Quoting kidneystones: Given his distaste for David Frum...

"Distaste??" What in God's name are you talking about? Brink & Frum are old college buddies. They were charter members of Harvard Law's Federalist Society together. They watched Reagan win the presidency from a Cambridge dorm room together. What could possibly forge a more enduring bond between two young conservatives than that??

Brink and David may have gone to college together, but Brink rejected David's clammy embrace during their last exchange at bhtv and voted for Acorn. Their rupture's probably complete. Brink has a new agenda and wants to bring liberals and libertarians together. I expect, however, that spiraling unemployment, economic stagnation, and more handouts to Wall St. cronies will drive Brink closer to ordinary, small-government Americans.

Brink Lindsey makes the point that the U.S. Market is the driver behind the bulk of the innovation achieved by the world's pharmaceutical industry. I remember an econ professor making that point at an event I attended not too long ago, and someone replied by pointing out several major European drug companies (implying that the professor was wrong, since there are so many profitable foreign drug companies). But Brink Lindsey's point was not that what's important about innovation is that U.S. drug companies are more innovative, his point was that the U.S. market, being what it is - large and *relatively* unregulated - is the driver behind pharmaceutical innovation (therefore IF U.S. drug companies are on average more innovative, it would have to be because of their location in, or increased access to, the U.S. market, but the fact that they're American companies would be incidental). Of course, the econ professor I mentioned made his point in perhaps an imprecise way; he said something to the effect of "we're subsidizing the world right now in terms of drug research," which is ambiguous. He may very well (and probably did) have meant what Brink Lindsey meant, but it could have

Quoting Jay J: Brink Lindsey makes the point that the U.S. Market is the driver behind the bulk of the innovation achieved by the world's pharmaceutical industry. I remember an econ professor making that point at an event I attended not too long ago, and someone replied by pointing out several major European drug companies (implying that the professor was wrong, since there are so many profitable foreign drug companies).

But Brink Lindsey's point was not that what's important about innovation is that U.S. drug companies are more innovative, but that the U.S. market, being what it is - large and *relatively* unregulated - is the driver behind pharmaceutical innovation (therefore IF U.S. drug companies are on average more innovative, it would have to be because of their location in, or increased access to, the U.S. market, but the fact that they're American companies would be incidental).

Of course, the way the econ professor I mentioned said it may not have been as precise as possible; he said something to the effect of "we're subsidizing the world right now in terms of drug research," which is ambiguous. He may very well (and probably did) mean what Brink Lindsey meant, but it could

Quoting kidneystones: ...handouts to Wall St. cronies will drive Brink closer to ordinary, small-government Americans.

Yeah, I'm sure the fastest way to a Cato fellow's heart is populist grandstanding about "Wall Street cronies." There's nothing a Classical Liberals hate more than Wall St.

Quoting AemJeff: if you assume that it is the case that the U.S. market exerts some marginal effect, could you definitively argue that increased access and better prices wouldn't outweigh the benefit of that effect?

While it may be both vague and ideologically convenient, I do think there is something to it. The idea is, basically, "the US is so profitable that competing companies innovate their way to a larger share of those profits." OK, but that assumes a pretty static pie of demand. I think your reply above is the nub of a valid counterargument. As a defense of the current system, "US profitability" rests on the idea that this is the only way to profit, but that's not the case. As it's now, health care provision is essentially a cartel: a small group has erected huge barriers to market entry to defend their access to a captive group of price-takers with inelastic demand, and the cartel then extracts as much as they can from that aggregate (if it all comes from the rich few and they can't sell to the poor, so what?). If, instead, you increase the pool of potential customers by, say, having universal health care, the

AemJeff, I'm not sure where to start. Umm, first, I guess I'll say, I'm not sure who has the burden of proof. I think the argument is that because of the size and relatively unregulated nature of the U.S. market, it is more profitable for drug companies to sell to, or develop in the U.S. market compared to smaller and/or relatively more regulated markets. Of course, that something looks right on paper like this, does not mean it is true, but I think the plausibility of the argument should be acknowledged. If we can't discuss things at this point, then I imagine we can't discuss very much at all (and of course I'm open to hearing other claims that appear very plausible as well, but simply saying you don't have the burden of proof doesn't seem to accomplish anything). As to your argument asking how I know that increased access and better health prices wouldn't outweigh the "marginal effect" the innovative U.S. market has, that you hypothetically allow is possible, for argument's sake: Well, there are a couple of ways for me to read this. One is that you are trying to help me look at the overall benefit of

SM writes more nonsense...[...] Your bogus claims are demonstrably wrong. The first sleight of hand is to conflate large health-care providers, which in some markets may enjoy almost monopolistic power, with pharma research companies which may be small or large. In and around MIT, for example, there are a large number of bio-tech companies researching for profit. There is no cartel. The potential for profit drives innovation and research. Competition exists; and any company with the cash and know-how to get in the game can. The key is being able to sell the research to larger players. They may be able to in a market that includes a public-option health-care program. If you think that big government can provide the best environment for research we need only look to Cuba, North Korea and the former Eastern Bloc. Innovation comes from free enterprise. Big government is more monopolistic than any cartel, real or imagined.

