Most of the value of automated cars would not be on highways though - right now manually-driven cars are pretty efficient on highways. The largest value of automated cars is getting rid of stop signs and traffic lights, and completely eliminating gridlock.
Of course, this is only applicable if you COMPLETELY automate cars. If you mix manually-driven cars in almost none of the benefits are obtained.
I do agree with you that people are attached to driving - that may ultimately prevent automated cars from ever taking off seriously. Sure, an automated cruise control might be helpful on long trips, but I want to go to work without touching a steering wheel. I'd like the commute to take half the time, with 1/4th the pollution. I'd like to be dropped off at the door when I get there. I'd like 16 lanes of cars at a 4-way intersection to proceed through barely slowing down resulting in trip times that resemble what you'd get if you had a direct road from point A to point B. I'd like cars to automatically report for regular maintenance intervals while their owners are at work and report to the impound if owners refuse to have this done, and I'd really like the almost-zero accident rates that would result from this. If you regulated the system that drives the car to ensure compatibility and then granted immunity for certified vehicles you'd probably eliminate all legal costs related to cars as well, and virtually all car-associated crime. Oh, auto insurance would be a thing of the past as well.
I do agree that pedestrians and animals would be an issue with accomplishing this. Perhaps the roads would have sensors to warn the system of anybody coming near the street.
As far as recreational driving goes - in theory you could have amusement parks where you could rent a manual car if you want to drive around, or something like that. A car is a fairly dangerous machine - we don't let people shoot at stuff in their front yards for entertainment, so why should we let random people drive like idiots?
Sure, this is all a bit utopian - for the reasons you state people are unlikely to accept giving up their "right to drive" anytime soon. The shame is that we're probably not that far off technologically from being able to actually implement something like this. And it would probably pay for itself - I wouldn't be surprised if just about any western government could just give away a free car to every one of its citizens and recoup the cost in a few years or less from savings in medical/enforcement/etc.
Uh, in such a world why would we need pilots? And why would we want manually-flown planes flying through the dense automated traffic near the surface? And why wouldn't we want the aircars to be able to fly arbitrarily high?
Automation will really be the key to making this work. However, if you have automation then you don't need aircars - just automate the traffic on the ground. Optimize car designs for comfort and you could just board your car at 10PM and wake up on in Florida. For longer trips than this you'd use conventional airliners and rent a car. No need for parking lots either - just put huge garages at various points in an area and have cars drop people at the door.
can you give an example of *anything* that is heavier than air and can constantly overcome the force of gravity without expending energy
Sure, the house I'm sitting in is heavier than air and doesn't fall into the core of the Earth, and doesn't expend any energy (nor does anything beneath it).
No, I can't think of anything suspended in the air that is more dense than air that does the same.
Given a constant downward force, staying in the same position requires a constant upward force.
Absolutely.
That upward force requires energy, in some form.
Uh, I'm not aware of any known law of physics that makes this statement follow your previous one. Generating a force does not require energy - performing work requires energy. If a force does not act over any distance then no work is done.
A machine that generates a levitational force that causes it to neither ascend nor descend would not be required by the known laws of physics to expend energy. (Feel free to point me in the direction of a reference if I'm wrong on this one.) It is just that nobody has figured out how to do it (and I'm not expecting anybody to do so anytime soon).
My mouse is pulled towards the Earth's core with a force, and a balancing force is exerted upwards upon it by the desk. This situation is completely stable without any expenditure of energy. The gas in a black dwarf star is in a similar situation (although in that case the gas is diffusing) - the star will never grow or collapse unless acted upon by an external force, despite posessing almost no potential energy at all (with respect to any physical processes that actually occur to it).
No laws of physics would be violated if somebody managed to figure out a way to get rid of the desk my mouse sits on and replace it with some levitation machine that consumes no energy (provided the mouse does not gain altitude).
Liquid He is pretty expensive, although most of what you go through is LN2.
The multi-million-dollar cost of an MRI sounds about right. I've seen research NMRs in the same price range just for the magnets. An NMR/MRI magnet needs to be very powerful, very uniform/stable, and in the case of an MRI it needs to fit a patient inside. That is a lot of superconductor wire. It is still a pretty exotic technology.
Most likely the person claiming MRIs were only $50 in India was mistaken (perhaps they confused it with some other technique). Or it was out-of-pocket cost and not true cost. An MRI in the US probably only costs $50 or less if you look at out-of-pocket cost for an insured person. The insurance company on the other hand pays quite a bit more. If the Indian government subsidizes MRI tests then the price would obviously be lower to consumers. It doesn't change the actual cost, however.
Do people sue pregnancy test kits if it tells them they weren't pregnant and they drank alcohol and the baby was born with problems? Or condom manufacturs for getting deadly diseases?
I don't have any references (in part due to the wonderful US judicial system that ensures that only lawyers can find out how the law has been interpreted with no free access to data online), but I'm sure the answer to all your questions is yes. In the US people sue for the most frivolous of reasons - if you actually have an arguable case it is guaranteed it will get litigated.
If they do, they havent been very successful.. cause those products still exist on the market.
Depends on how you define success. You call 1-800-SUE-M'ALL, the lawyer has you mail him the form that gives him 1/3rd of any settlement, and then the lawyer calls up the manufacturer and says that they'll go away for $10k. The lawyer makes $3k for a total of 25 minutes worth of work, and you get $7k for your "trouble". The company will settle just to not have to deal with the district court of Nowhere, MO and its plaintiff-leaning juries.
I can't really understand students who don't have medical insurance. The rates are VERY low for good quality insurance. It probably has to do with the fact that few students die of chronic diseases. Students probably spend more on beer than it would cost to buy insurance.
remember the key elements here aren't dollars or personnel, it's time and risk
Agreed (and I think that it is tempting to loose sight of this in the effort to reduce costs and personnel). However, both time and risk benefit from economies of scale. If this is a company's 75th drug development/launch and a particular project team's 3rd the risk is FAR lower than if you're a startup reinventing the wheel. Likewise you don't waste as much patent time making contacts and developing your processes. In the time it takes a startup just to find a reliable supplier of API (and do all the necessary GMP audits) they could have just as easily cemented a licensing agreement with a major pharma. That major pharma can very quickly make the API themselves or use one of their many existing external partners to do it. Every other step of the process is already lined up as well. A startup would waste a lot of time reinventing the drug development process, and if they discover they missed something that takes a year to complete (such as some safety study) they could end up with major delays. And then if the drug takes off then they still need to find some way of promoting it and scaling up to market-scale manufacture.
