Thursday Highlights

Links?

  1. A question of bias. Case in point.
  2. Zoooom, or should that be “hyper-zoom”.
  3. Eating only fast food, what really happens.
  4. Moving towards single payer, because we all wish our health care was as good as the VA. The wealthy just wish they had it so so good. This is their strategy for getting that. File *that* under “cunning plan”.
  5. Reading between the lines that means plastic = cheese and the big companies like Nabisco &c have figured out how to make sawdust taste “good”. Apparently we can thank Ms Obama.
  6. Copyright silliness.
  7. Our brilliant, err, cunning foreign policy plan. I recently read a hisory of the Crimean War. Cunning plans seem to spring up in foreign policy quite frequently. (as in Am I jumping the gun, Baldrick, or are the words “I have a cunning plan” marching with ill-deserved confidence in the direction of this conversation?)
  8. Poverty is ended in the US. Who knew? By the calculation a single person making about 11k per year is “below the poverty level”  but that same person typically gets 20k in aid .. putting them well above the poverty line, hence my conclusion. Oddly enough a single young 20-something makinger 11k per year but who live at home with his parents counts as “below the poverty line” by their calculation I think.
  9. Our tone deaf and aggressively stupid Administration, exhibit A.
  10. Putting Mr Coates down a few notches.
  11. Diet and exercise are the key I suppose.
  12. No no no. Congress-critters are on a par with used car salesmen, it’s the life long bureaucrats and executives that are on a par with criminals.
  13. Well grammar is one culprit, I suspect “because they don’t read” is the other.
  14. This was known before Oct. 1 2013.
  15. Hint: people who defended Mr Obama vis a vis the IRS scandal don’t have a leg to stand on regarding criticism like that without being hypocritical.

20 Responses to Thursday Highlights

  1. 4.Moving towards single payer, because we all wish our health care was as good as the VA. The wealthy just wish they had it so so good

    If your position is that Democrats have a level of intelligence and foresight to launch an almost Emperor Palpatine level plan to institute single payer, then you should embrace it. After all, what evidence of intelligence do you have for your side? Chris Christie closing down the GWP bridge to ‘punish’ Fort Lee? If someone is really this much smarter than you, you should just step aside and shut up.

    But in reality the idea that the ACA is just a ‘stealth single payer’ is pretty much nonesense. Mass. has had Obamacare since Romney was governor there and there’s no evidence of a mass movement towards single payer there. Other countries, like France and Germany, have universal coverage through a network of subsidized private insurance systems as opposed to the single payer system of Canada or the UK. If anything the ACA has probably made it harder for advocates of single payer since the law mostly has worked pretty well and it’s easier to simply tweak the existing law than rewrite everything from scratch.

    As for a month or two of website problems being such a diaster that the only solution now is single payer. Is ignorance so fashionable with conservatism that their commentators have to ‘signal stupidity’ in their posts? Back when we brow beated you into writing up a summary of the ACA, you demonstrated you actually do have a functional understanding of how the law works. So this being the case, you should know the exchanges are something like 20% at most of health coverage. Most people get coverage either thru their employer if they are working or thru the gov’t if they are old or very poor. So even if the website was something important why would single payer be the obvious next step? That’s kind of like saying because the GWB has a lot of traffic on it New Jersians will ditch driving cars and buy themselves personal helicopters.

  2. #8

    8.Poverty is ended in the US. Who knew? By the calculation a single person making about 11k per year is “below the poverty level” but that same person typically gets 20k in aid

    In that case you’re also asserting no one earns between $11K and $30K? After all, why work and make only $29K if by making just $11K you could enjoy a total of $31K in cash and benefits?

    Oddly enough a single young 20-something makinger 11k per year but who live at home with his parents counts as “below the poverty line” by their calculation I think.,

    Your confusing poverty with bills. John McCain once demonstrated how out of touch he was when he make a quip about having so many homes he couldn’t keep track of them. I’m sure McCain has bills that I could never handle. All those utility bills, property tax, staff, estate managers etc. By your logic McCain isn’t really richer than you or I since he has huge bills that we don’t. But McCain’s bills are a function of his not being poor. Likewise someone who makes only $11K who lives rent free with mom and dad is also poor. Such a person cannot afford normal market rent and living on their own.

