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

[Shalamar]

I can't tell if your post is aimed at me (in response to what I wrote) or if it's using my post as a springboard.

Spring board. I also know it'll be soundly ignored.

 

[Ziggurat]

How is that not what you were talking about?

You decided to insert into option B a condition it never had, that it might in the long run lead to more saved lives than option A. Since the basis for my choice was which option saved more lives, this completely upends the entire calculus.

 

[jimbob]

You decided to insert into option B a condition it never had, that it might in the long run lead to more saved lives than option A. Since the basis for my choice was which option saved more lives, this completely upends the entire calculus.

But your rationale for believing that is not based in reality. If it was, then Bill and Melinada Gates wouldn't need to put money into malaria research.

 

[Ziggurat]

But your rationale for believing that is not based in reality. If it was, then Bill and Melinada Gates wouldn't need to put money into malaria research.

First, you haven't been following the discussion, because this isn't relevant. And second, I've said multiple times now that if you object to the choices on offer, take it up with twinstead, he's the one who created the comparison.

 

[Emily's Cat]

You decided to insert into option B a condition it never had, that it might in the long run lead to more saved lives than option A. Since the basis for my choice was which option saved more lives, this completely upends the entire calculus.

Noooooo.... The entire basis of your argument is that it's better to let people die now because they can't afford the price on the cure... and to use those proceeds to invest in research for other future treatments. The entire premise of your position is that letting people die right now is a better option, because you assume that those research endeavors will lead to more lives saved in the long run.

That's all assumption on your part - there's no guarantee that 1) proceeds from current profits will be used to find cures as opposed to me-too lifestyle $$ generating drugs and 2) a cure can even be found.

Without that assumption on Option B... well... you're just letting a bunch of people die now because they can't afford a drug, and there is no ethical offset to that at all.

 

[Ziggurat]

Noooooo.... The entire basis of your argument is that it's better to let people die now because they can't afford the price on the cure... and to use those proceeds to invest in research for other future treatments.

No, this is not the entire basis of my argument. To start with, twinstead's comparison makes zero reference to proceeds, investments, or research, but merely to a situation in which a cure exists but is too expensive for some versus a situation where the cure does not exist at all. twinstead expressed a preference for the latter.

I said that I preferred the former, because it meant more people would live. I'm still baffled that this is in any way a controversial position to take, but apparently it is. After that, we got into discussions about how we might end up in one situation versus the other, and investment, research, and proceeds arose in that context, but it wasn't actually part of the original question. Furthermore, even in those regards you still have the sequence wrong. Investment comes first, THEN research, and only at the end proceeds. I said nothing about how those final proceeds would be spent.

The entire premise of your position is that letting people die right now is a better option, because you assume that those research endeavors will lead to more lives saved in the long run.

Nope. In my hypothetical, we START in a situation where there is no cure. There's no question about letting people die: they're going to die regardless until a cure is found. So, what do we do to help find a cure? We set up a situation where anyone who does find a cure gets to make ****-tons of money off their cure until the patent expires. I think this will lead to a cure being found sooner, and therefore more people being saved, than setting up a situation where people who find a cure CANNOT make a ****-ton of money off their cure.

That's all assumption on your part - there's no guarantee that 1) proceeds from current profits will be used to find cures as opposed to me-too lifestyle $$ generating drugs and 2) a cure can even be found.

I never made assumption #1, because I never said anything about what would be done with the proceeds from drug sales. And because you fail to understand the sequence of events I posited, you fail to see that assumption #2 isn't relevant. If no cure can ever be found, then nobody can ever be overcharged for that cure, can they?

Without that assumption on Option B... well... you're just letting a bunch of people die now because they can't afford a drug, and there is no ethical offset to that at all.

Still wrong, because again, you screwed up the sequence of events.

 

[wareyin]

No, this is not the entire basis of my argument. To start with, twinstead's comparison makes zero reference to proceeds, investments, or research, but merely to a situation in which a cure exists but is too expensive for some versus a situation where the cure does not exist at all. twinstead expressed a preference for the latter.

That is not at all how I read twinstead's post.

 

[twinstead]

That is not at all how I read twinstead's post.

I think this is the post in question. I said:

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

It is assumed that both situations are bad, but when I said , "because she couldn't afford the cure" I meant that it was more expensive than it actually needed to be, so if our healthcare was more cost effective and less expensive and available to more people she wouldn't have died because she couldn't afford it.

And that would be worse than dying of something that there was no cure for.

 

[Ziggurat]

I think this is the post in question.

Yes, that's the post.

