But this is the problem with capitalism and health care, the providers just stop if there's not enough money in it for them.
Is this supposed to be a flaw?
If the cost of a lab is $500/patient then the patient (or their insurance) pays the $500 and the lab exists. If the cost of the lab is $50,000,000/patient, the lab probably shouldn't be funded, because its cost/benefit ratio is very bad and the same money could have saved more lives by putting it somewhere else.
What would you do in the alternative? Have the government provide unlimited funding for things that cost more than they're worth?
That's precisely the question, isn't it? In the case of medical treatment, you decide. Do you want to run a test if it costs you $500? What if it's $50,000,000? Or, in practice, you decide ahead of time by choosing how much insurance to carry, and then it's the premiums on insurance that would cover $50M tests that probably isn't worth it to you.
You might then have concerns about people who can't afford a reasonable amount of insurance, but that's a question of whether the government should provide insurance subsidies to the poor, not a question of who decides how much is worth having. Do you even want someone other than yourself deciding the most that can be spent on saving your life?
> What's the RoE on the military or poetry, for example?
Defense and copyright are tragedy of the commons. Everybody wants there to be a military force to fend off invaders but the benefits redound to everyone, including people who don't pay. People have the incentive not to pay as long as someone else is covering the cost, but then since everyone has that incentive it would end up under-funded. As a result there is a law requiring everyone to pay.
The way things like that ought to work is that there should have to be a separate vote by the general public in order to increase the budget for that specific department. Then bloated budgets get voted down because the public can see when they're excessive.
Medical facilities aren't a tragedy of the commons. You pay for one if you need it and if there are enough people who need one to pay for it to exist, it does. If there aren't, by what reasoning should it? The people paying are the same people using it and they don't value it by as much as it costs.
So if you have a very rare disease which might cost a lot more to treat because there's no economies of scale you are... Not worth it? Your life is unworthy because it's unprofitable to save you? Or your mom, dad, sibling, loved one?
You need to be very, very deep into pure inhumane financial thinking to even consider this as a good outcome for a society. Please die if it's too expensive to care for you, it's economical eugenics.
The patient (or whoever is paying the bill) and the provider determines the "worth". If they can't agree on a price, then it's not worthwhile.
In communism, would you really want to extract the equivalent of $50m of labour and resources in order to provide one person with this test? I can't imagine how that would be affordable.
Putting a monetary price on it in order to quantify the cost doesn't fundamentally change the equation. In the communist utopia I imagine it would be more like forcing x architects, engineers and builders to construct the facilities for the testing, x researchers and scientists to develop and conduct the test, x caregivers, plumbers, cleaners, drivers, baristas, chefs, etc for x weeks to provide this "free" test for one individual. Is that "worth" it?
You don't need to invoke the boogeyman of "communism", in advanced developed societies there's plenty of examples of expensive treatments being provided to the edge cases of healthcare because it's such a minuscule amount of people suffering from these illnesses that on the overall scheme of things it's not a huge burden to society to allow someone to live if they have a chance.
Before you bring it up: yes, of course it's not perfect, of course some people do not get access to some treatments but it's overall a much better outcome than leaving people to fend for themselves and pay for treatments inaccessible to any non-millionaire.
If your only morality is through economic/financial terms I really invite you to question why you think that way, there are many other ways to think of trade-offs for providing access to specialty life-saving treatments even if it's at a cost to society, it just depends on what you think should be valuable. To me, life is valuable, and if a society can support giving more treatments at a loss to create less suffering it's a good society.
Yes. If Salk had this mentality, then Polio may stand up there with cancer and AIDS as one of the big 3 killers. Instead, he spread the solution and its nearly eradicated in the world. we might have also tried to monetize the COVID vaccine and grind the US into an early depression with that kind of thinking.
>What would you do in the alternative?
Fund the science and make use of taxpayer money to advance society instead of giving billionaires tax cuts. You'd think a community focused on tech would undersand that you can't treat skilled thinking the same way as an assembly line.
if it means me and all my people can one day not get STD's, yes. 50m is a steal. Medcine is one of the few fields like tech where the solution is very hard to come by, but extremely scalable once it is derived. It should be the most important aspect to focus on if you want future RoI. Even if it's the indirect cost of your citizens (or you) not dying of some disease.
we don't think of STDs as deadly, but apply it to cancer and the value is obvious.
