[HN Gopher] The Mark Cuban Cost Plus Drug Company
___________________________________________________________________
The Mark Cuban Cost Plus Drug Company
Author : yawnxyz
Score : 706 points
Date : 2021-01-27 18:53 UTC (4 hours ago)
(HTM) web link (costplusdrugs.com)
(TXT) w3m dump (costplusdrugs.com)
| fireeyed wrote:
| My friend recently got admitted to the hospital. There must be 10
| people during the intake who didn't seem to be doing anything.
| Some "nurses" were just observers. There were two admin people
| who came into to take personal information. 2 medical techs who
| just took temperatures and nothing else and finally a real nurse
| who did all the vitals and finally the doctor after 2 1/2 hours.
| Imagine the efficiencies that could be extracted and passed on to
| the patients.
| phkahler wrote:
| >> There are no hidden costs, no middlemen, no rebates only
| available to insurance companies. Everybody gets the same low
| price for every drug we make.
|
| I've been advocating this for a while. Any given provider should
| have the same price for a given drug or procedure, regardless of
| insurance concerns. Putting this in law would probably help a
| lot.
| tpmx wrote:
| I thought this space was already cornered by companies in India?
| That's where most of the world gets it cheap generics from, I
| think.
| mikeyouse wrote:
| Very true - but it turns out they all collude to raise prices -
| some actual competition will go a long way:
|
| https://www.biospace.com/article/justice-department-charges-...
| tpmx wrote:
| Some actual competition on generics from a US company, with a
| _much_ higher salary cost?
|
| Also, from the web site:
|
| - "We are hoping to introduce over 100 additional drugs by
| the end of 2021."
|
| - "By 2022, building a pharmaceutical factory of our own in
| Dallas, TX"
|
| I can't shake the feeling it's just a shallow rebranding play
| using a billionaire's personal brand. Perhaps many americans
| don't trust non-US brands, even when it comes to generics?
| tasty_freeze wrote:
| I don't care if it is rebranding inexpensive Indian
| generics so long as they are vouching for the quality.
| tpmx wrote:
| Is there a quality problem with generics in the US? There
| doesn't seem to one in Europe (or at least Sweden). I
| assume you also have regulations and testing protocols
| etc?
| mikeyouse wrote:
| There were actually a number of scandals out of India on
| this front as well:
|
| https://www.npr.org/sections/health-
| shots/2019/05/12/7222165...
|
| It's extremely hard to enforce GMP and QA/QC from across
| the world and there's a strong incentive to cheat and lie
| when it comes to these costly procedures. Whether it'll
| be any better in a US manufacturing facility is of course
| up for debate.
| tpmx wrote:
| I had never before heard the acronym GMP in this context.
| It appears to mean:
| https://en.wikipedia.org/wiki/Good_manufacturing_practice
|
| > Because the FDA requires very specific GMP requirements
| that differ from those of the EU and other countries,
| drugs approved or synthesized without US FDA
| certification cannot be legally sold in the U.S.
|
| Sounds a bit like trade protectionism - but I assume that
| goes both ways between e.g. EU and US.
| [deleted]
| lcall wrote:
| There is a similarly interesting, nonprofit drug company that is
| trying to resolve shortages and price problems, and where the
| founding hospital system is also a nonprofit with a very good,
| long-term reputation (and good personal experience--their intake
| forms to get a blood sample drawn totaled 2 reasonable pages,
| where the next-nearest hospital came out at 11 pages of icky
| legalese including documents by reference), and have generally
| done friendly good work for a long time as far as I can tell.
|
| Wikipedia says (lightly edited here for brevity): "Civica Rx is a
| nonprofit generic drug manufacturer .... started by national
| philanthropies and leading US health systems. By [EO] 2019, over
| 45 health systems representing 1200 hospitals were members of
| Civica. Member ... pharmacists and clinicians help prioritize the
| medications Civica makes.... By the end of 2019 Civica had 18
| medications (28 SKUs) in production, and plans to bring over 100
| medications to market in five years through various manufacturing
| approaches such as partnerships, developing ANDAs, and building
| its own manufacturing capability. ... The first shipment of
| Civica private-label medication was vancomycin, delivered to
| Riverton Hospital, a part of Civica founder health system
| Intermountain Healthcare, in October 2019." (
| https://en.wikipedia.org/wiki/Civica_Rx )
|
| (edit: somebody else here also mentions civica and has a couple
| of other links, in their comment.)
| yboris wrote:
| UI comment: the top banner vibrates (small-large jitter) when you
| scroll a few pixels down.
| gallegojaime wrote:
| The "Find a Pharmacy" option doesn't work for me either.
| bluedino wrote:
| It's funny how privatizing space travel made costs plummet.
|
| Privatized healthcare, on the other hand, is a disaster.
| bhupy wrote:
| Except...it's not obvious that the root cause of the US's
| current healthcare disaster is "privatization". I work in the
| industry, and by far the #1 most jarring misconceptions I see
| floating around forums like this is conflating of "privatized"
| with "employer sponsored because of decades of tax incentives
| and mandates". The US is not the only country that has a
| public-private mix of healthcare, but it is pretty much the
| only developed country where private health insurance is
| predominately received through employers rather than on the
| individual market.
|
| If you want a true apples-to-apples cost of public vs private
| healthcare, you should look at Medicare Advantage vs Original
| Medicare. When you turn 65, you have the option to enroll
| either in "Original Medicare", which is what we usually think
| of when we talk about "single payer healthcare in America", or
| you can enroll in Medicare Advantage (aka Medicare "Part C"),
| where the premiums that would go to the CMS instead go to
| private insurers like Humana, United, Oscar Health, Aetna,
| Clover, etc. These plans replace Original Medicare, also cover
| Part D prescription drug benefits, and often include
| supplemental benefits that Original Medicare doesn't already
| cover. There are some interesting findings so far:
|
| - 39% of Medicare beneficiaries are on private Medicare
| Advantage plans instead of the public "Original Medicare".
| Because everyone is entitled to "Original Medicare", this is
| purely voluntary. This number has been growing so rapidly, that
| we expect by 2025, more seniors to be on a private plan than
| the public one. There's also great variance by State. In
| Florida, Pennsylvania, Wisconsin, Michigan, Minnesota, Oregon,
| Alabama, Hawaii, and Connecticut -- nearly 50% of beneficiaries
| are on Medicare Advantage. By 2022, we expect more seniors in
| those States to be on a private plan than a public one.
| https://www.kff.org/medicare/issue-brief/a-dozen-facts-about...
|
| - For most beneficiaries, Medicare Advantage costs about 39%
| less than Original Medicare.
| https://healthpayerintelligence.com/news/medicare-advantage-...
|
| - Medicare Advantage plans are, on average, of higher quality
| than the public Original Medicare.
| https://healthpayerintelligence.com/news/medicare-advantage-...
|
| - In Urban areas, Medicare Advantage costs less per capita to
| administer than Medicare -- and that's not including the extra
| Medicare Part D insurance that you would have to buy if you're
| on the Original Medicare plan.
| https://www.commonwealthfund.org/publications/issue-briefs/2...
| mhh__ wrote:
| The US healthcare "market" seems to be the worst of any
| imaginable healthcare system combined.
| lifeplusplus wrote:
| one is a necessity and other one is not. If it's too expensive
| to launch stuff to space, most companies won't. If it's
| expensive to get a drug, well you will either pay up or suffer
| until you die.
| DubiousPusher wrote:
| Exactly. One market is elastic the other is inelastic.
| lifeplusplus wrote:
| I had forgotten those terms.. yea nothing mysterious going
| on here. This is well understood situation. Everyone should
| take micro-economics not matter the profession.
| savanaly wrote:
| But we have markets in necessities and they work just fine.
| What's the difference from healthcare?
| atonse wrote:
| Well before space X, we did have private companies, but they
| were government contractors and a monopoly. So they had no
| incentive to reduce prices.
|
| It's almost like SpaceX took rockets from being a consulting
| business to a product business.
| macksd wrote:
| There's an excellent book (well it had bad reviews, actually,
| because it was perhaps overly detailed and tedious, but I
| enjoyed it) about the Gemini project called On The Shoulders
| of Titans. Reading through the notes of how NASA interacted
| with contractors was terrifying: here's some money to study
| something. Turns out it was very subtly different from what
| NASA had intended them to study. Here's more money to do
| another study. Now here's money to build a prototype. Oh
| you're 90% done and out of money? Here's twice as much money.
| Oh now you're 99% done and out of money? He's the same amount
| again. Oh it doesn't work but you can argue it's NASA's
| fault? Here's more money to start over. You're done? Actually
| we're gonna scrap this particular mission objective now.
|
| Space X owns something much close to an end-to-end objective:
| it's not a study, or a build, it's getting the thing to
| orbit, end of story. I think if you could set up the
| situation so that a company owns the end-to-end story of your
| health, things might be better off. That sounds more like
| Kaiser Permanente and my impression is that's exactly what
| happened. In reality our healthcare system is typically more
| like Gemini: contractors, tons of regulations, but none of
| them really own the end result so it's a public/private mix
| of bureaucratic mess, misaligned incentives, and buck-
| passing.
| rtkwe wrote:
| Part of that is it was very very hard to know back then
| what was needed and what would work. Now a lot of the
| fundamentals are well hammered out and the big challenge
| for SpaceX was the landing not figuring out how to build
| rockets in the first place.
|
| Also the ACA did have some successes in doing kind of what
| you're talking about. There were incentives in there to
| avoid readmittance before 30 days and to all appearances
| it's been a success.
|
| https://www.statnews.com/2016/12/27/obamacare-success-
| penalt...
| goatcode wrote:
| Private healthcare existed long before prices skyrocketed.
| Health insurance did not.
| DubiousPusher wrote:
| Not really though. Not in the way it does today. Medicine up
| to 1900 was largely ineffective. And most of what we consider
| modern medicine has its roots in the 1940s. Which
| coincidentally is about the same time employer provided
| health insurance started becoming common.
| notsureaboutpg wrote:
| I agree to some degree about how standardized and effective
| medicine is now.
|
| But it's not at all true that medicine up to 1900 was
| largely ineffective... Medicine even way way back in
| ancient times was pretty effective (not the level it is now
| but neither was it "largely ineffective" that's just not
| historically true).
| hkt wrote:
| Actually, throughout history (at least 500 years in the UK,
| since the end of the guild system) people have paid what was
| essentially a premium in order to access medical care at the
| point of need - effectively insurance, if not always named as
| such.
|
| Most of these organisations were mutuals, eg, member owned,
| and would have pre-existing relationships with doctors etc
| that would control costs.
|
| In this way, there were no perverse incentives - people had
| "insurance", and they wanted that money to cover as many
| eventualities as possible. The bigger the pot of money, the
| more resilient the community.
|
| So actually, health insurance has a long legacy. The problem,
| I would suggest, is shareholders who are not the principal
| beneficiaries of the service.
|
| FWIW, in the UK we found that a system of mutuals and
| municipally owned hospitals was sufficiently imperfect that
| we created the NHS anyway. Probably best to skip to single-
| payer in the US, imo.
| eloff wrote:
| It turns out markets are a great solution to some kinds of
| problems and not so much for others. There's a lot of reasons
| why healthcare doesn't approximate a free market very well, and
| why government intervention here tends to do better than the US
| system. Yes I know there is plenty of government intervention
| in the US healthcare system - it's just not the right kind of
| intervention.
|
| The US is actually the only developed nation without a public
| healthcare system, it also has the highest healthcare costs of
| any nation on earth. Coincidence?
|
| It seems like a pretty big mess at the moment.
| starik36 wrote:
| The costs are high across the system, including government
| sponsored programs like Medicare. It's a systemic problem and
| even touches software.
|
| https://maxwelljordan.medium.com/why-healthcare-in-us-is-
| so-...
| bhupy wrote:
| > The US is actually the only developed nation without a
| public healthcare system,
|
| That's false on multiple counts. First of all, the US does
| have a public healthcare system, Medicare and Medicaid.
| Second of all, there exists other developed nations with
| fantastic healthcare systems that are driven by purely
| private systems: namely Switzerland (widely regarded to be
| one of the best healthcare systems on the planet) and the
| Netherlands. Even more perfectly fine developed nations
| operate on public/private mixes, including Germany and
| Belgium.
|
| > it also has the highest healthcare costs of any nation on
| earth. Coincidence?
|
| In this case, it is indeed a coincidence. In order to
| attribute "privateness" to the high cost, you have to show a
| causal relationship. Unfortunately, there's a lot of evidence
| that makes it very difficult to draw that causal line:
| private Medicare Advantage plans are about 39% cheaper than
| the public "Original Medicare"
| (https://healthpayerintelligence.com/news/medicare-
| advantage-...), while also being of higher quality
| (https://healthpayerintelligence.com/news/medicare-
| advantage-...). In urban areas, the private Medicare
| Advantage plans cost less to administer per capita than the
| public "Original Medicare"
| (https://www.commonwealthfund.org/publications/issue-
| briefs/2...).
| bravo22 wrote:
| You are assuming that healthcare is a free market. There is
| tremendous regulation, encouraged by incumbants, to keep away
| the competition.
|
| You should look at historical healthcare expenditure by the
| US.
