US Insulin prices 8 times higher than in other nations(eurekalert.org)
eurekalert.org
US Insulin prices 8 times higher than in other nations
https://www.eurekalert.org/pub_releases/2020-10/rc-uip100620.php
268 comments
Abuterol/Ventolin rescue inhalers are $70 here, but like $5 everywhere else. They managed to get them repatented by claiming that the old versions were a major contributor to global warming. I guarantee you that thousands have died because of this price change.
I can't begin to imagine the burden of asthmatic Americans when the inhalers cost so much. Yes, they're about $5 in Australia, and I've even gotten them for free on occasion when I was unemployed.
Some quick stats about the medication from wikipedia [0] - The medication was generally available in the UK 1969 (1982 for USA), and in 2017 was the tenth most prescribed medication in the USA.
When I saw news popping up over the last year or so about how exciting it was for a generic inhaler to be approved and available I was surprised and appalled by the whole ordeal, to be honest. It's an essential medicine. Generics have been available for ages here.
How on earth can companies and the government be allowed to do this to people? I mean, the literal answer is probably the oligarchy. I would have thought that people who can manage their chronic health conditions and avoid becoming disabled (or dead) would be infinitely more exploitable than those who can't, but I guess the numbers have been crunched and that mustn't be the case. It's unspeakably awful.
[0] https://en.wikipedia.org/wiki/Salbutamol
Some quick stats about the medication from wikipedia [0] - The medication was generally available in the UK 1969 (1982 for USA), and in 2017 was the tenth most prescribed medication in the USA.
When I saw news popping up over the last year or so about how exciting it was for a generic inhaler to be approved and available I was surprised and appalled by the whole ordeal, to be honest. It's an essential medicine. Generics have been available for ages here.
How on earth can companies and the government be allowed to do this to people? I mean, the literal answer is probably the oligarchy. I would have thought that people who can manage their chronic health conditions and avoid becoming disabled (or dead) would be infinitely more exploitable than those who can't, but I guess the numbers have been crunched and that mustn't be the case. It's unspeakably awful.
[0] https://en.wikipedia.org/wiki/Salbutamol
What company did that?
For those who may find themselves unable to afford their prescription insulin, you should know that Walmart Pharmacies (in most states IIRC) offers both long-acting and short acting formulas (even have a 70/30 formula) under the Novalin brand name over the counter(no prescription needed) for $25/per 10ml vial of u-100.
Product Names:
Novalin N - XR for basal
Novalin R - fast acting for bolus
Novalin 70/30 - just a premix of the two shown 70% N 30% R.
It may not be the best formulation out there but so long as you pay close attention to how your body responds to it (ie. Typical bolus duration, Blood Glucose mg/dl lowered per unit of insulin etc) when you first start using it, it can be just as effective as the name brand anologues.
Sure, it has a longer duration and takes a bit longer before it takes effect, but those shortcomings can be addressed by simply making adjustments to when you are dosing.
I typically need to bolus about 1unit/12g of carbs 20-25 minutes prior to eating with Novalin vs 1unit/15g 10-15 minutes before using an analogue.
I've actually used Novalin R in lieu of analogues in my insulin pump now for about a year with no issues. I realize getting these devices may be financially out of reach for many since they are expensive, even with insurance. If you're interested in using one but are not able to afford the cost of initial cost, Medtronic used to offer a payment plan that did not require good credit at all (mine was a complete dumpster fire) back when I got mine 6 years ago so people who are interested and could possibly afford to make monthly payments it's worth taking to your doctor and the manufacturers reps about the options they have available.
Sorry in advance for any grammatical/spelling errors, on mobile topping in a text box ~6 lines tall and 32 characters wide.
Product Names:
Novalin N - XR for basal
Novalin R - fast acting for bolus
Novalin 70/30 - just a premix of the two shown 70% N 30% R.
It may not be the best formulation out there but so long as you pay close attention to how your body responds to it (ie. Typical bolus duration, Blood Glucose mg/dl lowered per unit of insulin etc) when you first start using it, it can be just as effective as the name brand anologues.
Sure, it has a longer duration and takes a bit longer before it takes effect, but those shortcomings can be addressed by simply making adjustments to when you are dosing.
I typically need to bolus about 1unit/12g of carbs 20-25 minutes prior to eating with Novalin vs 1unit/15g 10-15 minutes before using an analogue.
I've actually used Novalin R in lieu of analogues in my insulin pump now for about a year with no issues. I realize getting these devices may be financially out of reach for many since they are expensive, even with insurance. If you're interested in using one but are not able to afford the cost of initial cost, Medtronic used to offer a payment plan that did not require good credit at all (mine was a complete dumpster fire) back when I got mine 6 years ago so people who are interested and could possibly afford to make monthly payments it's worth taking to your doctor and the manufacturers reps about the options they have available.
Sorry in advance for any grammatical/spelling errors, on mobile topping in a text box ~6 lines tall and 32 characters wide.
24$ for 5x3 ml in Russia [1]
> The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.
Here in Russia price can only go up from manufacturer’s price. Simpler world.
[1] https://redapteka.ru/catalog/lekarstva/endokrinologiya/sakha...
> The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.
Here in Russia price can only go up from manufacturer’s price. Simpler world.
[1] https://redapteka.ru/catalog/lekarstva/endokrinologiya/sakha...
I wonder if this has anything to do with drug re-importation laws.
I wish someone would do something about it. Like an executive order or something.
I wish someone would do something about it. Like an executive order or something.
Is this a reference to the first Presidential debate?
As a diabetic I was excited to hear when Trump said that he had made Insulin as cheap as water.
However it still looks like it costs around $300 per vial at my pharmacy.
As a diabetic I was excited to hear when Trump said that he had made Insulin as cheap as water.
However it still looks like it costs around $300 per vial at my pharmacy.
https://www.forbes.com/sites/avikroy/2020/07/24/trumps-most-...
As one might expect, the pharma companies are fighting his executive order in the courts. Here's one article with some details.
As one might expect, the pharma companies are fighting his executive order in the courts. Here's one article with some details.
There's also no timeframe for implementation, lacks specific implementation details, and the only teeth it seems to have is that these Federally Qualified Health Centers (FQHCs) may potentially be excluded from grants.
Yeah, my friend who has a daughter with Type 1 laughed her ass off at that comment.
I'll be the first to admit that I have very limited knowledge of the pharmaceutical industry, but from what I've gleaned, it's such a tangled, multi-tiered morass of different actors, contracts, and regulations, that it may be a few years before we see any movement on the market's pricing, if at all.
I have a lot of hope for his ambitions to enact a favored nation's policy wrt Medicare's drug pricing, but since his administration's seemingly been lackluster on executing his order limiting insulin markups by federally funded clinics, I doubt his policies are anything other than paper tigers.
I have a lot of hope for his ambitions to enact a favored nation's policy wrt Medicare's drug pricing, but since his administration's seemingly been lackluster on executing his order limiting insulin markups by federally funded clinics, I doubt his policies are anything other than paper tigers.
Prices have changed dramatically for some people. There were 4 executive orders about it in late July. Once was specific to insulin, but the important order enforces most-favored-nation status on drugs. The USA is supposed to get the cheapest international price.
This won't help everybody. It has the same flaw as price-matching at Best Buy. The manufacturer could sell a different model in each country. For example, the USA gets one set of pill sizes (20 mg, 40 mg, 80 mg) and the rest of the world gets a different set of sizes (25 mg, 50 mg, 75 mg).
To combat that obvious maneuver, the orders make it easier to import drugs. Americans had been getting in trouble for importing drugs, even if the same ones are sold here. This made it easy to have different prices in different countries. It was like DVD region enforcement. The orders change that, making it really hard for manufacturers to keep the USA price high.
The type of insulin you get for "$300 per vial" might only be available in the USA, or it might actually cost that much (and seldom be prescribed) outside the USA. You might also be facing the issue of retail prices lagging behind wholesale prices. Check other retail locations.
This won't help everybody. It has the same flaw as price-matching at Best Buy. The manufacturer could sell a different model in each country. For example, the USA gets one set of pill sizes (20 mg, 40 mg, 80 mg) and the rest of the world gets a different set of sizes (25 mg, 50 mg, 75 mg).
To combat that obvious maneuver, the orders make it easier to import drugs. Americans had been getting in trouble for importing drugs, even if the same ones are sold here. This made it easy to have different prices in different countries. It was like DVD region enforcement. The orders change that, making it really hard for manufacturers to keep the USA price high.
The type of insulin you get for "$300 per vial" might only be available in the USA, or it might actually cost that much (and seldom be prescribed) outside the USA. You might also be facing the issue of retail prices lagging behind wholesale prices. Check other retail locations.
Can't tell you're being sarcastic or not but there was an executive order[1] signed in July to address this. We'll see if this will bring down prices.
1.) https://www.whitehouse.gov/presidential-actions/executive-or...
1.) https://www.whitehouse.gov/presidential-actions/executive-or...
Yeah, it worked perfectly, now it’s cheaper than water.
That executive order shows the full-on insanity and dysfunction of our political system in the US:
1. Other countries achieve lower drug prices because their governments regulate those prices.
2. The US (especially a particular political party) is anti-government regulation, especially when it comes to price controls, so drug prices are MUCH higher in the US.
3. Thus, the US president has issued an executive order to allow reimportation of drugs so that the US can take advantage of other countries' lower drug prices.
In other words, we won't pass our own regulations, so we are explicitly delegating our regulatory authority to other nations so that we can take advantage of the effects of their regulations.
Honestly, whether or not you are pro or anti regulation, this current state is just f'ing insane. You certainly can't consistently state that you are anti-regulation and be for this policy.
1. Other countries achieve lower drug prices because their governments regulate those prices.
2. The US (especially a particular political party) is anti-government regulation, especially when it comes to price controls, so drug prices are MUCH higher in the US.
3. Thus, the US president has issued an executive order to allow reimportation of drugs so that the US can take advantage of other countries' lower drug prices.
In other words, we won't pass our own regulations, so we are explicitly delegating our regulatory authority to other nations so that we can take advantage of the effects of their regulations.
Honestly, whether or not you are pro or anti regulation, this current state is just f'ing insane. You certainly can't consistently state that you are anti-regulation and be for this policy.
It's regulation that is stopping me from buying the cheapest price. I don't want the US to force a particular price in the US. And even if they did, I would still want to be able to buy from anywhere in the world, regardless of where the lowest price is.
Yeah, you want to take advantage of the regulation of those other countries, which you can't get in the US.
Let's not forget the need for patent reform in this area. The current state of patents around drugs in the US is crazy.
You mean the regulations that limit competition in the US and restrict manufactures and grant monopoly rights? These are the regulations that are good right?
What are you talking about when it comes to manufacturing insulin? I mean, yes, I definitely do want regulations around the safety of drug manufacturing, but beyond that what regulations specifically are you referring to that restrict the manufacturing of insulin?
One example:
>The second reason, the authors noted, is that there isn't significant competition in the U.S. insulin market. Price competition typically comes from the introduction of a generic drug that directly competes with a branded product.
>But the authors said that current insulin makers have blocked the entry to such products by getting new patents based on things such as a new delivery device.
https://www.usnews.com/news/health-news/articles/2019-11-07/...
Patent reform would help bring generics on the market and reduce prices.
>The second reason, the authors noted, is that there isn't significant competition in the U.S. insulin market. Price competition typically comes from the introduction of a generic drug that directly competes with a branded product.
>But the authors said that current insulin makers have blocked the entry to such products by getting new patents based on things such as a new delivery device.
https://www.usnews.com/news/health-news/articles/2019-11-07/...
Patent reform would help bring generics on the market and reduce prices.
I'm not sure why people don't see the problem with "I don't want any price regulation in the US, but I want to personally benefit from price regulation done in other countries". It's a whole different level of selfishness.
Can you describe how selfishness comes into play? I want everyone to be able to purchase at the lowest price and don't want them to be limited to buying only from the US.
Because they are voting for no regulation and no M4A in their own country, while eating off the plate of countries that do negotiate drug prices and have socialized healthcare.
Which countries are you referring to that negotiate drug prices? Up thread we were discussing the opposite: price controls.
And other countries benefit from the high drug prices in America that fund pharmaceutical research.
I don't see them gnashing their teeth over the ethical considerations of that.
I don't see them gnashing their teeth over the ethical considerations of that.
Pharma spends more money on marketing than they do on R&D, the whole excuse that the costs are largely driven by research is tired and debunked.
It would be nice if the article directly linked to the report. The PDF can be downloaded from https://www.rand.org/pubs/research_reports/RRA788-1.html
The price charts are on page 10.
The price charts are on page 10.
This is a news release for a report, which can be found here: https://www.rand.org/pubs/research_reports/RRA788-1.html
Additionally, the RAND Corporation appears to have a high factual reporting with a slight left political bias, according to mediabiasfactcheck.com. https://mediabiasfactcheck.com/rand-corporation/
Additionally, the RAND Corporation appears to have a high factual reporting with a slight left political bias, according to mediabiasfactcheck.com. https://mediabiasfactcheck.com/rand-corporation/
I was thinking this might be due to the lvles of diabetes in the US, but after checking, to my surprise the US is actually ranked 41st ?
https://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/r...
https://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/r...
