9 ms·

This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life.

folli 7y ago
Universal healthcare won't help you there, since it also requires a stringent cost-benefit-calculation, e.g. the British system is very (in)famous for this.
- orhmeh09 7y ago
  Ah, but then you have all these with the ever-increasing demand for profit and the issues caused by that incentive on top of it all. Is that an improvement?
- DanBC 7y ago
  > e.g. the British system There isn't a "british" system because health is devolved. There are four separate systems, one each for Scotland, Northern Ireland, Wales, and England. > requires a stringent cost-benefit-calculation There are lots of problems with the English NHS, but this is almost never one of them. Unless you have particular examples?
  - philjohn 7y ago
    I'm assuming it's the widely debunked "death panel" talk that was doing the rounds during the ACA debate.
- philjohn 7y ago
  That is for approving new treatments, not for ongoing lifesaving care, so is an apples to oranges comparison IMHO. The drug needs to have a proven benefit, which usually comes down to how much longer does it give you, if it's only marginally better than the existing treatment, but orders of magnitude more expensive they work with the manufacturer to bring the cost down to where it can be approved. A lot of what was written about the UK system during the ACA debate was outright falshoods or misrepresentations (e.g. the infamous "death panels", whilst ignoring the Kafkaesque nightmare that can be the US system). Tell you what, I'd take the NHS over what you've got any day of the week, as would the vast majority of people in the UK.
zndr 7y ago
So, this is why, at least in the US, EU and a few other countries, we have orphan drug policies. If you don't know orphan drugs are drugs that could be a life saving medical necessity for rare diseases that do not have a large enough base of users to make the drugs affordable. I'm not talking about Shkreli "affordable", but it's literally not feasible to spin up manufacturing, or final trials, or educational materials for doctors affordable. So governments offer massive subsidies or cost investments for some of these drugs that often only help TENS of people, not hundreds, or thousands or millions. What's missing is a similar policy for funding otherwise for-profit efforts like the authors.Educational tools and products are often seen as less valuable but I believe they could be immensely helpful. Now as to the authors original flaws? Well, his product has a clear sell-through referral potential, but it's not really functional to do so with prescription drugs. That being said, selling this product to a CVS or a webmd as a feature could be really good, or major hospital networks, or heck even pharma companies. But all of that is often year+ sales cycles, you can't just luck into that.
- andrey_utkin 7y ago
  You do realise that every dollar invested into low scale consumption matter is a dollar not invested into high scale consumption matter?
planetzero 7y ago
"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D. The US is the back-bone of the medical system for the rest of the world and also has the best medical schools and best quality hospitals (the majority of people with money come to the US for life-saving surgeries..this has to tell you something). We need to push the true costs of things to the patient, which will force the price down...not replace the existing inefficient layer of the insurance companies with an even more inefficient layer called the government. This has worked with many cosmetic surgeries, which used to be very expensive, but aren't covered by insurance. Insurance should only cover rare surgeries that can't use the free market to reduce the costs. I can't think of anything that the government runs better than the private sector. Healthcare is no different.
- NeedMoreTea 7y ago
  Don't have to put money into R&D. Between the MRC and NIHR, the UK's NHS puts at least a couple of billions (Sterling) into clinical research each year, making them the largest clinical research funder in Europe. They're not researching generics. Oh and they were one of the original funders of PubMed Europe. I can think of lots of things the government does better than the private sector, although admittedly outside the US.
- pgsbathhouse 7y ago
  >Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D. This is a completely false right-wing talking point. It takes 10 minutes to uncover how just totally bullshit this is. Don't ever repeat again or anything remotely like it (aka the rest of your post). https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://other98.com/taxpayers-fund-pharma-research-development/ https://other98.com/taxpayers-fund-pharma-research-developme... The government never sees a return in any form on the money taxpayers put forth. But private companies do. Just waiting like vultures to snag whatever makes it through the proof of concept phase and claim credit. >I can't think of anything that the government runs better than the private sector. ISP's? Roads? Social services? Schools? Emergency Services?
