocketbook, and that, along with the gold that was sewn inside my mothers’ coat was all they had to start with in the New World of America.

The root cause, however, of the hyperinflation…whether in late 1940’s China, Weimar Republic, or postwar Hungary was that their respective governments chose to print much more currency in relation to the available goods and services or the backing of some valuable/scarce commodity like gold….increasing the money supply in the economy.  Once that happened to a noticeable extent and is allowed to continue, hyperinflation was an almost inevitable result.  And from my studies of those periods, it was usually the working and middle classes…especially pensioners and others on fixed incomes who got screwed the most from hyperinflation as the wealthy and well-connected had ways of moving their wealth out of the weakened currency and country. 

There are many talented operating system and application designers/programmers out there.  (One small example: Linus Torvalds, Finnish developer of the Linux operating system.)

I’m not sure he’s the best example considering I recalled reading an interview many years ago where he admitted to moving to the US from Finland, in part, because of lower taxes.  He’s also supposedly registered to vote here in the US.

Comment #81: exholt  on  02/23  at  11:56 AM

MikeEss, the only reason American companies “dominate” software is because of Microsoft, which does have a dominant share of most market it plays in. No other software segment other than the desktop segment is as strongly dominated by a single company - even tentacular database giant Oracle has its hands full with SAP AG. American companies are also increasingly propped up not by American ingenuity and technical skill, but by outsourced Indian ingenuity and technical skill, which they have thoughtfully purchased in an attempt to reduce their operating costs and return greater “shareholder value”. Furthermore, the desktop segment is being rapidly eroded by small developers working in the “app” model and a growing international open-source community. That kind of market dominance is rapidly fading in software - I’m guessing it won’t be around much longer.

Comment #82: katydid  on  02/23  at  12:08 PM

The root cause, however, of the hyperinflation…whether in late 1940’s China, Weimar Republic, or postwar Hungary was that their respective governments chose to print much more currency in relation to the available goods and services or the backing of some valuable/scarce commodity like gold….increasing the money supply in the economy.

Again, you’re missing the forest for the trees.  I never stated or implied that the currency presses weren’t rolling in that period, just that there were other factors that exacerbated and made things worse if you weren’t a FOC. 

as the wealthy and well-connected had ways of moving their wealth out of the weakened currency and country.

My own family had residental rental properties in Shanghai, but the economic conditions made the sale of them virtually impossible, hence my families 1946-1949 emigration from China, in one grand-uncles’ case, taking the last plane out because as a missionary priest he was in particular danger from Mao et. al.

My great-grandfather had enough holdings here in America so as to have enough money to live on, but all his children and his nieces and nephews came here with either a little bit of wealth as Mother Avengers’ family did, or without even a pot to piss in, aside from clothes and some personal items.

Comment #83: Dark Avenger Guardian Chow Mein  on  02/23  at  01:29 PM

”...even tentacular database giant Oracle has its hands full with SAP AG.”

...true, but not in the database arena, where SAP has no offering.  SAP may be hurting PeopleSoft, but Oracle has become so much more, and RDBMS software remains Oracle’s core business and core strength. 

There are many other database products available (Microsoft’s SQL Server is - I hate to admit it - a solid product, which I use every day and have learned to like), including excellent open-source projects like MySQL.  But I wouldn’t be surprised if Oracle remained dominant for another decade or so.

Web development strategies like LAMP (Linux + Apache + MySQL + PHP, all of which can be obtained and used for free) are cutting into the profit margins of the big guys, and could mark the beginning of the end of Microsoft’s and Oracle’s dominance.

Now, if we could just hasten the decline of Intel, maybe the computer business, hardware and software, could become much more competitive — for the benefit of all mankind instead of just a handful of people in Washington State and Silicon Valley…

(Meanwhile, Google is attempting to become the next Microsoft.  It never ends.  Capitalism always tends toward monopoly, when it is allowed to do so…)

Comment #84: MikeEss  on  02/23  at  01:48 PM

Manju, I’ve seen a study that shows that 50% of US pharmaceutical drug costs are paid for via government funding (university labs, etc) and that marketing pharmaceuticals is by far the greatest expense.

