4 ms·

I feel kinda bad for the writer, because it's a good question: no, curing patients is not a good business model, just like public transit is not a good business

I feel kinda bad for the writer, because it's a good question: no, curing patients is not a good business model, just like public transit is not a good business model. What a lot of folks neglect are N+1-order effects, because those are harder to quantify and fail to reach the predetermined decision some executive or board or shareholder has already made. Is curing patients a bad business model? Sure, for the biotech company it is, but those cured patients are far more likely to go on living longer, healthier lives, and in turn contribute additional value to society - which will impact others in ways that may also create additional value. That doesn't even get into the jobs and value created through the R&D process, testing, manufacturing, logistics of delivery, ongoing monitoring, etc. As long as the value created is more than the cost of the treatment, then it's a net-gain for the economy even if it's a net loss for that singular business. If all you're judging is the first-order impacts on a single business, you're missing the forest for the trees.

anonymouskimmer 11mo ago
If a person dies from a disorder in their 20s, they'll never buy your heart medication in their 70s. Today's patient is tomorrow's patient.
- Spooky23 11mo ago
  The issue with that logic there is those basic drugs are mostly generic now. That money is less, and goes to the PBM and generic manufacturers in India.
- stego-tech 11mo ago
  The longer someone lives, the more potential value they can contribute to a society. The opportunity cost is something we've figured out from a medical perspective, but shareholders want returns today, not returns fifty years from now. That is what we need to address.
  - jojobas 11mo ago
    They could use profit in 50 years, but it will possibly be someone else's profit.
    - bluGill 11mo ago
      If the executive lives longer it is their profit.
      - jojobas 11mo ago
        It could be a different company's profit.
  - reactordev 11mo ago
    The longer someone lives, the more potential value can be squeezed. This is how they should think.
    - tartoran 11mo ago
      I don't like the squeezing mindset but if people contribute to their health insurance and don't use those services because they're healthy it could be seen as squeezing those patients but it really isn't, it's just how insurance should work.
  - lotsofpulp 11mo ago
    >The longer someone lives, the more potential value they can contribute to a society. This is a function of how old the sick person is, as well as how severe their sickness and hence recovery will be. The data says, for the most part, healthcare is needed when one is close in age to exhausting their body’s capability anyway.
  - shridharxp 11mo ago
    >The longer someone lives, the more potential value they can contribute to a society. This is questionable. Highly populous countries have worse living conditions than moderately populous ones, currently.
- jagged-chisel 11mo ago
  Treat vs cure. You treat them so you can go on treating them. If you cure them, maybe you’ll treat them later and or maybe you won’t - but that’s outside the current bonus cycle / opportunity window.
  - animal531 11mo ago
    I'm not sure I agree, when we humans only lived for 50 years there were no time to develop any range of other diseases that we are experiencing now in later life, so even if you cure A there will definitely be many many opportunities to treat anywhere from B-Z.
- com2kid 11mo ago
  The FDA needs to declare death a disease that patentable drugs can be developed against. All of a sudden the flood gates get opened to encouraging drug research on anything that keeps people alive longer.
  - sebmellen 11mo ago
    I quite like this concept. Did you come up with it?
    - com2kid 11mo ago
      No, it is a common trope in futurism circles. Because death is not technically a disease, right now if a company came up with a literal immortality pill they wouldn't be able to get it patented or get FDA approval for it.
      - philipkglass 11mo ago
        It's a common trope but also wrong. If you invent a pill that gives old people the mental and physical vigor of 25 year olds, you don't need to patent or trial it as an immortality pill. Just pick one of the many medical conditions associated with advancing age, like osteoporosis or male pattern baldness, and prove that it safely and effectively treats that condition. If the pill cures baldness and also gives patients improved muscle tone and working memory as a side effect, the FDA won't complain about those beneficial side effects. Once the drug is approved for treating baldness it can be prescribed off-label for other conditions and/or the manufacturer can progressively run trials for treating additional conditions, similar to how GLP-1 drugs originally developed for diabetes treatment have now been tested and approved for treating obesity.
        com2kid 11mo ago
        > Just pick one of the many medical conditions associated with advancing age, like osteoporosis or male pattern baldness, A drug that maintained telomere length doesn't treat anything directly. A drug that slows down metabolism and extends life by 20% on average, not patentable.
- FerretFred 11mo ago
  Yeah, maybe not cure them as such, maybe just get them to a healthy-enough state to go back to functioning but still needing The Medication.
- wodenokoto 11mo ago
  That is not the alternative to curing disease that is being proposed. The choice is between healing for good or keep on continued medication. Or more bluntly: sell a product or sell a subscription
  - anonymouskimmer 11mo ago
    The point I was trying to make is that most pharma companies have many products for many disorders and diseases. Curing one of those diseases will make a few life-long patients for some of your non-curing treatments.
