No doubt, but as I see it, this discussion is about whether the argument against the proposed reforms is a bad faith argument or a glib argument, not whether it’s a convincing argument to one who begins with a different set of assumptions.

The key here is the tradeoff issue, though. If one accepts that there are tradeoffs that go beyond taking money out of the pockets of opponents of reform, then how those tradeoffs get valued turns into a very subjective thing.

Surely there is a reason that the patents are developed here and not there, no?

When here becomes very much like there, why is it not fair to wonder if innovation will follow suit?

The point is that there are tradeoffs in any reform. No system is perfect, obviously, but it is foolhardy to think that there are no tradeoffs involved in reform, and particularly the reforms under discussion. Our system may well fail to provide access to adequate health care for a large number of people, but it also seems to do a pretty good job of providing for increasingly high quality of health care for the overwhelming majority of people. Indeed, one could say that the quality of health care that we deemed “adequate” 30 or 40 years ago would be deemed unacceptably poor today. To the extent that the US provides a majority of the world’s medical innovation, it is also appropriate to ask whether increasing standards of health care in other countries is at least in part dependent on innovation that comes from the US.

One could even argue that, although it is sad that many people lack access to health insurance, those people still have access to a level of care to which only the wealthiest people in the not-so-distant past had access – if anyone had access to it at all (because that level of care did not exist).

Personally, I think that the innovation tradeoff under the proposed legislation is relatively small (although I think the overall tradeoffs far exceed what in my opinion will be a very minimal benefit from the proposed legislation), particularly because I think advocates of this position overestimate the extent to which our existing system is subject to market forces, while underestimating the extent to which other systems are subject to market forces (and to be fair, I think both sides of the health care debate do this, because it is consistent with both sides’ ideological biases). However, there are plenty of good-faith reasons to believe that the tradeoff in innovation is quite large if you begin with the assumption that the major difference between the US system and other systems is the degree to which they are subject to market forces.

Me:

Yes, there are definitely tradeoffs to making changes to our current system. No argument there. But Jaybird hasn’t said anything that convinces me that the tradeoff will be a drastic drop off in medical innvoation, and that therefore we should keep the status quo. His arguments are vague, just what ifs and maybes. He hasn’t cited anything but his own suspicions and guesses, and not a single concrete fact.

I don’t begin with the assumption that the difference between the US and other countries is the degree to which they are subject to market forces. It could be that the U.S. has laws that prevents generics from hitting the market longer than similar laws elsewhere. It could be due to differences in tax policy. I really have no idea.

Mark:

Think about it this way: imagine having this debate in 1930. Would we have said that all the people who died of things like polio at that time died needlessly, even if they had access to the best health care available at that time? Presumably, the answer is “no,” we would not have. Yet we say that people who die without health insurance die needlessly today, even though they still have access to a far greater level of health care than was available to even the wealthiest persons in 1930.

Me:

People died of polio in 1930 because we didn’t know how to stop people from getting it, not because we knew how to stop it but denied vaccines to people because they had no insurance. Deaths from ailments for which we have treatments but withhold them from people because of money are needless. Death from things we haven’t figured out how to treat are tragic and unfortunate, but ultimately are unavoidable. Maybe I’m missing your point, but this thought experiment doesn’t follow for me.

Mark:

Now, even though I’m opposed to the leading Dem proposals, I’m personally an advocate of some fairly broad reforms (especially something like Wyden-Bennett), and I’ve said in the past that I even think a single-payer system would be at least a modest improvement over the existing system, even after factoring in the tradeoffs. But advocates of reform seem to do a poor job recognizing that the innovation argument against reform is a good-faith argument that involves more than just hypotheticals, but instead relies on the notion that improving quality of health care is a very real benefit of the existing system that has (and continues to) prevented many, many deaths that would have occured otherwise.

Me:

The argument about innovation relies entirely on hypotheticals! We don’t know what effect reform will have on innovation since we haven’t enacted the reforms yet.

You’re also assuming that the current health care system is the cause of innovations in drugs, tests, medical devices, etc. But how can that possibly be conclusively true?