Well, there are 3 stages in the US: 1. University 2. Venture Capital 3. Big Pharma. Government is mostly involved in the dirst stage when the tech is discovered and patented at the university or research hospital level. The NIH is the biggest player here but private institutions like Howard Hughes play a significant role in the financing.

But the 2nd stage is mostly private and has nothing to do with marketing (since the drug hasn’t been proven effective yet). Financing here is dominated by VC firms, weathy individuals (Angels), and public financings (IPOs). Big Pharma will sometimes get involved here but usually they wait until there is significant clinical data. Venture investors usully hope to exit by selling to Big Pharma (usually when the drug is in the last stage of clinical trials before being approved).

From discovery to commercialization, the risk is MASSIVE, with the vast majority of drugs never getting to market.

So, take dendreon (DNDN) for example, a publicly traded company so you can look it up. They have a highly advanced dendritic cell therapy for cancer (i forget which type). The tech came out of stanford and i guess its safe to assume stanford got some govt grant. dndn purchased the tech more than 15 years ago ( i think stanford got shares in the company). To make a long story short, 15+ years later DNDN has burned thru more than $100million (i’m approximating, it may be more) of VC money including an IPO just to fund the clinical trials and display enough human efficacy in clinic to get approved by the fda.. During that time there were a lot of skeptics and frankly there still are. but these guys believed in the tech so they took the risk not knowing for certain whether they’d come out on the other end and eventually get to market.

well, the fda gave them the go ahead in 2010. they raised another $221+ million in a secondary offering in order to set up production, and that amount includes marketing cost, I assume.  That’s more than 300 million bucks over 15+ yrs and they hadn’t made a red cent yet.

It is this system that has produced the bulk of miracle drugs that the whole world benefits from.

Comment #85: Manju  on  02/24  at  04:18 AM

Prove this assertion. Six of the eight largest pharma companies are non-US

Of course, your assumption that most drug development takes place in the US is flawed anyhow. You might have heard of a few little companies called Roche, GlaxoSmithKline, Novartis, Sanofi-Aventis, AstraZeneca, or Bayer? No? Because they’re 60% of the top ten pharmaceutical companies in the world and none of them are based in the US

This is a little deceptive because the innovation usually doesn’t originate with Big Pharma. They usually get involved in the later stages of research and often thru joint development or licensing deals with these small biotechs or other healthcare companies. Its in this universive of approximately 4000 small companies where the innovation is occurring. These companies are domiciled about 50% in EU and 50% in the USA. The pacific rim does stuff within their mega-corps so it’s a little harder to decipher. I don’t have stats on the innovation as I was just going on experience but this 2006 report from the European Biotech Industry more or less aligns with my experience. In genral, Europe is following the US and trying to adapt our entrepreneurial spirit. Needless to say, Russia, China, India, are looking to the American-way even more.

The report finds that the European and the US biotechnology industries both have around 2000 companies, but the US sector employs nearly twice as many people, spends around three times as much on research and development, has twice the number of employees involved in research and development, raises over twice as much venture capital, and has access to 10 times as much debt finance. It earns twice as much revenue.

Despite the right-minded high-level political intentions to transform Europe into an innovation-intensive economic powerhouse, Europe’s biotechnology project is in danger of foundering from the relative dearth of that most vital of fuels for innovation: money. There is a good deal of national government enthusiasm for biotechnology, apparent in a myriad of technology transfer initiatives, seed funding schemes, and taxation schemes encouraging bioscience and other high technology research and development.

According to John Hodgson, Partner at Critical I - a specialist biotechnology consultancy – who authored the study: “Venture capital is a luxury. Less than 10% of European companies win venture funds each year. But it is an indispensable luxury. Only properly capitalised companies can hope to compete globally in knowledge-intensive industries like biotechnology.” The report shows that Europe’s science base is inventive, and the establishment of over 100 new biotechnology firms across Europe in 2004 is testimony to the fact that its inventors are entrepreneurial, too.

Comment #86: Manju  on  02/24  at  04:38 AM

It shouldn’t cost you any more to buy one more pill than it costs them to make one more pill, and if it does the market is being artificially manipulated.