It is assumed that both situations are bad, but when I said , "because she couldn't afford the cure" I meant that it was more expensive than it actually needed to be

There is no objective measure of how expensive medicine needs to be.

so if our healthcare was more cost effective and less expensive and available to more people she wouldn't have died because she couldn't afford it.

And that would be worse than dying of something that there was no cure for.

The person dying might feel worse, but that's personal and subjective. A person who lives because they can afford a cure even if it's "more expensive than it actually needed to be" will feel better than if they die because there's no cure, and the difference between the two situations for the latter person is much, much greater (they live versus they die) than for the former person (they die in both cases).

Society is still better off with a cure that is "more expensive than it actually needed to be" (whatever that means) than with no cure.

 

[sunmaster14]

Yes, Ziggurat is right (about both his interpretation of twinstead's post and about his rebuttal). On the other hand, twinstead captures a very popular (and indeed human) sentiment. I think that sentiment is what drives a lot of the difference in outlook between liberals and conservatives. In a world of limited resources, some people are going to get what they need, and other people will not. How those allocations are made is the crucial difference. Rationally, making those allocations by willingness to pay (which of course will incorporate ability to pay) is the optimal policy. However, liberals view that as unfair because the original distribution of wealth is unfair. It's not unreasonable to consider fairness, and it's not unreasonable to consider wealth distribution to be unfair, at least in part. The key point I think liberals are missing, however, is that virtually any allocation policy you use (aside from random lottery) will be unfair by some measure. And random lottery is certainly not going to maximize utility.

I do agree with twinstead that it is indeed worse for a loved one to die because a cure is out of reach financially rather than because a cure doesn't exist at all. However, that is due to an irrational cognitive bias on the part of human beings. Such cognitive biases should not be the only, or even primary, input into designing social policy.

 

[Emily's Cat]

No, this is not the entire basis of my argument. To start with, twinstead's comparison makes zero reference to proceeds, investments, or research, but merely to a situation in which a cure exists but is too expensive for some versus a situation where the cure does not exist at all. twinstead expressed a preference for the latter.

I said that I preferred the former, because it meant more people would live. I'm still baffled that this is in any way a controversial position to take, but apparently it is. After that, we got into discussions about how we might end up in one situation versus the other, and investment, research, and proceeds arose in that context, but it wasn't actually part of the original question. Furthermore, even in those regards you still have the sequence wrong. Investment comes first, THEN research, and only at the end proceeds. I said nothing about how those final proceeds would be spent.

Your reading of twinstead's post, and your interpretation of it, is vastly different from mine... I suspect it's considerably different from the reading of nearly everyone in this thread.

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

Twinstead is quite clearly expressing discontent with a system in which people make massive profits off of life-saving treatments, in a way that DENIES cures to whoever can't afford the monopoly pricing of a profit-driven company.

He draws a comparison:
People die because a cure doesn't exist = bad
People die because a cure DOES exist but is priced so high that it is denied to them = worse

You, however, took that and ran with it. And you ran a bit sideways, my friend. You selected a position in which you believe it is ethically preferable to allow some people to die by denying them an existing cure, because the profits hypothetically get invested in developing other cures.

Twinstead did NOT express a preference for a situation where the cure doesn't exist at all. That is NOT what s/he said. That's what you read.

Nope. In my hypothetical, we START in a situation where there is no cure. There's no question about letting people die: they're going to die regardless until a cure is found. So, what do we do to help find a cure? We set up a situation where anyone who does find a cure gets to make ****-tons of money off their cure until the patent expires while denying a cure to other people so they can maximize their profits. I think this will lead to a cure being found sooner, and therefore more people being saved, than setting up a situation where people who find a cure CANNOT make a ****-ton of money off their cure.

I've added the piece that you seem to have missed - the piece that is the explicit bone of contention here.

 

[Emily's Cat]

The person dying might feel worse, but that's personal and subjective. A person who lives because they can afford a cure even if it's "more expensive than it actually needed to be" will feel better than if they die because there's no cure, and the difference between the two situations for the latter person is much, much greater (they live versus they die) than for the former person (they die in both cases).

Society is still better off with a cure that is "more expensive than it actually needed to be" (whatever that means) than with no cure.

OKay, just so you understand... You are in the camp of "It's preferable that some people die of starvation so that bread makers can make a ****-ton of money off of people even though bread is plentiful... than to have everyone at risk of starvation when no bread can be made.

You are preferring the situation that actively denies people access to continued-existence so that a small number of people can make an extremely large profit.