The startups only need to get one thing right to make big money - the initial discovery. So, why jeopardize 80% of the reward trying to capture the last 20% (which you only get it you execute perfectly)? You'd do better to spend your time discovering some new drug for another 80% return...
I agree with you on the challenges of tailored therapies. If companies find ways to succeed in that model they could really pull ahead. This kind of approach also is likely to be more likely to yield cures for many of the complex diseases that have remained elusive (psychiatric issues, systemic problems like diabetes, cancer, etc). Most of these conditions probably have dozens of causes, and if you can break down patients into specific groups with unique therapies you're more likely to help them.
If NIH begins developing royalty-free drugs, the industry will collapse overnight. NIH is supported by public money - if they can make a drug that "competes" with an pharma-industry drug, it will be almost literally free.
Only if the NIH spending is far in excess of private R&D. As you pointed out most likely it will start out small. So most drugs would be private at first. However, the public model can be evaluated. Some argue that public R&D would be inefficient and wouldn't get anywhere. Maybe they're right, maybe they're wrong - if we try it on a small scale we can see how it works and not just argue about it. If the NIH spends billions and comes up with nothing the spending will end up getting cut. If they revolutionize the world they'll get expanded. Either way the public has nothing to lose (except maybe a few billion if it turns out to be a waste).
The problem is that the sound-bite crowd is all for massive all-or-nothing solutions. Let's ban patents. Let's fix prices at 50cents/pill. Let's fix them at $1/pill. Let's ban drug advertising. All-or-nothing solutions are very risky and ignore the complexity of the problem.
Why not try something reasonably inexpensive and see how it works? It could be scaled up fairly quickly, and if it goes astray it could be scaled back without massive economic havoc (and without destroying the whole medical industry). Small solutions are almost invariably better than big ones for these reasons.
This is just nonsense, the entire IT world except disk manufacturers has always used 1meg=1024bytes for *binary* storage devices it doesn't make any sense at all to use SI units when the underlying device is binary because the size of the disk only fits exactly if you work in Base2.
I am a part of the IT world. I do not have anything to do with disk manufacture, and never have. I prefer the use of SI units. So clearly there is debate. The fact that we're going back and forth about this only reinforces that there is debate...
And not all storage devices fit on an address boundary (virtually nothing but ram chips do actually). And many that do don't need to out of engineering necessity.
With 10 bits you can store 2^10 different value which equals 1024 and *not* 1000. Perhaps you'd like us to stop using the last 24 values so it more conveniently fits into the SI scheme??!
No, use all 1024. Just don't call it 1.000KB - call it either 1KB (rounded off) or 1.024KB if you must be precise. Or just call it 1024 bytes. DNA has a pitch of 3.6nm - for some reason biochemists manage to deal with not being able to simply redefine the nm to make it come out at an even 4. Most professions have to deal with non-even numbers. The IT world has even managed to figure it out with floating data types...
I think we can explain that with the patent / wait / tweak / repatent cycle that lets the pharmacorps be wildly profitable forever without producing anything useful.
Uh, if nothing they produce is useful, then why do insurance companies pay so much for their wares? Maybe the reason they're not working on anything else is that nobody has come up with anything better to work on? And why doesn't somebody who knows better develop a cure for cancer - they'd make a fortune selling it for $100/dose even if they get no repeat sales?
Sure, you eventually have to test stuff in real people - and there are risks every time you do that - but the legitimate practical difficulties there are nowhere near enough to explain how crappy the pharmaceutical / medical device market is.
Why is it that so many products get weeded out in clinical trials? Why is it that we have drug recalls? How many medical researchers do you see out there talking about how they've gotten the human/animal non-equivalency thing all worked out? Do you know anybody respected in the health care profession who professes this? Sure, I can stand up and wax philosophical about how we should have the flying car problem fixed by now, but that doesn't make me an aeronautical engineer...:)
And there is a whole lot more to healthcare than pharmaceuticals and medical devices. I don't think the problem with the overall industry is that nobody wants to do anything more than just tweak existing products. The problem is that human beings are very complex systems, and most drugs are pretty crude tools - you just pick ONE enzyme or receptor and massively stimulate or block it. An analogy might be trying to debug software using a screwdriver - you're only going to get so far prying chips off the motherboard. Maybe a better analogy would be trying to fix a buggy computer program by replacing functions from the C library with NOOPs - you could probably fix some bugs that way or at least mitigate them (by fixing security holes in apache by wiping out the TCP stack, for instance).
Biochemistry is complex stuff. The human body wasn't engineered with the intent of making repairs simple or straightforward. Biochemical pathways overlap and intersect and messing with one function can disrupt 45 others. Sure, it is only finite in complexity and sooner or later we'll figure it out, but finite != simple.
Of course, we have how many different drugs to help old men get it up?
This is actually in part a result of public policy debacles.
We choose to spear companies who put money before the sick. So, companies have learned to develop (when possible) products that treat problems that don't kill people.
Listening to a grandma with diabetes talk about choosing between food and insulin makes for a sympathetic audience screaming for an end to excessive drug profits. Listening to a grandpa with erectile dysfunction talk about choosing between food and Vaigra does not. So, companies have gotten the message - the public wants more pills like Viagra and fewer drugs like insulin. Sure, that isn't what they say with their mouths, but it is what they say with their wallets. When you can charge $5/pill without complaint for one drug, and get calls for government intervention when you charge $3/pill for another drug, which would you focus your R&D efforts on improving?
IMHO, pharmaceutical research should really be limited to government-funded research.
Good points.
I've been an advocate of competition between public and private research. Keep the patent system EXACTLY as it is now, but have the NIH (or some other body) do full soup-to-nuts drug development, and offer the resulting approved drugs for royalty-free manufacture. Consumers would have a selection of both cheap and expensive new medications to choose from. The public could evaluate the model and see whether it is working from a cost perspective. Industry could still make profits - they just have another competitor. Also, the NIH could outsource some of their work to industry as makes sense - they would not give up the patents (and jeopardize the cheap medicines for the public), but they could pay private industry to develop their drugs. Essentially we're transferring the risk of drug development to the government - and the resulting drugs don't need to be priced to recoup losses. And if the whole thing turns out to be a waste of taxpayer funds then you can just go back to what we have now not having gutted the entire pharma industry...
Where as, taking an existing pattented medication, and tweeking it's formula just enough to get a new patent (as well as an extension on the original) is a relatively cheap investment and can be brought to market much more quickly.
Uh, developing a new drug (a variation on an existing one) does not affect the original's patent life in any way.
