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November 06, 2007
Questions, Questions
I really need some time to sit down and respond to this, but read Tigerhawk's questions for health care reformers. They're fair ones, and worth thinking about for anyone interested in the issue.
November 6, 2007 | Permalink
Comments
The problem isn't TigerHawk's questions... it's the Mankiw article he's citing, which is highly selective and extremely debatable in the way its looking at the various statistics in question. I particularly the notion advanced by Mankiw that people who haven't applied for Medicaid are uninsured "in name only"... um, yes, and the name for that would be, er, "uninsured." I think Mankiw's article continues to suggest how Republicans are planning to run against the healthcare issue - minimizing, cherry picking, and suggesting that everything is sort of okay (except, as Mankiw usggests about obesity, whe it's not, but even then, offer no concrete proposal to try and address it). If so, this issue will be an even bigger loser for them than I've already thought.
Posted by: weboy | Nov 6, 2007 11:34:51 AM
"Worse,we're far and away the likeliest to report spending more than $500 out-of-pocket on prescription drugs annually. That's a problem, as higher out-of-pocket costs mean more of us going without prescriptions, which means less maintenance of conditions and, thus, more cost when our chronic illnesses balloon into catastrophic health events. Indeed, 42 percent of Americans with chronic conditions -- the exact same percentage who report paying more than $500 for drugs -- report skipping care, drug doses, or doctor's appointments due to cost. That's cheaper for them in the short-term, as they can spend some of the money on food or rent. It's more expensive for us, however, as we pick up the huge bill when they end up in the hospital in full cardiac arrest. "
Doesn't the above mean that they would rather have the money and take the risk with there health? Better then to give them the money rather than the meds.
Also about medical error, when you say that their is more medical error in the USA, does that take into account the fact that we get more medical care?
Posted by: Floccina | Nov 6, 2007 11:57:37 AM
If X million people are already eligible for Medicaid or private insurance and choose not to take it no level of reform short of compulsory enrollment will change that. That would be solved by a one paragraph bill, not a billion dollar reform of the entire system.
Same with medical records, millions of people would not voluntarily allow the collection of their personal information. If millions opt out then the old system must stay in place to accommodate them negating the projected benefits, at least partially.
Why would a discussion on insurance and funding reform offer solutions for social and personal health issues? Once we agree to leave the current system alone and then start a debate about social issues that’s fine but one shouldn’t be confused with the other or used to justify a major overhaul to our current system.
Posted by: Nate O | Nov 6, 2007 12:00:34 PM
Some of the comments over at hawk's site made me laugh. OMG the Mexicans! And lawyers!
Posted by: chowchowchow | Nov 6, 2007 12:04:11 PM
I'll take a few of the questions-- providing nuance on a few of them, along with a few answers.
Innovation. Will your plan decrease the quantities of drugs and devices used in American health care, or the prices paid for those drugs and devices? If so, it will decrease the rate of return on investment in new technology. At the margin, a reduced rate of return will reduce the quantity of investment in new technology. How much reduced innovation is acceptable? No fair claiming that there will be no reduction in innovation unless your plan sustains the profitability of the drug and device industries at current levels.
Among those that really have looked at this issue, this question is a little more complex than suggested here. The question isn't just the amount of innovation, but also the type/degree of innovation. In today's system, with no focus on value-based medicine/ cost-effectiveness, an incremental innovation can lead a disproportionate increase in cost. We need a system that fairly compensates based on the degree of innovation provided, not simply any innovation. I'm a firm believer that our current system is actually horribly inefficient here, and that a health-system that better rewarded degree of innovation could actually allow for lower returns to the innovation industries generally, without actually impact the total sum of innovation as a whole. (In simpler terms, some companies today make a fair amount of money offering little in terms of degree of innovation, if we take some of these profits away via cost-effectiveness approaches, but in exchange offer more profit for fewer, more significantly greater innovations we'd come out ahead.) My general fear is that this is a wildly complex issue, and a government system is more apt to focus on cost versus cost-effectiveness (i.e. there may be technologies that are worth 100K per patient per year on a value basis). A second, major concern here, is that from a societal utility perspective, innovations in health care should be compared to innovations in other areas. Meaning we shouldn't have a system where we are overly harsh in the "carrot" offered to health technology companies, such that financial capital is disproportionately moved into other industries. We need a similar look at the carrots (i.e. profits) offered to other industries and realign accordingly. My suspicion is that if you did a comparison looking at profit potential across industries, factored in the degree of regulation and risk inherent in health innovation compared to others, we'd be looking at the profits/costs of other industries before health care.