    Now you can argue in that individual case the kid is lazy or that he enjoys this lifestyle so he isn’t acting to improve his lot. But that’s besides the point. Nobody is telling John McCain he can’t live in his mom’s basement and put his income into a bigger bank account rather than numerous estates.*

    * David Brooks observed that some expenses do come as a requirement of class. Hence you have upper class people who may make $400K per year but because it’s expected in their social group to spend $180K per year on private schooling, nannies, etc. per kid that after doing that and paying taxes they are really ‘no better off’ in terms of ‘free money’ than a person who makes a much more modest salary. Strictly speaking John McCain couldn’t live like a homeless begger and still earn the income he does. But even if you factor that out, a lot of his ‘expenses’ are imposed by his lifestyle choices.

  3. 15.Hint: people who defended Mr Obama vis a vis the IRS scandal don’t have a leg to stand on regarding criticism like that without being hypocritical.

    Congress passes a law that says groups can be tax exempt if they do ‘education’ but not if they are political parties. IRS Bush appointees sets up a set of ‘flags’ to trigger more scrutiny to determine if a application is really more for a political party. (i.e. “Tea Party” in the name is an indication it’s a party!).

    Giant brouhaha over the fact that some of these triggers are for conservative names (i.e. ‘patriot’, ‘tea’ etc). Only after the ruckus dies down is it revealed left wing terms were also being flagged (i.e. ‘progressive’, and medical pot groups…though I suppose you could call that libertarian more than liberal).

    Of course as a result of the ruckus, the law is basically now being ignored and you can be tax exempt even if you are a political party. Since that benefits both sides no one is objecting even though that’s NOT the law that was passed.

    How does this compare to “Bah Fort Lee has pissed me off, make a traffic jam happen there”?

  4. Mr Howard,
    You are claiming that the wealthy like, say, Mr Trump, professional athletes, and the President just wish they’d upp-ed for a term so they too could get in on that VA action?

    Seriously?

    Back in the real world, people had to mount protest lines and post conditions that were in hospitals during the Iraq war to get some movement to repair horrific conditions.

    But it is good to hear things aren’t as bad as they were.

  5. Boonton,

    . (i.e. “Tea Party” in the name is an indication it’s a party!).

    For those who got a modicum of education, Tea Party refers to a tax revolt and in the original case it wasn’t (as you are well aware) not a party in the sense of political group, but party in the sense of festivities. But you knew that I’m guessing.

    Only after the ruckus dies down is it revealed left wing terms were also being flagged (i.e. ‘progressive’, and medical pot groups…though I suppose you could call that libertarian more than liberal).

    The claim wasn’t that no liberal groups got investigated, but that a disproportionate number of conservative ones esp. in swings states did. Just like the Christie bridge kerfuffle, the ring-leaders got sacked. There are a lot of parallels. To be consistent, if you want to blame Christie (which I think is right) you should also blame Obama for the former (which I also do).

    How does this compare to “Bah Fort Lee has pissed me off, make a traffic jam happen there”?

    Seriously? Using political clout for partisan/personal purposes was the fundamental problem in both cases.

  6. “You are claiming that the wealthy like, say, Mr Trump, professional athletes, and the President just wish they’d upp-ed for a term so they too could get in on that VA action? ”

    No. What in those links makes you think I’d claim that? If anything my claim is that you can’t reasonably use the VA as a “bogeyman” for “terrible health care stemming from single-payer”. The satisfaction level of the average VA customer seems to be comparable to (or excess of) the satisfaction level of the “average” non-VA health care consumer with “average” health insurance using “average” doctors and/or hospitals.

