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The discussion is whether or not single payer would stifle innovation. Given that most of what companies do is revenue generation and product line expansions, it feels like we're a different conversation. Finding out whether a cancer treatment is useful for other cancers is a good thing, but not exactly big innovation. When that's the lions share of the R&D budgets we're using to claim innovation are going to such a small selection of drugs, I don't think we're taking about the same thing. This is way off in the weeds and we're all spending 2 pages to discuss a tangent made from a point in a post by a guy who hasn't even bothered to back up anything.
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Oct 23, 2020 02:59
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Jaxyon posted:The discussion is whether or not single payer would stifle innovation. I think defining innovation will help move that conversation forward because I don't think there is agreement on what it means. For me, innovation is creating different treatments for diseases, be it something that has no effective treatment or an improved treatment for a condition with at least one effective treatment. I would measure success in innovation by measuring the maximum potential QALY (or similar a metric) are generated per dollar in total R&D costs across the whole system. The denominator there includes VC money that goes to failed biotechs, pharma dollars that go to R&D, acquisition prices paid by pharma, etc. and the numerator includes patients that could benefit from a treatment more than their current treatment, regardless of if they take it. As an example, a new drug that could help 100,000 patients a year gain 1 QALYs and cost $1b to develop would give 1 QALY per $10,000. I'd consider that a great deal given the literature. Is that a fair place to start?
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Oct 23, 2020 03:22
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wins32767 posted:I think defining innovation will help move that conversation forward because I don't think there is agreement on what it means. My pushback here is that I think we should consider the opportunity cost of how we decide to invest in healthcare as a society. QALYs are calculated on the basis of data generated in a clinical trial; how frequently do people in the real world get care that’s as high quality and accessible as in a clinical trial? Not often. If the rest of our healthcare system isn’t up to snuff, then it doesn’t make sense societally to allocate all this money to drug development. Even if you use QALYs to argue in favor of label extensions as being positive innovation, I think it’s kind of missing the forest for the trees when overall health outcomes are so poor despite our exorbitant healthcare expenses. The innovation becomes irrelevant if it’s not built on a foundation of quality and accessible healthcare, which doesn’t exist because of our hosed for-profit system. Jaxyon posted:Is Merck spending most of it's R&D budget to find new markets to sell Keytruda(a drug they didn't invent) over the next few years creating innovation? I’m not contesting this point as a generalization, but just wanted to share a little context about Keytruda because I think it’s actually one of the few examples where all the investment on using R&D to find new markets as opposed to using it to develop new drugs is worthwhile. Keytruda is a type of cancer immunotherapy drug called a PD-1 inhibitor. Keytruda is the most commonly used one, but there are about a half dozen others on the market that basically do the same thing (more on that later). This class of drugs has really revolutionized the treatment of a huge percentage of metastatic/advanced cancer types, and data coming out now is starting to suggest benefits for some early stage cancers as well. Depending on the cancer, generally about 20-50% of patients will respond to these treatments, so it’s not a cure all. But for the patients that do respond, the responses can be extremely durable. Like durable enough that in late stage lung cancer, you can see 20% of patients still alive after 3... 4... 5... years, even though treatment is given generally only up to two years, and we don’t have enough longitudinal data to know how long those patients will keep living. Really remarkable stuff. I think Keytruda has a case to be the single most important drug in the past 20-30 years on the basis of the magnitude of efficacy, the severity of disease treated, and the breadth of applicability. Trying to find another 10 cancer types where it can be used is probably going to deliver more value to society than trying to come up with another 10 drugs. But all the other drugs in the same class? Great example of inefficient allocation of resources, and of the failures of the US capitalist system applied to healthcare. All these other drugs in this class are effectively identical to Keytruda. There are minor differences in how they’re engineered, but there is no clinical evidence to suggest that this matters one iota in terms of patient outcomes. Since they all work the same, the companies compete by trying to race to get approved in new cancer types first. The rewards for getting there first (I.e. unfettered US pricing) are so great that they’re taking more and more risk by moving into pivotal studies even where there isn’t very compelling biologic or clinical rationale to do so. A lot of these studies are still successful because the drugs are that good, but a lot of them fail too. Have we ever had a study that’s compared any of these drugs head to head? No, and at this point it’s unnecessary because we know they’re effectively the same. But there’s no medical benefit to investing in the R&D for the other drugs in these new tumor types as opposed to just using Keytruda. So what benefit do we get from capitalism’s purported sledgehammer of justice, market competition? Frivolous R&D expenses (and commercial expenses, including TV ads) from multiple companies with the same product, and big shocker, no (or negligible) price competition. They all cost in the $13-15K/month ballpark IIRC, a difference slight enough that insurers generally don’t consider the price to be a deciding factor among the drugs, let alone doctors or patients. Current regulations prevent generic/biosimilar versions from entering the market for another 10+ years, so no price competition there. And regulations prevent the biggest insurer in the country, Medicare, from negotiating prices. It’s outrageous, which is a word I swear I don’t use frequently but can’t stop myself from using it every time I post about US healthcare. So Keytruda might not be the individual drug I’d pick to as the poster child for inefficient/non-innovative R&D, but its numerous step-cousins do an excellent job illustrating the fuckedness of the system. Sorry for the screed, hope at least one of you nerds finds it interesting or informative! Sharks Eat Bear fucked around with this message at 22:22 on Oct 23, 2020 |
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Oct 23, 2020 05:52
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wins32767 posted:I think defining innovation will help move that conversation forward because I don't think there is agreement on what it means. Sure, but I don't think we really disagree on innovation in this context. Do you think someone who says "I worry that single-payer will reduce medical innovation" means: a) "I really really hope that this treatment for Mantle cell lymphoma can be proved to be effective for Primary mediastinal B cell lymphoma while also making it possible for the company that produces it to juice it's stocks and get it's C-level execs the highest quality of sex worker on their yacht, via spending far more on those things than my cancer research" or b) "I am worried that some stuffy government bureaucrat will decide that my illness isn't worthy of research compared to looking at how to make DMV wait times longer and raising the price of stamps by 3 cents" I know my quotes are tortured, but we both know the answer is B. That is what people are worried about. Is it important to make a new cancer treatment available for more cancers because cancer sucks? Yeah absolutely that work needs to be done. I fail to see why that would suffer under socialized a universal healthcare system. If the answer is "reduced revenue for the companies and they're greedy so they won't cut stock buybacks before they cut R&D" then that suggests some solutions that are entirely possible. Jaxyon fucked around with this message at 09:36 on Oct 23, 2020 |
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Oct 23, 2020 08:48