Personnel. Will your plan decrease the incomes of physicians and other health care providers? ... you might argue that we do not need our absolutely smartest people competing to get into medical school.
This is true. Consider trends towards evidence-based medicine, using population-based data to determine treatment algorithms, etc. you end up with what the medical establishment likes to call "cookbook medicine." Following a recipe is easier than developing one and we need more recipe-following in medicine. There are obviously differences by specialties, but as a whole, I think this is true.
Individual vs. social taste for risk.
One of the absolutely most important points, albeit with a slightly different focus. If we look at risk acceptance in other facets of life, we are significantly more risk-seeking than we allow for in health care. This is an area that is ripe for some primary research, for any aspiring health care academics out there.
System of rationing. There are, in the end, only three ways to allocate health care (or any other good or service): queuing (standing in line, literally or figuratively, for a fixed supply), bureaucratic fiat (government or HMO "experts" decide what test or treatment is appropriate in each situation), or auction (ability to pay).
I'd either state the last one differently or add another, which is willingness to pay. In other words, you could have targeted co-pays that really don't impact on ability to pay as much as willingness, i.e. tradeoffs against other facets of life. A $50/$100 co-pay for example would fit this for many people. Add in sliding-scale/exemptions for low-income folks, and ability to pay is no longer the focus but willingness. In a pure sense, its fourth option that is really a blend of the second and third mentioned above.
Practice specialties are already famously competitive over the dollars available to support their procedures. Cardiac surgeons and interventional cardiologists have been punching it out for years, recognizing that their different treatment methods are often competing for the same patient's expenditures. One can imagine similar fights breaking out between spine surgeons and physical therapists and neurosurgeons and psychiatrists. I am sure there are many other such examples. The question, therefore, is how will your proposal shift the allocation of dollars in the system from one specialty to another? Note that most of us ought not care what the answer is, but it has enormous bearing on the political viability of your proposal.
A huge problem for those that prefer centralized, government-driven solutions. This contributes to the overall lack of political feasibility of these solutions. They either gloss over these issues and don't offer real reform, or they offer real reform which threatens some docs, who will then crush the proposals politically. One the big advantages of a consumer-driven approach on these issues of quality.
The adoption of new technology and the First Amendment.
First Amendment cases have made clear distinctions between commercial speech and political speech. Banning DTC ads is not a constitutional issue.
The quality of our bureaucrats.
Again, this is primarily a problem for centralized, government-driven solutions.
Posted by: wisewon | Nov 6, 2007 12:08:38 PM
As to whether TigerHawk's 'questions' are fair ones, that doesn't look that way to me.
TigerHawk on Innnovation: At the margin, a reduced rate of return will reduce the quantity of investment in new technology. How much reduced innovation is acceptable? No fair claiming that there will be no reduction in innovation unless your plan sustains the profitability of the drug and device industries at current levels. [emphasis added].
I'm not going to dissect the whole list of questions (not now, anyway), but this early question displays the pajamas media outlook - raising the 'fair' question issue.
Given that advertising is a larger percentage of biz expenses in the drug industry than research and development (which seems to be an established fact), it doesn't follow that innovation is tied to current levels of drug company profitability. The "adminstrative and general" entry on corporate operations statements hide a huge set of expenses (including lobbying and interest group fees/grants) that have no effect on innovation whatsoever. Even R&D is a carefully manipulated number, since the tax laws (and legal interpretations of some dubiousness) partition expenses in several non-obvious (to the outside observer) ways.
It also needs to be observed that drug industry profits (in percentage terms) are substantially higher than many other industries. TigerHawk seems to be saying that those profits should be guaranteed under any reform - which is a very strange thing for any conservative believer in free markets to insist upon.
Other of TigerHawk's questions relate to this profit issue, but in a different direction. For example, under Capital Investment, the implication of the questions is that reform should limit expenditure for MRI/CT scanners etc because they are used too much. The problem is probably not use, but duplication - with each competitive provider in a market having to purchase their own latest equipment - often resulting in more equipment per capita/per region than can be kept productively busy, and the tendency to use the equipment because its capital cost has to be returned through usage fees.