Quoting kidneystones: The first sleight of hand is to conflate large health-care providers, which in some markets may enjoy almost monopolistic power, with pharma research companies which may be small or large.

Oh oops, has this whole debate the country has been having been about opening up the pharma market, while I thought it was about changing the rules of the road for the "monopolistic" health care providers in my example? My bad. I guess I was confused by the "health care reform" title and all the wrangling between the health insurance industry and consumer advocacy groups. My mistake. You can't just pronounce something "demonstrably false" and then fail to demonstrate it. Citing examples of communist and/or military dictatorships' lack of innovation (I think there just might be a lurking variable there) or getting all panicky about Big Gubmint is, ahem, less than persuasive.

Quoting Jay J: The only other way I can imagine your statement here being interpreted is that you are making a direct argument that somehow innovation would be unharmed because of better prices/increased access.

I think that is what he's saying (or at least that's what I read him to be saying when I agreed with him and expanded upon his point)

Stapler Malone, You make an interesting point:

I have yet to see a good case that selling twice as many Fancy New Wonderdrug doses at half the price would cripple the incentive to create Fancy Next Wonderdrug.

I'm not surprised that you haven't seen anyone make a good case against that. I mean, it's just simple math, right? I have to wonder if that's how the health care market works though. You just give everyone universal care and boom, there's twice as many Fancy Next Wonderdrug customers. I hate to get non-theoretical (really, I do) but my understanding is that well over half the population has insurance right now, so we're not talking about expanding the pool of covered by nearly so large a proportion. I suppose we could just implement price controls, that would work, at least at holding prices down. Without them, the larger pool of consumers will cause demand (and therefore price) to go up (it's not like buying toilet paper in bulk at Sam's, it's like everyone deciding to go to the local gas station to purchase small packs). I imagine price controls are an argument for another day, but I'm not confident that everything

Thanks for your thoughtful response Jay J! Price control is not a policy option that I'm personally going to carry any water for, in part because of its political infeasibility (imagine the tea party howls of "socialism," and this time they'd be right!). Much more importantly, because it just wouldn't work: Price controls -> black markets -> dangerous counterfeit drugs + organized crime syndicates + loss of revenue (to both innovative private corporations and tax-collectors who bankroll public goods) -> well-founded outcry from all sides to abandon price controls. So yeah, not my bag. As for the notion that increasing demand (or rather, empowering the nascent demand currently stored in the poor & uninsured) will drive up prices, I think I disagree. My recollection of college economics is admittedly rusty, but I feel like a new equilibrium would be reached to serve that demand. More demand only raises prices if supply of health care provision remains constant. This is where adding more players to the health care providing side of the equation is important. You are quite right that the current heath care companies might be happy to just stick with the lucrative >50% of Americans whom they

Quoting Stapler Malone: I think that is what he's saying (or at least that's what I read him to be saying when I agreed with him and expanded upon his point)

It's a little more complicated than that. I agree with the basic premise, that reform as structured is going to threaten pharma innovation but it's not a simple question of their having less profit because of prices falling to invest in R&D. It's that the structure of the reform is going to lead to more bulk purchases of drugs, especially for the very sick who will be government subsidized. And the inclination of a system like that is to cover Wonderdrug 1 from Company A (say Prozac) but not Wonderdrug 2 from Company B (say Zoloft). Clinically, they are more or less the same, so there's no reason to cover both--it's inefficient because you end up buying in less bulk. That's why, when you go to a single-payer country, you'll find they tend not to do duplicates like that. But the thing is, when you have those head-to-heads, Viagra vs. Cialis, Claritin vs. Zyrtec etc, the incentive on pharma is not simply to go for big breakthroughs to tackle whole

Quoting PreppyMcPrepperson: the inclination of a system like that is to cover Wonderdrug 1 from Company A (say Prozac) but not Wonderdrug 2 from Company B (say Zoloft). Clinically, they are more or less the same, so there's no reason to cover both--it's inefficient because you end up buying in less bulk. That's why, when you go to a single-payer country, you'll find they tend not to do duplicates like that.

This is similar to the point McMegan made when she colorfully compared Mark Schmitt to a socialist pamphleteer decrying "wasteful competition." I have to admit, it's a very valid criticism, and I'm not sure there is a good way around it. I found it quite persuasive when Megan brought it up (as well as here in your iteration).

Quoting Stapler Malone: This is similar to the point McMegan made when she colorfully compared Mark Schmitt to a socialist pamphleteer decrying "wasteful competition." I have to admit, it's a very valid criticism, and I'm not sure there is a good way around it. I found it quite persuasive when Megan brought it up (as well as here in your iteration).

Good point--wish I'd remembered that and had the energy to go in search of the dingalink, too tired now. I'm not sure how to get around it either, and I'm someone who, like Brink, is inclined to allow smart government interventions in providing health care. This is one thing that really worries me, and that isn't being talked about because the whole debate's gotten mired in 'death panel' hysteria.

