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Bad economics in a post titled "Why Free Market Healthcare is factually superior to alternatives" on r/AnCapCopyPasta
Allow importation of drugs and medical services/devices (huge Deal)I would like to begin by pointing out that the USA already imports drugs from a number of countries. The FDA has many overseas offices in nations like India and China to ensure drugs meet quality standards.
Allowing people to import drugs would have largely the same effects as implementing price controls (assuming it works). Unless other countries raise their payment rates to be more equitable with their wealth or magically decide to sign a treaty to solve this issue (unlikely, considering that the EU has been unable to deal with this in the past), we will see a massive loss in Research and Development, which would stall innovation in the sector. This is a problem that will be present with price controls as well, so it is one we will have to deal with sooner or later. I would provide solutions to the problem, but that is beyond the scope of this R1.
Again, all this hinges on the fact that importing drugs drastically reduces drug prices, but evidence isn't so cut and dry here. As this article puts it:
importation wouldn’t actually move us forward. It carries real harms. One such harm is system costs: repackaging, relabeling, testing, tracking of the supply chain and reporting to the federal government, which would have to review states’ reports. Even the study that Florida conducted on potential savings must have been very expensive. We’d be paying the overhead for both state and federal governmental oversight. Add to that the environmental costs of additional shipping, packaging, relabeling, etc.Importation would be a lot less efficient than price controls because of the extra costs we would have to pay (both pecuniary and non-pecuniary) to actually import the drugs into the United States. This additional cost would almost entirely be wastage, since none of it goes into the healthcare system to provide care for the people. Next, this article takes a deeper look into the costs of importing drugs, and finds that it would result in only 1-2% savings in cost and may expose the American people to safety risks such as counterfeit, adulterated, and substandard drugs. In fact, the Canadian government has stated that “Health Canada does not assure that products being sold to U.S. citizens are safe, effective, and of high quality, and does not intend to do so in the future”. Lastly, importing drugs may strain the origin nations market for drugs as well. Canada, for one, is already experiencing drug shortages, and don't have the supplies to sell to Americans.
The best method to combat high prices is to switch to the system of price controls employed by other countries, where the price they are willing to pay for drugs is based on their efficacy, which would address the high consumption under Medicare. As for the problem with Americans preferring branded drugs, there regulations on substitution that prevent pharmacists from substituting generics and lead to physicians writing no-substitute prescription far more frequently then they should. These regulations would have to go as well.
The last point I would like to make is that, ignoring the importation costs and safety risks, importing drugs only saves money because it takes advantage of foreign price controls, which is ironic, considering that the people who advocate for the importation of drugs tend to oppose price controls.
Allow competition across state lines for health insurance (Huge deal)This is marked as a huge deal, but most evidence points to the fact that it would do very little. At most, it would reduce variance in healthcare premiums across the nation, but not the overall cost, so some may benefit, but some will definitely lose. Now to the evidence, the Affordable Care Act allows states to form agreements with each other and five states already allow insurers to sell across state lines. However, no insurer actually takes advantage of this as of now. As this study puts it:
According to many insurance experts, the primary barrier for an insurer looking to enter a new market is not the state’s regulations, it’s the cost of building up a provider network at discounted prices.The massive cost of negotiating new networks deters insurers from expanding their plans beyond that of their state. Lastly, this study states that shows that regulation is only one of many drivers of high cost of health insurance, so it is clear that the free market will not be able to adequately address the cost.
End the practice where local hospitals can veto the establishment of new hospitals ( Called Certificates of public need)I agree 100%. There was actually a great post about it over on (Trigger warning for Bernie bros) neoliberal. However, there is evidence that repealing CON Laws may help by introducing new competitors into the market, it is doubtful that they will improve quality without first addressing physician scarcity.
