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

[wareyin]

Hmmm. I gather you're against doing anything drastic about global warming then?

? Are you implying that doing something about global warming now is equivalent to pricing lifesaving drugs out of the reach of poor people?

 

[jimbob]

I think it is more absurd to claim that hypothetical people using a hypothetical cure are more important than real people using an existing cure.

I'm not the one who created the comparison of an exclusive cure with a completely unavailable cure. If you think that's the wrong things to compare, take it up with twinstead.

Developing an ongoing treatment for male-pattern baldness would probably be more profitable than a one-off vaccine against malaria.

Developing a me-too drug that can get some of Viagra's profits without violating the patents would also be a rational use of R&D resources.

I see no reason to accept your assertion that allowing massive overspending and bloated administration somehow improves lives saved by accelerating research into lifesaving treatments.

Nobody prefers more people dying. That's not what's going on.

You're comparing something that is known and current and includes volitional acts by actual humans that directly lead to the death of other humans... to something that doesn't exist and hasn't been invented but has the potential to maybe result in fewer deaths overall if it actually occurs at some undefined future point in time.

And you're choosing the unknown piece as being ETHICALLY superior to removing the volitional acts that directly lead to death now.

Indeed, I am not entirely sure how Martin Shkreli contributed to saving people's lives.

I also haven't seen an answer to questions about why anyone should assume that the extra hypothetical research would be on lifesaving treatments as opposed to those which are most profitable.

 

[jimbob]

Take a look here in the other Obamacare thread. After I presented that evidence, all of my interlocutors skedaddled out of the thread, except for one particularly clueless one.

That isn't how I read that thread.

 

[jimbob]

Meh, seems like a small part of the problem. Regardless, most of the problem is caused by having 50 different regulatory agencies, one for each state. Also, because private insurers in the US don't insure people over the age of 65 (that's what Medicare is for), they end up insuring a group of people with lower average claims than the population as a whole. That makes administrative overhead look worse, since the denominator in the calculation is lower. Medicare's overhead is 2-3% I think, but the greater efficiency implied by the headline number is mostly an illusion.

The number of people in admin, rising from 19% of the health workforce to 27% of the health workforce doesn't strike me as it being a beacon of private-sector efficiencies.

 

[Ziggurat]

Nobody prefers more people dying. That's not what's going on.

That's exactly what twinstead's post meant.

 

[sunmaster14]

? Are you implying that doing something about global warming now is equivalent to pricing lifesaving drugs out of the reach of poor people?

Yes. Except instead of lifesaving drugs, global warming alarmists want to price energy out of the reach of poor people.

 

[Ziggurat]

The number of people in admin, rising from 19% of the health workforce to 27% of the health workforce doesn't strike me as it being a beacon of private-sector efficiencies.

Of course it isn't. The health sector is incredibly regulated, and that's a major contributor to the administrative overheard.

 

[Wudang]

That article is about government price control not about private companies bidding to supply medicines to a large buyer. As an example, I am asthmatic and over the years I have seen the brands of inhalers change as the NHS negotiated better prices with different suppliers of the same classes of relievers. I also saw my favoured treatment for perennial rhinitis disappear from the NHS list as it was decided they couldn't negotiate a low enough price when balanced against the perceived benefit. I could still get it through my private health care (on which I pay tax as a benefit of £379 per annum) but I couldn't be bothered. BTW that cost is much lower than I would pay as an individual because I work for a very big company which can negotiate lower prices because it's purchasing on behalf of a lot of people.
And it also helps the drug companies by reducing their direct marketing costs and advertising.

Interestingly the main thing messing my google searches was that most of the results were telling me how to get funding to do medical research and the bulk of the results were national entities or charities/philanthropic foundations.
And nobody skedaddled. Architect addressed it and Francesca. I suggest you re-read what they wrote

 

[wareyin]

Yes. Except instead of lifesaving drugs, global warming alarmists want to price energy out of the reach of poor people.

