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The original analogy alluded to when things needed to be cut, good things were chosen instead of bad things. In your analogy everything is bad. I don't see what my opinion has to do with the fact that you are changing the opinion of the analogy itself, and trying to brand the change as "sense", instead of what the change really is, your opinion. :bored:Quote:
Originally Posted by Lewkowski
Good things aren't being cut though. Wasteful spending is being cut. Pet projects are being cut. The national government shouldn't be running huge programs, programs should be local.Quote:
Originally Posted by Illusions
Thats pure opinion, and we all know it. Hell, I'm pretty conservative and I still recognize the fact that some programs work best on the national level.Quote:
Originally Posted by Lewkowski
Just saying, Lewk, I think $1.6 billion dollars in medical research isn't, you know, wasted. Which was one of the cuts proposed by the GOP for the rest of 2011. There are plenty of other very worthy programs that shouldn't have been on the chopping block.
I bet the come-back will be that the government shouldn't be doing what big pharmacy can do more efficiently.Quote:
Originally Posted by wiggin
To which we can respond by linking to hundreds of posts by Tear and Wiggin explaining exactly how and why government spending is necessary for awesome medical research.
Of course cutting government spending for medical research might make those greedy pharma bastards take notice :mad:
I'm not sure you should be annoyed at 'greedy pharma bastards' in that the large proportion of the cost of developing and validating a new drug is borne by them (billions of dollars per drug), and the large proportion of that is passed onto the American consumer and not other countries due to restrictive laws. As a result, the US healthcare system is to an extent subsidizing healthcare for much of the world (just like our defense establishment means other people can skimp). Undoubtedly part of the discussion in reducing growth in medical costs is going to be exporting some of those costs to those countries that have been freeloading until now.
So if I don't like one part of the medical research I should just suck it up for the common good? Needless to say I disagree. The government's only real role in medical research should be in regards to defense. We need some common sense research in case of a WMD attack uses biological/chemical/disease oriented attacks. Some additional research could be used for prevention of epidemics that could hit the US and the like but for the most part if you want research, you contribute your own money to it.Quote:
Originally Posted by wiggin
Wait a second - you think the bulk of the NIH shouldn't exist?!Quote:
Originally Posted by Lewkowski
Presumably you feel that we should have research on bioweapon detection and treatment because it's for the common good of US citizens' health, yes? Well, I have news for you - so is the rest of the NIH budget. The fact of the matter is that most of the NIH (and NSF) budget is for funding projects that are too early to be of significant interest to industry - they even fund small startups that don't have enough concrete data for VCs to bite, and with fewer strings attached to boot.
I consider a number of ailments to be threats to national security: cancer, neurodegenerative diseases, cardiovascular disease, and aging-related diseases that limit the productivity and health of American citizens. Given the fact that corporate funding only goes so far, it makes lots of sense to fund the NIH. It provides critically needed medical improvements that extend the lifespan and useful years of Americans, keeps American education and industry competitive, and all at a pretty low price (something like 1% of the total budget).
I'm also curious what part of medical research you would dislike so much to damn the rest of the funding.
Me not liking certain research is a hypothetical. The point is in my view the government doesn't get to make these decisions. People get to choose where their dollars go to. The government has a limited role. The primary being defense against internal and external enemies. IE: Other countries and criminals. The governments secondary role is to ensure contracts are adhered to and upheld.
I would say the majority of people support medical research. So why then does government have to forcefully take it? Why can't people do this on a voluntary basis? This already occurs in some areas as billions flow into research/awareness drives via charity.
I agree in general that the government (i.e. Congress or the President) should not be directing research funding. I'm uncomfortable with earmarked funds being given to the NIH or NSF; I rather they be given X amount of money and a broad mandate, and the experts at the various organizations decide on disbursing the funds according to scientific merit and potential societal impact.
Yet I think it's very unlikely charities would be able to pull in ~$38 billion, which is the combined NIH and NSF budget (not including various other research budgets that help fund basic science, like quite a bit of DoD and DoE money). One of the largest research oriented charities I know of, the American Cancer Society, has a budget of about $1 billion a year, and a good chunk of that goes to advocacy and the like rather than research. You'll get another handful that are in the hundreds of millions range, and after that you fall off a very steep cliff. Furthermore, there's even less money available for non-medical research, even though non-medical breakthroughs have driven much of the technological innovation in the last 60 years (and much of our economic prosperity).
What about defense-related medical research? I work in regenerative medicine, something the US military is extremely interested in for obvious reasons. Our work rests on work done by mechanical engineers, polymer chemists, materials scientists, cell biologists, and more. How can you separate out 'relevant' research by your rubrics and 'non-relevant' research?
