CBO: Obamacare costs revised downward, again. Finds lower than expected premiums.

[Emily's Cat]

Why do you think they make those investments? Because other rich people will then be buying that stuff at high prices, providing the profits that justify those investment risks. You aren't actually disagreeing here, you're just looking at a different step in the same process.

Clearly the Waltons are well known for producing high-end goods that only other rich people can afford?

Alternatively, of course, we might note that it's obvious that Warren Buffet is only investing 99% of his wealth in charitable endeavors because it's going to get him more wealth...

 

[Ziggurat]

Clearly the Waltons are well known for producing high-end goods that only other rich people can afford?

We were talking about new expensive technology. The Waltons are not relevant to that discussion.

Alternatively, of course, we might note that it's obvious that Warren Buffet is only investing 99% of his wealth in charitable endeavors because it's going to get him more wealth...

That isn't investing, and it has basically nothing to do with the dynamics of medical technology advancement.

I really don't understand why you're trying to move the discussion so far away from the actual topic.

 

[Ziggurat]

Only if you can absolutely PROVE that the technology WILL be invented in the future, as opposed to it *might* be possible.

I don't know specifically what technology will be invented, but it's a safe bet that life-saving medical technology of some sort WILL be, provided that there is still a profit motive, because we've been doing that for decade now.

We *might* in the future invent a way to download our brains into robot bodies so we'll never die.

Unlike medical advances, there is no track record to suggest such an event.

By your argument, it's unethical of us not to invest untold billions into research for that,

No. If you honestly believe that, you have failed at an incredibly fundamental level to understand what my argument is. I am not demanding the allocation of anyone's resources to anything. I am demanding that we not remove the incentive that would otherwise exist for people to CHOOSE to invest their own resources in life-saving medical technology.

If someone thinks that downloading brains into computers is the wave of the future, and wants to invest their own money in that, I will not stand in their way. Furthermore, I will not attempt to prevent them from charging as much money as they want to should they manage to succeed. Would you? If someone spent a fortune and succeeded, would you demand that the result be available to all at some government-determined price? Because that would be the equivalent difference here. This has nothing, nothing, to do with me demanding anyone allocate their own resources to anything.

And again, I'm still waiting for any sort of explanation: why is more dead people ethically superior to fewer dead people? You have made that claim, but you are not even trying to support it. Instead, you're constructing ridiculous straw men and running down rabbit holes of irrelevancy.

 

[3point14]

There's a balance in there somewhere. I don't know exactly where that somewhere is, but it's there.

In the UK, NICE do it with the QALY


It's not perfect, and there are sometimes newspaper stories of outraged relatives angry that their mum/child/grandparent is on the wrong side of the line (it's not framed that way, of course). The line sometimes moves in response, I believe.

 

[Emily's Cat]

I am not demanding the allocation of anyone's resources to anything. I am demanding that we not remove the incentive that would otherwise exist for people to CHOOSE to invest their own resources in life-saving medical technology.

??? Who is talking about that last bit?

And again, I'm still waiting for any sort of explanation: why is more dead people ethically superior to fewer dead people?

Nobody has made that claim. You created that strawman yourself.

The actual question is: Are more dead people because the cure doesn't exist ethically superior to fewer dead people because some of those people can't afford the cure.

You've said that fewer dead people, because some people can't afford the cure is superior. I've said it's a flawed premise - you can't count people who are dead because a cure doesn't exist. You can't attribute cause to the nonexistence of a thing.

You've been applying this in an argument where you believe it is better to invest in technology so that at some point in the future it is possible that fewer people might die because we might find a cure. I'm all for investing in cures. But I don't think it makes any sense to attribute people who have died today and in the past to the non-investment in a non-existent cure.

ETA: back to the logical premise...

Are more dead people because the cure doesn't exist ethically superior to fewer dead people because some of those people can't afford the cure.

This is a much more accurate assessment of the discussion at hand than the gross oversimplification that you've presented. In this case, it is ethically superior to NOT DENY care to some people, given that a cure exists. The underlying question is: Is it possible for these people to be helped, given the state of the world as it is. In the first clause, the answer is no. The cure does not exist, it is not possible for those people to be helped. Since it is not possible, it is cannot be unethical to let them die. In the second clause, the answer is yes. The cure does exist, and it is possible for those people to be helped. Therefore, it *may* be unethical to let them die. Not *is*, just *may*. But we're comparing *may* to *cannot*.