I don't find your claim or comparison credible, based on previous threads in which you discuss global warming. I'm not going to start a massive derail about it, so I won't ask for cites.

 

[sunmaster14]

That article is about government price control not about private companies bidding to supply medicines to a large buyer.

If the large buyer completely dominates the market, then it isn't a competitive market. It will distort cost-benefit feedback from the end consumer. In particular, if the government is involved, you don't get cost-benefit feedback from the end consumer at all. What you get instead is politics, which tends to favor those who are the noisiest or most well-connected.

As an example, I am asthmatic and over the years I have seen the brands of inhalers change as the NHS negotiated better prices with different suppliers of the same classes of relievers.

I have asthma as well, and I've experienced the same. I don't know the details, but I suspect a lot of formulations have come off patent and there is now competition from generics.

I also saw my favoured treatment for perennial rhinitis disappear from the NHS list as it was decided they couldn't negotiate a low enough price when balanced against the perceived benefit. I could still get it through my private health care (on which I pay tax as a benefit of £379 per annum) but I couldn't be bothered.

You couldn't be bothered because it still costs too much, or because you have to go to a different doctor to get a prescription? If it's the former, then I suppose that's a good thing (from a market efficiency perspective). If the latter, then that's an inefficiency created by the British system.

BTW that cost is much lower than I would pay as an individual because I work for a very big company which can negotiate lower prices because it's purchasing on behalf of a lot of people.

It's not necessarily the case because of bargaining power. It might be because the private insurer implicitly subsidizes that particular medicine by spreading the costs throughout its pricing scheme. You (or your company) might be paying for it in other ways (e.g. higher premiums, or higher costs for other medicines).

And it also helps the drug companies by reducing their direct marketing costs and advertising.

They save marketing costs because they only have to market to a few government bureaucrats rather than tens of thousands of doctors? Ummm, no thanks. That's not a recipe for benefiting from competition and consumer feedback.

Interestingly the main thing messing my google searches was that most of the results were telling me how to get funding to do medical research and the bulk of the results were national entities or charities/philanthropic foundations.

And nobody skedaddled. Architect addressed it and Francesca. I suggest you re-read what they wrote

Architect and Francesca were not the ones clamoring for evidence. It was the people I called out in this post. It was really weird to see them whining about how I refused to give evidence while they studiously avoided addressing the evidence that I had presented dozens of posts before.

 

[sunmaster14]

I don't find your claim or comparison credible, based on previous threads in which you discuss global warming. I'm not going to start a massive derail about it, so I won't ask for cites.

It doesn't have to be a massive derail. I think we can all agree that those who advocate drastic reductions in CO2 emissions now are effectively advocating for lowering the standard of living of people today in order to raise the standard of living of future generations. It's not an unreasonable policy, although I will note that future generations will probably be a lot wealthier than people alive today (putting aside the negative effects of global warming), so maybe we should give more weight to the welfare of those presently alive.

You, of course, could say the same thing about drug development, but I think the positive benefits of increased investment will ripen in the more immediate future. In particular, they promise to help many people who are already alive.

 

[Wudang]

In particular, if the government is involved, you don't get cost-benefit feedback from the end consumer at all. What you get instead is politics, which tends to favor those who are the noisiest or most well-connected.

And as in that other thread you're making easily-disproved assumptions. For example https://yellowcard.mhra.gov.uk/the-yellow-card-scheme/

They save marketing costs because they only have to market to a few government bureaucrats rather than tens of thousands of doctors? Ummm, no thanks. That's not a recipe for benefiting from competition and consumer feedback.

Here's how it actually works https://www.nice.org.uk/

Architect and Francesca were not the ones clamoring for evidence. It was the people I called out in this post. It was really weird to see them whining about how I refused to give evidence while they studiously avoided addressing the evidence that I had presented dozens of posts before.