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The current US single payer plans don't change the relationship between privately run biopharmaceutical companies and payor(s), especially in terms of how R&D is funded. The only difference is who that payor is -- currently a mix of commercial (Aetna, BCBS) and public (Medicare, Medicaid) vs. whatever the single payor entity is called. From the pharmaceutical company's perspective there are only two things that single payer directly changes for them in regards to novel therapies: 1) expected reimbursement after discounts and 2) market share. Reimbursement rates will definitely go down because otherwise what's the point of consolidating buying power. Market share could go up in some limited circumstances, but much more likely to go down because the easiest way to constrain costs is establish more rigid pathways through lower price generics/biosimilars or older, inferior branded therapies. Both of these changes result in reduced revenue. Single payer doesn't tell private biopharmaceutical companies what to do with this revenue. There's no direction on how much profit they recognize and what's done with it (e.g., normal dividends, stock buybacks to appeal to investors) nor is any government bureaucrat deciding whether an illness is worthy of a private company to research (your b example). The same internal decision process applies to R&D spend where pharma/investors build an risk-adjusted cashflow to determine break-even on an individual clinical development program. Probability of technical (Ph1/Ph2/Ph3) and regulatory (BLA/NDA acceptance, FDA approval) success at each development stage remain the same. Revenue goes down due to lower reimbursement and market share per above. Pre-approval clinical, regulatory, and SG&A costs remain the same because the work still has to get done. Post-approval SG&A spend may go down, but all of these expenses in the cashflow are gated on technical and regulatory success. Some SG&A spend will persist depending on role. Need for finance/accounting, forecasting, analytics, etc. still necessary for basic investor relations, demand/expense estimation, performance tracking. To use your MCL example, marketing isn't developing an expensive ad campaign right now for a disease with 10k incident patients per year and relatively few HCP targets (heme oncs as opposed to GPs) and won't do so in the future, either. They're still going to need to spend money on basic HCP/Patient websites, education materials, etc. that exist in non-US countries today. Field sales spending should go down, but only to the point where the marginal ROI of an additional rep is <0%. You could lower expenses at all stages of the cashflow by just taking a 25% wack at compensation or whatever, but don't know why this would disproportionately apply to SG&A rather than R&D. Ultimately the relative split of R&D vs. other spend should remain fairly similar, just lower aggregate spend amount on both. The cashflow math and investment decision making process is pretty straightforward. I don't see any reason to believe that lower expected revenues would make more clinical development programs RA NPV positive. Single payer isn't going to force private entities in the healthcare system, pharma or otherwise, to operate at a perpetual loss to maintain status quo R&D. And maybe status quo R&D isn't terribly important or should at least be deprioritized relative to other things, but that's a separate discussion vs. aligning on directionality of expected changes. KingNastidon fucked around with this message at 15:27 on Oct 23, 2020 |
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Oct 23, 2020 15:25
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Jaxyon posted:Is it important to make a new cancer treatment available for more cancers because cancer sucks? Yeah absolutely that work needs to be done. I fail to see why that would suffer under socialized a universal healthcare system. If the answer is "reduced revenue for the companies and they're greedy so they won't cut stock buybacks before they cut R&D" then that suggests some solutions that are entirely possible. I don't think universal healthcare (with implied price negotiation) in the USA would drastically reduce medical innovation. It would probably impact it a little but the main impact would be on industry profitability. It all depends on how it's implemented and (as I said before) the susceptibility of US lawmakers to financial influence has a huge impact on this. I do think you are conflating several different issues and to be honest I am not quite sure what the exact point you are making is. Can I ask what it is you are proposing?
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Oct 23, 2020 18:45
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knox_harrington posted:I don't think universal healthcare (with implied price negotiation) in the USA would drastically reduce medical innovation. It would probably impact it a little but the main impact would be on industry profitability. It all depends on how it's implemented and (as I said before) the susceptibility of US lawmakers to financial influence has a huge impact on this. I am arguing against the idea that single payer would necessarily reduce innovation. If it's vague, that's because the person who said that provided no proof or support, and several people have decided it's correct while I, like you, think that it doesn't have to be true.
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Oct 23, 2020 19:22
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Jaxyon posted:I am arguing against the idea that single payer would necessarily reduce innovation. What would be the mechanisms for which single payer would increase innovation if that's defined as any are sent through clinical development and eventually approved? If we believe that clinical development is largely done at small biotechs with no revenue stream or profits, what is going to cause VC's to invest more in this sector when clinical outlays are the same, but the future revenue stream is lower? No one is going to be able to provide specific evidence that single payer, which could be implemented in various ways, will produce some specific quantifiable negative outcome. But there's value in at least aligning on the likelihood of up/down/flat and drivers for each.
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Oct 23, 2020 19:30
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BiggerBoat posted:
If you recently lost your job you should see about Medicaid and/or exchange plans. A lot of people assume they won't qualify for Medicaid because it isn't "for them", or because they remember rules from pre-2008, and while there is some variability from state to state one of the things that happened with the ACA is that a new minimum standard for who was covered was established, and not just in terms of income range. My sister, who is around your age and recently lost her job as a mid-level exec at a small local bank, assumed that she wouldn't be able to get it because it used to be that the standards for Medicaid were a lot like food stamps (couldn't qualify unless you had a kid, can't have any money in savings), but the ACA mandated that only income could be used as a baseline determining factor, and if you are completely unemployed then you should qualify. Edit: lol popping into the actual current conversation, which I hadn't read yet when I made this post- I think the fundamental thing to recognize here is that basically all of the existing roles of the pharma companies would need to continue to exist in any formulation of single-payer, and I think that advertising, while an obvious target for cuts, is maybe a little TOO easy to say. Basically, you have the Coke vs Pepsi marketing which is clearly a waste of money, as laid out above in the effort post about cancer treatments, but you still need to publicize your studies to get participants, propagate the differential outcomes to doctors/pharmacies/etc. It's probably true that given private companies maximize for profit and government orgs maximize for public good (generally) there is some set of changes you could make that would lead to greater public good in the US, but that doesn't necessarily mean that it leads to greater innovation, or greater global good (though if you include those factors in your optimization then maybe it could). The thing is, when people talk about M4A being cheaper on a per-person basis, they explicitly are talking about people in the US, and that's where the focus of the argument is (for valid reason, of course). However, if we kill off multinationals by subsuming their functions into our structure for US health care, there's an actual loss globally even as the US benefits locally, and I think that's what all the professionals in the thread are saying. Because there are so fewer strong international governing bodies, we have let multinationals fill the gap, and while this is obviously a terrible state of affairs and one we should work against it also means that if we take aim at