There are only a few ways to extend the patent on a drug. The most common is a 6-month extension for evaluating a drug in a pediatric population. There is very little market for pediatric drugs, so nobody would research them if it weren't subsidized in some way. Since this extension was put into law most drugs are now tested in pediatric populations (at some point), greatly increasing the safety/efficacy data available to doctors that would otherwise have to treat children off-label.
That's about it. There have been legal games played by less-ethical companies trying to forestall competition, but courts and public pressure have largely put a stop to this. The large-pharma industry has figured out that they're already making plenty of money - there is no sense endangering the whole patent system by playing games to stretch things out by a few months.
I'm all for punishing companies that play games with patents - a patent is a contract between an inventor and the public. The inventor gets the stability of a known period of exclusivity before they invest money in R&D. The public gets free access to the invention after this period of time. You can debate how long this time should be, but it is an arrangement that should be made BEFORE the money gets spent on R&D. Neither side should try to change the deal after this point. Companies that play games should be fined BIG money, and if the public wants to change patent law they should make the changes effective in a few years and only for new patents.
This is the only valid part of your post. The pharma companies blow an insane amount of money on advertising.
I agree with you and are torn on this issue. If anything it is more an indictment of the society we live in than the pharma industry - people care more about how a product is promoted than whether it works. Some would argue that ads should be banned, but then you're at the mercy of your doctor (who might be up-to-date or not, and who might care more about either patient care or about avoiding liability or about the cute sales rep offering tickets to the big game). I tend to be one of the camp that patients should be participants in their care - and that means that they have to know what is out there treatment-wise.
And if it didn't increase profits industry wouldn't be spending money on advertising. Because of this, fewer drugs would be developed if you got rid of the advertising than not. If advertising turns a non-viable $10M/yr drug into a viable $100M/yr drug then getting rid of the ads would also get rid of the impetus to develop the drug.
A new drug is developed that is inferior in efficacy but superior in that it isn't about to run out of patent protection.
In the US such a drug would not be approved. The more likely scenario is that the new drug is more effective than the old drug, but not to a large degree. Then you have the choice between a 50-cent pill that works well, or a $5 pill that works 15% better.
However, insurance companies usually step in when this happens and refuse to pay for the more expensive drug unless the older drug is not effective. If consumers want to pay for the more expensive pill out of pocket then arguably that should be their right. And in some cases that extra 10% might be worth the costs (what is the cost of leaving a chronic condition under-treated?).
And if you're allergic or otherwise intolerant to/of the old medication you won't be complaining about the fact that somebody bothered to come up with an alternative. A lot of people seem to think that all the population needs is exactly one treatment for any given condition. Many people respond differently to various drugs, and having a selection on the market allows doctors to find something that works well for individuals (regardless of what the aggregate statistics say).
Not as stupid as you seem to think, because if I have the patent on the best drug available, I don't need to worry about developing a better one until someone else trumps my drug. Obscenely long lasting patents don't stop all innovation but they create a lot of inertia.
Uh, can you name a strong-selling drug developed in the last 20 years where the original manufacturer didn't continue working on a better version? How about one where somebody else didn't "trump them"? About the only examples you'll find are drugs only a few years old - and that would be simply because it hasn't happened yet.
Sure, if a drug only makes $50M a year there won't be a long line of people looking to improve upon it (unless the improvement is likely to sell more) - at that price the company that originally developed the drug is probably wishing they hadn't bothered (they probably incorrectly estimated the market). However, if a drug makes $500M or more per year chances are that somebody else is working on something better - and these drugs are the ones that dominate health care costs (well, the pharmaceutical aspects of it - for some reason nobody talks about all the other costs of healthcare - maybe because they are both wasteful and unprofitable - the former is forgivable as long as it comes along with the latter).
Don't get me wrong - there should be a way to get drugs out there for conditions that are unprofitable from a marketing standpoint, but that is really a different issue. Essentially you need to have a public source of development funding for these drugs (funding that doesn't stop at the academic lab).
Yes because obviously, patents were invented before drugs.
Uh, patents certainly predate modern drugs. By modern drugs I mean ones that have been tested for safety and efficacy. Sure, people have been selling pills as cures for ages. If we returned to those days profits could be had easily without the need for patents.
Most of the R&D cost for a modern drug is associated with testing for safety and efficacy. Sure, the creative part is working out mechanisms, leads, etc. A good part of that is funded by grants and is done in academia. However, cost-wise this is actually a very small part of drug development. The big costs are the clinical trials and development/scale-up/etc - not the most creative aspect of drug development, but they're essential to ensuring drugs are safe and effective. And you have to spend all that money (hundreds of millions of dollars) knowing only that the drug candidate is more likely than not to fail testing.
We'd still have the industry, it just wouldn't be so bloated and wasteful.
While there is certainly waste in the pharmaceutical industry, I'm not convinced it is as large as you imply. The big problems with drug development are risk and cost - there is a high level of risk that a drug candidate won't work out, and it costs a lot of money to find that out. While more money gets spent on advertising than R&D - the fact is that the advertising money is low-risk - it is spent on products that are known to work and make money. The R&D money, on the other hand, is invested in products that are more likely to not work out than they are to be profitable.
On top of that, the marginal cost of manufacturing pills is very low - so once the R&D is done anybody could just copy your product and have it on the market, with only branding and a one-year head-start available to promote the original product. Insurance companies are VERY efficient at eliminating this advantage - within weeks of a drug losing patent protection its sales plumet to a fraction of what they were originally.
If we're going to have unpatented drugs, the development model will have to change substantially. Most likely they would have to be developed entirely using public funding. If you're going to do that, why get rid of patents? Just have the NIH develop drugs and issue them with a royalty-free non-exclusive license - you'd get cheap drugs (for buyers - the cost would be borne by taxpayers) but you'd still have access to privately developed drugs if you pay what you're paying currently. Then you could compare the models and see how they both work out before gutting a multi-billion-dollar industry on an unvalidated hope that somebody will pick up the job of making pills even if you can't make any money doing it...
Well, I agree that it is something that is up for discussion/debate/etc. However, think about it another way: My body belongs to me - so why can't I sell myself into slavery for cash? That's how slavery used to work (non-US style slavery in the ancient world - it wasn't racial at all). Slavery was just another type of financial relationship between employer and employed.
Even if you make slavery voluntary and remove any racial issues, I still think that slavery should not be permitted. It tends to be an arrangement entered into between two parties that do not have equal bargaining positions, and its effective permanence makes it hard to change your mind.
