Politics Discussion Thread (Heated Arguing Warning)

[Mr. Cairo]

4) There've been nazis in the USA for almost a century, they've accomplished less than nothing, and are set to still be insignificant for the next century even despite minor reprises of Street Fighter: Commies v Nazis.

I really hope that the next couple of years proves you right.

[Krill]

And the thread comes full circle .

Darrell

I don't get it.

[Mardoc]

Not sure from your first sentence whether you are pro-Patent or anti? Patents serve to protect a company's IP theoretically so they can recoup the investment they made in R&D. Pricing during the patented period is generally "what the market can bear" not "what the average consumer can afford". There are many examples of companies hiking drug prices if they think they can get away with it.

Patents are probably a necessary evil.  I can't think of any better way to motivate research; the fact that a patents' value in cash is proportional to its value is hard to replicate with any other system.  But they certainly do cause a lot of harm during the monopoly phase.

Also on patents, it's not like pharma companies sit still and let them expire; there are many ways they can try to get around it. The latest attempt to completely circumvent is to transfer to a Native American tribe (sovereign entity) not subject to the Patent laws:

That seems pretty ridiculous.  But, well, it looks like Congress made the mess, so Congress should be able to fix it.  That story suggests that the drugs might still lose patent protection despite the clever legal manuever, or at worst case they gain seven years.  From what I read elsewhere, they only intended the exception to apply to state-run universities and it was clever lawyers who realized that Indian tribes might also fit the law as written.

Anyway, I won't claim that literally everything gets better all the time, but most things get better most of the time.  One drug might stay on patent, but apparently 22 came off patent this year: http://medcitynews.com/2017/01/infograph...ring-2017/
In addition to probably another 20ish being invented/approved, bringing their price from infinity to merely very high.

Being English, I don't pretend to understand Jim Crow, but I think that the assertion that white southerners would have rushed towards integration without them is disingenuous.

It would have been a typical logistic curve, just like integration in the North without the laws.  Well, probably a bit slower, due to the starting point - but don't underestimate historic Northern racism.  Very slow at first, as only weirdly principled or desperate people break the taboo, but speeding up as it became normalized, with only a few irrelevant holdouts at the end.  But the process must have started already, or they wouldn't have bothered with the laws.

Do you want stories of the friends, family & colleagues who lost everything last month; it's not just a case of rebuilding the house, it's losing all your personal possessions - memories? Here's one about the friend of a colleague whose home was flooded in the Tax Day flood last year and had to be completely rebuilt; he was due to collect the keys the week after the storm came through, but it had flooded again....

Most of Houston isn't required to have flood insurance, but that doesn't matter because the government will come along and bail them out. And not the State government (who might have to then take some responsibility) but the Federal government. So all the local Republicans can continue to be happily anti-regulation and not make any attempt to fix the problem (instead spending their time trying to enact discriminatory legislation and ban local city tree ordinances) and rely on the Feds to bail them out. Oh, and they also get to create specious arguments for voting against bailouts for other states' disasters, as Ted Cruz did after Hurricane Sandy.

If they can tell you stories, they didn't lose everything.  They've still got their lives, still got any financial assets, still apparently have their jobs and their health.  Still have their memories, unless they picked up amnesia.  Loss of photos should basically not happen these days, since you can put them all in a single flash drive in a ziploc in your pocket if you don't have them on the cloud.

I won't claim it's a good thing, but have a little perspective here.  They're certainly better off than a new immigrant.

Sure, we ought to handle flood insurance better, but a ban on floodplains is the bluntest instrument possible (and easiest to mess up).  Would be much better to have true risk-based insurance, which would affect house prices and decisions - or to alter building codes in flood prone areas (or buildings rebuilt with flood insurance money), so that ground floors were built from water-resistant materials like concrete or stilts - or to simply let people take the consequences of their decisions with a safety net to prevent absolute poverty, like we do with 101 other types of risk.

[Chevalier Mal Fet]

I want to avoid jumping into this (arguing with strangers on the Internet about politics I have learned is one of the largest possible wastes of time in this all-too-brief human life...which makes me question why I found it intriguing enough to read the last couple pages), but I think it's worth noting that most of the news stories about the flooding in Houston I've seen mention that the area is built on tough, rocky soil that isn't great at absorbing water anyway. Plus, the city has a modern, well-thought out drainage system, but growth is outpacing it as everyone rushes into Houston to get a piece of the good life (4th largest city in America, and I believe the fastest-growing). Even then, it still wouldn't have been an issue but for the fact that Harvey parked itself on top of the city for a week. No city in the world has a flood control system prepared to deal with that. Sauce for all that

Anyway, I'll let you resume your regularly scheduled pounding of each other (Mardoc, it's extremely heartening to see how civil and calm you're able to remain in the face of some rather heated insults. You do your side credit).