multinationals without a suitable replacement in mind we are potentially creating a vacuum that nothing is able to fill in the short-term. That's where the loss of innovation is coming from, the fact that governments set standards for drug trials but don't run them themselves, typically. Basically, if we intend to take action which has the logical consequence of running some of these companies out of business, we should be concerned about how we handle that, because you can't just point at it and shout "nationalized!" when the functions and benefits come from it being international. We'd need to move some of these functions into the UN or some other organization established by treaty to really keep from having some sort of knock-on effect when we decide not to continue subsidizing these companies, which isn't to say that it shouldn't happen, just that you need to think of second-order effects and not just the immediate consequences in the immediate vicinity. I don't have sources, I'm not in the field and wouldn't know how to properly vet them, but this is just my thought process as a layman who supports M4A in the US. It probably isn't as simple as I would like it to be or even as simple as I could reasonably picture, and I'd rather someone else do the legwork of policy, but I don't think it's outrageous to say you need to acknowledge the existence of trade-offs on ANY policy, because then you can buttress it and find a way to fill those gaps. In this case, it just means that when we move to restructure our national policy we should also be making overtures internationally to avoid disruption of ongoing trials and make sure that research efforts DON'T take a hit, but it's not something I've seen discussed with any seriousness and the effort posters have been making the case for it pretty well IMO BougieBitch fucked around with this message at 21:27 on Oct 23, 2020 |
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Oct 23, 2020 20:23
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KingNastidon posted:What would be the mechanisms for which single payer would increase innovation if that's defined as any are sent through clinical development and eventually approved? If we believe that clinical development is largely done at small biotechs with no revenue stream or profits, what is going to cause VC's to invest more in this sector when clinical outlays are the same, but the future revenue stream is lower? Sounds like the development stream should be nationalized because, like in healthCARE, the profit motive is at odds with people wanting to live. I mean, I can't think of an industry that more strongly illustrates the failures of capitalism than medicine as a whole. If you're ever at a point where you're depending on VC's to fix societal problems then you've hosed up. Jaxyon fucked around with this message at 23:25 on Oct 23, 2020 |
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Oct 23, 2020 23:09
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Jaxyon posted:Sounds like the development stream should be nationalized because, like in healthCARE, the profit motive is at odds with people wanting to live. The process of nationalizing drug development and commercialization currently handled by multinationals headquartered in different countries would be a really interesting discussion, but it's not part of any US single payer proposal. It's not fair to assert clinical development levels will remain at status quo under single payer when that claim will actually require additional legislation or government action. I'd like more single payer advocates to be honest about the likely vacuum such that voters don't feel burned by false promises.
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Oct 24, 2020 17:03
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KingNastidon posted:The process of nationalizing drug development and commercialization currently handled by multinationals headquartered in different countries would be a really interesting discussion, but it's not part of any US single payer proposal. It's not fair to assert clinical development levels will remain at status quo under single payer when that claim will actually require additional legislation or government action. I'd like more single payer advocates to be honest about the likely vacuum such that voters don't feel burned by false promises. Oh now the international nature of drug development matters, when before it was all essentially irrelevant because the US was the source. No, what you have is what you think will be a failing of single payer, that you can't actually prove and you've admitted that. Voters are literally dying because of our current system. I think this is less about your concern for voters and more about your personal reservations. I agree, it's a possible thing that could happen. If it does, I'd imagine it's in the best interest of every country in the world to fix it. Single payer isn't some sort of pie in the sky overpromised nirvana, it's literally a common public policy that is working fine all over the world and works fine here.
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Oct 24, 2020 18:47
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Also I've noticed that those of you that are very concerned with innovation have not gone into the treatments that are currently not funded because the market value of that research is an insufficient incentive. Should we be warning the votes of that false promise or what? Jaxyon fucked around with this message at 19:18 on Oct 24, 2020 |
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Oct 24, 2020 18:53
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Opposing health care as a human right because the drug companies need the money for research is like opposing abolition because the slavers need the money to produce cotton.
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Oct 24, 2020 19:07
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Jaxyon posted:Oh now the international nature of drug development matters, when before it was all essentially irrelevant because the US was the source. You're combining a bunch of separate discussions. The US contributes and outsized portion to drug development because it's an outsized source of revenues because our reimbursement rates and out of pocket costs are higher than other countries. You can believe that while also questioning how the US nationalizing massive ex-US companies like AstraZeneca, Roche/Genentech, or Bayer. If the goal is not nationalize those companies but rather build up the capabilities within the US federal government then that's fine, but it's not part of the current single payer proposals. Jaxyon posted:No, what you have is what you think will be a failing of single payer, that you can't actually prove and you've admitted that. Voters are literally dying because of our current system. I think this is less about your concern for voters and more about your personal reservations. There are only three ways pharmaceutical innovation can go after US does single payer -- up, down, flat. I and others have provided the potential reasons why innovation would go down if US implements single payer in line with the current proposals. I've asked you to provide potential drivers to explain how innovation would go up or at least stay flat and your response is to nationalize clinical development, which is not part of the single payer proposal we're discussing. It's both my concern for voters and personal reservations. Meaningful healthcare reform beyond ACA, single payer or otherwise, should be a layup for either liberals or leftists. The US is a clear outlier on the issue and healthcare touches every single person in the country. They can't gently caress this up and overpromise/underdeliver because it will cause a backlash that results in dismantling those reforms and/or limiting progress to similar changes in other sectors. I'm wary of individuals or groups that seek to gain power/influence based on disingenuous or misleading claims even even if I generally agree with their end goal. Jaxyon posted:Single payer isn't some sort of pie in the sky overpromised nirvana, it's literally a common public policy that is working fine all over the world and works fine here. I agree. If I was appointed god king of US healthcare then some flavor of single payer would be my preferred choice to maximize aggregate outcomes. Doesn't mean there shouldn't be an honest discussion of the second order supply side effects. We've spent a lot of time the past few pages on the pharmaceutical industry that comprises 10-15% of total healthcare spend. Anyone with personal/financial exposure to the healthcare sector is going to take a bath here if you want to meaningfully lower healthcare spend. If advocates don't acknowledge that and explain why it's still better than the status quo then someone else is going to do it.