  7. Back in the real world, people had to mount protest lines and post conditions that were in hospitals …

    Hospitals = One hospital, Walter Reid. Yes that was the only bad hospital and the only bad experience with health care in the entire country.

    For those who got a modicum of education, Tea Party refers to a tax revolt and in the original case it wasn’t (as you are well aware) not a party in the sense of political group, but party in the sense of festivities.

    Parties in this sense do not usually apply for tax exempt status.

    The claim wasn’t that no liberal groups got investigated, but that a disproportionate number of conservative ones esp. in swings states did.

    A claim backed up by no evidence. The only evidence was that right wing terms were used as ‘flags’ (i.e. Tea Party). Only later did it turn out that left wing terms were also flagged (‘Progressive’). And disproportionate is meaningless here. The fact is the way the law is written, both a ‘Tea Party’ group and a ‘Progressive Party’ group *should* be scrutinized when apply for tax exempt status. If lots of Tea Party groups apply suddenly in a state then the scrutiny should follow the applications. In other words, if 20 Tea Party applications came in in 2010 and 5 Progressive ones the person processing them *should* have been disproportionate.

    Seriously? Using political clout for partisan/personal purposes was the fundamental problem in both cases.

    Except in the first case you have an attempt to apply the law. You can criticize the method but despite lots of searching and whohaaing you found nothing to indicate anything like “these groups are pissing me off, let’s screw with them by going hard on their tax exempt applications”. In the second you clearly have that by people that go all the way up to just below Christie himself. (In fact, with the IRS I believe they couldn’t even find anyone higher than a Bush appointee, correct me if I’m wrong)

    “You are claiming that the wealthy like, say, Mr Trump, professional athletes, and the President just wish they’d upp-ed for a term so they too could get in on that VA action? ”

    This is another problem with inequality, it distorts the conversation. Why are the super-rich or mega-celebrities considered the the standard by which we should evaluate policies? If there a proposal on the table to give every American the healthcare that Mr. Trump gets? If so then I’ll take that over universal access to the VA.

  8. Just to throw this in there…I don’t have a problem with inequality per se, including when it means that the super-rich can afford more and better health care than everyone else. Short of rank totalitarianism I see no way around the fact that someone with $10B in his pocket is always going to be able to afford better medical care than I can, and there will always be someone who’s that wealthy. And I’m fine with that. My complaints with the current system are:

    1. How does it serve those at the “bottom”? The “least of these” as it were?

    2. How well does it serve the “average person”? Is there an alternative that would be more easily navigable (or cheaper) without significantly degrading care?

    3. How well does it serve the U.S. on a macro level? How much “ROI” do we get in terms of national health relative to how much we spend?

    Looking around the globe I can’t help but think there’s probably something better. And when I say “better” I mean both “better than Obamacare” and “better than what we had prior to Obamacare”.

  9. When Mr Trump is in the UK, where do you think he goes for health care? Does he wait in line at a NHS clinic? No he goes to his own private doctor which is all perfectly legal even though the UK has single payer.

    I agree with you about there being ‘better than Obamacare’ options but my partiality towards the law is that it is essentially an incubator. You have multiple health system ideas being brewed inside it so ones that are better are more likely to grow and ones that are not are likely to decline.

    What’s amusing to me is the one aspect the right is focusing on, the exchanges, are actually their thing. The exchanges are essentially ‘voucher based health care’. You buy your own insurance from a private company of your choice with a voucher based on your income. Want to be cheap? You can. Want all the bells and whistles, if you’re willing to use your own money you’re free to go for it. If this idea doesn’t work then it doesn’t bode well for most market based replacements (for example, many Republicans ideas would use the tax code giving people generous deductions or credits for buying health care…..so essentially your ‘voucher’ shows up in April when you file your taxes instead of when you’re shopping for insurance…big deal!).

    I think Mark does put his finger, loosely, on the issue with single payer. If it’s great, then great but if it’s bad then there’s few chances to escape. The VA has been amazingly good recently, but it also has been bad. Whose to say National VA is going to look like it does now and not like it did when it was more Born on the 4th of July VA?