ericmcer 7y ago
At least in the above scenario the hospital has a financial incentive to treat you (part of why we perform loads of unnecessary surgeries in this country). I’m for a public system I just think it is very difficult to do correctly, and if we go into it with idealism instead of extreme pessimism we will fail to secure it against those who prey on exploiting public money.
- TheOtherHobbes 7y ago
  Private healthcare already preys on exploiting the money of the public. I'm not convinced the distinction between "public money" and "the money of the public" is particularly clear in these situations. And of course you don't need a hypothetical "correct" solution - just one that's clearly less exploitative of consumers.
avip 7y ago
You will be facing same financial dilemmas with public healthcare. But it may be more transparent.
0xdeadbeefbabe 7y ago
> because tech people are so idealistic Unless idealism is the strategy to combat idealism?
gen220 7y ago
Just my opinion, but I don't think "private markets" are incompatible with a proper valuation of human life? It's a bit macabre, but, to me, "dead people don't pay taxes / generate GDP" seems pretty interchangeable with "dead people don't pay insurance premiums / contribute to a risk pool". To me, the problem is that billed medical costs (what the hospital charges you) have come unhinged from realized medical costs (what the hospital spends on helping you, including salaries, supplies, etc). If that world is alien-sounding, it's similar to how the billed education costs at universities have come unhinged from realized education costs. In both of those environments, the ballooning costs seem to be propped up by well-intentioned but fundamentally "unnatural" source of funds, in the form of government subsidies. These have been exploited by profiteering and accounting optimizations, over the course of literal decades. If your surgery costs 2k to perform, the hospital will happily charge you 20k, collect 3k in insurance, and write off the remaining 17k as un-recovered medical expense, for which the government will reimburse some portion. The more obvious solution to me, would be to take a hard look at how these subsidies are actually used (/gamed), and steadily reduce/focus them over time, so that hospitals don't have an incentive to inflate costs. The source of the problem isn't anything fundamental about "the private market", it's rather about the current set of public incentives that have distorted the private market into it's current form.
flarg 7y ago
No it isn't. Even in the UK the much vaunted GP will reject any health initiatives unless they help improve their bottom line. And the initiatives are from the NHS and are free!
nec4b 7y ago
An honest question, what value does the government assign to the human life in your opinion? In my experience the elites from countries with universal healthcare seek treatment for themselves and their families in countries which have private options, while the majority of the population is stuck in long waiting lines and substandard care. In Micheal Moore's Sicko Slovenia was mentioned as role model because its universal healthcare. Well it just happens that if you need a thumb operation you only have to wait 13 years there to get your turn. [1] Wouldn't the rational response be to asses both pluses and minuses of public and private healthcare, recognize that not all health related problems are the same and build a better system from first principles rather than shoot blanket ideological responses? [1] - https://translate.google.com/translate?sl=sl&tl=en&u=https%3A%2F%2Fwww.rtvslo.si%2Fzdravje%2Fnovice%2Fneverjetnih-13-let-cakalne-dobe-za-operacijo-noznega-palca%2F509241 https://translate.google.com/translate?sl=sl&tl=en&u=https%3...
ci5er 7y ago
What is the proper value of human life? Does it change over time? And is the budget-wise national-healthcare-system administrator qualified to make that determination for you? And, if they do not want you to get better while waiting on line (most people do bet better for most things, except, broken legs, without treatment) or want you to die while waiting on line, why are the lines so long? In any case, even in Singapore, with arguably the best-balanced system in the world, things are complicated, when people's lives are on the line... https://faculty.chicagobooth.edu/john.cochrane/research/papers/after_aca.pdf https://faculty.chicagobooth.edu/john.cochrane/research/pape...

