The value of 12 days

That is what this chart asks:

An $80,000 per course of treatment that is better than the previous regime. It providers, on median, an extra twelve days of life before half of the cohort dies.

Backing out some very rough calculations, that gives a quality adjusted life year cost of at least $2.5 million dollars. It could be much more as I am assuming that each day is a great day instead of probably a severely discounted day.
Update 1: Someone who actually knows WTF they are talking about passed me the Journal of Clinical Oncology CBA on this drug. I was off by a bit.

Incremental cost per life year saved
† 410,000
Incremental cost per qualityadjusted
life year
† (low impact
of diarrhea to high impact of

For 2007 US Dollars.

In Great Britain, a drug that has an incremental improvement over regimes like this might be worth a couple thousand dollars. If the drug prolongs life but keeps a person in the ICU for the incremental days, its incremental value would be close to zero. If the twelve extra days on average are spent out of the hospital and in great shape, it might be worth $4,000.

In the United States, we are paying 625 100 times the British willingness to pay for a quality adjusted life year in this case.

Is that how we want to use our resources? If so, than be ready to see health care costs continue to accelerate. If not, then we need to change our intellectual property regime as well as incorporate and accept some systems of no in order to get the price for a drug like this down to reasonable levels.

KY and a dry screw

Kentucky submitted their Medicaid Expansion waiver today. and it is a doozy.  There are a couple of interesting and potentially useful nuggets ( I liked the wrap-around policies so that a family that qualifies for multiple categories of aid stay on one plan for simplicity’s sake), a couple of things that I could live with but don’t like and then work requirements tied to health insurance which CMS has always shot down.

Below is a pair of screen shots from the cost justification section of the waiver that I found utterly fascinating.  The top shot is what the state projects will be the enrollment and cost per person per month (PMPM) growth without the waiver.  The  bottom is what the state projects would happen to enrollment and costs with the waiver.  The 1115 waiver is supposed to be at least budget neutral and coverage neutral.

TLDR: Fewer people enrolled at higher costs.

Let’s look at the data below the fold:

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Late Night Open Thread: Among the Wild Libertarians

Yes, it’s almost too easy a target. But then again, they’re Libertarians, so they should be used to it by now. The NYTimes:

In a year when the two major parties are consumed by tensions, defections and chaos, the Libertarian Party, which sees itself as their alternative, displayed some of the same traits as it wrestled with nominating two former Republican governors for its presidential ticket at its annual convention over the weekend. But there was also a palpable sense of excitement at the event, held at a hotel here less than 10 miles from Disney World.

For an antiwar party that promotes legalizing marijuana and tearing up the tax code, 2016 has brought hope that acceptance in the political mainstream is imminent amid broad discontent with the probable nominees from the major parties.

The Libertarian Party is the country’s third largest by voter registration, excluding people who consider themselves independent, but it is often overlooked as a political sideshow with a hodgepodge of positions that many consider to be either overly liberal on social issues or too conservative fiscally…

Dave Weigel, at the Washington Post, is far more sympathetic:

ORLANDO — Former New Mexico governor Gary Johnson won the Libertarian Party’s presidential nomination on Sunday, fending off five rivals from different factions on two closely fought ballots and securing more than 55.8 percent of the total vote.

But Johnson’s near-miss on the first ballot kicked off an afternoon of protests and delegate glad-handing, with the vice presidential race to be decided later. Johnson had run a careful campaign with an eye on the general election, picking former Massachusetts governor Bill Weld — like him, a Republican who switched parties — as his running mate. In Saturday night’s debate, Johnson, alone among the top-five contenders, said that he would have signed the 1964 Civil Rights Act and that he thought people should be licensed to drive cars. He was loudly booed for both positions…

Johnson’s rivals, especially Libertarian activist Austin Petersen and software engineer John McAfee, saw an opportunity to drag out the process. They briefly huddled on the convention floor and worked delegates, as Johnson had unfruitful conversations with critics and then walked outside for an interview with MSNBC…

(Earlier WaPo reports here and here.)