"Health Care does not operate in an open market; if you draw a supply-and-demand diagram for health care there is no quantity to put on the horizontal axis and no price to record on the vertical axis.It is not a commodity that is bought and sold at a given price on an open market. Proposals to introduce market forces in health care are largely concerned not with the provision of health care itself but with the provision of health insurance. The intrinsic costs of providing insurance are relatively low. There are no expensive inputs to purchase, no uncertainty of design or technology to be concerned with. The major inputs are personnel and computing capacity. There are few major issues of innovation; unlike the rapid changes characteristic of medical practice, the service of providing insurance to pay for them does not evolve rapidly. A successful private insurance company follows an ancient formula; it stratifies its clientele by risk class and charges premiums adapted to each class. The most successful companies are generally those that manage to exclude the riskiest clents. Public universal health insurance schemes

If our goal is to improve the general health of our populace, perhaps health care reform is not where all the potential gains are. I suspect that programs that subsidize the more expensive healthy foods, over the cheap unhealthy foods, may be more effective both in the absolute health gained, and in the amount of health gained per dollar. Or, perhaps giving everyone a free gym membership would, in the long run, be cheaper then having a million obese diabetics (Tax incentives for people that hit the gym twice a week?). I realize this is more intrusive then people would prefer, more then I would prefer really, but I don't see how it is avoidable, considering how much the gov't is involved in health care. Edit:
What happened to that soda tax they were talking about anyways?

And thank you Stapler Malone, for that thoughtful response. There does appear to be much to be 'epistemologically humble' about. I'v gotta run and do, you know, life outside of message boards. But in due time, I'll consider your points and check out that podcast you linked to.

Since when does BHTV have re-runs?

Quoting kidneystones: Presidenting is difficult. On that much differing parties can agree. Brink is looking for new friends. Given his distaste for David Frum, it's easy to understand why Brink might want to play a duet on Josh's shiny, black piano artfully framed in the background. Love the lighting on those stairs, Josh. And the black sweater/shirt? Elegant and understated. Simply screams: I'm one of the people.

...of my mental health. Did you edit out "something you just threw on?"

Quoting look: ...of my mental health. Did you edit out "something you just threw on?"

He definitely did. I recall chuckling about it last night.

Quoting Jay J: But Brink Lindsey's point was not that what's important about innovation is that U.S. drug companies are more innovative, his point was that the U.S. market, being what it is - large and *relatively* unregulated - is the driver behind pharmaceutical innovation

What innovation? I don't see why everyone's so concerned with drug innovation. It's virtually meaningless. All of the big, civilization-changing innovations in medicine happened fifty, sixty years ago: vaccines. Since then, the only medical knowledge that has had an impact on health on the largest scale is: stop smoking. Maybe 'eat better and exercise', too. Most new drugs don't work, and those that do have health outcomes that are irrelevant on the level of the nation-state. And this discussion concerns policy on that level.

Quoting nikkibong: He definitely did. I recall chuckling about it last night.

Bless him.

Something he just threw on? Oh yes. look writes...[...] Interesting background, yes? Bookcases are so 20th century. Republicans sit before books and plaques. (hope you're taking notes, nikkibong) I could add something about the beard-stroking, but won't. I trimmed back the commentary on demeanor etc. to stay within the comment guidelines; and as a tribute to Josh's refined 'less is more' composition. Good eye.

Quoting kidneystones: I could add something about the beard-stroking, but won't.

But just did.

Quoting kidneystones: I trimmed back the commentary on demeanor etc. to stay within the comment guidelines ...

... and then added it back anyway:

Quoting kidneystones: Something he just threw on? Oh yes.

[...]

Interesting background, yes? Bookcases are so 20th century. Republicans sit before books and plaques. (hope you're taking notes, nikkebong)

But who's counting.

Quoting Ray: What innovation?

You forgot about Poland!!!1! I mean, Viagra!!!1!

Quoting nikkibong: Since when does BHTV have re-runs?

Oh, since near the beginning.

Lindsey's in the lead for the humane libertarian prize. Not much competition though. "The Predator State" is an excellent book. I can't agree with every word written in it, but it's definitely worth a read if you're interested in public policy and economics. It's full of facts and ideas I'd never encountered before.

The healthcare debate is beyond my expertise. The one Brink would like to see, consumer oriented, is similar to David Goldhill's proposal in "Atlantic" magazine a couple of months ago. I think the monkey on the Presdent Obama's back for sometime to come will be the economy. In some states the unemployment levels are getting quite high. Regardless of what the stock market is doing unless these numbers come down the Democrats will not have the wind at their backs no matter how distasteful the Repubicans are to many. John

Quoting kidneystones: I could add something about the beard-stroking, but won't. I trimmed back the commentary on demeanor etc. to stay within the comment guidelines; and as a tribute to Josh's refined 'less is more' composition. Good eye.

Yes, I thought of that too late. But I think a man who so carefully considers his background (is that a Persian rug?) can take a little ribbing. Love ya, Josh. OTOH, is Brink trying too hard?

Quoting Jay J: AemJeff,

I'm not sure where to start.

Umm, first, I guess I'll say, I'm not sure who has the burden of proof. I think the argument is that because of the size and relatively unregulated nature of the U.S. market, it is more profitable for drug companies to sell to, or develop in the U.S. market compared to smaller and/or relatively more regulated markets. Of course, that something looks right on paper like this, does not mean it is true, but I think the plausibility of the argument should be acknowledged. If we can't discuss things at this point, then I imagine we can't discuss very much at all (and of course I'm open to hearing other claims that appear very plausible as well, but simply saying you don't have the burden of proof doesn't seem to accomplish anything).