I'd be careful in assuming these are honest questions from TigerHawk. They look to me to be quite self-serving of an industry participant and conservative gotchas waiting to pounce.
Posted by: JimPortlandOR | Nov 6, 2007 12:16:52 PM
Free Clinics
http://www.tcsdaily.com/article.aspx?id=103007B
“Any patient will be seen once, but to become a regular patient at St. Luke one must be uninsured and have income below 150% of the federal poverty level -- $30,975 for a family of four - and not be eligible for any other ongoing federal health program, such as Medicare. Patients are re-certified every six months.”
Someone will someway solve this problem.
Posted by: Floccina | Nov 6, 2007 12:18:50 PM
Wisewon wrote:
"Individual vs. social taste for risk.
One of the absolutely most important points, albeit with a slightly different focus. If we look at risk acceptance in other facets of life, we are significantly more risk-seeking than we allow for in health care. This is an area that is ripe for some primary research, for any aspiring health care academics out there."
Great point WiseWon. Robin Hanson takes about this. He talks about over regulation of health risks on econtalk (www.econtalk.org).
I wish that we were allowed more self care (like the abilty to buy meds perhaps after passing a test.)
Posted by: Floccina | Nov 6, 2007 12:23:35 PM
wisewon
i think the time and effort you put into sharing your knowledge and observations on health care make a real contribution.
Posted by: jacqueline | Nov 6, 2007 12:24:24 PM
JimPortland, there use to be ads in the back of Fortune, Forbes, and some other weeklies to the effect that not being a medical professional you can purchase a franchise to offer diagnostic testing and receve X% returns. A few years back sleep apena testing was huge, not because it helped the majority of people but they marketed brillantly telling people if they couldn't sleep they needed to get tested. Insurance companies finally clamped down but billions where wasted. The only way to iliminate these abuses is to not allow the purchase of the machine or their usage
Posted by: Nate O | Nov 6, 2007 12:42:41 PM
The problem isn't TigerHawk's questions... it's the Mankiw article he's citing, which is highly selective and extremely debatable in the way its looking at the various statistics in question
Seriously! Tigerhawk's questions were sensible and reasonable (though answerable), but that Mankiw piece was all kinds of messed up.
It's not that Canada's life expectancy blows America's away--it's that America spends so many times more on care than Canada does, and therefore should be blowing Canada's L.E. away.
The fact that people above median income still find themselves not buying insurance represents either an injustice (pre-existing conditions pricing them out of coverage) or an inefficiency (young, healthy people forgoing coverage and preventative care).
There's no tradeoff between a second tv and an extra year of life--it's more like working another five years to live for one more. (I guess that makes sense if you really love your job.)
Posted by: Consumatopia | Nov 6, 2007 12:54:59 PM
There is a lot to chew on in these comments and I do not have time to respond here to all of them, but one thing is clear: No ban on truthful DTC advertising is possible under the First Amendment, at least as it is currently construed by the Supreme Court. Quite to the contrary, the federal courts have systematically limited the ability of the FDA to regulate truthful advertising of medical products.
I think this is one of the most interesting questions facing plans that purport to reduce costs by reducing access to drugs and devices: How do you prevent the manufacturers from turning denials of coverage into political issues?
As for JimPortland's charge that my questions are self-serving -- well, to each his own. I grant that I may look at the health care system from a different perspective than either a provider or a patient, but I understand more about the economics of innovation than most people. I do not hide the fact that I am in industry, but I also care a great deal about hitting on the best answer over the long term. Indeed, I know a lot of people in the industry who feel the same way. Yes, in my day job I might well support a legislative result that benefits my stockholders, but one of the reasons I blog pseudo-anonymously is that I like to understand and perhaps argue for positions that are not perfectly congruent with my professional self-interest.
By the way, I am hardly alone in having different interests in my professional life than as a patient or a taxpayer. The health care debate involves an enormous number of people who are in a similar position. Virtually everybody who knows anything about the subject -- with, I admit, the exception of a few self-made experts like Ezra -- is in a position to make a useful contribution to the discussion only because he or she is part of the 16% of the economy that participates in the delivery of health care services.
Indeed, my self-interest as a consumer of health care dominates my self-interest as an executive. A close family member of mine suffers from multiple sclerosis and has benefited enormously from the tremendous amount of innovation in that field. I am very worried -- and legitimately so, by the way -- that a radically different system of healthcare finance in this country will destroy the rate of return on investment for incremental improvement in MS drugs. If anything, that drives my concern over innovation.