thousand_nights 11mo ago
yeah but the pharma comapnies are only in the business of selling drugs so they would need to diversify into retirement homes or somnething to profit from actually curing people
- stego-tech 11mo ago
  I mean, that's one way to look at it I suppose, and it's why you see Healthcare Insurers and Private Equity diversify into elder care for a captive audience. In reality though, I was not-so-subtly trying to suggest that if something is necessary for the public good (curing diseases) but a bad business model, then perhaps Capitalism itself is the wrong vehicle for that segment of industry and a different option - be it an incentive structure, government-owned pharmaceutical research, or managed economy - is needed. Society fundamentally needs things that are simply bad business - sheltering everyone (lowers long-term housing revenue), feeding everyone (lowers long-term food revenue), healing everyone (lowers long-term healthcare revenue), educating everyone (lowers the value of degrees/credentials). If our economic model prohibits or discourages achieving optimal resource usage and human outcomes, then it's our obligation to explore and identify alternatives that may improve those outcomes respectively.
  - tacitusarc 11mo ago
    > In reality though, I was not-so-subtly trying to suggest that if something is necessary for the public good (curing diseases) but a bad business model, then perhaps Capitalism itself is the wrong vehicle for that segment of industry and a different option - be it an incentive structure, government-owned pharmaceutical research, or managed economy - is needed. I believe the great innovation of capitalism is markets, and the next era of economic and social progress will be driven by mixed capital/social good markets. For example, what if you tied the tax rate for an industry to a combination of broad social goods (say, homelessness) and industry-specific goods (say the incidence rate of cancer for cancer drug companies), such that if we’re in a the middle of a homelessness crisis and many people have cancer, the tax rate might be 50%, vs if there is virtually no homelessness and we’ve cured cancer, maybe it’s 10%. Obviously there are other market approaches but eventually they would be converted to capital markets, so something like the above makes sense to me as a start.
kiba 11mo ago
With public transit, value capture is possible if you have the right business model. Public transit is ultimately real estate development. However, I prefer that the value capture is by the public rather than a private corporation.
- stego-tech 11mo ago
  Public Transit was very much thrown in there as an example of the kinds of societal-good projects that often are "bad" business models or run at a loss (Japan being a very notable exception, kinda). Thing is, anyone even casually looking at n+1-order effects sees that the value created isn't for the transit system itself, but all the components that make it function (jobs, logistics, and materials for trains, rails, signals, ports, tunnels, etc) and all the effects of easing people movement (more money to spend, more job opportunities, cleaner air, safer streets, etc). Real estate is one such effect, provided communities recognize the benefit of real estate near stations and not let naysayers constrict development around them (like you see in much of America, for some reason).
im3w1l 11mo ago
I think it's the opposite. I think people are very aware of those effects, and that's actually why they ask the question in the first place. They ask it "is this good business" not just because they care about the answer itself but because they want to start a debate on how society should promote the invention of cures. Like I think most people in most industries are passionate people that really want to do good, but they do need to eat too.
- devsda 11mo ago
  Do you believe the current medical research is held back by the price limitations and if we just infuse more money, we'll find cure for many more diseases ? Even if we consider that, we'll reach the same position as today because if only rich can afford medicine, the market will price that in and it's customer who can barely afford the medicine will shift from middle class to upper middle class and so on.
selcuka 11mo ago
> I feel kinda bad for the writer, because it's a good question: no, curing patients is not a good business model, just like public transit is not a good business model. Betteridge's law of headlines: "Any headline that ends in a question mark can be answered by the word no."
- energy123 11mo ago
  Energy123's law of headlines: Any headline that ends in a question mark will have an associated comments section mentioning Betteridge's law, despite that law having being empirically falsified.
  - selcuka 11mo ago
    Selcuk's Law of Generalisations: Any mention of an adage will have an associated comment claiming that it can be falsified by giving at least one counter-example.
    - energy123 11mo ago
      The answer is 'yes' more than 50% of the time according to a few studies. It's not just one counter-example.
    - nvader 11mo ago
      To you and your parent, I present: Nvader's law: Any law you named after yourself is ipso facto much less impressive.
charcircuit 11mo ago
>just like public transit is not a good business model. Uber has almost a 200B market cap for offering private transit. There is a working business model for transit.
- richbell 11mo ago
  Uber's business model is to be a loss leader to hamper competition, then jack up rider rates and lower drive rates. This is technically a 'working' business model, but hardly one that benefits the people.
  - exasperaited 11mo ago
    Uber more generally exists not as a service provider but as an international legislative bulldozer: everywhere will be reduced to the misery of the land of the free. They exist only to fuck up worker protections in every form they take.
- loeg 11mo ago
