13 ms·
Ray Dalio talks about this phenomenon in his free book Big Debt Crises. He shows data that debt bubbles are cyclical and exhibit the same characteristics each t
by Sargos 7y ago
Ray Dalio talks about this phenomenon in his free book Big Debt Crises. He shows data that debt bubbles are cyclical and exhibit the same characteristics each time. The debt bubble that played out from 1927-1940 also exhibited increasing wealth inequality which led to massive social and political volatility. In relation to that cycle we are around 1936.
Income inequality and political crisis will likely be very high in the coming years (even as it's already high as you can probably tell by recent events) and we might see some pretty stark changes in our economy and policies. Perhaps more social programs to lessen the damage of the gap such as free healthcare or universal basic income. The recurring bubbles do hurt but eventually they give way to the next cycle of debt inflation and exuberance.
- on_and_off 7y agoAs somebody having moved from a country with a good health care system (ie even if you are poor, going to the doctor is not a big issue), the us health care system is definitely one of the most shocking aspects of this country. It is extremely weird how the USA feel like a mix of first and third world countries.
- codingslave 7y agoThe thing is, the USA has subsidized everyone elses health care systems. All major health care innovations were invented here. So when your drug prices are cheap, its because your country has access to free USA drug innovation. What created modern health care (free market privatized drug companies and equipment manufacturers), also causes health care to be a broken system. Theres two sides to this coin
- 9HZZRfNlpR 7y agoWhat is the source of this all meds are created in the USA? Plenty of strong European companies out there, now of course all companies are global. I'm trying to get some strong arguments since i hear this all the time. Also, by that thinking, all the suckers and losers in the market subsidize others.
- fooker 7y ago> All major health care innovations were invented here. Citation needed.
- malandrew 7y agohttps://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Me... I never went through the whole list because it took a super long time, but when I tried sampling where most of these ~300 drugs were developed, it was like 80% developed in the US. I got through like 50-60 of them before I gave up. 50-60 should be good enough to be representative of the 300 or so. Feel free to go through them yourself if you don't believe me.
- brmgb 7y ago> Feel free to go through them yourself if you don't believe me. I didn't so I did. I checked the first thirty listed in the Wikipedia article. Of those, only 8 have been developed in the USA including one developed by the American branch of a Swiss company. That's merely 26%. Not insignificant but quite far from 80%. After a quick sampling of the rest I would be surprised if the exact proportion is above a third.
- malandrew 7y agoI just went through the first 24 and you couldn't possibly have gone through the first 30 since I hit 8 drugs developed in the US in the first 20. So you're clearly lying about fact checking my statement. 11 were developed in the US and one more was introduced to western medicine by an American traveling. And if you only include drugs developed in the last 100 years, of which there are 14, 10 were developed in the United States, so 71%. What has the rest of the World been doing for the last century? Halothane - England (1956) Isoflurane - United States (1979) Nitrous Oxide - England (1772) Oxygen - N/A Ketamine - United States (1966) Propofol - United States (1989) Bupivacaine - Sweden (1957) Lidocaine - Sweden (1885) Ephedrine - China (?, introduced to western medicine by an American traveling to China) Atropine - Germany (1833) Midazolam - United States (1976) Morphine - Germany (1803) Aspirin - France (1853) Ibuprofen England (1953) Paracetamol - United States (1877) Codeine - France (1832) Fentanyl - United States (1960) Methadone - Germany (1937) Amitriptyline - United States (1960) Cyclizine - United States (1947) Dexamethasone - United States (1957) Diazepam - United States (1959) Docusate - ??? Fluoxetine - United States (1972) It's ridiculous how hard it is to figure out where most of these were developed. When I first went through the WHO list, I did so in reverse by year of discovery: https://en.wikipedia.org/wiki/List_of_drugs_by_year_of_discovery https://en.wikipedia.org/wiki/List_of_drugs_by_year_of_disco...
- robert_foss 7y agoI think this is a very commonly told story in the US. I would like to see the data backing it up.
- Ididntdothis 7y agoThere is no data. Everything in the US medical system is opaque. It’s the same story with hospitals. They say they have to overcharge everybody to compensate for the people who don’t pay. But there are no real numbers to demonstrate that.