Posted by: TigerHawk | Nov 6, 2007 1:08:22 PM
A second, major concern here, is that from a societal utility perspective, innovations in health care should be compared to innovations in other areas. Meaning we shouldn't have a system where we are overly harsh in the "carrot" offered to health technology companies, such that financial capital is disproportionately moved into other industries. We need a similar look at the carrots (i.e. profits) offered to other industries and realign accordingly. My suspicion is that if you did a comparison looking at profit potential across industries, factored in the degree of regulation and risk inherent in health innovation compared to others, we'd be looking at the profits/costs of other industries before health care.
My suspicion is exactly the opposite--we have way too much carrot in health care research that doesn't really seem to change life expectancy significantly, and way too little in other areas like clean energy. That's especially true if your looking at global welfare rather than just American welfare--clean water, nutrition, education and infrastructure in poorer nations seem like they'd offer way more bang for your back than exotic new treatments to squeeze out extra years of life for the aged. That and new information and energy technologies would raise our GDP enough that we'd be able to put more resources into health research in the long run.
Posted by: Consumatopia | Nov 6, 2007 1:13:09 PM
I think this is one of the most interesting questions facing plans that purport to reduce costs by reducing access to drugs and devices: How do you prevent the manufacturers from turning denials of coverage into political issues?
I think the point of such plans is not necessarily to reduce costs--which is probably impossible--but to make sure the costs go to the right things. It's really hard for the government to deny coverage to Medicare patients because benefits are focused on a tightly focused, well-mobilized, high-participation voting group. The electoral benefits of their care outweigh the electoral costs paid by the general population. Extending coverage to everyone brings the costs and benefits into symmetry--extending more care to everyone increases costs for everyone.
So, we can't stop it from turning into a political issue--but once costs expand enough, it becomes a zero-sum game among drug manufacturers--the country will just be spending as much as it can possibly spend, and the only way for your drug to get more money is for your competitor's to get less.
Posted by: Consumatopia | Nov 6, 2007 1:22:52 PM
I think Tigerhawk is asking these questions sincerely, but they are a bit disingenuous. He starts off his post at least somewhat agreeing with the idea that our healthcare system is broken and needs to be fixed. But his questions are based upon taking every facet of our present healthcare system and treating it as a sacred cow. It seems that the only way to convince him of making changes to our system is to make sure that it stays exactly the way it currently is except that it also manages to magically provide healthcare to every American.
Obviously things will not be able to stay exactly the same. In fact, I'm willing to go on record stating that pharma companies' profits, for just one example, will probably go down under any healthcare plan that actually helps people.
But so what? The typical conservative argument that any drop in profits will dry up all innovation, but that's bullshit. Let's say a pharma company is considering the pros and cons of doing the work required to develop Drug X and bring it to the market. Under the current system their expected profits on Drug X would be $.10/pill, but under the soon-to-be-enacted universal healthcare law, their expected profits drop to $.05/pill. Will they still proceed with Drug X?
Of course they will, because the alternative would be $.00/pill profit on a drug that doesn't exist. New drugs are developed on the basis of their efficacy and expected profitability, not because Americans so generously provided the company with an extra billion dollars of profit last year.
Pharma companies, medical equipment makers and healthcare providers of all types have a choice to make. They can fight all reforms that might impinge upon their current profits/salaries and find themselves with fewer and fewer customers every year because Americans increasingly can't afford healthcare, or they can accept lower profit margins/salaries as the price to pay for having an actual profession.
Having the right to charge $100 per pill or office visit doesn't mean diddly if no one can afford to take the pill or come to the office. That's the iceberg floating in the path of every single drug company, every hospital, every doctor and MRI manufacturer. It'd be nice if they would wake up to that fact and work for more than this month's paycheck or this quarter's earnings report.
Posted by: Stephen | Nov 6, 2007 1:30:00 PM
No ban on truthful DTC advertising is possible under the First Amendment, at least as it is currently construed by the Supreme Court. Quite to the contrary, the federal courts have systematically limited the ability of the FDA to regulate truthful advertising of medical products.
