Goldman Sachs questions whether curing patients is a sustainable business model • Hacker News Board

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#201

Post by padobson » Fri, Apr 13, 2018, 1:48 PM UTC

This is just bad business, only particularly egregious because it's in healthcare.

No great product mind I've ever studied sacrificed making a great product for a more profitable, adequate product.

In the long run, the company that makes the best product always wins. Apple was never worried about cannibalizing the iPod to make a better product in the iPhone. You won't find anything in Amazon's leadership principles[0] that could justify this kind of thinking. Even Wal-Mart, after pressuring their suppliers for lower costs, doesn't keep the difference as profits. They push their prices lower and build trust with the customer.

Curing patients is absolutely a sustainable business model, and only the most small minded, short-sighted Wall Street suit would think it isn't.

[0]https://www.amazon.jobs/principles

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#202

Post by cko » Fri, Apr 13, 2018, 1:48 PM UTC

PeterStuer wrote: post #24

The 'ideal' drug from a business point of view not only not cures the patient long term, it offer a short term mitigation while increasing the risk on relapse and thus future recurring consumption of the treatment. At the same time it can be IP protected to block alternatives and has an insured third party collective payment coverage to guard against the treated running out of funds to afford the perpetual dependency…

Well, not increase the risk of relapse, since clinical trials usually have relapse or time to some sort of negative event as an endpoint to look for.

But to have patients need to take it in steadily increasing doses for life? Yes, that would describe most maintenance medications out there. And encourage patients to have the illusion that “oh, there’s a pill for that” as one of the factors.

While I was a pharmacist at a long term care pharmacy, it was not unusual to see patients on more than 20 meds. Some of the meds are to be taken more than once daily. “Pill burden” is the term we use to describe this.

What I’ve observed is there is a point of no return in any chronic condition where you can’t diet and exercise your way out of it and you’re relegated to higher and higher doses of diabetic or hypertensive meds. For life.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#203

Post by GiorgioG » Fri, Apr 13, 2018, 1:49 PM UTC

rectang wrote: post #167

GiorgioG wrote: post #152

Earlier quoted context omitted.

> Creating a public institution with no pressure to make profit is a disaster waiting to happen. We seem to have no problem with throwing $700 billion per year on the military and nobody is pressuring them to make a profit. Is that a disaster? No? "But that's different!" It's only "different" because that's what we've been led to believe.

The US military is spectacularly inefficient, and the US military-industrial complex is a parasitical behemoth per Eisenhower's critique. It's not like the problem is unknown; the issue is that the state has to have a monopoly on violence, so we live with the inefficiency. Encouraging a marketplace of competing militia would not a viable approach. :)

> The issue is that the state has to have a monopoly on violence

A monopoly on violence in what context? The planet? That doesn't seem to be necessary for most countries. Within the country itself? That's the job of local law enforcement.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#204

Post by scottishfiction » Fri, Apr 13, 2018, 1:53 PM UTC

rectang wrote: post #167

GiorgioG wrote: post #152

Earlier quoted context omitted.

> Creating a public institution with no pressure to make profit is a disaster waiting to happen. We seem to have no problem with throwing $700 billion per year on the military and nobody is pressuring them to make a profit. Is that a disaster? No? "But that's different!" It's only "different" because that's what we've been led to believe.

The US military is spectacularly inefficient, and the US military-industrial complex is a parasitical behemoth per Eisenhower's critique. It's not like the problem is unknown; the issue is that the state has to have a monopoly on violence, so we live with the inefficiency. Encouraging a marketplace of competing militia would not a viable approach. :)

The state doesn't have to have a monopoly on violence; as the use of private military contractors has proven.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#205

Post by FranzFerdiNaN » Fri, Apr 13, 2018, 1:57 PM UTC

rocqua wrote: post #195

PeterStuer wrote: post #156

Earlier quoted context omitted.

"parasites that'll use it as money drain" sounds remarkably like shareholders.

The difference is that shareholders lose something (the value of their shares) when they drain a company of its assets. This might still be short-sighted, but there is at least a balancing force. In public services, where making a loss is o.k. this is just included in the loss, and there is essentially nothing that encourages the 'parasite' to not drain the system.

Well, even that no longer seems to be assured. Plenty of ways to strip a company and make a profit in the short term, destroying the company in the long term.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#206

Post by d0lph » Fri, Apr 13, 2018, 2:00 PM UTC

Thriptic wrote: post #198

gpvos wrote: post #39

The story goes that in China, doctors used to be paid for keeping you healthy. When you got sick, they didn't get any money anymore. This sounds to me like a system with the proper incentives.

Really? Because then I would just take on young healthy patients and refuse to take on sick ones.

So you would need to restrict Drs ability to turn people away.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#207

Post by croon » Fri, Apr 13, 2018, 2:03 PM UTC

refurb wrote: post #161

xg15 wrote: post #48

Earlier quoted context omitted.

It would still require that the company that develops the cure could make more profit off it than it would make with chronic treatments. So if you went purely for profit, you could only develop a cure if: - you could price it higher than the price of the chronic therapy over the full lifetime of a patient. or - you could sell it to more patients than you could have sold the chronic treatment. A lot more, because ever…

It would still require that the company that develops the cure could make more profit off it than it would make with chronic treatments. No it doesn't. Why? Because there are multiple companies. If company X is making $10B per year on a poor treatment, there is still an incentive for another company to create a cure, even if it only makes them $1B.

No, there's an incentive for another company to make a treatment and only make $9B(/y).

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#208

Post by crawfordcomeaux » Fri, Apr 13, 2018, 2:03 PM UTC

Systemic mechanisms in the culture of capitalism are in direct conflict with the Hippocratic oath.

Capitalism breeds inequality and so it does harm.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#209

Post by coldacid » Fri, Apr 13, 2018, 2:05 PM UTC

pjc50 wrote: post #183

TomK32 wrote: post #120

Earlier quoted context omitted.

They are profitable on the bigger scale of a national economy. Sadly no one give a damn about that these days. In Germany we have the studies Betriebswirtschaft (business) and Volkswirtschaft (national economy) and the latter is loosing vital ground in politics. It gets worse if you look to the UK where a of lot public services are handed to companies, for example the merger of all social benefits Universal Credit is…

"Universal Credit" is a horrendous scheme that manages to combine (malicious) ignorance of the needs of its beneficiaries with ignorance of how to run a large software project. The idea sounds great on paper - there are a lot of different benefits, why not reduce duplication by merging them into one scheme then only asking for personal information once - but it ignores cashflow . People can be left without money to l…

Sounds like the Phoenix payroll project here in Canada, except for social services. There is no way this will end well, and I wouldn't be surprised if it leads (indirectly) to the death of clients.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#210

Post by teddyh » Fri, Apr 13, 2018, 2:09 PM UTC

nfriedly wrote: post #197

I wonder if insurance companies do anything towards funding cheap "unsustainable" cures? Seems like it'd have a high ROI for them.

Companies don’t actually want profit if it would also benefit every competitor equally. A cure for a disease would benefit all insurance companies, so there is no competitive advantage for an insurance company to develop one.