4 ms·

What’s the maximum price you’d pay for a cure to a rare, fatal pediatric disease? Answer this question, and you’re on the journey to the solution to the proble

What’s the maximum price you’d pay for a cure to a rare, fatal pediatric disease? Answer this question, and you’re on the journey to the solution to the problem you are talking about. Tell me some BS why the question doesn’t matter or is wrong or whatever, and discover why “Dunning Kruger” is at least part of the answer.

potato3732842 11mo ago
>Answer this question, and you’re on the journey to the solution to the problem you are talking about. Tell me some BS why the question doesn’t matter or is wrong or whatever, and discover why “Dunning Kruger” is at least part of the answer. I posit that the people who hold an ideology, moral compass, world view, or whatever else you want to call it, that permits the question to even be framed in this way are a root problem exacerbating many other problems in society, healthcare likely being one. I don't know what the "solution" is but the fact that ~1:5 dollars in this country is spent on maintenance of the human body is just wild and likely unsustainable or indicative of some gross error in how we measure such things.
Spivak 11mo ago
From experience from my peers getting pregnant it's the cost of a "selective reduction" (which can be 1 to 0). Newly pregnant friends are spending $$$ on tests in utero to weed out children with such things. You're free to downvote, it won't make it less true. Genetic testing is all the rage in my social circle. No parent want's "dies basically immediately after birth" disease which is a surprising about of genetic conditions and way more people than I expected were silent carriers of at least one.
- doctorpangloss 11mo ago
  well, you didn't answer the question, but it sounds like you are saying $40,000? how much do you think Orchid costs? do you think it even works? $40,000 cap would exclude all the therapeutics targeting rare disease being developed today. not just pediatric. all. it would exclude tirzepatide, which costs $250,000 to $400,000 for most people. if you want to cure obesity. and by the way, congress expressly banned paying for all weight loss treatments from medicare. > Newly pregnant friends are spending $$$ on tests in utero to weed out children with such things. do you think pregnancies at age 40 compared to pregnancies at age 20 are more expensive, or less expensive? define expensive, yes? and what price should the government pay? should it pay 40 year old mothers different than 20 year old mothers? it's too bad that i'm being downvoted, since you're engaging with the question and hopefully it is really illuminating why there are no easy answers to capping healthcare costs. it starts with people, especially people who think of themselves as being very smart, being unable to specify a max price they are willing to pay, which is conceding that a market-based solution can exist but be very deeply flawed.
  - Spivak 11mo ago
    Because I don't think there is a max price. Like of course there is in practice case by case because individuals don't have infinite money but nobody wants to be told "sorry, we can treat your condition but we're not going to because you're not valuable enough to society to get it." The episode Critical Care in Voyager muses on what such a system looks like formalized and it's awful. And I think what makes it so that we're resistant to caps is because it's not just rare diseases you could write off as unlikely to ever get that are ruinously expensive and it's likely that in everyone's social sphere they know multiple people personally who've had "blown out their out of pocket max by factors of 5-10x" medical issues. It's a this really can happen to you thing. So I think if your goal is to reduce healthcare costs on a nation scale your only option is make it so your people develop health problems less and tackle the smaller but much much much more frequent expenses. Things like ending the caps on the number of doctors, giving nurse practitioners full prescribing rights, moving more medications OTC, ending drug patent loopholes or for critical medications or "buying out" the patient so it can be immediately be made generic, adding more restrictions to testing so doctors have to actually think before ordering every test under the sun because it's not their money, massively reducing the regulations on medical devices, I could go on forever. Stupid unnecessary expense times your population is way more money than the treatment for some rare disease.
jancsika 11mo ago
I think you're misrepresenting "Dunning Kruger." It only predicts that the subset of your respondents already known to be low ability in the domain of health care economics will end up inflating their assessment of their own ability in the same domain. (Perhaps also inverted for high ability respondents.) You're claiming to predict that-- for particular branch of response types-- all respondents will be low ability. There are a lot of ways I would characterize that claim, but none of them would be "Dunning Kruger." In fact, my gut tells me that some significant number of flame wars I've read over the years were due to this confused heuristic.