|
| The problem isn't providing healthcare for all... it is the
| method and the cost. Universal payer is one way. It is not
| the best way and in fact Medicare is one reason costs are
| currently high. It is a bit like a car that used to get 30MPG
| and now gets 15MPG, and getting worse, and the solution being
| offered is for all of us to collectively chip in and buy gas
| for those who can't -- which is not tenable in the longterm
| because you're spending more and more of the GDP on
| transportation.
|
| There are other ways of giving everyone coverage. One scheme,
| would be giving people money. Enough to cover average cost of
| healthcare plans and say education plans. The individual is
| then responsible for their own healthcare and has the funds
| to purchase health insurance. Then you have a healthy market
| and have mechanisms for the costs to come down.
| eloff wrote:
| I'm not assuming anything. I'm starting that even in theory
| healthcare isn't very amenable to a market solution. I
| think you disagree with that. It's possible to have a
| reasonable position on both sides, I don't think it's a
| solved problem.
|
| Where I think we both agree is that the current disastrous
| mix of regulation and free markets in the present US system
| is a terrible solution.
| bravo22 wrote:
| I entirely agree with you on the above!
| luma wrote:
| A free market involves a customer that has the option to
| simply not buy what is on offer. Healthcare can never be a
| free market in this sense, because the customer is faced
| with a choice of "buy service and/or product" or "be dead".
|
| That is entirely unlike the choice involved in buying
| something like a refrigerator and seriously skews the
| applicability of traditional free market thinking to the
| problem.
| bhupy wrote:
| > Healthcare can never be a free market in this sense,
| because the customer is faced with a choice of "buy
| service and/or product" or "be dead".
|
| What you're referring to here is a high "price elasticity
| of demand", and markets are used to provision all sorts
| of goods for which this is true. Food, for example, is
| predominately provisioned by the market, and consumers
| are constantly faced with a choice of "buy food" or
| "starve to death".
| dogsgobork wrote:
| Different types of food are fungible goods. If broccoli
| is expensive I can instead purchase carrots and still
| survive. If I think chemotherapy is too pricey, I can't
| take an aspirin instead to treat the cancer (at least not
| with the same prognosis).
| bravo22 wrote:
| This is very true, and not at all what I mean when I say
| "choice". In free market choice means alternative
| vendors. Do you have other choices for getting chemo
| besides the one hospital?
|
| You may be surprised to know that 80% of hospitals in the
| US are non-profit. The evil profit motive isn't the
| reason their bills are so outrages.
|
| In the 60's US healthcare expenditure was 5% of the
| economy and it is close to 20% right now.
| dwohnitmok wrote:
| I'm curious (you don't come out one way or the other on
| this from your comment, but this will help me make sense
| of where you're coming from) do you think there are any
| domains where a free market doesn't work? Or is your
| position that free markets work universally (or less
| absolutely, that free markets work for almost all
| practical purposes and fail only in very artificial
| environments).
| bravo22 wrote:
| Free markets don't work when the cost of the transaction
| isn't paid by the two sides of the transaction but by a
| third party. For example the environment where I can buy
| a gas guzzler from you and drive away polluting the
| environment. There you need intervention but the
| framework of intervention and has to meet some specific
| criteria. I don't want to digress.
|
| Other than that I have yet to see a problem that isn't
| solved by this scheme: increase the set of choices
| available to the person, and in some corner cases give
| them money so they are free to choose.
|
| You have to bear in mind that the alternative to the free
| market approach is for someone else to come in an
| constrain either the buyer and seller in some way. Ths
| may work for a limited time and for a specific set of
| buyers and sellers but it won't work beyond that. Given
| that people have diverse and evolving needs the forced
| solution causes long term harm. Then you'll need some
| kind of propoganda machine to either exagerate the good
| or down play the harm.
|
| To be clear I do not believe that we have a free market
| in the US in a lot of areas and what people conceive of
| as free market -- or rather what has been shoved down
| their throat as free market is anything but that.
| dwohnitmok wrote:
| I think you and I probably would have different notions
| of what it means to "solve a problem." In this case I
| suspect you have a notion that a free market in many ways
| nicely sidesteps needing to even resolve this question in
| the first place. It frees one from having to commit to
| overarching, centralized value systems and instead allows
| for gestalt value systems to arise naturally from the
| behavior of people. This nicely avoids the issue of
| needing to impose a higher authority's will on a
| population and all the authoritarianism that that entails
| as well as the inevitable schism between a centralized
| value system and what people actually want. (I happen to
| disagree with this take and can expand on why if you're
| curious, but if this accurately reflects your views,
| there's enough commonality at least for me to make the
| next point.)
|
| > increase the set of choices available to the person
|
| This view abstracts behavior into that which is governed
| by "choice" and "coercion." I think this binary
| distinction is a fine model for a lot of domains, but a
| poor one for healthcare.
|
| Choice feels much more like a spectrum in the domain of
| healthcare than it does in other domains. For a rough
| sample of points along this spectrum, you have "do this
| or die immediately," "do this or die in the next several
| months," "do this or suffer permanent disability," "do
| this or suffer great pain," "do this or suffer some
| probability of some amount of disability," "do this or
| suffer mild discomfort," "do this or be slightly
| annoyed."
|
| The far-"left" part of this spectrum cannot ever
| realistically expand its set of choices. The most extreme
| version of this is that you're literally incapacitated
| and so can never make a choice of e.g. what hospital to
| go to and what treatment to administer no matter how many
| hospitals or treatments exist.
|
| However, I think the same problem persists in less
| extreme states as well. Health ailments can directly
| impact a person's ability to choose to begin with in a
| variety of ways apart from just physical or mental
| incapacitation or degradation. Various treatments and
| healthcare choices impose switching costs that reduce a
| person's choice even when they are nominally capable of
| making one. For example, if a patient chooses a single
| hospital for a bout of appendicitis (when they are in
| such pain that they cannot make a choice in that moment
| other than to dial 911), even once the acute problem of
| surgery passes, they are unlikely to be able to choose a
| separate hospital for their post-surgery hospital stay
| without jeopardizing their health due to movement and
| continuity of care concerns.
|
| Even in non-emergency cases there is an extreme
| information asymmetry and unpredictable path dependence
| (certain choices lock into other choices down the line
| but the nature of how they lock in may not be apparent at
| the beginning) that make it hard to formulate what
| "choice" would even look like.
|
| In some ways, I personally view the need for coercion in
| the healthcare space as precisely a way to return to a
| world where modelling things as a binary distinction of
| "choice" vs "coercion" makes sense again.
|
| Any plan for regulation of healthcare always must deal
| with a distinction between "elective" and "necessary,"
| "non-essential" and "essential," "covered" and "not
| covered." That line is drawn precisely where we have a
| best guess that the model of a binary "choice" vs
| "coercion" holds vs the model of a spectrum of choice;
| the ideal is that care is provided to boost a patient
| back into a universe where the binary "choice" model is a
| reasonably good approximation.
|
| More generally there is the problem that healthcare has a
| weird squeeze of monopolistic and non-monopolistic needs.
|
| At a base level, in almost all domains including
| healthcare you need some amount of a regulatory framework
| to counteract the problem that market participants
| generally have an incentive to decrease the number of
| choices to the other side. I think you probably agree
| with "coercion" at this level (stuff like preventing
| collusion among players, certain stances on breaking up
| certain kinds of monopolies, etc.).
|
| But the problem is that in healthcare you do want
| powerful players because there are benefits we want to
| reap from large players. Large drug makers are the only
| ones capable of performing substantial R&D and regional
| hospital and transportation networks are really the only
| ways you can get the necessary infrastructure and
| expertise to treat a lot of things. On the buyer side you
| want large insurance pools to even out risk for people.
|
| But those all have inherent monopolistic tendencies that
| are exacerbated by the problems of choice that I
| mentioned.
| bhupy wrote:
| Different types of healthcare are also fungible. And not
| all healthcare is cancer! I think the biggest problem
| with having any discussion around healthcare policy is
| that we automatically assume that we should treat routine
| treatments and visits the same way we treat catastrophic
| accidents like cancer and brain surgery.
| triceratops wrote:
| > consumers are constantly faced with a choice of "buy
| food" or "starve to death".
|
| And funnily enough, food is heavily government-subsidized
| and regulated. It's not really a free market either.
|
| Also starving to death isn't really the same level of
| urgency as dying of a heart attack. There's a couple
| orders of magnitudes difference in the amount of time
| available to make a purchase decision, and the level of
| physical and mental stress you're under while making that
| decision.
| dwohnitmok wrote:
| Food is much more fungible than healthcare. The loss of
| any number of food items can be substituted by an
| overwhelming number of any other food items without the
| consumer ending up dead.
|
| Healthcare is not as fungible. Most medications have
| single-digit or even no effective alternatives.
|
| For an illustrative example and the flip side of the
| coin, water is a good example of where unregulated
| markets do terribly (since you really do need water and
| can't substitute it with something else and it's also
| geographically heavily monopolistic). Potable water
| production and pricing in all developed countries is
| heavily regulated for good reason.
| bhupy wrote:
| The vast majority of healthcare expenditure is preventive
| or planned care, which is largely fungible. MRIs are
| fungible. Primary care is fungible. Antibiotics are
| fungible.
|
| To the extent that healthcare isn't fungible, it's in
| very specific cases like end-of-life care, cancer,
| catastrophic surgery, and rare patented drugs. They also
| account for a tiny minority of overall health
| expenditure.
|
| We can use different tools across both of those problems.
| dwohnitmok wrote:
| > The vast majority of healthcare expenditure is
| preventive or planned care
|
| I don't think that's true for the U.S. Preventive care
| and planned care (if understood to be stuff like
| physicals, blood checks, screening, etc. including your
| examples of MRIs and primary care) as far as I remember
| is actually a small minority of healthcare expenditures
| (< 20% is a number I recall). I can try to root around
| for sources if you're curious, but I'm also curious where
| you're getting the impression of "vast majority."
|
| > Antibiotics are fungible.
|
| Not really. Definitely not in the same way that food is
| fungible. I assume you're talking about generics here?
| But generics again actually make up a startlingly small
| minority of healthcare expenditure costs despite making
| up the majority of prescriptions IIRC (again I'm going
| off memory but I think it was something like 75% of
| medication expenditures are due to medicines with no
| allowed generic alternatives).
|
| Basically the places that you're suggesting the free
| market should best apply to are already the smallest
| slices of the healthcare expenditure pie (and also
| already quite effective in that limited domain).
| kgwgk wrote:
| I think he includes things like hip replacements which
| are "elective" and not of the "pay now or be dead" kind.
| dwohnitmok wrote:
| Ah, I don't ever remember reading numbers for those so I
| can't comment on that (I'd be curious if anyone has a
| breakdown of surgery costs by elective, semi-elective,
| and emergency).
|
| But even stuff like hip replacement kind of is on a
| sliding scale. How much choice do you have if the
| alternative is death? What about cognitive impairment?
| What about blindness? What about impaired range of
| motion? What about mild discomfort? What about pure
| annoyance?
| bravo22 wrote:
| That's not entirely accurate and that's not even the
| meaning of free market.
|
| Water is also a necessity as is food and you can have a
| free market for those.
|
| The questions are: 1. Does the buyer have enough choices
| or alternatives to choose from when it comes to
| healthcare? 2. Do those who offer services have a
| monopoly on the service?
|
| When you look at the US market you'll find that it
| doesn't meet those criterias. Market forces are
| _prevented_ from acting and being able to reduce costs.
|
| The fact that there is a captive audience, as you
| suggest, means that we cannot just shovel money into it.
| You end up exactly where you are. Costs go up because it
| is a necessity. Same reason food prices go up when there
| is a shortage. It is not a luxury.
| dwohnitmok wrote:
| > Water is also a necessity as is food and you can have a
| free market for those.
|
| What makes you say this (RE water)?
| mizay7 wrote:
| I think you are making a more articulate defense of
| private/market based health care than i usually hear. but
| i think fundamentally health care has too many forces
| that make it untenable for a market. there is no real
| satiation point in care, people are price inelastic, many
| services cannot be priced before delivery, there is
| little opportunity to do repeated business for most of
| the costliest services, comparison between providers is
| very difficult, most of the choice happens under
| incredible duress when you are your weakest point. health
| care is just not a consumer good that responds well to
| market mechanisms.
| bravo22 wrote:
| I suppose it all depends on how you define market
| mechanisms. What I've found -- after personally studying
| the subject -- is what a lot of people consider free
| market is the opposite of what the literature considers
| it to be.
|
| To answer your point:
|
| Most/all of the issues you raised are met by "pooling"
| aka insurance. The need arises at random and when it does
| there is a massive cost and you urgently need the
| service. This is what insurance is for.
|
| What I was suggesting isn't that people go and pay the
| doctor out of pocket -- although they can. Rather that
| they purchase insurance. Those who can't get $$ indexed
| to some national average or whatever scheme you prefer.
| The point is everyone gets to purchase insurance if they
| so prefer.
|
| The problem is that choice of insurance providers is
| artifically limited right now and the choice of
| healthcare providers is as well. So you have a system
| where you are captive to the need and those who provide
| the service have a monpoly. Naturally costs will rise.
