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2/ A common argument is that other countries free-ride on US investments in healthcare R&D and their supposedly better healthcare systems are in fact freebie positive distortions of a more "natural" healthcare market like the US. I don't know how true this is, but let's say it is
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3/ Let's also ignore distortions common to all healthcare markets, such as societal aversion to euthanesia and overinvestment in painful end-of-life care that patients don't want and doctors don't choose for themselves. This occurs for various institutional reasons.
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4/ Is the US healthcare market rational with those 2 qualifications? (others free ride, there are universal distortions where the US is not special).
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5/ R&D and leading-edge advances come from learning rate delivered by activity on some frontier. So the question of rationality hinges on the long-term value of where the frontier activity is.
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6/ Blockbuster drugs (with no value judgments on whether they are for HIV, ED, or heart disease) and super-advanced surgery with augmented reality are not "good" or "bad" outside of a societal health condition and simple possibility.
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7/ But the kinds of leading-edge innovation delivered by the US "advanced" system tells you where the frontier is: in biochemistry labs and extremely advanced treatment facilities (for people with weird and rare kinds of cancer for example). This was not always the case.
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8/ Healthcare innovation used to depend on learning rate delivered by number/variety of care episodes so care correlated with advances. The frontier, in other words, used to coincide with the world of care delivery. Public health WAS the field laboratory.
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9/ Today, public health and epidemiology connect a healthcare "market" to a healthcare "innovation" sector via a set of prioritization choices that reflect profit-making potential rather than incidence rates. Again, just an observation, not a judgment.
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10/ Ie, the health conditions that get prioritized are efficiently privatizable ones. Healthcare evolves by corporations deciding for instance that "diabetes" is a better market, and more worth privatizing, than some other condition which offers weaker margins.
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11/ Goes without saying that the efficiently privatizable conditions may not be the ones that represent the greatest societal burden. Social and moral of course, but in the US, we mean primarily economic burden.
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12/ Condition A that represents say a -1% drag on the GDP (ie fixing it would add 1% to growth) goes unaddressed because there is no way to privately make a sweet profit off it.
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13/ While Condition B, that is a 10th place rounding error in GDP terms gets a huge amount of attention/resources because it has efficient private market development potential. Call these "charismatic diseases."
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14/ A charismatic disease/condition is 3 things: a) Easy to market (strong "brands" in symptom terms) b) Easy to dramatize via relateable life narratives ("the American dream, but with diabetes") c) Most importantly: good for drive-by interventions instead of open-ended care
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15/ Charismatic diseases are (Carsean) finite-game diseases where there is such a thing as a clear win condition (or escalation sequence thereof) marketable as a "cure narrative." This does not mean the condition is necessarily curable, just that there's an tree of things to try
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16/ By contrast, infinite game diseases/conditions that require open-ended care relationships are a systemic blindspot. They are hard to privatize, and a system that only targets what is privatizable tends to just give up and let sufferers just live awful lives till they die
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17/ Again, just an observation. Draw your own conclusions about whether tradeoffs made by other countries are better or worse. The point is, "the US has the best healthcare" is a very narrow claim: "best healthcare that a system based on privatizing diseases can deliver"
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18/ Equally, resist the temptation to write off advances made by other countries simply because they aren't accompanied by the innovation theater of the US: patents, big fortunes, miraculous-seeming outcomes for a few.
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19/ Non-private innovations LOOK different: large-scale assembly line cataract operations at "eye camps" in India for example. Or of course, immunization/vaccination.
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20/ The US used to lead on those fronts too about a century ago (eg. Rockefeller foundation work on eliminating hookwork in the US south), but now mostly that's left to "poor" countries.
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21/ tldr of the thread: Don't buy into naive arguments that the US healthcare system is "best in the world" and if your experience of it sucks, it's only because because "other countries free-ride" and you didn't buy enough Big Pharma shares.
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22/ Addendum to point 12: In some cases a net negative societal health condition may be "negatively privatizable" where some other sector (sugar, tobacco) has a stronger incentive to keep the condition alive than the healthcare sector does to cure it for profit.
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