Americans Cross Border into Mexico to Buy Insulin(khn.org)
khn.org
Americans Cross Border into Mexico to Buy Insulin
https://khn.org/news/americans-cross-border-into-mexico-to-buy-insulin-at-a-fraction-of-u-s-cost/
121 comments
The Wynns went there about 5 years ago. To sum it up: It's a dental free-for-all, and there's no accreditation process or licensing, and everyone there is trying to sell you something on commission. But if you find a good dentist, you'll pay about 30-40% of what it'd cost in the US.
https://www.youtube.com/watch?v=KAECrmAOqy4
https://www.youtube.com/watch?v=KAECrmAOqy4
It is not just insulin. Prices of all drugs have been rising in the US, from 2x to 3x at a minimum, to 1000x in some cases.
The reason is insurance. When individuals are paying for drugs, drug companies can only charge what individuals can afford. When insurance is paying for drugs, drug companies charge what insurance companies can afford, and insurance companies are able to pay much higher prices (and they recover their costs by raising premiums.) You can't blame pharmaceutical companies for not leaving money on the table.
The fact that Medicare is legally not allowed to negotiate drug prices (a big handout by Bush administration to Big Pharma) isn't helping either.
The reason is insurance. When individuals are paying for drugs, drug companies can only charge what individuals can afford. When insurance is paying for drugs, drug companies charge what insurance companies can afford, and insurance companies are able to pay much higher prices (and they recover their costs by raising premiums.) You can't blame pharmaceutical companies for not leaving money on the table.
The fact that Medicare is legally not allowed to negotiate drug prices (a big handout by Bush administration to Big Pharma) isn't helping either.
If that'd be the case then any country with a single-payer healthcare system would suffer from similarly inflated drug prices as the US, but that's simply not the case [0].
What's stopping US insurers from pressuring drug companies into price agreements? Shouldn't that be also in their best interest, instead of just passing the costs along to the patients? If that's all they are doing, what do you actually need them for?
In Germany, price agreements between drug manufacturers and insurers happen plenty of times, and it usually works out because drug companies take reduced profits over no profits, any time of the day. Patients still have the option to buy the "fancy version", paying out of their own pocket, but the vast majority of patients are completely fine with whatever their insurance covers.
[0] https://www.commonwealthfund.org/publications/issue-briefs/2...
What's stopping US insurers from pressuring drug companies into price agreements? Shouldn't that be also in their best interest, instead of just passing the costs along to the patients? If that's all they are doing, what do you actually need them for?
In Germany, price agreements between drug manufacturers and insurers happen plenty of times, and it usually works out because drug companies take reduced profits over no profits, any time of the day. Patients still have the option to buy the "fancy version", paying out of their own pocket, but the vast majority of patients are completely fine with whatever their insurance covers.
[0] https://www.commonwealthfund.org/publications/issue-briefs/2...
Insurance companies in the US have to pay out a certain percentage of the premiums they take in (80% last I checked) [0]. So they're also incentivized to let prices climb; their 20% for "administration and profit" is inflated when prices are inflated.
[0] https://www.healthcare.gov/health-care-law-protections/rate-...
[0] https://www.healthcare.gov/health-care-law-protections/rate-...
That makes sense if it’s a monopoly, but presence of many insurance carriers and variety of plans introduces some price checks.
Insurers routinely exclude drugs that they think are overpriced, they also switch to generics the day a drug goes off patent, sometimes forcibly.
Insurers routinely exclude drugs that they think are overpriced, they also switch to generics the day a drug goes off patent, sometimes forcibly.
In the US, three pharmacy benefit managers (PBMs) control >70% of the market. [1] In an oligopoly, higher prices aren't such a bad thing.
[1] https://www.fda.gov/NewsEvents/Speeches/ucm599833.htm
"Capturing the Benefits of Competition for Patients" Speech by Scott Gottlieb, MD Commissioner of Food and Drugs March 7, 2018
[1] https://www.fda.gov/NewsEvents/Speeches/ucm599833.htm
"Capturing the Benefits of Competition for Patients" Speech by Scott Gottlieb, MD Commissioner of Food and Drugs March 7, 2018
> Shouldn't that be also in their best interest, instead of just passing the costs along to the patients?
But aren't those cost actually being passed onto the employer via the employees health care plan?
Here is Australia, where we have universal help care, we have a system call PBS and it's role is to define the drugs that get subsidized under that universal help scheme.
To keep those cost down it tries to pick generic versions of these drugs.
When Australia join a free trade agreement with the USA a side affect of joining that agreement was a weakening of the PBS.
We now have a situation where drug companies are able to manipulate the PBS for their gain, coming at the expense of the tax payer:
https://theconversation.com/the-tricks-companies-use-to-get-...
But aren't those cost actually being passed onto the employer via the employees health care plan?
Here is Australia, where we have universal help care, we have a system call PBS and it's role is to define the drugs that get subsidized under that universal help scheme.
