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

[Ziggurat]

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.

Jesus H Christ, Cat, I JUST corrected you on this! I said nothing about how the profits would be spent. Here are my exact words from the section you just quoted:

"I said nothing about how those final proceeds would be spent."

That was literally the last sentence of that quoted section. So after quoting this sentence, you turn around and tell me what I'm supposedly saying these profits will be spent on. Are we going to have to go through this a third time?

Twinstead did NOT express a preference for a situation where the cure doesn't exist at all.

Let me repeat what you just said:

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

If you say that B is worse than A, how can I take that as anything other than a preference for A?

That is NOT what s/he said. That's what you read.

B is worse than A. I read that as a preference for A. Is it really a mystery to you as to why I would read it that way? Seriously?

 

[Emily's Cat]

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.

That's exactly what I needed! Thank you for providing better wording for me .

Ziggurat... That's the tradeoff that twinstead was talking about, that's the situation I'm talking about.

The current situation is one in which a cure exists. The drug companies have a large range of possible prices, and have chosen prices that maximize their profit. That price point is one that means many people will die because they can't afford it. The drug company could make a profit with a lower price and help many people live... but they have chosen a price that maximizes their profits at the expense of lives.

The assumption that is usually made is that drug companies are justified in setting such incredibly high prices, because they need the money for R&D. They need that money so they can go on to invent other drugs.

Twinstead objected to that viewpoint.

You objected to Twinstead's objection.

Thus we have a disconnect. Your position (based on recent posts as I understand them) is that it's better to have a cure that some people can't afford than to have no cure at all. At face value, I agree with you - it is trivially true.

The problem is that this isn't what's being compared. This isn't what twinstead was opining on, and it's not what I've been talking about. It's such a trivial element of the situation that I didn't even realize that's what you were talking about.

What the rest of us have been talking about is whether it's better to have a cure now that some people can't afford and trust that the manufacturer will invest those maximized profits in developing more cures in the future... or whether it's better to reduce the profit margin and allow more people now to stay alive because there's no certainty that a) the manufacturer will invest in finding a cure rather than a lifestyle drug and b) that a cure can even be developed in any reasonable time frame.

Hopefully, this will get us on the same page Then, even if you disagree, at least I'll feel better knowing we're talking about the same thing.

 

[Ziggurat]

Except that the current situation is that there are known treatments, but that not everyone can afford them.

In other words, you're saying that the choice that twinstead presented is not one of the important choices we face. That's a perfectly valid position, but the implication is not that my preference on twinstead's choice is wrong, but rather that we should focus on a different question. And I won't object if you do. Hell, I might prefer talking about a more sensible question, if you've got one on offer.

 

[jimbob]

At least one of was claiming that the existence of universal healthcare in countries other than the US was causing future deaths by retarding medical research by some (rather tenuous and not very convincing) mechanism.

This is equivalent to saying that a cure for disease C won't exist because of universal healthcare.

In reality, there are treatments or cures for diseases D-Z and they are available to poor people in most developed countries due to universal healthcare.

 

[Ziggurat]

Ziggurat... That's the tradeoff that twinstead was talking about, that's the situation I'm talking about.

Then you've done an absolutely crap job of talking about it.

The current situation is one in which a cure exists.

Twinstead explicitly raised the possibility of a cure not existing. If you only wanted to talk about what to do in a situation where the existence of a cure was already a given, then twinstead's choice isn't relevant, is it? How can it be? I TOLD you this way back in post 86, but you didn't listen.

 

[sunmaster14]

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.

Presumably, if the rest of the world valued those lives, they would find a way to pay for a malaria drug. Bill Gates is doing that. If he promises to pay $1000 for each dose of malaria drug and do it for millions of people, I have no doubt that there would be a flurry of investment in new malaria drug research.

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.

