5 ms·

I've had to use the CDC lab to figure out a drug-resistant Trichomonas infection. Lots of very skilled people at that facility and this is a bad one to lose; it

I've had to use the CDC lab to figure out a drug-resistant Trichomonas infection. Lots of very skilled people at that facility and this is a bad one to lose; it was the only lab that did those sorts of tests. There's not enough money in it for commercial labs.

pfannkuchen 2y ago
How is there not enough money in it? Do only poor people get these sorts of issues? Serious question, no shade on poor people.
- Cthulhu_ 2y ago
  The article mentions something about resistant strains; that's going to be low volume, so high upfront investments for a one time result. In theory, I'm not an expert. But this is the problem with capitalism and health care, the providers just stop if there's not enough money in it for them.
  - AnthonyMouse 2y ago
    > But this is the problem with capitalism and health care, the providers just stop if there's not enough money in it for them. Is this supposed to be a flaw? If the cost of a lab is $500/patient then the patient (or their insurance) pays the $500 and the lab exists. If the cost of the lab is $50,000,000/patient, the lab probably shouldn't be funded, because its cost/benefit ratio is very bad and the same money could have saved more lives by putting it somewhere else. What would you do in the alternative? Have the government provide unlimited funding for things that cost more than they're worth?
    - RandomLensman 2y ago
      Who determines "worth"? What's the RoE on the military or poetry, for example?
      - AnthonyMouse 2y ago
        > But this is the problem with capitalism and health care, the providers just stop if there's not enough money in it for them. That's precisely the question, isn't it? In the case of medical treatment, you decide. Do you want to run a test if it costs you $500? What if it's $50,000,000? Or, in practice, you decide ahead of time by choosing how much insurance to carry, and then it's the premiums on insurance that would cover $50M tests that probably isn't worth it to you. You might then have concerns about people who can't afford a reasonable amount of insurance, but that's a question of whether the government should provide insurance subsidies to the poor, not a question of who decides how much is worth having. Do you even want someone other than yourself deciding the most that can be spent on saving your life? > What's the RoE on the military or poetry, for example? Defense and copyright are tragedy of the commons. Everybody wants there to be a military force to fend off invaders but the benefits redound to everyone, including people who don't pay. People have the incentive not to pay as long as someone else is covering the cost, but then since everyone has that incentive it would end up under-funded. As a result there is a law requiring everyone to pay. The way things like that ought to work is that there should have to be a separate vote by the general public in order to increase the budget for that specific department. Then bloated budgets get voted down because the public can see when they're excessive. Medical facilities aren't a tragedy of the commons. You pay for one if you need it and if there are enough people who need one to pay for it to exist, it does. If there aren't, by what reasoning should it? The people paying are the same people using it and they don't value it by as much as it costs.
        piva00 2y ago
        > Medical facilities aren't a tragedy of the commons. You pay for one if you need it and if there are enough people who need one to pay for it to exist, it does. If there aren't, by what reasoning should it? The people paying are the same people using it and they don't value it by as much as it costs. So if you have a very rare disease which might cost a lot more to treat because there's no economies of scale you are... Not worth it? Your life is unworthy because it's unprofitable to save you? Or your mom, dad, sibling, loved one? You need to be very, very deep into pure inhumane financial thinking to even consider this as a good outcome for a society. Please die if it's too expensive to care for you, it's economical eugenics.
    - quantified 2y ago
      STDs spread. It's not just the one patient who benefits, is it? Fantasize about people not spreading STDs all you want, it came from somewhere and can go further. Public health isn't just the one person.
      - Volundr 1y ago
        Exactly this. If it's a novel test, it might cost $50,000 a person to do the test, while if it's mainstream and your doing millions, it might cost $50. Doing the test on one person at $50k may prevent you from ever having to reach the scale where you can do it for $50 (but have millions of infections).
      - AnthonyMouse 1y ago
        > STDs spread. It's not just the one patient who benefits, is it? You're making the case that the market would have the incentive to provide these things because the insurance company would rather pay for an expensive test than have a larger number of claims if the disease spreads.
        quantified 1y ago
        People would rather stick their heads in the sand on average. Insurance companies would be spending on cheaper preventions for all kinds of things instead of expensive cures if they operated like you describe. They'd be ripping a new one in the meat industry to forestall antibiotic resistance, for example.
        AnthonyMouse 1y ago
        > Insurance companies would be spending on cheaper preventions for all kinds of things instead of expensive cures if they operated like you describe. The existing law has a massive defect that prevents any of that sort of thing from happening right now. We capped insurance company profits as a percentage of claims, so the only way they can make more money is by paying out more and bigger claims. We basically banned them from having any incentive to lower costs because now lower costs mean lower profits instead of higher ones. But that's a flaw in the existing system, not a flaw in the general concept. > They'd be ripping a new one in the meat industry to forestall antibiotic resistance, for example. There are already various state and federal laws restricting the use of antibiotics in livestock. But in general what leverage does an insurance company have over the meat industry?