  Not sure if this is just a misunderstanding but Uber is not "public transit" (a term of art), which is what GP is talking about. Uber is just not relevant to the point GP was making.
BrenBarn 11mo ago
> If all you're judging is the first-order impacts on a single business, you're missing the forest for the trees. The problem is our society is set up to give a lot of power and influence to businesses that are precisely interested in their own tree and not interested in the forest at all.
m463 11mo ago
if there was a way to support this say in taxes, it would make good business sense. But the devil is in the details of implementing that.
tptacek 11mo ago
Saying that curing diseases is a bad business model is like saying discovering the world's largest gold mine would be a bad business because you'd eventually run out of gold. The underlying argument doesn't make sense.
- navigate8310 11mo ago
  When the supply runs dry, demand will naturally increase. Hoarders will be golden at that stage.
  - nvader 11mo ago
    "I've seen gluts not followed by shortages, but I've never seen a shortage not followed by a glut." -- Nassim Taleb
- energy123 11mo ago
  The argument only makes sense under certain assumptions: you can't protect the IP from being copied (leading to competition and eroding economic rents), or the government will place a price ceiling (price controls). Otherwise, the demand will be highly inelastic, so you cannot really invent a better business model. The pricing power you would wield as the monopoly provider of life & death would be tremendous. It would be fruitful to put the example in the article under closer scrutiny.
- PunchyHamster 11mo ago
  It does make sense if you turn it around "Having permanent patient by treating only symptoms is better than curing them right away" Basically living (comfortably, or at all) as a subscription service
  - tptacek 11mo ago
    No, this is the basic naive argument I'm responding to. It's nice to have long-term recurring revenue, but customers have a very strong preference for a cure, which means the owners of cures will outcompete the owners of subscription treatments. And then to say those cure-owners are in a "bad business", again, is like saying you'd go "aw shucks" if you happened on an enormous seam of gold.
Aurornis 11mo ago
> As long as the value created is more than the cost of the treatment, then it's a net-gain for the economy even if it's a net loss for that singular business. This is precisely the type of work that is best funded through government: Work that can be net positive for the populace but doesn’t have a viable business model attached. There’s another layer to consider even with government-driven efforts: Resources are never infinite. The number of potential R&D opportunities exceeds available research dollars and even human personnel many times over. There comes a point when you need to allocate finite resources to the efforts that provide better cost to benefit ratios. I don’t think it’s helpful to go full hardcore utilitarian, but the reality can be that the cost of coming up with a cure for a rare genetic condition that impacts only a small number of people might be better spent on research toward a drug which incrementally reduces heart disease, for example. Finding permanent cures for rare conditions is a heart-warming idea, but in reality it’s a lot harder and more expensive than most people assume. Likewise, when people become enamored with these ideas of finding permanent cures for rare genetic ideas they can be missing the big picture that it may not be one of the better uses of that money even if you took raw capitalism and investment dollars out of the picture. There are so many more opportunities for widespread health improvement in the boring conditions and even lifestyle diseases than in hypothetically curing the rare genetic conditions. It may not feel as heart-warming to talk about things like reducing obesity, but we’re witnessing an incredible society-wide health improvement with GLP-1 drugs that is orders of magnitude more benefit across society than something like curing a rare genetic disease.
socalgal2 11mo ago
> ~public~ transit is not a good business model. ~public~ transit can be a good business model if it's setup correctly. The majority of Japan's 100 train companies are setup such that they own both trains and complementary interests. Office buildings, shopping centers, super markets, apartments. The better their trains are the better their other businesses do by delivering people to them. The better their other businesses are the more people want to use their trains. https://ir.tokyu.co.jp/ja/ir/news/auto_20251111595684/pdfFile.pdf https://ir.tokyu.co.jp/ja/ir/news/auto_20251111595684/pdfFil...
- appreciatorBus 11mo ago
  Yup. North American public transit is frequently a terrible business model because North American land use is designed to push everyone’s daily destinations further and further apart, making all transportation more expensive, and making transit uncompetitive with anything else.
- Ferret7446 11mo ago
  While public transit is a good business model, corrupt public transit is an even better business model. The amount of public funds that some US public transit funnels away is astounding.
- ehnto 11mo ago
  It's fair to note that Japan's private rail networks have often been joint public/private investments, but I don't think that negates your point. I think public transit is something the public should invest in, profitable or not, as a service to ourselves (the public). But it can also be done profitably in certain circumstances.
  - socalgal2 11mo ago