As to your argument asking how I know that increased access and better health prices wouldn't outweigh the "marginal effect" the innovative U.S. market has, that you hypothetically allow is possible, for argument's sake:

Well, there are a couple of ways for me to read this. One is that you are trying to help me look at the overall benefit of

I have been indoctrinated with enough neo-classical economics to view the notion that the U.S. market subsidizes pharmaceutical research as intuitively plausible. Raising the potential for profits increases investment. If 90% of men inexplicably went bald in the next two months, then companies would become more interested in finding a cure for baldness. Libertarians often cite some European country that paid regular citizens to paint. No supply and demand -- just creating a painting would get you a flat fee. Well, of course it increased art (or "art") production because... that's where the money is. This seems utterly basic. The problem is really a question of how much and what kind of innovation we want. We do not want innovation for the sake of innovation, especially if it comes at the expense of welfare. One obvious way the government compels innovation (contra the free market) is by granting temporary monopolies on ideas. One obvious way the government could increase innovation is by making those monopolies permanent instead of temporary. And therein lies the problem: what are the welfare effects of granting permanent monopolies? Brink Lindsey, fast becoming my favorite libertarian (or liberaltarian), makes a significant

Jay, I don't know if the American market has a measurable effect on "innovation" or not. I definitely don't see anything backing up the argument except a feeling, an intuitive sense that it must be true, on the part of people like Brink. When somebody raises an argument with such a flimsy basis, and then frames it such that we're assuming its unproven consequences, that feels to me like sleight of hand.

I've also seen the "innovation" argument used before, in other contexts. Microsoft used it as a general defense during its anti-trust troubles. Corporate innovation is a slippery notion - Microsoft's successes, for instance, were all ideas taken from other sources (in cases, it can easily be said they were stolen - ask about the relationship between MS-DOS and CP/M if you're interested) and in many cases the real technological innovators were forced out of the market by Microsoft's sheer mass suddenly becoming a force in what had been a relatively flat playing field. So, I'm pretty skeptical of the very notion as it's generally expressed by big players in massive markets.

AemJeff, I think you're being *very* uncharitable when you say that the view that innovation could

well, the rug very nicely covers the coffee and dogshit stains.... and the elegant black shirt....well, it is a maroon waffle shirt....good for california 8AM (pre-breakfast, not postmodern)...

Quoting jcohen57: (pre-breakfast, not postmodern)...

I think I'd like this to be my personal blurb from now on, maybe get it on a business card...

Quoting Jay J: AemJeff,

I think you're being *very* uncharitable when you say that the view that innovation could be harmed by universal health care is backed up by nothing but a "feeling" or "intuition." You make it sound as if the argument is analogous to "I have intuited that the Rolling Stones have more artistic value then The Beatles, therefore we should stop the production of Beatles albums." OK, at worst, the claim you're objecting to is a 'synthetic, a priori' statement with empirical implications. If you're going to exclude these kinds of arguments, then I don't at all see how you could have any opinion whatsoever on the matter, one way or another. If you aren't going to dismiss these kinds of arguments out of hand, then it doesn't really matter that it *feels* like a sleight of hand; you should engage the argument on its terms, something Stapler Malone was/is willing to do.

As for your innovation comparison, that's just really not impressive. So someone somewhere used the word innovation in a way you didn't like? I mean, talk about vague, ya know? In any case, I'm not a big market player, and neither is Brink Lindsey. If you wanna say that

What I'm trying to say is that the argument is being treated as if it has more heft than I think it deserves. It is a "'synthetic, a priori' statement with empirical implications." I don't think it should be excluded from a serious discussion on the merits of policy choices; but, its status within such a discussion ought to be related to its strength as an argument. Even if we assume the effect exists, we have no way to reliably quantify it or compare it to the benefits of policy ideas that might adversely affect it. I fail to see how Brink or anybody else shows that this is a particularly compelling argument.

Broad, abstract nouns like "innovation" can be read to mean any damn thing somebody wants to read into them. Microsoft's use of the term was particularly bad because the real world implication of that language was the opposite of the sense of it that they wanted to convey. In that particular case there's a strong argument that the direct result of Microsoft's near monopoly status as a software developer was a significant reduction in

Cain, Serious question: What is the mechanism that will shift research dollars away from "anti aging, hair loss, and boner pills" and into malaria research, and will this change have no adverse impact on the bottom line of the pharma companies? I ask because we have a couple of different claims running.. one is that the profits of big pharma will be OK, so no need to worry about innovation. Another is that the government can step in and fill the gap (I know you only made one of these claims, but I'm trying to keep track of them all). Just so I'm clear, the claim is that the government can step in and subsidize innovation, and continue to subsidize the world's innovation? And this is as plausible as the claim that the private US market now subsidizes the world? My home base is philosophy (not that I'm expert in that either) and I try to understand economics.. perhaps I just need to see some of the steps laid out.