The U.S produces by far the most new medical patents than any other country, and its statistics in this measure may actually be underrepresented because of American corporations relocating their headquarters to other countries in order to take advantage of the lower corporate tax rates there. So again here we see that the United States far and away leads the world in medical innovation. If a free market system were inferior, it would be hard to see how this would be the case.This one is funny because it is most definitely not the free market at work here. There is significant government intervention to ensure innovation through IP Law, which grants a company temporary monopoly over their drug, increasing profits. As I said before, legalizing drug imports (one of the free market solutions proposed) would end up destroying innovation in the US, so a free market would not be any better than a universal healthcare system. Lastly, I would like to address corporate taxation. While it is true that the USA used to have the highest corporate tax rate of any nation, the effective tax rate was on par with nations that have a much lower tax rate due to the massive amount of tax avoidance. In fact, despite having the highest tax rate, the USA actually collects the least revenue as a percent of GDP when compared to peer nations (2% as opposed to the 3% average) so it does not result in companies relocating to foreign nations.
Is actually closer to 12 million people, or about 3.9% of the population as of 2009. In other words 96.1% of the population is covered or foregoes insurance even though they can afford it or qualify for assistance. This is hardly a statistic to get up in arms about.This may as well be true, but we need to take a closer look at amount of care Americans receive rather than determining if they simply have access. A study by the Commonwealth Fund (also published in Health Affairs) finds that
Adults in the U.S. are more likely than those in the 10 other countries to go without needed health care because of costs. One-third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill a prescription because of costs. This percentage is down from the 2013 survey (37%). As few as 7 percent of respondents in the U.K. and Germany and 8 percent in the Netherlands and Sweden experienced these affordability problems.This shows that American adults consistently fall behind when it comes to actually receiving the care they need when compared to Europe, despite European healthcare systems having longer wait times. Additionally, according to world bank data, the US lags far behind in terms of life expectancy. One can argue that the low life expectancy is due to high obesity rates in the US, but this argument is weak, considering that while obesity rates are lower in peer nations, they still remain high in most of these nations. It can also be noted that nations like Germany have much higher rates of smoking and drinking, yet this doesn't seem to reduce their life expectancy to American levels.
Another thing to keep in mind is that the access to healthcare in America is high partly due to government programs such as the ACA and Medicare/Medicaid, which will no longer exist under a free market, which may lower coverage rates. In fact, the ACA extended coverage to twenty million Americans who were previously uninsured.
This strongly implies that there is little to no correlation between wealth and life expectancy in the United States.This part is downright disingenuous. I'm not entirely sure why there is so much mental gymnastics with race and whatnot in the post. This paper published in the Journal of the American Medical Association finds that there is a massive correlation between income and life expectancy, with a 15 year gap between the top 1% and the bottom 1% of men. Living in an impoverished neighborhood shaves 15 years off your life simply due to the conditions that arise from inequality.
Next up is the cost portion:
A prime example of this is higher wait times even for medically necessary services. This is a forgone conclusion because the costs of a good or service cannot be side stepped or controlled like prices can be.There actually isn't much bad economics in the first half of this section. The ancap is largely correct in his assessment of prices vs costs. However, I would like to point out that while Canada has high wait times, they spend only 47% what the US does. At this price point, it is easy to argue that the costs are worth it. In fact, they spend less then just the public sector of the US, yet are able to reliably guarantee healthcare for their entire populace, indicating high levels of wastage in the public healthcare sector in America. In fact, over $50 billion is lost to terrible administration alone. This shows that there is significant room for improvement in the public sector in America.
Lastly, Canada spends even less than than the OECD average, so their issues with wait times are greater than those of other universal healthcare systems. It is unfair to look at Canada alone. If you compare international wait times, most nations don't have wait times as high as Canada, and people usually don't have to wait long for medically necessary services. As I've stated before, most people are still able to reliably access medical care and drugs, unlike in the US, despite higher wait times, which shows that the wait time argument is a little exaggerated.