It's not a personal debate. Why does it matter who makes the point? Are those people supposed to re-post the same stuff Architect and Francesca did? I don't understand

 

[sunmaster14]

And as in that other thread you're making easily-disproved assumptions. For example https://yellowcard.mhra.gov.uk/the-yellow-card-scheme/
Here's how it actually works https://www.nice.org.uk/

Could you explain more what your point is? Linking to such general websites isn't very helpful. If I did something similar, I would point you to this and be done with it.

It's not a personal debate. Why does it matter who makes the point? Are those people supposed to re-post the same stuff Architect and Francesca did? I don't understand

I think if somebody is going to pester me for evidence, and berate me for not providing it, he has an obligation to respond to that evidence or acknowledge that it has been provided. The pestering went on for pages and pages, and my excuse for not providing it was that these same people had shown a pattern of wasting my time by asking for more and more detailed evidence, going away after it was presented, and then later arguing the same old points as if they had never been rebutted. I can tolerate incivility, and I can tolerate ignorance, but I am somewhat impatient with people who I see as deliberately wasting my time.

 

[Wudang]

Sorry been rather busy and my tendency to abruptness surfaced.
Briefly there exist mechanisms for patients and doctors to report how medicines work. This is taken sufficiently seriously that practically any reported side effect is recorded and will be on the leaflets which accompany the medicine. A nice crib sheet for hypochondriacs.
There are bureaucrats in the process but primarily the selection of treatments is by experts with a very big emphasis on being evidence-based and a lot of reaching out. Unlike the politicians who prefer debunked economic theories. There's a decent and reasonably sized article on wk which shows the scope of the assessment.

 

[sunmaster14]

Sorry been rather busy and my tendency to abruptness surfaced.
Briefly there exist mechanisms for patients and doctors to report how medicines work. This is taken sufficiently seriously that practically any reported side effect is recorded and will be on the leaflets which accompany the medicine. A nice crib sheet for hypochondriacs.
There are bureaucrats in the process but primarily the selection of treatments is by experts with a very big emphasis on being evidence-based and a lot of reaching out. Unlike the politicians who prefer debunked economic theories. There's a decent and reasonably sized article on wk which shows the scope of the assessment.

I am well aware of the impressive government bureaucracy the UK has set up. I do not believe it maximizes utility even though it purports to. Personally, I find this type of calculation disturbing:

A patient has a life-threatening condition and is expected to live on average for 1 year receiving the current best treatment which costs the NHS £3,000. A new drug becomes available that will extend the life of the patient by three months and improve his or her quality of life, but the new treatment will cost the NHS more than three times as much at £10,000. Patients score their perceived quality of life on a scale from 0 to 1 with 0 being worst possible health and 1 being best possible health. On the standard treatment, quality of life is rated with a score of 0.4 but it improves to 0.6 with the new treatment. Patients on the new treatment on average live an extra 3 months, so 1.25 years in total. The quality of life gained is the product of life span and quality rating with the new treatment less the same calculation for the old treatment, i.e. (1.25 x 0.6) less (1.0 x 0.4) = 0.35 QALY. The marginal cost of the new treatment to deliver this extra gain is £7,000 so the cost per quality life year gained is £7000/0.35 or £20,000. This is within the £20,000-£30,000 that is suggested by NICE to be the limit for drugs to be cost-effective.[29]

It is much better for these cost-benefit decisions to be delegated to a level well below that of a national government bureaucracy. Not all individuals derive the same utility from fixed sums of money, nor even from being alive.

 

[jimbob]

I am well aware of the impressive government bureaucracy the UK has set up. I do not believe it maximizes utility even though it purports to. Personally, I find this type of calculation disturbing:



It is much better for these cost-benefit decisions to be delegated to a level well below that of a national government bureaucracy. Not all individuals derive the same utility from fixed sums of money, nor even from being alive.

Basically this post but not as a Poe...