    The voucher type solution keeps the whole system unstable. Patients want all the bells and whistles, but don’t want to pay. Providers want to get paid lots. Between them competiting insurance companies offer ways of balancing that equation. No one solution is stable or will appeal to everyone but that instability should kill off the bad.

    Single payer systems do have competition. A bad doctor will see his Medicare patients leave him for another doctor and that will hurt his practice (probably sink it, most doctors couldn’t survivie without Medicare). But I’m not sure the system as a whole works as well as it can.

    I would propose a simple modification. Anyone who wants too could opt to ‘buy into’ the VA or Medicare or even Medicaid. Just pay the gov’t the average cost per patient and they issue you a card even if you’re not old or a vet. This would be a self financing expansion so you don’t have the entitlement problem (those who qualify the ‘normal way’ would still get the reduced or zero premiums). You get an array of different choices and you keep the private payer system on top of that.

  10. Mr Howard,
    Obamacare was not the solution to your points. At best, which it does poorly I think, it is a distraction and an impedance to things which might productively solve the problem. Like wealth in general, the solution for those (#1) “at the bottom” is to get everyone more wealthy, strong economic growth helps the poor far better than re-distribution. Likewise medical improvements in automation, medicines and flexibility are the avenues in which #1 and #2 will be helped. Obamacare doesn’t touch that at all in a positive way, with some negatives (add new taxes on medical device development for example). Right now, bringing a new drug or device to market costs $1 billion and ten years to overcome the regulatory burdens. We spend enough on healthcare that big companies are willing to jump this hurdle. Compare medicine, computers & consumer electronics, and nuclear power. Regulatory hurdles are impossible for nuclear power, virtually non-existent for C&E and high for healthcare. Unsurprisingly there has been basically no advancements in nuclear power, medicine we are told is stalling and C&E continue to proliferate like mad. It’s not a coincidence. If Washington was sane the thrust for medicine would be how to lower the costs and barriers to market for new medical innovations.

    Obamacare (again at best) marginally improved #1 at what will come to be a relatively high cost (in price and quality of care) for those in category for #2. Things like increased taxes on medical developments will damage #3.

  11. Likewise medical improvements in automation, medicines and flexibility are the avenues in which #1 and #2 will be helped. Obamacare doesn’t touch that at all in a positive way, with some negatives (add new taxes on medical device development for example).

    Let’s say I have a hospital and I bring in all the Google nerds and automate the hell out of it. If I pull that off I can offer surgery at the hospital for less than everyone else. Insurance companies would love to make me a ‘preferred network hospital’. I would give them low prices and still reap profits while other hospitals struggle to avoid bankruptcy while charging higher prices. The insurance policies that use me can offer better healthcare at lower premiums, which would give them an advantage in either the exchanges or in employer provided markets.

    Not saying that Obamacare had that in mind but I’m not seeing why it would inhibit such innovation, if not encourage it.

    Right now, bringing a new drug or device to market costs $1 billion and ten years to overcome the regulatory burdens.

    The burden is finding a new drug that does something useful. In many ways I think this is a low hanging fruit situation. Finding a small molecule that can be mass produced, tolerated by the human body and also exploits some potent mechanism of action (like shutting down a protein in a cancer cell or disrupting a virus’s replication in a way that the virus cannot easily mutate around) is getting harder and harder since all the easier to find ones have been found. You may find a new drug by simply tweaking an existing one to make it slightly better, but then you’re entering a market that already has competition.

    The well may have dried up but it’s an open question whether all the remaining drugs will simply be much harder to find or if a new field will be found where wells gush new compounds as quickly and as easily as they used too.

  12. Boonton,

    Let’s say I have a hospital and I bring in all the Google nerds and automate the hell out of it.

    But you can’t do that in the US. You cannot have a hospital in which none of the equipment is federally approved.

    Not saying that Obamacare had that in mind but I’m not seeing why it would inhibit such innovation, if not encourage it.