There have been attempts at accounting for deadweight loss in the U.S economy from adopting the Bernie Sanders "Medicare for all plan". Conover (2017) estimates the deadweight losses from the additional new taxes required by the Sanders Medicare-for-All plan would range from $625 billion to $1.1 trillion.Yes there is deadweight loss to taxation, which is counteracted by government spending, which is stimulatory in nature. In addition, it is worth pointing out that Bernie Sander's funding plan is especially inefficient, considering how he wants to increase capital gains and corporate taxes to far above the OECD average, a wealth tax, etc. There are much more efficient taxes that can be used to fund healthcare, such as consumption taxes, land value taxes, any pigouvian tax, etc. Not sure how this is a point exactly.
ConclusionWhile some of the points made in the ancap post are decent, a large portion of it is misguided. I think it would do the post's creator some good to look into the economics of healthcare and health policy. AnCapCopyPasta sidebar says "Win arguments instantly", which is funny because looking at the content there, the only arguments they are going to be winning are those against kids who haven't a clue what is being talked about.
It is only fitting that I end this R1 with the Economists' declaration on Universal Healthcare Coverage (see here for list of signatories), led by Lawrence H. Summers on behalf of 267 signatories, of which some notable economists include Ken Arrow (Known for his seminal paper on the economics of healthcare, now passed), Piketty, Stiglitz, Vernon Smith (A Libertarian from GMU lol), David Cutler (leading health policy researcher), among many others. While the way we go about achieving universal access is debatable, the concept is strongly supported by the majority of economists. UHC is good economics.
The Free to Play Experience: Thoughts from a "paid" player
I rejoined STO in early 2020 after several years away (think Legacy of Romulus). When I came back, I kind of dove in: started to budget to buy about 5000 zen per month, picked up the LTS on a 50% sale in April, picked up the legendary fed pack, etc.submitted by ErikRogers to sto
I really love the game, and spending on it helped keep "the grind" from getting too bad... but I was curious, how is the grind for a true F2P player?
At first I thought about spinning up a new character and just not allowing myself to use any "paid" features, but that's tough... Even if I don't use my ships, I get admiralty cards, slots, the extra V. Adm. token, etc. Also, it's kind of hard to have the will power to not use my resources on the "F2P" chraracter. I decided the right approach was to spin up a whole new account and NEVER spend cash.
That was about a month ago. I've been playing my "F2P" account as my main since then. It's been pretty fun and I thought I might share my perspective on the free to play experience as it compares to the paid one.
The First Character
I decided to spin up a Federation-allied Romulan captain as my 'main' character on this account. Like most Star Trek fans, I'm a federation guy. The Romulan tutorial and story arc are some of the best in the game, and I never really played through them on my regular account. This would be a good time to enjoy that content. I also feel the whole STO story makes more sense as a Romulan. Belonging to a budding nation's navy helps explain why a Fleet Admiral still flies around patroling the beta quadrant and helping tag Epohh.
These are all good reasons for running Romulan, but my real reason was more practical: Playing as a Romulan gives me cheaper access to Superior Romulan Operative Bridge Officers (SRO) and the Dynamic Power Redistributor Module console (DPRM) while allowing me to fly all my favorite Starfleet ships.
The F2P experience during the leveling up process is pretty much the same as it is for a paid player. The most important difference is that as I F2P player, I don't have access to a scaling T6 ship while I level. This is kind of a blessing in disguise in my books. I've found that the T6 "scaling" ships tend to outperform T1-T4, but needing to rely on the allowed me to play around with a greater variety of ships. This is important, since once I hit level 65 that variety got cut down in a pretty big way...