The same issues tend to exist with privacy - once you give it up it is hard to get it back, and the people giving it up and the people paying for it to be given up tend to not have equal bargaining power.
I'd think that it is more likely that packing is more likely to be used to regulate genetic expression. It just happens that as a side effect it is also more protected from modification.
Kind of like having a backup media safe - the purpose of the safe usually isn't to prevent outside theft by professional thieves so much as to prevent casual treatment of media (employees using tapes and leaving them on desks when they are done leaving them susceptible to fire/flood/etc). However, the safe would make backup media a lot harder to steal.
I guess one way to help settle the question would be compare the map of conserved DNA against the map of packed DNA. If there isn't much overlap then the packing probably isn't a mechanism to achieve conservation.
I wouldn't be surprised if there isn't much correllation. The most conserved regions of DNA often are the most essential regions - and you can't very well completely shut off your ribosome genes...
True - humans are still subject to natural selection, although you might just as well call it artificial selection (a dubious distinction in this case). We just don't select for health as strongly as most species do, and instead favor other traits (intelligence, leadership, good looks (which normally indicates health but not as much today), whatever).
I wouldn't be surprised if this leads to life expectancy remaining stable despite ever-increasing medical technology. The more we are able to cure disease, the less selective pressure against being prone to disease. Every next generation will become more and more "unhealthy" and there will be an equilibrium between technology and evolution. On the other hand, with less selective pressure on health chances are that other traits will accelerate in evolution - intelligence will no doubt increase leading to an increase in this trend.
Who knows, in 500 years we might be blobs of tissue incapable even of crawling to the kitchen table or bathroom, living in robotic capsules that carry us from place to place. Or we might just live in pods and interact in a virtual world. Or we might just turn into cyborgs - we'd use technology for the stuff that technology is good at, and biology for the stuff we haven't figured out yet.
It all just seems like a natural consequence of evolution - stuff that one species used to depend on turns out to be superfluous in another species. Humans are structured to use their intelligence to solve problems that other creatures solve with brawn - should it surprise us that as a result we become physically weaker and weaker?
I don't think that cures are always shied away from - despite the limited profit potential there are still companies that work on new vaccines.
However, you are right that cures are often less profitable. Perhaps the government ought to offer bounties for them or something like that.
Fundamentally, however, I think the big issue is that we just don't know how to cure a number of diseases. Most diseases that were cured were infectious or were the result of fairly easy-to-understand mechanisms. Nobody really knows what makes some people have really high cholesterol levels. Nobody really knows what causes some people to develop diabetes. Because we don't understand the complete mechanism of the disease we treat the symptoms. Diabetics have problems because of high blood sugar, so we make a pill that lowers blood sugar. However, we don't really understand why every cell in their body ignores insulin, so we can't really fix the underlying problem. But we can come up with progressively better ways to treat the symptoms.
And a big issue is that you can't experiment on people. If you could treat people like lab rats we'd probably have most of these diseases figured out by now...
Even that isn't a great comparison. I can make a jet engine, test it until it explodes, and then take what I learn and make the next model.
I can't pick a random molecule, give it to a patient, see how horribly they die, and then come up with a better molecule.
Just look at medical advances in the rodent care industry - if we could treat people like we treat lab mice we'd have cured cancer 20 years ago most likely...
I'm not sure that the summary is universal - not all major pharma companies have been dominated by merger activity.
To some degree it might have been inevitable - you can only have so much competition in an industry. Sure, the drug industry used to sustain all those companies, but costs have risen a lot in the last 20 years.
I think the big problem is that all of the "easy" drugs have been taken. Drug development used to consist of running huge libraries of compounds against targets and finding hits. To some degree this is still the case, but all the low-hanging fruit is gone. The trick is finding new targets, and that requires advances in biochemistry. You aren't going to find the next antibiotic by just randomly screening molecules against bacteria - those libraries were all mined to death in the 80s. And antibiotics don't pay well in any case.
Also - your new drug has to be better than existing drugs to be of any use. Existing drugs work pretty well - raising the bar significantly.
Don't get me wrong - I think a lot of drug executives spent too much time enjoying their $5/pill margins and forgot that those pills are only patented for a decade (effectively). However, I don't think this is the full picture.
A very good comment. I'd be interested if you have data to the contrary, but I suspect that most development of drugs (beyond some initial leads) tends to happen in fairly large pharma companies. Once you have a compound that has some activity in an assay the process of developing it and testing it is fairly streamlined these days. It costs a fortune, and it benefits significantly from economies of scale.
Small companies can outsource a lot of it to CROs/etc, but it probably isn't any more expensive just to license it to a major player that has some space in their pipeline. These deals are structured in various ways. Sometimes it is just a lump sum, but more often it is an ongoing relationship with milestone payments if the drug works out. Sure, the reward is lower if the drug does become big, but the risk is a LOT lower if it fails and the small research-driven company can focus its effort on more R&D for the next drug and less on how the previous drug is doing in trials.
Uh, I'd hardly call SiCKO an objective analysis of universal health care. Try watching Dead Meat. And yes, one set of anecdotes isn't really any better than the other.
The fundamental issue is cost. People are fundamentally mortal - keeping them alive when they are in situations that are likely to kill them tends to cost money. SOMEBODY has to come up with that money, or they will die (regardless of how much you outlaw death).
Now, I'd be happy to admit the current US system isn't ideal. However, you can't pretend that EVERYBODY can get medical care equivalent to what good private insurance plans currently provide without a huge increase in costs. Sure, you could try price-fixing, but that only works until the next generation decides not to become doctors.
I have a coworker in the UK who had a VERY nasty battle with pneumonia due to delays in treatment. It took a week or two of failed treatment with painkillers to even get an X-ray, and another week just for the X-ray to be read. Sure, it was all free, but he ended up nearly disabled for a month. In the US you could walk into any emergency room with difficulty breathing and you'd be diagnosed within a few hours and sent home with an inhaler (if necessary) and a prescription for antibiotics. Sure, you'd also get a bill for maybe $400 or so as well if you weren't insured.
The big problem comes when it is time to decide how long somebody lives. Health care costs go up exponentially as you age, and most socialized programs basically become hospice programs - they treat you nicely while working to ensure you die as quickly as possible so that you stop costing money.
Again, there are probably better ways of helping to alleviate health care costs for the poor than what we have now. However, completely socialized medicine tends to accomplish only one thing - equality (for those who aren't politically connected). Everybody gets treated in a mediocre manner...
