The problem is the NPV calculations - tying you money up from 15 years before you see a return in a high risk sector ( where most things fail ) - doesn't make mathematical sense.

What makes mathematical sense is to rely on optimists to try anyway and then buy them at the right time when you can get the most return on your investment.

This is what a company like Pfizer does - it goes around buying innovative companies - taking the products and sacking the people [1]. They are extremely successful - but if everybody behaved like that we'd be fcked.

( I over emphasise for effect - but broadly true )

Indeed, that is the likely scenario as humans are greedy. People generally don't have the will to hold out for the bigger rewards, they want instant gratification to quash the feelings of their greed in the moment. They don't have to choose instant gratification, but if they want to then I suppose investment helps ensure that they still work on something useful when instant results cannot be seen.

That is not what most of us want in a democracy otherwise we would never go forward. Our society expects the government to Lead and not simply comply with the current mood. That is the problem we have now when every action is calculated on short term election result and not long term benefit for the whole society. If a democratic government were supposed to only enforce the majority expectations we would never change those expectation and our view of what is right/wrong.

If that were the case we would let leaders rise up to take the lead instead of calling on representatives to carry our messages to the central meeting place. It may be your dream to be able to sit back to not have to speak with your representative frequently – and fair enough, democracy is unquestionably hard work! – but that sentiment is not at all reflected in the democratic societies that I'm familiar with. Most definitely not the USA, which HN is skewed towards. American society as a whole is quite clear about the importance of hiring public servants to represent the people, to not have rulers take over. There is no liberty held more dear. Indeed, there are always outliers who don't align with the rest of the society. Hence why we have government to clean them up. Unquestionably there are Americans who don't believe in, or at least don't wish to participate in, democracy, but the individual does not a society make.

There are societies that do expect leaders to take the lead. It is not an unheard of concept and you might even stay it is historically common. But those are not democratic societies.

However looking from the outside, it does look like democracy is failing in the US.

The problem appears to be that it's money, not the people, who have the largest influence on who is elected.

The large amount of money swirling in the system, and the pretty much unregulated use of very powerful persuasive tools - has corroded the US democracy.

Today the technology allows you to surround each and every person in their own advertising bubble online - all data driven to get the outcome the payers want.

And then the effect of the candidates needing money to get elected - and them having to sign up to stuff just to get the money.

Take sensible gun reforms - something that poll after poll suggests there is broad support - is effectively blocked by the arms lobby.

Is it blocked or has society not needed to bring the outliers in line? (Democratic) government isn't there to lead. Government is there only to clean up after society recognizes that some are not falling into line. Society must lead. Saying "Yes, I support gun reforms" in a random poll isn't the same as action, of course. Also looking in from the outside, I don't see any real societal movement on this front.

Funnily enough, in my country where we do find clear societal movement that pushed to move away from guns in our history, and a government that stepped in to clean up the outliers who still tried to wield guns afterwards, it was rooted in society wanting to protect their money from the poor and aboriginals. If it is such that American society is driven by money above people, it is curious that there isn't the same kind of interest in protecting that money from people.

Perhaps money in the USA isn't as important as it appears to those of us only looking in?

Public servants carrying out messages? Really? Like a post office? Is the society which lives up to this noble standard aware of the more modern versions of these servants, such as, gee I don't know, TCP/IP?

Or maybe society doesn't want a constant referendum mode (fine by me, I'd expect it to be a spectacular disaster), and prefers servants to have a bit of built-in intelligence? But it causes behaviors which make them indistinguishable from leaders, e.g.: coming up with new ideas, influencing others, attempting to shape the future. I don't see anyone arguing for dumber representatives (I mean... not explicitly!), so seemingly the majority agrees.

> American society as a whole is quite clear about the importance of hiring public servants to represent the people, to not have rulers take over. There is no liberty held more dear.

False dilemma. The liberty held dear is the liberty to fire the representatives. A "leader" is not a synonym of "ruler". There is surely a lot of options between "servants" and "rulers taking over" (whatever the latter is supposed to mean).

Treating an illness is even more profitable than curing it though

If you could cure it, you could charge more than treatment - because it's more valuable to the person getting cured. If you had cancer with a 5 year expected survival rate, would you pick (arbitrary round numbers)

$10,000 per year in treatment to manage it but you've still got cancer.

$55,000 paid over 5 years, $5000 more than you would pay to just manage it, but you also don't have cancer any more.

Imagine you invent a way to cure cancer and it costs you 10000$ a treatment. How much do you charge the customer? Two times that? Ten? Twenty? At what point is someone going to stop in and force you to sell at a lower price? How long till public opinion turns against you? What if competition forces the price down? There are lot of variables that might lead to you ending up at 10000$ + a few percent profit margin.

Now imagine you have a medication that's 100$ a dosage. You sell it for 120$. That's 84 doses to cover the cost of a cancer treatment. Assuming the same markup on treatment that's 100 doses.

At this point it's the simple question what the company is more likely to get away with: Many small doses with a profit margin that add up? Or one large treatment with a big profit margin?

Right now reality shows that the small doses seem to work better. An example would be insulin. In the US it costs 30$ a dose upwards. Production costs are at less than 10$. [0] That's a 200% markup.

With numbers like these, why would you ever cure something?

[0]: https://marketrealist.com/healthcare/cost-to-manufacture-ins...

The lower bound is surely the same as long term treatment, right? No player here would choose more expensive treatment that doesn't cure the patient. Insurers get premiums for longer if you live, and governments rely on having a workforce.

If governments act beyond the bounds of negotiating as a large buyer and legislate, have they not already done that for the treatment already? Is there as much to lose as you think?

> With numbers like these, why would you ever cure something?

Because you can charge more. Being cured is better than not being cured. If being ill and getting partially treated cost $100/month, would you honestly not pay $100.01/month forever but be cured?

Your arguments about public opinion and pressure rely people stepping in because your business practices are immoral, but this is what you're already accusing them of without any actual repercussions.

> What if competition forces the price down

If someone has a cure cheaper than your non-cure, frankly you're already fucked as a business. This also means that anyone who isn't the current main supplier has a very obvious reason to release an actual cure because then they'll get all of the business.

Assuming free market, the cost of total cure will probably settle on at least 2-5x of an average life expectation times a treatment cost per year, minus some minor operational expenses.

Are you assuming multiple suppliers for that cure or a single supplier?

Very different. In the case of a single supplier - wouldn't it make sense to pay everything you own ( minus what else you need to live ) to survive?

In the case where there were multiple suppliers ( with no collusion between them ) - then the price could be driven down to the cost of production, rather than the value that it brings.

So for example food is essential to live - yet it's cheap.

That's assuming you get to negotiate with every customer. If it's one price for everyone then while what you say is true for each person's max (ignoring the complexity of people looking after others, the same logic applies of "everything you can afford") that's different for everyone so the optimal price can vary.

The solution there is to sell the same thing to different people at differences prices - lots of ways of doing this.

For example America pays lots more for it's pharma drugs than other countries.

You have to actually treat it though - if the patient dies, it isn't profitable either. I suppose (all morality aside), the optimal profitability would be in a cure that required an annual installment fee.

Everyone dies of something - you don't save lives, you delay death.

The older people are the more likely they will have multiple chronic things to be treated - diabetes, arthritis etc .

This is one of the challenges that society hasn't quite got to grips with yet - and it's why health care costs are climbing ever upwards.

I'm interested to know why you think this.