[Dreylin]

Anyway, I won't claim that literally everything gets better all the time, but most things get better most of the time.

I don't think we're going to change each other's opinions on this, but it has been an interesting discussion.

If they can tell you stories, they didn't lose everything.  They've still got their lives, still got any financial assets, still apparently have their jobs and their health.  Still have their memories, unless they picked up amnesia.  Loss of photos should basically not happen these days, since you can put them all in a single flash drive in a ziploc in your pocket if you don't have them on the cloud.

You're right, I didn't know any of the people who died in the floods. And as for jobs and health, there are many others who have lost those as well - businesses & hospitals flooded as well and the disruption to everything has not been insignificant.

I won't claim it's a good thing, but have a little perspective here.  They're certainly better off than a new immigrant.

I'm not sure what immigrants have to do with this? I'm an immigrant and I didn't lose anything to move to the US.

or to simply let people take the consequences of their decisions with a safety net to prevent absolute poverty, like we do with 101 other types of risk.

I think your opinion of the abilities of safety nets to prevent absolute poverty are higher than mine; when someone can go bankrupt paying for medical treatment - even with insurance - then something's not right.

[Dreylin]

I want to avoid jumping into this (arguing with strangers on the Internet about politics I have learned is one of the largest possible wastes of time in this all-too-brief human life...which makes me question why I found it intriguing enough to read the last couple pages), but I think it's worth noting that most of the news stories about the flooding in Houston I've seen mention that the area is built on tough, rocky soil that isn't great at absorbing water anyway. Plus, the city has a modern, well-thought out drainage system, but growth is outpacing it as everyone rushes into Houston to get a piece of the good life (4th largest city in America, and I believe the fastest-growing). Even then, it still wouldn't have been an issue but for the fact that Harvey parked itself on top of the city for a week. No city in the world has a flood control system prepared to deal with that. Sauce for all that

Broadly correct, yes. Generally the center of the city is better planned to cope with water, but the suburbs are less so. In several areas the rainfall was not the issue, but the back-up was threatening to overflow the reservoirs and several controlled releases resulted in additional flooded neighbourhoods. That was about sheer volume, but I've been here 4years this time and we've had 3 major flooding events during that period - the others not as bad as Harvey, but still.

[Mardoc]

I think your opinion of the abilities of safety nets to prevent absolute poverty are higher than mine; when someone can go bankrupt paying for medical treatment - even with insurance - then something's not right.

Well, I mostly agree. But usually when this happens, it's because if you got the same illness 20 years ago, you'd be dead. Old medicine is mostly cheap. I would like reforms, but not if that means sacrificing medical research. There's too far left to go.

The most frustrating part of the entire US healthcare debate to me is that all the focus is on payment, and virtually none of it is on reducing cost through market reforms. We could be expanding doctor training programs, nurse training programs, getting rid of 'certificate of need's for hospitals, and otherwise unleashing the private sector to fix the problem. We could relax the restrictions on who's allowed to do what, and how much education they need, just a little bit on the margins. We could automate large portions of the job to improve productivity, and unleash competition, and...instead we just argue about who has to pay the bill. Just about everywhere I look, I see inefficiencies that are defended as 'that's the way we've always done it, you don't want to risk safety, do you?' When really they're there because they increase someone's salary.

Pharmaceuticals are a small share and only the latest stuff is expensive, but there's still room to work there too. Perhaps we could modify the patent laws to allow a company to trade extra time on patent for a price cap. We could certainly revise Good Manufacturing Practice laws to put the focus on sampling and analysis of the final product, instead of putting it on 'did you fill out the paperwork that says you made this batch the same way you made the last batch'. Although manufacturing is a negligible fraction of most drug costs, it's the part I know about and it drives me up a wall that engineers aren't allowed to help reduce costs.

Similarly with most medical equipment. The basic regulatory philosophy is that nobody knows anything about why medicine works, so you can't change anything without running a double blind thousand-person in-patient study. Which in practice means you can't change anything, because a study is too expensive.

I'm not sure what immigrants have to do with this? I'm an immigrant and I didn't lose anything to move to the US.