Since I've played most story content before, I did a lot of skipping in order to pick up mission rewards that would suit my final build. I decided to focus on disruptors, since they're one of the easier energy types to play without dropping cash (easiest is definitely phasers, but disruptors are close). I played Echoes of Light repeatedly for the Entoiled Techonology set, Brushfire for the House Martok Omni & Defense Configuration Engineering Console, Blood of the Ancients for the Preserver Resonant Set, and one playthrough of Beyond the Nexus for Reinforced Armaments. I also played Smash & Grab numerous times in order to pick up Plasma-Disruptor Beam Arrays. I noticed a lot of earlier build guides suggested these as beams. I'm guessing the move to rolling proc's every weapon cycle instead of every shot reduced the value of these, since they give up a modified in order to have both the plasma and disruptor procs. I did eventually ditch them in favour of standard Disruptor DBB's once I hit Level 65, but I do recommend keeping Smash & Grab in mind while levelling, since it's a quick episode that pumps out beams. (A little clarification on Plasma-Disruptors: They have both procs, but they are disruptors not plasma weapons. This means that plasma boosting tactical consoles do not boost their damage).
Choosing my Free Endgame Ships
I really wish that federation-allied Romulan captains could choose federation ships to use with their tokens. I do like warbirds, but I would have loved to pick up the T5 Sovereign Assault Cruiser and T5 Defiant Tactical Escort Retrofit as my free ships. Instead, I got Ha'apax Advanced Warbird with my R.Adm. token and the Mogai Heavy Warbird Retrofit with my V.Adm. token. I consider choosing the Mogai to have been a mistake. Not because it's a bad ship, but because I knew I'd want to eventually pick up the Emergency Weapon Cycle trait, and the most efficient way to get that is the Morrigu. What I failed to realise is that the Morrigu is the T6 Mogai. So what's the problem? My plan was to eventually upgrade my V.Adm. ship as a low-cost way to get another endgame ready ship...but why bother? The T5U Mogai is just a worse Morrigu... I also planned on grinding my way to the Romulan Elite pack with it's T6 Malem, so the T'Varo Retrofit was not a better choice. (At least I realised that at the time...) the ship I should have picked up was the D'Deridex. Why? Not because it's a particularly great ship: It handles like a Starbase. Mostly because I know I will never bother grinding for the T6 version, and the D'Deridex is the iconic Romulan ship. Oh well, missed opportunity I suppose.
The First Wall: Level 65
We've all know that mission difficulty scales as you level. This scaling is not linear though. I knew this going in, so I made sure to have my V.Adm. ship decked out with blue/purple weapons, and purple everything else by the time I hit level 65. I chose to use the Bajor Defense set for D/E/S, mostly for the the two piece pump to Phasers/Disruptors/Plasma weapons. Kitting out the ship this way does make it possible to play the content, including TFO's on Normal. It doesn't mean you'll never blow up. I'm sure a better pilot could have handled this better, and probably done better than I did at this point. Perhaps even run Advanced TFO's without a single piece of XV gear and with a regular T5 ship but I found that flying a non-upgraded T5 V-Adm ship was unpleasant. It was time to start the grind.
The Grind Part 1 - You're gonna need a bigger boat
Not actually bigger, but better... I was not happy with the specs of a non-upgraded V.Adm. T5 ship, so I decided to hit the ol' exchange and see what it would cost me for something a little tougher. There are numerous T5 ships on the exchange that sell for less than the standard 15M energy credit cap. 2 of those have free upgrades to T5U included: The Hirogen Hunter Heavy Escort and the Undine Nicor Warship. The Nicor is a little pricier than the Hunter since it was retired from the lockbox T5 prize box earlier in 2020, so I went with the Hunter for an affordable 3M EC. Grinding 3M EC wasn't that bad. I found a few techniques to help, the simplest of which were Tour the Galaxy and Endeavors. My Mogai's singularity core didn't extend the length of slipstream or reduce the cooldown, so it was only good for a few hundred thousand EC per day, but combined with endeavors, admiralty (tough with so few ship cards!) and running Rescue and Search and Ninth Rule a few times per day, I was able to save up enough credits in just a few days. I bought my Hunter for a cool 3M EC and named her: RRW D'Liru.