To keep those cost down it tries to pick generic versions of these drugs.
When Australia join a free trade agreement with the USA a side affect of joining that agreement was a weakening of the PBS.
We now have a situation where drug companies are able to manipulate the PBS for their gain, coming at the expense of the tax payer:
https://theconversation.com/the-tricks-companies-use-to-get-...
> When individuals are paying for drugs, drug companies can only charge what individuals can afford.
Insurance companies are consumers’ only venue for price negotiation.
Sick people in urgent need of a drug will likely not shop around, they will pay the asking price, sign up for any financing plan offered if the sticker price seems too high, or just charge it to the credit card.
Insurance companies are consumers’ only venue for price negotiation.
Sick people in urgent need of a drug will likely not shop around, they will pay the asking price, sign up for any financing plan offered if the sticker price seems too high, or just charge it to the credit card.
The fact that Medicare is legally not allowed to negotiate drug prices (a big handout by Bush administration to Big Pharma) isn't helping either.
That's entirely untrue.
Medicare pays for drugs either through Part B or Part D. In Part B, Medicare takes a discount by fiat, they get the same discount as commercial insurers.
For Part D, Medicare push the drug purchasing to private companies who can negotiate, lowering the cost of premiums.
Saying "Medicare can't negotiate" is technically true if you twist the meaning of the words, I guess?
That's entirely untrue.
Medicare pays for drugs either through Part B or Part D. In Part B, Medicare takes a discount by fiat, they get the same discount as commercial insurers.
For Part D, Medicare push the drug purchasing to private companies who can negotiate, lowering the cost of premiums.
Saying "Medicare can't negotiate" is technically true if you twist the meaning of the words, I guess?
So what you're saying is that private companies can negotiate on Medicare's behalf, but that they can't negotiate themselves. Sounds like they can't negotiate to me.
What would they negotiate for? They aren't directly paying for the drugs.
"Oh hey, can you charge this other guy less money for me?"
"Oh hey, can you charge this other guy less money for me?"
> What would they negotiate for? They aren't directly paying for the drugs
They are in Part B, by your own description, but instead of negotiatinh they just get the deal that commercial insurers (who each have less leverage than Medicare would) get.
And in Part D they are subsidizing the actual payors, and it wouldn't be entirely unheard of for a participant in that role to negotiate costs for services purchased by the subsidized payors, each of which had less negotiating power than the central subsidizer.
They are in Part B, by your own description, but instead of negotiatinh they just get the deal that commercial insurers (who each have less leverage than Medicare would) get.
And in Part D they are subsidizing the actual payors, and it wouldn't be entirely unheard of for a participant in that role to negotiate costs for services purchased by the subsidized payors, each of which had less negotiating power than the central subsidizer.
In terms of Part B, commercial insurers play no role at all. What happens is the drug companies send in their sales to Medicare and they crunch an average price and pay that. Think of it as Medicare riding on the coattails of the commercial plans.
For Part D, I see your point, but research has found that the Medicare price that insurers negotiate for drugs is often less than what commercial plans pay, so they are doing a good job on behalf of Medicare.
One thing to keep in mind can you really call it a "negotiation" when one of the parties represents a sovereign entity? CMS (Centers for Medicare and Medicaid) gets even more discounts above what I described earlier. For example, the 340B discount knocks 23.1%+ right off the top. Same thing for Medicaid. There is no negotiation here, the gov't simply says, "we get this discount or we ban you from participating in public programs".
For Part D, I see your point, but research has found that the Medicare price that insurers negotiate for drugs is often less than what commercial plans pay, so they are doing a good job on behalf of Medicare.
One thing to keep in mind can you really call it a "negotiation" when one of the parties represents a sovereign entity? CMS (Centers for Medicare and Medicaid) gets even more discounts above what I described earlier. For example, the 340B discount knocks 23.1%+ right off the top. Same thing for Medicaid. There is no negotiation here, the gov't simply says, "we get this discount or we ban you from participating in public programs".
> One thing to keep in mind can you really call it a "negotiation" when one of the parties represents a sovereign entity?
Yes, sovereign entities negotiate all the time; being a monopsony is probably more relevant than being sovereign, but arguably only a monopsony can negotiate on fair terms with a monopoly supplier.
Yes, sovereign entities negotiate all the time; being a monopsony is probably more relevant than being sovereign, but arguably only a monopsony can negotiate on fair terms with a monopoly supplier.
Balance of power makes those less negotiations and more fiats.
Not sure about some of the numbers there. They say that a 3 month supply is $3700.
Humalog without insurance costs $95 per 3 ml cartridge, let's say it's a $100. This would mean that this child needs 37 cartridges for 3 months, or 12 cartridges per month, 3 per week.
That's a pretty crazy amount of insulin. I'm a T1 diabetic, that doesn't eat particularly healthy, and I need 2-3 cartridges a month, almost an order of magnitude less than the person in the article.
I don't think those numbers are right.