Also, shouldn't higher levels = more demand = lower prices?
Increasing supply relative to demand results in lower prices.
Medication for chronic disease is a highly inelastic market. The other such market is oil. Prices react to spikes and sudden drops in demand, otherwise they are stable. No one is going to bring a new plant onstream unless there are certain takers for the output.
In reality, other nations use the force of law to restrict the free market in their domain forcing countries that have more fair and free markets like the US to subsidize the other countries' artificially set prices. I am not saying the drug companies have no blame to shoulder, they have plenty. Just know that this isn't just a simple case of an evil capitalist trying to price gouge.
How exactly do other countries do this?
And what is the "fair and free" price of insulin?
And what is the "fair and free" price of insulin?
> How exactly do other countries do this?
Almost all wealthy countries except the US, use a single payer system where the government sets the price of drugs.
> And what is the "fair and free" price of insulin?
Free as a victim of diabetes, some marginal cost to the countries budget based on a negotiation with the pharma company.
Typically, because the country has enough scale, it is cost effective for the government to design and estimate costs for a government run facility to produce the drug and use that as a bargaining chip including if needed voiding the IP rights of that foreign entity for national defense reasons.
Almost all wealthy countries except the US, use a single payer system where the government sets the price of drugs.
> And what is the "fair and free" price of insulin?
Free as a victim of diabetes, some marginal cost to the countries budget based on a negotiation with the pharma company.
Typically, because the country has enough scale, it is cost effective for the government to design and estimate costs for a government run facility to produce the drug and use that as a bargaining chip including if needed voiding the IP rights of that foreign entity for national defense reasons.
> Typically, because the country has enough scale, it is cost effective for the government to design and estimate costs for a government run facility to produce the drug and use that as a bargaining chip including if needed voiding the IP rights of that foreign entity for national defense reasons.
You got a link about that because I am super interested to read into that more. I believe india doesn't respect medical IP but I'm surprised first world countries that produce medical IP do and that the US apparently isn't ripping off foreign countries medical IP who do that in retaliation.
You got a link about that because I am super interested to read into that more. I believe india doesn't respect medical IP but I'm surprised first world countries that produce medical IP do and that the US apparently isn't ripping off foreign countries medical IP who do that in retaliation.
I was just using anecdotal stuff I've heard about before. A quick search brought up: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.3....
I haven't cross checked it, but it seems to state similar things to what I've heard before, like “compulsory licensing” which was only un-done because of NAFTA, but that just means its a political bargaining chip that is not currently cashed.
I'm sure other countries have different rules, Canada is more beholden to the US than any other country.
I haven't cross checked it, but it seems to state similar things to what I've heard before, like “compulsory licensing” which was only un-done because of NAFTA, but that just means its a political bargaining chip that is not currently cashed.
I'm sure other countries have different rules, Canada is more beholden to the US than any other country.
In other countries, they negotiate prices at the country level.
Sweden has ~10M people. Blue Cross/Blue Shield has 107M members in the US.
The problem is not that insurers in the US are not "big enough" to negotiate prices effectively.
The problem is not that insurers in the US are not "big enough" to negotiate prices effectively.
I'm not convinced that's true. If the market really is free and fair, and the price is currently 8 times more than elsewhere, why are foreign pharmaceutical companies not flooding the US market?
Why are there not dozens of silicon valley startups springing up to 'disrupt' this market - clearly there are large margins to be made given the price is so much higher at the moment.
It sounds more like some regulatory capture has happened which is keeping prices artificially high, than that all other countries are artificially low.
Why are there not dozens of silicon valley startups springing up to 'disrupt' this market - clearly there are large margins to be made given the price is so much higher at the moment.
It sounds more like some regulatory capture has happened which is keeping prices artificially high, than that all other countries are artificially low.
> It sounds more like some regulatory capture has happened which is keeping prices artificially high
This. Not sure if it's a system bug, or a feature: the system may have been designed for this to happen.
This. Not sure if it's a system bug, or a feature: the system may have been designed for this to happen.
One cannot import drugs into US unless they get FDA approval for that particular drug from that particular manufacturer from that particular country.
Which somewhat undermines the original claim that the US market is more free and fair than any other...
Wait, you mean the low international price of a medicine that was developed and given to humanity for free is now somehow a burden on US drug companies? I doubt it.
The original insulin that is off-patent is very cheap. What is expensive in the US is newer versions that are safer and more effective.
Why would the "free market" be the most important in the first place?
Insulin lispro was under $50 a vial sticker price the day it came out.
One price is set artificially and it ain't the one you're thinking of.
One price is set artificially and it ain't the one you're thinking of.
Profit margins aren't a "the total shall be X billion USD" division across countries. Making less profit in one country has nothing to do with what your profit margin will be in another one.
Prices are always set to maximize profit, and what the customer is willing to pay you is the biggest factor in the equation.
Prices are always set to maximize profit, and what the customer is willing to pay you is the biggest factor in the equation.
If using the force of law makes something 8 times cheaper than the free market, then so much the worse for the free market. The whole argument in favor of the free market -- which holds for most products -- is that market competition can provide things cheaper than government fiat. If the market can't do that in this instance, then who needs it?
I've heard this before and dont understand the reasons - is it really just an oligopoly ripping us off? I rarely trust newpaper articles because it is so politicized, but this looks like it really is.
Also I understand there are newer Insulins which may have a patent, but the original is 100 years old and patent was not an issue. Why aren't there more manufacturers?
Also I understand there are newer Insulins which may have a patent, but the original is 100 years old and patent was not an issue. Why aren't there more manufacturers?
Off-patent insulin is $25/vial at Walmart. I’ll yield to any diabetics for additional nuance, but AIUI, this form of insulin is harder to correctly administer.
The newer, patent protected versions are safer and more effective. Again, AIUI, patent protection for at least one form is expiring or expired recently.
The newer, patent protected versions are safer and more effective. Again, AIUI, patent protection for at least one form is expiring or expired recently.
OK $25 for every 1-3 weeks isn't cheap as I'd like but looks more like I'd expect. The Rand report has a table of different kids of insulin but doesn't list which ones have a patent. Would be good to know if the middle income countries listed like Turkey/Chile have the more modern variants or the original ones.
I've known about relatively inexpensive off patent insulin for a while now. It's really strange how it almost never comes up in discussions about drug prices. I've had an open question for about as long as I've known about off patent insulin.
People often say that expensive insulin leads to "deaths". How accurate is this statement? It's hard to get a straight answer because the word "death" is so politicized and its meaning can be stretched extremely far. I'm not trying to make a statement either way about what the price of insulin should be, just trying to quantify how much "death" it causes.
People often say that expensive insulin leads to "deaths". How accurate is this statement? It's hard to get a straight answer because the word "death" is so politicized and its meaning can be stretched extremely far. I'm not trying to make a statement either way about what the price of insulin should be, just trying to quantify how much "death" it causes.
What’s off-patent insulin? Is it different somehow?
My understanding is the newer long acting insulins work so well for many it is like they no longer have diabetes, they can pretty much eat whatever they want and be fine. The older insulins require more careful management of diet and blood sugar levels than the long acting types and are less convenient for that reason.
> the newer long acting insulins work so well for many it is like they no longer have diabetes, they can pretty much eat whatever they want and be fine.
I seriously doubt this. Type 1 diabetes is _a lot_ harder to manage than simply taking long acting insulin and you can go about your day regularly. Almost anything you ingest has the ability to raise your glucose levels and a single dose of insulin is not enough.
Having long lasting insulin can be potentially deadly if not administered properly as it can tank your glucose levels and make you hypoglycemic. You need to be aware of your glucose levels and eat something to increase it if it starts going down below healthy levels. For example, if you take too much of the long acting insulin late at night, it's possible your insulin levels drop during the night and you're not awake to do anything about it (this is one of the reasons people use sensors, it'll ring an alarm if your glucose levels are too low/high).
Some people also use a combination of a 1 or 2 long-lasting insulin doses as a base and use short-lived insulin for small adjustments throughout the day.
I seriously doubt this. Type 1 diabetes is _a lot_ harder to manage than simply taking long acting insulin and you can go about your day regularly. Almost anything you ingest has the ability to raise your glucose levels and a single dose of insulin is not enough.
Having long lasting insulin can be potentially deadly if not administered properly as it can tank your glucose levels and make you hypoglycemic. You need to be aware of your glucose levels and eat something to increase it if it starts going down below healthy levels. For example, if you take too much of the long acting insulin late at night, it's possible your insulin levels drop during the night and you're not awake to do anything about it (this is one of the reasons people use sensors, it'll ring an alarm if your glucose levels are too low/high).
Some people also use a combination of a 1 or 2 long-lasting insulin doses as a base and use short-lived insulin for small adjustments throughout the day.
Yes, in general it's worse across the board. It takes longer to start working and continues working longer, both things you want to avoid in short-acting insulins.
Can confirm. Type 1 who switched away from Eli Lilly insulins (Humalog and Humulin N) to the Novo Nordisk (Novolin R and Novolin N) equivalents sold at Wal-Mart.
Much more planning involved, and a big adjustment compared to Humalog and Humulin. My A1Cs are also a bit higher (6.1 instead of 5.9) to give myself more safety margin.
-----
Why'd I switch? First I pay less out of pocket than I did compared to insurance co-pays for the name brand stuff. That is, $90/mo for short-acting, long-acting, lancets, test strips and syringes... compared to $170/mo in insurance co-pays for the Eli Lilly and Abbott equivalents, and probably around $800 MSRP.
The second is I no longer need to wait for refill authorizations which too many doctor offices drag their feet on, in addition to insurance companies enforcing only a tiny number of refills per auth (as in, requiring a physician's authorization for the insulin you'll use until you die EVERY SINGLE MONTH) which creates yet more delays and sometimes numerous phone calls to get a prescription refilled since you constantly need an authorization from the prescribing doctor. "If they keep messing up, why not switch doct--" I have. Four times, across three different HCOs, and three different insurance companies. They all screw up and fail to respond to the pharmacy on occasion, sometimes for several months (and a dozen plus phone calls) in a row.
It wasn't even about the cost anymore. The ridiculous bureaucracy with the ultimate position of, "it's the patient's fault" held by every other party forced my hand.
Much more planning involved, and a big adjustment compared to Humalog and Humulin. My A1Cs are also a bit higher (6.1 instead of 5.9) to give myself more safety margin.
-----
Why'd I switch? First I pay less out of pocket than I did compared to insurance co-pays for the name brand stuff. That is, $90/mo for short-acting, long-acting, lancets, test strips and syringes... compared to $170/mo in insurance co-pays for the Eli Lilly and Abbott equivalents, and probably around $800 MSRP.
The second is I no longer need to wait for refill authorizations which too many doctor offices drag their feet on, in addition to insurance companies enforcing only a tiny number of refills per auth (as in, requiring a physician's authorization for the insulin you'll use until you die EVERY SINGLE MONTH) which creates yet more delays and sometimes numerous phone calls to get a prescription refilled since you constantly need an authorization from the prescribing doctor. "If they keep messing up, why not switch doct--" I have. Four times, across three different HCOs, and three different insurance companies. They all screw up and fail to respond to the pharmacy on occasion, sometimes for several months (and a dozen plus phone calls) in a row.
It wasn't even about the cost anymore. The ridiculous bureaucracy with the ultimate position of, "it's the patient's fault" held by every other party forced my hand.
IME people tend to underestimate most aspects of type 1 diabetes, especially how big an ask it is to suggest someone switch insulins on short notice and out of desperation.
And the bureaucracy is ridiculous. I'm the most financially responsible person I know in my age group, yet I annually get letters threatening to send me to collections for charges I was not warned about by a weird middleman company that I get automatically charged through for medical supplies for my pump. Haven't heard from them this year, and I've called them 4 times so far trying to figure out where the charges went. It turns out they have 3 accounts registered under my name for these things and none of them are the account that my orders have been going to. At this point I'm just going to wait for the annual letter I guess.
Good job on the A1C though. I want to get there someday, but I get sudden massive drops in blood sugar out of nowhere about once every two weeks and it scares the crap out of me. I'm optimistic I'll figure it out eventually though
And the bureaucracy is ridiculous. I'm the most financially responsible person I know in my age group, yet I annually get letters threatening to send me to collections for charges I was not warned about by a weird middleman company that I get automatically charged through for medical supplies for my pump. Haven't heard from them this year, and I've called them 4 times so far trying to figure out where the charges went. It turns out they have 3 accounts registered under my name for these things and none of them are the account that my orders have been going to. At this point I'm just going to wait for the annual letter I guess.
Good job on the A1C though. I want to get there someday, but I get sudden massive drops in blood sugar out of nowhere about once every two weeks and it scares the crap out of me. I'm optimistic I'll figure it out eventually though
Wow a monthly refill authorization sounds really onerous! I can't believe they make you do that. It sounds like they try to make the process as cumbersome as possible so you go away. Which you did. I think I would do the same.