    I think trying to get the incentives right is important and that "public" transit rarely gets it right. It relies on politicians to fund it and they have so many strings being pulled on that they can rarely give it the funding it needs. It will always show up as an expense and as such there will always be an incentive to cut funding to "lower the expense". If they ever have a surplus it will be syphoned off to something else instead of invested. Of course many cities have great "public" (run by the government) transportation for some definition of "great" but many have issues of funding. IIUC, NYC and London are both seriously underfunded. Conversely, AFAICT, these private Japanese trains in a city of a comparible size are not. If you don't want to compare to Tokyo, then compare to Osaka https://www.keihan.co.jp/corporate/ir/individual/ https://www.keihan.co.jp/corporate/ir/individual/ https://www.hankyu-hanshin.co.jp/docs/integratedreport2025_j_view.pdf https://www.hankyu-hanshin.co.jp/docs/integratedreport2025_j...
bluGill 11mo ago
Public transit is a good business model if you don't have to compete with government subsdized roads and you don't have government limits on what you can charge. Good luck finding anyplace without those.
- devsda 11mo ago
  > Public transit is a good business model if you don't have to compete with government subsdized roads and you don't have government limits on what you can charge Without subsidized roads, its easy for deep pockets to offer exorbitant prices for land and monopolize the roads. Anyone not planning to charge high prices for usage will be held off by high acquisition prices at "market" rates. There's only so much land and roads possible to a given location, privatized roads is like giving default monopoly. It will turn out just like the isp situation, only worse.
  - bluGill 11mo ago
    Subways in NYC had found ways to compete with each other before the government took over. (though admittedly this was enabled by very dense areas, and long term not the best for the overall city). However your point is destroyed by counter example.
brianwawok 11mo ago
With that logic curing someone of a deadly disease at 10 is good for society because they have much to contribute, but curing someone at 80 is bad for society because their best contributions are behind - and they are a net resource drain. That’s not a good path to head down. (Cure a doctor he generates value, don’t cure a prisoner he drains value).
danielmarkbruce 11mo ago
>> If all you're judging is the first-order impacts on a single business, you're missing the forest for the trees. This is one of those things that sounds clever but is total nonsense. Communism sounds nice too. The key problems are: a) incentives and b) ability to see the trees instead of pretending to see a forest because you are blind to the details.
ChrisMarshallNY 11mo ago
> If all you're judging is the first-order impacts on a single business, you're missing the forest for the trees. Sounds like typical American C-Suite thinking. From what I can see, maybe Chinese companies see further, and that may just be because the government is so powerful, over there, and the government is known for taking the long view.
guywithahat 11mo ago
Public transit is a great business model, what are you talking about? The only time it seems to be a bad business model is when governments take it over and run it. Transit relies on recurring customers paying you basically every day, or subscribing. It has a reliable, stable revenue stream which is relatively inelastic, which are generally precursors for a good business model
BurningFrog 11mo ago
> those cured patients are far more likely to go on living longer, healthier lives, and in turn contribute additional value to society That's not true for diseases that hit those at or near retirement, which is probably most of them. They are mostly drawing pensions without contributing much economically. Note 1: This is just stating economic facts, not advocating any ghoulish policy. Note 2: I expect that Note 1 will be ignored.
michihuber 11mo ago
Why would curing patients not be a good business model? Of course it is, if you charge the right price, just like “building and selling (not leasing out) houses” can be a good business model. No subscription or 2nd order effects needed.
DrScientist 11mo ago
There are also higher order effects in terms of business model - if you look at the broader business model of health care. A concrete examples abound in the infectious disease space - many antibiotics are curative of something that would otherwise be fatal - and while there isn't a huge amount of money in antibiotics it has in effect contributed to the larger market of older people's diseases like cancer. Every intervention simply delays death - and the older you get the more health care you need.
DrScientist 11mo ago
>As long as the value created is more than the cost of the treatment, then it's a net-gain for the economy even if it's a net loss for that singular business. Specifically on this - this is pretty much how pharma companies negotiate prices with governments - using quality adjusted years of life or saving from alternative costs. > If all you're judging is the first-order impacts on a single business, However you do have to pay the companies involved otherwise the activity doesn't happen ( as the companies will go bust and cease to exist ) - cf lack of significant research into new antibiotics. That's why the above happens.
thrance 11mo ago
I think this is a bad argument for socialized healthcare (Which I am 100% for BTW). Look at retired people, they contribute very little to society. From a purely economical POV, letting them die is the correct course of action. I, and many others, find this morally abhorrent. We should provide healhcare because it is the correct thing to do, not because it is economically viable. The whole point of a society is for its members to live better lives collectively than they would individually, not to maximize some abstract value. So, determine democratically how much resources we should pool into healthcare and distribute that fairly among ourselves, on an as-needed basis. That's how it works in much of the 1st world, and it works reasonably well. Better than in America, that's for sure, as can be seen by the higher life expectancies and cheaper medicine overall.