| Putting political preassure on government to increase
| spending is easy way out but that will only shovel more
| money from the pockets of the many into the pockets of
| the few. In fact this was predicted when Medicare was
| first introduced, and here we are. It is not like doctors
| and providers magically became greedy capitalists in the
| last 40 years.
|
| Also to be very clear this isn't an issue of "profits".
| Insurance companies don't have huge profit margins. They
| make their "wealth" by being a monopoly. The execs make
| their money on the rise in stock prices which isn't
| sensitive to their 3-5% profit margin.
| mizay7 wrote:
| so you are arguing that many small insurers, with
| insurance not bound to employment, would create a healthy
| price-quality structure in us health care? akin to the
| german model?
|
| i think that has some merit, but its hard for me to
| imagine that having the payer, be disconnected from the
| consumer can really create a stable market without heavy
| handed regulation.
|
| i dont think insurance can really get you to an efficient
| market. health care is simply not a good where price and
| substitution apply as in many other markets. and rather
| than jumping through hoops to invent such a market lets
| agree that this an ethical part of social contract and
| manage it with the best technocratic solutions that our
| society can offer. E.G. NHS and NICE
| triceratops wrote:
| > The fact that there is a captive audience, as you
| suggest, means that we cannot just shovel money into it.
|
| I think the argument for single-payer is that the buyers
| of healthcare now have a monopsony to drive down costs
| with.
| bravo22 wrote:
| Sure but that single payer has political motivations and
| sources of influence which ensure that won't happen.
|
| If concentration of power was good we'd just find a few
| wise persons to run the country and leave it all up to
| them. Other than the little snag, the sinle buyer
| argument would work.
|
| Giving the individual the money to make their choices is
| a better way to ensure that people get what they want. A
| universal healthcare plan (irrespective of how it is
| funded) because different people -- or even the same
| person at different stages of their life -- don't have
| the same needs and the same risk profiles.
| trboyden wrote:
| Not accurate and the car insurance market provides the
| model health insurance should be based on. In car
| insurance you have multiple providers you are free to
| choose from with different coverage levels and service
| options. If your bad driving history prevents you from
| getting standard insurance, government programs provide a
| backstop alternative way to get coverage. Yes the
| alternative costs more, as it should, because you are
| responsible for your driving habits. But there are also
| government programs on top of that for low income
| drivers.
|
| The point is, the free market should be plan A, and
| government programs should only exist to cover the gaps.
| Ultimately, people should be responsible for their own
| health, but in special cases, for no fault of their own
| issues, government should provide a backstop because it
| is the right thing to do.
|
| Most taxpayers would agree with that. What they don't
| want is to be forced into something that is inferior and
| on top of that be penalized to subsidize someone else's
| premium.
| fallingknife wrote:
| Privatization doesn't make costs plummet, competition does. In
| most cases, our healthcare system is not competitive even when
| it is private. e.g. emergency rooms. You will just go to the
| closest one. If you look at areas where healthcare actually is
| a competitive market, e.g. Lasik surgery, the situation is very
| different.
| [deleted]
| breck wrote:
| Healthcare is a disaster because of copyright and patent laws,
| not necessarily because of privatization.
|
| https://longbets.org/855/
| pasabagi wrote:
| I think the space successes have far less to do with
| privatization, and far more to do with Space X, specifically
| the combination of a massive amount of capital sloshing about,
| Elon Musk being good at getting his hands on that capital, and
| there being an absolute army of engineers who would walk over
| coals to build rockets.
|
| That NASA hasn't been able to capitalize on this situation is
| more about NASA's failures than anything else.
| maxerickson wrote:
| German healthcare has private providers and insurance and so
| on. It just has sensible regulation to go with it.
|
| There are subsidies and everyone is required to pay into the
| system, but the administration is privately run.
| eatbitseveryday wrote:
| Albendazole is given as an example on the page. Last time I was
| in China, I purchased a pack of these pills just in a grocery
| store pharmacy, no prescription needed. It was something under a
| dollar per pill. How does Albendazole still cost $13 / pill to
| produce?
| newsclues wrote:
| Made in America costs more?
| alexhwoods wrote:
| THANK YOU
| mindcrime wrote:
| I know it's trendy to hate on billionaires, and by no means do I
| think this step makes Mark Cuban the new "Mother Teresa" or
| anything. But I have to say, by and large, I feel like Cuban is
| legitimately a "good guy" as billionaires go. Yes he's rich, and
| he's unabashed about it, but he seems like a normal and
| reasonable human being nonetheless.
| duxup wrote:
| How do you feel you know this?
|
| I don't know the man either way, and you may be spot on, but
| outside folks whose work is largely charitable and etc, how
| does anyone feel they know these things?
| mindcrime wrote:
| _How do you feel you know this?_
|
| My impression of Mark Cuban has been built up over the years
| from a variety of sources, ranging from a brief in-person
| encounter[1] with him, to reading his book, his blog posts,
| etc., to seeing him on TV in various forms, interviews he's
| done, etc. There isn't exactly one specific thing that stands
| out by itself.
|
| All of that said, it's a very subjective thing, and for all I
| know Mark works very hard to cultivate that specific image
| for his own ends. I have no problem saying that my impression
| could be wrong. But based on the limited evidence I have
| available, that's where I'm at with it at the moment.
|
| [1]: I don't typically hang out with billionaires or
| anything. The only reason I've met Cuban is because he was
| once a keynote speaker at an event I attended. After his
| speech he hung out with the hoi polloi and mingled and
| interacted with people. I spent maybe 3 minutes chatting with
| him personally about my business, and maybe another 10-15
| minutes listening to him talk to a small crowd that gathered
| around him. To be fair, that encounter probably went as far
| in shaping my impression of him as anything. I think the
| single biggest thing was that he displayed no condescension
| or smug superiority or anything towards people who weren't on
| his financial level. He was respectful, attentive, and
| reasonable even when talking with some rando like me.
| brandall10 wrote:
| When I found out the a-hole on Silicon Valley was partially
| based on him, I had to do a little research
|
| Couldn't find one negative experience. There are several
| threads on Quora for instance detailing how he treats
| everyone with respect and is a genuinely good dude.
| duxup wrote:
| Thank you. I prevaricate your response.
| brundolf wrote:
| Broken clock, etc.
|
| (the "broken clock" being the obscenely wealthy as a class, not
| necessarily Cuban himself)
| andrewon wrote:
| not sure if the world can count on his moral value, but more
| competition is always good. If the narrative of generic drug
| pricing fixing is true, it would be a wonderful business
| opportunity as well.
| technotony wrote:
| He's a major investor in my company, and can 100% attest that's
| true. What's most astonishing about him is how responsive he is
| even two years after making that investment. He must have so
| many companies and he's still always showing up and encouraging
| and providing value. He's pretty direct when he thinks we are
| doing the wrong things, but that's always appreciated. His
| super power is handling all that over email (mostly).
| adventured wrote:
| I second that sentiment. I was in business with Cuban for
| many years, he always responded quickly and could always be
| reached via email / messaging in a matter of minutes in most
| cases if something came up. An almost ideal investor for an
| entrepreneur and his terms are very unusual in the industry,
| he often takes common shares with no strings, he's on the
| same playing field as the founders.
| stretchcat wrote:
| The real Mother Teresa was no 'Mother Teresa.'
| StavrosK wrote:
| What, you aren't a fan of needless suffering?
| joachimma wrote:
| To be fair, when it was her time, neither was Mother
| Teresa.
| StavrosK wrote:
| For thee, but not for me.
| citizenkeen wrote:
| I think a lot of that comes down to his background. Mark Cuban
| is from a very blue collar background. Compare that to
| Bezos/Musk/Gates/Zuckerberg, all of whom were from money.
| lawwantsin17 wrote:
| If by "very blue collar" you mean his father OWNED a car
| upholstery shop. Funny how owners still get to be called
| working class like that. Wonder how much that fake news
| costs?
| phkahler wrote:
| Isnt he the one who returned a bunch of Covid stimulus money
| after being called out on not needing it? Perhaps an oversite
| in his business empire, or perhaps damage control?
| tw04 wrote:
| There are two options when you're rich like Cuban is (clearly
| there's more but to dumb it down).
|
| You can acknowledge that while it took hard work, and luck to
| get where you are, you likely would not have done it if you
| hadn't been born into a society that fosters the ability to
| move up the social ranks. If Mark Cuban were born in Libya
| there's almost no chance he becomes a billionaire for instance.
|
| Or you can pretend like the reason you're rich is solely of
| your own doing, and that the world owes you something.
|
| Cuban seems to be the former, and while he's not going to
| volunteer to just give all his money away, he is trying to help
| society collectively improve. It's a stark contrast between his
| approach and say, the Koch brothers.
|
| I guess the best way I'd put it is Cuban is a capitalist who
| believes in the social contract.
| frongpik wrote:
| Off topic. What do you mean by "if he was born to Libya"?
| Does it imply prior existence? The official theory is that we
| are created during those 9 months, assembled like cars, and
| if so, he couldn't be born to libya because the body
| assembled in libya would be completely different. In the
| unofficial theory, e.g. buddhism, prior existence is a thing,
| but even then Mark couldn't be born to Libya: there were only
| few choices for him matching his prior achievements and every
| path would lead to a billionaire status.
| zarkov99 wrote:
| By and large this country is very lucky with the billionaires
| it continues to produce: Bezos, Cuba, Buffet, Gates, Paul
| Allen, Zuckerberg, Dorsey, Musk, etc, all seem to be incredible
| people who are committed to do good. I think it has something
| to do with the fact that these people are self-made and for the
| most part made their billions without having to sell their
| souls to the devil.
| EForEndeavour wrote:
| I legitimately can't tell if this is satire, particularly the
| "self-made" part.
|
| Bezos' parents loaned him a quarter-million dollars in 1995
| [1].
|
| Gates' mother, while on the board of directors of United Way,
| convinced IBM to invest in MS in 1980 [2].
|
| Zuckerberg's parents sent him to the crazy selective and
| expensive boarding school Philips Exeter Academy and was
| privately tutored in comp sci before college [3].
|
| [1] https://www.cnbc.com/2018/08/02/how-jeff-bezos-got-his-
| paren...
|
| [2] https://www.nytimes.com/1994/06/11/obituaries/mary-
| gates-64-...
|
| [3] https://www.newyorker.com/magazine/2010/09/20/the-face-
| of-fa...
| saberdancer wrote:
| It's a long way from quarter of a million to Amazon.
|
| How many people get quarter of a million in inheritance or
| have rich parents? It's silly to call out "self made" just
| because someone got a loan. Bezos did not inherit billions
| of dollars, he is a billionaire now. By any metric he is a
| self made billionaire.
| tshaddox wrote:
| The point isn't that it wasn't hard work to grow from
| $250,000 to billions. The point is that there's a big
| difference between saying "anyone who works hard can
| build a company like Amazon" and "anyone who works hard
| and got $250,000 from their parents can build a company
| like Amazon."
| 1MoreThing wrote:
| It's a lot longer from zero (or negative, in you have
| student loans) to a quarter million if you're working
| outside the SV/software engineer salary bubble.
| Aunche wrote:
| This is a straw man. Nobody thinks that "self-made" means
| that you literally had no help whatsoever. Bezos was a
| hedge-fund SVP before starting Amazon, so it's not as if he
| was particularly hurting for more funding.
| tshaddox wrote:
| It's not a straw man if the first commenter was intending
| to use "self-made" to actually mean something to a reader
| anywhere close to an average reader. To an average
| reader, even on this website which probably skews
| American and wealthy, it's just not reasonable to refer
| to someone as a "self-made billionaire" when they
| received a loan from their parents that's well over 3
| times the median _household_ income in the United States.
| Aunche wrote:
| Self-made just means that you made the money with your
| own effort as opposed to inherited it. There's nothing in
| that comment that attempts to paint them as relatable. If
| they wanted to do that, they would talk about Bezo's
| teenage mother and adoptive Cuban-immigrant father. For
| all we know, that $250,000 could have been money gifted
| to Bezo's parents while he was employed at DE Shaw.
| chipgap98 wrote:
| I think out of the group you named at least Zuckerberg and
| Bezos have sold their souls to the devil
| desireco42 wrote:
| I would separate here, Bezos is evil because he is just
| amassing wealth, avoids taxes and pretty much is focused
| only on himself. Contrast that with Cuban who is also
| amassing wealth, but also is trying to do what is good for
| the community.
| meowface wrote:
| Bezos has donated a lot to charity, including $10 billion
| to fight climate change and $100 million to food banks in
| 2020. Sure, he could donate more, but % wise that's
| probably more than many people reading this have donated
| in 2020. And I don't want to start a debate over it, but
| I do believe that the primary intention behind Blue
| Origin is to benefit humanity.
|
| The main issue with Bezos is worker conditions at Amazon,
| I think.
| desireco42 wrote:
| These are mostly tax moves, not genuine concern, in my
| view.
|
| https://www.bloomberg.com/news/articles/2020-02-18/jeff-
| bezo...
| lostapathy wrote:
| And in the 90's, many were convinced Gates _was_ the devil.
| [deleted]
| zarkov99 wrote:
| I am conflicted about Zuckerberg, I think I understand
| where you are coming from, but Zuckerberg contributes
| heavily to charity and perhaps might not have realized the
| monster he was creating in Facebook. Similarly Dorsey. I do
| not get the Bezos hate.