Quoting Jay J: I think our understandings are probably just too divergent to come to any sort of understanding at all, (even the kind with disagreement left over). See I do not see conservative think tanks as the inventor the language of innovation, I see neoclassical economics as that inventor. I know very smart people poo-poo neoclassical economics, but some very swart people swear by it. That leaves us pretty much nowhere, but I bring it up to carve out some rhetorical space that hopefully you won't be able to dismiss out of hand based on the origin of the concept (and I'm not using the concept as a knock-down argument, the tone of your original post to me in this thread not withstanding).

On to more direct talk of innovation, I said in my post most recent to this one, that I think innovation means that better/more effective treatments/drugs/technologies are produced. I don't think it needs to be said, but it would follow that treatment of disease (for those who have access to care) would improve over that time. Of course, there may be a lag, with treatment pulling up the rear, but the idea is that if

I think before I can take arguments seriously that the currently proposed health care reforms, or some other health care reform, will or will not hurt medical innovation, I will need to see some data showing what percentage of patents (or some other metric) private financing is responsible for. I imagine it would be tough to figure out who has majority responsibility for alot of things, but I would be interested in seeing a study that made the attempt.

Quoting Jay J: ...Brink Lindsey's point was not that what's important about innovation is that U.S. drug companies are more innovative, his point was that the U.S. market, being what it is - large and *relatively* unregulated - is the driver behind pharmaceutical innovation (therefore IF U.S. drug companies are on average more innovative, it would have to be because of their location in, or increased access to, the U.S. market, but the fact that they're American companies would be incidental).

Reading over the replies I am surprised that no one pointed out that the reason we over-pay for drugs in the US compared to other countries (and thereby pad the profits and R&D budgets for pharmaceutical corporations around the world) is not a relative lack of regulations. It is because of our patent regulations that we pass along the costs of R&D disproportionately to our nation's sick and injured. It seems to undermine the authenticity of the convictions of free market conservatives when they argue for regulation that benefits businesses under the auspice that the regulation is for the common good (i.e. it benefits future generations through R&D). I thought free marketers were supposed to be more

look writes...[...] Brink is excessively agreeable. Given the unemployment numbers; a scowl and a can of beans would have made better props. Or perhaps cat food. Meow!

I've read different numbers about private/public split of medical research in the states. It seems to be about 70/30.

However that number doesn't tell the whole story. From what I've read and it follows intuitively that the amount of private vs public research depends greatly on the nature of the disease. Things like allergies, blood pressure, and erectile dysfunction get a majority of their funding from private research because the big markets make the eventual return on investment more attractive. For things that are more esoteric, complex, and have smaller markets tend to be funded almost exclusively by the public, for instance organ transplants and low-prevalence or especially deadly varieties cancer.

Setting aside the fumfering of course.

The Hayek bit they were talking about:

Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong…

…Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken.

Friedrich Hayek, The Road To Serfdom (Chapter 9)

Hey, I wrote something similar recently!

Quoting claymisher: The genius of social insurance is that you can indemnify people against risks they can't avoid and over which they have (almost) no control.

(That's what you get for stealing from a thief.)

Nice of Josh Cohen to bring up the progressive health care talking point/narrative of the US awful Infant Mortality and Life Expectancy.
A narrative that does not address the following
The US has more Minorities which have a higher Infant Mortality rate and shorter Life Expectancy.
The US US tries to save low-birthweight babies rather than label them unsalvageable. It would be nicer if Brink had called him on it.

Quoting messwithtexas: Reading over the replies I am surprised that no one pointed out that the reason we over-pay for drugs in the US compared to other countries (and thereby pad the profits and R&D budgets for pharmaceutical corporations around the world) is not a relative lack of regulations. It is because of our patent regulations that we pass along the costs of R&D disproportionately to our nation's sick and injured.

Interesting point. Something I'd like to see (but would likely be waaay too boring for any real human) is a diavlog about commercial patents and intellectual property policy.

Quoting Stapler Malone: Interesting point. Something I'd like to see (but would likely be waaay too boring for any real human) is a diavlog about commercial patents and intellectual property policy.

I disagree - that would be an extremely interesting topic, and I'd gladly watch.

Quoting AemJeff: I disagree - that would be an extremely interesting topic, and I'd gladly watch.

me too

Quoting AemJeff: What I'm trying to say is that the argument is being treated as if it has more heft than I think it deserves. It is a "'synthetic, a priori' statement with empirical implications." I don't think it should be excluded from a serious discussion on the merits of policy choices; but, its status within such a discussion ought to be related to its strength as an argument. Even if we assume the effect exists, we have no way to reliably quantify it or compare it to the benefits of policy ideas that might adversely affect it. I fail to see how Brink or anybody else shows that this is a particularly compelling argument.

Broad, abstract nouns like "innovation" can be read to mean any damn thing somebody wants to read into them. Microsoft's use of the term was particularly bad because the real world implication of that language was the opposite of the sense of it that they wanted to convey. In that particular case there's a strong argument that the direct result of Microsoft's near monopoly status as a software developer was a significant reduction in

Quoting Jay J: Umm, first, I guess I'll say, I'm not sure who has the burden of proof.

I think the person who makes a claim that there would be a particular, especially non-intuitive, effect has the burden of proof, although there is some general requirement that someone supporting a change consider possible bad effects, of course. Or that's how I think of it; obviously, there are no actual rules.

I think the argument is that because of the size and relatively unregulated nature of the U.S. market, it is more profitable for drug companies to sell to, or develop in the U.S. market compared to smaller and/or relatively more regulated markets.

How would one support this claim? I see a lot of speculation along those lines (from, say, Megan McArtle, etc.), but not the evidence that it is based on or often even the specific link. [Edit: I responded to this before reading the subsequent posts, and I do think the one link that Preppy mentions and that McArtle apparently made in one diavlog sounds more compelling than the more general claim.] We had a discussion here about the profitability/use of drug company funds, and I pulled some numbers from Pfizer's 10-K, and one thing that I recall is that the profits reported came slightly more from outside the US than in the US. Given what we hear about the much greater profitability of drug sales in the US (because of higher prices), I thought

No, that would be an awesome diavlog (If done right). I was actually thinking about trying to get a job at the USPTO (Examiner) after graduating for awhile, but was told I would be pretty low on the food chain(IF even accepted), and have a hard time advancing without any graduate degrees.

Quoting sirfith: A narrative that does not address the following
The US has more Minorities which have a higher Infant Mortality rate and shorter Life Expectancy.

It would be nicer if Brink had called him on it.

Brink's not a racist, though. he understands that the better way to describe populations who have higher infant mortality rates and shorter life expectancy than average is: populations with poor health care. And he further realizes the circularity of arguing that the only reason the U.S. has high infant mortality and low life expectancy, despite its great wealth, is because it offers poor health care. Oh well! Thanks for the argument from circularity and racism!

Quoting Ray: ...

Oh well! Thanks for the argument from circularity and racism!

Heh.

Fine, I should have been more careful, the kind of regulation in question makes a difference. Price controls, like they have in Canada, would be a kind of regulation that, prima facie, would lower profits. In any case, it seems incidental, because the claim is that the higher profit motive here makes the U.S. market (and granted, whatever kind of regulation we have) the attractive place to do research and develop drugs/treatments/technologies. The opposite claim is that we can 1) give health care to everyone, 2) do it cheaper than what we have now, and 3) either that the bottom lines of health care developers will not be hurt, thereby not hurting development, or that the government can simply step in and fill the research/development gap. The claim is not that we can do two out of three, and that would be better than what we have now, the claim is that we can do all three (without price controls, BTW). The claim is not that it's worth trying to do all 3, but acceptable if we can only get 2 (with universal care being the non-negotiable piece), it's that costs will be controlled, care will be universal, and the pace of

Stephanie, On the burden of proof, I think I expressed my doubt in perhaps a coy manner; both sides seem to be making claims, so arguments which shift the burden hard to one side or another don't seem to get us anywhere. Of course, it's all fine and good to be agnostic or ambivalent, but not only are there no actual rules, but both the left and the right have positions, so they both bear the burden of proof insofar as they're making claims (It seems appropriate to rake them both across the coals accordingly. I usually find philosophical arguments against universal care, coming from the right, to be completely bogus; it's when we get into the nitty gritty that my skepticism is turned slightly toward the left). As for what constitutes an argument, I think we must have very different ideas about that. The conclusion is that there is good reason to fear that innovation (improvement/development) of drugs/treatments/technologies will be harmed (the pace will slow significantly). The fact that the premises used to support this conclusion are unproven or here unquantified does not mean they do not form part of an

Quoting jcohen57: well, the rug very nicely covers the coffee and dogshit stains....

and the elegant black shirt....well, it is a maroon waffle shirt....good for california 8AM (pre-breakfast, not postmodern)...

Heh. Thanks, Josh.

Meow.

For two weeks work. Gitmo? Open. Torture prosecutions? Forget'em. Transparency? Next topic. US troops out of Iraq? US troops into Afghanistan. Targeted assassinations? On. Renditions? On. Just showing-up and not being Bush carries a lot of weight in some circles. If he had an once of integrity he'd turn it down. I mean. Would mean so much more to be renominated and win it again next year. Meow!

Quoting kidneystones: Just showing-up and not being Bush carries a lot of weight in some circles.

You seem to have forgotten about the beer summit.

If you like sucking on bubbles, this summit's for you. Remind me: national holiday; statue, or both? I still say Acorn should turn down the peace prize at least once.

Quoting kidneystones: If you like sucking on bubbles, this summit's for you.

Remind me: national holiday; statue, or both?

I still say Acorn should turn down the peace prize at least once.

Well, I hope we wait a bit before putting O's picture on the currency. Would it be rude to point out that the average Physics Nobel is awarded 20 years after the work is done?

Get you branded a 'racist' in some circles. Why can't you just clap with the crowd, Simon. Acorn is moving hearts and mountains (of cash, that is, to cronies). A national park? (I mean just for the Gates summit). And how do you know the physics prize, isn't next?

Quoting Ray: Brink's not a racist, though. he understands that the better way to describe populations who have higher infant mortality rates and shorter life expectancy than average is: populations with poor health care.

And he further realizes the circularity of arguing that the only reason the U.S. has high infant mortality and low life expectancy, despite its great wealth, is because it offers poor health care.

Oh well! Thanks for the argument from circularity and racism!