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Oct 24, 2020 19:19
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KingNastidon posted:You're combining a bunch of separate discussions. The US contributes and outsized portion to drug development because it's an outsized source of revenues because our reimbursement rates and out of pocket costs are higher than other countries. You can believe that while also questioning how the US nationalizing massive ex-US companies like AstraZeneca, Roche/Genentech, or Bayer. If the goal is not nationalize those companies but rather build up the capabilities within the US federal government then that's fine, but it's not part of the current single payer proposals. I said the process, not the companies. This is something we already do, or do you think that NIH spending only goes to products US companies make? quote:There are only three ways pharmaceutical innovation can go after US does single payer -- up, down, flat. I and others have provided the potential reasons why innovation would go down if US implements single payer in line with the current proposals. I've asked you to provide potential drivers to explain how innovation would go up or at least stay flat and your response is to nationalize clinical development, which is not part of the single payer proposal we're discussing. You have claimed concerns for voters that are very specific and focused. The current system kills 40k people a year. Republicans have literally tried to remove preexisting coverage and then just lied and said they're not doing that and it has worked on millions. You don't spend any time on drugs that aren't innovated on because there's no market incentive. Our current system reduces innovation and that's something you haven't even mentioned, despite a professed concern for voters and innovation. You could also be talking about ways to incentives innovation even under the current system, while reducing drug costs. But you haven't, you've made an argument with no proof that fits your confirmation bias. So let me again provide another research paper relevant to this topic. It even partly agrees with you! quote:I agree. If I was appointed god king of US healthcare then some flavor of single payer would be my preferred choice to maximize aggregate outcomes. Doesn't mean there shouldn't be an honest discussion of the second order supply side effects. We've spent a lot of time the past few pages on the pharmaceutical industry that comprises 10-15% of total healthcare spend. Anyone with personal/financial exposure to the healthcare sector is going to take a bath here if you want to meaningfully lower healthcare spend. If advocates don't acknowledge that and explain why it's still better than the status quo then someone else is going to do it. Oh no what if all the money going to the blackhole of a few healthcare companies was being spent on aggregate demand.
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Oct 24, 2020 19:37
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doverhog posted:Opposing health care as a human right because the drug companies need the money for research is like opposing abolition because the slavers need the money to produce cotton. I'm pretty sure all the people with the effort posts started and ended them with "so yeah we still obviously need single-payer, but let's be plain about possible drawbacks", everyone agrees that US health care is hosed and needs to change ASAP, it's just about making sure we don't collapse the Jenga tower by virtue of being the last rich country to get around to it. I've seen Nastidon make some pretty bad posts in other threads (generally by explaining why a bad thing happened mechanically when the discussion didn't really need that kind of nuance), but this is pretty much the ideal thread for the perspective being brought and it'd be nice if we could actually keep the long-form posts going because I think there's a lot to be gained from this being a srs business policy thread. If we can acknowledge that drug development (in the sense of efficacy and safety testing done almost exclusively by large companies) is important, then step 2 is to come up with a viable solution to keeping it alive in the absence of those large companies, because, again, it's an international problem that currently is being funded by the US through profit-motive. To address Jaxyon's point above, these companies conduct trials using an international pool of participants, but the money being made is in the US. Approval in other countries is happening because the marginal cost of getting it once it is already approved in the US is virtually nil, but most drugs wouldn't make it to that phase if the payoffs were half the current size, because the risk and benefit projections of the initial drugs would go from net positive across all outcomes to net negative, i.e.: Odds of failing at phase 1: 25% Cost of failing at phase 1: -1 Odds of failing at phase 2: 25% Cost of failing at phase 2: -2 Odds of failing at phase 3: 25% Cost of failing at phase 3: -3 Odds of making it to market: 25% Value of making it to market: +8 Where at present the weighted benefit of proceeding with a drug is +1/2, but if the value of making it to market was only +4 it would be -1/2 and the drug would not proceed to the first phase. Obviously this is an over simplistic example, and I realize people mock economics and game theory in particular, but it seems to me that the only premises you need to accept here are: 1. The US is currently the most profitable single market for drug sales 2. If the US got single-payer health care and began doing national negotiation on drug prices the level of profitability for drug companies would decrease 3. Given tighter margins, fewer drugs have the potential to be profitable and therefore fewer drugs will be taken through the steps needed for approval. If you disagree with one of those premises, then specify which one and lay out why, but all else being equal it seems that the argument that single-payer plans as-proposed would decrease the number of new drugs brought to market. To head off the obvious arguments (which you have already made and people have already agreed with): -Yes, profitability of a drug has no relation to how much good it does, as in the case of the copycat cancer drugs or Viagra. This is actually a key part of this point, as we should acknowledge that many of the drugs that are on the cusp of profitability might actually do a huge amount of good if we were able to confirm their safety and efficacy, such as new antimicrobials that were mentioned upthread. -Yes, a public entity that was able to do the same job as the existing private entity would be massively better, but I am not aware of any proposals of the sort, and especially not any that are included in any current healthcare plans. Due to the necessary scope, it may not be possible to create such an entity within the bounds of the US, because testing requires MASSIVE number of participants, and for many conditions there simply aren't enough candidates in JUST the US to fill a trial and have any real level of statistical power. Thus, it would need to be an international undertaking if the goal is to totally replace the existing pharma companies. -No, these concerns do not outweigh the net positive from improving US health care, especially not to US citizens. The reason they are worth mentioning is because they are a meaningful externality to the REST of the world, not because they would have some massive impact on US citizens. Essentially, the US has been paying a wealth tax to these private companies, and after they vacuum up some percent of it to pay their employees they spread the remainder around to the entire world as new approved drugs. The goal is to find a way to give the US better health care while also making sure that we are still funding those new drugs, and there ARE legislative ways to do that even if we don't want to totally supplant the drug companies. For instance, one idea I've heard floated is bounties for needed drugs or classes of drugs. I have no idea about the merits of this idea versus any other, but that's the point of bringing up the shortfall created by the US fixing health care, to make those ideas part of the policy discussion as well! Edit: It's also kind of funny to me that this discussion is happening with an ongoing health crisis taking center stage, like there's literally no way that the US could single-handedly develop a coronavirus vaccine even if we threw all of our national budget at it because we straight up do not have the combination of study participants, researchers, and manufacturing capacity on-hand. Given that, how can we expect to replicate that in the next 5-10 years if we move to a single-payer model? It's absolutely something that we would rather be handled by companies with broad public accountability or directly by the government, but if you aren't taking the steps to get there then it isn't going to happen by accident. BougieBitch fucked around with this message at 20:00 on Oct 24, 2020 |
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Oct 24, 2020 19:48
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Jaxyon posted:I said the process, not the companies. I don't know what this means. Jaxyon posted:This is something we already do, or do you think that NIH spending only goes to products US companies make? I'm positive some NIH funding for basic drug discovery goes towards pre clinical drugs that are ultimately out-licensed to companies not based in the US. You keep bringing up the NIH but it's not at all relevant to clinical development and commercialization at private healthcare entities, which is what single payer would affect. Current single payer proposals aren't changing NIH funding nor the scope of what they do. Jaxyon posted:You have claimed concerns for voters that are very specific and focused. The current system kills 40k people a year. Republicans have literally tried to remove preexisting coverage and then just lied and said they're not doing that and it has worked on millions. There are no republicans on this forum so I don't feel the need to criticize republican healthcare proposals, or lack there of. Jaxyon posted:You don't spend any time on drugs that aren't innovated on because there's no market incentive. Our current system reduces innovation and that's something you haven't even mentioned, despite a professed concern for voters and innovation. Don't know what this means. What's a specific example of a drug that isn't innovated because there's no market incentive? The existing system has plenty of incentives to produce novel drugs. Orphan disease act, fast track, breakthrough therapy, accelerated approval, priority review, real-time oncology review. But most critically, no hard cap on WAC cost or reimbursement. The cost of therapies is almost always inversely correlated with the number of patients it could treat. You aren't going to have private companies spending money on ultra orphan diseases if they're not reimbursed at a level to at least break-even given the low number of patients. Jaxyon posted:So let me again provide another research paper relevant to this topic. It even partly agrees with you! What's your takeaway from this? I'm not going to read 55 pages if I don't know what you're trying to prove/refute. Jaxyon posted:Oh no what if all the money going to the blackhole of a few healthcare companies was being spent on aggregate demand. Who/what is the blackhole? Where are these dollars going? What is aggregate demand in this context?