Humalog without insurance costs $95 per 3 ml cartridge, let's say it's a $100. This would mean that this child needs 37 cartridges for 3 months, or 12 cartridges per month, 3 per week.
That's a pretty crazy amount of insulin. I'm a T1 diabetic, that doesn't eat particularly healthy, and I need 2-3 cartridges a month, almost an order of magnitude less than the person in the article.
I don't think those numbers are right.
> Humalog without insurance costs $95 per 3 ml cartridge, let's say it's a $100.
You have a citation that it’s available from every provider in the country at that price? The person quoted specifically said they’d been quoted that much and I would assume that people aren’t making up reasons to go on 5 hour drives.
You have a citation that it’s available from every provider in the country at that price? The person quoted specifically said they’d been quoted that much and I would assume that people aren’t making up reasons to go on 5 hour drives.
I don't. I have this link that lists a bunch of providers and their prices and I don't see anyone going over $100 per 3ml cartridge: https://www.goodrx.com/humalog?dosage=3ml-of-100-units-ml&fo...
Of course, there might be a more expensive provider that I don't know of.
I don't think that those people are making up reasons to go on 5 hour drives, but I do think it's quite likely that journalists fudged the numbers or just found some theoretical maximums and approximated the price from there. Just so it's a juicier story, of course.
Of course, there might be a more expensive provider that I don't know of.
I don't think that those people are making up reasons to go on 5 hour drives, but I do think it's quite likely that journalists fudged the numbers or just found some theoretical maximums and approximated the price from there. Just so it's a juicier story, of course.
It’s a direct statement from one person, not approximation. Either the journalist or the source has to be wrong for it to be incorrect. It’s possible but I’m assuming this is yet another example of the exhaustively documented broken economic model in American healthcare producing wide varaiation as everyone charges whatever they can get away with.
i have had several insurances and switched between sometimes having to pay upfront cost, for a 10/ml vial it is around 230. I know, for example, I need around 9 vials per 3 months. pretty expensive stuff.
*edit, as I am on an insulin pump I only take fast-acting insulins. Lantus/Levemir other longer acting insulins usually are more expensive than the fast-acting stuff.
*edit, as I am on an insulin pump I only take fast-acting insulins. Lantus/Levemir other longer acting insulins usually are more expensive than the fast-acting stuff.
They say her 3 month supply was $3700. Branding and "format" will affect the numbers. Pen? Vile? Pump? Humalog? Novalog? did the somewhat vague "3 month supply" include both short and long acting versions in the price tag?
I don't doubt the numbers, but I do detect some omission/simplification to make it seem extra stark.
I don't doubt the numbers, but I do detect some omission/simplification to make it seem extra stark.
Key phrase from the article is "modern generation of insulin". A good overview of the design and effects of the new insulins are here :
https://onlinelibrary.wiley.com/doi/full/10.1111/dme.13692
( "Lessons for modern insulin development" ).
Still even with prices of modern insulins I'm not sure it makes much sense.
Fiasp is an example of one of the most modern ones and still I can't find a price higher than $125 per 3ml: https://www.goodrx.com/fiasp?dosage=3ml-of-100-units-ml&form...
Fiasp is an example of one of the most modern ones and still I can't find a price higher than $125 per 3ml: https://www.goodrx.com/fiasp?dosage=3ml-of-100-units-ml&form...
rotated between novolog and humalog 10/ml vials quite a bit (insulin pump - don't use long acting) and they are priced identically.
Basing things on previous numbers for myself (my insulin has changed since then because the insurance gets to override my doctor and experience).
Assuming
- 50 units of Lantus per day -> 4.5 vials per 3 months @ 300/vial = 1,350 USD/month
- 80 units of Apidra per day -> 7.2 vials per 3 months @ 300/vial = 2,160 USD/month
total = 3,510 USD/month
Now, to be fair, I'm older and have more insulin resistance than a younger diabetic would. Either way, the numbers without insurance add up real quick.
Assuming
- 50 units of Lantus per day -> 4.5 vials per 3 months @ 300/vial = 1,350 USD/month
- 80 units of Apidra per day -> 7.2 vials per 3 months @ 300/vial = 2,160 USD/month
total = 3,510 USD/month
Now, to be fair, I'm older and have more insulin resistance than a younger diabetic would. Either way, the numbers without insurance add up real quick.
I think your numbers here are either out of date or not consistent for some reason. I got a batch of Humalog yesterday which claims 'retail price $1416.59' for 10 100 unit pens.
I didn't know this was news. My mother, a US resident who's lived in the US for ~30 years, in a border town, goes across every time she needs any sort of medical care.
The Red Cross only takes cash, but it's so much cheaper (actually affordable).
The Red Cross only takes cash, but it's so much cheaper (actually affordable).
Huh, who woulda thought paying cash would be cheaper than filing a bunch of forms with an insurance company, giveing them a hefty discount, then waiting a few months to get paid.