| stretchcat wrote:
| Doesn't Zuckerberg still have a controlling interest in
| Facebook? Seems to me, that makes him more culpable than
| most of the rest.
| lancesells wrote:
| I'm just looking at what Wikipedia says Zuckerberg is
| worth but it's $69B. Looking at what Forbes said his
| charity (which does not mean 100% his money) they donated
| $410 million in 2018. That's ~0.006% of his wealth
| meaning it's not even giving away a penny out of $100.
| It's close to half a penny out of $100.
|
| I understand net worth of $69B is on paper but none of
| these guys are philanthropic.
| holbrad wrote:
| Are you sure it's not 0.594% of his networth as opposed
| to 0.0006?
| oh_sigh wrote:
| You're off by a factor of 100.
| [deleted]
| lancesells wrote:
| Edit: My math was off. Thanks to those correcting me.
| meowface wrote:
| One of the big issues with Zuckerberg's optics are the
| circumstances around Facebook's creation. An app to rate
| people's attractiveness, laughing in chat logs that
| people would trust him with their personal information,
| etc. Combined with the externalities and immense power
| they now have, it's not a great look.
|
| However, I agree that he's probably a better person than
| most give him credit for, and I think he's really stuck
| between a rock and a hard place on a lot of these issues.
| Especially things relating to politics,
| mis/disinformation, and free speech. I consider the
| proliferation of non-paid online services (who therefore
| can only survive by making money in other ways) the true
| bane of humanity; not any particular executive. (That
| said, I'm also not going to let anyone off the hook once
| they deliberately choose to create such a service.)
|
| I had a high opinion of Bezos until the disclosure of
| Amazon's poor working conditions. His making the minimum
| wage for workers $15/hour is a good step, but I think
| they're going to need to do a lot more before that
| reputation changes. Other than that, I admire him.
|
| Dorsey seems to be the least hated of the bunch, and I
| like him, personally. He seems like he still has a kind
| of hacker mindset, and I believe he genuinely wants to
| make Twitter a force for good in the world. I'm not sure
| if he'll be able to accomplish it, though.
| rland wrote:
| How many more billionaires than those that you've named has
| it produced?
|
| What about Exxon, AT&T, Aetna, AIG, Goldman, DuPont Chemical,
| Lockheed, McKinsey?
|
| There's a pretty obvious bias there: the ones you name do
| good because you named the ones who do good. (which, really,
| you could examine: how much of that perception is PR?)
|
| We're not lucky to have billionaires. We'd be just as well if
| there were none at all.
| antman wrote:
| What do you consider most probable:
|
| - They are all the greatest people ever
|
| - They all can afford to employ the most expensive personal
| marketing teams ever
| SeanLuke wrote:
| > all seem to be incredible people who are committed to do
| good
|
| Gates and Zuckerberg were far from models of piety in how
| they came into their fortune.
| wpdev_63 wrote:
| Make no mistake Mark Cuban is a snake if you ever lookup his
| past business dealings. He made his money by basically pushing
| out fellow founders at paypal.
| jermaustin1 wrote:
| > He made his money by basically pushing out fellow founders
| at paypal.
|
| I wasn't aware he was a founder at PayPal. I didn't even know
| he had worked for them.
| arrosenberg wrote:
| Mark Cuban made his money selling Broadcast.com to Yahoo.
| mtgx wrote:
| As a society we should have better policies than depending on
| the 1 in 100 good-heart billionaires, don't you think?
| breck wrote:
| Ever since he joined Shark Tank that show has become one of the
| best things to happen to our economy in the 2000's.
|
| He's exposing millions of Americans to the long term benefits
| of a value creation, non-linear thinking, honesty is the best
| policy, builder/craftmanship mindset.
|
| When I was a kid growing up far away from Silicon Valley we had
| "The Apprentice" to learn from. Shark Tank (especially Cuban,
| but really the whole cast), is orders of magnitude better.
| skizm wrote:
| I believe there was a point when Shark Tank would take some
| amount of equity from every business that came on the show
| regardless of if one of the sharks invested or not. Cuban
| called BS and said he wouldn't be on the show if that was the
| case. The policy was removed as a result.
|
| Smart move too, since you will probably get better companies
| on the show without that sort of policy.
| breck wrote:
| Yes. I can confirm this is exactly what happened (roommate
| almost went on the show, pre-Cuban. though I'm sure theres
| a lot more to the story that insiders would know).
| valarauko wrote:
| Curious: does the show take equity IF the sharks invest? I
| haven't really seen the show beyond a few episodes.
| Judgmentality wrote:
| No. The negotiations are real, and while there is a
| follow-up due diligence to close (or not) the deal, that
| is it. Note that anywhere from 1/3 to 2/3 of deals fall
| through in the due diligence phase, depending on the
| shark.
|
| The first season, before they brought on Marc Cuban, the
| show took a percentage just for appearing on the show (so
| even if you didn't get a deal, you still gave up equity).
| The second season, Marc Cuban came on and insisted they
| remove that rule.
|
| https://www.forbes.com/sites/emilycanal/2016/10/21/about-
| 72-...
|
| https://www.cheatsheet.com/entertainment/do-the-deals-on-
| sha...
| mcculley wrote:
| I have attended a few presentations where Phil Dumas,
| founder of UniKey, described his experience winning an
| investment on Shark Tank. He explained that there were
| many unattractive terms in the agreement he received
| after the recording that made him ultimately decline the
| investment. My takeaway was that it doesn't matter what
| happens on the show, the real offer is more complicated.
|
| (I have never seen the show, so I don't know how the
| offers are described. As an investor, I cannot imagine
| any offer that can be made verbally in the timespan of a
| television episode being meaningful.)
| Judgmentality wrote:
| The shows are edited for time. Each negotiation, which
| airs for about ~10 minutes on the show, takes an average
| of 2 hours to shoot (with a surprisingly wide variance).
| dylan604 wrote:
| It's meaningful in getting future guests/contestants to
| be willing to appear on the show. If all of the sharks
| only ever said no, nobody would want to go on the show.
| They have to at least make the audience think deals are
| happening to keep an audience. After that, if the deal
| actually completes or not are not relavent to the
| producers of the show. They just need to line up the next
| round of chum to bring out in front of the sharks.
| alistairSH wrote:
| _I have never seen the show, so I don 't know how the
| offers are described._
|
| Usually it's just one of the sharks offering something
| like "I'll pump in $500k for a 20% stake." (numbers made
| up) No details beyond that.
| mmcconnell1618 wrote:
| I love when "medical" products with incredible claims show
| upon Shark Tank because Cuban usually shreds the owner's
| claims in about 2 seconds. He doesn't seem to tolerate
| grifters very well.
|
| This venture seems like a shot across the bow of anyone
| trying to squeeze an unfair percentage on top of generic
| drugs. Kudos to Cuban for launching this but it is
| something the US government should have been doing decades
| ago through drug price negotiation for medicare.
| Zolt wrote:
| I too had a lot of respect for Cuban regarding this.
|
| Article from Inc:
|
| Mark Cuban Made Shark Tank Change Its Contracts After
| threatening not to return until an equity clause was
| removed from contestants' contracts, Mark Cuban finally got
| his way.
|
| Just for appearing on the show, owners agree to give up 5%
| of their company or 2% of future royalties.
|
| ...
|
| Cuban said the clause was removed retroactively, meaning
| every contestant who's appeared on the show since Season
| One will be relieved of the commitment. However, how that
| will work out logistically remains unclear.
|
| https://www.inc.com/will-yakowicz/mark-cuban-forces-shark-
| ta...
| pradn wrote:
| You have a rather charitable interpretation of the show. I
| saw 4 powerful combative "investors" holding ordinary folks
| in their fists, playing with their lives, and sometimes even
| verbally abusing them. The show offers a lottery ticket on
| top of the lottery ticket out of day-to-day work that is
| creating a new business. What invention the participants
| bring is commodified a second time, a double grotesquerie. I
| absolutely can't stand it, and the show, in teaching viewers
| to hold unsuccessful contestants in contempt, also promotes a
| sort of circus-like misanthropy.
| mattdeboard wrote:
| You grew up watching The Apprentice? wow, wild. it started
| airing in 2004
| donkeyd wrote:
| So.. Someone who was 12 back then is now 29. Doesn't seem
| that wild to me.
| mattdeboard wrote:
| ...Great, thanks for checking in.
| breck wrote:
| Yup, my mom and I watched it together for years. At least
| it was worth it for that QT (now somtimes we still watch
| Shark Tank together). This is back when I was still a
| script kiddy and lemonade stand entrepreneur.
|
| I also read "Art of the Deal" or whatever that crap was
| called.
|
| Sometime I can tell you the story of how I sued a Fortune
| 50 company after a minor disagreement because I thought
| that's how business was done.
|
| I can only laugh about all that now, and shout "thank you"
| to Cuban that we have at least one highly entertaining
| business show that also teaches mathematically correct ways
| of thinking about business.
| m8s wrote:
| I think at certain levels of wealth, being "normal" is simply
| impossible. But there are people who use their fortunes for
| altruistic causes and that should be celebrated. Unfortunately,
| most of these cases simply highlight fundamental issues in
| other areas of our society.
| Eric_WVGG wrote:
| This is awesome. I've been daydreaming for years that Bezos
| would launch some kind of "CostCo, but drugs" operation, as I
| figured he had the infrastructure... but this will do just
| fine.
|
| He should get insulin and epipen factories running ASAP, those
| are very high profile scams in the US right now.
|
| Looks like they could use some web dev help...
| yepthatsreality wrote:
| Amazon usually waits until it can clone the operations before
| it dives into a new territory. Even though they would be set
| up for it quite easily as you say, they're approach in the
| past has been more EEE...or more politely adopt and optimize.
| aj7 wrote:
| By the way, Costco's prices are pretty good in the current
| environment, especially in large quantities.
| criddell wrote:
| There was a pretty good thread about insulin on this story
| when it was posted to Reddit:
|
| https://www.reddit.com/r/UpliftingNews/comments/l5vv6m/billi.
| ..
| maxerickson wrote:
| Costco sells a bunch of generics. Their Allegra is super
| cheap compared to everyone (or was the last I checked).
| perrylaj wrote:
| Most in my state (CA) also have fully functional
| pharmacies, and the prescription drug prices are much
| cheaper much of the time. I shopped around when I went
| through a period of poor insurance (years ago) and my
| monthly medication costs were $25 at Costco, and the
| nearest competitor I could find was just over $100 when
| paying cash. Also, I believe that California, you do not
| need a Costco membership to purchase from the Costco
| pharmacy.
| aj7 wrote:
| That is correct. Just tell them you're going to the
| pharmacy at the entrance.
| triceratops wrote:
| You also don't need a Costco membership to purchase
| alcohol. And a lot of Kirkland liquor is the absolute
| bomb.
| Larrikin wrote:
| What is good besides the vodka being a near identical
| done of Grey Goose? I feel like I got kind of burned with
| their tequila, which was extremely mediocre.
| TylerE wrote:
| Their scotch can be good, but look up the specific
| bottling. Sometimes it'll be something like a "factory
| second" of MacCallan 18... not the prime barrels, not as
| good as the stuff actually sold by macallan, but also
| about 1/3rd the price.
| triceratops wrote:
| The gin is pretty good value. I agree about the tequila.
| tshaddox wrote:
| I've heard that their scotch is extremely competitive at
| that (low) price range.
| ryneandal wrote:
| Not sure if their supplier has changed in the past few
| years, but their bourbon is pretty good for the price.
| There was speculation it was from Jim Beam, some kind of
| Knob Creek barrels.
| klondike_ wrote:
| This isn't the case everywhere. It depends on which state
| you live in
| tshaddox wrote:
| I think this is only true in a handful of states. In
| California, there's apparently an old law that you can't
| have members-only alcohol clubs, so Costco technically
| has to let you buy alcohol.
|
| I tried this once last year before I had a membership,
| and the person at the entrance told me they would need to
| get an employee to escort me, and it might take an hour,
| because they're busy.
|
| Presumably this is the kind of thing that a court would
| smack down, since I'm pretty sure they're required to
| _actually provide reasonable access_ , but I was just
| trying it for fun and didn't make a fuss about it.
| CogitoCogito wrote:
| > I tried this once last year before I had a membership,
| and the person at the entrance told me they would need to
| get an employee to escort me, and it might take an hour,
| because they're busy.
|
| > Presumably this is the kind of thing that a court would
| smack down, since I'm pretty sure they're required to
| actually provide reasonable access, but I was just trying
| it for fun and didn't make a fuss about it.
|
| Also it makes no sense for them to need to escort you.
| They scan your card on checkout so how would you buy
| stuff other than alcohol anyway?
|
| Anyway I've never heard of anyone being told that before.
| I understand not making a fuss (we are social animals
| after all), but it probably should be done so they don't
| keep trying BS like that.
| Eric_WVGG wrote:
| They sell generics, but I don't believe they actually make
| them.
|
| Allow me to clarify: CostCo sells everything at a fixed
| profit margin (I believe it's around 18% but I could be
| mistaken). I have no idea where their generics come from, I
| doubt they manufacture themselves, so before the CostCo
| markup they are subject to the same inflated prices you'll
| find anywhere else before the pill reaches the drugstore or
| your doctor or whatever.