anonymouskimmer 11mo ago

If a person dies from a disorder in their 20s, they'll never buy your heart medication in their 70s. Today's patient is tomorrow's patient.

Spooky23 11mo ago
The issue with that logic there is those basic drugs are mostly generic now. That money is less, and goes to the PBM and generic manufacturers in India.
stego-tech 11mo ago
The longer someone lives, the more potential value they can contribute to a society. The opportunity cost is something we've figured out from a medical perspective, but shareholders want returns today, not returns fifty years from now. That is what we need to address.
- jojobas 11mo ago
  They could use profit in 50 years, but it will possibly be someone else's profit.
  - bluGill 11mo ago
    If the executive lives longer it is their profit.
    - jojobas 11mo ago
      It could be a different company's profit.
- reactordev 11mo ago
  The longer someone lives, the more potential value can be squeezed. This is how they should think.
  - tartoran 11mo ago
    I don't like the squeezing mindset but if people contribute to their health insurance and don't use those services because they're healthy it could be seen as squeezing those patients but it really isn't, it's just how insurance should work.
- lotsofpulp 11mo ago
  >The longer someone lives, the more potential value they can contribute to a society. This is a function of how old the sick person is, as well as how severe their sickness and hence recovery will be. The data says, for the most part, healthcare is needed when one is close in age to exhausting their body’s capability anyway.
- shridharxp 11mo ago
  >The longer someone lives, the more potential value they can contribute to a society. This is questionable. Highly populous countries have worse living conditions than moderately populous ones, currently.
jagged-chisel 11mo ago
Treat vs cure. You treat them so you can go on treating them. If you cure them, maybe you’ll treat them later and or maybe you won’t - but that’s outside the current bonus cycle / opportunity window.
- animal531 11mo ago
  I'm not sure I agree, when we humans only lived for 50 years there were no time to develop any range of other diseases that we are experiencing now in later life, so even if you cure A there will definitely be many many opportunities to treat anywhere from B-Z.
com2kid 11mo ago
The FDA needs to declare death a disease that patentable drugs can be developed against. All of a sudden the flood gates get opened to encouraging drug research on anything that keeps people alive longer.
- sebmellen 11mo ago
  I quite like this concept. Did you come up with it?
  - com2kid 11mo ago
    No, it is a common trope in futurism circles. Because death is not technically a disease, right now if a company came up with a literal immortality pill they wouldn't be able to get it patented or get FDA approval for it.
    - philipkglass 11mo ago
      It's a common trope but also wrong. If you invent a pill that gives old people the mental and physical vigor of 25 year olds, you don't need to patent or trial it as an immortality pill. Just pick one of the many medical conditions associated with advancing age, like osteoporosis or male pattern baldness, and prove that it safely and effectively treats that condition. If the pill cures baldness and also gives patients improved muscle tone and working memory as a side effect, the FDA won't complain about those beneficial side effects. Once the drug is approved for treating baldness it can be prescribed off-label for other conditions and/or the manufacturer can progressively run trials for treating additional conditions, similar to how GLP-1 drugs originally developed for diabetes treatment have now been tested and approved for treating obesity.
      - com2kid 11mo ago
        > Just pick one of the many medical conditions associated with advancing age, like osteoporosis or male pattern baldness, A drug that maintained telomere length doesn't treat anything directly. A drug that slows down metabolism and extends life by 20% on average, not patentable.
FerretFred 11mo ago
Yeah, maybe not cure them as such, maybe just get them to a healthy-enough state to go back to functioning but still needing The Medication.
wodenokoto 11mo ago
That is not the alternative to curing disease that is being proposed. The choice is between healing for good or keep on continued medication. Or more bluntly: sell a product or sell a subscription
- anonymouskimmer 11mo ago
  The point I was trying to make is that most pharma companies have many products for many disorders and diseases. Curing one of those diseases will make a few life-long patients for some of your non-curing treatments.