A story like that really puts into context what expensive insulin means. When it's expensive, they want to make sure you don't sell it. So even people who can get it through insurance are affected.
For contrast an experience from a rich European country: My doc writes me a yearly prescription. I forgot to renew it once, and had to pay out of my pocket to get my insulin. He sent me a backdated prescription I could use to get the cost reimbursed.
A story like that really puts into context what expensive insulin means. When it's expensive, they want to make sure you don't sell it. So even people who can get it through insurance are affected.
For contrast an experience from a rich European country: My doc writes me a yearly prescription. I forgot to renew it once, and had to pay out of my pocket to get my insulin. He sent me a backdated prescription I could use to get the cost reimbursed.
Monthly refill authorization is simultaneously the craziest thing I’ve heard and also so characteristically on theme for US health insurance I didn’t doubt it for a second.
Hey this is Blue Cross, does Bill still need insulin this month?
Yea, he has type 1 diabetes, it’s a chronic and lifelong condition he will need insulin every month.
Cool, cool, we will check back in next month to see if he needs more.
Do you expect me to come up with a cure for type 1 diabetes by next month?
No, that would be ridiculous.
Well why check every month?
In case he doesn’t need it anymore.
How would that happen?
Hmm.... good point, we can talk about it more next month when we check in to see if Bill needs more insulin.
head slamming into desk sound
Hey this is Blue Cross, does Bill still need insulin this month?
Yea, he has type 1 diabetes, it’s a chronic and lifelong condition he will need insulin every month.
Cool, cool, we will check back in next month to see if he needs more.
Do you expect me to come up with a cure for type 1 diabetes by next month?
No, that would be ridiculous.
Well why check every month?
In case he doesn’t need it anymore.
How would that happen?
Hmm.... good point, we can talk about it more next month when we check in to see if Bill needs more insulin.
head slamming into desk sound
Why aren't there more manufacturers?
Low profits and a giant moat. The civilized world keeps prices down because their governments do the buying, and meanwhile any new entrant needs to prove bioequivalence.
It's not that the market was totally innovation-free. Human insulin was a gigantic breakthough when Genentech brought it to market back in 1978.
Low profits and a giant moat. The civilized world keeps prices down because their governments do the buying, and meanwhile any new entrant needs to prove bioequivalence.
It's not that the market was totally innovation-free. Human insulin was a gigantic breakthough when Genentech brought it to market back in 1978.
> Low profits
If its low profits how come other countries' prices are much lower? Either the manufacturers there have lower costs or they're charities.
>and a giant moat
I'd think all the VC money sloshing around should be able to figure something like this instead of another social media platform.
If its low profits how come other countries' prices are much lower? Either the manufacturers there have lower costs or they're charities.
>and a giant moat
I'd think all the VC money sloshing around should be able to figure something like this instead of another social media platform.
>
I'd think all the VC money sloshing around should be able to figure something like this instead of another social media platform.
Would be nice , but unless you convinced VCs to invest in a non profit this startup would be sold within 3 years to big pharma.
NHS style healthcare is the only way to go
Would be nice , but unless you convinced VCs to invest in a non profit this startup would be sold within 3 years to big pharma.
NHS style healthcare is the only way to go
I wonder if eminent domain laws apply to intellectual property?
Given the varying level of regulations in different countries "up to" means nothing where medical care is concerned.
What matters most is what are the prices in countries with equally strict quality controls, which would be, unless I'm mistaken, the EU, the British Commonwealth, Japan, and a few other places.
And the answer to that question seems to be >6x which is bad enough.
One of the things I've learned about persuasion is that I'm never, ever, going to persuade some people. What I can do is persuade people who can do it for me. In many cases, then, my time and effort is best spent on recruiting the folks who are good at explaining to others. In my experience most of these people can smell bullshit coming a mile away, and so if the first 'fact' out of my mouth is reproachable, I've already put them on the defensive.
I often hear, "we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism - we can't let 'those people' beat us. It's ugly, and if you have to stoop to that, is it really worth winning? It's no good living forever if you can't live with yourself.
What matters most is what are the prices in countries with equally strict quality controls, which would be, unless I'm mistaken, the EU, the British Commonwealth, Japan, and a few other places.
And the answer to that question seems to be >6x which is bad enough.
One of the things I've learned about persuasion is that I'm never, ever, going to persuade some people. What I can do is persuade people who can do it for me. In many cases, then, my time and effort is best spent on recruiting the folks who are good at explaining to others. In my experience most of these people can smell bullshit coming a mile away, and so if the first 'fact' out of my mouth is reproachable, I've already put them on the defensive.
I often hear, "we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism - we can't let 'those people' beat us. It's ugly, and if you have to stoop to that, is it really worth winning? It's no good living forever if you can't live with yourself.
> I often hear, "we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism - we can't let 'those people' beat us. It's ugly, and if you have to stoop to that, is it really worth winning? It's no good living forever if you can't live with yourself.
I don’t think anyone’s complaining about the price due to nationalism or racism... they just want to be able to afford insulin to keep themselves alive like they’d be able to in other countries.
I don’t think anyone’s complaining about the price due to nationalism or racism... they just want to be able to afford insulin to keep themselves alive like they’d be able to in other countries.
Not certain I succeeded, but I was trying to word it as a general comment rather than an indictment of this particular article, which does a reasonably decent job in that regard. This class of article suffers from that problem often, and something about that has always bugged me but I couldn't clearly express why.
There's a fine line between "France did X and the sky did not fall," and evoking Us-vs-Them emotions. Some people will bring that energy no matter how you state it, but let's try not to invite it in.
There's a fine line between "France did X and the sky did not fall," and evoking Us-vs-Them emotions. Some people will bring that energy no matter how you state it, but let's try not to invite it in.
[deleted]
> they just want to be able to afford insulin to keep themselves alive like they’d be able to in other countries.
It's a silly argument to compare countries on a single issue though. Insulin is probably cheaper in Germany (I have no clue since I've never bought any), but our taxes are much higher as well. For somebody who has no money to buy insulin, that doesn't matter much, as they wouldn't pay any taxes. For most people however, that means something, as it would cut deeply into their budget.
All of these things are trade-offs, you can't view them isolated and expect to gain any insights.
It's a silly argument to compare countries on a single issue though. Insulin is probably cheaper in Germany (I have no clue since I've never bought any), but our taxes are much higher as well. For somebody who has no money to buy insulin, that doesn't matter much, as they wouldn't pay any taxes. For most people however, that means something, as it would cut deeply into their budget.
All of these things are trade-offs, you can't view them isolated and expect to gain any insights.
> It's a silly argument to compare countries on a single issue though.
If you can't afford to buy drugs you need to keep yourself alive, what other issues matter for you?
If you can't afford to buy drugs you need to keep yourself alive, what other issues matter for you?
> ... but our taxes are much higher as well.
Not sure who the "our" is in your comment, but:
"So there you have it, if you are wealthy and live in California you are paying more income tax than people who live in the European Unions’ largest economy. Of course this is only one facet of the tax system. There are many others, like the value added tax of 19% in Germany, but Germany’s corporate tax rate is 15% while ours in 35%. If you live in California and are paying these high rates you can’t even take solace in the fact that you’re working less. In Germany the average work week is 35 hours with 24 paid vacation days and 10 paid holidays!"
http://bvcocpas.com/how-the-united-states-tax-rates-compares...
Not sure who the "our" is in your comment, but:
"So there you have it, if you are wealthy and live in California you are paying more income tax than people who live in the European Unions’ largest economy. Of course this is only one facet of the tax system. There are many others, like the value added tax of 19% in Germany, but Germany’s corporate tax rate is 15% while ours in 35%. If you live in California and are paying these high rates you can’t even take solace in the fact that you’re working less. In Germany the average work week is 35 hours with 24 paid vacation days and 10 paid holidays!"
http://bvcocpas.com/how-the-united-states-tax-rates-compares...
That quote is about a person with a million dollars in wages in the highest income tax state and it doesn't factor in payroll taxes which contribute to the tax wedge on income. The tax wedge for a single worker with no children earning the nations average wage in 2019 was 49.4% for germany and 29.8% for the united states [0]. That's not to say government provided healthcare is incompatible with lower taxes as there are other countries around the US tax wedge rate with government healthcare but germany is not a good example of that especially for the average person.
[0]: https://taxfoundation.org/publications/comparison-tax-burden...
[0]: https://taxfoundation.org/publications/comparison-tax-burden...
While the numbers are from a decade or two ago: yes, I'm pretty sure the top 10% in the US pay more taxes than the average person in Germany. But that's really not a large factor for most people because they're by definition not in the top percentage of the country.
> Insulin is probably cheaper in Germany (I have no clue since I've never bought any)
Yeah maybe you shouldn't be making opinions out of pure ignorance of the situation at the factual and emotional level.
Yeah maybe you shouldn't be making opinions out of pure ignorance of the situation at the factual and emotional level.
Drilling down, there's a PDF: https://www.rand.org/pubs/research_reports/RRA788-1.html
Looks like for human insulin Germany is 1/12th the cost.
There's a lot of pricing theater going on in the US too. The MSRP seems to be a game of psychological anchoring the manufactures are playing with the insurance companies, who always get a discount. But that is a whole other kettle of fish.
"First, the manufacturer prices available in the MIDAS data do not reflect rebates or other discounts that might have been applied after drugs left the factory; we expect that, in many countries (and particularly in the United States), the net price paid for drugs was lower than the reported manufacturer prices shown in our results tables."
Looks like for human insulin Germany is 1/12th the cost.
There's a lot of pricing theater going on in the US too. The MSRP seems to be a game of psychological anchoring the manufactures are playing with the insurance companies, who always get a discount. But that is a whole other kettle of fish.
"First, the manufacturer prices available in the MIDAS data do not reflect rebates or other discounts that might have been applied after drugs left the factory; we expect that, in many countries (and particularly in the United States), the net price paid for drugs was lower than the reported manufacturer prices shown in our results tables."
The same exact products from the same manufacturers are priced in this manner. Quality is not driving the price higher.
I don't think that's true.
There was a job opening I looked at about ten years back where the whole responsibility was writing bin packing algorithms to allocate batches of medications to countries based on the quality control guidelines of that country and the tolerances achieved in manufacturing a particular batch. [Edit] I suspect the rationale is that both products are fine, and the regulations represent overreach, so we're going to mollify them. But the banking and finance industries were complaining about overreach right up until the crash (as they have before every single crash). The money it costs you to comply also costs you your objectivity.
You might be able to overclock the hell out of an Intel processor that was binned several notches down from the top, but that depends on how good the yields were that week. It's possible you just got a slightly shittier processor.
There was a job opening I looked at about ten years back where the whole responsibility was writing bin packing algorithms to allocate batches of medications to countries based on the quality control guidelines of that country and the tolerances achieved in manufacturing a particular batch. [Edit] I suspect the rationale is that both products are fine, and the regulations represent overreach, so we're going to mollify them. But the banking and finance industries were complaining about overreach right up until the crash (as they have before every single crash). The money it costs you to comply also costs you your objectivity.
You might be able to overclock the hell out of an Intel processor that was binned several notches down from the top, but that depends on how good the yields were that week. It's possible you just got a slightly shittier processor.
do you really think the Eu and Canada have worse medicine? (seriously). Their stuff is probably better than the one here, as the EU does have tighter controls in substances and what is allowed during manufactoring of medicine, food processing, and beauty products.
They effectvely operate in a 'white list' basis, where a product has to be shown to be safe to be allowed, while the US operates in a 'black list' basis, where anything can be used until it is shown unsafe, and banned, which usually gets banned too late.
That's why you have so many cancerogenic products that are banned in the EU, while they are still used here in the states.
They effectvely operate in a 'white list' basis, where a product has to be shown to be safe to be allowed, while the US operates in a 'black list' basis, where anything can be used until it is shown unsafe, and banned, which usually gets banned too late.
That's why you have so many cancerogenic products that are banned in the EU, while they are still used here in the states.
> do you really think the Eu and Canada have worse medicine?
I'm not sure where you got this impression, since I started with the opposite at the top of the thread.
I'm not sure where you got this impression, since I started with the opposite at the top of the thread.
[deleted]
[deleted]
Your comment is a mess. You essentially "throw a rock and then hide your hands" by stating that the rest of the world has wildly different quality controls, and then you state that you aren't going to argue about it but leave that point to other readers.
>..."we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism
Not really, what we're really saying is that with our tech resources, talent, governance and supplier pipelines we should be able to do better.
>..."we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism
Not really, what we're really saying is that with our tech resources, talent, governance and supplier pipelines we should be able to do better.
It's gatekeeping regulation under the guise of "quality control". Drug companies don't want competition from the bottom, they're happy with a regulatory framework that keeps small companies from entering the market.
Insulin itself would be simple and cheap to produce, but getting through the approval process is so expensive, it wouldn't make economical sense to then sell the product near cost. Insulin isn't the mass-market product it once was, because it has fallen out of favor for Type II diabetes and Type I diabetes is relatively rare.