 

[Emily's Cat]

Yes, Ziggurat is right (about both his interpretation of twinstead's post and about his rebuttal). On the other hand, twinstead captures a very popular (and indeed human) sentiment. I think that sentiment is what drives a lot of the difference in outlook between liberals and conservatives. In a world of limited resources, some people are going to get what they need, and other people will not. How those allocations are made is the crucial difference. Rationally, making those allocations by willingness to pay (which of course will incorporate ability to pay) is the optimal policy. However, liberals view that as unfair because the original distribution of wealth is unfair. It's not unreasonable to consider fairness, and it's not unreasonable to consider wealth distribution to be unfair, at least in part. The key point I think liberals are missing, however, is that virtually any allocation policy you use (aside from random lottery) will be unfair by some measure. And random lottery is certainly not going to maximize utility.

I do agree with twinstead that it is indeed worse for a loved one to die because a cure is out of reach financially rather than because a cure doesn't exist at all. However, that is due to an irrational cognitive bias on the part of human beings. Such cognitive biases should not be the only, or even primary, input into designing social policy.

I'm not a liberal. In the case of life-saving cures, however, there's a bit of a difference when it comes to "willingness to pay".

If you're trapped in a burning building, and a firefighter comes along and tells you that he'll rescue you if you give him everything you own... Is that a fair trade? When the alternative is death, then the other side of the trade holds an exploitative monopoly position.

It's the mob telling you that they'll "protect" your beautiful store from being wrecked with a baseball bat, as long as you pay them every month.

Do you think that's a fair trade and a free choice?

 

[sunmaster14]

I'm not a liberal. In the case of life-saving cures, however, there's a bit of a difference when it comes to "willingness to pay".

If you're trapped in a burning building, and a firefighter comes along and tells you that he'll rescue you if you give him everything you own... Is that a fair trade? When the alternative is death, then the other side of the trade holds an exploitative monopoly position.

It depends if he had an obligation to rescue you given past contracts and expectation, etc. If he is a professional firefighter, paid by taxes or whatever, then of course it is extremely unethical (and probably illegal) for him to demand a huge payment in exchange for rescuing you. If it's just some bystander who would be putting his life at risk and therefore has no legal or even ethical obligation to rescue you, then I don't see a problem with him demanding a large payment in exchange.

I'll note that this situation has already, sort of, happened to a friend of mine. He was diagnosed with pancreatic cancer, and his only hope was to get a Whipple procedure, pronto. Unfortunately, it is an extremely difficult surgical procedure, and only a handful of surgeons in the area were qualified to do it (and among them the morbidity/mortality rates varied tremendously, so you really wanted the best one). The best one, and indeed the one he was entitled to get based on where he was being treated, just happened to have left for a 2 week vacation. Frustrating to say the least, since every day counts, but what could he do? I suppose he could have offered the surgeon $100,000 to postpone his vacation and do the surgery right away. Would it have been wrong for the surgeon to offer that? In the event, he had the surgery a few weeks later, but when they opened him up they discovered that the cancer had spread from the pancreas, so there was no point in doing the procedure. He died about 4 months later.

It's the mob telling you that they'll "protect" your beautiful store from being wrecked with a baseball bat, as long as you pay them every month.

That's quite a bit different. The mob would be creating the problem at the same time as solving it for you.

 

[jimbob]

How was Cain's post a misrepresentation of your view, Sunmaster14?

 

[twinstead]

I believe once a nation has achieved the wealth and power that the United States has, it can afford to inject a little more human "cognitive biases" into designing social policy. Not as the primary driver perhaps, but fairness should be part of the equation

 

[Ziggurat]

OKay, just so you understand... You are in the camp of "It's preferable that some people die of starvation so that bread makers can make a ****-ton of money off of people even though bread is plentiful... than to have everyone at risk of starvation when no bread can be made.

It really doesn't work for you to tell me what I believe. You keep getting it wrong, and it's quite tiresome. This isn't even a matter of you honestly misunderstanding me either, because you're not asking me if I believe this, you're lecturing me. Do you honestly think this approach is going to do anything other than annoy me? If that's the goal, then I suppose it's a successful strategy, but if it isn't, I suggest trying a different approach.

Exclusive cures for fatal diseases are not the equivalent of bread. This is a very, very bad analogy.

You are preferring the situation that actively denies people access to continued-existence so that a small number of people can make an extremely large profit.

I prefer a situation where some people with a disease die to a situation where everybody with that disease dies, yes. Why wouldn't I prefer less dead people to more dead people? It provides the dead no benefit to give them more company in death.

 

[Ziggurat]

I'm not a liberal. In the case of life-saving cures, however, there's a bit of a difference when it comes to "willingness to pay".

That's fine. There are a number of things one can do to try to avoid people dying because they can't afford medicine while still allowing high prices for novel cures. But none of those possible methods were on the table, and you don't need to attack the choice I make between the choices twinstead presented if what you really want to do is put a third option on the table. I've said this before, but you didn't clue in.