You lost your house when you moved. By definition. On purpose. Which is the same thing that 95% of flood victims lost. Admittedly, you lost your house on your own planned schedule.

My point is that Houston is such a strong economic center, that produces so much wealth for so many varied people, that I don't want to sacrifice it to comply with one size fits all floodplains restrictions. If I were to move to Houston, I expect I would be getting around a 20K raise, in addition to being able to buy a similar house for 100K less. That will pay for a lot of flood rebuilding and still come out ahead. I won't be, but that's for non-flood reasons.

[AdrienIer]

Similarly with most medical equipment.  The basic regulatory philosophy is that nobody knows anything about why medicine works, so you can't change anything without running a double blind thousand-person in-patient study.  Which in practice means you can't change anything, because a study is too expensive.

Without said double blind study scams become a million times more likely to succeed. Because, once again, companies don't really care about you getting better, they only care about making money and if possible making money in the short term.

The system is built on the fact that doctors trust the medicine they prescribe. When a new drug comes out that cures a certain illness they know it's been tested and that the new cure works. If there are no regulations on new stuff being put out on the market the doctors will have to make their own research to see if it works, but they don't have the time to do that. So they'll be stuck between possibly missing out on a new better treatment or possibly killing their patient because the new medicine might not work.

And as a patient, do you want to be treated with a drug that has been proved by rigorous studies that it works better than its alternatives or by what Joe at the bar cooks up in his basement ?

Long story short, because companies don't care for the common good (nor for your good) but only for their financial well being they can't be blindly trusted when it comes to public good areas like healthcare.

[Dreylin]

The most frustrating part of the entire US healthcare debate to me is that all the focus is on payment, and virtually none of it is on reducing cost through market reforms.

Agreed, but while Republican politicians keep the focus on the Affordable Care Act, there won't be meaningful debate on the real issues.

You lost your house when you moved.  By definition.  On purpose.  Which is the same thing that 95% of flood victims lost.  Admittedly, you lost your house on your own planned schedule.

I sold my house. It was planned in advance and at market value so I did not have to rush through paperwork, and I realised the full market value of the property. I did not lose any of my possessions in the move, what I did not bring with me were sold or donated before I left. I planned ahead for where to live when I arrived, I did not have to scramble to find temporary housing, or stay on the couch of family or friends.

It's a false equivalency, and not one I would dare to make to anyone who had just lost their home.

[Mardoc]

When a new drug comes out that cures a certain illness they know it's been tested and that the new cure works. If there are no regulations on new stuff being put out on the market the doctors will have to make their own research to see if it works, but they don't have the time to do that.

I'm not talking about new drugs here.  We don't know biology well enough yet, and I agree that most doctors are not smart or well trained enough to judge.  Nor do I even object in principle to the FDA.  I object to the way the FDA regulates.

I'm talking about new ways of making the old drugs.  We should define a drug by a certain chemical formula, crystal structure, excipient, and purity.  Maybe define some standard laboratory tests as well, which it needs to pass, to mimic blood-absorption rates or whatever else I'm overlooking, having gone into a field where I'm allowed to use my knowledge to reduce costs.  Instead we define it by 'went through these manufacturing steps'.  Basically we assume that chemistry is not a field of knowledge, that medicine is magic and only by waving the magic wand in the exact same manner as before can we treat people.

Similarly, we should define a respirator by airflow rates, pressures, failsafes, controls, that sort of thing.  Instead we define it by 'went through these manufacturing steps'.  Assuming that mechanical engineering and physics is not a thing, instead we can only treat people by waving the magic wand in the exact same manner as before.

When the FDA inspects a pharmaceutical plant, the most important thing they want to see is the documentation.  I think they ought to be running independent tests on the drugs' purity and chemical makeup, randomly grabbing samples as they leave the factory, instead of scheduling visits to see the documents.  Who cares what the manufacturer is doing inside the factory?  Check that the pills are good instead!

It's why a bag of saline solution costs $10/bag for 'medical-grade' while a sterile food-grade salt solution with flavor and coloring added, like Gatorade, costs $0.50.  It's why a 'cheap' generic medicine will cost you $4/ 30 day supply (maybe 10 grams) while other specialty chemicals are lucky if they can sell for $4/kg (edit, ok, $40/kg. Still a huge difference).  There are probably millions of similar examples.  No single one will solve the medical cost problem, but we could knock off a huge amount of the cost if we applied the knowledge from science and technology instead of blindly always repeating what we did yesterday.