The way other countries get around this is price controls. They just tell the companies what drugs are allowed to cost, so profits are limited not by competition, but by fiat.
Insulin itself would be simple and cheap to produce, but getting through the approval process is so expensive, it wouldn't make economical sense to then sell the product near cost. Insulin isn't the mass-market product it once was, because it has fallen out of favor for Type II diabetes and Type I diabetes is relatively rare.
The way other countries get around this is price controls. They just tell the companies what drugs are allowed to cost, so profits are limited not by competition, but by fiat.
I was always told we pay high prices to support research, which has been proven to be BS time and time again. The drug companies spend way more on marketing.
The capitalist market driven research only creates expensive drugs that treat wealthy people. India is coming up with a cheap paper based covid test, using governemnt backed research. Other countries are leaving us in the dust on results and research.
The capitalist market driven research only creates expensive drugs that treat wealthy people. India is coming up with a cheap paper based covid test, using governemnt backed research. Other countries are leaving us in the dust on results and research.
From my brief time in research, the team that developed the tech often gets royalties for the work that gets commercialized, which pays salaries for future projects. The University where the work was done taxes that revenue, in exchange for having provided facilities (old hand-me-down facilities may have their value considerably overstated), and so they are dis-incentivized to encourage any changes to the status quo, because there's money involved.
You'd have to break that supply chain, and I don't know if there's any easy way to do that.
You'd have to break that supply chain, and I don't know if there's any easy way to do that.
I wonder how long it will take the "favored nations" policy to get through the courts. And if it gets nixed by the courts, will Congress pick up the ball.
https://www.forbes.com/sites/avikroy/2020/07/24/trumps-most-...
https://www.forbes.com/sites/avikroy/2020/07/24/trumps-most-...
As someone who is type 1 diabetic, and someone who has had insurance that required me to pay up front, and then get reimbursed after the fact - insulin was charged at ~200 dollars a vial, I can't speak for everyone, as everyone is different - but i would hazard to guess that most use 2-3+ vials a month (of rapid acting, on a pump).
I had a 40 day insurance lapse when I started my new job and it was $350 for a vial for me :( luckily I only needed to buy one, and it was enough to last me until the end of the period.
For a full year and a half before that, I had to go to the pharmacy every 20 days to pick up more insulin because my insurance didn't want to risk paying for medicine that I could still use after leaving my job / insurance.
For a full year and a half before that, I had to go to the pharmacy every 20 days to pick up more insulin because my insurance didn't want to risk paying for medicine that I could still use after leaving my job / insurance.
> 40 day insurance lapse
How does that sort of thing affect you? I can't imagine the pressure of knowing you 'can't' get ill for a period of time!
Do you stop biking to work, avoid DIY projects, skip the 5-a-side sessions that month...?!
How does that sort of thing affect you? I can't imagine the pressure of knowing you 'can't' get ill for a period of time!
Do you stop biking to work, avoid DIY projects, skip the 5-a-side sessions that month...?!
I was very upset about not being warned during the interview process and even had a conversation with HR about it
> Do you stop biking to work, avoid DIY projects, skip the 5-a-side sessions that month
On the contrary, at the time I had to drive a two hour round trip daily on 285* where I was often graphically reminded of the dangers of traffic. I mentioned this point specifically when talking to HR, but ultimately I didn't really have any recourse
*(edited to remove reference to spaghetti junction, didn't realize there were multiple spaghetti junctions out there)
> Do you stop biking to work, avoid DIY projects, skip the 5-a-side sessions that month
On the contrary, at the time I had to drive a two hour round trip daily on 285* where I was often graphically reminded of the dangers of traffic. I mentioned this point specifically when talking to HR, but ultimately I didn't really have any recourse
*(edited to remove reference to spaghetti junction, didn't realize there were multiple spaghetti junctions out there)
Missed signing up for COBRA? I did too, but I had the backing knowledge that my family of medical professionals could probably wrangle something for me in an emergency.
In 2001, Acthar sold for about $40 a vial. Today: more than $40,000. An increase of 100,000 percent.
"Medicare is not allowed to negotiate the price of drugs because of a law passed by Congress." [1]
26-year-old recently removed from his parent’s insurance plan, was found dead in his home because he couldn't afford $1,300 per month for insulin. [2]
This is basically white-collar looting. It is sad that this allowed to happen in USA.
[1] https://www.cbsnews.com/news/the-problem-with-prescription-d...
[2] https://www.nytimes.com/2018/06/22/well/diabetes-patients-at...
26-year-old recently removed from his parent’s insurance plan, was found dead in his home because he couldn't afford $1,300 per month for insulin. [2]
This is basically white-collar looting. It is sad that this allowed to happen in USA.
[1] https://www.cbsnews.com/news/the-problem-with-prescription-d...
[2] https://www.nytimes.com/2018/06/22/well/diabetes-patients-at...
The problem is not that one company attempts to raise its prices, the problem is that it is very difficult for competitors to undercut them. The FDA has made it very expensive to introduce and support products in the US pharmaceutical market; it has imposed huge compliance costs, and helped drug companies sustain those costs through exclusivity arrangements.
Moralizing about health issues feels good, but these issues are created by simple economics (market and regulatory issues), not ethical deficiencies.
Moralizing about health issues feels good, but these issues are created by simple economics (market and regulatory issues), not ethical deficiencies.
Or you could do what literately every other country in the world does, and have price controls.
There's a huge hidden cost to price controls through - they don't promote innovation as much as markets do. The US develops over half the world's new pharmaceuticals, if we imposed price controls today, we would have fewer life saving medications tomorrow because the companies couldn't afford to do as much R&D.
well considering we already subsidize the early R&D for these companies with our University system, and insulin hasn't changed in 50 years, I see no reason we can't price control certain drugs. Could even use this as a guide https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Me...
> insulin hasn't changed in 50 years
That is false. The insulins sold today are MUCH better than the ones sold 50 years ago. They're much better than the ones sold 25 years ago. Admittedly, the ones sold 25 years ago are effective, but it is much more convenient using an insulin that kicks in in 15-20 minutes and has a relatively short peak than one that kicks in in 30-60 minutes and has a long peak. It's doable either way, but the quality of life is much different.
That is false. The insulins sold today are MUCH better than the ones sold 50 years ago. They're much better than the ones sold 25 years ago. Admittedly, the ones sold 25 years ago are effective, but it is much more convenient using an insulin that kicks in in 15-20 minutes and has a relatively short peak than one that kicks in in 30-60 minutes and has a long peak. It's doable either way, but the quality of life is much different.
Trivially untrue, right? Recombinant DNA technology is younger than 50 years so we used porcine insulin before that. It'll still work, honestly, if you're up for it.
Let's make sure people in their 20s aren't dying because they can't afford insulin before we start worrying about how to promote innovation in the insulin market.
If drugs are too expensive, then at some point more lives/quality of lives are lost because people can't access them than are saved from more drug development.
A balance must be found between ensuring fair access at affordable prices, and ensuring fair returns to the pharma industry. This is precisely the goal of pharmaceutical price regulation in the UK:
https://en.wikipedia.org/wiki/Pharmaceutical_Price_Regulatio...
A balance must be found between ensuring fair access at affordable prices, and ensuring fair returns to the pharma industry. This is precisely the goal of pharmaceutical price regulation in the UK:
https://en.wikipedia.org/wiki/Pharmaceutical_Price_Regulatio...
[deleted]
I think that there are Americans who don't feel like volunteering to pay money they don't have food drugs they need for that.
What innovation does insulin production for diabetics require?
Much of drug R&D is funded through the NIH.
You're talking about introducing another layer of complexity on top of an already Byzantine system. Price controls come with many issues, such as incentivizing lobbying & corruption, as well as dis-incentivizing market entry & long-term investment, resulting in a lack of capital expenditures which causes inefficient production.
Healthcare is complicated, and we need to simplify it as much as possible; this is a great example of a situation where we could use 'simple rules for a complex world'.[1]
[1] https://hbr.org/2012/09/simple-rules-for-a-complex-world
Healthcare is complicated, and we need to simplify it as much as possible; this is a great example of a situation where we could use 'simple rules for a complex world'.[1]
[1] https://hbr.org/2012/09/simple-rules-for-a-complex-world
Your comment and the one higher in this chain makes it sound like a hard problem when it's only a problem for the United States and no other (1st world) country. I don't really understand how that's possible.
It's a well-established pattern.
https://www.theonion.com/no-way-to-prevent-this-says-only-na...
https://www.theonion.com/no-way-to-prevent-this-says-only-na...
>"When disagreeing, please reply to the argument instead of calling names. "That is idiotic; 1 + 1 is 2, not 3" can be shortened to "1 + 1 is 2, not 3." "
>" Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith. "
https://news.ycombinator.com/newsguidelines.html
>" Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith. "
https://news.ycombinator.com/newsguidelines.html
Someone (skipants) did respond that way:
> Your comment and the one higher in this chain makes it sound like a hard problem when it's only a problem for the United States and no other (1st world) country. I don't really understand how that's possible.
Yes, healthcare is byzantine in the US, but it's not less complex in any other first world country, yet America is a dramatic outlier -- in a bad way -- in terms of price to performance. Countries that do markedly better on such measures are also countries which tend to have some kind of price controls built into their healthcare system.
While I understand the temptation to bristle at the more needling comment, it's hard not to see debating over whether someone whose username is "Asshat" is being unfairly sarcastic as a bit beside the point. (Also, the good admiral did not, as far as I can tell, attack you, he attacked what he perceived to be your argument.)
> Your comment and the one higher in this chain makes it sound like a hard problem when it's only a problem for the United States and no other (1st world) country. I don't really understand how that's possible.
Yes, healthcare is byzantine in the US, but it's not less complex in any other first world country, yet America is a dramatic outlier -- in a bad way -- in terms of price to performance. Countries that do markedly better on such measures are also countries which tend to have some kind of price controls built into their healthcare system.
While I understand the temptation to bristle at the more needling comment, it's hard not to see debating over whether someone whose username is "Asshat" is being unfairly sarcastic as a bit beside the point. (Also, the good admiral did not, as far as I can tell, attack you, he attacked what he perceived to be your argument.)
I can assume good faith while still believing your comment is driven by the same American Exceptionalism mentality that leads to the mindset echoed by The Onion article. If your concern is that the reply comes across as mocking rather than engaging: the article was more concise and more eloquent than the potential diatribe I had written up, so I used it.
I am not an American, and I do not believe in American Exceptionalism.
Sure, our healthcare system is crazy. But is healthcare really inherently complicated? This is a solved problem basically everywhere else in the world.
Germany has had universal healthcare since the 1880's under Otto von Bismarck. This has been a solved problem for more than a century.
The problem is that everywhere else in the world doesn't have the delusion that unfettered capitalism and healthcare are compatible.
The US manages to pick and choose socialistic policies in some areas, and I'm more or less just waiting for them (us) to come around to the view that basic healthcare is just one of those things that everyone needs in order to have a decent shot at life so you might as well just provide it as a blanket service.
The US manages to pick and choose socialistic policies in some areas, and I'm more or less just waiting for them (us) to come around to the view that basic healthcare is just one of those things that everyone needs in order to have a decent shot at life so you might as well just provide it as a blanket service.
The US system is far from perfect, but blaming its dysfunction on 'unfettered capitalism' is absurd.
The US healthcare system is among the most heavily regulated industries in the US economy. Among those regulations are FDA policies that give Big Pharma monopolies on new drugs. The FDA extends these monopolies for decades, allowing companies to operate as state-created monopolies. Once the state-created monopoly times out, competitors face a years-long approval process before they can market a generic version of an already approved drug.
The US healthcare system is among the most heavily regulated industries in the US economy. Among those regulations are FDA policies that give Big Pharma monopolies on new drugs. The FDA extends these monopolies for decades, allowing companies to operate as state-created monopolies. Once the state-created monopoly times out, competitors face a years-long approval process before they can market a generic version of an already approved drug.
You're absolutely right, "unfettered" is hyperbole. I just get a bit weary of the "free market will fix it" attitude, because it's only really free market if all involved parties are free to set the terms of the transactions, and most consumers of healthcare do not actually have much power to do that (or even to know the terms before "purchase"). So the "free market," to the extent that it exists, optimizes for those participants who do have that power, to the detriment of the end user. In my opinion, of course.
That’s true. But given the relative success of socialized healthcare in most other countries, I’m not sure why you’re seizing on the “unfettered” part rather than the “capitalism” part.
Perhaps you should be arguing against lobbying instead of arguing “well, if we try to stop big pharma they’ll just fuck us so might as well roll over and die”.
Somehow, every other country on earth seems to be managing.
Corruption in the British NIH seems a non-problem. The newspapers would be full of it if it were.
Those compliance costs are in the best interest of large pharmaceutical companies, they lobby for it. If these regulations did not exist, small companies would be destroying the disproportionate profits to be made from generic drugs.
I wouldn't otherwise argue for price controls, but if you give these companies the gift of keeping competition from the bottom out, you need to account for that, because competition is the only thing keeping a lid on prices in a free market.
