site banner
PaperclipPerfector  3d ago (text post)   2236 thread views

Small-Scale Question Sunday for January 5, 2025

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

2
Top Bottom Old Controversial Comments
Jump in the discussion.

No email address required.

For context for those not in the know, prep is a drug that allows for participation in gay orgies without contracting HIV. Your US insurance is legally required to provide it at no cost (thanks Congress). It is not especially cheap to your insurer, and those costs are covered by elevated prices for users in general.

I don’t believe the orgy is required.

You know what else isn’t cheap to your insurer? Anything on this list. Those drugs reach about 30x as many people as Prep (circa 2021), and most of them cost more per month.

If you’d like to complain about healthcare spending, there are plenty of better targets that don’t rely on baiting a disgust reaction.

I too am very smart and can't think of any difference between a drug that treats blood cancer and one that treats a lifestyle choice.

The comparison between the drugs that treat type 2 diabetes/cardiac issues and those in question is left for the reader.

I don’t believe the orgy is required.

I haven't run the numbers, but I've been friends with a decent amount of gay men in my life, and my impression is that this particular virus would have no chance to spread among the non-drug-addict population, if gay men had about the same amount of sexual partners as straight men.

Eh, sodomy is just much much riskier than having sex the proper way.

I don’t believe the orgy is required.

Sure, it doesn't have to be orgies, but doing a lot of sleeping around with partners you don't know well is the main use case. Rates of HIV transmission for PIV sex are less than one per 1000 instances of sleeping with an infected partner. Even the highest risk forms of sex are about 1 in 72 chance, though I get that that's certainly high enough that you wouldn't want to cavort with a person known to be infected without prophylaxis. Meanwhile, drugs to suppress viral load in an infected individual, which should be done anyway to prevent the deleterious health effects, also prevent HIV transmission, so if this is with someone you know has HIV, it isn't needed, provided they just use that. The chief use case, then, is if you're often sleeping with people (especially men with men) whom you don't trust or don't know whether they have it.

That said, I agree that in general, it should be possible to buy insurance with fewer mandated things, especially along hydroacetylene's take-responsibility-for-yourself lines.

If you’d like to complain about healthcare spending, there are plenty of better targets that don’t rely on baiting a disgust reaction.

I have no issue with baiting a disgust reaction here. Taxpayer money to enable behavior that I find reprehensible is more distasteful than taxpayer money wasted.

I mean, a health insurance plan with an ‘on your own head be it’ provision so it doesn’t cover type-2 diabetes or HIV treatment is a major market blind spot which healthshare partly exists to solve.

I believe the generic drugs (now available in the US) are much cheaper:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9341201/

The list price of PrEP medication and its impact on the ability to scale up use to have public health benefit was described in research literature as early as 2008, four years before the drug was approved. A study published that year assessed the cost effectiveness of implementing a PrEP program targeting men who have sex with men in New York City. The model to determine cost-effectiveness used the 2007 wholesale list price of TDF/FTC, which the authors note was $31USD per pill, making the monthly supply $930USD.

On May 16, 2019, Gilead Sciences CEO Daniel O’ Day testified in front of Congress on the pharmaceutical company’s reasoning for keeping the price of TDF/FTC at approximately $1800 for a 30-day supply. O’Day offered that despite the high cost of the medication, it did not impede access, stating, “We offer a wide range of programs to help ensure that people have access to Truvada when they need it. For example, 98% of people who use our copay Assistance Program have no out-of-pocket costs.

Luckily, several structural changes recently have helped turn the tide on some of these upstream structural barriers to PrEP access. The U.S. Services and Preventative Task Force A grade rating for PrEP in 201911 helped reduce or eliminate cost sharing for PrEP. In 2021 as generic TDF/FTC became more widely manufactured and reduced the price of a 30-day supply from $1800 for brand name PrEP down to $40 for a generic, many of these restrictive payer and clinical guideline policies have been removed.

Mentioned this a few weeks ago, iirc it's $20,000 a year. Something like 10x my entire lifetime of medical expenses, but I end up paying for it anyway.

@self_made_human’s source suggests that it’s dropped to $40/month, better than most of these Medicare prescriptions. Probably fewer users, too.

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats