1/ Quickie tweetstorm on the danger of the "best healthcare" mythos (in terms of R&D and advanced treatments) in the US.
Conversation
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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Replying to
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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