If we had an actual free market, then most of these problems would disappear. First of all, in a free market there are no barriers to entry, and this assumption holds up particularly well in the case of health-care where anyone can start a local business. All of this competition means lower prices for you (and lower profits for business). Second, consumers are informed (no asymmetries); they're not swayed by silly superstitions and they don't need something like ten years of training. Moreover, bad decisions are perfectly reversible and consumers have lots of time to shop around. Third, indivisible benefits and costs: not happenin' here. When other people get sick and die, it's on them. Some people -- yes, I'm talking about communists -- like those two old white guys in the video -- will complain about how much is lost in "worker productivity" on account of days missed due to tooth aches and chest pains. Well, boohoo. Fourth: the children. It's actually better if fewer kids see doctors because it toughens them up. It's like my doctor says, "what doesn't kill you can only make you stronger." This may sound counter-intuitive to you. If it does sound counter-intuitive, then you're stupid, and you need to get your "duh-face" checked out... if you can. Fif: no government bureaucrats. Instead of decisions made by some poindexter in Washington who thinks he knows more than your doctor, under a free market they'll be made by some business major in Connecticut who doesn't care if he knows better than your doctor.

 

[Wudang]

It is much better for these cost-benefit decisions to be delegated to a level well below that of a national government bureaucracy. Not all individuals derive the same utility from fixed sums of money, nor even from being alive.

Well that was what we used have and called a "post code lottery" and there was an outcry that someone in one region could get a treatment that a person in another region couldn't. NICE was originally set up to establish best practice for what actually worked and was cost effective. And note that NICE issues recommendations to fund or not and the local body (Primary Care Trust) can then decide. If the decision is not to fund it then the patient can consider other treatments or pay themselves or via a private health care provider.

 

[sunmaster14]

Basically this post but not as a Poe...

You could do that same unfunny, ignorant and completely disingenuous analysis in every other market too. The idea that health care isn't amenable to free market dynamics is a liberal fallacy. Even if I were to grant that emergency health care transactions require government intervention (and I don't, there are many markets for emergency services which work quite well) that still leaves 98% of health care consumption available for free market reform.

I know we've had this discussion before jimbob. The fact that you keep recycling the same old tripe is not encouraging.

 

[Emily's Cat]

That's exactly what twinstead's post meant.

Wow. No.

Option A: Applying X now will save a near-definite Y lives.
Option B: Not Applying A now means that Y lives will nearly-definitely perish... but maybe someday (and there's no guarantee) some new Q might be invented, and that Q could maybe (not certainly) save more than Y lives over the course of future history.

Preferring Option A is NOT synonymous with preferring that more people die. Not in any way. Not even a little bit. Even with a bunch of rhetoric and semantic games rubbed all over it, it isn't synonymous at all.

There really is nothing more to be said on this topic.

 

[sunmaster14]

Well that was what we used have and called a "post code lottery" and there was an outcry that someone in one region could get a treatment that a person in another region couldn't. NICE was originally set up to establish best practice for what actually worked and was cost effective. And note that NICE issues recommendations to fund or not and the local body (Primary Care Trust) can then decide. If the decision is not to fund it then the patient can consider other treatments or pay themselves or via a private health care provider.

The problem isn't only on the side of refusing to pay for "insufficiently cost-effective" treatments, although that does cause most of the free-rider problem for expensive new cancer drugs and the like. The problem is also on the side of making it free for a patient to get "sufficiently cost-effective" treatments. Maybe it's not worth it for me to pay £3,000 for an extra quality-adjusted life month, but if I'm getting it for free, then what the hell. I'll take it. What's great about the free market is that the consumer gets to make his own cost-benefit decisions. Prices adjust, and, consequently, productive resources are allocated accordingly. The NHS is just getting in the way of all that - artificially increasing demand for the stuff that government bureaucrats think is important and artificially reducing demand for the stuff that government bureaucrats think is unimportant. If the government did this in any other sector of the economy, it would be called a centrally-planned, command economy, and rightly so.