|
| What I've been imagining, specifically, is generics
| manufacturer that applied a fixed profit margin -- "cost
| plus" -- to their products. I guess that's not precisely
| the CostCo model, but you get my drift now.
| jacobriis wrote:
| "CostCo sells everything at a fixed profit margin (I
| believe it's around 18% but I could be mistaken)."
|
| You're mistaken no they don't.
| Eric_WVGG wrote:
| You're right, it's not fixed. It caps at 14% for outside
| brands, 15% for "Kirkland" brands, but averages at 11%
| (2019). https://www.inc.com/jeff-haden/how-does-costco-
| compete-with-...
|
| Contrast to markups of 25 to 50% for typical retail, and
| for generic drugs in the thousands.
| https://www.thepharmaletter.com/article/1-000-pharmacy-
| mark-...
| _underfl0w_ wrote:
| Still waiting for the clarification. You nailed the
| denunciation, though.
| U8dcN7vx wrote:
| Didn't Amazon buy PillPack? Not sure I can seem them moving
| to manufacture product though it certainly is possible.
| nceqs3 wrote:
| I like Mark as well but he has had is bad moments.
|
| Hanging out with Tai Lopez and making vids with him??! Come on.
| tomelders wrote:
| Imagine you and I share an apartment and we split the rent
| between us. It's not a great apartment. There's mould in the
| bathroom caused by a lack of ventilation. The carpet is a mess.
| The power keeps cutting out if we plug too many things in.
|
| Now imagine I tell the landlord I'm going to move out unless he
| fixes these issues and he then offers me a 50% discount on the
| rent. Now imagine he recoups that discount by putting your rent
| up by the same amount. And now imagine that I use those savings
| to buy a nice big TV for the two of us. The bathroom is still
| covered in mould. The carpet is still a mess. The power still
| cuts out all the time. And you pay more rent than me.
|
| But I bought an awesome TV for us. So I'm the good guy right?
| dylan604 wrote:
| What an unrealistic comparison. No landlord would ever do
| that, nor would the roommate agree to the changes that the
| landlord would attempt to make even if that is something the
| landlord would do.
| ficklepickle wrote:
| Aren't you in Vancouver? I've had landlords here that would
| absolutely do something like that. Many slumlords would do
| anything they think they can get away with.
| kortilla wrote:
| This analogy would work if you were already paying 10000x
| more than the roommate in the first place.
|
| Remember, all of the talk of billionaires "paying less in
| taxes than their assistants" is not based on raw collected
| amounts, it's based on percentages. A billionaire with an
| effective federal tax rate of 15% on 50 million income is
| paying 7.5 million in taxes, which is more than all of the
| federal tax collected from the bottom 10% of income combined.
| [deleted]
| kirillzubovsky wrote:
| From what I understand generic drugs are currently often made
| overseas, and then sold back to American market. Although he
| may not be a bad guy, he simply knows how to make money, and
| there are many billions left for the taking in this market.
| Definite not Mother Theresa, but better done locally, at the
| least.
| hoopleheaded wrote:
| The recent events where he helped Delonte West make for a
| pretty uplifting story that helps me believe Cuban is a decent
| and empathetic human being.
| chad_strategic wrote:
| I'm not going to over analyze this good news.
|
| I'm going to accept that at least one thing in the world seems to
| have gone right today.
| xiphias2 wrote:
| 2 if you look at what's happening with GameStop
| offtop5 wrote:
| I'm a bit too cynical to believe a benevolent billionaire will
| save us.
|
| Me thinks theirs something else at work here. I could see Mark
| Cuban building this company up , selling it for billions at which
| point we're back were we started
| jawns wrote:
| I agree, either there's something else going on or he's
| entirely genuine about the mission -- in which case it's
| unlikely to thrive.
|
| While this business model can work in some industries, in this
| particular heavily regulated industry, Cuban is either going to
| discover that it's harder than it looks and fold in a few
| years, or he's trying to sell a grand vision and offload it for
| a profit before the cracks in the foundation are discovered.
|
| I would be more inclined to see the mission as genuine if this
| were launched as a public benefit corporation or B corp (but
| even then, the promises such companies make of serving the
| public good can be overblown).
| deelowe wrote:
| I believe Mark Cuban is an altruist, but as you alluded to, the
| empires he builds are not inherently benevolent and could
| eventually end up in the same place over time as ownership
| changes.
| ksm1717 wrote:
| It's easy pickings but putting your name on a generic drug
| company seems like an oxymoron. This and the thing in the news
| recently with Delonte West's rehab that Mark Cuban sponsored -
| not even an attempt to get the stink of PR off of it which rubs
| me the wrong way
| retrac wrote:
| I'm not usually a "market" guy, but some good competition in
| generic drug production might actually save us. Presumably, he
| sees large potential profits by aggressively undercutting the
| non-competitive overpriced generics. If that takes off, it
| could be a good thing overall.
| wrsh07 wrote:
| I'm also pretty cynical about this. It will only work if it
| fundamentally changes the pharmaceuticals industry
|
| They could make up the loss on volume, though. Especially if
| selling outside the US
|
| Or as you say, they might join the incumbents and renege on the
| promise painted here
| sn_master wrote:
| I like to know where those drugs are manufactured. I don't want
| to buy from another Ranbaxy...
| treelovinhippie wrote:
| This is hilariously bizarre from a non-US perspective, but your
| country is so primitive in this area that a "Mark Cuban" branded
| solution is probably the most viable path out of the mess.
| thesausageking wrote:
| "The Mark Cuban Cost Plus Drug Company" is a mouthful. Did he
| really need to put his name on it?
|
| I also don't see anyone else listed on the website. No
| physicians, no chemists, no engineers. It doesn't inspire
| confidence.
| xiphias2 wrote:
| Actually I like it that an investor gives his name to a
| company. Usually problems start when he's not the main owner
| anymore though....
| valarauko wrote:
| "Cuban Drug Company" would be more fun
| dfxm12 wrote:
| The CDC? :)
| marton78 wrote:
| Cuban Drug Dealership
| res0nat0r wrote:
| I wonder how much of a shakeup between this and whatever Amazon
| Pharmacy is doing may have on pricing...
|
| https://pharmacy.amazon.com/
| athenot wrote:
| The name let me to think it was related to Cost Plus World
| Market, the home goods store.
|
| https://www.worldmarket.com
| xmichael0 wrote:
| Not sure, but albendazole seems over priced still. I bought 6
| tablets less than a year ago in Costa Rica for about $5
| dexwiz wrote:
| Mark Cuban must have my conversations bugged. I recently was
| talking to a friend about how the rich should realign how they do
| large charity spending.
|
| In previous decades a rich industrialist may have built a library
| or a university building. This made sense when education was for
| the rich, and knowledge was inaccessible the wider public. But
| now knowledge is cheap, and large gifts like this are
| disconnected from today's average public person. Also putting a
| name on a hospital that still puts people into debt isn't a good
| image either.
|
| Now the wider public needs cheaper pharmaceuticals. In order of
| the rich to stay in power for extended periods, they need to give
| some amount of handouts. Nuevo rich don't understand this, so
| they look to predecessors, and look on how they spent their money
| (hospitals, universities, etc), without realizing why they spent
| it. Expect to see more charity capitalism aligned with today's
| needs: generic drugs, taxi services, even phones and internet
| access.
| tthun wrote:
| is this sort of the "free market" example of disruptions in
| healthcare space that could may be move healthcare in US towards
| a model where you pay for what it actually costs instead of the
| inflated and opaque pricing that private health insurance thrives
| on ?
| wrsh07 wrote:
| In spite of the missing question mark, I think the answer is
| yes
|
| I'm not even particularly bullish about companies being able to
| improve transparency (it's a really complicated system, the
| incumbents stand to make/lose enormous sums of money, even when
| lower cost alternatives exist doctors might be contractually
| obligated not to discuss them)
|
| But I think that this is a really good step
|
| Similar to toasttab or chownow in the food ordering space
| weeboid wrote:
| Nice, $GME the fuck out of big pharma
| ChuckMcM wrote:
| This is great, do Insulin now.
| woadwarrior01 wrote:
| Everything is relative. The first generic they're launching at
| $20 a tablet: Albendazole, retails for less than 50 cents a
| tablet in India.
| asdfadsfgfdda wrote:
| I doubt $.50 is the true cost, there's a program to donate
| millions of tablets to developing countries:
|
| https://mectizan.org/partners/glaxosmithkline/
| georgeecollins wrote:
| People in the US can afford to pay a lot more for healthcare
| than in India. They just can't afford to pay twice as much as
| other industrialized countries.
| retrac wrote:
| Mebendazole (functionally equivalent to albendazole, as I
| understand it) is 4 USD a tablet here in Ontario. So even
| with this you're still paying 3x as much.
| [deleted]
| flowerlad wrote:
| Close to $0.03 USD:
|
| https://www.sastimedicine.com/salt-alternatives/5785-736518/...
| aiven wrote:
| compare price of labor between usa and india. Outsourcing
| everything to asia will be beneficial for company (and probably
| consumers since lower prices), but not for americans who work
| for cuban rn
| markdown wrote:
| This isn't the garment industry. Labour costs in drug
| manufacturing (as opposed to drug development) are
| negligible.
| randyrand wrote:
| From the original title, i thought the company was called
| "Transparent".
|
| That would have been a better name than this long name.
| f430 wrote:
| You can shit on billionaires and capitalism all you want but you
| can't argue with the benefits of trickle down effect of wealth.
|
| Somebody has a big ego and wants to put his name on schools,
| hospitals? Let him.
|
| Somebody wants to make a profit by exploiting the inefficiencies
| of an industry? Let him.
|
| Wallstreetbets wants to take out a few hedgefunds by beating them
| at their own game? Let's go.
| ksm1717 wrote:
| "Can't argue with the benefits of the trickle down effect of
| wealth"... yes I think decades of economic doctrine have
| covered the benefits. Probably should keep in mind other things
| like the consequences
| Nelkins wrote:
| I wonder what the chances are that they take on insulin.
| cyokada wrote:
| Albendazole can be found for US$ 1 in drugstores in Brazil.
| lawwantsin17 wrote:
| Wait, who's funding this? Doesn't mention his name.
| ttul wrote:
| " The first product we are producing is Albendazole. Albendazole
| is an antiparasitic drug that currently has a list price of
| approximately $225 per tablet (currently listed average cash
| price per tablet on goodrx.com)."
|
| I bought this in Canada for maybe $30 last year. And not just one
| pill. An entire course of it.
| whitej125 wrote:
| For those interested... I thought this was a pretty good book
| going over the creation and evolution of the US Healthcare
| system. It's equal parts fascinating and infuriating.
|
| An American Sickness: How Healthcare Became Big Business and How
| You Can Take It Back
|
| by Elisabeth Rosenthal
|
| ASIN : 1594206759 Publisher : Penguin Press; 1st edition (April
| 11, 2017) Language : English Hardcover : 416 pages ISBN-10 :
| 9781594206757 ISBN-13 : 978-1594206757
| sitkack wrote:
| This needs to get plugged into medicare/medicaid on a national
| level.
| jimbokun wrote:
| Looks like Mr. Cuban is demonstrating that, sometimes, a superior
| business plan is the shorter path to justice than waiting for the
| Courts and the Legislature to catch up.
|
| Wiping out their businesses financially might be the most
| effective way to fight them, in the short term.
| mikepurvis wrote:
| Given the name and positioning of this business, I would say
| it's partly a PR stunt and partly an act of charity (a non-
| charitable approach would be to undercut by only 30-50% instead
| of 90%).
|
| So yeah... it's great that billionaires occasionally step up to
| "fix" issues created by corruption and inadequate
| regulation/oversight, but I think if you're going to take a
| position that this is somehow better than waiting for the
| system to fix it, it might be more instructive to look at how
| this works in countries with a functioning bureaucracy. For
| example the drug given on the homepage is Albendazole, which
| they're selling for $20-- well guess what, that pill is $2 in
| the UK and has been since the patent expired in the 90s:
|
| > "In other countries, there are price control methods. The
| government steps in to ensure drug prices do not increase by a
| certain amount," Alpern says. "There are no price control
| mechanisms in the U.S."
|
| https://www.npr.org/sections/goatsandsoda/2017/12/11/5677534...
| JumpCrisscross wrote:
| > _a non-charitable approach would be to undercut by only
| 30-50% instead of 90%_
|
| Not if you're fighting deeply entrenched incumbents.
| Switching costs are huge, financially and politically. You
| need patients to hammer their providers to give them access
| to these drugs through this channel.
|
| 50% off is big, but it's something incumbents could match.
| 90% off leaves you with a profit margin, gets you PR points
| and holds the hounds at bay. Bonus: if you work out your
| competitors' debt loads and price at a level that they
| couldn't, financially, sustain.
| mikepurvis wrote:
| If the incumbent is a large scale pharmaceutical company
| with thousands of drugs in its portfolio, then it can most
| definitely afford to lose money under-cutting you when you
| only make a small handful.
|
| And I think that really just underscores why this approach
| is the Google Fiber of the US pharma market-- it may be
| able to force prices down for a handful of select
| customers, and may be helpful for proving a point about
| true costs and the need for regulation, but its existence
| is most certainly not some kind of proof of the invisible
| hand stepping in to solve this problem on its own and that
| regulation is therefore unnecessary.