If you paid them, for one more pill, whatever the cost is to make another pill; they would never get back the massive money it costs them for creating the drug in the first place. You are only looking at the variable cost (cost to make the next pill) not the massive fixed cost (R&D;).

Comment #87: Manju  on  02/24  at  05:06 AM

@sirkowski: Yep ,in Quebec they are free (covered by the government medical insurance system) AND by law don’t need parental consent or notification for children 14 and above. Cue all the wingnuts gasping and clutching their pearls.

(Note: the LAW is actually that medical procedures can be done without parental consent or notification for children 14 and above. It’s about doctor/patient confidentiality. Abortion is just considered another medical procedure, like any other.)

Age of consent is also 14, though Harper’s conservatives certainly are dead set on increasing it to 16(and IANAL but that may have incidence on the above-mentionned parental notification exemptions) and there’s a weird exception about anal sex, which is for age 18 and above only EXCEPT if you’re married (and seriously, IMO if you’re under 18 and already married, I think whether you can legally have anal sex is pretty much the least of your concerns).

Comment #88: BlackBloc  on  02/24  at  03:32 PM

#74,
Biebers telling this to a highly influenced demographic of tweens who follow him. Dont denounce the influence he has on them. If were going to take someone elses comments about Bieber’s comments concerning health care seriously, then we should take that seriously as well. Anyways, what a douche for having that view-now music no longer means rock’n roll but ab only pledges, virginity rings and xristian lectures by a boy. He’s the Tebow of tween music.

Comment #89: BeanS  on  02/24  at  07:41 PM

Chet: Pharma does significant R&D;. Indeed others on this thread have said so much as a counter to my points.

But Pharma plays in late stage R&D;, usually phase III, the last trials before FDA approval. These trials have considerably less risk than earlier ones, but are also considerably more expensive.

Public Universities (and private) as you mention also do (govt-financed) R&D;, but they focus on the very earliest stage: proof-of principle, etc. Here the risk is huge but the costs are less. To go from that stage to commercialization is a long, risky, and expensive project. Here, Venture Capital, Wall Street, and wealthy individuals bridge the financing until its ready for Big Pharma.

So, Big Pharma provides liquidity to the market. Without them buying tech, investors would have fewer options to exit an investment, which means less capital in drug discovery which means less… well…drug discovery.

This cost is not calculated into the fixed cost of producing one extra pill. So the “Big Pharma can produce pills cheaply” argument is flawed.

Comment #90: Manju  on  02/25  at  03:06 PM

If you paid them, for one more pill, whatever the cost is to make another pill; they would never get back the massive money it costs them for creating the drug in the first place. You are only looking at the variable cost (cost to make the next pill) not the massive fixed cost (R&D;).

That’s not always true. Sometimes they are just screwing you. Case in point: I take large doses of Dexedrine on prescription as treatment for an obscure brain quirk called Reward Deficiency Syndrome (caused by drastically under-performing dopamine receptors in the brain). Those damned capsules cost over a buck apiece. The research that led to the development of Dexedrine is now over a hundred years old, and the drug itself was first produced in the 1930s. What costs could they still have to pay off?

Comment #91: sunsin  on  02/26  at  01:11 AM

Well, ok, but they don’t. The average pharma company has an “R&D;” budget equal to approximately 2% of their advertising budget.

The 2000 biotechs out there spend close to 100% on R&D;, since they have no product and nothing to sell. They do this in hopes that Big Pharma will purchase them. Without Big Pharma providing this liquidity in the market, there is no R&D;. Pharma needs money to purchase the tech.

Right, so not really any kind of research or development. The investment is in FDA approval, not in the scientific development of new drugs. Phase III trials aren’t “research”, they’re “trials.” It’s right there in the name!

No, R&D;refers to everything up till approval, including phase III. There’s a lot of science going on here as they are turning a mere compound into medicine. It has to be formulated and the proper dosing has to be discovered. Indeed, this is the most expensive part of the process. They are indeed developing drugs here.

Right - the most important and significant part.

Only if you don’t give a rats ass about actual medicine. I mean the clinical trials cover such stuff as how the compound reacts in HUMANS. Or how about a little thing called safety.

Comment #92: Manju  on  02/27  at  03:27 AM
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