U.S. Politics: Confirming The Trumpocalypse

[OldGimletEye]

Just now, Ser Scot A Ellison said:

OGE,

Patent law is abused but it is useful in that it gives people a reason to innovate.  A financial incentive to innovate.  That doesn't mean it shouldn't be modified and reformed.

Well precisely speaking, it gives people excess returns to innovate, I think. Question is whether we can eliminate those excess returns or some of them by spending more on public research.

And by excess return I mean more return than what is necessary to bring a factor of production into use.

Anyway, our patent policies is one piece of this whole thing that should be talked about more, but isn't unfortunately.

[Ice Queen]

2 minutes ago, Werthead said:

The FBI can only comment on internal security cases, so I'm assuming they went on the email offensive because that was wholly in their remit. This Russian stuff involves foreign security issues, so I'm assuming they couldn't do anything without coordination with the CIA and other bodies. But yeah, it's more than a bit bizarre that the email story kept coming up and this stuff, which is far more incriminating, was kept quiet even though the media in Washington had a whiff of it in October.

Gotcha, thanks! That does make sense. Maybe they're playing the long game, especially now that Trump is PEOTUS and soon to be POTUS. They'd better have their facts straight before they accuse the President of the United States of treason. 

[Ser Scot A Ellison]

2 minutes ago, OldGimletEye said:

Well precisely speaking, it gives people excess returns to innovate, I think. Question is whether we can eliminate those excess returns or some of them by spending more on public research.

And by excess return I mean more return than what is necessary to bring a factor of production into use.

How can you quantify what it takes to bring every factor of production into use.  It will vary on an individualized basis?  

This is why economics bothers me.  It claims certainty about things that are necessarily in flux.

[Ice Queen]

4 minutes ago, Ser Scot A Ellison said:

With Triage, under Single Payer, there will be points in time where someone is not treated because they are not currently emergent and they die waiting for treatment.  I guarantee it.  

Single payer is the least bad option.  I mean that exactly as I say it.  It is not and cannot be a panacea.

People who die waiting for treatment (transplants, etc.) is not the same thing as being unable to get treatment due to lack of funds. It's disingenuous to suggest otherwise.

[OldGimletEye]

Just now, Ser Scot A Ellison said:

How can you quantify what it takes to bring every factor of production into use.  It will vary on an individualized basis?  

Okay, but do you have a problem with the idea that monopolies restrict output and raise prices?

As far as quantification goes, I agree that empirically, that's a bit of a tricky issue. However, I don't think it is necessarily insurmountable, if you have some data, with enough variation in strength of patent laws, public spending and rates of innovation. If you would find that weaker patent laws don't lead to less innovation, then that might be some evidence of excess profits.

[Rippounet]

21 minutes ago, Ser Scot A Ellison said:

Yup.  That's why I favor single payer.  But single payer, because it is a utilitarian measure cares little for the individual within the system.  It cares that the system works for most not that the system works for all.  It is a trade off.  

I think you're vastly overestimating the negative consequences of single payer. In fact, I'm even struggling to understand what your objections are exactly.

For instance, pharmaceutical companies are doing great in all European countries. Some regulations may prevent them from doing outrageous profits, but they're still making shitloads of money so it's not like regulations are hurting innovation in any meaningful way.

This is something that was pointed out by an American colleague of mine: people in the US tend to be misinformed about European systems and often make erroneous assumptions.
This is really obvious when discussing health care. During the debates about Obamacare, many politicans in the US (especially Republicans of course) spouted a lot of nonsense about European health care systems. But this is 2017: with the internet, you can easily check how the British, French or German systems work and decide for yourself what are their best sides, and the pitfalls to avoid.

Quote

With Triage, under Single Payer, there will be points in time where someone is not treated because they are not currently emergent and they die waiting for treatment.  I guarantee it.  

