Thursday, March 26, 2009

My debate with Andrew Sullivan


I may be glorifying a brief email/post exchange by calling it a debate, but regardless, here it is.

I have a lot of respect for Sullivan. He's a compulsively readable and very rational conservative who has had his faith in his ideology, church and state slammed by one horrible revelation after another. He's been transformed in less than a decade from an Iraq war supporting Republican fan of George Bush into a furious critic of deception, torture and domestic spying and one of Barack Obama's biggest supporters. That's one hell of a transformation and he did it with a certain amount of grace, apologizing for his 'unspeakable' arrogance and condescension towards Iraq war opponents back when he was on the other side. That's a level of class I'd hope I'd show in similar circumstances.

He did a post this morning defending Barack Obama's big spending budget from the perspective of a conservative uncomfortable with it philosophically but resigned to it's necessity, it did however include this passage:
On healthcare, I fear that restraining costs means rationing in the end and expanding the power of the public sector in ways that will reduce patient choice and slow innovation and research. At the same time, I can see that the combination of our current expectations and the revolution in medical science will mean huge increases in spending which, because healthcare is distributed through third party insurance, is very hard to curtail without more government. But Obama is right to ask back: so what do you propose? On energy, I'd say a gas tax hike balanced by a payroll tax cut. On healthcare, I'm not so sure. It's hard to oppose the upgrade in information technology as a cost-saver. I can see the merits of getting more people insured. As long as any reform is careful to prevent the private sector being squeezed out of business, I'm open to persuasion. But I'm more cautious on this than most, I guess. I value the private healthcare system in the US, that, for all its faults, has innovated medicines that have saved my life.
Well I had to respond to the implication that innovation is somehow the sole province of the private sector and he made my email his dissent of the day here.

He took my point about the contribution of public money to healthcare innovation but objected to what he saw as my hostility to the drug companies making a buck.
Two-thirds of pharmaecutical (sic) research is done by the private sector. There's no question that they cannot replace the NIH, but their research should not be dismissed as hair and hardons. Their work is more geared to treatments for specific diseases, and is vital.
My letter actually generated two posts from Sullivan, with the follow up here.
I find the knee-jerk hostility to private companies that take enormous risks and make products that save and improve lives to be baffling. It's a form of bigotry on the left - a loathing of the private sector and an inane notion that somehow public dollars are more virtuous than private ones.
Well I may have been a bit snarky towards the drug companies, but I think a lot of their behavior has warranted it: for instance I'd be interested in finding out what percentage of their research budget is devoted to making tiny molecular changes to existing compounds that allow them to continue making a profit when their patents lapse or they find a new application for them.

For that matter, what about the reverse of his argument? I've seen a fair amount of kneejerk hostility from the right against any undertaking or product born of the public sector - my email was spurred specifically by Sullivan's tossed off assumption that 'of course' public healthcare would stifle innovation. Andrew, what's with the loathing of the public sector and the inane notion that somehow private dollars are more virtuous than public ones?

And what has a public healthcare system got to do with pharmaceutical innovation anyway? Canadian healthcare doesn't include pharmacare and the Americans don't look like their even planning anything close to the coverage we have, so the argument doesn't even apply.

Plus, I can actually point to examples of the profit motive stifling innovation, can proponents of the 'public healhcare would stifle medical innovation' myth point to any concrete examples of public healthcare actually doing so?

UPDATE: A third follow up from Sullivan and one of his readers offering some perspective:
I currently work as a contractor for NIH and I see how even when companies develop their drugs, they heavily rely on the NIH funds to run their clinical trials (in this case, for cancer). It is clear that there are certain areas they don't want to put money into, even when in the future they will profit from it, so they turn to the government to do the dirty work: the tedious, extensive and expensive road of the clinical trials. More so in cases of rare cancers or diseases, where there is no money to be made yet.

Anyway, I'm not dismissing the role of pharmaceutical companies, I'm just trying to elevate the role of public research to its rightful place.

Amen. Sullivan seemed to miss the irony of accusing me and leftists in general of an unreasoning censorious loathing of big pharmaceutical companies. I was responding to his atypically unreasoning, almost reflexive assumption that more government involvement in healthcare would ipso facto mean less innovation. I did so by pointing out that the number one supporter of medical innovation and research, not just in the US but in the entire world is already and always has been, the government.

Sullivan responded by reducing my point down to 'lefties hate drug companies for trying to make money'.

And righties have real trouble ever admitting that sometimes government, big government, does some things better than the private sector does.

UPDATE: Follow up number four. I seem to have struck a nerve with Sullivan's readers. One writes in to point out some of the harsh truths about drug company priorities and gets a bottom line position from Andrew on the subject:
The core issue is whether we can treat drugs as products like any other, i.e. products that are restricted by price. This means that the poor will get worse treatment than the rich. As long as basic care is guaranteed, I can live with the inequality, and I do not see the government's role as ending it.
And there, my respect for Sullivan as a rational thoughtful conservative aside, is the Rubicon we can't cross together. Both ethically and pragmatically I disagree with Sullivan's comfort with treating health as just another commodity with unequal access determined by whether you can afford the treatment you need.

UPDATE: Almost a week since my initial email and Andrew is still indignant on behalf of the poor maligned drug companies.

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