potato3732842 11mo ago

>Answer this question, and you’re on the journey to the solution to the problem you are talking about. Tell me some BS why the question doesn’t matter or is wrong or whatever, and discover why “Dunning Kruger” is at least part of the answer. I posit that the people who hold an ideology, moral compass, world view, or whatever else you want to call it, that permits the question to even be framed in this way are a root problem exacerbating many other problems in society, healthcare likely being one. I don't know what the "solution" is but the fact that ~1:5 dollars in this country is spent on maintenance of the human body is just wild and likely unsustainable or indicative of some gross error in how we measure such things.

Spivak 11mo ago

From experience from my peers getting pregnant it's the cost of a "selective reduction" (which can be 1 to 0). Newly pregnant friends are spending $$$ on tests in utero to weed out children with such things. You're free to downvote, it won't make it less true. Genetic testing is all the rage in my social circle. No parent want's "dies basically immediately after birth" disease which is a surprising about of genetic conditions and way more people than I expected were silent carriers of at least one.

doctorpangloss 11mo ago
well, you didn't answer the question, but it sounds like you are saying $40,000? how much do you think Orchid costs? do you think it even works? $40,000 cap would exclude all the therapeutics targeting rare disease being developed today. not just pediatric. all. it would exclude tirzepatide, which costs $250,000 to $400,000 for most people. if you want to cure obesity. and by the way, congress expressly banned paying for all weight loss treatments from medicare. > Newly pregnant friends are spending $$$ on tests in utero to weed out children with such things. do you think pregnancies at age 40 compared to pregnancies at age 20 are more expensive, or less expensive? define expensive, yes? and what price should the government pay? should it pay 40 year old mothers different than 20 year old mothers? it's too bad that i'm being downvoted, since you're engaging with the question and hopefully it is really illuminating why there are no easy answers to capping healthcare costs. it starts with people, especially people who think of themselves as being very smart, being unable to specify a max price they are willing to pay, which is conceding that a market-based solution can exist but be very deeply flawed.
- Spivak 11mo ago
  Because I don't think there is a max price. Like of course there is in practice case by case because individuals don't have infinite money but nobody wants to be told "sorry, we can treat your condition but we're not going to because you're not valuable enough to society to get it." The episode Critical Care in Voyager muses on what such a system looks like formalized and it's awful. And I think what makes it so that we're resistant to caps is because it's not just rare diseases you could write off as unlikely to ever get that are ruinously expensive and it's likely that in everyone's social sphere they know multiple people personally who've had "blown out their out of pocket max by factors of 5-10x" medical issues. It's a this really can happen to you thing. So I think if your goal is to reduce healthcare costs on a nation scale your only option is make it so your people develop health problems less and tackle the smaller but much much much more frequent expenses. Things like ending the caps on the number of doctors, giving nurse practitioners full prescribing rights, moving more medications OTC, ending drug patent loopholes or for critical medications or "buying out" the patient so it can be immediately be made generic, adding more restrictions to testing so doctors have to actually think before ordering every test under the sun because it's not their money, massively reducing the regulations on medical devices, I could go on forever. Stupid unnecessary expense times your population is way more money than the treatment for some rare disease.

jancsika 11mo ago

I think you're misrepresenting "Dunning Kruger." It only predicts that the subset of your respondents already known to be low ability in the domain of health care economics will end up inflating their assessment of their own ability in the same domain. (Perhaps also inverted for high ability respondents.) You're claiming to predict that-- for particular branch of response types-- all respondents will be low ability. There are a lot of ways I would characterize that claim, but none of them would be "Dunning Kruger." In fact, my gut tells me that some significant number of flame wars I've read over the years were due to this confused heuristic.