thousand_nights 11mo ago

yeah but the pharma comapnies are only in the business of selling drugs so they would need to diversify into retirement homes or somnething to profit from actually curing people

stego-tech 11mo ago
I mean, that's one way to look at it I suppose, and it's why you see Healthcare Insurers and Private Equity diversify into elder care for a captive audience. In reality though, I was not-so-subtly trying to suggest that if something is necessary for the public good (curing diseases) but a bad business model, then perhaps Capitalism itself is the wrong vehicle for that segment of industry and a different option - be it an incentive structure, government-owned pharmaceutical research, or managed economy - is needed. Society fundamentally needs things that are simply bad business - sheltering everyone (lowers long-term housing revenue), feeding everyone (lowers long-term food revenue), healing everyone (lowers long-term healthcare revenue), educating everyone (lowers the value of degrees/credentials). If our economic model prohibits or discourages achieving optimal resource usage and human outcomes, then it's our obligation to explore and identify alternatives that may improve those outcomes respectively.
- tacitusarc 11mo ago
  > In reality though, I was not-so-subtly trying to suggest that if something is necessary for the public good (curing diseases) but a bad business model, then perhaps Capitalism itself is the wrong vehicle for that segment of industry and a different option - be it an incentive structure, government-owned pharmaceutical research, or managed economy - is needed. I believe the great innovation of capitalism is markets, and the next era of economic and social progress will be driven by mixed capital/social good markets. For example, what if you tied the tax rate for an industry to a combination of broad social goods (say, homelessness) and industry-specific goods (say the incidence rate of cancer for cancer drug companies), such that if we’re in a the middle of a homelessness crisis and many people have cancer, the tax rate might be 50%, vs if there is virtually no homelessness and we’ve cured cancer, maybe it’s 10%. Obviously there are other market approaches but eventually they would be converted to capital markets, so something like the above makes sense to me as a start.

kiba 11mo ago

With public transit, value capture is possible if you have the right business model. Public transit is ultimately real estate development. However, I prefer that the value capture is by the public rather than a private corporation.

stego-tech 11mo ago
Public Transit was very much thrown in there as an example of the kinds of societal-good projects that often are "bad" business models or run at a loss (Japan being a very notable exception, kinda). Thing is, anyone even casually looking at n+1-order effects sees that the value created isn't for the transit system itself, but all the components that make it function (jobs, logistics, and materials for trains, rails, signals, ports, tunnels, etc) and all the effects of easing people movement (more money to spend, more job opportunities, cleaner air, safer streets, etc). Real estate is one such effect, provided communities recognize the benefit of real estate near stations and not let naysayers constrict development around them (like you see in much of America, for some reason).

im3w1l 11mo ago

I think it's the opposite. I think people are very aware of those effects, and that's actually why they ask the question in the first place. They ask it "is this good business" not just because they care about the answer itself but because they want to start a debate on how society should promote the invention of cures. Like I think most people in most industries are passionate people that really want to do good, but they do need to eat too.

devsda 11mo ago
Do you believe the current medical research is held back by the price limitations and if we just infuse more money, we'll find cure for many more diseases ? Even if we consider that, we'll reach the same position as today because if only rich can afford medicine, the market will price that in and it's customer who can barely afford the medicine will shift from middle class to upper middle class and so on.

selcuka 11mo ago

> I feel kinda bad for the writer, because it's a good question: no, curing patients is not a good business model, just like public transit is not a good business model. Betteridge's law of headlines: "Any headline that ends in a question mark can be answered by the word no."

energy123 11mo ago
Energy123's law of headlines: Any headline that ends in a question mark will have an associated comments section mentioning Betteridge's law, despite that law having being empirically falsified.
- selcuka 11mo ago
  Selcuk's Law of Generalisations: Any mention of an adage will have an associated comment claiming that it can be falsified by giving at least one counter-example.
  - energy123 11mo ago
    The answer is 'yes' more than 50% of the time according to a few studies. It's not just one counter-example.
  - nvader 11mo ago
    To you and your parent, I present: Nvader's law: Any law you named after yourself is ipso facto much less impressive.

charcircuit 11mo ago

>just like public transit is not a good business model. Uber has almost a 200B market cap for offering private transit. There is a working business model for transit.

richbell 11mo ago
Uber's business model is to be a loss leader to hamper competition, then jack up rider rates and lower drive rates. This is technically a 'working' business model, but hardly one that benefits the people.
- exasperaited 11mo ago
  Uber more generally exists not as a service provider but as an international legislative bulldozer: everywhere will be reduced to the misery of the land of the free. They exist only to fuck up worker protections in every form they take.
loeg 11mo ago
Not sure if this is just a misunderstanding but Uber is not "public transit" (a term of art), which is what GP is talking about. Uber is just not relevant to the point GP was making.