We are not talking about laws changing how drug companies develop medicines or how tech companies build pacemakers. We’re talking about the feds giving subsidies for people to get health insurance. How, specifically, will that stop Pfizer or whoever it is from cranking out a new and better Viagra?

I can agree with you on one point: I’d be happiest of all with a single-payer system.

This is ludicrous. One of the bills provides subsidies for a family of four earning up to $88,000. If family X earns $87,999, are you really suggesting that they’re poor??

Bill Gates will not receive free health care under any plan being considered. He can buy his own insurance, or pay out-of-pocket entirely if he wishes. I can’t tell if this is just your sense of humor, or what, but really, you can’t possibly think that this is what is going on.

Oppose the various health care proposals all you want. But please, don’t make things up to support your position.

You can say that, no, we will also be providing health care to the upper middle class as well, and, indeed, we will… but the upper middle class has health care now (surely that’s one of the things that defines the upper middle class). Indeed, we will be providing health care to the rich! And the ultra-rich! Bill Gates will get free health care under this plan as well!

And if it turns out that he spends some of his own money and gets better health care than John Brodniak, we can ask how something like this could happen… how we could possibly live in the richest country in the world and not pay to save the life of someone like John Brodniak.

One could even argue that, although it is sad that many people lack access to health insurance, those people still have access to a level of care to which only the wealthiest people in the not-so-distant past had access – if anyone had access to it at all (because that level of care did not exist).

Personally, I think that the innovation tradeoff under the proposed legislation is relatively small (although I think the overall tradeoffs far exceed what in my opinion will be a very minimal benefit from the proposed legislation), particularly because I think advocates of this position overestimate the extent to which our existing system is subject to market forces, while underestimating the extent to which other systems are subject to market forces (and to be fair, I think both sides of the health care debate do this, because it is consistent with both sides’ ideological biases). However, there are plenty of good-faith reasons to believe that the tradeoff in innovation is quite large if you begin with the assumption that the major difference between the US system and other systems is the degree to which they are subject to market forces.

Think about it this way: imagine having this debate in 1930. Would we have said that all the people who died of things like polio at that time died needlessly, even if they had access to the best health care available at that time? Presumably, the answer is “no,” we would not have. Yet we say that people who die without health insurance die needlessly today, even though they still have access to a far greater level of health care than was available to even the wealthiest persons in 1930.

Now, even though I’m opposed to the leading Dem proposals, I’m personally an advocate of some fairly broad reforms (especially something like Wyden-Bennett), and I’ve said in the past that I even think a single-payer system would be at least a modest improvement over the existing system, even after factoring in the tradeoffs. But advocates of reform seem to do a poor job recognizing that the innovation argument against reform is a good-faith argument that involves more than just hypotheticals, but instead relies on the notion that improving quality of health care is a very real benefit of the existing system that has (and continues to) prevented many, many deaths that would have occured otherwise.

How about we call it “health care paid for with other peoples money for the poor”?

The bills in Congress are not “free health care for the poor.” The bills will offer subsidies to people who can’t currently buy health insurance. Plenty of middle class people can’t afford insurance. And again, we already provide free health care to the poor through Medicaid.

In the rest of your post, you’re pulling numbers out of thin air about how much R&D we should be doing or how much other countries are or aren’t doing and wondering whether health care reforms will slow us down. But you haven’t come up with a single, concrete fact about how much R&D is done here vs. elsewhere, and what relationship a country’s health care systems have on R&D in that country. If you are seriously prepared to say we should keep our health care system exactly as it is, even if people needlessly die because of it, you really should make a coherent, factual argument justifying it. Fretting about nebulous “good things that won’t happen” is not a strong argument for doing nothing, when we know that bad things happen right now because too many people fall through the cracks.

Lastly, and I don’t know why I’m even responding to this, but obviously I personally haven’t let anybody die. But I live in a society, and it’s of some concern to me when my fellow citizens suffer and die needlessly because we don’t have a reasonable health care system. I don’t know why this is an arguable point, but I guess that’s why I’m not a libertarian.

(I’m in the middle of writing a paper about what that would entail, actually…)