I wouldn't otherwise argue for price controls, but if you give these companies the gift of keeping competition from the bottom out, you need to account for that, because competition is the only thing keeping a lid on prices in a free market.
I'm not arguing that the pharmaceutical companies are 'good guys', just that the situation was created by the FDA. I think the simplest and safest solution is to reduce compliance costs (which are extremely high in the USA), and allow the new entrants (initially small companies) to rectify the situation. This is not an instantaneous fix, and I will admit that it is a bit unsatisfying, but it's a robust solution.
Fair enough, but with that proposal you have the FDA and pharmaceutical companies positioned against you.
Price controls - at least with a Democratic administration - are more realistic, because the FDA doesn't care about that and the pharmaceutical companies at least get to keep their moat, which they will prefer over some lost profits from generics.
Price controls - at least with a Democratic administration - are more realistic, because the FDA doesn't care about that and the pharmaceutical companies at least get to keep their moat, which they will prefer over some lost profits from generics.
I completely agree that the pharmaceutical companies will lobby to keep the current regulatory barriers. 'Big Pharma' has specialized in regulatory compliance, not drug development and production, so they'll fight to protect the barriers.
I don't think price controls will work quite as well as you do, and I disfavor solutions which require a benevolent bureaucracy (and executive branch).
I don't think price controls will work quite as well as you do, and I disfavor solutions which require a benevolent bureaucracy (and executive branch).
Yes, they are indeed created by ethical deficiencies. There is nothing in the way of the legislators to pass a law which says insulin and similar substances created to treat diabetes cannot cost more than 100$ a vial. The only thing in their way is their greed. Their greed for sweet lobbying money.
The Supreme court ruled that cross marketing agreements were okay. Which allows a drugs companies to buy off generic competitors. Also generic drug companies are colluding on prices and the government just occasionally fines the companies instead of throwing corporate officers in prison.
On the scale of a market in the many many billions, the costs imposed by FDA aren’t even a rounding error. That’s not why drugs are expensive.
Generally, Pharma companies charge a lot for medications in the US _because they can_ - because no one stops them. Lots of other countries have systems which limit price, or set drug prices according to value, or similar.
Why doesn’t the US? Fundamentally, it’s got to come back to allowing money and thus big business to influence the US political system so directly. Until this is fixed, sadly little is likely to change.
Generally, Pharma companies charge a lot for medications in the US _because they can_ - because no one stops them. Lots of other countries have systems which limit price, or set drug prices according to value, or similar.
Why doesn’t the US? Fundamentally, it’s got to come back to allowing money and thus big business to influence the US political system so directly. Until this is fixed, sadly little is likely to change.
Health insurance company profits are capped at 20% of the premiums they take in[1]. So not only because they _can_, but they actively want healthcare costs to go up, because that's the only way they get to increase their profits.
https://www.healthcare.gov/health-care-law-protections/rate-...
https://www.healthcare.gov/health-care-law-protections/rate-...
Meanwhile in Germany and Switzerland there are non-profit health insurance companies:
* https://en.wikipedia.org/wiki/Healthcare_in_Germany#Health_i...
* https://en.wikipedia.org/wiki/Healthcare_in_Switzerland#Comp...
Both usually rank quite well in various international comparisons.
The US has a great healthcare system, but abysmal health insurance.
* https://en.wikipedia.org/wiki/Healthcare_in_Germany#Health_i...
* https://en.wikipedia.org/wiki/Healthcare_in_Switzerland#Comp...
Both usually rank quite well in various international comparisons.
The US has a great healthcare system, but abysmal health insurance.
Lots (perhaps most?) of US health insurance providers also non-profit.
Are lot of tiny non profit insurance companies exist generally created by companies or religious groups to run their insurance. However, in terms of the overall market share it’s under 1/3 and significantly less when you look at companies that accept anyone.
Lot's of Hospital Systems in the US are ostensibly non-profit, but the number of Administrators & executives (and their salaries and bonuses) have been going way up
This doesn't appear to be true. There are other ways for health insurance companies to increase profits.
The US Health insurance industry spends on average, 86% of premiums on healthcare costs[0], which means they can increase their profits by reducing those costs, since 80% is the floor.
12% of the left over premium gets spent on operating expenses, which leaves the industry with a 2-3% profit margin[0]. So another way of increasing profits is for the companies to become more efficient.
These figures are for the industry as a whole. Any individual company will have other avenues of increasing profit, such as growing their market share.
[0] https://content.naic.org/sites/default/files/inline-files/20...
The US Health insurance industry spends on average, 86% of premiums on healthcare costs[0], which means they can increase their profits by reducing those costs, since 80% is the floor.
12% of the left over premium gets spent on operating expenses, which leaves the industry with a 2-3% profit margin[0]. So another way of increasing profits is for the companies to become more efficient.
These figures are for the industry as a whole. Any individual company will have other avenues of increasing profit, such as growing their market share.
[0] https://content.naic.org/sites/default/files/inline-files/20...
> Generally, Pharma companies charge a lot for medications in the US _because they can_ - because no one stops them.
Walmart charges what they do because they can as well. Pretty much everyone charges what they can and nobody stops them. There aren't many business out there pricing stuff lower than what they can get away with.
There is a billion dollar opportunity here for whoever sells insulin at half price to the US market. Looking at the enormous price differences, it seems very likely that the opportunity exists. These are manufacturing prices; presumably before subsidy [0]. Unless I've really misunderstood what they are saying there is a huge opportunity for someone to get rich here. The most likely reason the prices are high is because the US government has somehow made it illegal to sell cheap insulin.
[0] "First, the manufacturer prices available in the MIDAS data do not reflect rebates or other discounts that might have been applied after drugs left the factory; we expect that, in many countries (and particularly in the United States), the net price paid for drugs was lower than the reported manufacturer prices shown in our results tables." - In the linked report
Walmart charges what they do because they can as well. Pretty much everyone charges what they can and nobody stops them. There aren't many business out there pricing stuff lower than what they can get away with.
There is a billion dollar opportunity here for whoever sells insulin at half price to the US market. Looking at the enormous price differences, it seems very likely that the opportunity exists. These are manufacturing prices; presumably before subsidy [0]. Unless I've really misunderstood what they are saying there is a huge opportunity for someone to get rich here. The most likely reason the prices are high is because the US government has somehow made it illegal to sell cheap insulin.
[0] "First, the manufacturer prices available in the MIDAS data do not reflect rebates or other discounts that might have been applied after drugs left the factory; we expect that, in many countries (and particularly in the United States), the net price paid for drugs was lower than the reported manufacturer prices shown in our results tables." - In the linked report
Walmart sells an inexpensive OTC insulin type ($25 a vial).
https://diabetesstrong.com/walmart-insulin/
It's an older formulation, and not commonly prescribed, unless you're cost sensitive.
https://diabetesstrong.com/walmart-insulin/
It's an older formulation, and not commonly prescribed, unless you're cost sensitive.
Why doesn't competition step in and increase the supply of insulin, thereby decreasing its cost? If insulin is 1/8th the cost elsewhere why can't I import it from overseas and sell it locally, making arbitrage profits?
Is there something other than regulatory capture going on here? If not it's less a case of "because they can" and more a case of "because others can't".
Is there something other than regulatory capture going on here? If not it's less a case of "because they can" and more a case of "because others can't".
Because your cheaper product needs to be fda proved, which either is extremely expensive or these is some huge cartel conspiracy. Probably the first.
Short answer: because of regulations.
Just to give you an example how ridiculous the US health care is. I used to live in California and I had an inflamed wisdom tooth. It cost me so much to get it out (fully insured, premium+, high income insurance) that the amount I had to pay __after__ insurance (out of pocket) would have been enough to buy a ticket to go to Europe, visit a random country get the operation done, fully pay for (without insurance coverage) it and fly home to Cali.
Just to give you an example how ridiculous the US health care is. I used to live in California and I had an inflamed wisdom tooth. It cost me so much to get it out (fully insured, premium+, high income insurance) that the amount I had to pay __after__ insurance (out of pocket) would have been enough to buy a ticket to go to Europe, visit a random country get the operation done, fully pay for (without insurance coverage) it and fly home to Cali.
The state of Utah flies employees to Mexico to fill prescriptions there because: "The cost difference is big enough that the state's program can pay for each patient's flight, provide them with a $500-per-trip bonus, and still save tens of thousands of dollars"
https://www.pharmacist.com/article/utah-sends-employees-mexi...
https://www.pharmacist.com/article/utah-sends-employees-mexi...
FWIW health insurance and dental insurance are very different - dental insurance is always separate from health insurance and often covers very little, often nothing beyond checkups. The last time I had a plan offerred it covered up to $1200... but cost $100 a month. The cost was actually equivalent to the price of checkups. I'm not sure why this played out the way it did -- probably because it is procedure focused.
FYI the dental insurance company forced me to submit the claim against the general insurance company and only wanted to deal with the case when it bounced back. I had a premium dental insurance at the time. This is what insurance companies can do in the USA and most people who are moving that are not aware of it, because it is so unimaginable that one of the richest countries of the west has an insurance system like that.
>would have been enough to buy a ticket to go to Europe, visit a random country get the operation done, fully pay for (without insurance coverage) it and fly home to Cali.
This isn't even uncommon among people in Europe. A lot of people from Western Europe get on a 50 bucks Ryanair flight to Hungary or Romania, get their dental work done and fly back home.
This isn't even uncommon among people in Europe. A lot of people from Western Europe get on a 50 bucks Ryanair flight to Hungary or Romania, get their dental work done and fly back home.
The difference is the price of ticket to fly over a continent + the Atlantic Ocean vs fly over few countries. On the top of that, the other reason why people in some Western Countries (for example Ireland) do this is very surprising: quality of service. Ireland used to not have emergency dental service and even the general dentistry was not that great while being much more expensive (not US level though) than in Hungary, Romania or Poland. There is an entire industry specialised in Hungary and Poland to server Western clients.
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And this is the REAL issue. If I was allowed to start a pharma company as easily as I could start a software company then you bet I would be doing that instead of SAAS. I can guarantee that prices would be lower than the rest of the world, and that American pharma companies would be top-of-market in international markets as well.
But, the mafioso in-bed-with-the-gov-and-politicians absolutely corrupt elitist-owned system that we have in America is ruining this country.
And to all the people downvoting the "regulation" comments: You are being COMPLETELY intellectually dishonest, and you know it. Game theory validates that regulatory capture is 100% the issue. The Universe and nature work by a set of laws that has been investigated since the 50s with Von Neumann, Nash, etc. It is time that we stop telling ourselves that some politicians in government are going to magically create legal algorithms that outperform the laws of the nature. It is dangerous, immoral, and stupid and it ends up only protecting and embedding the existing corrupt elite for life.
But, the mafioso in-bed-with-the-gov-and-politicians absolutely corrupt elitist-owned system that we have in America is ruining this country.
And to all the people downvoting the "regulation" comments: You are being COMPLETELY intellectually dishonest, and you know it. Game theory validates that regulatory capture is 100% the issue. The Universe and nature work by a set of laws that has been investigated since the 50s with Von Neumann, Nash, etc. It is time that we stop telling ourselves that some politicians in government are going to magically create legal algorithms that outperform the laws of the nature. It is dangerous, immoral, and stupid and it ends up only protecting and embedding the existing corrupt elite for life.
I generally agree with the sentiment but you definitely go too far.
> Game theory validates that regulatory capture is 100% the issue.
Regulatory capture cannot be the issue because it exists pretty much everywhere (in the Western world, I guess), yet US prices/insurance/medical spending is higher than in e.g. Europe.
Maybe it's the US flavour of regulatory capture - that's an option - but then you should be railing against that, not pulling a fake reductio ad game theory argument out of your sleeve - I mean, what do you propose as the alternative, an unregulated drug market? I mean, I'm very much in that direction - I believe all drugs should be legal and accessible, the only restriction I'd put on the "freely" part of "freely accessible" (e.g. new/experimental drugs only if you're dying, hard drugs like heroin only if you go through 6 months of classes & psychiatric evaluation, etc.) - but even that's clearly still a "regulated market" (e.g. disallows misleading advertising).
> Game theory validates that regulatory capture is 100% the issue.
Regulatory capture cannot be the issue because it exists pretty much everywhere (in the Western world, I guess), yet US prices/insurance/medical spending is higher than in e.g. Europe.
Maybe it's the US flavour of regulatory capture - that's an option - but then you should be railing against that, not pulling a fake reductio ad game theory argument out of your sleeve - I mean, what do you propose as the alternative, an unregulated drug market? I mean, I'm very much in that direction - I believe all drugs should be legal and accessible, the only restriction I'd put on the "freely" part of "freely accessible" (e.g. new/experimental drugs only if you're dying, hard drugs like heroin only if you go through 6 months of classes & psychiatric evaluation, etc.) - but even that's clearly still a "regulated market" (e.g. disallows misleading advertising).