Agreed. Many years ago I knew people who worked in an IVF office in Northern California. There was some drug they needed / used / prescribed / ??? that was crazy expensive. One of the nurses would drive down to Tijuana once a month to stock up. I thought this was just common practice.
Insulin has been manufactured for decades, and is made by more than one company. Why are the prices rising?
Not all insulins are the same. My guess is that this insulin is glargine (https://en.wikipedia.org/wiki/Insulin_glargine) which just came off of patent in 2015. Glargine is a synthetic long-acting form of insulin that gives allows absorption without peaks, which is much better than previous types of long-acting insulins.
Short acting is the biggest problem. There's no generic for it.
My understanding is that there are insulin analogs that are vastly better treatments, due to being faster acting. These analogs are still patented.
However, even considering the patents, insulin prices for the same product are much higher in the USA than in Mexico or Canada. American prices have increased by an order of magnitude. [1]
IMO this rampant price gouging can only be explained by the pharmaceutical lobby, and a political apparatus addicted to their money.
[1] https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-i...
However, even considering the patents, insulin prices for the same product are much higher in the USA than in Mexico or Canada. American prices have increased by an order of magnitude. [1]
IMO this rampant price gouging can only be explained by the pharmaceutical lobby, and a political apparatus addicted to their money.
[1] https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-i...
It sounds like the solution should be that patients can opt for cheaper, worse treatments, if they do not like that the more recent treatments are also more expensive.
Why? Why should people have to pay inflated prices for treatments that have been standard since the 90s?
Edit: just to be clear, the price of Humalog, a patented analog, has increased in price by 700% in the last 20 years. This is not simply a case of newer treatments being more expensive.
Edit: just to be clear, the price of Humalog, a patented analog, has increased in price by 700% in the last 20 years. This is not simply a case of newer treatments being more expensive.
[deleted]
The short answer is patents. There's a cartel of a few makers (Novo-Nordisk, Lily and Sanofi) that slightly "improve" their insulin every few years to extend the patents. There are some generics available but they're not the fast-acting kind most diabetics use.
The perverse one is where the new patented version is only marginally more effective but 5x the price and they stop making the old one.
It's a sick system.
It's a sick system.
Is the new, still under patent, insulin that much better than what would be available to a generic manufacturer? If the previous generation would work for plenty of patients that’s a huge market opportunity.
What do you mean extend the patents? Making a new version of insulin prevents the older version from going out of patent?
[deleted]
Unlike most drugs insulin is derived from animal cells so it’s not really possible to make a generic because you can’t demonstrate that your end product is identical to an existing product (at least not as far as the FDA is concerned).
The formulations are constantly tweaked by manufacturers to evergreen the patents too. New patents allow the price to be pushed up without risking new competition arriving.
The formulations are constantly tweaked by manufacturers to evergreen the patents too. New patents allow the price to be pushed up without risking new competition arriving.
Insulin has been produced by bacteria since the 1980s when recombinant DNA techniques became viable. That’s very precisely controllable compared to the historic animal sources.
Because endless profit growth is the only thing that matters regardless of the morality or reality of the situation. And what better market to exploit than one where most people have to make a decision between being priced gouged or death.
This is of course an extremely simplistic way of looking at it but the reality is that we allow companies to abuse the patent system (under the guise of making research profitable for profiteering medical research) making generics impossible for things such as Insulin.
This is of course an extremely simplistic way of looking at it but the reality is that we allow companies to abuse the patent system (under the guise of making research profitable for profiteering medical research) making generics impossible for things such as Insulin.
Most insulin companies are not really making endless profit growth. They are very profitable but not by as much as you think. Secondly, no one runs a business of charity. Can't really blame them if they want to make huge profit by offering you something you really want.
The real solution here is that FDA needs to close the loopholes on the patents that help them renew patents indefinitely. Secondly, drug import must be simplified from countries like Canada, China and Mexico for personal consumption.
Third, people should opt for cheaper alternatives which might be slightly less effective than cutting edge.
The real solution here is that FDA needs to close the loopholes on the patents that help them renew patents indefinitely. Secondly, drug import must be simplified from countries like Canada, China and Mexico for personal consumption.
Third, people should opt for cheaper alternatives which might be slightly less effective than cutting edge.
I just wanted to start by addressing this one really disengenous comment
>Can't really blame them if they want to make huge profit by offering you something you really want
This isn't a company offering you something you really want. This is a company gouging the prices on something you literally need to live. So allow me to call you out on that shitty argument, first of all.
And second, many people don't have the option to opt for cheaper alternatives. They have one choice, which often leads to people having to ration their insulin and die from it [1]. So I would highly recommend you actually do some reading up on the situation before you make claims about alternatives.
[1] https://www.npr.org/sections/health-shots/2018/09/01/6416158...
>Can't really blame them if they want to make huge profit by offering you something you really want
This isn't a company offering you something you really want. This is a company gouging the prices on something you literally need to live. So allow me to call you out on that shitty argument, first of all.