The Grind Part 2 - Moving past mission rewards
By this point, I had changed my weapons, dropping the Plasma-Disruptor Beam Arrays in favor of a pair of Disruptor Dual Beam Banks up front, combined with the Nausicaan Beam Array and Energy Torpedo, then the House Martok Omni in the back along with a pair of Plasma-Disruptor Beam Arrays. I knew I wanted to be able to hit from the front with everything, so I switched out the rear BA's for the Kinetic Cutting Beam and a Disruptor Omni from the exchange. I also picked up the Assimilated Module and Zero-Point Energy Harness. I decided to put a pause on Reputation gear after that, though. I'd like to save a little dil, so I'll wait until my reputations hit Tier 6 and I can finish the projects at a discount. There's a lot of good stuff I can use, like the Terran and Romulan Disruptor Beam Arrays, but those can wait.
In the mean time, I began saving up dilithium for Phoenix upgrades (and of course, crossing my fingers for an epic token) and saving my credits for the holy grail of consoles: DPRM. At the time that I bought mine, these were floating right around the 15 million mark... I needed to cap out my EC to get this. Thankfully, I had picked up a few admiralty ships to help gain EC that way, and the Obelisk warp core to make Tour the Galaxy more profitable. With little effort, I can tour the entire Beta Quadrant and a planet or two in the Alpha quadrant to earn a pretty solid chunk of EC. Combined with endeavors and admiralty, I'm well over a million per day without wearing myself out. A week and a half, and I had my DPRM console. I moved down my list and picked up hull image refractors. This brings me to a pretty satisfactory ship, with only about a month's worth of playing to get there. I also picked up a Nicor for kicks. I haven't kitted it all out yet, I'm thinking of running it with Antiproton Dual Heavy Cannons. We'll see.
I also dropped a little EC on some traits Honored Dead and Onboard Dilithium Recrystalizer. I've combined these with The Best Defense from House Pegh and Predictive Algorithms to round out my straship traits. Not the best suite of starship traits, but not bad on a budget.
The R.R.W. D'Liru : My F2P Escort ship. Please note, the tactical console on the far right is a Bellum Distributed Energy Manifold, not a standard one. This has a higher boost for beams than a normal one, along with a boost of +1.4% to CritH. Kind of a poor man's Vulnerability Locators
So what's next for my F2P captain? Well, I think it's time to start selling dilithium for zen. I'd like to pick up the Malem Light Warbird from the Romulan Packfor it's trait: Withering Barrage. The pack is only 1,600 zen at 20% off, so the grind shouldn't really wear me out. I also need to buy the EC cap increase, since there are plenty of goodies priced above 15 million. (Like an Upgrade token for my Mogai!) Once I reach T6 in a few reputations I'll round out my build with reputation gear. And also start picking up cannons for to build a few ships around Withering Barrage. I plan on picking up the Fleet Shepard with my first five Fleet Ship Modules. It should be winter by the time I've done that, most likely and I will have also tossed the Winter Event ship in to my roster. Locators will need to be picked up somewhere in there too. That will take a bit of admiralty & TFO grinding for sure.
Closing Thoughts on the F2P experience
I've enjoyed trying F2P out. It's a grindier experience, but with the right strategy, you can gear up your fleet without burning out. I do find I'm more excited about my ships when I need to work hard to get. I tend to enjoy the grind more because of the delayed gratification that goes with it. I spent the last few days itching to buy Hull Image Refractors and when I did and finally threw them on for a run through Rescue and Search I loved seeing that effort pay off. By comparison, on my paid acount Hull Image Refractors were just a think to pick up after a key sale. Both the paid and F2P experience have unique benefits, and I'm not sure one is truly better than the other, though I will say that I do take a bit more pride in my F2P account than I do in my paid one. It's almost like the difference between buying or crafting something by hand: It's easier to take pride in the thing you built yourself. It has certainly been an interesting experience!