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Delle Eve's avatar

I missed you! Welcome back to the land of the public-facing! That was going to be all, but instead:

13. This was surreal commentary to me, because I used to work in health insurance where EVERYONE knows healthcare is scarce, and instead has ideological or pragmatic disagreements about which parts SHOULD be scarce (million dollar gene therapy? drugs that are technically approved but don't really work? convenience drugs that don't technically work better than taking the two meds separately except that they improve adherence by improving convenience? how much do you need to improve adherence before it's worth it?) or how to make parts that are supply-side scarce (rather than unaffordable on the demand side) like rural specialist access less scarce (okay, actually there's an aside to be had there about insurance networks that make all the "preferred" providers with preferential pricing be providers who are in urban areas, so if you have members of the plan who live rurally, well, too bad for them).

There is, yes, also the issue of the inability to discover whether a treatment for your condition exists at any price (I like IncitefulMed as a first pass search, but that's not a solution, just a search engine better than most; OpenEvidence will do too, and is still not a solution, just a tool), and the separate issue of trying to determine what the treatment costs, which there is an entire industry of band-aid solutions for that DO NOT SOLVE THE PROBLEM, which really just tells you how Byzantine the problem is. But I'm skeptical of the idea that unwillingness to admit to scarcity is a root cause of problems with healthcare policy in the US, just because policymakers and insurers explicitly argue about what should be scarce in healthcare and entirely the patient's responsibility to pay for, all the time.

(I'm less sure about other developed countries, but Singapore presents scarcity of total $$ relative to the rising cost of the package of care the government thinks of as normal AS the problem--or rather, American studies of Singaporean healthcare suggest that Singaporean policymakers believe so; take with the usual grains of salt.)

You can claim that the general public refuses to acknowledge scarcity and thinks everything should be paid for, maybe, (I'm not talking about socialized medicine as a concept; I'm talking about what's on the formulary/billing code book of reimbursed medicine, socialized or commercial) but I'm not convinced that has any impact on policy, especially compared to a lobby group like say the AMA, AHIP, or PhRMA.

20. You're probably already reading it because of the social circle you're in, but I strongly recommend Ada Palmer's Inventing the Renaissance if you like history books that are an opinionated girl telling entertaining stories about interesting individuals, and of course, the Italian Renaissance.

11. "why should our ingroup be any different, just because we’re also objectively correct?" - I literally laughed out loud, and since you could not see this, I felt I should interact socially by telling you so. I too am from a port city and grew up in the highly international culture that is natural sciences academia. You would think that hearing so many people speak English as a second language and being delighted to hear about where they came from would make me less afraid to interact in languages that I only kind of speak, but alas, it does not.

PS: Your baby is cute!

The Run to Mars's avatar

Really glad you published this. The premise and the form is inspiring. Makes me wanna shake off the rust and write again, too. Also, Bruce is a boss name.

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