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Oct 24, 2020 19:56
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I'm not going to reply to a post that splices mine that hard that says "I"m not going to read things, don't understand what you mean and can't support my position". Read it or not. I've made my posts.
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Oct 24, 2020 19:58
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If drug companies actually require more money for R&D instead of shareholder dividends or executive bonuses or for marketing or bribes or whatever we can just give them money. Like. As a line item in the budget. While still having health care that vaguely resembles the standards every other developed country in the world has. This isn't even hard, just write them loving checks from the goddamn Treasury or some poo poo. Why is this even a debate.
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Oct 24, 2020 20:01
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Basically pharma companies are super rich and have spent a ton of money to try and justify their massive cash flow and protect it. Which we all know but somehow "uh oh what if we have to stop producing drugs because you can't expect us to spend less on stock buybacks" becomes a 3 page conversation.
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Oct 24, 2020 20:07
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Complications posted:If drug companies actually require more money for R&D instead of shareholder dividends or executive bonuses or for marketing or bribes or whatever we can just give them money. Well it's a debate because that's not actually a functional policy. If you say "here have $2 billion for R&D" then they just shift any internal money that was going to R&D over to marketing or CEO salaries and you've effectively just given them free money. You could give them a tax deduction proportional to the amount of R&D they perform, but that could be seen as a protectionist play, since it benefits US pharma corps over ones in other countries. Basically, the best play if you want to fix it by just throwing a wad of cash is to just straight-up buy the companies, change the stated goals of drug development so that decisions are made based on the number of total years of extended lifespan a drug gives across all patients instead of the amount of money it makes, and continue operations as normal otherwise, but that has its own risks because the next time Republicans get control they can shift the priorities back around to loving the poors or sell the parts to whatever private companies still exist like state and local republicans have done for years with public infrastructure, so ideally we'd come up with a more durable solution if one exists. That's also not getting into what it would mean in terms of international borders and whatnot, like can the US just buy a company that has real property in China or Russia or whatever without starting a whole debacle? Do we give the international employees US citizenship and move them over here? IDK, so far as I know nationalization hasn't been successful outside of situations where the primary value of the company was physical property like railroads, telecomms, or oil production, but I'm not all that well-read overall so maybe someone else could link a primer Edit: Let me be clear, in response to the above post- I don't think pharma companies are "good, actually", basically this is an exercise in hostage-taking but it's pretty hard to completely decouple a company from one of its core functions the way you are proposing, which is why you actually need some fiddly policy proposal to handle it instead of just a mission statement. We can't even get a national bill passed to regulate the price of insulin (or just buy whatever operation is responsible for manufacture and do it ourselves), so it's a reasonable thing to be concerned about us doing on a larger scale BougieBitch fucked around with this message at 20:29 on Oct 24, 2020 |
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Oct 24, 2020 20:19
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BougieBitch posted:Basically, the best play if you want to fix it by just throwing a wad of cash is to just straight-up buy the companies, change the stated goals of drug development so that decisions are made based on the number of total years of extended lifespan a drug gives across all patients instead of the amount of money it makes, and continue operations as normal otherwise, but that has its own risks because the next time Republicans get control they can shift the priorities back around to loving the poors or sell the parts to whatever private companies still exist like state and local republicans have done for years with public infrastructure, so ideally we'd come up with a more durable solution if one exists. It's almost like there are no solutions as long as the current political system with all the inherent corruption exists.
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Oct 24, 2020 20:52
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BougieBitch posted:Well it's a debate because that's not actually a functional policy. If you say "here have $2 billion for R&D" then they just shift any internal money that was going to R&D over to marketing or CEO salaries and you've effectively just given them free money. You could give them a tax deduction proportional to the amount of R&D they perform, but that could be seen as a protectionist play, since it benefits US pharma corps over ones in other countries. Look, the premise is that it's pharma company profit that's funding drug R&D for the world (PS lol), and that doing anything to fix the US's broken loving healthcare will be a loss for everybody everywhere because of There are a variety of ways to perform research on drugs ranging from basic to clinical trials that can involve the private sector as much or as little as we like, and simply pointing to a profit sheet going down and lamenting the poor scientists' funding is disingenuous at best.
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Oct 24, 2020 22:29
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It has been pretty clear that the private market will research boner pills opposed to new antibiotics. The private market has failed, and ought to be dismantled.
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Oct 24, 2020 22:41
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Complications posted:Look, the premise is that it's pharma company profit that's funding drug R&D for the world (PS lol), and that doing anything to fix the US's broken loving healthcare will be a loss for everybody everywhere because of christ no one is saying this, the point is that you need to explain how you are doing it, you aren't just loading up a T-shirt gun with wads of cash. There's not any US department or agency that currently does anything like this, the closest we have the the FDA and we would need to multiply their budget by like 16 and establish a bunch of new departments and poo poo, it's not just a handwave. The current FDA budget across all departments is $5.7 billion and half of that is paid for by the industries they regulate, annual pharma R&D is like $150 billion across the industry, with individual companies contributing up to $12b a piece. That STILL doesn't address the other point, which is that phase 3 trials require like 1000-3000 participants, meaning 3000 people with the disease in question who aren't disqualified for various reasons. How are we going to do all of the necessary testing for any given drug, assuming the trial is for something reasonably specific like "stage 3 leukemia in adolescents" or whatever? Again, RIGHT NOW there are a bunch of companies doing trials for COVID vaccines and for a bunch of practical reasons they have concurrent trials in the U.K., Japan, South Africa, Brazil, etc. https://www.statnews.com/2020/10/23/covid-19-vaccine-trials-from-astrazeneca-johnson-johnson-to-restart/ There are a lot of practical reasons to do that, it's not just a cost-saving measure! If some gene would cause you to have a severe reaction to a drug, you could easily miss it if you are pulling your trial sample from a localized population. There are a lot of genes like this, where the frequency is extremely variable based on geographic location, so trials done only on US participants BY NECESSITY would be potentially deficient. BougieBitch posted:
doverhog posted:It has been pretty clear that the private market will research boner pills opposed to new antibiotics. The private market has failed, and ought to be dismantled. Are you planning to contribute? Yes, the private market should be dismantled, what is the actual PLAN though? BougieBitch fucked around with this message at 23:06 on Oct 24, 2020 |
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Oct 24, 2020 22:53
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BougieBitch posted:christ no one is saying this, the point is that you need to explain how you are doing it, you aren't just loading up a T-shirt gun with wads of cash. There's not any US department or agency that currently does anything like this, the closest we have the the FDA and we would need to multiply their budget by like 16 and establish a bunch of new departments and poo poo, it's not just a handwave. The current FDA budget across all departments is $5.7 billion and half of that is paid for by the industries they regulate, annual pharma R&D is like $150 billion across the industry, with individual companies contributing up to $12b a piece. The numbers do not impress me. $150 billion annually? Chicken feed to a government budget. We already know how to administrate budgets to organizations that are literally an order of magnitude larger than that, I assume that it's entirely possible to build another goddamn administrative wing onto an office building somewhere and build some labs for scientists to work out of. My answer to "how is the government going to do things that corporations are doing" is fuckin' obvious; the same way the corporations are but without profit motive. And also with government budget backing it. As for how trials get conducted, frankly, I assume that it's possible for assorted health systems to cooperate and handle it in cooperation with governmental entities (kind of like the WHO, or through the WHO, or hell through another international entity who the gently caress knows or cares) rather than corporations via some arcane means like 'talking to each other.' By all means though, enlighten me on the difference between filling out results forms on corporation vs government letterhead.