Gaming the patent system is obviously not doing much social good (except if it puts competitive pressure on the company with the patents to lower their prices). It is, however, an inefficiency in the system that comes with the territory. Sort of like how tax shelters come with a high income tax regime.

 

[sunmaster14]

That's exactly what I needed! Thank you for providing better wording for me .

Ziggurat... That's the tradeoff that twinstead was talking about, that's the situation I'm talking about.

The current situation is one in which a cure exists. The drug companies have a large range of possible prices, and have chosen prices that maximize their profit. That price point is one that means many people will die because they can't afford it. The drug company could make a profit with a lower price and help many people live... but they have chosen a price that maximizes their profits at the expense of lives.

Why is it up to the drug companies to be altruists or philanthropists? If you want to help poor people buy life-saving drugs, why don't you give up some of your own money to help them do it. This isn't aimed at you specifically. It's simply to note that drug companies are in the business of making profits, and the profit-making system has worked well up until now in enabling rapid medical progress. The solution to a drug being too expensive for a needy person to afford is to provide a subsidy to the needy person so he can buy the drug. I see no reason why this subsidy should be provided by the drug company. Why can't a charity, or even the government, do it?

 

[jimbob]

Why is it up to the drug companies to be altruists or philanthropists? If you want to help poor people buy life-saving drugs, why don't you give up some of your own money to help them do it. This isn't aimed at you specifically. It's simply to note that drug companies are in the business of making profits, and the profit-making system has worked well up until now in enabling rapid medical progress. The solution to a drug being too expensive for a needy person to afford is to provide a subsidy to the needy person so he can buy the drug. I see no reason why this subsidy should be provided by the drug company. Why can't a charity, or even the government, do it?

How is universal healthcare requiring the drug company to provide the subsidy?

You seemed to be complaining that Medicare and Medicaid shouldn't use their bulk-buying powers to negotiate the best prices, but that is a large organisation behaving as it should in the public interest. Drugs companies don't need to supply the NHS, for example, but many do - presumably because it is profitable for them to do so.

 

[Emily's Cat]

Why is it up to the drug companies to be altruists or philanthropists? If you want to help poor people buy life-saving drugs, why don't you give up some of your own money to help them do it. This isn't aimed at you specifically. It's simply to note that drug companies are in the business of making profits, and the profit-making system has worked well up until now in enabling rapid medical progress. The solution to a drug being too expensive for a needy person to afford is to provide a subsidy to the needy person so he can buy the drug. I see no reason why this subsidy should be provided by the drug company. Why can't a charity, or even the government, do it?

Sunmaster, do you believe that exploitation is a real thing?

 

[twinstead]

Sunmaster, do you believe that exploitation is a real thing?

I'm beginning to think he does not

 

[sunmaster14]

How is universal healthcare requiring the drug company to provide the subsidy?

The government uses its monopsony power to force the drug company to sell its drugs cheap. Which works fine in the short run, but guts the incentive to develop new drugs in the long run.

You seemed to be complaining that Medicare and Medicaid shouldn't use their bulk-buying powers to negotiate the best prices, but that is a large organisation behaving as it should in the public interest. Drugs companies don't need to supply the NHS, for example, but many do - presumably because it is profitable for them to do so.

Medicare and Medicaid are run by the government. The government is not, nor can it be, a private actor in a free market. Here are some of the ways that the government is different:

(1) Its decision making is driven by people whose interests are not aligned with the ultimate consumer; for example, a bureaucrat is concerned about his own job, first and foremost, as is a politician, but that rarely coincides with the interests of the government's beneficiaries;

(2) The government has ways to be coercive besides just using its regulation-given monopsony power;

(3) The government cannot go bankrupt and be removed from the free market gene pool, so to speak, for doing stupid things or otherwise being beaten by its competitors.