    Because there is a new tax on medical instrumentation and development.

    The well may have dried up but it’s an open question whether all the remaining drugs will simply be much harder to find or if a new field will be found where wells gush new compounds as quickly and as easily as they used too.

    That may be, but having an additional 1 billion dollar 10 year hurdle isn’t helping.

  13. But you can’t do that in the US. You cannot have a hospital in which none of the equipment is federally approved.

    Most of the automation that needs to happen in US healthcare is no in terms of medical devices but information management, communication, coordination etc. This is one of the reasons the VA does a great job, if you live in Alaska and are vacationing in Florida you can walk into a VA hospital and all your medical records and notes will be in front of the doctor by the time you sit down.

    Because there is a new tax on medical instrumentation and development.

    A rather modest one and what you overlook is if the gains are so fantastic the potential profits would make the tax trivial. A bypass can cost an insurance company $70,000 or more. If you have a device that can do the same job for $7,000 an insurance company would be happy to pay that plus extra to cover your tax and extra extra on top of that.

    It’s also rather circular. The tax pays for coverage, coverage pays for health care. If you’re saying instruments are the greatest thing in health care then they should recapture those taxes in the form of sales to people covered with insurance.

    That may be, but having an additional 1 billion dollar 10 year hurdle isn’t helping.

    The burden to get a new drug cleared is not $1B. That figure is including all the compounds they tested and failed. It would be nice if you could know ahead of time what compounds work and which don’t, figure that out and you’ll be a very rich man.

  14. Boonton,
    A modest tax is not an encouragement. It may not be a large impediment but it certainly is a step in the wrong direction.

    A bypass can cost an insurance company $70,000 or more. If you have a device that can do the same job for $7,000 an insurance company would be happy to pay that plus extra to cover your tax and extra extra on top of that.

    The liability and FDA regulatory hurdles to get that 7k device out are as noted, decades long and millions.

    The burden to get a new drug cleared is not $1B.

    Ok then, How many years? How many dollars? Now compare that to the regulatory burdens to bringing, say, the Raspberry Pi to market. Barriers to bringing thing to market slow development. I still fail to see how you resist admitting that. It beggars comprehension.

  15. The liability and FDA regulatory hurdles to get that 7k device out are as noted, decades long and millions.

    As though there’s no liability for performing bypass operations! And saving $63K per operation pays for quite a bit of profits, lawyer time and liability insurance.

    Where you concerns would have an impact would be a device that has a very modest improvement. For example, consider a device that costs $65,000 instead of the $70,000 operation. Such a device is only a modest winner for the insurance company.

    But here is a problem for your beef about the profits tax. If the device is not very profitable for the maker, the tax is minimal. If the device is then there’s a lot of money to spread around. In other words, you’re either holding a winning lottery ticket or your aren’t. If you are it’s economically silly not to cash it in. Saying the tax are going to discourage people from cashing in their lottery tickets is pretty silly.

    Ok then, How many years? How many dollars? Now compare that to the regulatory burdens to bringing, say, the Raspberry Pi to market.

    As I said, the primary cost is finding something that works. If you can’t find something that works, the barriers to market are irrelevant if you have nothing to bring to market.

    To find something that works you will have to pay for running down lots of dead ends…unless you’re very lucky and find the ‘magic bullet’ with the first compound you test (which sometimes happens, but like winning the lottery that’s not a trick you can repeat on a regular basis). Once you think you found something, you have to show it works…that means double blind human trials. Those are barriers to market but I’m not seeing how you could avoid them.

    What’s interesting about your analysis though is that you would actually make the problem of non-coverage worse. Dramatic innovation in a sector actually drives spending. That sounds paradoxical but it really isn’t. All products are in competition with each other, if one gets a whole lot better, more will be spent on it. Consider TV in 1970 versus today. Today many of us are paying more for cable than we are for electric. In 1970 your dad might have got annoyed when you left the lights on but watching TV was free. But, of course, in 1970 you had channels 2-13 3 or 4 of which probably came in pretty fuzzy. Today we have smart TV’s you can call with your phone. AS a result cable represents a larger, not smaller, portion of our budget.

