site banner

Culture War Roundup for the week of May 15, 2023

This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.

Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.

We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:

  • Shaming.

  • Attempting to 'build consensus' or enforce ideological conformity.

  • Making sweeping generalizations to vilify a group you dislike.

  • Recruiting for a cause.

  • Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.

In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:

  • Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.

  • Be as precise and charitable as you can. Don't paraphrase unflatteringly.

  • Don't imply that someone said something they did not say, even if you think it follows from what they said.

  • Write like everyone is reading and you want them to be included in the discussion.

On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.

9
Jump in the discussion.

No email address required.

I like this piece, but then and now feel like he's a little too dissmissive of the "cons" side of the calculation. Study #9, for instance, estimates that European-style price regulation could decrease innovation by as much as one third. I could reply with the Kaiser Family Foundation statistic that right now one third of people can't pick up their perscriptions at all because of the cost. If we reduce innovation by a third while expanding access to existing (and still increasing) innovation by a third, I'm not so sure we actually did that badly for ourselves.

I understand the study tries to account for the access side of things, but when they say that x reduced dollars leads to x less life years, I have to ask: aren't we basically already at about the peak of how long humans live? Are these extra life years at the very tail end of someone's life, low-quality, painful years that I probably wouldn't weight as highly as people who have their whole lives ahead of them gaining better medical care now? (As one commenter pointed out, if we really value all future life years equally, then the policy responsible for "worst thing in human history" would just be contraception). I could also add that this policy suggests Americans would get thousands more in savings, and that increases in income add life years in of themselves; likewise debt is a major driver of suicide - things I don't think the study accounts for in their life year ledger.

Also (unless I'm misreading) these studies seem to be addressing actual, old fashioned price controls, not pricing negotiations, which seem less drastic - it's what PBMs already do right now and no one seems to think they decrease innovation. I could be misunderstanding though.

This isn't to say that I don't take the argument seriously; we clearly gain from innovation and there should definitely be a big financial incentive to keep pharma companies churning out drugs. I'm just not sure if we're at the reasonable cutoff. When I tried googling, for instance, if we saw more pharma patents after Trump raised the patent period by four years, I couldn't find anthing. And as Scott points out, pharma companies wouldn't need to secure returns quite so crazy high if we didn’t make them go through a $billion+ ten-year approval process first.