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Oct 24, 2020 23:29
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BougieBitch posted:Well it's a debate because that's not actually a functional policy. If you say "here have $2 billion for R&D" then they just shift any internal money that was going to R&D over to marketing or CEO salaries and you've effectively just given them free money. You could give them a tax deduction proportional to the amount of R&D they perform, but that could be seen as a protectionist play, since it benefits US pharma corps over ones in other countries. How does this jive with the NHS producing all the innovation? If they're already providing all the underlying research why can't we also pay them to turn that research into treatments.
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Oct 24, 2020 23:31
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BougieBitch posted:Are you planning to contribute? Yes, the private market should be dismantled, what is the actual PLAN though? Plan is build up grassroots leftists organizations to primary corporate democrats, before that is done any talk about details is irrelevant. It cannot be fixed without that being done first. I'm sorry if I'm intruding but I really think you are missing the point. This thread is not about how taxes or research should work. It's about the state of US healthcare. (USER WAS PUT ON PROBATION FOR THIS POST) doverhog fucked around with this message at 23:48 on Oct 24, 2020 |
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Oct 24, 2020 23:45
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HootTheOwl posted:How does this jive with the NHS producing all the innovation? If they're already providing all the underlying research why can't we also pay them to turn that research into treatments. NHS is the british one, I'm assuming you were going for the NIH. The extent of that research is usually "synthesize a novel compound", "test in non-human subjects", and possibly "determine if this compound targets the appropriate cells or receptor sites in human tissue", not "determine the clinical efficacy and human safety for a variety of dosages and determine the list of side effects and interactions with other drugs". People fall into the trap of thinking that the first translates to the second, and it SUPER does not. Mice are cheap, and there are minimal ethical considerations, plus you can order them with whatever specific genetic abnormalities you need to test against. Humans want to be paid for their time and participation, your sample needs to be drawn in a way that ensures sufficient variance across all relevant factors to be suitably random, and there are tons of regulations and procedures that need to be followed. It's not the same sort of work, it is very technical and requires a lot of education and training to get to the point where you can do it effectively. There might be a lot of people in the sciences stuck at dead-end post-docs and the like right now, but I don't think it's a sure bet that we could find enough people to even SPEND another $150b without working our way up to it over at least a decade, maybe longer. I personally got an undergrad degree in biology, failed to make it into grad school, went back to school for CS and now can't find a job in the corona-wastes, so if we wanted to suddenly open up like 10,000 new positions at this theoretical new office I'd be all for it, but it is NOT just a matter of scaling up the things that exist in the NIH or FDA right now. doverhog posted:Plan is build up grassroots leftists organizations to primary corporate democrats, before that is done any talk about details is irrelevant. It cannot be fixed without that being done first. This is literally in the OP: "But it might stifle innovation". If you just want to talk about how politicians are bad there's like 5 threads for that, this is the US Healthcare thread and if you don't want to talk about the details of US Healthcare and all the ephemera attached to it then just don't, but don't poo poo up a thread that has a lot of effortposts just because you don't have any concrete opinions on the "how" part of the equation. Again, no one in this thread has posted anything close to "I like Joe Biden's plan" or "actually I think we can just keep things the way they are", so stop trying to frame it like requesting nuance is the same thing as opposing progress. Complications posted:The numbers do not impress me. $150 billion annually? Chicken feed to a government budget. We already know how to administrate budgets to organizations that are literally an order of magnitude larger than that, I assume that it's entirely possible to build another goddamn administrative wing onto an office building somewhere and build some labs for scientists to work out of. The WHO's annual budget for 2020-2021 is $5.84b, which, again, is for all programs. There have been concerns lately about certain countries having undue influence on WHO, imagine how much worse that problem would be if the US suddenly started paying them several times their annual budget to do stuff for us. It's really hard to come up with a single international entity that has both a meaningful impact and no ethical issues, because basically all of them have primarily been tools for exercising soft power since WW1. This obviously applies to businesses as much as to non-profits and treaty organizations, given the US's position during the Cold War, so it's not like the status quo is preferable or "safer" somehow, but it definitely means you can't beat capitalism by spending government money when it comes to problems with this kind of scope BougieBitch fucked around with this message at 00:26 on Oct 25, 2020 |
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Oct 24, 2020 23:56
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BougieBitch posted:NHS is the british one, I'm assuming you were going for the NIH. The extent of that research is usually "synthesize a novel compound", "test in non-human subjects", and possibly "determine if this compound targets the appropriate cells or receptor sites in human tissue", not "determine the clinical efficacy and human safety for a variety of dosages and determine the list of side effects and interactions with other drugs". People fall into the trap of thinking that the first translates to the second, and it SUPER does not. quote:There might be a lot of people in the sciences stuck at dead-end post-docs and the like right now, but I don't think it's a sure bet that we could find enough people to even SPEND another $150b without working our way up to it over at least a decade, maybe longer. I personally got an undergrad degree in biology, failed to make it into grad school, went back to school for CS and now can't find a job in the corona-wastes, so if we wanted to suddenly open up like 10,000 new positions at this theoretical new office I'd be all for it, but it is NOT just a matter of scaling up the things that exist in the NIH or FDA right now.