    A wave of massive innovation and new products in health care will not lower the % of GDP spent on health, it will raise it. That will increase the pressure on gov’t to cover people who can’t cover themselves. This is why I’ve been critical of using % of GDP spent on health as a metric of whether or not the law works.

    We do know, however, that we spend much more on health than other countries and get less outcome from it. So even without any discoveries there’s a lot of room IMO to bring that % down. That, though, is an information centered process as well as one of system structure. For example, are providers paid for avoiding unnecessary costs or are they paid for billing additional costs?

    To use the bypass example. Suppose some bypass operations are unnecessary. Well unlike a $7K device to replace a bypass, simply not doing an uneccessary bypass saves the full $70K as well as avoids a bunch of additional costs down the line (every time someone is cut open there’s some degree of ‘complications’)

  16. Boonton,

    To find something that works you will have to pay for running down lots of dead ends

    That’s right. And the FDA has made that running more expensive. And to take longer. You dodged again. You need to address this: “Barriers to bringing thing to market slow development. I still fail to see how you resist admitting that. It beggars comprehension.”

    Dramatic innovation in a sector actually drives spending.

    Yah, right. And dramatic improvement in healthcare might mean it might cost more to live with the health of your 20s until your are 100. Gosh, that’s horrible!.

    A wave of massive innovation and new products in health care will not lower the % of GDP spent on health, it will raise it

    Uhm. Yah, and innovations in automation will make us spend money on things like cars, computers and TVs. We should go back to sticks, clubs and subsistence farming.

    So even without any discoveries there’s a lot of room IMO to bring that % down.

    So, Obamacare reduced/removed liability costs? Oops nope. Look at your example, “To use the bypass example. Suppose some bypass operations are unnecessary” … but because we might get sued for not doing it, we better. The salient point being is that you’re focus is in the wrong place. Innovation is where you’re going to get your improvements in the median, not by shifting who gets what around fractionally.

  17. You haven’t really addressed my point about dead ends. No one knows which compounds will work and which don’t. Your billion dollar figure comes from the fact that on average for every compound that works, time and money is wasted studying ones that don’t.

    Uhm. Yah, and innovations in automation will make us spend money on things like cars, computers and TVs. We should go back to sticks, clubs and subsistence farming.

    Which is why I’ve argued against using ‘% of gdp spend on health care’ as a metric.

    So, Obamacare reduced/removed liability costs? Oops nope. Look at your example, “To use the bypass example. Suppose some bypass operations are unnecessary” … but because we might get sued for not doing it, we better.

    If bypass was a trivial operation this might be the case, but then if it was so trivial why would it cost so much? It seems this sword is double edged, if a doctor does 100 unnecessary bypasses in a year, there will be so many unnecessary complications, even deaths. That should be just as much of a liability problem for him. In fact it should be a bigger one. If your father dies and you allege malpractice because his cardiologist didn’t support a bypass, your lawyer would still have to prove that the bypass was highly likely to have prevented his death. That’s not as easy a case to prove as a case of a totally unecessary operation.

  18. Boonton,

    Which is why I’ve argued against using ‘% of gdp spend on health care’ as a metric.

    Yet you’ve argued that healthcare costs (in the US) are high? If you don’t use %/GDP by what metric do you evaluate “too high”?

    That’s not as easy a case to prove as a case of a totally unecessary operation.

    Seems to me the proof depends on exactly the same criteria. Presumably a diagnostic scan prior to the decision to have/not-have surgery is required for either determination. Dr A performs bypass if a cardiac artery is over 40% blocked, Dr B does them if 80% blocked. Dr B calls many of Dr A’s surgeries “unnecessary” yet there are likely studies/papers in the literature to support both. In either case (patient for Dr B has a heart attack’s lawyer can cite Dr A and his studies as indicating malpractice because the heart attack could/should have been avoided, likewise complications from surgeries by Dr A might sue citing Dr B claiming the surgery was un-necessary). Looks like to me this is a judgement call and malpractice should be off the table not that these surgeries are necessarily unwarranted.