I'm curious about the details of this for insulin. Is it a problem with one political party or with both? Does the pharma oligopoly control the politicians through donations/funding? Or is there a legitimate IP protection reason that the pharma companies have that justifies the lack of competition for insulin provision?
This is not about direct costs. It's about FDA banning competing products so one company can charge astronomical prices.
It's not that other countries didn't have the same rules. Before you can market a generic in Germany you must convince the Institute for Pharmaceuticals and Medical Devices that your product is comparable to the brand-name medication. People like to blame the FDA but tend to disregard that Europe and Japan have similar safety requirements.
When you read some of the inspection reports from White Oak you wonder: what would pharma manufacturing in <insert faraway country here> look like if they knew the FDA didn't exist!
When you read some of the inspection reports from White Oak you wonder: what would pharma manufacturing in <insert faraway country here> look like if they knew the FDA didn't exist!
As I understand it the FDA is different.
Even if your product is comparable to the brand-name medication, the cost, time, and uncertainty of getting a permit is so prohibitive that many smaller medications are left with well protected monopolists.
That's at least what I hear. I don't work in the industry.
Even if your product is comparable to the brand-name medication, the cost, time, and uncertainty of getting a permit is so prohibitive that many smaller medications are left with well protected monopolists.
That's at least what I hear. I don't work in the industry.
The monopoly or the public authorities aren't even the problem, natural monopolies are well understood and brought under control by regulation. There are three manufacturers of insulin in the US, about six worldwide. Everywhere else the natural monopoly is dealt with by price controls, except in the US. They could, but they don't want to.
Why would insulin be a natural monopoly? It seems like a commodity, which is kinda the opposite.
Aside from modern insulin variations under patent, but that's different.
I suspect the barrier to entry that creates these monopolies is again the access to FDA approval. You can only really make money in the US market, due to the price controls elsewhere.
The high US drug prices subsidizes the world to a big extent, and I wonder how much of a drug industry would survive if the US also went for price controls.
Aside from modern insulin variations under patent, but that's different.
I suspect the barrier to entry that creates these monopolies is again the access to FDA approval. You can only really make money in the US market, due to the price controls elsewhere.
The high US drug prices subsidizes the world to a big extent, and I wonder how much of a drug industry would survive if the US also went for price controls.
Why would insulin be a natural monopoly?
It's the confluence of the low profit margin, high barrier to entry (FDA) and inelastic demand. The market does not support more than five or six players worldwide. It's like that for any generic.
That's common to all commodity medical supplies. Remember the IV saline shortage after Hurricane Maria took out the manufacturers on Puerto Rico? That doesn't need FDA approval (the facility does need inspection though), but you don't spin up a sterile bulk manufacturing facility in 6 months because of upfront costs that will take an eternity to recover.
You can only really make money in the US market
{{citation needed}}
You can fleece the US citizen only so much. Elizabeth Warren showed in 2004 how stretched he is, and it has only gotten worse since. The rest of the world may pay less but it's bigger. Also, when you can justify the cost to the public authorities it will be paid - note that a course of glecaprevir/pibrentasvir Hep C protease inhibitor is 26 kUSD in the US and a comparable 27 kGBP in Britain. A heap of money, but beats the liver transplant, both in cost and quality of life.
The bigger threat to pharma is the poor return on investment. Information technology pays off faster and with lower risk. Goldman Sachs suggested the government step in, they are the only ones with big enough pockets. The suggestion is sound.
It's the confluence of the low profit margin, high barrier to entry (FDA) and inelastic demand. The market does not support more than five or six players worldwide. It's like that for any generic.
That's common to all commodity medical supplies. Remember the IV saline shortage after Hurricane Maria took out the manufacturers on Puerto Rico? That doesn't need FDA approval (the facility does need inspection though), but you don't spin up a sterile bulk manufacturing facility in 6 months because of upfront costs that will take an eternity to recover.
You can only really make money in the US market
{{citation needed}}
You can fleece the US citizen only so much. Elizabeth Warren showed in 2004 how stretched he is, and it has only gotten worse since. The rest of the world may pay less but it's bigger. Also, when you can justify the cost to the public authorities it will be paid - note that a course of glecaprevir/pibrentasvir Hep C protease inhibitor is 26 kUSD in the US and a comparable 27 kGBP in Britain. A heap of money, but beats the liver transplant, both in cost and quality of life.
The bigger threat to pharma is the poor return on investment. Information technology pays off faster and with lower risk. Goldman Sachs suggested the government step in, they are the only ones with big enough pockets. The suggestion is sound.
> It's the confluence of the low profit margin, high barrier to entry (FDA) and inelastic demand. The market does not support more than five or six players worldwide. It's like that for any generic.
That's precisely what I'm saying!
If we agree on the facts, our difference seems to be that I don't consider FDA regulations "natural". They can be reformed, and then we'd see many suppliers cranking out cheap plentiful insulin.
That's precisely what I'm saying!
If we agree on the facts, our difference seems to be that I don't consider FDA regulations "natural". They can be reformed, and then we'd see many suppliers cranking out cheap plentiful insulin.
They can be reformed, and then we'd see many suppliers cranking out cheap plentiful insulin.
That's just nonsense. The other highly inelastic market is oil, there are massive price excursions when supply and demand are not matched. Have you seen what happened when oil demand dropped this spring? Prices completely fell off a cliff! Demand will not increase just because new capacity enters the market, instead prices will drop to make everyone unprofitable, including the new entrant, who will never be able to recover the initial investment.
That's just nonsense. The other highly inelastic market is oil, there are massive price excursions when supply and demand are not matched. Have you seen what happened when oil demand dropped this spring? Prices completely fell off a cliff! Demand will not increase just because new capacity enters the market, instead prices will drop to make everyone unprofitable, including the new entrant, who will never be able to recover the initial investment.
It sounds like we agree that prices would fall.
Since the problem we're talking about is the very high prizes for insulin etc in the US, does that mean we agree this would be a solution for that problem?
Since the problem we're talking about is the very high prizes for insulin etc in the US, does that mean we agree this would be a solution for that problem?
Your comment seems to suppose that basic economics do not apply to healthcare; do you believe that it's a 'special case'? I see healthcare as being similar to every other market, and think that the cost issues are driven by regulations and incentives.
Healthcare is an inelastic market. If the new iPhone is too expensive, keep an old one, of buy a used one. If your insulin dose is too expensive, you die. Normal market rules of supply and demand do not entirely apply to Health care markets.
> If your insulin dose is too expensive, you die.
While that is true, you are not including the option of switching to a cheaper insulin. The older insulins (R/N/L) were, the last time I checked, something like $25 per bottle, over the counter.
While that is true, you are not including the option of switching to a cheaper insulin. The older insulins (R/N/L) were, the last time I checked, something like $25 per bottle, over the counter.
Cheaper insulin is worse insulin, harder to manage, and ultimately will shorten your lifespan. If you've never used it before/are underresourced about its useage it can 100% still mean a death sentence. Still inelastic imo.
Haha, no. If your insulin dose is too expensive, you die. If my insulin dose is too expensive in America, I ship it from generics factories in India¹.
The problem for you is that you can't do what I do. And maybe the problem for you is also that I can't sell you what I get this way.
So in America you have 'shortages'. I do not. And if you wanted, you could also choose not to have 'shortages'.
I remember the same thing happening when Chloroquine was 'in short supply'. I could always get some. You never could. This is by choice. You live by rules that the universe does not require of you. These are probably for other reasons like perhaps you believe in living by the categorical imperative. But there are predators in this forest who do not believe in that.
¹ Even insulin can come here stably and safe. But drugs for other conditions are easier. And what I'm saying here is not strictly true if you're familiar with the details: it's not actually a generic, etc. etc. The important thing is that it's cheap and available.
The problem for you is that you can't do what I do. And maybe the problem for you is also that I can't sell you what I get this way.
So in America you have 'shortages'. I do not. And if you wanted, you could also choose not to have 'shortages'.
I remember the same thing happening when Chloroquine was 'in short supply'. I could always get some. You never could. This is by choice. You live by rules that the universe does not require of you. These are probably for other reasons like perhaps you believe in living by the categorical imperative. But there are predators in this forest who do not believe in that.
¹ Even insulin can come here stably and safe. But drugs for other conditions are easier. And what I'm saying here is not strictly true if you're familiar with the details: it's not actually a generic, etc. etc. The important thing is that it's cheap and available.
[deleted]
It sounds like you’re saying “this isn’t a problem if you simply break the law”, which obviously isn’t a real solution to the problem.
Demand is relatively inelastic in healthcare.
Supply is not. The fact that I need a product does not constrain suppliers from supplying it. So normal supply elasticity of supply rules apply.
There are lots of inelastic markets, and I'd agree they do often suffer from short-term price volatility, but the US healthcare market suffers from longer-term price 'anomalies', which I believe are a product of its unique regulatory landscape.
Other markets with inelastic demand and/or supply also suffer from long-term price anomalies: take housing/rental in SF. There’s certainly some more contributing factors that make an inelastic market turn into a problem, but it’s fairly obvious that it’s not governed by the regular “simple” market explanation of supply and demand converging to a price point if the demand is essentially fixed.
Housing and real estate have a regulatory environment which may be as Byzantine as that in healthcare! Real estate is a little 'better' because you have competing regulatory regimes which serve to (somewhat) moderate the extremes, but it's still quite bad.
If you're looking for a contrasting inelastic market (one with a simpler regulatory landscape), I'd look for other industries with high capital costs, such as semiconductor manufacturing.
If you're looking for a contrasting inelastic market (one with a simpler regulatory landscape), I'd look for other industries with high capital costs, such as semiconductor manufacturing.
FWIW, I was sketching out the situation in the US healthcare market generally, and not specifically referring to the insulin situation.
To expand slightly (all IM opinion/observation):
a) Often, there isn't a 'market', as there might not be multiple competitive options for each disease.
b) Even in situations where there are (say) two roughy similar treatments for a disease, market forces don't always apply - manufacturers differentiate via other routes and try to avoid price erosion.
c) It's uncertain how often price directly influences prescribing decisions (in the US, or indeed in many countries).
To expand slightly (all IM opinion/observation):
a) Often, there isn't a 'market', as there might not be multiple competitive options for each disease.
b) Even in situations where there are (say) two roughy similar treatments for a disease, market forces don't always apply - manufacturers differentiate via other routes and try to avoid price erosion.
c) It's uncertain how often price directly influences prescribing decisions (in the US, or indeed in many countries).
> these issues are created by simple economics (market and regulatory issues), not ethical deficiencies
I don't think that "because economics" is a card that can be played to completely nullify any questions about ethics. We can and do make decisions at many different levels (from individual to nation-state) over how the economy works and how markets are regulated, and ethics are relevant any time decisions are made which affect other people.
I don't think that "because economics" is a card that can be played to completely nullify any questions about ethics. We can and do make decisions at many different levels (from individual to nation-state) over how the economy works and how markets are regulated, and ethics are relevant any time decisions are made which affect other people.
Absolutely. Just like most of the bad situation in the US, it was created by a regulatory body or the government directly.
This is regulatory capture. The moralizing still applies, but it just applies to more people.
I agree, get rid of patents to allow anyone to compete. Then shut down the FDA (which has been subject to regulatory capture), and create a new smaller regulatory agency.
I live in CA and have type 2 diabetes, and I need to inject insulin once per day; on average, I use 1 insulin pen per month. The cost of 5 pens box at local pharmacy is about $33. The price used to be $40+ per box two years ago and recently dropped. So the insulin cost for me is about $7 per month.
I usually only care about the “real” price, which is the price I actually paid, rather than the prices from an article.
Maybe there’s difference between a type 1 patient, but this is my personal experience.
I usually only care about the “real” price, which is the price I actually paid, rather than the prices from an article.
Maybe there’s difference between a type 1 patient, but this is my personal experience.
Your costs would be much higher with Type 1: somewhere between 10-30mL (3-10x 3mL pens) is more typical.
This is actually addressed in the article though:
> The study used manufacturer prices for the analysis. The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.
This is actually addressed in the article though:
> The study used manufacturer prices for the analysis. The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.
At a point wouldn't it be cheaper to hop on a flight to London , and check yourself into a hospital ?
I know if I wasn't upper middle class I'd likely be skipping medicine right now.
NHS style healthcare should be a human right
I know if I wasn't upper middle class I'd likely be skipping medicine right now.
NHS style healthcare should be a human right
It is, and tons of people do it. Although they go to Mexico/India/SE Asia. There are entire medical tourism packages offered by hospitals in these countries - including airfare, surgeries/consultations, drugs, hospital stays, recovery at fancy resorts - all still working out to a fraction of the cost of treatment in the US.
> "At a point wouldn't it be cheaper to hop on a flight to London , and check yourself into a hospital ?"
The NHS doesn't offer free non-emergency healthcare to non-UK residents. In general, you would have to prove that you are a legal UK resident before you'd be admitted. Obviously, in an emergency they would treat you no matter what (but potentially send you a bill afterwards).