| JumpCrisscross wrote:
| > _it can most definitely afford to lose money under-
| cutting you when you only make a small handful_
|
| Which gives you a textbook Sherman Act claim.
|
| In any case, a loss-tolerant competitor doesn't argue for
| a 50% discount versus 90%.
| mikepurvis wrote:
| Of course not-- it argues for not bothering to enter this
| space at all unless you're doing so with ulterior
| motives, for example as a PR stunt.
|
| As for antitrust laws, isn't the whole point that we're
| in this mess because the incumbents are all conspiring to
| fix prices and the existing consumer protection systems
| which should be preventing that have been failing
| Americans for decades and thank goodness for the free
| market which created the necessary incentives for Mark
| Cuban to swoop in and start this business?
| JumpCrisscross wrote:
| > _incumbents are all conspiring to fix prices and the
| existing consumer protection systems which should be
| preventing that have been failing Americans for decades_
|
| The Sherman Act prohibits monopolies or cartels damaging
| competitors. As a competitor, you have standing. As a
| consumer, you do not.
|
| I think this business could be phenomenally cash-flow
| positive in short order. It's not dissimilar from the way
| Teva started, just further down the pipeline.
| at-fates-hands wrote:
| Which in turn creates another long term disaster waiting to
| happen.
| chadlavi wrote:
| The "sometimes" there being "when you live in a country that
| respects businesses more than humans"
|
| The market should never be relied on to be the one to fix
| injustice.
| dnautics wrote:
| If by market you mean "for profit companies", that's correct.
| But if "market" is taken to mean "marketplace of ideas"... In
| free market philosphy there is a lot of sunlight in the gap
| between corporate behemoths and government, ranging from
| individual action through mutual benefit associations all the
| way up to pbcs and ngos. The point is government should also
| not be relied upon to correct injustice. In the end justice
| is up to the _people_ , and if a for-profit takes the banner
| of justice that's decentralization of power at work.
| m463 wrote:
| robust competition cleans up a lot of problems.
|
| Also, as an employee having a company that has to actually
| compete can really eliminate a lot of BS. If you're in the
| 800-lb gorilla, there can be a lot of dysfunction. If you're in
| a company with an 800-lb gorilla, there's a good chance what
| you do may not matter (unless its really good).
| taurath wrote:
| Robust competition doesn't exist without strong regulation,
| because the natural state of competition is monopoly even
| with a medium barrier to entry. Almost all of our companies
| nowadays are high barrier to entry.
| satyrnein wrote:
| In this case, isn't the barrier to entry itself regulatory?
| The drug approval process stops new entrants and federal
| law stops consumers from buying drugs from other countries.
| Otherwise, I imagine there would be a pretty robust market,
| given that these are generics and there's no R&D involved.
| hh3k0 wrote:
| If we'd ban lobbying we wouldn't have to wait for one business
| to show up from somewhere else than the depths of depravity.
|
| If we'd ban lobbying we could have laws against companies that
| show nothing but utter disdain for life.
| HenryBemis wrote:
| "Lobbying" is legitimising bribes from corporations
| politicians. It is as simple as that.
|
| If USA wants to change the game (they don't) they can ban all
| corporate donations (aka legalized bribing), allow only
| donations by individuals, and then impose/enforce a limit of
| $10-25-50k per person (or something reasonable). Anyone
| playing tricks to game that rule get a penalty of x20 the
| excessive amount donated (e.g. via others). Also put all
| donations in public record. As simple as that.
|
| It makes no sense to me that you (USA) spent $14bn [0] on
| this election.
|
| [0]: https://www.cnbc.com/2020/10/28/2020-election-spending-
| to-hi...
| h_anna_h wrote:
| I think that you are being too optimistic here.
| jimbokun wrote:
| Sure, but what odds do you give to that happening in the near
| future?
| ch4s3 wrote:
| How do you practically ban lobbying without removing the
| ability of private citizens to directly interact with the
| legislature? There are good reasons to allow groups of people
| to get together and pay someone to go hassle congress on
| their behalf. Regular people are busy with their own lives
| after all, and most of them live far away from Washington.
| And sometimes you want to complain to a representative from
| outside of you own district, because they're sponsoring
| legislation that would hurt you, or blocking legislation that
| would help you.
| mikem170 wrote:
| We could start by banning political campaign funding from
| corporations and unions.
|
| I took a look at a handful of western democracies and they
| all either banned or drastically curtailed this. People
| need to be in control of their government, and that
| includes campaign funding.
| mindslight wrote:
| You write the laws to apply to companies but not private
| citizens. A major owner of a pharma company could still
| lobby privately as themselves, but at least they'd be
| paying taxes on that expense rather than having it hidden
| as a corporate writeoff.
|
| (And before anyone chimes in with "but corporations are
| just groups of private citizens" - they're explicitly not.
| Corporations are fundamentally defined by having a charter
| from the government to reduce the owners' liability, and
| thus we would expect them to incur additional regulations)
| ch4s3 wrote:
| I imagine CEOs would just lobby privately and in person
| then, but pay a team to do all of the other leg work.
| This is trickier issue than people popularly imagine.
|
| Influencing the leaders of a global super power is
| incredibly valuable, and lots of people want to do it for
| a lot of reasons.
|
| In your proposal, would you ban NGOs, non-profits, and
| unions from lobbying? Why or why not?
| mindslight wrote:
| If the CEO were paid an extra $10M salary so they could
| turn around and personally spend it on a lobbying firm,
| that would at least reduce the efficiency of said
| lobbying by 37%.
|
| The biggest issue is the complete lack of reporting, and
| anything that pushes the money flows more into the open
| (your hypothetical CEO is then personally responsible) is
| a step forward. Take a look at the stark difference
| between campaign finance reporting for individual
| candidates, and everything else.
|
| Your last bit is a loaded question. If an entity's
| business _is_ lobbying, then obviously they can engage in
| lobbying. But they could only be funded by individuals,
| not companies whose business is other-than-lobbying.
| Judgmentality wrote:
| You could limit the amount of money you can make via
| lobbying. If it was illegal to make more than $1 MM a year
| through lobbying, suddenly the playing field would be
| significantly more level. If a corporation can pay you $1
| MM and a group of citizens can pay you the same, suddenly
| you care more about the message than the receipt. And the
| majority of ultra-rich lobbyists will do something else,
| because that's not nearly enough money to interest them.
|
| I'm not a fan of limiting salaries in general and I do not
| believe this is a good solution, but I believe it's likely
| to be better than the current situation. This is just me
| spitballing on a whim, having put approximately 60 seconds
| of thought into a solution. Hopefully people more informed
| will reply with better solutions or an informed explanation
| of what's wrong with my idea.
| dstick wrote:
| He forgot "by companies". Your point is valid. It should be
| banned for companies. Either directly or indirectly.
| tolbish wrote:
| Universal health care may be a more pragmatic approach than
| "ban lobbying", IMO.
| geodel wrote:
| Huh, I have seen countries where lobbying is illegal but they
| are vastly more corrupt than US.
|
| Finding one scapegoat and blaming all problems to it seems
| cartoonish level simplistic.
| hh3k0 wrote:
| It's almost like this isn't an either/or type of situation
| where a nation either has lobbying banned or suffers from
| corruption.
|
| (And absolutely no one other than you has made this
| oversimplification in this comment chain.)
| vkou wrote:
| > Looks like Mr. Cuban is demonstrating that, sometimes, a
| superior business plan is the shorter path to justice than
| waiting for the Courts and the Legislature to catch up.
|
| This is a very bold claim, that we do not currently have the
| data to evaluate.
|
| In ten or twenty years, we can revisit it, and conclude whether
| or not it is actually true.
| dnautics wrote:
| I am super rooting for Mr. Cuban. As I alluded to in a previous
| post (not half a day ago), this is something I want to work on:
|
| https://news.ycombinator.com/reply?id=25925876&goto=threads%...
|
| If I am not mistaken, the biggest challenge as I see it is that
| according to the FDA abandoned (generic drug) program, the Cost
| Plus Drug company will not be able to advertise many of its
| drugs to advertising monopolies that the FDA has handed out to
| companies (e.g. Shkreli, but also many bigger pharma
| companies), which according to a doctor friend of mine is a
| business killer. However, it's entirely likely that through
| sheer force of personality and name recognition, Cuban can
| force through a program of "check our company first", without
| advertising any particular drug, that gets popular among
| doctors. Hopefully that will drive eyes to the company without
| running afoul of the FDA's well intentioned but horribly gone
| wrong rule.
| mikece wrote:
| I've wondered for a long time how much money could be saved if
| the non-trivial administrative overhead of insurance companies
| were removed from all but truly catastrophic cases (where claims
| start at $10k or more) and medical, dental, and drug costs were
| paid out of pocket (including via an HSA account). There are
| numerous cases where cash-only medical clinics are able to offer
| up-front pricing for a fraction of what is billed to medical
| insurance companies. If Cuban's idea is "we don't do insurance
| but you're free to pay with an HSA card or seek reimbursement
| from your insurance company" then this could be a huge winner.
| giantg2 wrote:
| The problem is that most people don't have $10k that they could
| pay directly.
|
| You might find this interesting too.
| https://slatestarcodex.com/2020/04/20/the-amish-health-care-...
|
| Edit: why is this downvoted?
| nickff wrote:
| The biggest problem is that most of the money in healthcare
| actually goes to pay salaries, mostly those of nurses and
| doctors, but administrators are up there too. Pharmaceutical
| companies are not as profitable as one might imagine, and drugs
| are a relatively small fraction of total healthcare costs.
| pettusftw wrote:
| Pharmaceutical companies are actually far more profitable
| than I imagined.
|
| Pharma companies enjoy a profit margin averaging 26%, medical
| device companies 12%, and hospital groups (which includes
| non-profits) 8%. Insurance companies are closer to 3%.
|
| https://www.americanprogress.org/issues/healthcare/reports/2.
| ..
| Darmody wrote:
| Then why the same drugs are incredibly cheaper in other
| wealthy countries? They don't pay salaries there?
|
| Healthcare in the US is a scam. There's no other way to look
| at it.
| paulmd wrote:
| Salaries are certainly a part of it - medical staff are
| paid much lower in other countries.
|
| Because they don't have to pay for their education.
| Governments there recognize that having lots of doctors is
| a public good and don't saddle them with hundreds of
| thousands of dollars of debt from medical school.
|
| Doctors aren't the ones who pay that medical school bill
| (if they get a job). It's their patients who pay the
| medical school bills.
|
| The problem of medical expenses in the US is a very complex
| one. It's essentially at the nexus of a whole bunch of
| problems with our society. Higher education is too
| expensive. We have too many middlemen. Strong intellectual
| property laws make drugs and devices expensive. Patent laws
| make evergreening more profitable than innovation. Intense
| regulatory requirements for approval make competition very
| limited for pharmaceuticals. The government doesn't
| maintain control of the products resulting from the blue-
| sky R&D it funds. etc etc.
| munk-a wrote:
| This will partially ignore your attribution that the US
| problem is a complex multi-faceted issue (I agree with
| that but wanted to focus in) - you mention that higher
| education is too expensive and suggest that there are
| many other societal factors that make the US
| noncompetitive. This can cause an effect like we're
| seeing with the US healthcare market but the US does well
| in a lot of the more transferable industries (like
| software development) and I'm not seeing how the factors
| you're highlighting for healthcare wouldn't equally apply
| to all of those transferable jobs.
| munk-a wrote:
| That is a pretty vague statement which I've not seen born
| out. I work in tech loosely associated with healthcare and
| I've needed to learn how the different companies involved in
| the charging process interact and it's super murky - there
| are a lot of "preferred rates" offered by HCPs to insurers.
| These "preferred rates" end up leading to the outrageous out-
| of-network charges some folks have been exposed to. These
| only seem to exist to justify the constant spending into
| marketing and sales on both sides to make it appear that
| negotiations are saving companies 80% of the "cost" in their
| partnership - while nobody ever ends up paying full price
| except really unlucky patients. Additionally the system of
| manufacturer rebates on prescriptions appears to exist solely
| to bump up the price to insurer - so a 80$ med sold for 160$
| with an 80$ rebate might trigger the insurer to pay out 80$
| as half the cost of the medication before the patient
| receives the medicine for free due to the additional rebate -
| this ends up squeezing the insurer who will squeeze the
| patient all that much harder when it comes time to settle the
| monthly fees.
|
| The US system is absolutely lousy with corruption and ends up
| diverting a large amount of money toward marketing which is
| rather baffling - whether a treatment is appropriate or not
| is a decision I'd rather my doctor made on the basis of
| efficacy - not because one of the companies had a catchy
| jingle or because one of them recently took him out to lunch.
|
| Hospital administration does cost a fair amount, but be
| careful here - it's like education - some of those
| administrators have moved up the seniority chain to positions
| where they essentially do nothing and get paid for having
| their ass in a chair - but a lot of that administration goes
| to fighting against the extremely aggressive tactics of
| insurers and manufacturers. While those administrators would
| ideally be unnecessary due to better regulations being in
| place they do provide justifiable savings for the hospital
| (it's cheaper than not having them in many cases) under the
| current system.
|
| It's all really complicated and murky.