It happens, it's undeniable. And when it happens, it makes the headlines, since it is not supposed to happen. Such occurrences come from some hospitals being understaffed and/or malpractice of some sort...
Why are they understaffed btw? Because conservative governments have cut funding to the public health care system. But maybe I digress...
Anyway, my point is, it's actually very rare. While in the alternative system, people dying because they can't afford treatment is quite frequent. You might see this as a trade off. I'd argue that it's not even supposed to be one, because if there is enough funding for the health care system, it's not supposed to happen.

I'm also tempted to ask you if you have any evidence that triage is worse in countries with a single payer system than in the US. Because as far as I know, people die in ERs in the US too... I'm not sure why you would assume that a privatized system is better at triage...
I guess some wealthy people can afford better treatment through clinics and avoid any kind of queue... But this is also the case in single payer systems...

In a nutshell, it seems to me your objections rest on erroneous assumptions. Nut again, maybe I just don't understand them (?).

[Ser Scot A Ellison]

12 minutes ago, Crazy Cat Lady in Training said:

People who die waiting for treatment (transplants, etc.) is not the same thing as being unable to get treatment due to lack of funds. It's disingenuous to suggest otherwise.

No, someone who is not emergent at the time of treatment will get lower priority under the triage used in any medical system.  This is not changed in single payer.  This isn't merely "waiting for transplant".  This is part of medical practice generally.  It happens and single payer doesn't change that.  In fact, because more people will be in the lines it could exacerbate it.

[Ser Scot A Ellison]

4 minutes ago, OldGimletEye said:

Okay, but do you have a problem with the idea that monopolies restrict output and raise prices?

As far as quantification goes, I agree that empirically, that' a bit of a tricky issue. However, I don't think it is necessarily insurmountable, if you have some data, with enough variation in strength of patent laws, public spending and rates of innovation. If you would find that weaker patent laws don't lead to less innovation, then that might be some evidence of excess profits.

That's why I favor reform, not elimination.

[OldGimletEye]

Just now, Ser Scot A Ellison said:

That's why I favor reform, not elimination.

Well maybe you're right. Maybe instead of giving patents out for 20 years, we just give them out for 5 years or whatever.

Whatever the reform might be, this is one piece of public policy that doesn't get enough discussion in my view.

[Ser Scot A Ellison]

5 minutes ago, Rippounet said:

I think you're vastly overestimating the negative consequences of single payer. In fact, I'm even struggling to understand what your objections are exactly.

For instance, pharmaceutical companies are doing great in all European countries. Some regulations may prevent them from doing outrageous profits, but they're still making shitloads of money so it's not like regulations are hurting innovation in any meaningful way.

This is something that was pointed out by an American colleague of mine: people in the US tend to be misinformed about European systems and often make erroneous assumptions.
This is really obvious when discussing health care. During the debates about Obamacare, many politicans in the US (especially Republicans of course) spouted a lot of nonsense about European health care systems. But this is 2017: with the internet, you can easily check how the British, French or German systems work and decide for yourself what are their best sides, and the pitfalls to avoid.

It happens, it's undeniable. And when it happens, it makes the headlines, since it is not supposed to happen. Such occurrences come from some hospitals being understaffed and/or malpractice of some sort...
Why are they understaffed btw? Because conservative governments have cut funding to the public health care system. But maybe I digress...
Anyway, my point is, it's actually very rare. While in the alternative system, people dying because they can't afford treatment is quite frequent. You might see this as a trade off. I'd argue that it's not even supposed to be one, because if there is enough funding for the health care system, it's not supposed to happen.

I'm also tempted to ask you if you have any evidence that triage is worse in countries with a single payer system than in the US. Because as far as I know, people die in ERs in the US too... I'm not sure why you would assume that a privatized system is better at triage...
I guess some wealthy people can afford better treatment through clinics and avoid any kind of queue... But this is also the case in single payer systems...

In a nutshell, it seems to me your objections rest on erroneous assumptions. Nut again, maybe I just don't understand them (?).

There is no way to avoid the pitfalls.  It is impossible.  If every nation devoted every scrape of cash its economy produced to medical care in a single payer system there would still be people who died due to lack of available resources.  

I think single payer is the least bad option for medical systems but I'm not kidding myself that it can fix every problem it is presented with.