ETA2: Just to try to be even more clear, the problem is that you're not even comparing apples and oranges. You're comparing apples and tennis shoes.

 

[Ziggurat]

Nobody has made that claim. You created that strawman yourself.

No, I did not. Let's review:

the only thing worse than 'your mama died because the cure hadn't been invented yet' is 'your mama died because she couldn't afford the cure'.

Why is that worse?

If you think about it logically and not emotionally, you'll see that you have in backwards. In the former case, everyone in your mama's medical condition will die. In the latter case, only some people in your mama's medical condition will die. Why should any moral person prefer the former to the latter? They should not, obviously. The latter may be unfair, but the former is still objectively worse.

It's worse in terms of ethics, at the very least.

twinstead came up with the comparison, not me. I simply challenged his assertion. You supported his assertion. This isn't a straw man.

Why is it ethically worse to have a situation where fewer people die than more people die? That's not a straw man, that is literally your claim in response to my challenge to twinstead.

The actual question is: Are more dead people because the cure doesn't exist ethically superior to fewer dead people because some of those people can't afford the cure.

The hilighted part is the important part.

You've said that fewer dead people, because some people can't afford the cure is superior.

No. I've said fewer people dead is superior because there are fewer people dead.

I've said it's a flawed premise - you can't count people who are dead because a cure doesn't exist. You can't attribute cause to the nonexistence of a thing.

The only reason to do any comparison at all is if we're able to do something to determine which scenario occurs. If one or the other alternative eventuates because of conditions outside of our influence, then a comparison is pointless, and there can be no ethical distinction between them. It's like saying sunny days are ethically preferable to cloudy days. You have made an ethical comparison between these two scenarios, which means you have implicitly agreed to the premise that there is something we can do to make one or the other occur.

If you think that we cannot, then you cannot assign an ethical preference for one or the other, the question simply becomes meaningless.

You've been applying this in an argument where you believe it is better to invest in technology so that at some point in the future it is possible that fewer people might die because we might find a cure. I'm all for investing in cures. But I don't think it makes any sense to attribute people who have died today and in the past to the non-investment in a non-existent cure.

That's not the relevant scenario. I'm not talking about the past, I'm talking about the future. The relevant scenario is this:
Option 1: allow companies to charge lots of money for new advanced medical technology, which will become cheaper over time. Companies invest in research, and develop a life-saving treatment for some disease. They charge lots of money for it at the start. Rich people with the disease spend that money, and live. Poor people with that disease cannot afford the treatment, and die, until at some further point in the future it becomes cheap.
Option 2: we do not allow companies to charge lots of money for new advanced medical technology. Investment in research is much slower. No treatment is developed for the above disease, or it is developed much later. People with the disease die, rich and poor alike, until much later.

Option 1 is more unequal, but fewer people die. Option 2 is more equal, but more people die.

twinstead's post suggests he prefers option 2. Your posts suggest you prefer option 2. Do you prefer option 2? I prefer option 1 because fewer people die. Furthermore, I think we need not consider anything except the fact that fewer people die in order to conclude that option 1 is preferable to option 2.

In this case, it is ethically superior to NOT DENY care to some people, given that a cure exists.

That was not one of the options presented by twinstead. Blame him if you think leaving it out was a mistake, not me.

 

[Border Reiver]

No, I did not. Let's review:











twinstead came up with the comparison, not me. I simply challenged his assertion. You supported his assertion. This isn't a straw man.



Why is it ethically worse to have a situation where fewer people die than more people die? That's not a straw man, that is literally your claim in response to my challenge to twinstead.







The hilighted part is the important part.







No. I've said fewer people dead is superior because there are fewer people dead.







The only reason to do any comparison at all is if we're able to do something to determine which scenario occurs. If one or the other alternative eventuates because of conditions outside of our influence, then a comparison is pointless, and there can be no ethical distinction between them. It's like saying sunny days are ethically preferable to cloudy days. You have made an ethical comparison between these two scenarios, which means you have implicitly agreed to the premise that there is something we can do to make one or the other occur.



If you think that we cannot, then you cannot assign an ethical preference for one or the other, the question simply becomes meaningless.







That's not the relevant scenario. I'm not talking about the past, I'm talking about the future. The relevant scenario is this:

Option 1: allow companies to charge lots of money for new advanced medical technology, which will become cheaper over time. Companies invest in research, and develop a life-saving treatment for some disease. They charge lots of money for it at the start. Rich people with the disease spend that money, and live. Poor people with that disease cannot afford the treatment, and die, until at some further point in the future it becomes cheap.