And second, many people don't have the option to opt for cheaper alternatives. They have one choice, which often leads to people having to ration their insulin and die from it [1]. So I would highly recommend you actually do some reading up on the situation before you make claims about alternatives.
[1] https://www.npr.org/sections/health-shots/2018/09/01/6416158...
> This isn't a company offering you something you really want.
That is completely irrelevant in my opinion. The question is would you have have $300 insulin or none ? That is the choice consumer has unless of course someone (like government) can use coercive force against the company. In that case less companies would be willing to even enter the market.
Yes, expensive health treatment leads to death. There is nothing surprising about it. It is the way of life. But to avoid that death you can not steal from others or force others to work against their will.
That is completely irrelevant in my opinion. The question is would you have have $300 insulin or none ? That is the choice consumer has unless of course someone (like government) can use coercive force against the company. In that case less companies would be willing to even enter the market.
Yes, expensive health treatment leads to death. There is nothing surprising about it. It is the way of life. But to avoid that death you can not steal from others or force others to work against their will.
For a lot of people, the answer is none. You're advocating for the death of people who can't afford insulin which to me is completely and utterly barbaric.
In this case, the end result is going to be either the government stepping in (since the role of the government is to ideally care for its citizens) and forcing prices down, or the people suffering will eventually enact violent action against said corporations.
In this case, the end result is going to be either the government stepping in (since the role of the government is to ideally care for its citizens) and forcing prices down, or the people suffering will eventually enact violent action against said corporations.
I do not see why slavery and theft is a morally superior choice here either.
People suffering would eventually be violent towards the corporations then they would destroy what little chance they even had to survive. Most societies like Venezuella, India have tried that model and are curently at the bottom of the pile.
People suffering would eventually be violent towards the corporations then they would destroy what little chance they even had to survive. Most societies like Venezuella, India have tried that model and are curently at the bottom of the pile.
People are going to be violent when they're pushed into a corner where they have no chance of survival.
Again, you're advocating for the death of people that can't afford insulin. Why do you believe people deserve to die if they can't afford it?
Again, you're advocating for the death of people that can't afford insulin. Why do you believe people deserve to die if they can't afford it?
Also here are numbers:
Eli Lilly had a revenue of $22B with a net income of just $204M last year. So roughly they have made $1 profit for every $100 of revenue. Does not look like "endless greed for profit" to me here. In fact I will not buy their stocks.
Eli Lilly had a revenue of $22B with a net income of just $204M last year. So roughly they have made $1 profit for every $100 of revenue. Does not look like "endless greed for profit" to me here. In fact I will not buy their stocks.
The actual price the manufacturer charges hasn't been going up much. Novolog list and net prices show Novolog vial has gone up 36% in price since 2001 (less than inflation) and Novolog Pen has gone up 3% since 2001.[1]
[1] https://www.drugchannels.net/2016/12/novo-nordisk-sheds-new-...
[1] https://www.drugchannels.net/2016/12/novo-nordisk-sheds-new-...
There seem to be services that mail insulin from Canada already, which is significantly cheaper.
Is it really cheaper, or necessary to fly to Mexico to pick it up yourself?
https://www.canadianinsulin.com/
Is it really cheaper, or necessary to fly to Mexico to pick it up yourself?
https://www.canadianinsulin.com/
Since this is technically not legal, i wonder what percent get taken by customs
Same with tech actually. Busy flying a family member halfway across the world because the price diff on a single (!) laptop and cellphone covers the long haul flight costs.
Literally fly over, crash on my couch and spend a week exploring a different country for zero additional cost.
Literally fly over, crash on my couch and spend a week exploring a different country for zero additional cost.
What country and tech? I haven't heard of this before and I wonder if it's a recent phenomenon due to the strength of the US dollar.
Are you talking about the US or China?
What if this whole time the wall is really to keep US residents inside the country to make sure those hard working pharma execs get their rightful money? The slats are like those parking garage spikes that go one way -- US residents stay in, and everyone else can come in but never leave, keeping the easily exploited workforce from drying up.
Nah, that'd never happen.
Nah, that'd never happen.
[deleted]
There are five beneficiaries of these prices (or the broken system): Insurance, Doctors, Hospitals, Suppliers (Drug companies) and Politicians. It is easy to fix - fix the government (Politicians) - and everything fixes itself. And once the government is fixed, incentivize them to punish monopolies.
because it was haphazardly stitched together we ended up with healthcare that
1. does not cover everyone 2. it is rationed by for-profit companies 3. is is expensive and can bankrupt you 4. tied to employment which means you can lose it easily 5. confusing since you often have to deal with paperwork and multiple providers
If you are rich and can afford it the american system is great but it is awful for everyone else.
1. does not cover everyone 2. it is rationed by for-profit companies 3. is is expensive and can bankrupt you 4. tied to employment which means you can lose it easily 5. confusing since you often have to deal with paperwork and multiple providers
If you are rich and can afford it the american system is great but it is awful for everyone else.