I think a simple solution is for the government to provide significant funding for early stage research, which can later be picked up by the private sector for development. The funding is competitively awarded on the basis of merit and potential impact, and the ramifications for society are sorted out later.
You say the government's role is to protect us against enemies, including internal ones. What more potent enemy is there than influenza or HIV? How much damage do the depredations of age do to our citizens and our prosperity? I guarantee you, disease has prematurely killed and crippled far more Americans than any external threat, and caused greater damage to our economy and way of life. Do we have a problem with Social Security? Well, let's make Americans in their 60s healthier by better medical technologies so they can work longer and need less of a safety net. Are our medical costs spiraling? Let's find innovative ways to forecast predispositions to various chronic conditions and personalize preventative medicine. Do we lose far too many sick days to influenza? Let the CDC track viral mutation trends and fund research to develop better, faster methods of producing vaccines.
There is a clear role for government here, and it's also cheap (and far more efficient than a balkanized private charity effort, each with their own criteria and priorities). There's no doubt that the real budget problems are in mandatory programs, which have been conspicuously avoided by both parties. Claiming that cutting $60 billion+ from discretionary spending is 'progress' - when some of those programs do a lot of good - is absurd and only relevant in context of the sad state of American politics.
given that their marketing budgets exceed their research budgets by far i think it's safe to say that the americans are probably bearing the costs of excessive marketing and greed more than of else
What is true for pharma isn't true for all of the biomedical industry (when was the last time you saw an ad for a CT machine?), and the data you cite is mischaracterized. IIRC I spent a few posts taking that claim apart back in the day. There's some truth to it, but less than you think.
We have some local and regional imaging centers doing the advertising "war". I can shop around for my mammogram, but that doesn't mean it's as competitive as it should or could be......Quote:
Originally Posted by wiggin
That's different. Plenty of private hospitals will advertise their services, and various diagnostic centers will do the same - these costs are local and not part of the manufacturer's costs. But the manufacturers of the products are hardly trying to do direct-to-consumer marketing of the benefits of device A over device B for finding problem C. Marketing there is limited almost entirely to physicians and administrators, and is not limited to the US.
(I have seen a few ads more about brand recognition than anything else - for example, GE had some ads talking about their fancy technology which included some bits about their scanners. But that hardly qualifies.)
Yeah, I've see the ads for the GE smart light. But if you're a self-pay patient, somehow the hospitals and diagnostic centers find you. Of course they're "local costs" but that's how self-insured patients shop, and they know it.Quote:
Originally Posted by wiggin
I'll admit I didn't know that prices for CT-machines were artificially low in eg. the EU and thus subsidised by Americans (who are of course getting their CT-scans for little reason) :confused:Quote:
Originally Posted by wiggin
I'm pretty sure the data wasn't so mischaracterised that you could call their research and "marketing" budgets anywhere close to equal, even when you start defining much of marketing as "education" :o but I'll admit I don't really remember what you said on this matter,Quote:
and the data you cite is mischaracterized. IIRC I spent a few posts taking that claim apart back in the day. There's some truth to it, but less than you think.
To be honest, I don't know; I was actually thinking more along the lines of implantable defibrillators and the like, which are priced higher in the US since there's little collective bargaining.Quote:
Originally Posted by Aimless
Not really interested in going through this again.Quote:
I'm pretty sure the data wasn't so mischaracterised that you could call their research and "marketing" budgets anywhere close to equal, even when you start defining much of marketing as "education" :o but I'll admit I don't really remember what you said on this matter,
It's part and parcel of the far-right in the US to believe that no real good can come out of gummint research that couldn't be done better and faster by private research. It would be hilarious in a sad way if all the Pubbie cuts made it through, it'd basically be tantamount to the U.S. throwing their collective hands in the air and saying "science, not interested, rest of the world do it". While Chinese science has its problems, this move certainly wouldn't work against them.Quote:
Originally Posted by wiggin
Yeah but I'm trying to figure out if the EU is twisting the manufacturers' arms to get the goods for less than a reasonable price and if the Americans really are somehow "subsidising" the implantable defibrillators of the Swedes.Quote:
Originally Posted by wiggin
I don't know about Sweden specifically, but there are collective bargaining agreements in place for most medical 'goods', not just drugs. The US by and large doesn't have these agreements (though smaller scale agreements exist for some largish insurers and the like, it's nothing compared to the bargaining power of, say, France). Pharma is just the highest profile (and probably biggest) example.Quote:
Originally Posted by Aimless
The free rider problem is a sticky one. Normally a price discrimination problem like the pharma one (and, to a lesser extent, other medical goods) leads to arbitrage opportunities, where people would buy in the cheap market in sell in the expensive market until prices equalized (this happens a little). But since prices are tightly controlled in the cheap market and there are rules against this arbitrage in the expensive market, the price differential is artificially maintained. If the barriers come down by prices are still controlled at the cheaper market levels, the industry stands to lose a lot of revenue, and potentially will stop development of high risk drugs given the cost/benefit analysis. More likely, they'll just be like other high fixed-cost industries (like airlines) that are perennially broke and needing taxpayer rescues. (BTW this free rider problem isn't a country-specific thing. Even inside the US there are those who pay a lot more for drugs than others. Medicare can't negotiate prices legally, so they might pay more than someone in a large HMO who bargained down the price, while someone with minimal/no insurance might pay a LOT more. This is unfair inside the US just as it is unfair internationally.)