Option 2: we do not allow companies to charge lots of money for new advanced medical technology. Investment in research is much slower. No treatment is developed for the above disease, or it is developed much later. People with the disease die, rich and poor alike, until much later.



Option 1 is more unequal, but fewer people die. Option 2 is more equal, but more people die.

The reality of course is that neither Option 1 or Option 2 are accurate, and ignore the reality of what actually occurs in countries with universal health care - the greater number of units of the cure sold offsets the lower per unit profit, and investment in developing new products continues to occur.

 

[Emily's Cat]

No, I did not. Let's review:

I'd be concerned about giving that "more business and development-friendly society" (read: profit-driven) too much credit; the only thing worse than 'your mama died because the cure hadn't been invented yet' is 'your mama died because she couldn't afford the cure'. There's a world of "cures" that the average person can't afford even now

Why is that worse?

If you think about it logically and not emotionally, you'll see that you have in backwards. In the former case, everyone in your mama's medical condition will die. In the latter case, only some people in your mama's medical condition will die. Why should any moral person prefer the former to the latter? They should not, obviously. The latter may be unfair, but the former is still objectively worse.

It's worse in terms of ethics, at the very least.

twinstead came up with the comparison, not me. I simply challenged his assertion. You supported his assertion. This isn't a straw man.

Let's rewind a bit. Yes, twinstead came up with the comparison, but it was clearly tongue in cheek. Additionally, you trimmed a portion of twinstead's post (which I have added back above).

Twinstead was not saying "don't invest" or "prevent people from investing" or anything of the sort. He was pointing out that a profit-driven medical industry creates situations where cures are priced for profit which results in people dying because they can't afford the cure.

You, however, seemed to take twinstead seriously, then further compounded it by effectively taking a stance that people dying because a cure has been priced out of their range by someone seeking profit is ethically superior to people dying because a cure doesn't exist.

Subsequent discussion led us to a point where you've effectively attributed cause to the nonexistence of a cure for all deaths related to that condition that occurred prior to the invention of that cure. Then you go further and cast them as unethical because a cure didn't exist. You implicitly hold to blame the people who didn't invent a cure before the cure was invented.

Let's recast this: You effectively claim that a class of people denying food to another class of people because they can't afford it, and allowing them to die from starvation... is ethically superior to... everyone in that region dying in a famine.

Just because more people live in one scenario than another doesn't imply that it is ethically superior.

As yet another analogy here... Consider the following two scenarios:

A) The entire planet is divided into either a master or a slave caste. The masters have access to all of the resources, to do with as they please. The slaves only what resources are given to them by their masters, and exist at barely subsistence levels.

B) The planet gets smashed by an asteroid and ever single person on the planet dies.

Which of those scenarios is ethically superior?

 

[sunmaster14]

The reality of course is that neither Option 1 or Option 2 are accurate, and ignore the reality of what actually occurs in countries with universal health care - the greater number of units of the cure sold offsets the lower per unit profit, and investment in developing new products continues to occur.

Are you saying that drug companies and the like don't know how to price their products to maximize profit? And perhaps that they need the Canadian government to set prices for them?

The truth is that medical innovation and progress would slow materially if the US moved to a single payer system. As things stand now, the profits to be made in the US market are the driving force behind most medical progress. The rest of the world is getting a free ride off of US health care consumers. You're welcome, by the way.

 

[Emily's Cat]

That's not the relevant scenario. I'm not talking about the past, I'm talking about the future. The relevant scenario is this:
Option 1: allow companies to charge lots of money for new advanced medical technology, which will become cheaper over time. Companies invest in research, and develop a life-saving treatment for some disease. They charge lots of money for it at the start. Rich people with the disease spend that money, and live. Poor people with that disease cannot afford the treatment, and die, until at some further point in the future it becomes cheap.

Yeah, this doesn't actually seem to have been borne out by any evidence. On average, Pharmaceutical manufacturers book about 25% profit per year - AFTER they have accounted for R&D. In the past several years, several drugs under patent have increased in price, not decreased, some by as much as 3X - not because of any need to recoup R&D costs (which are already accounted for prior to that 25% profit margin, mind you), but because the companies decided that people would be willing to spend that much to not die. There's been no significant decrease in the price of drugs after the first 2 years of coming off patent - both generics and brands stabilize at high prices, because people are "willing" to pay exorbitant amounts to not die or have low quality of life. Pharmaceutical manufacturers have repeatedly developed minor variations of an existing drug, and introduced it just prior to their patents expiring in order to extend their position in the market at that price point, even though they have NOT expended any material cost in the form of R&D.