    You haven’t really addressed my point about dead ends.

    I did too. Many dead ends means drug companies are highly sensitive to costs increases due to testing, which makes each dead end more costly then it would be. And you continue to dodge the question noted. Why the continued pretense?

  19. Yet you’ve argued that healthcare costs (in the US) are high? If you don’t use %/GDP by what metric do you evaluate “too high”?

    By the fact that other countries seem to spend a lower % yet get the same or better output from their systems.

    Two different ideas here, let me illustrate with food. Let’s say we both buy a hamburger for lunch. I spend twice as much as you. That’s perfectly fine, if my hamburger is at least twice as good as yours. If our hamburgers are equal in quality, though, then presumably I would spend half as much yet not suffer any decline in quality. So it would make sense for me to rethink my budget with an eye towards the idea that I’m spending too much for my midday burger.

    But suppose a gourmet burger joint opens and offers a burger that costs 4 times your cheap burger, 2 times my overpriced burger but is twenty times as good. Then I might switch to it, you might switch to it as well. Our wives would look at the weekly spending and note with alarm that our spending on lunch has dramatically increased. It has yet in terms of quality our spending has actually declined.

    Let’s say we measure burger quality in a unit called ‘Burgs’. Before I spent $7, you spent $3.50 on a burger of only 1 burg. I was spending $7 per burg, you were spending $3.50. Now the gourmet burger would cost $14 and have 20 burgs of quality. We now spend $0.70 per burg of quality. We can, in a fair sense, tell our wives that we have in fact reduced our spending on getting a burg of burger quality. We just took the savings and then some and spent it on even more burgs!

    We are really talking about two different concepts here. The first is can we get what we are getting more efficiently. The second is will there be new innovations exciting enough to make us willing to spend more on health care? These are two different concepts but they are joined in the sense that if we are wasting money, that’s wasted money. I don’t know if it will get easier or harder to invent wonderful new drugs in the future, but in either case I’d rather make the dollar stretch more rather than less.

    Looks like to me this is a judgement call and malpractice should be off the table not that these surgeries are necessarily unwarranted.

    It’s very hard to win a malpractice case if the doctor was following what’s considered the generally accepted standard of care. If it’s generaly accepted that bypass is done for blockages over 50%, it will be very hard to claim malpractice on the grounds that the operation was unnecessary.

    On the other hand, if it’s unheard of to operate at 27% blockage and the doctor did so because he read the result upside down and thought you were 72% you’d probably have the start of a case.

    I did too. Many dead ends means drug companies are highly sensitive to costs increases due to testing, which makes each dead end more costly then it would be.

    I’m not really clear why you think this is. A typical dead end will be a drug that does well in lab studies, seems to work in theory but then fails when it’s tested on humans. Since biological systems are very complex, it’s really not possible to know for sure before testing whether or not it will work. If you can solve that problem there’d be huge savings and you’d be very rich but I’m unclear which regulations you think cause that to be. Of course you can’t just test things on humans, protocols have to be written and reviewed, there’s all types of regulatory things to worry about and yes finding ways to make that more efficient would be great but you’d still have the bulk of the cost problem. You need all this time and money to find and recruit subjects, conduct the study and analyze the results only to learn what promised to be a huge breakthrough just doesn’t work.

    One model I can think of might be the movie business. Companies have some good ideas what types of movies will make a lot of money. They try to strategically fund projects that will turn into hits. Yet nonetheless there will be surprise hits that may make some small producers super rich and epic fails that the studios spend hundreds of millions on only to see them fizzle out. The movie business is not regulated the way drugs are by the dynamics are the same. The profits from the successful movies must be sufficient to offset the losses from the duds. A producer must either get very good at picking out what will be a hit or spread the money over lots of projects hoping to find enough megahits to offset many losses.

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