The obvious problem here is that the market doesn't have a lot of competition for each product, especially early on in its sales. So without any price controls it's likely they'll charge as much as the market can bear, which is likely to be a lot (and far more than is needed to recoup costs). The issue is that price controls lead to price discrimination, and even if the controls are applied universally the big question is where they should be set. Estimating how much revenue is needed to recoup costs and provide a reasonable profit margin is fantastically difficult given the uncertainties of the industry, and I'm honestly not sure what solution would work best.
Interesting take GGT had on the budget cuts in the Wisconsin thread; Republicans (more than Democrats) acting as if they are dealing with fiscal policies where they are merely pandering to the extremist fringes of their support base.
I take it as a given that what politicians are doing is not what they say they're doing. They're always being fairly self-interested. I am reading a political economy book right now on US development during and after the Civil War and I read a passage which came back to me when I read GGT's post. The rising financial class was advocating for civil-service reform, among other measures, and it wasn't because it would be good for the country. They said that was why they were doing so, but that was only true insomuch as they felt that what was good for them must be good for the rest of the country. They were pushing for it because the political spoils system *amidst all its very real flaws* was making bureaucracies like the Treasury too responsive to populist outcry, too inclined to make what the financial class felt were near-sighted and poor decisions during financial crises.Quote:
Originally Posted by Hazir
The political motivation doesn't matter. At all. I don't care why someone is pushing budget cuts in Wisconsin. It needs to make them. I'm ambivalent about the approach they're taking, but I don't think it's flat-out wrong. People across the pond can preach all they want about unions in a theoretical environment, but here in the US, unions are sclerotic and the least-adaptive agents in the field and with the current problems *fiscal, unemployment, general economic malaise, etc* they're one of the biggest, if not the biggest, obstacles to effectively responding. And the public workers unions are, by their natures, among the largest and the hardest to work around.
The problem is that the 'why' usually influences the 'how'.
Of course political motivations matter. Especially when they're cloaked as "other things".
It's disingenuous of the GOP to focus on unions, with their least-adaptive and bureaucratic problems (inherent within their own ineffective, outdated organizational structure and hierarchy) and then say they're the biggest obstacle to work around.....for passing public budgets.
For all their talk about making a smaller and more efficient government, Republicans choosing to pick on educators and unions first looks more like that overreaching gummint they criticize. It's a ruse to distract from *their own interests* which are political and monetary.
Why? Either you agree with the policy someone is trying to implement (and all the trade-offs, unintended consequences, etc that come along with whatever it is should it be enacted) or you don't, for your own reasons. The reasons that other person has are completely irrelevant. All those side-effects you may or may not be concerned about which are attendant on the policy will happen whether that other person is pure of heart or not. The benefits which made civil-service reform and the professionalization of the bureaucracy a good thing, a policy implemented by every advanced country were and would be there even though the forces pushing it were primarily interested in making the government less responsive to farmers complaining about how the country's fiscal policies were screwing them over.Quote:
Originally Posted by GGT
You don't know these things, which is why the majority votes blindly. I really like the idea of itemizing everything to be considered. I saw a David Brooks article recently that pushed the idea.Quote:
Originally Posted by LittleFuzzy
You mean referendums like in Switzerland?
Your response was too swift to be addressed to me. But if it was then no, legislators need to use their staff to itemize the trade-offs and unintended consequences of their vote. Party politics pretty much eliminate this here in the U.S. of A. We prefer to catalog ideology over consequences.
Neither do pretty much any of those legislators.Quote:
Originally Posted by Being