This is all technically true, but it all hinges on the definition of "truthful" of "DTC." Most think about DTC as television advertisements, as no one really talked about DTC until television ads were allowed in 1997. Practically speaking, what I wrote above stands. The practical effect is the following:
-- Truthful is based on a legal-regulatory interpretation on the "adequate provision" of the safety and efficacy and drugs
-- There was always a question on whether "adequate provision" could be achieved within a 30 second tv spot
-- In 1997, the FDA ruled that this was possible, given the caveat that ads encourage people to go to a specific magazine ad, physician or website such that they could receive the fuller picture and meet the "adequate provision" standard
-- Those that have studied the issue of consumer understanding of drugs based on DTC ads since 1997 have provided a good body of evidence that this "adequate provision" standard has not been achieved in TV spots
-- The FDA could reverse this ruling, and claim that "adequate provision" cannot be achieved via TV, hence no truthful advertising
-- This could be challenged but 1) It would be PR nightmare 2) the data would overwhelmingly support reversal
Posted by: wisewon | Nov 6, 2007 1:40:04 PM
My suspicion is exactly the opposite--we have way too much carrot in health care research that doesn't really seem to change life expectancy significantly, and way too little in other areas like clean energy. That's especially true if your looking at global welfare rather than just American welfare--clean water, nutrition, education and infrastructure in poorer nations seem like they'd offer way more bang for your back than exotic new treatments to squeeze out extra years of life for the aged. That and new information and energy technologies would raise our GDP enough that we'd be able to put more resources into health research in the long run.
Consumatopia,
I'd agree with the examples that you've pointed out. However, I was speaking about industries at a macro-level, and your examples were either a subsector (clean energy) of a specific sector (energy), or something that isn't an industry at all (global public health).
Also, I'd point out that I stated "degree of regulation and risk inherent in health innovation" as a key factor. When you're asking health technology companies to invest R&D dollars when the government has sole control of whether the product can even be sold and the technical risk of success is greater than 95%, there isn't another industry that faces that combination.
Posted by: wisewon | Nov 6, 2007 1:56:45 PM
“Under the current system their expected profits on Drug X would be $.10/pill, but under the soon-to-be-enacted universal healthcare law, their expected profits drop to $.05/pill. Will they still proceed with Drug X?”
Stephen: Your example assumes capital investment is a constant, which isn’t true. Capital is going to follow profit; so in your example, capital potentially invested in Pharma may move to high tech, or some other industry.
Posted by: DM | Nov 6, 2007 2:08:15 PM
http://cafehayek.typepad.com/hayek/2007/11/the-big-impact-.html
“According to Public Citizen, a source not particularly friendly to corporate interests, pharmaceutical industry profits in 2002 (the year I happened to stumble on) were 36 billion. If all pharmaceutical companies were forced to serve the public at zero profit, that would lower US health care expenditures from 1.3 trillion to 1.3 trillion.
That's a pretty small change
I'll carry it out to a few more decimal places. In 2002, total health care expenditurea in the US were $1.342 trillion. So taking out ALL pharmaceutical profits lowers that number to 1.306 trillion. I don't think there's any way you can argue that the profitability of the pharmaceutical industry is a large factor in the size of US health care costs or that moving to a system where government could exploit its power as a large buyer of drugs would lower total expenditures.”
Posted by: Floccina | Nov 6, 2007 2:21:36 PM
Also, I'd point out that I stated "degree of regulation and risk inherent in health innovation" as a key factor. When you're asking health technology companies to invest R&D dollars when the government has sole control of whether the product can even be sold and the technical risk of success is greater than 95%, there isn't another industry that faces that combination.
wisewon,
I'm not sure what the implications of such an observation would be. Since government regulation and unpredictable success of drug research are facts of life that must be taken as given, whether health research companies would be doing better without them doesn't matter to either me as a voter or even me as a private investor considering where I should stick my money.
Posted by: Consumatopia | Nov 6, 2007 2:21:59 PM
I don't think there's any way you can argue that the profitability of the pharmaceutical industry is a large factor in the size of US health care costs or that moving to a system where government could exploit its power as a large buyer of drugs would lower total expenditures
The assumption of folks like me who would want to move to such a system is not that profits are wasted, but that the private sector is researching the wrong things, or that we're just spending too much on research in general. Health care research is not the only area in which we are asked to trade between money and lives--spending more money to save more lives in one area means losing more lives in another.