[Commodore]

Just now, Ser Scot A Ellison said:

The emotional nature of the decision for the family.  The physical, psychological, and emotional problems the patient is suffering from.  It's hard to tell grandma you just don't have the money to pay for her kidney transplant and that you are going to let her die.  

Right, but something being a necessity doesn't mean choice/competition to fulfill that need can't exist. 

[Ser Scot A Ellison]

2 minutes ago, Commodore said:

Right, but something being a necessity doesn't mean choice/competition to fulfill that need can't exist. 

Commodore,

Sure, but if you are saying such choice is just like the choice to buy or not buy a washer and dryer you are kiding yourself.  This is choice on a different emotional plain and as such should be looked at differently from other economic decisions.

[Wrl6199]

4 minutes ago, Ser Scot A Ellison said:

There is no way to avoid the pitfalls.  It is impossible.  If every nation devoted every scrape of cash its economy produced to medical care in a single payer system there would still be people who died due to lack of available resources.  

I think single payer is the least bad option for medical systems but I'm not kidding myself that it can fix every problem it is presented with.

Yeah tats true.

[Jo498]

15 minutes ago, Rippounet said:

I guess some wealthy people can afford better treatment through clinics and avoid any kind of queue... But this is also the case in single payer systems...

Exactly. I struggle to think of cases that are clearly better off as far as healthcare is concerned in the US (except for some overpaid people working in healthcare and as you pointed out, pharma companies are not exactly poor in Europe). Maybe someone in the middle class with a good health plan and a stable job is more flexible because s/he would be forced into the public system in many European countries. Or these people might pay less (or get more for what they pay) in the US for insurance. But these are obviously and neither life-death issues nor  threatening one's livelihood once one gets sick.

I struggle to see how a slight worsening for those comparably well off (there will not be much of change for someone making 500k p.a. because they willl always be able to afford better than the public system if they wish) including the best paid healthcare professionals could be seen as worse than millions of people without decent health insurance, always one sickness away from financial ruin (or the choice between financial ruin and death).

[Rippounet]

16 minutes ago, Ser Scot A Ellison said:

There is no way to avoid the pitfalls.  It is impossible.  If every nation devoted every scrape of cash its economy produced to medical care in a single payer system there would still be people who died due to lack of available resources. 

My question is: have you identified any specific problem that doesn't actually exist in a privatized system? It seems to me people die due to lack of available resources regardless of what the system is.

[Ser Scot A Ellison]

1 minute ago, Rippounet said:

My question is: have you identified any specific problem that doesn't actually exist in a privatized system? It seems to me people die due to lack of available resources regardless of what the system is.

Nope.  That's why I favor single payer.  I still call it the least bad option.  The only advantage for existing private systems is that when prices are driven down by single payer there are fewer funds available for innovation.  But, if we deregulated and forced down prices the same problem would exist and without guarantees of care for all people.

[Ice Queen]

27 minutes ago, Ser Scot A Ellison said:

No, someone who is not emergent at the time of treatment will get lower priority under the triage used in any medical system.  This is not changed in single payer.  This isn't merely "waiting for transplant".  This is part of medical practice generally.  It happens and single payer doesn't change that.  In fact, because more people will be in the lines it could exacerbate it.

Are you seriously claiming that more people will die on waiting lists for treatment? I'd love to see some evidence for that assertion, because I'm calling BS. You don't know that and it's speculation at best. For live saving emergencies, people would get treated the same as they do now. It's when you get into non-necessary and non-emergency treatments that wait times increase. So you can't get your facelift done next Friday, big deal.

Triage is going to have failures no matter what system you have. Privatizing the system and making it a deregulated free for all won't change that. 

In 2009 I waited seven months for a knee surgery to repair a torn meniscus. Just sayin'. 

You're trying to walk the middle of the road here and are going to get squished just like grape. But we at least agree that there are going to be unnecessary and preventable deaths no matter what system is in place. The goal is to minimize that and to get people the care they need. 