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Most of the value of automated cars would not be on highways though - right now manually-driven cars are pretty efficient on highways. The largest value of automated cars is getting rid of stop signs and traffic lights, and completely eliminating gridlock.
Of course, this is only applicable if you COMPLETELY automate cars. If you mix manually-driven cars in almost none of the benefits are obtained.
I do agree with you that people are attached to driving - that may ultimately prevent automated cars from ever taking off seriously. Sure, an automated cruise control might be helpful on long trips, but I want to go to work without touching a steering wheel. I'd like the commute to take half the time, with 1/4th the pollution. I'd like to be dropped off at the door when I get there. I'd like 16 lanes of cars at a 4-way intersection to proceed through barely slowing down resulting in trip times that resemble what you'd get if you had a direct road from point A to point B. I'd like cars to automatically report for regular maintenance intervals while their owners are at work and report to the impound if owners refuse to have this done, and I'd really like the almost-zero accident rates that would result from this. If you regulated the system that drives the car to ensure compatibility and then granted immunity for certified vehicles you'd probably eliminate all legal costs related to cars as well, and virtually all car-associated crime. Oh, auto insurance would be a thing of the past as well.
I do agree that pedestrians and animals would be an issue with accomplishing this. Perhaps the roads would have sensors to warn the system of anybody coming near the street.
As far as recreational driving goes - in theory you could have amusement parks where you could rent a manual car if you want to drive around, or something like that. A car is a fairly dangerous machine - we don't let people shoot at stuff in their front yards for entertainment, so why should we let random people drive like idiots?
Sure, this is all a bit utopian - for the reasons you state people are unlikely to accept giving up their "right to drive" anytime soon. The shame is that we're probably not that far off technologically from being able to actually implement something like this. And it would probably pay for itself - I wouldn't be surprised if just about any western government could just give away a free car to every one of its citizens and recoup the cost in a few years or less from savings in medical/enforcement/etc.
Uh, in such a world why would we need pilots? And why would we want manually-flown planes flying through the dense automated traffic near the surface? And why wouldn't we want the aircars to be able to fly arbitrarily high?
Automation will really be the key to making this work. However, if you have automation then you don't need aircars - just automate the traffic on the ground. Optimize car designs for comfort and you could just board your car at 10PM and wake up on in Florida. For longer trips than this you'd use conventional airliners and rent a car. No need for parking lots either - just put huge garages at various points in an area and have cars drop people at the door.
can you give an example of *anything* that is heavier than air and can constantly overcome the force of gravity without expending energy
Sure, the house I'm sitting in is heavier than air and doesn't fall into the core of the Earth, and doesn't expend any energy (nor does anything beneath it).
No, I can't think of anything suspended in the air that is more dense than air that does the same.
Given a constant downward force, staying in the same position requires a constant upward force.
Absolutely.
That upward force requires energy, in some form.
Uh, I'm not aware of any known law of physics that makes this statement follow your previous one. Generating a force does not require energy - performing work requires energy. If a force does not act over any distance then no work is done.
A machine that generates a levitational force that causes it to neither ascend nor descend would not be required by the known laws of physics to expend energy. (Feel free to point me in the direction of a reference if I'm wrong on this one.) It is just that nobody has figured out how to do it (and I'm not expecting anybody to do so anytime soon).
My mouse is pulled towards the Earth's core with a force, and a balancing force is exerted upwards upon it by the desk. This situation is completely stable without any expenditure of energy. The gas in a black dwarf star is in a similar situation (although in that case the gas is diffusing) - the star will never grow or collapse unless acted upon by an external force, despite posessing almost no potential energy at all (with respect to any physical processes that actually occur to it).
No laws of physics would be violated if somebody managed to figure out a way to get rid of the desk my mouse sits on and replace it with some levitation machine that consumes no energy (provided the mouse does not gain altitude).
Liquid He is pretty expensive, although most of what you go through is LN2.
The multi-million-dollar cost of an MRI sounds about right. I've seen research NMRs in the same price range just for the magnets. An NMR/MRI magnet needs to be very powerful, very uniform/stable, and in the case of an MRI it needs to fit a patient inside. That is a lot of superconductor wire. It is still a pretty exotic technology.
Most likely the person claiming MRIs were only $50 in India was mistaken (perhaps they confused it with some other technique). Or it was out-of-pocket cost and not true cost. An MRI in the US probably only costs $50 or less if you look at out-of-pocket cost for an insured person. The insurance company on the other hand pays quite a bit more. If the Indian government subsidizes MRI tests then the price would obviously be lower to consumers. It doesn't change the actual cost, however.
Do people sue pregnancy test kits if it tells them they weren't pregnant and they drank alcohol and the baby was born with problems? Or condom manufacturs for getting deadly diseases?
.. cause those products still exist on the market.
I don't have any references (in part due to the wonderful US judicial system that ensures that only lawyers can find out how the law has been interpreted with no free access to data online), but I'm sure the answer to all your questions is yes. In the US people sue for the most frivolous of reasons - if you actually have an arguable case it is guaranteed it will get litigated.
If they do, they havent been very successful
Depends on how you define success. You call 1-800-SUE-M'ALL, the lawyer has you mail him the form that gives him 1/3rd of any settlement, and then the lawyer calls up the manufacturer and says that they'll go away for $10k. The lawyer makes $3k for a total of 25 minutes worth of work, and you get $7k for your "trouble". The company will settle just to not have to deal with the district court of Nowhere, MO and its plaintiff-leaning juries.
I can't really understand students who don't have medical insurance. The rates are VERY low for good quality insurance. It probably has to do with the fact that few students die of chronic diseases. Students probably spend more on beer than it would cost to buy insurance.
remember the key elements here aren't dollars or personnel, it's time and risk
Agreed (and I think that it is tempting to loose sight of this in the effort to reduce costs and personnel). However, both time and risk benefit from economies of scale. If this is a company's 75th drug development/launch and a particular project team's 3rd the risk is FAR lower than if you're a startup reinventing the wheel. Likewise you don't waste as much patent time making contacts and developing your processes. In the time it takes a startup just to find a reliable supplier of API (and do all the necessary GMP audits) they could have just as easily cemented a licensing agreement with a major pharma. That major pharma can very quickly make the API themselves or use one of their many existing external partners to do it. Every other step of the process is already lined up as well. A startup would waste a lot of time reinventing the drug development process, and if they discover they missed something that takes a year to complete (such as some safety study) they could end up with major delays. And then if the drug takes off then they still need to find some way of promoting it and scaling up to market-scale manufacture.
