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Goldman Sachs questions whether curing patients is a sustainable business model

arstechnica.com

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

#341

Post by rectang »

fjsolwmv wrote: post #334
Chaebixi wrote: post #245

Earlier quoted context omitted.

> The state doesn't have to have a monopoly on violence; as the use of private military contractors has proven. I don't think you know what the "[state] monopoly on violence" means. It does not mean all people authorized to use force are directly on the government payroll.

Rectang misused it first, by claiming "encouraging a marketplace of competing militia would not a viable approach. " Even though mercenary corporations are in fact competing militia.

Whatever large portion of the military we are not comfortable contracting out is going to continue missing out on the efficiencies induced by marketplace competition.

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

#342

Post by kdelok »

PeterStuer wrote: post #151
dominotw wrote: post #70

Earlier quoted context omitted.

> CDC reckoned they reduce the risk by about 40-60%. curious, Do you have a link to this by any chance? According to this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693492/ After looking at "328 households with 1441 members, including 839 children," for an entire year (2011) these authors determined that there was a difference of 4/10ths of one percentage point between those who received flu vaccine and those who…

As far as I remember flu vaccines work by looking at the origins of the yearly epidemic (in the east, typically china etc.), predicting which strains will become the dominant ones and then starting to cultivate neutered forms of those (in eggs) on a mass scale to have the vaccines ready by the time the epidemic hits 'the west'. Some years the predictions of the strain are wrong and the vaccines less useful as most pe…

They do strain selection twice a year (once for northern, once for southern hemisphere). The years where they get it wrong are usually the years where the strain jumps between different clusters.

It's really interesting stuff. Take a look at https://www.whocc.infectiousdisease.cam.ac.uk/antigenic-cart... for a bit of an overview on that stuff.

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

#343

Post by tonyarkles »

tonyarkles wrote: post #295
refurb wrote: post #248

Earlier quoted context omitted.

Did you include the HST? And gasoline taxes? And the ability to deduct mortgage interest and up to $18K in your 401k? My own person experience was that taxes were much lower in the US than Canada.

No, no, and no, just straight up income tax before deductions. The mortgage interest deduction would be great, no doubt, for people with mortgages. I also didn't include the monthly health insurance premiums, nor did I include the mandatory 3-week vacation pay, nor the 35-week maternity/paternity leave, etc etc. Nor tuition costs. I'd really love to see the numbers all across the board as a general "cost of living co…

It's been too long to be able to edit.

https://www.linkedin.com/pulse/20141010125950-31061941-what-... We do have a 401k-like system that has some neat perks:

- your contribution limit carries over, so if you have a tight year, you can contribute a bunch over the following couple of years

- you can temporarily withdraw from it tax-free to buy a house (it has to be replaced within 10 years or you'll owe income tax on it)

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

#344

Post by darawk »

Zooper wrote: post #337
darawk wrote: post #305

Earlier quoted context omitted.

Name literally one example of that being true. I'll wait.

https://img.washingtonpost.com/blogs/wonkblog/files/2015/02/...

In what way is sales and marketing spend related?

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

#345

Post by baursak »

marssaxman wrote: post #302
rectang wrote: post #167

Earlier quoted context omitted.

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 That is not the case in the USA, where the absence of such a monopoly is written into the federal constitution.

Are you talking about 2nd amendment? If so, that's not a grant to violence by any means. If you want to test if the state really has a monopoly on violence, try being violent, or simply disobedient with an officer of the state.

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

#346

Post by salawat »

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. :)

Uh huh... I'm guessing you aren't a fan of the 2nd Amendment then? Not trying to derail things, but assuming the State MUST have a MONOPOLY on violence is a terrible idea.

We give the government the leeway we do, because it is the best way to provide for the common defense of the nation. NOT because ONLY the State should have violence open to it as an option.

Anyway... Back to healthcare... The type of structure that made the military industrial complex problematic was specifically that the industrial part was doing everything they could via lobbying/bribery to maximize profit. A shift to a model where we attempt to minimize waste, and maximize effective treatment/cures turns the quality equation on it's head. You still run into the issue where riskier grants that 'may work' are going to have a harder case to make in order to be issued, but I think that once one gets away from trying to build industrial supply chains predominantly for treatments that don't result in cure, you would start to see materials and expertise to get industrial supply chains built period may become more easily accessible if not perhaps become much cheaper.

