Get Sick and Die; The State of U.S. Healthcare

The Something Awful Forums > Discussion > Debate & Discussion > Get Sick and Die; The State of U.S. Healthcare

HootTheOwl: May 13, 2012; Hootin and shootin

FizFashizzle posted:

Is there a concise argument/research against capping healthcare costs at x% of income?

I got into this the other day and just wasn't able to formulate my thoughts very well.

Such a mechanism already exists, it's called income tax and universal healthcare.

# ¿ Oct 20, 2020 20:28

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# ¿ May 10, 2024 12:30

HootTheOwl: May 13, 2012; Hootin and shootin

DandyLion posted:

Something that's not really talked about much is the concept of universal healthcare (intentionally) becomes non-viable once a plurality of the citizenry sink deep into 'lower class' wages. If most folks are no longer making enough money to even be taxed, how does the system pay for the medical care?

Following the current trends of middle class shrinkage and the entirety of wealth (99%+) being consolidated into a couple hundred families doesn't leave any room or functional requirement to provide healthcare to the masses, especially when getting to that point puts a big incentive on the upper class to cull the lower class as quickly/efficiently as possible without endangering themselves directly (and I suspect just letting people die because they weren't boot-strappy enough to save for their own care is just that ticket). This makes even more sense when viewed from the lens of current conservative/oligarchy propaganda convincing a large swath of poor uneducated American's that not paying for their own healthcare is the root of all evil.

The good news is that productivity is up and in the long term the economy will keep growing which means the total pool will keep growing.
And! Bbcause multiplication is communitive it doesn't matter how many or how few numbers you multiply by the tax rate because they'll add up to the same number.
And because we tax higher incomes at higher rates than lower ones it's better if incomes go down because that means a higher percentage of the total is taxed at the higher rate so we get even more money for healthcare!
It's amazing!

# ¿ Oct 21, 2020 02:54

HootTheOwl: May 13, 2012; Hootin and shootin

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.

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

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.

# ¿ Oct 24, 2020 23:31

HootTheOwl: May 13, 2012; Hootin and shootin

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.

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.

So pay them and do it? I'm not hearing a reason why the NIH can't do the last one other than they currently don't. If we're worried that paying companies to develop the drugs further means they'll just move money around then why don't we just do it ourselves?

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.

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?

# ¿ Oct 25, 2020 16:34

HootTheOwl: May 13, 2012; Hootin and shootin

Yes ACA was better than previous.
No it's no substitute for universal healthcare.
Source: Guy who finished paying off his cancer debt for the last 3 years only because the ACA made it a 3 year debt instead of being fired, expending his lifetime cap and dying in the street, and would have mutch rather have been able to stop working and rest instead of logging into the office VPN while in the hospital getting chemo drugs infused into him.

# ¿ May 4, 2021 14:34

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