The NHS doesn't offer free non-emergency healthcare to non-UK residents. In general, you would have to prove that you are a legal UK resident before you'd be admitted. Obviously, in an emergency they would treat you no matter what (but potentially send you a bill afterwards).
You're right about hospital care, but if you need insulin you'd get it from a GP, not a hospital.
Just about anyone can register for primary care. There isn't an "ordinarily resident" test for primary care. P142 of this: https://www.england.nhs.uk/publication/primary-medical-care-...
Ordinarily resident applies to secondary care, but not including detention in a mental health hospital under the mental health act and not including A&E treatment in the A&E unit.
---begin quote---
8.4 Who can register for free primary care services?
8.4.1 A patient does not need to be “ordinarily resident” in the country to be eligible for NHS primary medical care – this only applies to secondary (hospital) care. In effect, therefore, anybody in England may register and consult with a GP without charge.
8.4.7 It is important to note that there is no set length of time that a patient must reside in the country in order to become eligible to receive NHS primary medical care services.
8.4.8 Therefore, all asylum seekers and refugees, students, people on work visas and those who are homeless, overseas visitors, whether lawfully in the UK or not, are eligible to register with a GP practice even if those visitors are not eligible for secondary care (hospital care) services.
Just about anyone can register for primary care. There isn't an "ordinarily resident" test for primary care. P142 of this: https://www.england.nhs.uk/publication/primary-medical-care-...
Ordinarily resident applies to secondary care, but not including detention in a mental health hospital under the mental health act and not including A&E treatment in the A&E unit.
---begin quote---
8.4 Who can register for free primary care services?
8.4.1 A patient does not need to be “ordinarily resident” in the country to be eligible for NHS primary medical care – this only applies to secondary (hospital) care. In effect, therefore, anybody in England may register and consult with a GP without charge.
8.4.7 It is important to note that there is no set length of time that a patient must reside in the country in order to become eligible to receive NHS primary medical care services.
8.4.8 Therefore, all asylum seekers and refugees, students, people on work visas and those who are homeless, overseas visitors, whether lawfully in the UK or not, are eligible to register with a GP practice even if those visitors are not eligible for secondary care (hospital care) services.
That's pretty awesome.
Of course it's absolutely not practical, but if I ever wake up as a refugee in London I'll register with a gp
Edit : I almost want to see a SNL skit with a man who decides to have a mental breakdown, but prefers to do so in London vs the US
Of course it's absolutely not practical, but if I ever wake up as a refugee in London I'll register with a gp
Edit : I almost want to see a SNL skit with a man who decides to have a mental breakdown, but prefers to do so in London vs the US
I forgot to put the patient facing info in my post, so I'll link it here: https://www.nhs.uk/using-the-nhs/nhs-services/gps/how-to-reg...
They have leaflets with information tailored to homeless people, asylum seekers and refugees, gypsy Roma and traveller communities, and visitors from abroad.
They have leaflets with information tailored to homeless people, asylum seekers and refugees, gypsy Roma and traveller communities, and visitors from abroad.
> but if you need insulin you'd get it from a GP, not a hospital
Gotcha, I will ask for the nearest surgery ;)
Gotcha, I will ask for the nearest surgery ;)
Given how ludicrously wild medical billing is in the US, chances are you'd still come out ahead.
Amusingly, for simple stuff you'll often get away with it. I think you might actually be able to get sutures for a cut and walk away with the bill going to the Crown. Might get ropey if you had to get a specialist in.
I know if you just got something in your eye and it only needs to be irrigated to dislodge the debris you'll probably not be billed.
I know if you just got something in your eye and it only needs to be irrigated to dislodge the debris you'll probably not be billed.
I’m afraid it doesn’t really work like that - even as a British Citizen you’d still need to be resident here. And if not, then becoming a resident would require a visa first - then yes you could get NHS care, but it would not be a timely procedure.
Yep. But what do you do if you can't afford to do that? And even if you can, if you have a chronic condition, you would need to find a job in London (or whereever else you go).
I'm being a bit tongue in cheek , you can get round trip flights to London for 400$ or so.
No one should die due to an inability to pay. Even if you have a great job , you can still lose it
No one should die due to an inability to pay. Even if you have a great job , you can still lose it
> Even if you have a great job , you can still lose it
Especially likely if you're distracted or impaired by an illness - even if not yet diagnosed.
Especially likely if you're distracted or impaired by an illness - even if not yet diagnosed.
In India it is a big industry 'medical tourism'. You'll get a 5-star hospital with a trip to Taj Mahal bundled for free.
There is a Costa Rica Dental Group that advertises on a sports talk radio show here in Florida. They talk about their vacation / dental package.
You wonder what the coronaplague did to all the dentists in San Luis across the border from Yuma.
It's called medical tourism. If you don't have (and in some cases even if you have insurance) you can any necessary surgery done in Singapore:
https://www.health-tourism.com/medical-tourism-singapore/
https://www.health-tourism.com/medical-tourism-singapore/
> At a point wouldn't it be cheaper to hop on a flight to London , and check yourself into a hospital ?
Or walk into any Canadian pharmacy (if you can get into the country). Insulin doesn’t require a prescription here.
Dunno why almost everything else does though.
Or walk into any Canadian pharmacy (if you can get into the country). Insulin doesn’t require a prescription here.
Dunno why almost everything else does though.
Medicare doesn't pay for drugs. It pays premiums for private insurance that pays for drugs.
The law says that the private insurance negotiates the prices rather than the government.
So the implication, that drug prices are not negotiated, is incorrect.
Here's an article about children and babies paying lots for Acthar too:
https://www.cnn.com/2018/06/29/health/acthar-mallinckrodt-qu...
They aren't on Medicare!
Of course, the conclusion that the entire insurance system is broken is just as bad or worse.
The law says that the private insurance negotiates the prices rather than the government.
So the implication, that drug prices are not negotiated, is incorrect.
Here's an article about children and babies paying lots for Acthar too:
https://www.cnn.com/2018/06/29/health/acthar-mallinckrodt-qu...
They aren't on Medicare!
Of course, the conclusion that the entire insurance system is broken is just as bad or worse.
Is there any discussion as to why he didn't just switch to a cheaper (older) insulin? Last time I checked, it was still possible to get the older (R/N/L) insulins at around $25/bottle, over the counter.
Patients refuse to switch for a variety of reasons: fear that a different insulin will harm them, mental illness, discomfort with disturbing their insurance arrangement. You will hear diabetics (I am one, too) say that only a particular insulin works for them, even if that means they end up using no insulin at all, and/or haven’t seriously tried the cheap options.
Patient education is a necessary step to decreasing prices and encouraging innovative medications at the same time. As is decreasing the inevitable fury at diabetics like myself who dare to look inward.
Patient education is a necessary step to decreasing prices and encouraging innovative medications at the same time. As is decreasing the inevitable fury at diabetics like myself who dare to look inward.
How is that a good answer? Certain death will scare you much more than some discomfort or insurance arrangement. Cheap insulin works fine.
This is a classic case when some ridiculous example, where it's clearly patient's fault, is presented as the fault of the system.
This is a classic case when some ridiculous example, where it's clearly patient's fault, is presented as the fault of the system.
Cheap insulin works. For long-term outcomes, I'd certainly argue that it doesn't work "fine." But it's definitely better than death.
Outside of mental illness, I cannot fathom choosing death over trying a different type of insulin. I may be biased, because I've used so many different types over my life.
I think the "outside of mental illness" is a pretty important qualifier here. I've never hit the point personally where I'd prefer death to diabetes, but I've certainly been close, and were it not for a pretty fortunate life - good insurance, ability to afford a good doctor who is knowledgable in this field, ability to afford a CGM and never have to worry about paying for testing strips (another ridiculous expense - frankly far worse than insulin given how much larger of a population it impacts) - I could certainly see myself in their shoes.
The other comment said it well—I would additionally encourage you to help other diabetics to understand what flexibility they have, using your experience.
Would likely work if you had a CGM (continuous glucose monitor).
Blood glucose levels are really hard to get right with old insulin. Literally everything you do pushes your blood sugar demand up or down (sleep, stress, activity, macronutrient load/timing).
Modern insulin analogs tent to smooth out these variables.
Blood glucose levels are really hard to get right with old insulin. Literally everything you do pushes your blood sugar demand up or down (sleep, stress, activity, macronutrient load/timing).
Modern insulin analogs tent to smooth out these variables.
It is more difficult, but its not completely horrible. It's certainly better than the death in the post I was replying to ("was found dead in his home because he couldn't afford $1,300 per month for insulin."). I get that the older insulins are not as good. I get that they're more difficult to use. They are, however, most definitely better than dying. Any story that says says the person died because they couldn't afford 1300/ month for insulin is being disingenuous.
I don't know why this propaganda is so highly upvoted. Monthly insulin doesn't cost $1,300. Nowhere near that. Maybe if you select the highest priced option on the market. But what stops you from buying a reasonably priced option?
My sister paid ~$350 per 2 weeks in NC. The price depends heavily on where you are, how much you need, and how good your insurance is (she had none for other reasons).
Can you shed some light on the truth then? Why don't you provide specific numbers if you argue specific numbers?
Depending on how many units/day you need. There's a great website for finding low priced insulin:
https://www.goodrx.com/humalog
$68.38 for five 3ml cartridges of 100 units/ml.
So if you need 100 units/day (that's on the high end), that's two weeks worth.
https://www.goodrx.com/humalog
$68.38 for five 3ml cartridges of 100 units/ml.
So if you need 100 units/day (that's on the high end), that's two weeks worth.
You only covered the bolus requirements.
You also need a basal insulin for Type-1 diabetes (unless you're on an insulin pump, which is an entirely different class of expense), so something like Tresiba ($505) (https://www.goodrx.com/tresiba) or Lantus ($357).
Still not $1300/mo, but your price is also using temporary rebates and coupons, which certainly aren't always available.
You also need a basal insulin for Type-1 diabetes (unless you're on an insulin pump, which is an entirely different class of expense), so something like Tresiba ($505) (https://www.goodrx.com/tresiba) or Lantus ($357).
Still not $1300/mo, but your price is also using temporary rebates and coupons, which certainly aren't always available.
https://www.goodrx.com/basaglar
$250 for five 3ml at 100 units/ml (1500 units total).
https://www.goodrx.com/toujeo
$324 for three 1.5mL at 300 units/ml (1350 units total).
https://www.goodrx.com/lantus
$357 for five 3ml at 100 units/ml (1500 units total).
$250 for five 3ml at 100 units/ml (1500 units total).
https://www.goodrx.com/toujeo
$324 for three 1.5mL at 300 units/ml (1350 units total).
https://www.goodrx.com/lantus
$357 for five 3ml at 100 units/ml (1500 units total).
Supported by both parties for decades. The US healthcare is between social and full private in a deep hole of despair and the funniest to me is that people trying to blame it on the other party they support. There are good examples for successful healthcare models in Asia or in Europe, they just need to pick one and go with it.
This shouldn't be allowed to happen. These people need this to live and your extorting as much as inhumanely possible from them. As a Canadian this disgusts me, I hope that there is change to allow people to get medication they need.
I thought the current administration was going to fix this problem once and for all. 3.9 years in and we’re no better than that other guy. I encourage you to vote and make sure your voice is heard!
> The final, net prices paid for insulins are likely to be significantly lower than manufacturer prices in the U.S. because rebates and other discounts often drive down the price paid by individuals in the U.S.
I suspect this gives a hint to one contributing factor. Suppliers probably list much higher prices so that they can negotiate lower prices with insurance companies without losing profit. But then the consumer needs to use an "in-network" supplier to get those reduced prices, which removes competition and drives prices up even further.
I suspect this gives a hint to one contributing factor. Suppliers probably list much higher prices so that they can negotiate lower prices with insurance companies without losing profit. But then the consumer needs to use an "in-network" supplier to get those reduced prices, which removes competition and drives prices up even further.
The only thing almost as obscene as medical sticker prices in the US is the amount that just disappears after insurance settles. I have actually had a bill with a 94% "insurance discount" applied.
bingo, the kick backs work in a similar feedback loop. My insurance only covers long term rx from CVS. If I go somewhere else, they stop covering it after about 3 fills.
CVS is more expensive then my warehouse club price.
CVS is more expensive then my warehouse club price.
Why is anybody a modern day conservative/Republican if Democrats want to fix health care and everything that is broken with it can be attributed to Republicans? At least that's the vibe I get from reading here + Reddit on politics.
Seriously asking.
Seriously asking.
Because while that vibe may be an accurate representation of how things are portrayed on social media, it's not an accurate representation of reality. Without writing an expository essay:
1. Healthcare is actually hard at scale.
2. The incentive structure in the US (read, follow the money) is one which is against the public good.
3. There are many many many landmines of technical debt within the current US system which cannot be papered over or solved easily even if you waved a magic wand and got full buy-in for single payer universal healthcare tomorrow.
It's true in some respect that Republicans have taken a general stance against universal healthcare in American politics, but the idea that Democrats have any meaningful and decent strategy for fixing it is a misnomer. At best, we have some politicians who have said the correct words to convey the right sentiments, but no meaningful plans.