    - johnnyanmac 1y ago
      >Is this supposed to be a flaw? Yes. If Salk had this mentality, then Polio may stand up there with cancer and AIDS as one of the big 3 killers. Instead, he spread the solution and its nearly eradicated in the world. we might have also tried to monetize the COVID vaccine and grind the US into an early depression with that kind of thinking. >What would you do in the alternative? Fund the science and make use of taxpayer money to advance society instead of giving billionaires tax cuts. You'd think a community focused on tech would undersand that you can't treat skilled thinking the same way as an assembly line.
      - AnthonyMouse 1y ago
        > If Salk had this mentality, then Polio may stand up there with cancer and AIDS as one of the big 3 killers. If Salk had this mentality, the patent still would have expired after 17 years and he could have used the money to try to cure cancer or AIDS. > we might have also tried to monetize the COVID vaccine and grind the US into an early depression with that kind of thinking. Three different companies developed a COVID vaccine and it's not the kind of market where you can make more money by charging a million dollars each to a hundred people than by charging $100 each to the insurance companies of a billion people. > Fund the science and make use of taxpayer money to advance society instead of giving billionaires tax cuts. "Giving billionaires tax cuts" is not the only alternative use for the money and isn't even necessarily a worse one. If someone is a billionaire because of regulatory capture and monopolistic practices then we shouldn't be giving them anything, we should be breaking up their companies and eliminating the laws they bought to concentrate the market. If they're a billionaire because they built an honest company that employs thousands of people and makes useful products for reasonable prices, that's the thing that gives the government anything to tax in order to provide roads and schools and provides people with jobs and goods and services. We want more of that. Taking more of the money away should only be done if the government's use for it is high value. Which, by definition, things with a poor cost/benefit ratio aren't.
    - meristohm 1y ago
      Okay Tina. (In the words of Margaret Thatcher, there is no alternative.) What are some non-money ways to value what we do for each other?
      - AnthonyMouse 1y ago
        You're asking a philosophical question about what is still fundamentally an economics problem. Suppose we have a program which is saving lives for $50M each. There are other ways to spend the money that would save lives for $10,000 each. If we have $50M, should we save one life or 5000? This is not an academic trade off, it's what actually happens whenever the government allocates money to something with poor cost/benefit because there actually are ways to save lives or do other highly valuable things for even less than that amount of money and we don't have unlimited resources.
- Traubenfuchs 2y ago
  > Do only poor people get these sorts of issues? The millionaires in city center penthouses I have orgies with and sometimes meet in the spaceship-like waiting room of the fancy dermatologist in my home city and I say no.
- colechristensen 2y ago
  I believe it is of the "there's only one lab in the world that does this kind of thing" variety. Testing and various services for extremely rare diseases.
- SequoiaHope 2y ago
  It is so very important that we all understand this: not everything worth doing is profitable. Not everything which creates value for the economy or protects society is profitable. A system that expects all worthwhile things to be profitable will simply fail to do all worthwhile things and society will be worse for it. That society may appear to be functioning but it will not be the best society possible.
  - dapf 2y ago
    [dead]
  - ffsm8 2y ago
    > A system that expects all worthwhile things to be profitable will simply fail to do all worthwhile things and society will be worse for it I agree with the spirit of your message, but you're going way too far using all there. Some are not profitable, and the society is likely better off to socialize these. As a simple example: it's not profitable to provide food and housing for people without means, but if you don't, your society will be worse off - simply because these people will be forced into directions that are generally harmful to your living spaces. Sure, you could increase police presence in this particular example, but that'd still be an effective socialization, because now you just put them on jail, which is even more costly then just providing them housing and food.
    - johnnyanmac 1y ago
      Medical is pretty much the worst of both worlds. It generally isn't profitable and you need some of the most skilled personnel in the world to perform it. Thus, it is nigh impossible to socialize in the same way you can at least attempt to create shantytowns or gangs as socialized substitutes for enforcement and housing
      - AnthonyMouse 1y ago
        Where does "it generally isn't profitable" come from? The US healthcare system has many flaws, but lack of profitable medical facilities doesn't seem to be one of them. General healthcare is a very ordinary market. You want to go to the doctor once a year to get checked out, they send your blood to a lab to check your cholesterol etc., you pay them money for this. If they find some condition with a known treatment, you pay for the treatment. In case the treatment is very expensive, you buy insurance ahead of time. The reason people hate it is that people are willing to do anything in order to not die, so they want that level of resources to be available to them, but they don't actually want to pay anything, or to be denied if they decline to pay an extraordinarily large amount, because the alternative is death. But "pay a lot of money or people die" is the nature of it. You can try to paper over it with insurance or taxpayer subsidies but that trade off is inherent and that it makes people uncomfortable doesn't change the fact.
xtiansimon 2y ago
“There's not enough money in it for commercial labs.” == government’s duty

pfannkuchen 2y ago

How is there not enough money in it? Do only poor people get these sorts of issues? Serious question, no shade on poor people.