BrenBarn 11mo ago

> If all you're judging is the first-order impacts on a single business, you're missing the forest for the trees. The problem is our society is set up to give a lot of power and influence to businesses that are precisely interested in their own tree and not interested in the forest at all.

m463 11mo ago

if there was a way to support this say in taxes, it would make good business sense. But the devil is in the details of implementing that.

tptacek 11mo ago

Saying that curing diseases is a bad business model is like saying discovering the world's largest gold mine would be a bad business because you'd eventually run out of gold. The underlying argument doesn't make sense.

navigate8310 11mo ago
When the supply runs dry, demand will naturally increase. Hoarders will be golden at that stage.
- nvader 11mo ago
  "I've seen gluts not followed by shortages, but I've never seen a shortage not followed by a glut." -- Nassim Taleb
energy123 11mo ago
The argument only makes sense under certain assumptions: you can't protect the IP from being copied (leading to competition and eroding economic rents), or the government will place a price ceiling (price controls). Otherwise, the demand will be highly inelastic, so you cannot really invent a better business model. The pricing power you would wield as the monopoly provider of life & death would be tremendous. It would be fruitful to put the example in the article under closer scrutiny.
PunchyHamster 11mo ago
It does make sense if you turn it around "Having permanent patient by treating only symptoms is better than curing them right away" Basically living (comfortably, or at all) as a subscription service
- tptacek 11mo ago
  No, this is the basic naive argument I'm responding to. It's nice to have long-term recurring revenue, but customers have a very strong preference for a cure, which means the owners of cures will outcompete the owners of subscription treatments. And then to say those cure-owners are in a "bad business", again, is like saying you'd go "aw shucks" if you happened on an enormous seam of gold.

Aurornis 11mo ago

> As long as the value created is more than the cost of the treatment, then it's a net-gain for the economy even if it's a net loss for that singular business. This is precisely the type of work that is best funded through government: Work that can be net positive for the populace but doesn’t have a viable business model attached. There’s another layer to consider even with government-driven efforts: Resources are never infinite. The number of potential R&D opportunities exceeds available research dollars and even human personnel many times over. There comes a point when you need to allocate finite resources to the efforts that provide better cost to benefit ratios. I don’t think it’s helpful to go full hardcore utilitarian, but the reality can be that the cost of coming up with a cure for a rare genetic condition that impacts only a small number of people might be better spent on research toward a drug which incrementally reduces heart disease, for example. Finding permanent cures for rare conditions is a heart-warming idea, but in reality it’s a lot harder and more expensive than most people assume. Likewise, when people become enamored with these ideas of finding permanent cures for rare genetic ideas they can be missing the big picture that it may not be one of the better uses of that money even if you took raw capitalism and investment dollars out of the picture. There are so many more opportunities for widespread health improvement in the boring conditions and even lifestyle diseases than in hypothetically curing the rare genetic conditions. It may not feel as heart-warming to talk about things like reducing obesity, but we’re witnessing an incredible society-wide health improvement with GLP-1 drugs that is orders of magnitude more benefit across society than something like curing a rare genetic disease.

socalgal2 11mo ago

> ~public~ transit is not a good business model. ~public~ transit can be a good business model if it's setup correctly. The majority of Japan's 100 train companies are setup such that they own both trains and complementary interests. Office buildings, shopping centers, super markets, apartments. The better their trains are the better their other businesses do by delivering people to them. The better their other businesses are the more people want to use their trains. https://ir.tokyu.co.jp/ja/ir/news/auto_20251111595684/pdfFile.pdf https://ir.tokyu.co.jp/ja/ir/news/auto_20251111595684/pdfFil...

appreciatorBus 11mo ago
Yup. North American public transit is frequently a terrible business model because North American land use is designed to push everyone’s daily destinations further and further apart, making all transportation more expensive, and making transit uncompetitive with anything else.
Ferret7446 11mo ago
While public transit is a good business model, corrupt public transit is an even better business model. The amount of public funds that some US public transit funnels away is astounding.
ehnto 11mo ago
It's fair to note that Japan's private rail networks have often been joint public/private investments, but I don't think that negates your point. I think public transit is something the public should invest in, profitable or not, as a service to ourselves (the public). But it can also be done profitably in certain circumstances.
- socalgal2 11mo ago
  I think trying to get the incentives right is important and that "public" transit rarely gets it right. It relies on politicians to fund it and they have so many strings being pulled on that they can rarely give it the funding it needs. It will always show up as an expense and as such there will always be an incentive to cut funding to "lower the expense". If they ever have a surplus it will be syphoned off to something else instead of invested. Of course many cities have great "public" (run by the government) transportation for some definition of "great" but many have issues of funding. IIUC, NYC and London are both seriously underfunded. Conversely, AFAICT, these private Japanese trains in a city of a comparible size are not. If you don't want to compare to Tokyo, then compare to Osaka https://www.keihan.co.jp/corporate/ir/individual/ https://www.keihan.co.jp/corporate/ir/individual/ https://www.hankyu-hanshin.co.jp/docs/integratedreport2025_j_view.pdf https://www.hankyu-hanshin.co.jp/docs/integratedreport2025_j...

