On 2016-08-19 15:45, jbeattie wrote:
> On Friday, August 19, 2016 at 2:11:19 PM UTC-7, Joerg wrote:
>
> <snip>
>
>> 1. It is not socialized medicine, you have both private and
>> government health plans. Similar in Germany. I know because I have
>> lived there and had health insurance there. For decades.
>
> That is true. I misspoke about Belgium, it is a hybrid system -- but
> still far different from the US.
>
http://www.expatica.com/be/healthcare/Healthcare-in-Belgium_100097.html
> I did not misspeak about the other social services provided with
> tax-payer funds.
>
>> 2. It does not matter what sort of insurance, government-based or
>> not, a country has. A cost is a cost is a cost. Or do you truly
>> believe that the cost of a stenting procedure will miraculously be
>> lower because the Euros reimbursed by a goverment are somehow
>> "other" Euros than those coming from an HMO?
>
> Yes. Covered procedures are reimbursed at rates negotiated by
> insurers and doctors.
>
> A cost is not a cost is not a cost. The manufacturing cost for a
> stent is calculable and probably $.50 including materials and
> allocated overhead/R&D, etc.
Very wrong. I worked in that field.
> ... The cost of a stenting procedure,
> however, is whatever the market will allow.
In truly socialized plans it is not. There is a fixed reimbursement rate
and that's it. This is the case, for example, for Medicare patients.
> ... The market price in
> Belgium is depressed by the staggering number of doctors per capita
> and the rates that will be paid by the sick funds.
>
https://www.quora.com/How-does-the-healthcare-system-in-Belgium-work
>
> You cannot tie any of the price differential to the US tort system or
> the absence of "tort reform." The fact is, we have a
> medical-industrial complex that is fleecing us -- and Belgium has
> what conservatives call "socialized medicine."
We have both. Drug companies that are fleecing us and lawyers that are
fleecing us. Guess who ends up paying the $100k/year malpractice
premiums for a cardiologist. And the guy had a no-claim history.
> although he rolled-over on that one ...
And there we have one of his many mistakes.
> ... in consideration for exacting an
> excise tax of sorts from the drug manufacturers
Which was meshugginah to begin with and rightfully got repealed. That
tax has cost scores of jobs in the US. I saw it coming and bowed out of
medical devices in time.
> ... and some price
> concessions for drugs purchased under Coverage D in the doughnut hole
> (IIRC).
>
> The problem with ACA is that reimbursement for drugs is low -- there
> is a lot of out of pocket payable by the insured. But as for prices,
> go complain to big pharma.
>
No, let people buy outside the country. Simple.
>
>>> Costs for certain drugs and devices may be lower in some
>>> countries due to lighter regulation, but that is another issue --
>>> and one we could argue forever. I'm happy we never got
>>> Thalidomide in the US. OTOH, some drugs and devices are held off
>>> the market too long.
>>>
>>
>> But Canada did and they have the socialized medicine you seem to
>> like so much.
>
> Canada did what? I like Canada. My wife buys her drugs in Canada.
>
Drugs are cheaper there but if your are living there obtaining good
health care quickly unravels once you develop some serious or unsual
ailment. Then you either hightail it to the US or likely die.
>>>> The other effect is this: Many companies insist that I carry
>>>> professional liability. Every single time I honestly and
>>>> dutifully checked the box "Are you involved in the design of
>>>> medical devices?" it resulted in a decline-to-quote. Even
>>>> Lloyds of London declined. If I'd have been a rusty oil tanker
>>>> I guess they'd have underwritten. The consequence of this is
>>>> that if a client won't or can't cover liability on my part I
>>>> will not work for them. In pretty much all cases that had
>>>> resulted in the product not getting designed. While in Europe
>>>> we never had that issue. However, my insurer over there made it
>>>> crystal-clear that the insurance does not cover the US.
>>>
>>> Try my client Medmarc.
http://www.medmarc.com/Pages/default.aspx
>>> You're clearly not going to the right market.
>>>
>>
>> Thanks, but I got tired of filling out length applications only to
>> get a decline. Plus I am gradually retiring. Looks like they are
>> more geared towards companies, not individual consultants:
>>
>>
http://www.medmarc.com/Products/Insurance-Coverages/Pages/EO-Coverage-Features.aspx
>>
>>
>>
Among other avenues I have used a seasoned PL broker who knows the
>> market intimately. He tried a few carriers where he thought they
>> might but no dice.
>
> You need to go to a broker with access to Lloyds markets or better
> specialty markets.
>
As I mentioned earlier I _had_ a lengthy international conference call
with Lloyds in which three high level folks from London participated.
Mainly because I publicly complained about the fact that Marsh/IEEE
would decline to quote for med-tech guys. Rocking the boat is my style
in such situations and gets attention.
>>> If you are creating super-important medical devices that can
>>> kill people if they go wrong, then you should have appropriate
>>> insurance. You kill my family, I'll sue you. In Somalia, I would
>>> kill you. My heart does not go out to you.
>>>
>>
>> My clients must sign my agreement that has them carry liability.
>> But it doesn't matter much anymore because Obamacare has snuffed
>> out much of this market. I saw that coming in 2009 and swung the
>> steering wheel around, designing mostly industrial, ag, oil, gas,
>> aerospace electronics.
>
> How has ACA killed your business? I don't get it at all. ACA has
> been a feeding trough for hospitals and drug makers, and that's why
> even The Donald would not get rid of it.
>
Ever heard of ... the Medical Device tax? It's repealed now but it like
with spilled milk, once spilled you can't get much of it back into the
pot. Then there were all sorts of reimbursement rules and gravitation to
nonessential stuff such as elective sex change surgery.
In the VC world you could hear a loud tire screech when Obamacare became
law. No venture capital -> no job growth.
> On the one hand, you complain about the cost of healthcare in the US
> as compared to Belgium, but then you complain about a US attempt at
> trying to provide Belgium-like coverage under ACA (although far
> further away from socialized medicine than in Belgium). You complain
> about Obama raising the price of drugs when ACA does not set the
> price of drugs. You complain about the corporate tax rate as killing
> businesses, yet start-ups pay little, if any, in corporate taxes.
> You claim businesses are moving off-shore because of corporate tax
> rates, but you don't understand how corporate taxes work.
>
Belgium and most other countries where Americans falsely believe there'd
be purely socialized medicine in reality have a two-tier system. One is
government controlled and fairly restrictive in the care you get. The
other one is private and much richer in options. In _both_ there are
serious cost advantages and a large part of the reason is that their
tort law is not as screwed up as ours.
> Go to the Caribbean, but don't expect to escape taxes on your
> US-related income -- and when companies go to the Caribbean, they
> don't really GO to the Caribbean; they just incorporate there UNLESS
> they are going to the Caribbean for cheap labor. Sure, you
> personally or some small business could go to another country to
> avoid US taxes -- assuming you stopped making ANY money in the US.
> But the big multi-national corporations continue paying US taxes.
> They just shelter their foreign earnings.
>
It's not about me or other individuals. It's about companies. As I said
my former employer is moving to Costa Rica. They are in very good
company down there, in Coyol you almost don't need to speak Spanish.