4a. Because US health coverage tied to employment, it serves as golden handcuffs.
But hey, got to have those profits...
But hey, got to have those profits...
The reason health insurance became an employment perk was because of a tax loophole created during World War II. From A History of Employee Benefits and Taxation[1]:
> At the same time, the federal controls on wages was leading to significant angst and frustration among the labor market, and the threat of widespread strikes and other forms of labor protest became a serious threat to the economy and war effort. In response, the War Labor Board implemented a new income tax exemption to employers sponsoring employee health plans. This made employer contributions deductible on federal returns, while the benefits were entirely tax-free, to the employees [3].
> What started as a measure to avert crisis and labor strikes ended up becoming an expectation. As more and more employers leveraged these tax-benefitted health plans, American workers grew accustomed to getting their health insurance through work, rather than as individuals. The end of the war and the return home of American GIs exposed more workers to the new system, reinforcing its popularity and utilization [3]. By the 1960s, employer-sponsored health insurance plans had overwhelmingly displaced the formal individual market, a status that has persisted right into the start of the 21st century and provided a central tenant of the Affordable Care Act of 2008 [4].
In my opinion, this is yet another example of how even the most well-intentioned legislation can have disastrous consequences if it fails to account for incentives and second-order effects.
1. https://taxandbusinessonline.villanova.edu/resources-taxatio...
> At the same time, the federal controls on wages was leading to significant angst and frustration among the labor market, and the threat of widespread strikes and other forms of labor protest became a serious threat to the economy and war effort. In response, the War Labor Board implemented a new income tax exemption to employers sponsoring employee health plans. This made employer contributions deductible on federal returns, while the benefits were entirely tax-free, to the employees [3].
> What started as a measure to avert crisis and labor strikes ended up becoming an expectation. As more and more employers leveraged these tax-benefitted health plans, American workers grew accustomed to getting their health insurance through work, rather than as individuals. The end of the war and the return home of American GIs exposed more workers to the new system, reinforcing its popularity and utilization [3]. By the 1960s, employer-sponsored health insurance plans had overwhelmingly displaced the formal individual market, a status that has persisted right into the start of the 21st century and provided a central tenant of the Affordable Care Act of 2008 [4].
In my opinion, this is yet another example of how even the most well-intentioned legislation can have disastrous consequences if it fails to account for incentives and second-order effects.
1. https://taxandbusinessonline.villanova.edu/resources-taxatio...
This quotation carefully skirts around the actual reason why health insurance became an employment perk and why a tax loophole was created during WWII. In an intentionally deceptive way (not by the poster, but by the original author.)
People were getting their insurance through their unions. Before the unions started doing this, nobody associated health insurance with employment. This made people grateful and happy with their unions. The government, in order to weaken the unions, paid employers to give their employees insurance with a tax break.
Not understanding this makes the first sentence completely unconnected to the rest of the text. Health insurance was not a raise, heath insurance was an intentionally union-breaking subsidy to businesses to give bosses more leverage on wages.
i.e. this was not well-intentioned.
People were getting their insurance through their unions. Before the unions started doing this, nobody associated health insurance with employment. This made people grateful and happy with their unions. The government, in order to weaken the unions, paid employers to give their employees insurance with a tax break.
Not understanding this makes the first sentence completely unconnected to the rest of the text. Health insurance was not a raise, heath insurance was an intentionally union-breaking subsidy to businesses to give bosses more leverage on wages.
i.e. this was not well-intentioned.
> People were getting their insurance through their unions. Before the unions started doing this, nobody associated health insurance with employment. This made people grateful and happy with their unions. The government, in order to weaken the unions, paid employers to give their employees insurance with a tax break.
Do you have a source for this? Nothing I've read has made such a claim. Even the NYT says that the root cause of employer-based health care was wage freezes during WWII followed by the tax-exemption of employer-provided health insurance.[1][2]
1. https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th...
2. https://economix.blogs.nytimes.com/2013/07/30/the-question-o...
Do you have a source for this? Nothing I've read has made such a claim. Even the NYT says that the root cause of employer-based health care was wage freezes during WWII followed by the tax-exemption of employer-provided health insurance.[1][2]
1. https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th...
2. https://economix.blogs.nytimes.com/2013/07/30/the-question-o...
you are right, it forces people to stay in jobs they don't like a forego other opportunities like starting a business.
Yet entrepreneurism is highest in the US, not countries with universal coverage.
Goes to show that health care is not the only factor that people consider when starting a business. It's possible that other factors are significantly more important, enough so that people will start businesses in the US despite the poor health care - in my experience the availability of investment and networking opportunities is a huge factor.
Lot of variables not being controlled-for there...
What is your source for that claim?
That's the case in other countries, like France.
> If you are rich and can afford it the american system is great but it is awful for everyone else.
I know plenty of incredibly wealthy people who fly to places like France and Israel to see specialists, so take from that what you will.
I know plenty of incredibly wealthy people who fly to places like France and Israel to see specialists, so take from that what you will.