bluGill 11mo ago

Public transit is a good business model if you don't have to compete with government subsdized roads and you don't have government limits on what you can charge. Good luck finding anyplace without those.

devsda 11mo ago
> Public transit is a good business model if you don't have to compete with government subsdized roads and you don't have government limits on what you can charge Without subsidized roads, its easy for deep pockets to offer exorbitant prices for land and monopolize the roads. Anyone not planning to charge high prices for usage will be held off by high acquisition prices at "market" rates. There's only so much land and roads possible to a given location, privatized roads is like giving default monopoly. It will turn out just like the isp situation, only worse.
- bluGill 11mo ago
  Subways in NYC had found ways to compete with each other before the government took over. (though admittedly this was enabled by very dense areas, and long term not the best for the overall city). However your point is destroyed by counter example.

brianwawok 11mo ago

With that logic curing someone of a deadly disease at 10 is good for society because they have much to contribute, but curing someone at 80 is bad for society because their best contributions are behind - and they are a net resource drain. That’s not a good path to head down. (Cure a doctor he generates value, don’t cure a prisoner he drains value).

danielmarkbruce 11mo ago

>> If all you're judging is the first-order impacts on a single business, you're missing the forest for the trees. This is one of those things that sounds clever but is total nonsense. Communism sounds nice too. The key problems are: a) incentives and b) ability to see the trees instead of pretending to see a forest because you are blind to the details.

ChrisMarshallNY 11mo ago

> If all you're judging is the first-order impacts on a single business, you're missing the forest for the trees. Sounds like typical American C-Suite thinking. From what I can see, maybe Chinese companies see further, and that may just be because the government is so powerful, over there, and the government is known for taking the long view.

guywithahat 11mo ago

Public transit is a great business model, what are you talking about? The only time it seems to be a bad business model is when governments take it over and run it. Transit relies on recurring customers paying you basically every day, or subscribing. It has a reliable, stable revenue stream which is relatively inelastic, which are generally precursors for a good business model

BurningFrog 11mo ago

> those cured patients are far more likely to go on living longer, healthier lives, and in turn contribute additional value to society That's not true for diseases that hit those at or near retirement, which is probably most of them. They are mostly drawing pensions without contributing much economically. Note 1: This is just stating economic facts, not advocating any ghoulish policy. Note 2: I expect that Note 1 will be ignored.

michihuber 11mo ago

Why would curing patients not be a good business model? Of course it is, if you charge the right price, just like “building and selling (not leasing out) houses” can be a good business model. No subscription or 2nd order effects needed.

DrScientist 11mo ago

There are also higher order effects in terms of business model - if you look at the broader business model of health care. A concrete examples abound in the infectious disease space - many antibiotics are curative of something that would otherwise be fatal - and while there isn't a huge amount of money in antibiotics it has in effect contributed to the larger market of older people's diseases like cancer. Every intervention simply delays death - and the older you get the more health care you need.

DrScientist 11mo ago

>As long as the value created is more than the cost of the treatment, then it's a net-gain for the economy even if it's a net loss for that singular business. Specifically on this - this is pretty much how pharma companies negotiate prices with governments - using quality adjusted years of life or saving from alternative costs. > If all you're judging is the first-order impacts on a single business, However you do have to pay the companies involved otherwise the activity doesn't happen ( as the companies will go bust and cease to exist ) - cf lack of significant research into new antibiotics. That's why the above happens.

thrance 11mo ago

I think this is a bad argument for socialized healthcare (Which I am 100% for BTW). Look at retired people, they contribute very little to society. From a purely economical POV, letting them die is the correct course of action. I, and many others, find this morally abhorrent. We should provide healhcare because it is the correct thing to do, not because it is economically viable. The whole point of a society is for its members to live better lives collectively than they would individually, not to maximize some abstract value. So, determine democratically how much resources we should pool into healthcare and distribute that fairly among ourselves, on an as-needed basis. That's how it works in much of the 1st world, and it works reasonably well. Better than in America, that's for sure, as can be seen by the higher life expectancies and cheaper medicine overall.