| codegeek wrote:
| I would bet my life that costs would be lower. Insurance
| middleman in everything drives up the cost a lot due to so many
| overheads involved.
| minikites wrote:
| Why do we need a system as complex as this instead of just
| funding healthcare through tax dollars and giving it to
| everyone like many other developed nations?
| giantg2 wrote:
| Can you show where the tax funded systems are not complex? It
| might remove some issues, but it can create others. I don't
| think a simplistic solution exists anywhere in the modern
| world.
| minikites wrote:
| You're right that the back-end of any healthcare system is
| complex, but a government-funded single-payer system is
| simpler for the end user (every citizen), that was my
| point.
| giantg2 wrote:
| I must be missing something then.
|
| In the current system you walk in and hand them your card
| (insurance, Medicare, medicaid, etc) and they treat you.
| You get mailed a bill later.
|
| Tax funded systems would be similar. Walk in, give them
| your ID/card and get treated. Get a bill if it's a
| taxable condition (like Italy).
|
| Obviously there are other non-payment related differences
| like scheduling and what's covered.
| warkdarrior wrote:
| In the current US system, if your employer does not
| provide (any|sufficient) insurance coverage, you have to
| get your own and there are a million options all ready to
| fleece you. It is almost impossible to comparison shop
| and choose between 100 bad options.
|
| Yes, the mechanics are the same (go to doctor, get a
| bill), but your purchasing power as individual patient is
| really small compared to a whole country.
| giantg2 wrote:
| I agree many options are bad. Even employer insurance is
| expensive.
|
| Where is the individual's purchasing power a part of that
| scenario? Regardless of the group or person paying the
| provider, the bill is still substantial. The main money
| saver between the types is in system efficiencies like
| removing overhead, or instituting restrictions.
| minikites wrote:
| >The main money saver between the types is in system
| efficiencies like removing overhead
|
| I agree, we should remove the overhead created by the
| existence of private insurance companies.
| mcguire wrote:
| " _In the current US system, if your employer does not
| provide (any|sufficient) insurance coverage, you have to
| get your own and there are a million options all ready to
| fleece you. It is almost impossible to comparison shop
| and choose between 100 bad options._ "
|
| I've been using the ACA marketplace here in good ol'
| Alabama, and I've had the opposite problem. There are
| four choices, all from BC/BS.
|
| Note: I love the ACA. I will fight for the ACA unless and
| until I'm presented with an actual better option. Prior
| to the ACA, I had options from other companies, none of
| which covered my major problem.
| pjc50 wrote:
| The difference is in the NHS everyone is "on the same
| side", so the amount of bill inflation and money juggling
| that happens is basically zero.
|
| The NHS does demand management with waiting lists
| instead. Basically it's amazing for things that can be
| easily identified and given cheap medication for
| (insulin, antibiotics etc), amazing for emergencies which
| can be resolved with surgery, OK (but variable) for
| obstetrics, does a decent job at screening for common
| conditions, but tends to leave anything that won't
| actually kill you to wait.
|
| I've never had to think about billing.
| lkbm wrote:
| Here are some things in the current system I'm hoping a
| single payer system would fix:
|
| * I walk in, and they can tell me right away whether I
| will be billed or not. There's no "we'll see" and then
| maybe I get a bill in a few weeks.
|
| * I walk in to a different doctor's office and the answer
| as to whether I'm billed or not is the same as at the
| other doctor.
|
| * Because of these first two items, I walk in and they
| can tell me ahead of time what my bill will be.
|
| * We can now replace "walk in" with "check their websites
| (or call) and comparison shop".
|
| Maybe they can't tell me if my treatment is taxed until
| I'm diagnosed, but that still gives me the option to find
| out my bill before treatment. Once I'm diagnosed, if it's
| non-urgent I can shop around.
|
| Price transparency is non-existent in US healthcare.
| There's no big mystery as to why that would cause
| inefficiency and absurd costs.
| SahAssar wrote:
| Have you ever been in an ambulance and had to think about
| if the hospital they drive you to is in your coverage?
| That's the sort of thing I've been told about from
| American colleagues and friends.
| mcguire wrote:
| " _I must be missing something then._ "
|
| The part where you are one of the people who doesn't have
| a card from insurance, Medicare, Medicaid, etc.
| giantg2 wrote:
| Is that a real concern though? The ACA provides income-
| based funding and expanded Medicaid.
| minikites wrote:
| >In the current system you walk in and hand them your
| card (insurance, Medicare, medicaid, etc) and they treat
| you. You get mailed a bill later.
|
| The thing you're missing is that the current system in
| the USA is in no way like this.
| giantg2 wrote:
| That's completely false. I've had to deal with many
| medical bills in the US last year.
| minikites wrote:
| You must have good insurance if you think your experience
| is typical. Most people aren't so lucky.
| giantg2 wrote:
| It's this way for everyone I know, except for medicaid
| recipients.
| mcguire wrote:
| You are healthy and not self-employed, I take it.
| giantg2 wrote:
| Do you have insurance? I fail to she how being healthy
| and not self-employed affects the scenario as described
| (present card, get treated, recieve a bill).
| RHSeeger wrote:
| That bill can be for an amount that varies wildly based
| on your insurance, the doctor, who helps the doctor, what
| lab they send things too, and a large number of other
| options. If things work out well, your bill could be for
| $30. If you don't remember to ask the right questions,
| the bill could be $30,000.
| admax88q wrote:
| Youve skipped the step for obtaining a card in the first
| place. Something which is trivial here in Canada (easier
| than a drivers license, and free).
|
| Also theres none of this in-network vs out of network
| chaos. Emergency care always covered, doesnt matter where
| you go.
|
| It feels like youre trying not to understand how a public
| option could be better.
| flyingfences wrote:
| That's what insurance is supposed to be: coverage for the
| catastrophic cases. This use of insurance for ordinary,
| everyday medical care is ridiculous. I have insurance on my car
| in case of a catastrophic collision; can you imagine if I had
| to deal with them for every oil change and brake job?
| codegeek wrote:
| I make the same argument and people don't get it. We are so
| brainwashed about the whole health insurance thing in
| America. Get rid of insurance middleman in EVERYTHING and see
| how prices drop.
| jfrunyon wrote:
| Because it's not valid. Ignoring routine and preventive
| care makes those catastrophic cases almost inevitable.
| [deleted]
| codegeek wrote:
| I don't understand your argument. Even on insurance, a
| lot of Americans routinely ignore preventive care because
| of the hassles, overhead and out of pocket costs even
| after insurance. Unless you are lucky to have great
| insurance by your employer. The point is that insurance
| should NOT be involved in preventive care. It should be a
| direct free market cash exchange b/w just 2 parties.
| Patient and doctor. That's it. NO premiums, no copays, no
| coinsurance, no claim paperwork, no calling insurance
| companies to figure out the charges etc etc and most
| importantly, no dependency on having a job to be able to
| afford going to a doctor even for preventive care.
| pkaye wrote:
| Until it comes to dental work and hearing aids. Then people
| wish the insurance middleman was there.
| btilly wrote:
| The problem is that your catastrophic costs are likely to be
| massively higher if your problems are not caught by routine
| checkups and standard screenings. But if we make people pay
| the full costs for routine checkups and standard screenings,
| they won't bother getting them. So it is in the interest of
| your insurance company to make sure you get those checkups
| and screenings.
|
| By contrast your odds of a catastrophic collision have more
| to do with drivers and driving collisions than they do with
| whether you got an oil change recently. If they were insuring
| your cost of major repairs and buying a new car, then they
| would have an incentive to get involved with routine
| maintenance as well.
| throwawayboise wrote:
| I have good insurance from my employer but I haven't been
| to a doctor in at least 10 years. I don't think it's a
| given that people get routine care just because insurance
| covers it, or would avoid it if they had to pay (a
| predictable, modest amount) for it out-of-pocket.
| skybrian wrote:
| Auto insurance does give discounts for things like taking a
| defensive driving course. Some will give discounts for
| installing a tracker on your car to show that you don't
| speed.
|
| So it's not entirely out of the question that they could give
| discounts for properly maintaining your vehicle, if that were
| a major cause of accidents and it could be tracked.
| danepowell wrote:
| I fully agree that at least in principle it seems wrong to
| have insurance for routine care, when most insurance only
| covers catastrophe.
|
| I think the two practical problems with this view are (a)
| what's routine to you might be catastrophic (or at least
| seriously detrimental) to someone else, and (b) missing
| routine care often leads to catastrophic outcomes.
| nathanvanfleet wrote:
| I don't know, maybe the government should regulate the
| predatory behaviors or business instead of weird libertarian
| strategy that is already not working for people who have no
| insurance and their life is destroyed when they get sick?
| giantg2 wrote:
| You really think the current situation is libertarian?
|
| There is so much regulation around anything even remotely
| medically related. Just look at the HIPPA mess.
|
| Edit: why are you downvoting without rebuttal? Its utterly
| false to claim the system is libertarian.
| tdfx wrote:
| There's nothing libertarian about the US healthcare system.
| If anything, it's a great example of regulatory capture by
| the AMA and insurance industry.
| warkdarrior wrote:
| The libertarian angle does not work in real life, even if we
| ignore the regulatory capture practiced by insurers. Because
| there are not enough doctors/nurses in the country, you as a
| patient will always compete for medical attention with other
| patients. This will only drive prices up.
| lostapathy wrote:
| Libertarians would also allow more doctors to be educated.
| We don't have enough doctors now because the AMA acts as a
| cartel to limit supply of doctors. Libertarians don't like
| that either.
| paulmd wrote:
| The free market has decided that they don't want more
| doctors educated though. Guilds are very free market, do
| you not believe in freedom of association?
|
| I guess the true libertarian answer is that we don't
| really need certification at all, or that anyone should
| be able to start their own certification board. Like Rand
| Paul and his fake ophthalmology board he started to give
| himself credentials.
|
| Nothing is ever libertarian enough until we've removed
| all the regulations and let quacks practice medicine, is
| it?
| zepto wrote:
| In a free market we'd be able choose a non-guild doctor.
| lostapathy wrote:
| What about this is the free market?
|
| https://www.washingtonexaminer.com/thanks-to-doctors-
| there-a...
| mcguire wrote:
| The last time this came up, several people responded that
| they would be happy to go to a 'doctor' educated on
| YouTube.
|
| Which is lovely and all, until those doctors tell you
| vaccines are worthless and dangerous, and to slather a
| mixture of beef tallow, garlic, leek, and honey on your
| injuries.
| lostapathy wrote:
| I'm not sure how you made the jump from the AMA limiting
| med school enrollments to "youtube doctors".
|
| We could split the difference and expand existing med
| schools or start new ones with similar standards.
| aj7 wrote:
| I doubt this.
|
| To me, libertarianism is simply "might makes right," with
| the liberty part being everyone has the opportunity to
| grow into a bully. I've never seen a SINGLE libertarian
| policy that couldn't be interpreted this way, and I'm
| quite open to being corrected.
| GurnBlandston wrote:
| What?
|
| Libertarianism basically sees two possible crimes: force
| and fraud. Totally incompatible with "might makes right".
| satyrnein wrote:
| Here's a handful of typical libertarian positions (though
| certainly there's some variance): pro-choice, anti-war,
| pro-civil rights, pro-immigration, anti-drug-war. They
| don't seem to match your description of "might makes
| right".
| deelowe wrote:
| What? I went to a specialist today. My doctor scheduled the
| appointment. I had no say in it. This doctor is at one of two
| offices that I am allowed to choose from based on my
| insurance's negotiated contracts. This is insurance that is
| provided by my employer that I had no choice in. When I first
| saw the doctor, he prescribed meds that I had no choice in.
| The specific meds he prescribed were chosen as these are what
| the insurance company would prefer from a clinical
| perspective although they were extremely unlikely to help.
| And, on top of all of this, not once was I informed of the
| cost prior to services being rendered and if I had asked, I
| would have been told this wasn't possible.
|
| How is any of this libertarian? The libertarian solution
| would be that only individuals would be allowed to purchase
| insurance, that insurance would distribute funds to the
| individual (not the doctor or pharmacy), all fees would be
| provided prior to service being rendered and individuals
| would purchase meds without a prescription.
| munk-a wrote:
| > The specific meds he prescribed were chosen as these are
| what the insurance company would prefer from a clinical
| perspective although they were extremely unlikely to help.
|
| I work close enough to healthcare that I can say that while
| insurers do take cost of treatment into account they are
| looking to minimize ongoing treatment costs - if there is a
| 5$ pill and a 500$ pill available for treatment the insurer
| may prefer to trial you initially on the 5$ pill if it's
| been proven effective for a good proportion of patients,
| but they do use calculations to minimize those ongoing
| costs that includes costs from condition escalation (i.e.
| if you have a boil you're absolutely going to get
| antibiotics covered since dealing with a septic boil is an
| emergency room visit.
| deelowe wrote:
| That's pretty much what I described. I was prescribed
| antibiotics for a chronic issue. It made no sense at all,
| but the DR said it's what he must to do to follow the
| hospitals guidelines (which are determined by what the
| insurers want to see). I have gastro issues and modern
| antibiotics cause me all sorts of problems, so of course
| I had to deal with the pain and discomfort for 2 weeks
| all for something that made no difference whatsoever.