The cost of an MRI has NOT come down since they were introduced. In fact, the per-service cost has risen due to "inflation". There's a large number of medical devices - shower bars, crutches, braces, etc. that haven't been materially improved in decades, but have continued to rise in price.

On the whole, the cost of treatment doesn't come down over time so that poor people can afford it to. That's a large part of what's wrong with the medical industry, not just int he US, but worldwide.

 

[Emily's Cat]

Are you saying that drug companies and the like don't know how to price their products to maximize profit? And perhaps that they need the Canadian government to set prices for them?

The truth is that medical innovation and progress would slow materially if the US moved to a single payer system. As things stand now, the profits to be made in the US market are the driving force behind most medical progress. The rest of the world is getting a free ride off of US health care consumers. You're welcome, by the way.

This is one of those topics that makes me have to check my fiscal conservative card. I'm all for making a profit. I'm all for capitalism (I believe it's a more efficient and responsive economy than any other currently described). But I'm not for exploitation.

A lot of the profiteering in the medical industry is just that - exploitation. Yes, profit leads to innovation - capital is necessary to allow for an increased risk appetite. Excessive profit, in my opinion, tends to lead to exploitation. It leads companies to develop treatments but not cures. It leads them to price life-saving treatments at a level that guarantees a large number will die... then leverages the onus of their deaths to spread the cost-burden of their exorbitant pricing across society because insurance companies simply cannot deny access to life saving treatment solely because of cost. Of course, that means that a large number of people who don't have insurance, or who have very lean benefits, die anyway because the costs are ridiculous. But hey - they get to make their profit so it's all good.

When the companies doing the innovating are making 25% to 35% profit margins consistently, after having accounted for contributions to R&D, there's something wrong.

Then I feel like a dirty commie or something and I have to go wash my brain out.

 

[Beerina]

Ahh. The argument that we should deny people healthcare now, so that others in the future will live.

I am not saying that. What I am saying is that business-unfriendly government policies, and medical business-unfriendly policies in particular, slow technological progress.

And yes, since you asked, it may very well cost magnitudes more lives than it saves. I dealt with your objection in my post, noting the lives medical insurance saves are magnitudes less than the number saved by more rapid technological development.

These lives accumulate, like compounded interest. You do not see them in front of the cameras, though.

Becauese much of the world has terrible business climates, millions are dying needlessly each year because we have not cured many diseases.

So, yes, if your policy, whatever it is, puts a drag on development, thanks for being an apelike hunter-gatherer, seizing that which exists, instead of being a farmer, breeding cures faster. Thanks for being a mass murderer the likes of which Hitler and Stalin could only dream of.

Yes, you guys, who favor business-unfriendly policies. You. In your mirror. No joke. You.

 

[Ampulla of Vater]

This is one of those topics that makes me have to check my fiscal conservative card. I'm all for making a profit. I'm all for capitalism (I believe it's a more efficient and responsive economy than any other currently described). But I'm not for exploitation.

A lot of the profiteering in the medical industry is just that - exploitation. Yes, profit leads to innovation - capital is necessary to allow for an increased risk appetite. Excessive profit, in my opinion, tends to lead to exploitation. It leads companies to develop treatments but not cures. It leads them to price life-saving treatments at a level that guarantees a large number will die... then leverages the onus of their deaths to spread the cost-burden of their exorbitant pricing across society because insurance companies simply cannot deny access to life saving treatment solely because of cost. Of course, that means that a large number of people who don't have insurance, or who have very lean benefits, die anyway because the costs are ridiculous. But hey - they get to make their profit so it's all good.

When the companies doing the innovating are making 25% to 35% profit margins consistently, after having accounted for contributions to R&D, there's something wrong.

Then I feel like a dirty commie or something and I have to go wash my brain out.

This is a slippery slope. Who do you want to make the determination that 25% after R&D is too much? And would you feel the same about the bread companies making a similar profit? Both are theoretically necessary for people to have, so why would they be different?

 

[Emily's Cat]

This is a slippery slope. Who do you want to make the determination that 25% after R&D is too much? And would you feel the same about the bread companies making a similar profit? Both are theoretically necessary for people to have, so why would they be different?