The startups only need to get one thing right to make big money - the initial discovery. So, why jeopardize 80% of the reward trying to capture the last 20% (which you only get it you execute perfectly)? You'd do better to spend your time discovering some new drug for another 80% return...
I agree with you on the challenges of tailored therapies. If companies find ways to succeed in that model they could really pull ahead. This kind of approach also is likely to be more likely to yield cures for many of the complex diseases that have remained elusive (psychiatric issues, systemic problems like diabetes, cancer, etc). Most of these conditions probably have dozens of causes, and if you can break down patients into specific groups with unique therapies you're more likely to help them.
If NIH begins developing royalty-free drugs, the industry will collapse overnight. NIH is supported by public money - if they can make a drug that "competes" with an pharma-industry drug, it will be almost literally free.
Only if the NIH spending is far in excess of private R&D. As you pointed out most likely it will start out small. So most drugs would be private at first. However, the public model can be evaluated. Some argue that public R&D would be inefficient and wouldn't get anywhere. Maybe they're right, maybe they're wrong - if we try it on a small scale we can see how it works and not just argue about it. If the NIH spends billions and comes up with nothing the spending will end up getting cut. If they revolutionize the world they'll get expanded. Either way the public has nothing to lose (except maybe a few billion if it turns out to be a waste).
The problem is that the sound-bite crowd is all for massive all-or-nothing solutions. Let's ban patents. Let's fix prices at 50cents/pill. Let's fix them at $1/pill. Let's ban drug advertising. All-or-nothing solutions are very risky and ignore the complexity of the problem.
Why not try something reasonably inexpensive and see how it works? It could be scaled up fairly quickly, and if it goes astray it could be scaled back without massive economic havoc (and without destroying the whole medical industry). Small solutions are almost invariably better than big ones for these reasons.
This is just nonsense, the entire IT world except disk manufacturers has always used 1meg=1024bytes for *binary* storage devices it doesn't make any sense at all to use SI units when the underlying device is binary because the size of the disk only fits exactly if you work in Base2.
I am a part of the IT world. I do not have anything to do with disk manufacture, and never have. I prefer the use of SI units. So clearly there is debate. The fact that we're going back and forth about this only reinforces that there is debate...
And not all storage devices fit on an address boundary (virtually nothing but ram chips do actually). And many that do don't need to out of engineering necessity.
With 10 bits you can store 2^10 different value which equals 1024 and *not* 1000. Perhaps you'd like us to stop using the last 24 values so it more conveniently fits into the SI scheme??!
No, use all 1024. Just don't call it 1.000KB - call it either 1KB (rounded off) or 1.024KB if you must be precise. Or just call it 1024 bytes. DNA has a pitch of 3.6nm - for some reason biochemists manage to deal with not being able to simply redefine the nm to make it come out at an even 4. Most professions have to deal with non-even numbers. The IT world has even managed to figure it out with floating data types...
I think we can explain that with the patent / wait / tweak / repatent cycle that lets the pharmacorps be wildly profitable forever without producing anything useful.
:)
Uh, if nothing they produce is useful, then why do insurance companies pay so much for their wares? Maybe the reason they're not working on anything else is that nobody has come up with anything better to work on? And why doesn't somebody who knows better develop a cure for cancer - they'd make a fortune selling it for $100/dose even if they get no repeat sales?
Sure, you eventually have to test stuff in real people - and there are risks every time you do that - but the legitimate practical difficulties there are nowhere near enough to explain how crappy the pharmaceutical / medical device market is.
Why is it that so many products get weeded out in clinical trials? Why is it that we have drug recalls? How many medical researchers do you see out there talking about how they've gotten the human/animal non-equivalency thing all worked out? Do you know anybody respected in the health care profession who professes this? Sure, I can stand up and wax philosophical about how we should have the flying car problem fixed by now, but that doesn't make me an aeronautical engineer...
And there is a whole lot more to healthcare than pharmaceuticals and medical devices. I don't think the problem with the overall industry is that nobody wants to do anything more than just tweak existing products. The problem is that human beings are very complex systems, and most drugs are pretty crude tools - you just pick ONE enzyme or receptor and massively stimulate or block it. An analogy might be trying to debug software using a screwdriver - you're only going to get so far prying chips off the motherboard. Maybe a better analogy would be trying to fix a buggy computer program by replacing functions from the C library with NOOPs - you could probably fix some bugs that way or at least mitigate them (by fixing security holes in apache by wiping out the TCP stack, for instance).
Biochemistry is complex stuff. The human body wasn't engineered with the intent of making repairs simple or straightforward. Biochemical pathways overlap and intersect and messing with one function can disrupt 45 others. Sure, it is only finite in complexity and sooner or later we'll figure it out, but finite != simple.
Of course, we have how many different drugs to help old men get it up?
This is actually in part a result of public policy debacles.
We choose to spear companies who put money before the sick. So, companies have learned to develop (when possible) products that treat problems that don't kill people.
Listening to a grandma with diabetes talk about choosing between food and insulin makes for a sympathetic audience screaming for an end to excessive drug profits. Listening to a grandpa with erectile dysfunction talk about choosing between food and Vaigra does not. So, companies have gotten the message - the public wants more pills like Viagra and fewer drugs like insulin. Sure, that isn't what they say with their mouths, but it is what they say with their wallets. When you can charge $5/pill without complaint for one drug, and get calls for government intervention when you charge $3/pill for another drug, which would you focus your R&D efforts on improving?
IMHO, pharmaceutical research should really be limited to government-funded research.
Good points.
I've been an advocate of competition between public and private research. Keep the patent system EXACTLY as it is now, but have the NIH (or some other body) do full soup-to-nuts drug development, and offer the resulting approved drugs for royalty-free manufacture. Consumers would have a selection of both cheap and expensive new medications to choose from. The public could evaluate the model and see whether it is working from a cost perspective. Industry could still make profits - they just have another competitor. Also, the NIH could outsource some of their work to industry as makes sense - they would not give up the patents (and jeopardize the cheap medicines for the public), but they could pay private industry to develop their drugs. Essentially we're transferring the risk of drug development to the government - and the resulting drugs don't need to be priced to recoup losses. And if the whole thing turns out to be a waste of taxpayer funds then you can just go back to what we have now not having gutted the entire pharma industry...
Where as, taking an existing pattented medication, and tweeking it's formula just enough to get a new patent (as well as an extension on the original) is a relatively cheap investment and can be brought to market much more quickly.
Uh, developing a new drug (a variation on an existing one) does not affect the original's patent life in any way.