What I been hearing from progressives/Democrats that the US Healthcare system was poor for every one except the very rich and powerful. So how to you explain the longer life expectancy for whites and Asians in general? The rich ones (%1-2) are living so long that they drive the life expectancy number up? How do you explain that regardless of socio-economic status Black women are more likely to have a Premature Baby?

Keep up the racebaiting.

[quote=johnshaplin;132793[I]"The intrinsic costs of providing insurance are relatively low. There are no expensive inputs to purchase, no uncertainty of design or technology to be concerned with. The major inputs are personnel and computing capacity." [/i] Please help me understand this. So the intrinsic costs of providing insurance do not include the paying of claims? "Public universal health insurance schemes like Medicare do not evaluate risk. Since they are universal, they do not need to. Therefore, they save the major cost of providing private health care insurance." Here Gailbrath is saying that it is the evaluation of risk that is the major cost.
Does this mean that underwriting is the major cost? It would seem the major cost is paying claims. What about the fact that covering everybody for everything is expensive? "They pay their personnel at civil service salary scales and are under no obligation to return a dividend to shareholders or meet a target rate of return. Insurance in general is therefore intrinsically a service that the public sector can competantly provide at lower cost than the private sector, " I'm not sure this follows. Civil service pay is

Quoting sirfith: ...
Keep up the racebaiting.

"Racebaiting" is a word invented by racists. Its purpose is to turn a conversation away from the offensive things the racist has said and make issue of pointing out the offensiveness. Nice trick. It's been overplayed.

Quoting messwithtexas: Reading over the replies I am surprised that no one pointed out that the reason we over-pay for drugs in the US compared to other countries (and thereby pad the profits and R&D budgets for pharmaceutical corporations around the world) is not a relative lack of regulations. It is because of our patent regulations that we pass along the costs of R&D disproportionately to our nation's sick and injured. It seems to undermine the authenticity of the convictions of free market conservatives when they argue for regulation that benefits businesses under the auspice that the regulation is for the common good (i.e. it benefits future generations through R&D). I thought free marketers were supposed to be more concerned about free markets than the common good? I think the real underlying motivation for many free marketers is profit, not liberty, and this is a candid example of that.

I thought the big reason drugs cost more in the US than in other countries is that those other countries simply won't pay the freight of R&D. Pharma would rather sell some pills than not, so they shift all the cost to

Quoting sirfith: Nice of Josh Cohen to bring up the progressive health care talking point/narrative of the US awful Infant Mortality and Life Expectancy.
A narrative that does not address the following
The US has more Minorities which have a higher Infant Mortality rate and shorter Life Expectancy.
The US US tries to save low-birthweight babies rather than label them unsalvageable.

It would be nicer if Brink had called him on it.

There are so many factors involved in statistics. You are bringing up a couple of them which may make a difference. To call your comment racist is ridiculous. We sure as hell don't want anyone to be thinking past the rhetoric, so we'll just label them racist and they'll go away. Hopefully.

Quoting kidneystones: And how do you know the physics prize, isn't next?

You have a point. Nobel Prize for Physics: Barack Obama, for the grand unification of the forces of Hope, Progressivism and old-fashioned Chicago-style politics. Nobel Prize for Chemistry: Barack Obama for the use of an alcohol reagent to suppress reactions between police and black intellectuals. Nobel Prize for Medicine: Barack Obama for bringing health care to all. Nobel Prize for Economics: Barack Obama for dealing with the Bush financial meltdown. Nobel Prize for Literature: Barack Obama for "Dreams of my Father" Nobel Peace Prize: Barack Obama for... I'm still working on this one.

Scooooooooooooooooooooooooooooorrrrrrrrrrrrrrrrre!

Quoting Simon Willard: You have a point.

Nobel Prize for Physics: Barack Obama, for the grand unification of the forces of Hope, Progressivism and old-fashioned Chicago-style politics.

Nobel Prize for Chemistry: Barack Obama for the use of an alcohol reagent to suppress reactions between police and black intellectuals.

Nobel Prize for Medicine: Barack Obama for bringing health care to all.

Nobel Prize for Economics: Barack Obama for dealing with the Bush financial meltdown.

Nobel Prize for Literature: Barack Obama for "Dreams of my Father"

Nobel Peace Prize: Barack Obama for... I'm still working on this one.

LMAO. Well played.

Quoting Jay J: On the burden of proof, I think I expressed my doubt in perhaps a coy manner; both sides seem to be making claims, so arguments which shift the burden hard to one side or another don't seem to get us anywhere.

I don't entirely disagree, especially because I usually find debates about who has some supposed burden of proof based on some agreed rules of discourse or something tiresome. I think the better way of putting it is if you raise an argument as a reason not to do something, there should be something behind that argument more than "this might happen" or "this is a fear I have" -- evidence or a logical explanation of how it is likely to come about or some such. On the other hand, like I said before, if you want to make a change you should consider the likely effects and be willing to discuss why you don't think it will cause bad outcomes (or address what you would do if they do result).

As for what constitutes an argument, I think we must have very different ideas about that.