[Ser Scot A Ellison]

5 minutes ago, Crazy Cat Lady in Training said:

Are you seriously claiming that more people will die on waiting lists for treatment? I'd love to see some evidence for that assertion, because I'm calling BS. You don't know that and it's speculation at best. For live saving emergencies, people would get treated the same as they do now. It's when you get into non-necessary and non-emergency treatments that wait times increase. So you can't get your facelift done next Friday, big deal.

Triage is going to have failures no matter what system you have. Privatizing the system and making it a deregulated free for all won't change that. 

In 2009 I waited seven months for a knee surgery to repair a torn meniscus. Just sayin'. 

You're trying to walk the middle of the road here and are going to get squished just like grape. But we at least agree that there are going to be unnecessary and preventable deaths no matter what system is in place. The goal is to minimize that and to get people the care they need. 

It is absolutely speculation but reasonable speculation in my opinion.  More people who are gaining access to the system with the same limited resources.  Triage is good but it's not perfect.  Given the added strain of everyone being able to get treatment with little or no direct cost to themselves, particularly initially, there are going to be people who fall through the cracks.  There have to be.

But to be clear, I favor this system despite its draw backs for the very utilitarian reasons for which I criticize it.  I think Single Payer provides the best coverage to the most people.  I'm simply pointing out that it cannot be perfect, nothing can.

[Jo498]

First of all, one need not speculate, there are countries with such system that provide data. Second, if I understand you right, you mainly see a problem in transition with suddenly far more people wanting to get care. But this certainly cannot count in any way against single payer because it only shows how bad the current system is if it creates such a huge amount of untreated maladies that there would be an overload if all of them rushed to get treatment. Under this scenario it also seems logically impossible to me that the new system could be worse. Because if people in the new system die waiting, how do they die NOW? Not waiting because they know it is never going to be their turn (for treatment, it's everyone's turn to die eventually).

So it might be different people who die in the later system but I can assure you that they are usually the poor ones even in Europe. A few weeks ago some new demographical data were published and in Germany the life expectancy spread between the poorest and the richest quintiles is >11 years for males.

[Rippounet]

16 minutes ago, Ser Scot A Ellison said:

Nope.  That's why I favor single payer.  I still call it the least bad option.  The only advantage for existing private systems is that when prices are driven down by single payer there are fewer funds available for innovation. 

Hmmm... A quick google told me that while this is correct, the European Commission decided to invest a couple of billions to close the gap between the US and Europe for pharmaceutical R&D. This was voted for in 2007 and is currently in place.
Also, I'd argue that the gap wasn't that important to begin with, we're talking less than 5% of the overall budget for pharmaceutical R&D...

Lastly, there seems to be a debate going on about whether the US is truly ahead of Europe as far as developing new drugs is concerned. I found this paper that says that it isn't: http://content.healthaffairs.org/content/28/5/w969.full

So what I gather from my quick search is that there is a small gap in spending between the US and Europe, but that this does not translate into a significant difference in innovation. Of course, this was only a quick search and I'm not  an expert... But I think if the US was far ahead we'd know it (Europeans would flock to the US to get treatment for instance, just as Eastern Europeans sometimes move to Western Europe for that purpose).

5 minutes ago, Ser Scot A Ellison said:

It is absolutely speculation but reasonable speculation in my opinion.  More people who are gaining access to the system with the same limited resources.  Triage is good but it's not perfect.  Given the added strain of everyone being able to get treatment with little or no direct cost to themselves, particularly initially, there are going to be people who fall through the cracks.  There have to be.

Well, what happens is that people tend to be quicker to see a doctor when it costs them less ; also, they get sick leave more easily. This has been a consistent problem in France from what the media tells us. On the other hand, the fact that seeing doctors and getting tests is cheaper increases the chance of some pathologies being detected in their earlier stages. And studies have consistently showed that workers' productivity in France is significantly ahead of the US, though I can't claim to have evidence of a correlation (there are many other factors at play, including ethics).
So all in all, the strain is greater, it probably affects triage in a negative way at times, but it makes all kinds of prevention considerably more effective all the time.