There are only a few ways to extend the patent on a drug. The most common is a 6-month extension for evaluating a drug in a pediatric population. There is very little market for pediatric drugs, so nobody would research them if it weren't subsidized in some way. Since this extension was put into law most drugs are now tested in pediatric populations (at some point), greatly increasing the safety/efficacy data available to doctors that would otherwise have to treat children off-label.
That's about it. There have been legal games played by less-ethical companies trying to forestall competition, but courts and public pressure have largely put a stop to this. The large-pharma industry has figured out that they're already making plenty of money - there is no sense endangering the whole patent system by playing games to stretch things out by a few months.
I'm all for punishing companies that play games with patents - a patent is a contract between an inventor and the public. The inventor gets the stability of a known period of exclusivity before they invest money in R&D. The public gets free access to the invention after this period of time. You can debate how long this time should be, but it is an arrangement that should be made BEFORE the money gets spent on R&D. Neither side should try to change the deal after this point. Companies that play games should be fined BIG money, and if the public wants to change patent law they should make the changes effective in a few years and only for new patents.
This is the only valid part of your post. The pharma companies blow an insane amount of money on advertising.
I agree with you and are torn on this issue. If anything it is more an indictment of the society we live in than the pharma industry - people care more about how a product is promoted than whether it works. Some would argue that ads should be banned, but then you're at the mercy of your doctor (who might be up-to-date or not, and who might care more about either patient care or about avoiding liability or about the cute sales rep offering tickets to the big game). I tend to be one of the camp that patients should be participants in their care - and that means that they have to know what is out there treatment-wise.
And if it didn't increase profits industry wouldn't be spending money on advertising. Because of this, fewer drugs would be developed if you got rid of the advertising than not. If advertising turns a non-viable $10M/yr drug into a viable $100M/yr drug then getting rid of the ads would also get rid of the impetus to develop the drug.
A new drug is developed that is inferior in efficacy but superior in that it isn't about to run out of patent protection.
In the US such a drug would not be approved. The more likely scenario is that the new drug is more effective than the old drug, but not to a large degree. Then you have the choice between a 50-cent pill that works well, or a $5 pill that works 15% better.
However, insurance companies usually step in when this happens and refuse to pay for the more expensive drug unless the older drug is not effective. If consumers want to pay for the more expensive pill out of pocket then arguably that should be their right. And in some cases that extra 10% might be worth the costs (what is the cost of leaving a chronic condition under-treated?).
And if you're allergic or otherwise intolerant to/of the old medication you won't be complaining about the fact that somebody bothered to come up with an alternative. A lot of people seem to think that all the population needs is exactly one treatment for any given condition. Many people respond differently to various drugs, and having a selection on the market allows doctors to find something that works well for individuals (regardless of what the aggregate statistics say).
Not as stupid as you seem to think, because if I have the patent on the best drug available, I don't need to worry about developing a better one until someone else trumps my drug. Obscenely long lasting patents don't stop all innovation but they create a lot of inertia.
Uh, can you name a strong-selling drug developed in the last 20 years where the original manufacturer didn't continue working on a better version? How about one where somebody else didn't "trump them"? About the only examples you'll find are drugs only a few years old - and that would be simply because it hasn't happened yet.
Sure, if a drug only makes $50M a year there won't be a long line of people looking to improve upon it (unless the improvement is likely to sell more) - at that price the company that originally developed the drug is probably wishing they hadn't bothered (they probably incorrectly estimated the market). However, if a drug makes $500M or more per year chances are that somebody else is working on something better - and these drugs are the ones that dominate health care costs (well, the pharmaceutical aspects of it - for some reason nobody talks about all the other costs of healthcare - maybe because they are both wasteful and unprofitable - the former is forgivable as long as it comes along with the latter).
Don't get me wrong - there should be a way to get drugs out there for conditions that are unprofitable from a marketing standpoint, but that is really a different issue. Essentially you need to have a public source of development funding for these drugs (funding that doesn't stop at the academic lab).
Yes because obviously, patents were invented before drugs.
Uh, patents certainly predate modern drugs. By modern drugs I mean ones that have been tested for safety and efficacy. Sure, people have been selling pills as cures for ages. If we returned to those days profits could be had easily without the need for patents.
Most of the R&D cost for a modern drug is associated with testing for safety and efficacy. Sure, the creative part is working out mechanisms, leads, etc. A good part of that is funded by grants and is done in academia. However, cost-wise this is actually a very small part of drug development. The big costs are the clinical trials and development/scale-up/etc - not the most creative aspect of drug development, but they're essential to ensuring drugs are safe and effective. And you have to spend all that money (hundreds of millions of dollars) knowing only that the drug candidate is more likely than not to fail testing.
We'd still have the industry, it just wouldn't be so bloated and wasteful.
While there is certainly waste in the pharmaceutical industry, I'm not convinced it is as large as you imply. The big problems with drug development are risk and cost - there is a high level of risk that a drug candidate won't work out, and it costs a lot of money to find that out. While more money gets spent on advertising than R&D - the fact is that the advertising money is low-risk - it is spent on products that are known to work and make money. The R&D money, on the other hand, is invested in products that are more likely to not work out than they are to be profitable.
On top of that, the marginal cost of manufacturing pills is very low - so once the R&D is done anybody could just copy your product and have it on the market, with only branding and a one-year head-start available to promote the original product. Insurance companies are VERY efficient at eliminating this advantage - within weeks of a drug losing patent protection its sales plumet to a fraction of what they were originally.
If we're going to have unpatented drugs, the development model will have to change substantially. Most likely they would have to be developed entirely using public funding. If you're going to do that, why get rid of patents? Just have the NIH develop drugs and issue them with a royalty-free non-exclusive license - you'd get cheap drugs (for buyers - the cost would be borne by taxpayers) but you'd still have access to privately developed drugs if you pay what you're paying currently. Then you could compare the models and see how they both work out before gutting a multi-billion-dollar industry on an unvalidated hope that somebody will pick up the job of making pills even if you can't make any money doing it...
Well, I agree that it is something that is up for discussion/debate/etc. However, think about it another way: My body belongs to me - so why can't I sell myself into slavery for cash? That's how slavery used to work (non-US style slavery in the ancient world - it wasn't racial at all). Slavery was just another type of financial relationship between employer and employed.
Even if you make slavery voluntary and remove any racial issues, I still think that slavery should not be permitted. It tends to be an arrangement entered into between two parties that do not have equal bargaining positions, and its effective permanence makes it hard to change your mind.
