4 ms·

Reminds me in some way of this tweet from PG last year: > Paul Graham (@pg) — Markets are usually quite clever but one place they break is in encouraging treat

by markbao 11y ago

Reminds me in some way of this tweet from PG last year: > Paul Graham (@pg) — Markets are usually quite clever but one place they break is in encouraging treatments rather than vaccines. Subscription revenue. https://twitter.com/paulg/status/498875418527543297 https://twitter.com/paulg/status/498875418527543297

mdpopescu 11y ago
As someone else already replied, that's an incentive problem. If you change the incentives to "pay $X a month while healthy, pay nothing when sick" then the profit would be in the cure. Unfortunately, we switched from that a while ago (my understanding is that we used to do "pay while healthy" around the 1900s) and now the current way seems "normal".
- paxcoder 11y ago
  While what US has now is bad, your solution is not complete: One can imagine that in your scenario a doctor can claim you're not really sick, or lie that you have been cured. So what actually becomes profitable is not treating people.
- caskance 11y ago
  That's essentially just the divide between fee for service and capitation, both common models. HMOs work the way you describe. ACOs have been around not as long (at least, by that name) but became big with Obamacare and essentially do the same thing.
- bartkappenburg 11y ago
  How about getting less sick by using a cure? That's still sick but the cure works (but maybe not in the strict definition of 'cure').
- Fomite 11y ago
  Except that tweet isn't really accurate - vaccine research is pretty active, and modern, new vaccines have made their makers a fair bit of money. Beyond that, vaccines are a "Pay $X per month while healthy" treatment - you have to treat everyone whether they're sick or not, and as long as humans keep breeding, you have a replenishing customer base unless we manage the (rare) feat of eradication. The problem is that modern vaccine targets are hard. Multiple strains, dangerous responses from partial immunity (Dengue), very rapid viral evolution (HIV, flu), etc.
  - maxerickson 11y ago
    What about stuff that isn't very transmissible person to person? (like Lyme disease, which had a vaccine pulled, I'm under the impression that it was not pulled for great reasons)
    - Fomite 11y ago
      One of my examples, dengue, is vector born, like Lyme. That's no promise the vaccine will be easy to develop. In the case of Lyme, I'd assert there's very few drug development paradigms that are robust to anti-scientific hysterics (says the person at a conference that regularly gets chronic Lyme picketers).

by markbao 11y ago

mdpopescu 11y ago

As someone else already replied, that's an incentive problem. If you change the incentives to "pay $X a month while healthy, pay nothing when sick" then the profit would be in the cure. Unfortunately, we switched from that a while ago (my understanding is that we used to do "pay while healthy" around the 1900s) and now the current way seems "normal".

paxcoder 11y ago
While what US has now is bad, your solution is not complete: One can imagine that in your scenario a doctor can claim you're not really sick, or lie that you have been cured. So what actually becomes profitable is not treating people.
caskance 11y ago
That's essentially just the divide between fee for service and capitation, both common models. HMOs work the way you describe. ACOs have been around not as long (at least, by that name) but became big with Obamacare and essentially do the same thing.
bartkappenburg 11y ago
How about getting less sick by using a cure? That's still sick but the cure works (but maybe not in the strict definition of 'cure').
Fomite 11y ago
Except that tweet isn't really accurate - vaccine research is pretty active, and modern, new vaccines have made their makers a fair bit of money. Beyond that, vaccines are a "Pay $X per month while healthy" treatment - you have to treat everyone whether they're sick or not, and as long as humans keep breeding, you have a replenishing customer base unless we manage the (rare) feat of eradication. The problem is that modern vaccine targets are hard. Multiple strains, dangerous responses from partial immunity (Dengue), very rapid viral evolution (HIV, flu), etc.
- maxerickson 11y ago
  What about stuff that isn't very transmissible person to person? (like Lyme disease, which had a vaccine pulled, I'm under the impression that it was not pulled for great reasons)
  - Fomite 11y ago
    One of my examples, dengue, is vector born, like Lyme. That's no promise the vaccine will be easy to develop. In the case of Lyme, I'd assert there's very few drug development paradigms that are robust to anti-scientific hysterics (says the person at a conference that regularly gets chronic Lyme picketers).