Cthulhu_ 2y ago
The article mentions something about resistant strains; that's going to be low volume, so high upfront investments for a one time result. In theory, I'm not an expert. But this is the problem with capitalism and health care, the providers just stop if there's not enough money in it for them.
- AnthonyMouse 2y ago
  > But this is the problem with capitalism and health care, the providers just stop if there's not enough money in it for them. Is this supposed to be a flaw? If the cost of a lab is $500/patient then the patient (or their insurance) pays the $500 and the lab exists. If the cost of the lab is $50,000,000/patient, the lab probably shouldn't be funded, because its cost/benefit ratio is very bad and the same money could have saved more lives by putting it somewhere else. What would you do in the alternative? Have the government provide unlimited funding for things that cost more than they're worth?
  - RandomLensman 2y ago
    Who determines "worth"? What's the RoE on the military or poetry, for example?
    - AnthonyMouse 2y ago
      > But this is the problem with capitalism and health care, the providers just stop if there's not enough money in it for them. That's precisely the question, isn't it? In the case of medical treatment, you decide. Do you want to run a test if it costs you $500? What if it's $50,000,000? Or, in practice, you decide ahead of time by choosing how much insurance to carry, and then it's the premiums on insurance that would cover $50M tests that probably isn't worth it to you. You might then have concerns about people who can't afford a reasonable amount of insurance, but that's a question of whether the government should provide insurance subsidies to the poor, not a question of who decides how much is worth having. Do you even want someone other than yourself deciding the most that can be spent on saving your life? > What's the RoE on the military or poetry, for example? Defense and copyright are tragedy of the commons. Everybody wants there to be a military force to fend off invaders but the benefits redound to everyone, including people who don't pay. People have the incentive not to pay as long as someone else is covering the cost, but then since everyone has that incentive it would end up under-funded. As a result there is a law requiring everyone to pay. The way things like that ought to work is that there should have to be a separate vote by the general public in order to increase the budget for that specific department. Then bloated budgets get voted down because the public can see when they're excessive. Medical facilities aren't a tragedy of the commons. You pay for one if you need it and if there are enough people who need one to pay for it to exist, it does. If there aren't, by what reasoning should it? The people paying are the same people using it and they don't value it by as much as it costs.
      - piva00 2y ago
        > Medical facilities aren't a tragedy of the commons. You pay for one if you need it and if there are enough people who need one to pay for it to exist, it does. If there aren't, by what reasoning should it? The people paying are the same people using it and they don't value it by as much as it costs. So if you have a very rare disease which might cost a lot more to treat because there's no economies of scale you are... Not worth it? Your life is unworthy because it's unprofitable to save you? Or your mom, dad, sibling, loved one? You need to be very, very deep into pure inhumane financial thinking to even consider this as a good outcome for a society. Please die if it's too expensive to care for you, it's economical eugenics.
  - quantified 2y ago
    STDs spread. It's not just the one patient who benefits, is it? Fantasize about people not spreading STDs all you want, it came from somewhere and can go further. Public health isn't just the one person.
    - Volundr 1y ago
      Exactly this. If it's a novel test, it might cost $50,000 a person to do the test, while if it's mainstream and your doing millions, it might cost $50. Doing the test on one person at $50k may prevent you from ever having to reach the scale where you can do it for $50 (but have millions of infections).
    - AnthonyMouse 1y ago
      > STDs spread. It's not just the one patient who benefits, is it? You're making the case that the market would have the incentive to provide these things because the insurance company would rather pay for an expensive test than have a larger number of claims if the disease spreads.
      - quantified 1y ago
        People would rather stick their heads in the sand on average. Insurance companies would be spending on cheaper preventions for all kinds of things instead of expensive cures if they operated like you describe. They'd be ripping a new one in the meat industry to forestall antibiotic resistance, for example.
        AnthonyMouse 1y ago
        > Insurance companies would be spending on cheaper preventions for all kinds of things instead of expensive cures if they operated like you describe. The existing law has a massive defect that prevents any of that sort of thing from happening right now. We capped insurance company profits as a percentage of claims, so the only way they can make more money is by paying out more and bigger claims. We basically banned them from having any incentive to lower costs because now lower costs mean lower profits instead of higher ones. But that's a flaw in the existing system, not a flaw in the general concept. > They'd be ripping a new one in the meat industry to forestall antibiotic resistance, for example. There are already various state and federal laws restricting the use of antibiotics in livestock. But in general what leverage does an insurance company have over the meat industry?
  - johnnyanmac 1y ago
