``..The pharmaceuticals are indeed a problem. Even in countries with national health systems, AFAIK, the pharma companies are private we can't get socialism all in one leap.
As for the bad health effects of the existing capitalist system, there's no doubt that they are real...'' JJ
----
What amazes me is that many of the structures and institutions for socializing healthcare are already in place and can be manipulated into easing the burden off a huge number of people. But what has been developed are an endless series of weighted regulations that effectively increase the burden on the individual and away from the service delivery system.
You can start just about anywhere in this vast system. Start with the pharma industry and the FDA. You can drop prices by getting rid of patent extensions and shortening the time a patent runs. You can start a system that `ages' drugs into the generic tract very quickly. You can start beefing up the testing schedules and adjusting the protocols for other drugs so that wide spread clinic testing is available for people who want to try new drugs for chronic conditions, but completely open availability is limited until trials are determinant. I am thinking about anti-depressants and HIV for example. Nobody seems to know how ADs work, which strikes me as dangerous, but if people want them and understand they are lab animals, then fine.
You can virtually erase the war on drugs (and de-populate the prison industrial complex at the same time) by getting rid of the `controlled substances' classification and converting most of these back into prescription schedules. You can lighten up the prescription system itself with reclassifications that don't require an MD prescription. Some drugs require monitoring that are quite common, while others are for short term use and don't need much follow-up at all. Drugs like cortisone for example do need to be monitored more heavily than say birth control pills. Anti-biotics need monitoring even if they are for short term use to keep them from being over used. Various kinds of lab tests and other monitoring systems don't particularly need MDs except on some initial evaluation and some later follow-up.
There is a whole section of the pharma industry that has patents on testing schemes, disposable kits, protocols, QA and associated chemistries that really need to become generic from the get go. In fact a lot of the expense of lab testing is directly tied to the cost of these one use, patented disposable kits.
Another way to cut down costs is to really regulate---duh. For example the FDA can approve a general approach, design or protocol and coordinate with the patent system so that fifteen meaningless variations on exactly the same thing isn't patentable.
The idea that any of this is an increase in `government control' is just bullshit since government created the same controls to privilege profit schemes rather than medical care in the first place.
As to the health effects of capitalism... Gee. You think maybe neoliberalism is killing us? Yeah I think so. That's were the burden of cost for health care belongs since that's where the costs are generated. Since when was free and unlimited access to a healthy work force a corporate right?
The healthcare issue has been so heavily conflated by neoliberal garbage that most people forget that we already have a national socialized medicine system but it is means tested (medicare, medicaid). Private insurance companies should hardly bitch since they are the enforcement, billing, and payment contractors.
The most direct route to socialized medicine is to make the Medicare Medicaid systems (overhauling HICFA at the same time) more widely available by moving the `means tested' scale upward to included more people and covering all of some classes for some schedules. For example, all children under twelve should be covered for yearly comprehensive pediatric medical exams that include vision, hearing, and dental, as well as vaccinations. You can adjust these schedules for teenagers to include elementary sex education, birth control, contraception, STDs, (and yes abortion on demand), or pregnancy and pre-natal care, and so forth. These would be voluntary procedures and systems that are free or with a very modest co-pay for those able to pay. You can make some of this available through the local school systems (thus helping to re-fund the public health school nurses who used to be part of the public education system). You can outline a variety of emergency triage and stabilization schedules that cover most classes with a sliding scale of co-pay for follow-up admissions and more extensive treatment. The vast majority of ER visits do not result in admissions. If you target this kind of care to the county and city publicly funded hospitals and clinics, then you automatically rehabilitate those service delivery systems---since the feds would be essentially paying counties and cities to provide medical care.
Then you can also re-establish federal support for the states county hospital systems by privileging these systems for the federally subsidized nursing and medical school intern and resident placements (plus increasing those placements). You can channel public funding away from private medical education and toward state run schools and country hospitals and re-vitalize all these crumbling systems.
When all of these adjustments are coordinated together, it seems to me you could get a vast improvement in medical care and coverage, and almost none of this needs some grand legislative packaging to promote. All of it can be done under minor regulatory reform legislation. What's really missing (besides zero political will) is understanding (or caring) how all these pieces can be fit together.
At least part of the problem with healthcare reform discussions, is they focus on the individual recipient, rather than on the service delivery systems. The essential problem is the system not the person. Notice that the usual way to kill healthcare reform is drive discussions into a corner over `ballooning' costs, as if the individual's health and desire is the issue. But the ballooning costs are being driven by the existing system's unlimited profit taking schemes, not the individual's health problems or their presumed unlimited desires to be put under the knife. We haven't suddenly gotten sicker or developed some strange taste for expensive procedures. The system has gotten sicker and developed an un-strange profit making taste for more exotic procedures. The chronic disease driving up medical care costs is profit.
The presumed `crisis' is almost entirely smoke and mirrors to obscure and obfuscate the nature of the problem and to make believe that some how people have developed some exploding `need' for medical care. Au contraire mon amis. It is a neurosis of the health insurance industry which seems to be gripped by a bi-polar disorder over its own highly questionable need to be the center of attention in every discussion. As if insurance companies have anything to do with healthcare. Fucking ridiculous.
Explain it to me jackoff. Yes, the big ugly dick moist with its own neoliberal dew must go in deeper. Oh,... my god that feels good.
CG