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

#347

Post by rectang »

salawat wrote: post #346
rectang wrote: post #167

Earlier quoted context omitted.

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. :)

Uh huh... I'm guessing you aren't a fan of the 2nd Amendment then? Not trying to derail things, but assuming the State MUST have a MONOPOLY on violence is a terrible idea. We give the government the leeway we do, because it is the best way to provide for the common defense of the nation. NOT because ONLY the State should have violence open to it as an option. Anyway... Back to healthcare... The type of structure that…

> I'm guessing you aren't a fan of the 2nd Amendment then?

The 2nd Amendment is completely compatible with the philosophical concept of monopoly on legitimate violence as articulated by Weber.

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

#348

Post by fricat1ve »

AnthonyMouse wrote: post #320
TeMPOraL wrote: post #93

Earlier quoted context omitted.

I think it's totally ok, and it should be accepted. Public services are meant to be cost centers. If they bring in profits, they do so indirectly (e.g. better health of citizens -> better GDP -> more money in taxes). The trick is to still find ways to apply pressure so that a service gets better and more efficient in time, instead of attracting parasites that'll use it as money drain. Like a lot of healthcare-related…

> The trick is to still find ways to apply pressure so that a service gets better and more efficient in time, instead of attracting parasites that'll use it as money drain. A huge part of the problem is the public reaction to how for-profit research is supposed to work. In theory a cure is highly valuable. People should be willing to pay as much for it as the alternative, meaning as much as it would cost for multiple…

>People should be willing to pay as much for it as the alternative

Maybe. But maybe there's also something wrong with expecting that much. Somehow Sidney Farber didn't decide that he was going to charge the families of kids with ALL the actuarial value of the remainder of their lives.

It can be frustrating to see the public, out of ignorance, grossly misjudge the relative contributions to health of, say, a vaccine developer relative to a self-promoting surgeon. But there is something new and rather strange with this way of seeing medicine as a "capture the value"-type enterprise.

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

#349

Post by jernfrost »

It is an excellent example of why health care is fundamentally at odds with capitalism.

Now I don’t see this as black and white. The free market is a useful tool one can use in healthcare WHERE it makes sense.

However that is not nearly as many places as the conservative free market fan club thinks it is.

This ought to be a reminder that more market does not equal better. More market thinking in health care is to the contrary going to bring worse results.

It is an extremely difficult problem to solve which means they only way to deal with it is through experimentation, tinkering and data gatering. Not through ideological silver bullets.

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

#350

Post by AnthonyMouse »

salawat wrote: post #326
AnthonyMouse wrote: post #320

Earlier quoted context omitted.

> The trick is to still find ways to apply pressure so that a service gets better and more efficient in time, instead of attracting parasites that'll use it as money drain. A huge part of the problem is the public reaction to how for-profit research is supposed to work. In theory a cure is highly valuable. People should be willing to pay as much for it as the alternative, meaning as much as it would cost for multiple…

Nay, sir. Just because there exists a multi-million dollar over a lifetime treatment regime doesn't mean that it is okay to suddenly "own" an equivalent chunk of cash from everyone cured. We invent treatments because we CAN'T find a cure. The treatment represents society's best effort to alleviate suffering. We solve problems so that we don't have to suffer them as a society/species anymore. Businesses exist until we…

> Just because there exists a multi-million dollar over a lifetime treatment regime doesn't mean that it is okay to suddenly "own" an equivalent chunk of cash from everyone cured.

The chunk of cash is the only reason the company is doing the research to begin with.

If finding a cure was easy then it would have been found a thousand years ago -- as some of them were. The ones remaining are hard and require a lot of resources to solve. If you want someone to put that kind of money in against a high probability of failure, they have to be able to expect an even larger amount of money to come back to them if they succeed or they won't do it.

The alternative is government funding, but then you're spending pretty much the same money. The taxpayer now has to pay the tab for all the high risk/reward research that didn't pan out. And then you're subject to all the usual government issues with bureaucracy and cronyism and principal-agent problems because you've put a thick layer of abstraction between the researchers and the patient outcomes.

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