- paulsutter 7y agoEnough Americans believe this myth to perpetuate the insane costs and poor service that we endure here
- coldtea 7y ago>The thing is, the USA has subsidized everyone elses health care systems. All major health care innovations were invented here. So when your drug prices are cheap, its because your country has access to free USA drug innovation. Sorry, what? My country doesn't have any "free access" to drug innovation, it pays mucho dinero to buy drugs, and American companies hold and enforce all kinds of patents on them. It's also not some "one way" innovation street. Tons of medical/drug innovation, especially all the major "low hanging fruits" (which make up for most of modern health benefits) up to the mid-20th century came from outside the USA. And that's not counting all the major European etc drug companies GlaxoSmithKline (British), La Roche (Swiss), Novartis (Swiss), Sanofi-Aventis (French), Bayer (German), Boehringer Ingelheim (German), etc. Of the top 5 grossing drug companies, only 1 is American (#1 Pfizer). And the revenues of #1 are close to the revenues of #2 and #3, (45 vs 40 and 38 billion) so it's not like some great disparity where Pfizer takes all. Not to mention that a lot of "USA innovations" were created by immigrants, whose country of origin paid for their raising, education, etc, even up to their undergraduate degree, and then they went to the USA and innovated as researchers... Slow down with the chauvinism...
- malandrew 7y agoOnce the patents expire, your country gets the free access. If you didn't develop a drug or pay for its development, but get access to it one day at only the cost of manufacture, then you're getting the R&D for free. All of the drug companies you mentioned, while not founded in America, do most of their R&D in America. You're right about many immigrants developing those drugs, but they came to America to do so. You should ask yourself "why?" For the record, I'm an immigrant to the US.
- coldtea 7y ago>Once the patents expire, your country gets the free access. Everybody gets the free access (including other American companies). Like you get free access to European drugs, once the patents expire. But all this is played into the cost of the drug while the patent holds. Nobody sells drugs at a cost, so there's that... >All of the drug companies you mentioned, while not founded in America, do most of their R&D in America. That's just wrong. >You're right about many immigrants developing those drugs, but they came to America to do so. You should ask yourself "why?" More cushioned life, compared to a place like China (at least of yore), and opportunities to make it big in business.
- peteretep 7y agoRight, I mean, aside from Roche, Novartis, Bayer, GlaxoSmithKline, Sanofi, AstraZeneca, Teva, Takeda, Merck, NovoNordisk, the synthesis of antibiotics and vaccines and modern surgery, what have the non-Americans ever contributed?!?!?!?!!!!!! > All major health care innovations were invented here To quote Rage Against the Machine: whoever told you that is your enemy
- chipotle_coyote 7y agoSince people were asking for citations, here's a couple, but they seem to contradict your assertion: "US Pharmaceutical Innovation in an International Context," the American Journal of Public Health. "We explored whether the United States is responsible for the development of a disproportionate share of the New Molecular Entities (NMEs) produced worldwide. [...] The United States was responsible for the development of 43.7% of the NMEs. The United Kingdom, Switzerland, and a few other countries innovated proportionally more than their contribution to GDP or prescription drug spending, whereas Japan, South Korea, and a few other countries innovated less. Conclusion: Higher prescription drug spending in the United States does not disproportionately privilege domestic innovation, and many countries with drug price regulation were significant contributors to pharmaceutical innovation." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/ "Global Drug Discovery: Europe is Ahead," Health Affairs Vol. 28 Supplement 1. "It is widely believed that the United States has eclipsed Europe in pharmaceutical research productivity. Some leading analysts claim that although fewer drugs have been discovered worldwide over the past decade, most are therapeutically important. Yet a comprehensive data set of all new chemical entities approved between 1982 and 2003 shows that the United States never overtook Europe in research productivity, and that Europe in fact is pulling ahead of U.S. productivity. Other large studies show that most new drugs add few if any clinical benefits over previously discovered drugs." https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.5.w969 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.5.... The argument that the US "subsidizes" the rest of the world's health care is something that US pharmaceutical companies would very much like us to believe, but the evidence for it appears to be pretty shaky.
- malandrew 7y ago> We collected data on NMEs approved between 1992 and 2004 and assigned each NME to an inventor country. I'm curious why they chose that time period. It was published in 2010. This omits 6 years between publication date of the article and the end of the range they chose and omitted all data prior to 1992. How would the data differ if you didn't choose this 12 year period? > although fewer drugs have been discovered worldwide over the past decade, most are therapeutically important. > Other large studies show that most new drugs add few if any clinical benefits over previously discovered drugs. These two statements contradict one another and the second one sounds awfully like moving the goal posts because the data doesn't support the conclusions.