How could it possibly be otherwise?
Never mind $50M, suppose it would cost twenty trillion dollars to save you. The large majority of the entire US GDP. The majority of everyone in the whole country, ignoring all other problems and lives to dedicate all of their time to saving you. And if they did that, they could; but not otherwise.
Is that worth it? No, it can't be, because a million other people would die instead. There exist things that are possible but not reasonable and some of those things are in medicine.
If Salk had this mentality, the patent still would have expired after 17 years and he could have used the money to try to cure cancer or AIDS.
> we might have also tried to monetize the COVID vaccine and grind the US into an early depression with that kind of thinking.
Three different companies developed a COVID vaccine and it's not the kind of market where you can make more money by charging a million dollars each to a hundred people than by charging $100 each to the insurance companies of a billion people.
> Fund the science and make use of taxpayer money to advance society instead of giving billionaires tax cuts.
"Giving billionaires tax cuts" is not the only alternative use for the money and isn't even necessarily a worse one.
If someone is a billionaire because of regulatory capture and monopolistic practices then we shouldn't be giving them anything, we should be breaking up their companies and eliminating the laws they bought to concentrate the market.
If they're a billionaire because they built an honest company that employs thousands of people and makes useful products for reasonable prices, that's the thing that gives the government anything to tax in order to provide roads and schools and provides people with jobs and goods and services. We want more of that. Taking more of the money away should only be done if the government's use for it is high value. Which, by definition, things with a poor cost/benefit ratio aren't.
You're making the case that the market would have the incentive to provide these things because the insurance company would rather pay for an expensive test than have a larger number of claims if the disease spreads.
Suppose we have a program which is saving lives for $50M each. There are other ways to spend the money that would save lives for $10,000 each. If we have $50M, should we save one life or 5000? This is not an academic trade off, it's what actually happens whenever the government allocates money to something with poor cost/benefit because there actually are ways to save lives or do other highly valuable things for even less than that amount of money and we don't have unlimited resources.
> Is that worth it? No, it can't be, because a million other people would die instead. There exist things that are possible but not reasonable and some of those things are in medicine.
We are talking about reality here, not some made-up fantasy to justify your outlook on it. I don't think I needed to preface my argument with that since I'd expect to discuss with rational and reasonable beings. Considering reality, where we live and touch grass, it's better that some rare diseases with high costs for treatment get subsidised by the whole pool of money society gathers for healthcare, within reasonable bounds of what the aforementioned system can bear.
I really thought I didn't need to guard myself against some bizarre outworldly conjecture with no basis in reality. You can toy with models and inflated situations to be pedantically argumentative but I'd much rather try for us to base this in more-or-less real situations. Paying for the US$ 5 million treatment of one kid with a very, very rare disease which is treatable can be afforded if a society is wealthy enough.
Or isn't the USA wealthy enough to care for its population?
The existing law has a massive defect that prevents any of that sort of thing from happening right now.
We capped insurance company profits as a percentage of claims, so the only way they can make more money is by paying out more and bigger claims. We basically banned them from having any incentive to lower costs because now lower costs mean lower profits instead of higher ones.
But that's a flaw in the existing system, not a flaw in the general concept.
> They'd be ripping a new one in the meat industry to forestall antibiotic resistance, for example.
There are already various state and federal laws restricting the use of antibiotics in livestock. But in general what leverage does an insurance company have over the meat industry?
Meanwhile there are charities that can save a life for on the order of $3000-$5000. Spending millions of dollars on one person is saying that person's life is worth more than the thousand others who could have been saved with the same money.
People have a hard time understanding this because the consequences are indirect. You spend millions of dollars to save a kid, but you took it from a company that would have hired a hundred people. Three of those people really needed the money. One of them needed it to pay someone to get the mold out of their house, so instead that family of five ended up in the hospital and two of them died. Another would have used it to repair the brakes on their car and because they couldn't, they died in a car crash along with the person they hit. The third simply couldn't afford to make rent without a job and then froze to death in the street.
On top of this you have the other 97 people who wouldn't have died, but certainly didn't enjoy being unemployed.
Should we care about one person more than all of these others put together, or does it matter how much something costs because it's always a trade off against something else?