The same issues tend to exist with privacy - once you give it up it is hard to get it back, and the people giving it up and the people paying for it to be given up tend to not have equal bargaining power.
I don't know that there is any evidence for that.
I'd think that it is more likely that packing is more likely to be used to regulate genetic expression. It just happens that as a side effect it is also more protected from modification.
Kind of like having a backup media safe - the purpose of the safe usually isn't to prevent outside theft by professional thieves so much as to prevent casual treatment of media (employees using tapes and leaving them on desks when they are done leaving them susceptible to fire/flood/etc). However, the safe would make backup media a lot harder to steal.
I guess one way to help settle the question would be compare the map of conserved DNA against the map of packed DNA. If there isn't much overlap then the packing probably isn't a mechanism to achieve conservation.
I wouldn't be surprised if there isn't much correllation. The most conserved regions of DNA often are the most essential regions - and you can't very well completely shut off your ribosome genes...
True - humans are still subject to natural selection, although you might just as well call it artificial selection (a dubious distinction in this case). We just don't select for health as strongly as most species do, and instead favor other traits (intelligence, leadership, good looks (which normally indicates health but not as much today), whatever).
I wouldn't be surprised if this leads to life expectancy remaining stable despite ever-increasing medical technology. The more we are able to cure disease, the less selective pressure against being prone to disease. Every next generation will become more and more "unhealthy" and there will be an equilibrium between technology and evolution. On the other hand, with less selective pressure on health chances are that other traits will accelerate in evolution - intelligence will no doubt increase leading to an increase in this trend.
Who knows, in 500 years we might be blobs of tissue incapable even of crawling to the kitchen table or bathroom, living in robotic capsules that carry us from place to place. Or we might just live in pods and interact in a virtual world. Or we might just turn into cyborgs - we'd use technology for the stuff that technology is good at, and biology for the stuff we haven't figured out yet.
It all just seems like a natural consequence of evolution - stuff that one species used to depend on turns out to be superfluous in another species. Humans are structured to use their intelligence to solve problems that other creatures solve with brawn - should it surprise us that as a result we become physically weaker and weaker?
I don't think that cures are always shied away from - despite the limited profit potential there are still companies that work on new vaccines.
However, you are right that cures are often less profitable. Perhaps the government ought to offer bounties for them or something like that.
Fundamentally, however, I think the big issue is that we just don't know how to cure a number of diseases. Most diseases that were cured were infectious or were the result of fairly easy-to-understand mechanisms. Nobody really knows what makes some people have really high cholesterol levels. Nobody really knows what causes some people to develop diabetes. Because we don't understand the complete mechanism of the disease we treat the symptoms. Diabetics have problems because of high blood sugar, so we make a pill that lowers blood sugar. However, we don't really understand why every cell in their body ignores insulin, so we can't really fix the underlying problem. But we can come up with progressively better ways to treat the symptoms.
And a big issue is that you can't experiment on people. If you could treat people like lab rats we'd probably have most of these diseases figured out by now...
Even that isn't a great comparison. I can make a jet engine, test it until it explodes, and then take what I learn and make the next model.
I can't pick a random molecule, give it to a patient, see how horribly they die, and then come up with a better molecule.
Just look at medical advances in the rodent care industry - if we could treat people like we treat lab mice we'd have cured cancer 20 years ago most likely...
I'm not sure that the summary is universal - not all major pharma companies have been dominated by merger activity.
To some degree it might have been inevitable - you can only have so much competition in an industry. Sure, the drug industry used to sustain all those companies, but costs have risen a lot in the last 20 years.
I think the big problem is that all of the "easy" drugs have been taken. Drug development used to consist of running huge libraries of compounds against targets and finding hits. To some degree this is still the case, but all the low-hanging fruit is gone. The trick is finding new targets, and that requires advances in biochemistry. You aren't going to find the next antibiotic by just randomly screening molecules against bacteria - those libraries were all mined to death in the 80s. And antibiotics don't pay well in any case.
Also - your new drug has to be better than existing drugs to be of any use. Existing drugs work pretty well - raising the bar significantly.
Don't get me wrong - I think a lot of drug executives spent too much time enjoying their $5/pill margins and forgot that those pills are only patented for a decade (effectively). However, I don't think this is the full picture.
A very good comment. I'd be interested if you have data to the contrary, but I suspect that most development of drugs (beyond some initial leads) tends to happen in fairly large pharma companies. Once you have a compound that has some activity in an assay the process of developing it and testing it is fairly streamlined these days. It costs a fortune, and it benefits significantly from economies of scale.
Small companies can outsource a lot of it to CROs/etc, but it probably isn't any more expensive just to license it to a major player that has some space in their pipeline. These deals are structured in various ways. Sometimes it is just a lump sum, but more often it is an ongoing relationship with milestone payments if the drug works out. Sure, the reward is lower if the drug does become big, but the risk is a LOT lower if it fails and the small research-driven company can focus its effort on more R&D for the next drug and less on how the previous drug is doing in trials.
Uh, I'd hardly call SiCKO an objective analysis of universal health care. Try watching Dead Meat. And yes, one set of anecdotes isn't really any better than the other.
The fundamental issue is cost. People are fundamentally mortal - keeping them alive when they are in situations that are likely to kill them tends to cost money. SOMEBODY has to come up with that money, or they will die (regardless of how much you outlaw death).
Now, I'd be happy to admit the current US system isn't ideal. However, you can't pretend that EVERYBODY can get medical care equivalent to what good private insurance plans currently provide without a huge increase in costs. Sure, you could try price-fixing, but that only works until the next generation decides not to become doctors.
I have a coworker in the UK who had a VERY nasty battle with pneumonia due to delays in treatment. It took a week or two of failed treatment with painkillers to even get an X-ray, and another week just for the X-ray to be read. Sure, it was all free, but he ended up nearly disabled for a month. In the US you could walk into any emergency room with difficulty breathing and you'd be diagnosed within a few hours and sent home with an inhaler (if necessary) and a prescription for antibiotics. Sure, you'd also get a bill for maybe $400 or so as well if you weren't insured.
The big problem comes when it is time to decide how long somebody lives. Health care costs go up exponentially as you age, and most socialized programs basically become hospice programs - they treat you nicely while working to ensure you die as quickly as possible so that you stop costing money.
Again, there are probably better ways of helping to alleviate health care costs for the poor than what we have now. However, completely socialized medicine tends to accomplish only one thing - equality (for those who aren't politically connected). Everybody gets treated in a mediocre manner...