As for the voluntary decision of drug companies to sell at a low price to the NHS, well, in large part that's "found" money for them. If their marginal cost of production is low, and they can be reasonably assured that various laws restricting the export/import of drugs will be enforced, so that they won't be cannibalizing their sales in the US, then it can still be a win for them to sell to the NHS at a price far below what they can get in the US. Of course, it's the US consumer paying high prices which makes this viable. Otherwise, drug companies would see diminished future profit opportunity and scale back investment accordingly.

 

[sunmaster14]

Sunmaster, do you believe that exploitation is a real thing?

Of course. But in a free market where transactions are voluntary, I don't think it is. Sure, markets aren't perfectly free, and not everybody is acting out of their own volition, but it's close enough. Invariably, when you see exploitation in the market, it's because of some collaboration between a corporation and government. A corporation is really not capable of exploiting anybody without the government's help.

 

[twinstead]

Of course. But in a free market where transactions are voluntary, I don't think it is. Sure, markets aren't perfectly free, and not everybody is acting out of their own volition, but it's close enough. Invariably, when you see exploitation in the market, it's because of some collaboration between a corporation and government. A corporation is really not capable of exploiting anybody without the government's help.

To refine the question, are you saying that prior to government intervention, child labor, monopolies, price gouging, dangerous working conditions, etc didn't exist?

 

[sunmaster14]

To refine the question, are you saying that prior to government intervention, child labor, monopolies, price gouging, dangerous working conditions, etc didn't exist?

Well, it might be somewhat tautological, but according to my definition, coercing or tricking somebody to work for you (i.e. sell you his labor), or to buy your product, is not allowing him to do so of his own volition. The government should prohibit (or otherwise punish) the use of fraud or the use of threats by one party to induce another party into transacting.

Child labor, to the extent that the child is not mentally capable of entering into a labor transaction voluntarily, should be prohibited. Dangerous working conditions should be allowed as long as they are disclosed, or at least not fraudulently concealed. I don't see anything wrong with price gouging, or monopolies for that matter, as long as they happen naturally without government facilitation. Monopolies almost always do require government facilitation.

To me exploitation involves removing the element of volition or agency from the one being exploited. This can certainly happen through deception.

 

[Emily's Cat]

To me exploitation involves removing the element of volition or agency from the one being exploited. This can certainly happen through deception.

Do you feel that it is not exploitation when the alternative to the presented option is death? Do you consider it to be free volition and full agency in that case?

 

[sunmaster14]

Do you feel that it is not exploitation when the alternative to the presented option is death? Do you consider it to be free volition and full agency in that case?

I don't see what's so special about death. It is merely an unhappy choice, not qualitatively different from having to endure pain or fear or loss or hunger or thirst or boredom or humiliation or a hundred other possible bad things.

 

[quixotecoyote]

Sunmaster, do you believe that exploitation is a real thing?

I don't see what's so special about death. It is merely an unhappy choice, not qualitatively different from having to endure pain or fear or loss or hunger or thirst or boredom or humiliation or a hundred other possible bad things.

I'm torn between this meaning "Yes and it's ok" and "Yes but I choose to define it out of existence."

 

[theprestige]

I'm torn between this meaning "Yes and it's ok" and "Yes but I choose to define it out of existence."

You must have missed the post where sunmaster recognized the existence of what he defines as exploitation, and said that it was not ok.

 

[theprestige]

I'm torn between this meaning "Yes and it's ok" and "Yes but I choose to define it out of existence."

You must have missed the post where sunmaster recognized the existence of what he defines as exploitation, and said that it was not ok. What sunmaster's post about death really means is that you and Emily's Cat define exploitation more broadly than he does.

But I suspect that you will both agree that exploitation includes at least his definition. And I suspect that you will both agree that what he defines as exploitation is not ok.

 

[Wudang]

I don't see what's so special about death. It is merely an unhappy choice, not qualitatively different from having to endure pain or fear or loss or hunger or thirst or boredom or humiliation or a hundred other possible bad things.

Apart from the whole death being generally not a temporary state thing?