Maybe -- present the argument and I'll tell

Without trying to step between you and Jay on this, I want to be sure I've been clear on my original point. My concern about "burden of proof" isn't based on an understanding of any set of formal rules of discourse. The point that concerns me is filtering. Obviously, if you have to answer every single argument, regardless of how well reasoned, or well supported it is, then it's impossible to have any sort of meaningful public debate. Just because somebody asserts X, X doesn't automatically become a useful part of the discussion. Some argument about why X is important has also to have been provided, and a positive judgment on the quality of that argument has t have been agreed upon, before answering X becomes a useful component of the argument. My position here is that the case hasn't been made in regard to the relationship between innovation in pharma R&D and US market conditions (however intuitively true that might seem); and, as such, it doesn't fall upon people arguing that US market conditions ought to be regulated differently to answer objections raised on that basis.

Quoting stephanie: I don't entirely disagree, especially because I usually find debates about who

That's really the news. Anyway, Dickerson, agrees: the upside of turning down the prize this year is enormous. He can't possibly resist another chance to stand in the spotlight, however, even if it's clear nobody deserves any reward for two weeks work.

Quoting AemJeff: Without trying to step between you and Jay on this, I want to be sure I've been clear on my original point. My concern about "burden of proof" isn't based on an understanding of any set of formal rules of discourse. The point that concerns me is filtering. Obviously, if you have to answer every single argument, regardless of how well reasoned, or well supported it is, then it's impossible to have any sort of meaningful public debate. Just because somebody asserts X, X doesn't automatically become a useful part of the discussion. Some argument about why X is important has also to have been provided, and a positive judgment on the quality of that argument has t have been agreed upon, before answering X becomes a useful component of the argument.

I wouldn't refer to that as "burden of proof," but it actually sounds pretty similar to what I'm saying, so I guess I'm agreeing with you.

Quoting stephanie: I wouldn't refer to that as "burden of proof," but it actually sounds pretty similar to what I'm saying, so I guess I'm agreeing with you.

Yeah, it might not have been the ideal choice of phrasing.

what is the difference between the health insurance industry and the health care industry?? what does "public option" mean? are there different flavors?? what does"single payer" mean? what is the sound of one hand slapping??

Quoting Uhurusasa: what is the difference between the health insurance industry and the health care industry??

Health care also includes doctors and hospitals--ie the providers.

Quoting Uhurusasa: what does "public option" mean? are there different flavors??

Means an insurer that is run by the state as a nonprofit. There are a few variations/questions to be answered:
-you can have a pub-op that has access to tax payer subsidies and can probably run private insurers out of some markets or one that doesn't have any access to taxpayer subsidies and operates more or less like a private nonprofit -you can have a public option that's available in all 50 states, or one that can only enter particular states which have 'opted' in to allow it, OR one that is in available in all 50 states unless states 'opt-out'

Quoting Uhurusasa: what does"single payer" mean?

A system where there is just one national insurance agency managed by the state that provides for all citizens.

Quoting Uhurusasa: what is the sound of one hand slapping??

Try this.

thanks, for your reply, it has helped me refine my original questions. A. Insurance:
A means of indemnity against a future occurrence of an uncertain event; The business of providing insurance; Metaphoric: Any attempt to anticipate an unfavorable event; Blackjack: A bet made after the deal, which pays off if the dealer has blackjack; An insurance policy
en.wiktionary.org/wiki/insurance An indemnity is a sum paid by A to B by way of compensation for a particular loss suffered by B. The indemnifying party (A) may or may not be responsible for the loss suffered by the indemnified party (B). Forms of indemnity include cash payments, repairs, replacement, and reinstatement.
http://en.wikipedia.org/wiki/Indemnity B. Health Care:
Health care (often healthcare in British English), is the treatment and management of illnesses of the elderly, and the preservation of health through services offered by the medical, dental, complementary and alternative medicine, pharmaceutical, clinical sciences (in vitro diagnostics), nursing, and allied health professions. Health care embraces all the goods and services designed to promote health, including “preventive, curative and palliative interventions, whether directed to individuals or to populations”.[1] The definition of health care is continously evolving, and varies significantly between different cultures.[2]
http://en.wikipedia.org/wiki/Health_care considering A. (Insurance) and B. (Health Care) as separate entities, how do we(the royal we) structure the optimal relationship between A and B? in other words, to

Quoting Uhurusasa: considering A. (Insurance) and B. (Health Care) as separate entities, how do we(the royal we) structure the optimal relationship between A and B? in other words, to get the best B.(for everyone) what would A. look like?

I am of the opinion that the key elements here are to spread the risk of illness (and therefore the cost of A) across as wide a pool as possible to have a risk level that is as close to the average in the population as possible and therefore the lowest cost possible. Therefore I favor (in this order) the following possible options for the structure of this relationship: 1. a federal no-interstate-barriers insurance exchange with mandatory individual purchase (and true fines on the mandate) and heavy subsidies--this would be something akin to the Wyden-Bennett bill, and also to the system currently employed in the Netherlands and Switzerland 2. single payer, as in a single state-sponsored entity that is the insurer for all, where the 'premiums' paid in are taxes--this would be the system currently in place in France I do not favor (3.) mixes of these two nor do I favor (4.) direct state-provided care.

Quoting Uhurusasa: what is the relationship between the quality of B. and

thank you! well said, i'll take your thoughts into consideration!!