[bumby]

Because it's not as simple a model as "access vs. cost". It's access vs. quality vs. cost.

Canada's HAQ index in 2015 was 87.6 vs. 81.3 for the US. However, Canada spent about $27B US on R&D vs. $495B for the US. On a per capita basis, the US outspends most the world on medical R&D. That drives the US total healthcare costs up while helping to drive down the healthcare quality costs elsewhere. To a certain extent, the US subsidizes the healthcare costs through much of the world, effectively allowing them to optimize for a 2 parameter model while the U.S. must still deal with a 3 parameter model.

[jason0597]

Yes, the US spends much more per-capita on medical R&D than other countries. But how do we know all this money is going into real R&D? How do we know most of it is not going into e.g. me-too drugs?

[bumby]

That's a potential real problem, but the concern should be across the board (i.e., how do we know other countries aren't funding me-too drugs) so it doesn't really help illuminate any disparity between countries (which is the context of this discussion).

I'm not trying to be dismissive, I just don't know how it's germane to the discussion unless we view all the other data through the same lens. The data I linked is per country in absolute and per capita basis that tries to put it in unbiased terms.

Are you claiming the US is disproportionately funding non-useful research? If so, how do we measure "useful" research funding?

[jason0597]

I do not know how to objectively measure useful research funding. However, this discussion reminded me of a graph I saw on the wtfhappenedin1971.com site [1]. It's not direct measurement of R&D development, but it sure as hell doesn't paint a good picture for all the spending that's going on. I wouldn't be surprised if a similar allocation of funds was happening in medical R&D as well.

[1] https://wtfhappenedin1971home.files.wordpress.com/2020/05/ey...

[bumby]

Yes, I'm familiar with that graph. There's a similar one for college tuition in the U.S.; interesting that both are industries where costs have been growing at more than GDP year over year.

However, the point between comparing countries still holds. If you use older data, you'll see that the U.S. had even more disproportionate R&D funding

[coliveira]

The important issue is that R&D spending is not a good measure of outcomes. A lot of R&D spending goes to high administrative salaries, equipment, facilities (real estate), and related costs that do not translate into outcomes.

[bumby]

What would you propose as a better metric of innovation?

I don't think there's a single perfect measure but if you put it in broader context of measures like Nobel prizes R&D spending, patents, etc. it does seem to paint the picture that the US disproportionately contributes to medical innovation.

It's very similar to the measure of health. There is no single great metric. Using a single metric like BMI or blood pressure is flawed. However, you can get a clearer picture if you bring together multiple metrics.