I'm totally aware that it's a slippery slope, and that I'm probably not internally consistent on this. There's a degree of immediacy to medicine, and it's also a field I'm fairly close to so I have more knowledge of it. That undoubtedly colors my opinion.

There's also not a bright line here. I can't pinpoint where red turns into orange, but I can tell you that red and orange are different

 

[Puppycow]

I would bet that the actual underlying cost is much higher. Your employer very likely contributes a substantial portion of the cost on your behalf. You only pay $250 per month, because your employer is paying the other $1050 for you as part of their compensation package.

Since sunmaster is the employer, he/she is seeing the entirety of the cost that you're sheltered from.

I agree that my costs are subsidized by my employer and the government, but even then, and you can look this up, the total health care expenditure per capita, including what the government spends, what employers spend and what individuals spend, is less than half what the USA spends. And the people live longer too.

A lot of people make this same assumption. Yes, the middlemen add a fee for their services... but that's not where the bulk of the cost is generated. Cutting out the middlemen isn't going to halve your costs, for example.

(snipped for brevity)

Well middlemen might be a bit of an oversimplification, but in fact, as I stated above Japan does spend less than half what the USA does (per capita). If you look at it as a ratio to GDP, Japan's is 10.1% to 17.1% in the United States. And the median person here is older. Because their system is much more logical and economically rational that that in the USA. Instead of a hodgepodge of private insurance companies and Medicare/Medicaid, there are two large insurance schemes administered by the government: one for employees and one for everyone else.

I'm sure you are an expert in your field, I don't question that, but from the perspective of keeping costs under control, the USA's system is demonstrably the worst, and Obamacare was like a bandaid when the patient needs a tourniquet. I don't blame Obama for this, btw, he only did what was politically possible, he couldn't do what is economically rational because at the end of the day you have to get a bill through both houses of congress or it won't happen.

Maybe when the costs for people like sunmaster14 (and a critical mass of other Americans) to become intolerable, the USA will finally consider a real fix. But it will be painful, because there's already so much invested in the status quo. Private health insurance companies would be decimated. Other countries control the cost of pharmaceuticals. You don't have these sociopaths like Shkreli jacking up the prices by 5000% just because they can.

 

[Ampulla of Vater]

I would imagine the U.S. being the U.S. factors into things too. Japanese people are overall skinnier and eat healthier than Americans. Plus, the government (I believe) owns the tobacco companies, so the same entity who provides healthcare also profits from those who smoke. I believe these nuances in other societies make a difference when it comes to government run healthcare.

I've also stated in other threads that physicians in other countries do not have to go hundreds of thousands of dollars into debt to complete med school. Who is going to do that only to come out and be paid Medicare rates?

 

[Ziggurat]

Let's rewind a bit. Yes, twinstead came up with the comparison, but it was clearly tongue in cheek.

Clearly? Not, it wasn't clearly tongue in cheek.

Twinstead was not saying "don't invest" or "prevent people from investing" or anything of the sort. He was pointing out that a profit-driven medical industry creates situations where cures are priced for profit which results in people dying because they can't afford the cure.

Yes, it does. And the alternative to profit-driven industry is one where new cures aren't developed as quickly, leading to more deaths in the long run.

Let's recast this: You effectively claim that a class of people denying food to another class of people because they can't afford it, and allowing them to die from starvation... is ethically superior to... everyone in that region dying in a famine.

Just because more people live in one scenario than another doesn't imply that it is ethically superior.

Why not?

As yet another analogy here... Consider the following two scenarios:

A) The entire planet is divided into either a master or a slave caste. The masters have access to all of the resources, to do with as they please. The slaves only what resources are given to them by their masters, and exist at barely subsistence levels.

B) The planet gets smashed by an asteroid and ever single person on the planet dies.

Which of those scenarios is ethically superior?

The former, obviously. Again, the comparison only makes sense if we have some say in the matter, which means we can affect whether or not the planet gets smashed by an asteroid. If we cannot affect whether the planet gets smashed by an asteroid, then there cannot be an ethical evaluation of the situation. Ethics simply isn't relevant in any situation where choice plays no role.

 

[Ziggurat]

Yeah, this doesn't actually seem to have been borne out by any evidence. On average, Pharmaceutical manufacturers book about 25% profit per year - AFTER they have accounted for R&D.

And what's the variability? Riskier investment requires a higher expected profit.