folli 7y ago

Universal healthcare won't help you there, since it also requires a stringent cost-benefit-calculation, e.g. the British system is very (in)famous for this.

orhmeh09 7y ago
Ah, but then you have all these with the ever-increasing demand for profit and the issues caused by that incentive on top of it all. Is that an improvement?
DanBC 7y ago
> e.g. the British system There isn't a "british" system because health is devolved. There are four separate systems, one each for Scotland, Northern Ireland, Wales, and England. > requires a stringent cost-benefit-calculation There are lots of problems with the English NHS, but this is almost never one of them. Unless you have particular examples?
- philjohn 7y ago
  I'm assuming it's the widely debunked "death panel" talk that was doing the rounds during the ACA debate.
philjohn 7y ago
That is for approving new treatments, not for ongoing lifesaving care, so is an apples to oranges comparison IMHO. The drug needs to have a proven benefit, which usually comes down to how much longer does it give you, if it's only marginally better than the existing treatment, but orders of magnitude more expensive they work with the manufacturer to bring the cost down to where it can be approved. A lot of what was written about the UK system during the ACA debate was outright falshoods or misrepresentations (e.g. the infamous "death panels", whilst ignoring the Kafkaesque nightmare that can be the US system). Tell you what, I'd take the NHS over what you've got any day of the week, as would the vast majority of people in the UK.

zndr 7y ago

So, this is why, at least in the US, EU and a few other countries, we have orphan drug policies. If you don't know orphan drugs are drugs that could be a life saving medical necessity for rare diseases that do not have a large enough base of users to make the drugs affordable. I'm not talking about Shkreli "affordable", but it's literally not feasible to spin up manufacturing, or final trials, or educational materials for doctors affordable. So governments offer massive subsidies or cost investments for some of these drugs that often only help TENS of people, not hundreds, or thousands or millions. What's missing is a similar policy for funding otherwise for-profit efforts like the authors.Educational tools and products are often seen as less valuable but I believe they could be immensely helpful. Now as to the authors original flaws? Well, his product has a clear sell-through referral potential, but it's not really functional to do so with prescription drugs. That being said, selling this product to a CVS or a webmd as a feature could be really good, or major hospital networks, or heck even pharma companies. But all of that is often year+ sales cycles, you can't just luck into that.

andrey_utkin 7y ago
You do realise that every dollar invested into low scale consumption matter is a dollar not invested into high scale consumption matter?

planetzero 7y ago

"This is precisely why we need universal healthcare. The incentive structure of private markets don't properly value human life." Government-run healthcare isn't a panacea that will 'value human life' any more than the insurance companies. You are still a number in a database somewhere. Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D. The US is the back-bone of the medical system for the rest of the world and also has the best medical schools and best quality hospitals (the majority of people with money come to the US for life-saving surgeries..this has to tell you something). We need to push the true costs of things to the patient, which will force the price down...not replace the existing inefficient layer of the insurance companies with an even more inefficient layer called the government. This has worked with many cosmetic surgeries, which used to be very expensive, but aren't covered by insurance. Insurance should only cover rare surgeries that can't use the free market to reduce the costs. I can't think of anything that the government runs better than the private sector. Healthcare is no different.

NeedMoreTea 7y ago
Don't have to put money into R&D. Between the MRC and NIHR, the UK's NHS puts at least a couple of billions (Sterling) into clinical research each year, making them the largest clinical research funder in Europe. They're not researching generics. Oh and they were one of the original funders of PubMed Europe. I can think of lots of things the government does better than the private sector, although admittedly outside the US.
pgsbathhouse 7y ago
>Most new drugs come out of the US and socialized governments create generics at a fraction of the cost, because they don't have to put any money into R&D. This is a completely false right-wing talking point. It takes 10 minutes to uncover how just totally bullshit this is. Don't ever repeat again or anything remotely like it (aka the rest of your post). https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://www.ncbi.nlm.nih.gov/books/NBK50972/ https://other98.com/taxpayers-fund-pharma-research-development/ https://other98.com/taxpayers-fund-pharma-research-developme... The government never sees a return in any form on the money taxpayers put forth. But private companies do. Just waiting like vultures to snag whatever makes it through the proof of concept phase and claim credit. >I can't think of anything that the government runs better than the private sector. ISP's? Roads? Social services? Schools? Emergency Services?

ericmcer 7y ago

At least in the above scenario the hospital has a financial incentive to treat you (part of why we perform loads of unnecessary surgeries in this country). I’m for a public system I just think it is very difficult to do correctly, and if we go into it with idealism instead of extreme pessimism we will fail to secure it against those who prey on exploiting public money.

TheOtherHobbes 7y ago
Private healthcare already preys on exploiting the money of the public. I'm not convinced the distinction between "public money" and "the money of the public" is particularly clear in these situations. And of course you don't need a hypothetical "correct" solution - just one that's clearly less exploitative of consumers.

avip 7y ago

You will be facing same financial dilemmas with public healthcare. But it may be more transparent.

0xdeadbeefbabe 7y ago

> because tech people are so idealistic Unless idealism is the strategy to combat idealism?

gen220 7y ago

Just my opinion, but I don't think "private markets" are incompatible with a proper valuation of human life? It's a bit macabre, but, to me, "dead people don't pay taxes / generate GDP" seems pretty interchangeable with "dead people don't pay insurance premiums / contribute to a risk pool". To me, the problem is that billed medical costs (what the hospital charges you) have come unhinged from realized medical costs (what the hospital spends on helping you, including salaries, supplies, etc). If that world is alien-sounding, it's similar to how the billed education costs at universities have come unhinged from realized education costs. In both of those environments, the ballooning costs seem to be propped up by well-intentioned but fundamentally "unnatural" source of funds, in the form of government subsidies. These have been exploited by profiteering and accounting optimizations, over the course of literal decades. If your surgery costs 2k to perform, the hospital will happily charge you 20k, collect 3k in insurance, and write off the remaining 17k as un-recovered medical expense, for which the government will reimburse some portion. The more obvious solution to me, would be to take a hard look at how these subsidies are actually used (/gamed), and steadily reduce/focus them over time, so that hospitals don't have an incentive to inflate costs. The source of the problem isn't anything fundamental about "the private market", it's rather about the current set of public incentives that have distorted the private market into it's current form.

flarg 7y ago

No it isn't. Even in the UK the much vaunted GP will reject any health initiatives unless they help improve their bottom line. And the initiatives are from the NHS and are free!

nec4b 7y ago

An honest question, what value does the government assign to the human life in your opinion? In my experience the elites from countries with universal healthcare seek treatment for themselves and their families in countries which have private options, while the majority of the population is stuck in long waiting lines and substandard care. In Micheal Moore's Sicko Slovenia was mentioned as role model because its universal healthcare. Well it just happens that if you need a thumb operation you only have to wait 13 years there to get your turn. [1] Wouldn't the rational response be to asses both pluses and minuses of public and private healthcare, recognize that not all health related problems are the same and build a better system from first principles rather than shoot blanket ideological responses? [1] - https://translate.google.com/translate?sl=sl&tl=en&u=https%3A%2F%2Fwww.rtvslo.si%2Fzdravje%2Fnovice%2Fneverjetnih-13-let-cakalne-dobe-za-operacijo-noznega-palca%2F509241 https://translate.google.com/translate?sl=sl&tl=en&u=https%3...

ci5er 7y ago

What is the proper value of human life? Does it change over time? And is the budget-wise national-healthcare-system administrator qualified to make that determination for you? And, if they do not want you to get better while waiting on line (most people do bet better for most things, except, broken legs, without treatment) or want you to die while waiting on line, why are the lines so long? In any case, even in Singapore, with arguably the best-balanced system in the world, things are complicated, when people's lives are on the line... https://faculty.chicagobooth.edu/john.cochrane/research/papers/after_aca.pdf https://faculty.chicagobooth.edu/john.cochrane/research/pape...