- JauntTrooper 7y agoRoche and Novartis are Swiss. GlaxoSmithKline is British. AstraZeneca is British/Swedish. Sanofi is French. Novo Nordisk is Danish. Bayer is German. Takeda and Daiichi Sanyko are Japanese. Teva is Israeli.
- tracker1 7y agoIt's less subsidizing as what a controlled market allows. Dual sourcing requirements and limiting extension patents would go a long way. Combined with a fiduciary responsibility for insurance (and more so medicare) negotiations on behalf of clients.
- throwaway156503 7y agoWhat's not often discussed in the same conversation is how high your effective tax rate is. Most Americans think the idea of, for example, a 58-61% effective tax rate in Sweden is simply ridiculous.
- on_and_off 7y agoFunny you would mention Sweden, it is on the top of the list of countries I plan to move to after spending some time in the USA :)
- yakz 7y agoBut don't you need to add in the employer+employee health insurance premium on top of the taxes for most Americans?
- throwaway156503 7y agoYes, but compared to an effective tax rate of 2X.XX%, most Americans do not pay 40% of their gross income to health care, and they like it that way. Everyone wants affordable healthcare in America, the question is a matter of where Americans spend on line items, but the debates in America revolve mostly around ideological concepts and not budget concerns directly.
- AstralStorm 7y agoThe remaining question is: if you spent the extra 10%, would you get Canadian levels of healthcare or not, for everyone? Also why compare to Sweden, cherrypicking? Could pick any other EU country. Or Canada. And it's not 40% towards healthcare. It's at most 27% of total tax (less because it's bracketed alongside education) - most of tax is other social spending, a lot of that being retired people. So healthcare is 7-10% of Sweden's GDP, or so. And falling. This being one of the most expensive healthcare systems in the EU, if not the most expensive. I guess you're trying to hide that your argument is invalid. Trying to justify US mismanagement or lack of health policies. For your information, USA spend almost 18% of GDP on government funded healthcare. And still rising. And USA is 28% richer than Sweden per capita, PPP normalized. This ignores additional private costs, which are probably significant. And getting very uneven access. Some in insurance and medical industry are striking it rich, who cares about social costs. A) https://en.wikipedia.org/wiki/Taxation_in_Sweden https://en.wikipedia.org/wiki/Taxation_in_Sweden B) https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html https://www.cms.gov/research-statistics-data-and-systems/sta... C) https://www.nationmaster.com/country-info/compare/Sweden/United-States/Economy https://www.nationmaster.com/country-info/compare/Sweden/Uni... Who cares about reality when there's a narrative waiting to be pushed.
- 033803throwaway 7y agoAlways keep in mind: the US spends more per capita on public healthcare than any other country in the world, except Norway[1] We pay for a single payer system, we just don't get it. [1] - https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
- wolco 7y agoYou trade that capital for increased jobs and profit. There is a health admin layer that exists that creates roles strictly to deal with insurance. There are insurance divisions that couldn't exist if insurance wasn't required with each transaction.
- spiralx 7y agoMost countries with universal coverage operate on some kind of insurance model, many with private providers, yet don't spend as much as the US does. Insurance companies are a factor in American health care costs but they're not the sole reason.
- fooker 7y agoSpends in paper. Getting billed 5000$ for an x-ray doesn't happen in most other countries.
- Retric 7y agoNo, the US government is actually #2 in handing money per person to healthcare companies. Though some of this is government employees or retirees. We also subsidize the most expensive people, including the elderly and people with cancer and AIDS. Plus, we directly subsidize hospitals in rural areas etc. It’s a giant flood of money.
- fooker 7y agoYou started with 'no', but then wrote nothing to contradict me.
- dzonga 7y agoI came from Zimbabwe, and the US is simply a rich third world country. oppression is the same, biased media as well which is polarized along political lines.
- Ididntdothis 7y ago“In relation to that cycle we are around 1936.” Let’s hope we don’t need a big war to get the country back on track ....
- mhroth 7y agoYeah, I'm trying to avoid 1939.
- AnimalMuppet 7y agoSo in this view, 1929 corresponds to 2008? But I'm not sure that it's going to play out the same, because the Fed took unprecedented action to keep 2011 from looking like 1932. They were not at all the same - we never hit 35% unemployment, nor anything like it, even if you take "discouraged workers" into account.
- RickJWagner 7y agoDalio is an interesting (and controversial) guy. I'll be very interested to see how his All Weather Portfolio (as told by Tony Robbins) does over the next decade.