In the past several years, several drugs under patent have increased in price, not decreased, some by as much as 3X - not because of any need to recoup R&D costs (which are already accounted for prior to that 25% profit margin, mind you), but because the companies decided that people would be willing to spend that much to not die.

Isn't being charged a lot to not die still preferable to not being able to buy the drug at any price?

There's been no significant decrease in the price of drugs after the first 2 years of coming off patent

And what about the price of the drug during those first 2 years coming off patent? Doesn't it drop quite a bit then?

both generics and brands stabilize at high prices, because people are "willing" to pay exorbitant amounts to not die or have low quality of life.

What counts as a high price at that point? Well, that's actually a fairly easy question to answer: a price such that profit margins (not simply on marginal cost but including capital investment in production) is above market rates.

So, are drugs that come off patent still priced high? You say they are, but that seems strange. Why would they be? They shouldn't be. If they are, new generic drug manufacturers should jump at the chance to enter the market and make above-market profits.

Unless there's some barrier to entry which prevents more manufacturers from entering the market. Then continued high prices make sense. But if there's a barrier to entry, then perhaps that's what you should focus on, if you want to reduce prices.

Pharmaceutical manufacturers have repeatedly developed minor variations of an existing drug, and introduced it just prior to their patents expiring in order to extend their position in the market at that price point, even though they have NOT expended any material cost in the form of R&D.

We were talking about people whose lives were at risk. If the new drug is simply a variation on the old drug, but the old drug will still save their life, then it doesn't really matter if they can't afford the new drug, so long as they can afford the old drug.

The cost of an MRI has NOT come down since they were introduced.

That's not the impression I've gotten. I'm having a hard time finding hard figures, but the Wikipedia entry had this quote:
"However, although the cost of MRI has fallen, making it more competitive with CT, there are not many common imaging scenarios in which MRI can simply replace CT"
Do you have hard data to the contrary?

There's a large number of medical devices - shower bars, crutches, braces, etc. that haven't been materially improved in decades, but have continued to rise in price.

I have a hard time believing that crutches are priced high because manufacturers are extracting exorbitant profits from them. They also aren't an example of high technology (and haven't been for well over 100 years), so why should we expect them to follow the trajectory of high technology prices?

On the whole, the cost of treatment doesn't come down over time so that poor people can afford it to.

But this sub-discussion isn't about the cost of treatment on the whole.

If we are concerned about overall costs, there are far better steps we could take than what's generally being discussed here. For example, the standard government exercise and diet recommendations are absolute crap, and even when followed they lead to old people typically being weak and frail, conditions which become very expensive to handle medically.

 

[quixotecoyote]

This is a slippery slope. Who do you want to make the determination that 25% after R&D is too much? And would you feel the same about the bread companies making a similar profit? Both are theoretically necessary for people to have, so why would they be different?

It's always good to remember that slippery slope as a metaphor comes from the slippery slope fallacy, and it's almost always fallacious. Doing one thing in a reasonable degree neither implies nor necessitates doing it in an unreasonable degree.

Doing a thing in reasonable circumstances neither implies nor necessitates doing a thing in unreasonable circumstances. Regulating companies that provide services necessary to sustain life so that "Pay-or-Die" is not an abused business model doesn't require us to go to any ridiculous extreme.

And as for bread, yes. If people can't afford to eat without going bankrupt, steps need to be taken to ensure that they are able to do so. Whether that's providing bread directly, mandating a living wage, or regulating the food companies, it's not incredibly important. Any would be acceptable. Chalking it up to the cost of a free market is not.

 

[Shalamar]

It's always good to remember that slippery slope as a metaphor comes from the slippery slope fallacy, and it's almost always fallacious. Doing one thing in a reasonable degree neither implies nor necessitates doing it in an unreasonable degree.

Doing a thing in reasonable circumstances neither implies nor necessitates doing a thing in unreasonable circumstances. Regulating companies that provide services necessary to sustain life so that "Pay-or-Die" is not an abused business model doesn't require us to go to any ridiculous extreme.

And as for bread, yes. If people can't afford to eat without going bankrupt, steps need to be taken to ensure that they are able to do so. Whether that's providing bread directly, mandating a living wage, or regulating the food companies, it's not incredibly important. Any would be acceptable. Chalking it up to the cost of a free market is not.

We couldn't just give people bread though. That would seriously impact the bread R&D industry, which means we would never see better bread. This means the unfortunate act of not allowing poor people to eat, so that people who can pay will be able to eat better bread in the future. /s