Coming from middle class in France to upper-middle class in the US, the quality of care in the US is so subpar it makes me sad.
Sure, in exchange, you don't have to plan your annual visit to the optometrist 3 months in advance, but I'd rather have a doctor that actually cares instead of useless shiny tech.
Sure, in exchange, you don't have to plan your annual visit to the optometrist 3 months in advance, but I'd rather have a doctor that actually cares instead of useless shiny tech.
Hmmm... as someone who came from Canada, I find the quality of care in the US superior to what I got in Canada.
Same (but not from Canada, from a former communist Eastern European country where there's universal healthcare). And I was in a much higher on the income ladder in said country then here in the US (relative to the country median income) and yet the health care I get in the US on the employer included plan is many times better then what I got back in Europe. To be fair I was going to the state health facilities there where my income level could afford me to go to private institutions which were vastly better, but you see, in the US I didn't have to do anything special to get better healthcare, I just went with what my employer gave me and it's much better than what the state gave me in Europe (and I was paying, in form of taxes, much more for it too).
It should be noted your opinion is contrary to every survey covering this topic I've ever seen.
I'm in the same boat as refurb, however these are just anecdotal experiences. It's possible that we're in rich areas (I know I am) and so the quality of the care reflects the clientele. In Canada it's more of a one-size-fits-all approach, but that one size is better than the average US hospital.
Indeed it's my experience only.
I would agree that the quality of care in the US has a much bigger spread than Canada. However, as a middle class person in both countries, there are benefits that you get in the US, you don't get in Canada.
I would agree that the quality of care in the US has a much bigger spread than Canada. However, as a middle class person in both countries, there are benefits that you get in the US, you don't get in Canada.
> you don't have to plan your annual visit to the optometrist 3 months in advance
Actually, US health insurance plans generally don't cover optometry. That's a separate "vision" plan that you generally only get through an employer if you are lucky. If you don't have it such a plan, you pay out of pocket.
Actually, US health insurance plans generally don't cover optometry. That's a separate "vision" plan that you generally only get through an employer if you are lucky. If you don't have it such a plan, you pay out of pocket.
I wonder if drugs are cheaper due to more relaxed regulations? the American FDA has many strict requirements around manufacturing and distributing drugs, but Mexico and Cananda do not need to follow the same standards, resulting in lower operating costs.
Lower operating costs = lower price.
Lower operating costs = lower price.
Nah.. Does the UK have lower standards or more relaxed regulations? What you're seeing here is the free market without government price control, at it's 'best'. Things in general are priced at what consumers are willing to pay. That's basically it.
"what consumers are willing to pay" is intermediated through health insurance companies, whose policy premiums have skyrocketed in the US in the last few decades.
Before relatively recently, most US medication consumers didn't understand that rising drug prices were a factor in the rise of their health insurance premiums. Now they are catching on to that, which is why it is becoming a politically important issue.
Before relatively recently, most US medication consumers didn't understand that rising drug prices were a factor in the rise of their health insurance premiums. Now they are catching on to that, which is why it is becoming a politically important issue.
This doesn’t happen with socialised healthcare that’s free at the point of service.
A government can negotiate lower prices than a commercial entity. They also can legislate to force bad actors to be reasonable.
Sadly the UK’s NHS is being slowly converted to the USAs fundamentally broken system of “what the market can bear”.
Rampant capitalism didn’t work for the banks either. They needed a social bailout when their markets crashed.
A government can negotiate lower prices than a commercial entity. They also can legislate to force bad actors to be reasonable.
Sadly the UK’s NHS is being slowly converted to the USAs fundamentally broken system of “what the market can bear”.
Rampant capitalism didn’t work for the banks either. They needed a social bailout when their markets crashed.
American healthcare is frankly - and I say this as an American - disgusting and infuriating. It needs to be re-structured from the ground up.
As a Dutch person who spoke to US people in Dutch hospitals —- who needed to pay full price —- I daresay the US health care system is worse than some 3rd world countries their health care system.
It is indeed infuriating.
It is indeed infuriating.
I think there are some differences though. "Worse" is a term that needs to define quantitatively what is worse. The quality is actually quite good here.
Agreed. In the US (just like in many places) you're not exposed to many problems if you have a good insurance and/or have enough money. The system is usually fast, you're treated well and the infrastructure, equipment etc. are great.
Life expectancy vs % of GDP spent on healthcare.
The US is a huge outlier: we spend way more than other countries and don't even live as long.
There are other ways to measure it too, which is good to investigate, as it is a complicated subject.
Here's a HN relevant way to measure it: how much time does your average 5, 50, and 500 person company spend dealing with health insurance stuff?
The startup I worked for in Italy spent 0 time on it, because it's not relevant to the company at all. Of course, Italy has massive amounts of bureaucracy for other things, which more than make up for the lack of it in health care, but that's another story.
The US is a huge outlier: we spend way more than other countries and don't even live as long.