    >Is this supposed to be a flaw? Yes. If Salk had this mentality, then Polio may stand up there with cancer and AIDS as one of the big 3 killers. Instead, he spread the solution and its nearly eradicated in the world. we might have also tried to monetize the COVID vaccine and grind the US into an early depression with that kind of thinking. >What would you do in the alternative? Fund the science and make use of taxpayer money to advance society instead of giving billionaires tax cuts. You'd think a community focused on tech would undersand that you can't treat skilled thinking the same way as an assembly line.
    - AnthonyMouse 1y ago
      > If Salk had this mentality, then Polio may stand up there with cancer and AIDS as one of the big 3 killers. If Salk had this mentality, the patent still would have expired after 17 years and he could have used the money to try to cure cancer or AIDS. > we might have also tried to monetize the COVID vaccine and grind the US into an early depression with that kind of thinking. Three different companies developed a COVID vaccine and it's not the kind of market where you can make more money by charging a million dollars each to a hundred people than by charging $100 each to the insurance companies of a billion people. > Fund the science and make use of taxpayer money to advance society instead of giving billionaires tax cuts. "Giving billionaires tax cuts" is not the only alternative use for the money and isn't even necessarily a worse one. If someone is a billionaire because of regulatory capture and monopolistic practices then we shouldn't be giving them anything, we should be breaking up their companies and eliminating the laws they bought to concentrate the market. If they're a billionaire because they built an honest company that employs thousands of people and makes useful products for reasonable prices, that's the thing that gives the government anything to tax in order to provide roads and schools and provides people with jobs and goods and services. We want more of that. Taking more of the money away should only be done if the government's use for it is high value. Which, by definition, things with a poor cost/benefit ratio aren't.
  - meristohm 1y ago
    Okay Tina. (In the words of Margaret Thatcher, there is no alternative.) What are some non-money ways to value what we do for each other?
    - AnthonyMouse 1y ago
      You're asking a philosophical question about what is still fundamentally an economics problem. Suppose we have a program which is saving lives for $50M each. There are other ways to spend the money that would save lives for $10,000 each. If we have $50M, should we save one life or 5000? This is not an academic trade off, it's what actually happens whenever the government allocates money to something with poor cost/benefit because there actually are ways to save lives or do other highly valuable things for even less than that amount of money and we don't have unlimited resources.
Traubenfuchs 2y ago
> Do only poor people get these sorts of issues? The millionaires in city center penthouses I have orgies with and sometimes meet in the spaceship-like waiting room of the fancy dermatologist in my home city and I say no.
colechristensen 2y ago
I believe it is of the "there's only one lab in the world that does this kind of thing" variety. Testing and various services for extremely rare diseases.
SequoiaHope 2y ago
It is so very important that we all understand this: not everything worth doing is profitable. Not everything which creates value for the economy or protects society is profitable. A system that expects all worthwhile things to be profitable will simply fail to do all worthwhile things and society will be worse for it. That society may appear to be functioning but it will not be the best society possible.
- dapf 2y ago
  [dead]
- ffsm8 2y ago
  > A system that expects all worthwhile things to be profitable will simply fail to do all worthwhile things and society will be worse for it I agree with the spirit of your message, but you're going way too far using all there. Some are not profitable, and the society is likely better off to socialize these. As a simple example: it's not profitable to provide food and housing for people without means, but if you don't, your society will be worse off - simply because these people will be forced into directions that are generally harmful to your living spaces. Sure, you could increase police presence in this particular example, but that'd still be an effective socialization, because now you just put them on jail, which is even more costly then just providing them housing and food.
  - johnnyanmac 1y ago
    Medical is pretty much the worst of both worlds. It generally isn't profitable and you need some of the most skilled personnel in the world to perform it. Thus, it is nigh impossible to socialize in the same way you can at least attempt to create shantytowns or gangs as socialized substitutes for enforcement and housing
    - AnthonyMouse 1y ago
      Where does "it generally isn't profitable" come from? The US healthcare system has many flaws, but lack of profitable medical facilities doesn't seem to be one of them. General healthcare is a very ordinary market. You want to go to the doctor once a year to get checked out, they send your blood to a lab to check your cholesterol etc., you pay them money for this. If they find some condition with a known treatment, you pay for the treatment. In case the treatment is very expensive, you buy insurance ahead of time. The reason people hate it is that people are willing to do anything in order to not die, so they want that level of resources to be available to them, but they don't actually want to pay anything, or to be denied if they decline to pay an extraordinarily large amount, because the alternative is death. But "pay a lot of money or people die" is the nature of it. You can try to paper over it with insurance or taxpayer subsidies but that trade off is inherent and that it makes people uncomfortable doesn't change the fact.

xtiansimon 2y ago

“There's not enough money in it for commercial labs.” == government’s duty