Posted by: Consumatopia | Nov 6, 2007 2:26:29 PM
I'm not sure what the implications of such an observation would be. Since government regulation and unpredictable success of drug research are facts of life that must be taken as given, whether health research companies would be doing better without them doesn't matter to either me as a voter or even me as a private investor considering where I should stick my money.
The implications are what I wrote at the top. While we should be thinking about whether changing the industry economics makes sense in terms of encouraging the right innovation, we should be careful to make sure we are doing that in the context of other industries. So given the high regulatory hurdles and low rates of success are "facts of life," and if we care about having sufficient innovation in this area, we do need to ensure there is sufficient "carrot"/profit that compensates for these additional risks.
Posted by: wisewon | Nov 6, 2007 2:50:15 PM
So given the high regulatory hurdles and low rates of success are "facts of life," and if we care about having sufficient innovation in this area
It's not a matter of "sufficient" innovation--there are number of areas of innovation that offer potential savings in lives per dollar spent. The underlying reasons why one area offers a lower return to investment than another simply do not matter to the investor, whether public or private. No CEO would ever say "we're making less money than the other industry, but that's just because this industry is inherently less profitable than they are" unless they wanted to encourage everyone to move their investments to the other industry.
So the implications, to the extent that there are any, are exactly the opposite of your assertion--the inherent difficulties of researching medicine mean we would get more bang for our buck elsewhere.
Posted by: Consumatopia | Nov 6, 2007 3:00:01 PM
So the implications, to the extent that there are any, are exactly the opposite of your assertion--the inherent difficulties of researching medicine mean we would get more bang for our buck elsewhere.
Medicine offers the biggest improvements in people's lives. I think the point is, most people do value potential health improvements for themselves/loved ones over most other things by a lot. So the "bang" in medicine, is much larger than what's offered by other industries. Given the differences in the "bang" its pretty tough for other industries to have a better "bang for the buck."
There is a reason that health care cost inflation is such a problem in all Western nations. Because people would rather spend their money on medicine than other things. You may think differently yourself, but there is a reason health care is growing faster than almost every other industry across the globe, because the macro-level "bang for the buck" is highest in health care. No other industry can compete with the health care "bang." The buck becomes less meaningful, this is the essence of the struggle with health care.
Medicine has the biggest bang for the buck in terms of social utility. The key is ensuring that financial incentives are similarly aligned. That's my point.
Posted by: wisewon | Nov 6, 2007 3:40:54 PM
I want to modify slightly what I said earlier.
So the implications, to the extent that there are any, are exactly the opposite of your assertion--the inherent difficulties of researching medicine mean we would get more bang for our buck elsewhere.
We can disagree on whether one field of investment offers social utility than another, but you'll have to admit that the inherent difficulties of researching medicine are a reason to research other things more than we otherwise would (even if its just a matter of spending a somewhat enormous amount instead of a really enormous amount). If researching medicine was easier than it is, and the gains to investment were more obvious, we would want more money poured into research. So however much we comparatively value various fields, inherent difficulties of researching some fields as opposed to others encourage us to adjust away from the hard ones.
However, as I argued above, I think there are numerous other reasons that health research is overvalued. Individually there are many people with money who have nothing better to spend their money on than a desperate bid to add a few minutes more to their lives. Socially the benefits of medical research are fairly scant--the dramatic gains we've seen in life expectancy are mostly from nutrition and sanitation rather than medicine. Despite spending many times more than other Western nations, Americans do not live as long as other nations. It's true that it's not those nation's health care systems that are responsible for this--it's our higher rate of accidents and unhealthful living. Which suggests that addressing those issues would offer way more social utility than increasing health care spending further.
The people want to spend more money on it is no evidence of social utility--just that human beings have a bias to spend way more on cure than we do on prevention and growth. Investments in safety, diet, environmental cleanup and protection, or simple economic growth would all almost certainly involve more net years of life expectancy added. But our economy doesn't reflect that, because the those benefits are either externalities or beyond the time horizons of people making medical financial decisions.
To desperate individuals with nothing to lose every penny spent on medical care is rational because there's no opportunity cost--time is up. To prevent such behavior would be cruel, but to subsidize it is absurd. The social utility of increased medical research is outweighed by the social opportunity cost. Put simply, spending more money on health care must be weighed against the greater number of lives we would save spending elsewhere.
I am the one arguing for saving lives here.
Posted by: Consumatopia | Nov 6, 2007 4:32:25 PM
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