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Peter Thiel Makes The Case For Confiscatory Taxation On Billionaires

This broke over at Forbes and is bouncing around the ‘nets today:

Peter Thiel, a PayPal cofounder and one of the earliest backers of Facebook FB +0.49%, has been secretly covering the expenses for Hulk Hogan’s lawsuits against online news organization Gawker Media. According to people familiar with the situation who agreed to speak on condition of anonymity, Thiel, a cofounder and partner at Founders Fund, has played a lead role in bankrolling the cases Terry Bollea, a.k.a. Hogan, brought against New York-based Gawker. Hogan is being represented by Charles Harder, a prominent Los Angeles-based lawyer.

Whatever you think of Gawker, Hulk Hogan, or Thiel himself, this is yet one more way in which extreme income inequality destroys civic life. It’s actually worse than many, given the clandestine way it deepens the corruption of the system that could (in theory) provide a check on the damage that purchased legislative and executive branches can do.


Here’s a take on the poison here revealed from Caterina Fake:

Champerty, as third-party litigation funding used to be called (and should probably be called again!) was formerly a crime, but the commercial litigation finance industry has been growing in recent years.

Fake notes that much of such litigation is actually a form of speculation, in which rich folks gamble on the possibility of significant payout.  One can imagine the “free market” argument that such funding levels the playing field, allows those who’ve suffered real harm to recoup, and thus makes the legal system a more efficient and effective dispute-settling and behavior-changing engine. But Thiel’s pursuit of Gawker illuminates what this leads to in the real world:

Generally, people avoid frivolous lawsuits because it often exposes them to as much scrutiny as those they sue, so what is significant about this case is that by funding Hogan behind the scenes, Thiel could get his revenge, escape exposure, and influence the outcome of the case.

For the very rich, this is a win however it goes, and damn the collateral damage.

Hogan’s lawyers made decisions against Hogan’s best interests, withdrawing a claim that would have required Gawker’s insurance company to pay damages rather than the company itself–a move that made Nick Denton, Gawker Media’s founder and CEO, suspect that a Silicon Valley millionaire was behind the suit.

I leave it to the actual lawyers to weigh in on the ethics (and consequences, if any) for such a litigation approach. For myself, I’ll note that what you have here is an insanely rich guy gaming the legal system to destroy a media outfit that pissed him off.

And with that, one more thought:  Franklin Roosevelt created the social welfare state in the US as an alternative to revolution.  Today’s plutocrats might want to think about that.  In plainer terms: to remain democracies, modern democractic states need to tax polity-buying wealth out of individual hands; income taxes and a levy on inheritances.  A 90% rate that kicks in well below an estate value of a billion bucks seems a good place to start.

A blogger can dream…

Image: Cornelius Bos, Lazarus in Heaven and the Rich Man in Hell, 1547.

Open Thread: Republicans Get Their Third-Party Challenge

From his hometown paper, the Boston Globe:

Former Massachusetts governor William F. Weld will announce Thursday that he is running for vice president, rejecting the Republican Party of which he has long been a member in favor of the Libertarian Party ticket of another former GOP governor, Gary Johnson of New Mexico, campaign aides to Johnson said Wednesday.

The two former chief executives are expected to announce their partnership Thursday in New York City, the Johnson aides said, the latest sign of the national Republican Party’s struggle to come to grips with the party’s takeover by presumptive nominee Donald J. Trump.

The decision, first reported Wednesday by the Associated Press, took Weld’s business partners and the current Republican governor, his protégé Charlie Baker, by surprise.

Weld’s strategy, according to people with whom he has spoken, is to take advantage of the anticipated media attention paid to two former governors from different parts of the country joining forces, hoping to win sufficient support to land in the televised debates….

I have a not-as-hard-as-for-most-Repubs spot in my heart for Bill Weld, among the last of the old-time Moderate Northeastern Repubs (and the guy who signed the very nice form letter required before our Wiccan friend could legally perform our marriage ceremony in this state). He has every reason to despise the Frothing Rightwing Nutball wing of his former(ish) party, per the NYTimes:

Mr. Weld’s best-known previous turn on the national stage was in 1997, when he resigned as governor to focus on his appointment by President Bill Clinton as ambassador to Mexico.