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Oct 25, 2020 16:34
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HootTheOwl posted:Wait, how do the companies do it then? Are you telling me that if a private company had and wanted to spend 150 billion they would seriously run into a personnel issue? It's getting a little out of healthcare and into government HR being a mess, but hiring for federal positions is notoriously slow. Check out the USAJOBS thread in BFC for plenty of examples, but TL;DR it's not unusual for it to take 6+ months to hire one person. I don't know enough about the internal processes of government hiring to recommend what should be changed, but I've personally received an offer letter for a federal position thirteen months after I interviewed for the role. I'd long since taken a job in the pharma industry by the time the offer came. Under whatever the current hiring regulations are, I don't know how a federal agency would manage to hire 10,000 people in enough time to do anything meaningful. The regulations are probably either intentional to hamstring them, or an overzealous inclusion requirement (must allow X time for internals, Y time for veteran interviews, then Z of open applicants before sending hiring package to Office A for review...), but again I have no idea.
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Oct 25, 2020 20:39
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Seems to me that most people here agree that universal healthcare is good and preferable, and that lack of drug price negotiation by medicare is stupid. From there it's a massive, giant leap to say "therefore all drug companies should be nationalised". The infrastructure to do global public-funded clinical research would be hard to put in place and I don't think you would get much agreement between countries on which studies to run. Drug development via international committee would be very slow and ex-US companies would likely be able to get drugs to market way quicker. Drug development is already pushed in particular directions by things like the orphan drug program, and I think that kind of carrot with price control as the stick is the option most likely to work. But, as I've said before, even this will require major political reform, and drug pricing is only a minor driver of excess health sector spending in the US. Like other posters have said "just nationalise it" isn't a plan it's an ideal. Also: related to the thread title, drug development is not "healthcare". Just sayin. knox_harrington fucked around with this message at 23:06 on Oct 25, 2020 |
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Oct 25, 2020 22:40
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To be fair, NIH does fund a significant amount of clinical research; they don’t exclusively fund basic research. The funding generally goes to individual academic investigators for smaller trials, and networks of academic investigators (called cooperative groups). There are frequently international collaborations between cooperative groups, as far as I’m aware mostly between the US and EU-based groups. And as a caveat, I’m only personally familiar with this model in cancer research so I’m not sure if other disease areas have similar arrangements. Nonetheless I think it provides a blueprint for what scaling a nationalized R&D industry could look like. One area that would be new to these groups AFAIK would be selection of pre-clinical candidates to enter in-human trials (I.e. IND stage), which could be a trickier decision to make than their current focus of deciding which research proposals to fund for drugs already in the clinic. Right now it’s “easy” for pharma to prioritize at the IND stage based on NPV — they want to invest in the drug candidates with the best shot at making lots of money. In a nationalized model there would still need to be some prioritization, but off the cuff I’m not sure what the right metric would be. Maybe something like the QALY metric that purports to measure value of a drug by its impact on both the quality and quantity of life for a patient, but tbh I’m not familiar enough with it to know if it’s legit. But whatever the metric is, I think it probably would require creating a new governmental body, rather than having an already-activated network of investigators like there is for clinical research. Despite working in the industry and having a moderate degree of knowledge about these topics, I’m definitely not an expert so if I’m off base here please correct me!
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Oct 26, 2020 06:50
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Well, I've worked quite a bit on academic multi-centre trials funded by research councils (MRC and Horizon framework etc) and they take a really long time and are not suitable for generating registrational level data as implemented. Not that they couldn't be but it would need huge organisation and lots of money. You could form a company to do it funded / owned by the constituent countries in the same way big defence projects are run, but they're not exactly paragons of efficiency and value. Writing a NDA or MAA is a huge undertaking on a different level from running an academic study and publishing a paper. Centrally directed drug development could also suffer from the continually shifting political landscape (see also defence projects) where the goalposts are shifted so often that your research never gets anywhere. QALYs are absolutely a valid measure of drug utility (or rather $ per QALY) and the US would need something like the much-maligned but actually pretty good UK NICE in a single payer system to work out if they'll pay for a treatment (cue screeching about death panels from the Right). While you don't know the efficacy you would need to have a rough guess at it and likely cost, and then factor that into whether you want to research a particular therapy. Would people be interested in discussing drug pricing? Personally I think that is the most difficult subject for drug company stooges like myself to answer, and thus probably where the key information lies.
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Oct 26, 2020 08:45
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We've already nationalized a bunch of research via the NIH. But I guess "nationalize the rest" is a bridge too far without a detailed plan from posters. It is fascinating to me that we have 3-4 pharma working posters here to tell me that single payer will reduce innovation and maybe cost them money, but nobody seems to have an interest in solving that perceived potential issue.
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Oct 26, 2020 17:50
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Jaxyon posted:We've already nationalized a bunch of research via the NIH. My whole last post was about what a model for nationalizing pharma company clinical stage R&D could look like? It's pretty surface level because I'm not an expert in that domain, but I don't think it's fair to say that my argument (or the arguments of other pharma posters ITT so far) have been that single payer will reduce innovation, therefore single payer BAD. I think there's unanimous support for single payer, and the discussion has been around 1) whether pharma could maintain its current raw R&D productivity if their budgets shrink from less US revenue due to price regulations (I think raw productivity would decrease if we assume that pharma companies remain for-profit), 2) whether raw R&D productivity = innovation/societal benefit (I think this is a categorical NO, and belies why pharma wants to frame the argument against single payer as a threat to "innovation"), and 3) whether nationalizing drug development would be able to overcome a potential decrease in for-profit pharma R&D productivity, on the basis of more efficient allocation of research budgets (e.g. less spend on "me-too") and ability to prioritize areas of high unmet need that are currently hosed by the for-profit system (e.g. novel antibiotics) My take is that if we accept (2), then it makes (1) kind of irrelevant, which is helpful because I think the thread has pretty thoroughly laid out the arguments for and against (1) and at this point we don't have much more than speculation. If you're convinced that you KNOW that raw R&D productivity will either increase OR decrease under a single payer system, then IMO it's a sign that you (the abstract "you", not specific to any poster) might be too confident in a hypothetical with lots of uncertainty. I like that the thread is moving to (3), because unlike UHC/single-payer, I'm not aware of any really robust international examples of nationalized drug development from basic research through regulatory approval*. Even though I think nationalized drug R&D is The Correct Thing, I personally lack the expertise or cleverness to imagine how it would work. This isn't to say that it's unworkable, but I think there's value in discussing what it would look like, given we can't just point to the rest of the world and say "it would work like that" as with UHC. We want to discuss a detailed plan because if we just say "nationalize the rest" then there's not really any discussion to be had? That doesn't mean that "nationalize the rest" is a bridge too far. That said if this is too much of a rabbit hole into a niche topic relative to all of US healthcare, then maybe it's worth spinning off into a