As to why this issue is so much worse in the US than elsewhere, that's its own separate essay, but largely comes down to the structure of healthcare mandated by the government since the 1920s, especially after the formation of Medicare and the passage of Part D combined with first mover disadvantages as much of the rest of the world had the opportunity to radically structure their healthcare infrastructure differently post WW2 while rebuilding inclusive of the cost of rebuilding, while the US did not. In a fit of irony, the US footed the bill and drove economic levers to help cement universal healthcare into much of Europe while failing to implement it at home. Even now, part of the complication is that the outsized pricing of healthcare in the US acts as a partly disconnected subsidy on the cost of healthcare elsewhere in the OECD.
After having worked in this space and seeing how completely and utterly fucked the US healthcare system is internally from a technology/records keeping perspective, to the entire payment processing flow, to the way we track and report healthcare incidences, the entire system is broken badly and needs a total overhaul, but that's a much bigger ask than incremental improvements which don't really move the needle much. The US healthcare system is (literally) a legacy codebase written in an esoteric language held together with fears and sorrows because the hopes and dreams already died. The only feasible way to fix its myriad bugs is a complete rewrite, but doing so will form it's own set of technical debt and bugs.
1. Healthcare is actually hard at scale.
2. The incentive structure in the US (read, follow the money) is one which is against the public good.
3. There are many many many landmines of technical debt within the current US system which cannot be papered over or solved easily even if you waved a magic wand and got full buy-in for single payer universal healthcare tomorrow.
It's true in some respect that Republicans have taken a general stance against universal healthcare in American politics, but the idea that Democrats have any meaningful and decent strategy for fixing it is a misnomer. At best, we have some politicians who have said the correct words to convey the right sentiments, but no meaningful plans.
As to why this issue is so much worse in the US than elsewhere, that's its own separate essay, but largely comes down to the structure of healthcare mandated by the government since the 1920s, especially after the formation of Medicare and the passage of Part D combined with first mover disadvantages as much of the rest of the world had the opportunity to radically structure their healthcare infrastructure differently post WW2 while rebuilding inclusive of the cost of rebuilding, while the US did not. In a fit of irony, the US footed the bill and drove economic levers to help cement universal healthcare into much of Europe while failing to implement it at home. Even now, part of the complication is that the outsized pricing of healthcare in the US acts as a partly disconnected subsidy on the cost of healthcare elsewhere in the OECD.
After having worked in this space and seeing how completely and utterly fucked the US healthcare system is internally from a technology/records keeping perspective, to the entire payment processing flow, to the way we track and report healthcare incidences, the entire system is broken badly and needs a total overhaul, but that's a much bigger ask than incremental improvements which don't really move the needle much. The US healthcare system is (literally) a legacy codebase written in an esoteric language held together with fears and sorrows because the hopes and dreams already died. The only feasible way to fix its myriad bugs is a complete rewrite, but doing so will form it's own set of technical debt and bugs.
Perhaps it's worth educating yourself on possible reasons. r/politics and HN are not the best places to do that, to put it mildly.
How would I go about doing that? I feel like every time I find a source, there's something wrong with it. All of the Republican "pundits" like Ben Shapiro + Candace Owens seem to have been "cancelled" for spreading racism and hate and misinformation. Can't trust CNN or Fox News, where am I supposed to become educated on politics?
I'll only talk about healthcare here, because this could degenerate into a flamewar otherwise, and I want to avoid that. Also, I'm no expert on politics, economics, or healthcare, so I'm open to any corrections. I'll try to remain as neutral as possible.
People have different thoughts about economic policy with regards to healthcare. Additionally, there are some cultural concerns.
For one, conservatives feel that liberals are too idealistic and don't have a good plan for actually paying for socialized healthcare. This is most commonly used against Bernie Sanders. Liberals argue that "competition drives down cost" is equally, if not more, idealistic.
Second, in places with "socialized" healthcare, health is thought of as society's responsibility, not the individual's responsibility. This conflicts with the American notion of individuality. Conservatives argue that the US's culture makes socialized healthcare infeasible without costs ballooning out of control, because people are selfish and don't care to protect their health. There is plenty of debate on this matter.
I'm guessing that healthcare is not the most important reason that conservatives vote Republican. Although it seems like a huge issue, there are other issues that might make someone choose one side over the other, even if they disagree with their side's healthcare policy.
People have different thoughts about economic policy with regards to healthcare. Additionally, there are some cultural concerns.
For one, conservatives feel that liberals are too idealistic and don't have a good plan for actually paying for socialized healthcare. This is most commonly used against Bernie Sanders. Liberals argue that "competition drives down cost" is equally, if not more, idealistic.
Second, in places with "socialized" healthcare, health is thought of as society's responsibility, not the individual's responsibility. This conflicts with the American notion of individuality. Conservatives argue that the US's culture makes socialized healthcare infeasible without costs ballooning out of control, because people are selfish and don't care to protect their health. There is plenty of debate on this matter.
I'm guessing that healthcare is not the most important reason that conservatives vote Republican. Although it seems like a huge issue, there are other issues that might make someone choose one side over the other, even if they disagree with their side's healthcare policy.
watwut(1)
Democrats had eight years to fix healthcare, they didn't fix this problem and they created numerous other problems.
This particular problem is due to heavy regulation creating a moat for large pharmaceutical companies to arbitrarily set prices. Republicans generally want to de-regulate, Democrats don't. Republicans generally want the free market to work things out, Democrats generally want the government to work things out.
Each side has been taking turns and as a result, we have had the government prevent the free market from working things out. We want everyone to be able to get healthcare, but we don't (or can't) force anyone to pay for insurance. We effectively incentivize people to not get insurance until they are sick, then we force insurance companies to take them on when they've never paid into the system. Somebody has to pay for all of it, and it ain't the government.
This particular problem is due to heavy regulation creating a moat for large pharmaceutical companies to arbitrarily set prices. Republicans generally want to de-regulate, Democrats don't. Republicans generally want the free market to work things out, Democrats generally want the government to work things out.
Each side has been taking turns and as a result, we have had the government prevent the free market from working things out. We want everyone to be able to get healthcare, but we don't (or can't) force anyone to pay for insurance. We effectively incentivize people to not get insurance until they are sick, then we force insurance companies to take them on when they've never paid into the system. Somebody has to pay for all of it, and it ain't the government.
They had about 4-5 months. https://www.beaconjournal.com/article/20120909/NEWS/30909944...
The Republican controlled Senate spent the other 7.5 years blocking most of the bills by the Democrats. They also attempted to repeal the ACA 70 times.
As to your "We effectively incentivize people to not get insurance", that was the point of the individual mandate which was repealed by the Republicans in 2017.
The Republican controlled Senate spent the other 7.5 years blocking most of the bills by the Democrats. They also attempted to repeal the ACA 70 times.
As to your "We effectively incentivize people to not get insurance", that was the point of the individual mandate which was repealed by the Republicans in 2017.
Alright, if you want to be nitpicky, they had decades to devise a reform, years to agree on it within the party, and months to actually get it passed. It eventually did pass and it wasn't repealed.
> As to your "We effectively incentivize people to not get insurance", that was the point of the individual mandate which was repealed by the Republicans in 2017.
There never was an effective individual mandate, but if there had been, it most likely would've been ruled unconstitutional. Whether you pay a small fine or no fine whatsoever, you are ultimately incentivized to defer paying the far higher insurance premiums.
> As to your "We effectively incentivize people to not get insurance", that was the point of the individual mandate which was repealed by the Republicans in 2017.
There never was an effective individual mandate, but if there had been, it most likely would've been ruled unconstitutional. Whether you pay a small fine or no fine whatsoever, you are ultimately incentivized to defer paying the far higher insurance premiums.
"Republicans generally want the free market to work things out",
-- why is the GOP so against people getting medicine from other safe countries, and 2. not allow medicare/medicaid to be able to negotiate prices?
They are basically both hampering competition where they can, and not allowing the gov. to be able to negotiate.
I am sorry but your comment doesn't hold water...
They are basically both hampering competition where they can, and not allowing the gov. to be able to negotiate.
I am sorry but your comment doesn't hold water...
If you let the government "negotiate" prices, that is not a free-market solution. Furthermore, Medicaid/Medicare is itself not a free-market solution and most Americans do not qualify for it. In fact, hospitals are running huge losses on these programs and they have to cross-subsidize it by charging other patients more.
As for banning imported drugs, this is a bipartisan issue, both parties have called for allowing it, but both parties are effectively against it.
As for banning imported drugs, this is a bipartisan issue, both parties have called for allowing it, but both parties are effectively against it.
This is from Sept. 20th:
"Even though insulin is not included among the drugs covered by the rule, the Trump administration Thursday issued a request for proposals seeking plans from private companies on how insulin could be safely brought in from other countries and made available to consumers at a lower cost than products here."
This is in regards to a law that allows states to import drugs from Canada at lower prices than they are sold here. So it looks like the administration is working on it.
This seems on par or worse than what the Sacklers did.
But because this is a multiheaded beast with no clear villain to blame, nothing really happens. Congress are to blame.
But because this is a multiheaded beast with no clear villain to blame, nothing really happens. Congress are to blame.
To put this in perspective: I am from Slovakia (Europe). I am type 1 diabetic. NovoRapid (10 x 3ml) costs 73€. My insurance (which is required in Slovakia and costs me about 70€/month) covers 64€. That means I pay only 9€. I usually get one package every three months. That means insulin costs me 3€ per month. Average salary in Slovakia is currently 13100€/year.
OK good data point. Is NovoRapid about the same as Novolog 70/30? 73 euro is about $86 which is about the same price as Wallgreens/RiteAid. CVS is more expensive.
https://www.goodrx.com/novolog-70-30
https://www.goodrx.com/novolog-70-30
It's the same as Novolog, not 70/30 though. Novolog 70/30 is a mix is a mix of two insulins - an intermediate acting & a faster acting insulin.
Private healthcare system is always expensive for the public.
Please tell that to the Swiss
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It's not just insulin. If you have an autoimmune disease, Enbrel or other biological agents cost all the about same in America. Over 5k per month.
All other countries price the drug at around 1 to 1.5k per month.
I'd been getting it from other countries over the years but, due to covid, it's not an option really.
The medical industry and its regulatory support by the government are doing a lot to destroy this country.
All other countries price the drug at around 1 to 1.5k per month.
I'd been getting it from other countries over the years but, due to covid, it's not an option really.
The medical industry and its regulatory support by the government are doing a lot to destroy this country.
The only medications on the market that can prevent the transmission of HIV in people who don't have HIV costs about $2000 a month in the US. In the UK, they cost $40 a month. That's a 50x markup.
HIV transmission could be virtually eradicated within the US if at-risk populations had access to the medications at the same price as people in the UK do.
HIV transmission could be virtually eradicated within the US if at-risk populations had access to the medications at the same price as people in the UK do.
Generates 8 times more gdp. Good for stats :-)
The argument I heard is that it is the US-based companies that are incurring all the R&D and subsequent safety approval costs. Once the drug is researched and determined to be safe, you'll have generic providers then make their own copies of it, for a fraction of the cost.
Is there any merit in this argument?
Is there any merit in this argument?
There's been a steady, and huge, increase of the prices of most pharmacy products. Not just prescription drugs. Look at vitamins. Some vitamins used to be extremely cheap. The manufacturing cost of Vitamin C is very low.
It's useful to compare prices between CVS in the US and Boots in the UK. They're the same company.
It's useful to compare prices between CVS in the US and Boots in the UK. They're the same company.
For a moment I have a mental image of narcos stop cooking anfetamine and start making insulin instead...
Or chemist diabetics making their own insulin at home.
Or chemist diabetics making their own insulin at home.
Several people in this thread are saying regulatory issues are a major cause. Can anyone elaborate on what those regulations look like?
I've been led to believe that a large fraction of pharmaceuticals consumed in the US are produced either entirely overseas, or else active ingredients are (and this causes challenges for the FDA to actively regulate those overseas producers).
Is it the case that in some Sanofi site in Frankfurt, the same insulin meeting the same standards is put into vials, some intended for the US market, some intended for other markets around the world ... and regulations prevent someone from buying vials in the EU and selling them in the US? Like, the regulation is not only about the production methods or quality control?
I've been led to believe that a large fraction of pharmaceuticals consumed in the US are produced either entirely overseas, or else active ingredients are (and this causes challenges for the FDA to actively regulate those overseas producers).
Is it the case that in some Sanofi site in Frankfurt, the same insulin meeting the same standards is put into vials, some intended for the US market, some intended for other markets around the world ... and regulations prevent someone from buying vials in the EU and selling them in the US? Like, the regulation is not only about the production methods or quality control?
Anyone trying to sell FDA controlled substances in the US needs FDA approval.
In case of insulin the problem is that currently it's a mess, supply is low, demand is high, so price is high too.
https://care.diabetesjournals.org/content/41/6/1299
In case of insulin the problem is that currently it's a mess, supply is low, demand is high, so price is high too.
https://care.diabetesjournals.org/content/41/6/1299
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