That did not go well: He was blocked by Senator Jesse Helms and withdrew his nomination after a heated battle in which Mr. Weld, a pillar of what was left of the moderate northeastern Republican establishment, loudly assailed Mr. Helms and the archconservatives who stood behind him.

A former prosecutor, Mr. Weld could appeal to some disaffected Republicans on a ticket alongside Mr. Johnson, at a time when other efforts by Republicans to recruit a third-party candidate — in part in the hopes of keeping anti-Trump Republican voters from staying home and costing the party’s lower-tier candidates — are close to fizzling…

I know next to nothing about Gary “420” Johnson, former governor of New Mexico, although I’m sure some of you can clue me in. (One reason Weld is a good choice: He gets attention from the ‘one of us’ Northeastern media claque.) The Libertarian National Convention will take place in Orlando over the Memorial Day Weekend, after which (assuming they beat their challengers; I’m assuming there will be challengers?) Johnson/Weld 2016 can start campaigning for the 15% polling level that will ensure them a spot at the national presidential debate…

It may be a portent that the news has already managed to get the Daily Caller overexcited…

Open Thread: The Free Staters Are Coming (Again)

Ah, a political splinter group which we can all agree deserves our mockery! From the Mother Jones article:

On February 18, hundreds of libertarians will flock to the Radisson Hotel in Manchester, New Hampshire, for the ninth annual Liberty Forum, a four-day conference featuring presentations on topics such as religious freedom, school choice, and “Anarchy: Dressing for Success.” A big draw will be Edward Snowden’s keynote speech, delivered over a live video stream. As the exiled NSA whistleblower speaks, conference goers may mull their own flight from government oppression—not to Russia, but to the haven of New Hampshire.

The Free State Project, which runs the Liberty Forum, has spent 15 years trying to recruit 20,000 libertarian-minded activists to take up residence in the Granite State. By accruing a critical mass of small-government advocates in a state with just 1.3 million people, the project seeks to exert substantial influence on state politics to create a utopia of social liberties and deregulated markets. Those who sign the Free State pledge promise to make the move to New Hampshire once 20,000 participants have signed up. Now, with 19,858 signers, the project’s organizers say they are finally recruiting the last of those volunteers.

However, the organizers readily admit they don’t know how many of the would-be Free Staters will actually come to New Hampshire. “That is the million-dollar question,” says Free State Project president Carla Gericke. “It’s all speculative at this stage.”…

I think that should be declared the official Libertarian motto: “It’s all speculative at this stage.”

Since [2003], 1,909 early movers have settled in New Hampshire, according to organizers. They have started a church, installed Bitcoin ATMs, and protested against an Uber ban. One Free Stater became a school board chairwoman and then used tax money to pay private school tuition for kids in her district. Free Staters in Grafton tried to declare their no-stoplight town a United Nations-free zone. In Keene, libertarian transplants upset old-timers by videotaping and challenging parking officers enforcing “the king’s tariff.”…

Still, it only became obvious recently that the project would hit its 20,000-pledge trigger. Last fall, after years of standing around conferences with clipboards and taking out advertisements in Reason magazine, the project’s organizers turned to Facebook. More than 2,500 new participants signed on during a four-month ad campaign targeting users who “liked” pages for Bitcoin, “voluntarism,” and George Carlin. In recent weeks, the group has ramped up its Facebook ad spending to $500 a day. Nearly 20 early movers have been arriving in New Hampshire each month—even in winter. “I really hope we can build something that’s historic,” Gericke says. “People are coming.”…

I’d like to hope that those Free State Projectors will spend the days between now and the NH primary harassing the media following the various GOP candidates, but I suspect they’re too busy screwing up the Sanders GOTV campaign. Nice enough people, individually, those Free Staters, but most of them could screw up a free lunch by asking for the change, as the proverb says.

Open Thread: The Grift Dream Will Never Die!

It says something about the sheer inanity of this year’s Repub field that Little Prince Rand can’t even get point-and-mock traction with stuff like this. Not to mention (via) Audit the Ted, because “the Ted Crus” receives funds from “the Goldmaine Sox”:

“I even like his hair!”