separate thread? My sense was that this thread didn't get a ton of traffic prior to this discussion so that it was OK to keep it going here, but understand if it might be drowning out other topics of discussion on US healthcare... *I'm aware that Cuba has a nationalized drug development system, but from my (admittedly limited) reading on the subject, it doesn't sound like it's anywhere close to the scale that we would be talking about for the US. But if others have more familiarity with it, would love to learn more knox_harrington posted:Well, I've worked quite a bit on academic multi-centre trials funded by research councils (MRC and Horizon framework etc) and they take a really long time and are not suitable for generating registrational level data as implemented. Not that they couldn't be but it would need huge organisation and lots of money. You could form a company to do it funded / owned by the constituent countries in the same way big defence projects are run, but they're not exactly paragons of efficiency and value. In the US, the cancer cooperative group studies frequently generate registrational level data. The timelines do tend to be a bit slower than industry-sponsored trials currently, but that might not be true if public-sponsored trials didn't have to compete with industry-sponsored trials for enrollment. And again going back to my point (2) above, maybe slower timelines are actually a GOOD thing if it means higher quality study designs & outcomes in terms of using robust endpoints and representative patient populations in trials, which IMO is a major issue with industry-sponsored research. The issue of putting together a regulatory package for submission to the FDA or EMA or whatever may also be mitigated if the drugs aren't owned by private companies; if the drugs are also publicly owned then there's no need for the confidentiality that underpins regulatory submissions, there could be complete transparency between the research sponsors and the regulators such that the administrative burden of submissions is much lower. Again, this is my speculation, I haven't personally worked on regulatory submissions myself so I'm sure it would require an overhaul of systems and personnel etc etc, but just saying that there could be an advantage from a nationalized R&D system in this respect. quote:QALYs are absolutely a valid measure of drug utility (or rather $ per QALY) and the US would need something like the much-maligned but actually pretty good UK NICE in a single payer system to work out if they'll pay for a treatment (cue screeching about death panels from the Right). While you don't know the efficacy you would need to have a rough guess at it and likely cost, and then factor that into whether you want to research a particular therapy. I think a discussion about pricing could be interesting, but I'm not sure what the nuance is beyond what you already described re: NICE -- having a strong single payer to negotiate prices & make formulary/reimbursement decisions. Seems like a relatively "plug and play" model compared to the unknowns of nationalized R&D.
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Oct 26, 2020 18:45
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Jaxyon posted:We've already nationalized a bunch of research via the NIH. gently caress off with this passive-aggressive bullshit. It's not their job to do your homework for you, and it's not their job to develop the proposal to restructure a huge portion of the healthcare system which would be required to avoid the resource allocation issue.
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Oct 26, 2020 19:08
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My main pushback is just on any sort of cut-and-dry solution, not because its wrong per se, but because there's not really any meat there, and if all you are talking about are the very broad strokes then you will inherently get more agreement than for any specific policy proposal, as in the national polling for these issues vs whether people vote for candidates whose plans match the descriptions. A necessary step of getting what we want passed is identifying what it is that people object to in a given plan, and while obviously the population of SA isn't representative, we can still anticipate the arguments that might be made by detractors or debate the relative merit of different methods of achieving the same goal. Again, the issue is that while we already do fund a lot of things through national policy, A. it is typically in the form of grants rather than direct employment and B. the amount we mean by "a lot" is not "the majority", "the plurality" or even "a large percentage", as I pointed out in terms of the current budget of relevant public orgs (~$6b each for WHO and the FDA). The NIH administers a total of $41.7b annually, but that's still only 1/3 of the R&D budgets of the pharma companies and only 10% of that is going directly towards national-level research, with another 80% going to public and private universities, medical schools, etc through the aforementioned grants, according to their own website: https://www.nih.gov/about-nih/what-...h%20activities. Even if we accept that a large portion of the R&D budget of the major pharma companies is wasted in terms of whatever metric we want to use, we still need to at least match whatever portion we consider "productive" - I can't speak to that, since I'm not in the industry and far from an expert, but at least for the sake of discussion we should consider what that number might be, because even if we are discounting it to 50% it is hugely eclipsing our current public spending if we were to wipe it out, so we'd need to make the argument that either much more of it is unproductive or that the changes we'd make would have a much smaller impact on direct profits and spending than the current US share of the market would indicate. Again, this is not to say that it's not a worthwhile goal, but spinning up a whole new department with a budget on that scale is not the work of a couple of years, but probably at least a decade. It's possible that grants could be allocated to a greater extent as well, but the marginal utility of doing that beyond a certain point is possibly rather poor, since the current system (at least in theory) is going to dole out grants according to the significance of the research in question, or at least how well-argued it is by whoever is writing the application. In terms of money saved by having the government doing both the research and the review, I'm not certain to what extent we could count on that to be a huge savings. The approval part of the process is relatively cheap (again, the FDA is doing it with only part of its budget, which is 30 times smaller than the amount spent on the R&D by drug companies if the numbers I've been citing are correct). If the argument is that the amount that needs to be recorded and reported is less, I'm not sure that's ideal - the consequences of a botched study are potentially catastrophic, so reducing the number of people that do the double-checking isn't optimal unless you think there's a cheaper way to implement a failsafe. I don't think it's fair to assume that public employees are more likely to be high-quality or more likely to operate in good faith in a vacuum either - at least where the path runs through academia, there's a lot of pressure to produce results, especially if you don't have tenure yet, and that can lead to mistakes and misrepresentation in data just as much as corporate profit-seeking does. Edit: Oh, and as a specific reply to "why can't we just do what the private companies do for hiring", it's not just the standards and such that are a roadblock (though they absolutely are), but also the fact we would be drawing from only the US talent pool, with maybe some few international applicants willing to uproot themselves to work for the government. Some of our grants already go to people in other countries or organizations that straddle the lines across multiple countries, so we can't absorb them into this theoretical government department. It's also not that we couldn't get to that level of funding eventually, but it isn't as though the huge companies did all their hiring in a single year - most of them have been around for close a century in one form or another, some of them longer than that, and that means you have a lot of people with huge familiarity with the systems they work with as well as a pre-defined tiered structure that is a lot more resilient to pieces being pulled out and replaced, not to mention a separate budget for HR that hasn't been included in this discussion. BougieBitch fucked around with this message at 19:49 on Oct 26, 2020 |
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Oct 26, 2020 19:41
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Sundae posted:gently caress off with this passive-aggressive bullshit. It's not their job to do your homework for you, and it's not their job to develop the proposal to restructure a huge portion of the healthcare system which would be required to avoid the resource allocation issue. I've posted several studies including one that I was told "I'm not going to read that" that explicitly states how single payer spending can be used to drive innovation. I think I've done my homework in this thread.
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Oct 26, 2020 21:51
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