 

[jimbob]

It really doesn't work for you to tell me what I believe. You keep getting it wrong, and it's quite tiresome. This isn't even a matter of you honestly misunderstanding me either, because you're not asking me if I believe this, you're lecturing me. Do you honestly think this approach is going to do anything other than annoy me? If that's the goal, then I suppose it's a successful strategy, but if it isn't, I suggest trying a different approach.

Exclusive cures for fatal diseases are not the equivalent of bread. This is a very, very bad analogy.



I prefer a situation where some people with a disease die to a situation where everybody with that disease dies, yes. Why wouldn't I prefer less dead people to more dead people? It provides the dead no benefit to give them more company in death.

Except that the current situation is that there are known treatments, but that not everyone can afford them. Some of these treatments are considered cost-effective in other countries.

I'll come back to malaria. Any treatment isn't likely to be very lucrative as the most vulnerable are too poor to afford more than a few dollars a year (if that). However a treatment, or even better a cure or preventative measure would save millions of lives, and allow many people to have decades more healthy life rather than dying early after prolonged ill-health.

If a drug company can come up with a treatment that gets round Viagra's patents, then that has a far larger Total Available Market, so even a small market share could be very lucrative. This isn't actually providing anyone with anything that is medically novel.

 

[sunmaster14]

How was Cain's post a misrepresentation of your view, Sunmaster14?

I just remembered that I had composed a long response to your posting of this once before, but I don't think I ever posted it. Here it is, in all of its glory:

(Despite having putting a cap in Abel, Cain ain't so capable.)

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.

Barriers to entry: Why are these high in health care? Anybody with a medical degree can hang out a shingle. There are probably a lot of areas where you don't even need an advanced degree: Elder care, transport, consulting. Just holding hands at the nursing home is a valuable health care service. The bigger stuff hardly has unusually high barriers to entry. A group of doctors can build or buy a medical imaging center for an investment of $1MM. Get the government out of the way, and you could actually have scans read by radiologists in India. How much does a hospital cost in comparison to a car factory or a semiconductor fab?

Information Asymmetry: Why is there something magical about health care versus, say, buying a car (especially a used one) or a smartphone or a house? I have little idea how a smartphone works these days, but I feel I can learn about a disease (diagnosis, treatment, prognosis) in a matter of minutes on the internet. Where is the kind of asymmetry that you have when buying a used car (or getting service on a car) or a house? The seller may know about hidden problems with a car or a house, or the auto service center may lie about what your car needs, but what could the health care provider do to deceive you? Is he going to lie to you about your test results? It's difficult for him to lie about what those results mean or what to do about them. That stuff is easily available on the internet for free, and it's always recommended to get a 2nd opinion for anything serious. Furthermore, there are doctor and hospital ratings sites all over the internet. If you can make a good decision about which hotel to stay in or which restaurant to dine in based on consumer feedback, I think the same should be true for choosing a provider or a course of treatment.

Bad decisions aren't reversible: In most cases, they are. You try physical therapy for a while, and it doesn't work, so you go to a different therapist. Or you try medicine or surgery. I'll grant that you better think long and hard before you ask a surgeon to lop off your penis because you always wanted to be a woman. But even that isn't irreversible these days.

Consumers don't have lots of time to shop around: If you're lying in the street unconcious and bleeding to death because you just got hit by a bus, then, yes, getting the best deal is not your first priority. But that's what catastrophic insurance is for, or perhaps a prepaid urgent care plan. The funeral industry has successfully sold people on prepaid funerals and plots of land because most people understand that their loved ones will be susceptible to being ripped off while in a highly emotional state. As for 95% of health care decisions, you have plenty of time. Even in the case of a cancer diagnosis, there are generally days or even weeks of discussion and research before deciding on an action plan. And there is nothing stopping you from switching providers in the middle of treatment.

Indivisible Benefits and Costs: Not sure what Cain means here, which I suppose is part of the problem when you present somebody else's argument from 5 7 years ago instead of your own. I'll assume he means that there are negative externalities of somebody else's poor health. If somebody refuses to pay for their own insurance, for example, society will cover the cost when they get sick. That's true for serious stuff, maybe not so true when it comes to quality of life type things. In any case, how is giving these people subsidized health insurance any different than just giving them free health care when they show up at an emergency room. Where's the cost savings?

Children: Huh?

Bureaucrats: Under single payer, you're dealing with government bureaucrats. Under comprehensive health insurance, you're dealing with insurance company bureaucrats (although, here you would have the option of changing insurers, maybe). With less comprehensive plans, it would be just you for most health care transactions.