There are other ways to measure it too, which is good to investigate, as it is a complicated subject.
Here's a HN relevant way to measure it: how much time does your average 5, 50, and 500 person company spend dealing with health insurance stuff?
The startup I worked for in Italy spent 0 time on it, because it's not relevant to the company at all. Of course, Italy has massive amounts of bureaucracy for other things, which more than make up for the lack of it in health care, but that's another story.
Using life expectancy to measure quality of health care is like using income to measure how smart you are. There may be some relationship, but too many confounding factors for it to be useful at all.
the treatment is fine. The billing practices are plain corrupt.
Part of this is because the US prices of drugs, subsidize the development of drugs around the world. Pharmaceutical companies rely on the US market to offset the R&D of the drugs, while then providing other countries with drugs above the marginal costs (which is still profitable). In this scheme, the pharma company benefits (they increase their profits) as do the other countries (they get cheap drugs). The loser in this arrangement is the US consumer who gets to pay high costs so everyone else can have ground-breaking drugs at low cost.
Please stop believing this self-serving bullshit propaganda by the companies. If other countries raised their prices, prices in the US wouldn't go down a single bit. They would just make more profits. The problem is that the US allows these insane and corrupt billing practices.
Those companies spend far more money on marketing than R&D an they’re heavily reliant on US funded research — almost every erything they do starts with NIH funding.
Source?
See e.g. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p... - it’s improved a little since then but it’s still nowhere near an explanation, especially since it’s not like drugs produced by non-US companies are massively cheaper in the US.
Not quite the proof I'd like to see. Johnson&Johnson sells a lot of things, the more purely pharmaceutical companies are closer to 1:1 in the graphic.
Then we have, Most of this marketing money is directed at the physicians who do the prescribing, rather than consumers. As Oliver pointed out, drug companies spent more than $3 billion a year marketing to consumers in the U.S. in 2012, but an estimated $24 billion marketing directly to health care professionals.
$27B in marketing but the graphic shows over $65B in R&D?
Then we have, Most of this marketing money is directed at the physicians who do the prescribing, rather than consumers. As Oliver pointed out, drug companies spent more than $3 billion a year marketing to consumers in the U.S. in 2012, but an estimated $24 billion marketing directly to health care professionals.
$27B in marketing but the graphic shows over $65B in R&D?
Total medical R&D spending in the US is a few hundred dollars per year per person, out of about $10,000 in total health care costs. That’s everything, not just private drug research. Research does not explain the huge discrepancy in costs.
For the big pharmaceutical companies, about 20% of revenues are spent on R&D. So you just paid $1000 out of pocket for a drug? About $200 of that is funneled back into R&D.
They can only do that because the US system is so broken so you are just reinforcing what the parent comment is saying (which may have been your intention but I was a little unclear on that)
Not even developing country standard, at least those countries still can afford some of it.
I've lived and worked in a few countries including the US.
In the US you are a "customer" first and then a patient. The entire healthcare system is run like a business that only cares about the money that they're making.
(Edit: small typo)
(Edit: small typo)
You are not treated as customer. You are treated like a "resource" whose wallet needs to be exploited.
Being a customer in a non-free/competitive market isn't that great.
As an example, I still can't wrap my head around the price difference in a medical bill if one has insurance or pays out-of-pocket. Providers charge insurances excessively more than out-of-pocket prices. And this is done openly. Then the insurances are charging the patient with higher premiums. I mean, come on! How is this even legal?!?
I share your frustration. I've had it go both ways, never in my favor. A chain MRI imaging provider gave me 33% off for paying cash on the condition that I not file a claim or take advantage of it against my annual out of pocket. But while transitioning between insurance companies and lacking the new card two of two specialists I saw wanted cash in advance and charged me about three times more than they were getting from me+my insurer before and then after when I finally received the insurance card.
this story cites one estimate that, for a certain list of drugs, the savings from buying in Mexico was 40-60%
that's huge. but -- how can US consumers possibly save any money by going to another country to buy a product? i thought globalization had brought US consumers free trade.
that's huge. but -- how can US consumers possibly save any money by going to another country to buy a product? i thought globalization had brought US consumers free trade.
there is no free trade in drugs,
US trade laws and agreements appear to protect certain sectors. has the US ever really had "free trade"?
The US is highly protectionist when it comes to intellectual property and agriculture. It generally only supports free trade in order to take advantage of lower labor costs and/or standards or raw materials in other countries.
How unpatriotic. I hope the border wall will also keep Americans inside to contribute to the economy instead of spending their money abroad. The health care industry needs money to survive! Pharma companies need money to do R&D! Build that wall, Mr. Trump! /s
We need to subsidize these poor drug manufacturers. It's hard times at GlaxoSmithKline.
Don't give them any ideas. They may also start not only searching your laptop and at the border but also for antibiotics.
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We only spent about 20 minutes walking around (probably spent more time in the border office), but it was a super memorable pit stop for me.