| RHSeeger wrote:
| Did you try saying no, that you weren't comfortable with
| this solution, and you'd like to discuss other options?
| You can always discuss what options are available with
| your doctor and then reach out to your insurance to see
| what and why they will do about it. You may not get the
| answer you want, and it will use up a lot of your time,
| but it is an option.
|
| Note: I've spent on the order of 30 hours on the phone
| over the past couple months trying to get things sorted
| out between my doctor, my insurance, and the provider of
| the drug that I need for my vision. The folks at the
| insurance can't always help, but they've always been
| willing to discuss things and see what they _can_ do.
| BurningFrog wrote:
| Healthcare already _is_ the most regulated industry in the
| US.
|
| Calling it libertarian shows you know nothing about either
| healthcare regulation or libertarianism.
| mlthoughts2018 wrote:
| > If Cuban's idea is "we don't do insurance but you're free to
| pay with an HSA card or seek reimbursement from your insurance
| company" then this could be a huge winner.
|
| This is the way it works for a lot of therapy and mental health
| services and it's horrible. Prices are absolutely insane,
| practitioners are not accommodating to patient schedules, and
| patients have absolutely zero bargaining power.
|
| In some ways doing it through insurance is kind of like a
| union. You all agree to accept certain inefficiencies,
| bureaucracy, etc., (and associated cost) in order for better
| collective bargaining terms.
|
| Of course people with great jobs usually don't care about
| unions. They don't need the collective bargaining power and
| thus figure the bureaucracy cost is just a loss they don't
| need.
|
| Same thing with very healthy people and insurance. If you're
| healthy you just figure, give me cheap catastrophe insurance,
| what do I care? But if you're in the depths of the medical
| industrial complex because you need frequent treatment for
| chronic conditions, you quickly learn that papering everything
| over with lots of bureaucracy to adhere it to better collective
| bargaining for patients is way better, and I'd rather take the
| nasty, churning quagmire of price inflating insurance than deal
| with spartan libertarian mini-insurance that essentially just
| results in rich-get-richer (i.e. genetically lucky healthy
| people just get to save money while everyone else suffers).
| supertrope wrote:
| The supply and demand imbalance in clinical psychology and
| psychiatry is why they can choose to be out of network.
| Demand is not only wanting a good or service but being able
| to pay for it. Mentally ill people tend to have less or much
| less money. The long term trend is not good; why become a
| psychiatrist when you can earn more as almost any other
| specialist? (With exception of pediatry).
| Analemma_ wrote:
| I'm sure individual experiences vary widely, but I know
| several people getting frequent treatment for chronic
| conditions, and none of them talk about how happy they are
| that an insurance company is collectively bargaining on their
| behalf. Most of them curse their insurance provider with
| every breath, and are firmly of the opinion that it would
| shoot them in the head if it thought it could get away with
| it.
| jfrunyon wrote:
| Generic manufacturers don't have anything to do with insurance
| companies, though, do they? Other than perhaps trying to
| convince insurance companies to put their drug on the
| formulary. It would be between the pharmacy & insurance.
| fallingknife wrote:
| Do drug companies get involved with insurance companies? I
| thought the pharmacies purchased the drugs, and then they
| handled that at the point of sale.
| colechristensen wrote:
| There is always an amount "billed" to insurance companies which
| is strictly imaginary. There is this billed rate, the
| negotiated rate per insurance provider, and a cash rate.
| aj7 wrote:
| So it winds up you pay for everything. Your "drug plan" too.
| SeanLuke wrote:
| It depends on the drug. Under my insurance, I get certain
| drugs for $0.
| colechristensen wrote:
| No, there's just a base rate that nobody pays used as a
| negotiation tactic that's still published on bills for
| whatever reason, you can see what your insurance provider
| actually pays as well.
| jjoonathan wrote:
| > a cash rate
|
| An equally imaginary number that gets hauled out during
| debates so that health care providers can pretend that
| insurance companies are the ones responsible for price
| inflation. If you actually try to obtain the cash rate,
| they'll give you a 2% "lol nice try" discount off the billed
| rate.
| aj7 wrote:
| I've been buying my drugs for cash for a decade. I'm lucky,
| I've got 5 prescriptions that run me ~$1000. I started when I
| found that open market pricing was lower than my insurance (UHC
| Optum) pricing.
| rush86999 wrote:
| I completely agree with you. That is why we started Tangerine
| Health (https://www.tangerinehealth.co). We charge a flat rate
| of $25 per visit. With new policy changes to Telehealth, we
| also launched virtual primary care with the same pricing model.
| If you have insurance we accept Aetna and UHC. We are in the
| process of getting Blue Cross as well. I believe also doctor's
| office visits are covered by HSA (not 100% sure but here's a
| link found: https://www.foley.com/en/insights/publications/2020
| /03/covid...).
| gigatexal wrote:
| The average American can't afford a 400 dollar expense and you
| are advocating a post pay insurance model? That seems very
| regressive.
| adventured wrote:
| > The average American can't afford a 400 dollar expense
|
| The average American has $432,000 in net assets, is the
| second richest in the world (behind Switzerland), and can
| trivially afford such an expense.
|
| Did you mean that around 12-16% of the population can't
| afford an immediate out of pocket $400 expense? Because
| that's the real figure according to the Federal Reserve study
| that's constantly misquoted.
|
| The median American has a higher net worth than either
| Germany or Sweden, and among the highest disposable income of
| any nation.
| SgtBastard wrote:
| Not even remotely accurate:
|
| https://en.m.wikipedia.org/wiki/List_of_countries_by_wealth
| _...
|
| The US is 22nd by median net wealth.
| ashayh wrote:
| "Poorer" countries than the US like Portugal, France,
| Japan, UK have far better health outcomes including _lower
| infant mortality_ , lower chronic diseases, better life
| expectancy than the US.
|
| The US is the only "developed" country where 10 are
| uninsured: https://en.wikipedia.org/wiki/List_of_countries_
| by_health_in...
|
| Another N% are under insured, or hampered by high
| deductibles, copays, limits etc.
|
| Whats the point of having a "high median net worth" if the
| basic needs of the people aren't met?
| gigatexal wrote:
| Now that's just being petty with stats. You knew I was
| talking about the majority of Americans not the richest.
| Sure if you take the arithmetic average of assets it will
| come out very high. But that's because the millionaires and
| billionaires skew the numbers.
| noir_lord wrote:
| Insurance companies are a symptom of the problem but the real
| solution is either single payer, something NHS like or
| something like the German model (which is probably the most
| similar of the major countries to what the US has now - though
| it's still three quarters state funded).
|
| The NHS was to an extent a statistical fluke (right politician
| in the right place, just post-WWII) that the right wing has
| been trying to dismantle for decades, without WW2 I'd be
| surprised if we had anything like the NHS.
|
| Basically you need politicians to ignore the lobbyists and do
| their job of regulating this shit for a better society.
|
| Sadly I don't see it happening though there are some hopeful
| trends.
| burlesona wrote:
| Ironically, the US Employer-Oriented health insurance _also_
| exists in large part because of the US response to WW2.
|
| During the war the US froze wages in order to try and prevent
| skyrocketing salaries due to the extreme demand for labor.
|
| To compete, most employers started offering generous benefit
| packages in lieu of the raises they were no longer able to
| offer.
|
| After the war, the larger employers found that the generous
| benefit packages were more cost-effective at retaining
| employees compared to higher pay, so they became "fans" if
| you will, and have supported the employer-based benefit
| programs in the US ever since.
|
| One concise reference:
| https://www.nytimes.com/2017/09/05/upshot/the-real-reason-
| th...
| cocoa19 wrote:
| I don't buy the single payer/Obamacare/more regulation speech
| as the single healthcare fix. NHS has a ton of problems of
| their own.
|
| We need a lot of doctors, more than what we are producing.
| It's baffling you need 100s of thousands of dollars to become
| a Dr in the US.
|
| Remove the undergrad requirement to apply for med school,
| like most of the world, and fix the college affordability
| problems.
|
| If the amount of money to produce doctors keeps escalating,
| it's not surprising medical care only goes up.
| noir_lord wrote:
| There is no single solution, the world isn't that neat
| however the NHS problems and it does have them are a result
| in large part to it been a political football for decades.
|
| Even with those problems we spend about half per capita on
| healthcare with about equal outcomes, also the US gov in
| one form or another already foots about 50% of the bill
| itself.
|
| > Results The UK spent the least per capita on healthcare
| in 2017 compared with all other countries studied (UK $3825
| (PS2972; EUR3392); mean $5700), and spending was growing at
| slightly lower levels (0.02% of gross domestic product in
| the previous four years, compared with a mean of 0.07%).
| The UK had the lowest rates of unmet need and among the
| lowest numbers of doctors and nurses per capita.
|
| https://www.bmj.com/content/367/bmj.l6326
|
| They do more for less with less and mostly do it well.
|
| Compare that to any other major country and it's good,
| compared to the US system it's very good.
|
| Does the US have amazing doctors, hell yeah of course but
| do they have a fair system when on average everyone gets
| what they need if not always what they want, I'd argue no.
| xcskier56 wrote:
| From some of the studies that I've seen of primary care
| practices moving to a cash only model, I think its in the range
| of 15-20% reduction in overhead costs. These were for the most
| part smaller independent clinics, so the number is probably
| lower for large health systems.
| DubiousPusher wrote:
| The problem is many people don't have cash either.
|
| https://www.federalreserve.gov/publications/2019-economic-we...
| throwawayboise wrote:
| There's a cash-based medical practice in my town. They don't
| accept or file insurance claims (they will give you an invoice
| with billing codes so you can file your own claim if you want).
| Their prices:
|
| New patient visit: $400 MD or $300 PA
|
| Follow up visit: $200 MD or $150 PA
|
| Labs: $25 draw fee + laboratory cost
| jfrunyon wrote:
| That's significantly more than my doctor - who is part of a
| major hospital/healthcare network and works primarily with
| insured patients - charges out-of-pocket...
|
| (I know this because they screwed up billing the insurance
| company and got denied, and tried to switch me to cash and
| bill me the higher amount instead. I love our healthcare
| system.)
| tlb wrote:
| A good comparison is veterinary medicine in the US. All the
| functionality is fundamentally the same, but insurance isn't
| common. Prices are vastly lower, and it's all super-convenient.
| Typical for an injury requiring stitches: $150, plus $15 for
| some antibiotics, which they hand you as you walk out.
|
| Every time I go to the doctor I wish I could take myself to the
| vet instead.
| heavyset_go wrote:
| My experience conflicts with your assertion. Costs for
| veterinary care have sky rocketed over the last 15 years, and
| costs for procedures without pet insurance are sometimes 75%
| to nearly the same price as the same procedures on humans.
| Prices for MRIs, X-rays, surgery and drugs are all very close
| to human medical care costs.
| poulsbohemian wrote:
| FWIW: I wonder if you are in an urban area? When I compare
| the cost of vet services with my friends in an urban
| setting relative to what we pay here in rural, small-town
| America, I'm shocked at the difference. We have a
| university about a two hour drive away with a noted vet
| hospital - even their services were priced better than
| those I've heard anecdotally on the other (more urbanized)
| side of the state.
| LinuxBender wrote:
| Me too. I suspect some of this is regulatory overhead and
| compliance. I can give pets injections (inoculations and
| antibiotics) without even talking to a vet. The only
| exception I ever ran into was antibiotics for a snake, as the
| feed store didn't carry that. To get those things for myself
| would require a prescription from a doctor.
| poulsbohemian wrote:
| Even more importantly: When you walk into the vet, they can
| estimate what your options will cost, so that you can make an
| informed decision.
|
| When it was our cat's time too, I was struck by his end of
| life experience versus that of a human. Whereas a human could
| have exhausted their life savings on futile treatment or end
| of life hospice care, Denver cat went quietly into that good
| night on his favorite blanket surrounded by his loved ones.
|
| I'm currently in need of some very common medical treatment,
| but the maze of providers I need to go through in order to
| get a referral just ain't worth it. Versus, if I were a cat
| or dog, I could simply go to the area university veterinary
| hospital and likely get my answer same day.
| mc32 wrote:
| Is it the same for studs or thoroughbreds?
|
| What I'm getting at is that for most animals the owner can be
| compensated for accidental death easily. (How much is a head
| of cattle at auction?)
|
| Not that this explains all the discrepancy, but it may
| explain a non trivial percentage.
| olyjohn wrote:
| Also your dog probably needs 1/10th the dose that an adult
| needs.
| mattkrause wrote:
| It's way more complicated than that: there are
| differences in metabolism as well as size. It varies from
| drug to drug too, but as a rule of thumb an average-sized
| dog needs about half of the average-sized human dose.
|
| Here's some FDA guidance on how to translate doses from
| animals to humans:
| https://www.fda.gov/media/72309/download
| philwelch wrote:
| Large dogs can be the same weight as small humans, so I'm
| not sure what accounts for 1/10th. Even medium-sized dogs
| like labs are about half the weight of a healthy,
| average-sized person.
| girvo wrote:
| Depends on the drug, but their metabolism isnt identical
| to ours, and humans can often require significantly
| higher doses compared to other animals when controlling
| for dosage per weight unit. But again it depends and
| there is no hard and fast rule as far as I'm aware.
| [deleted]
| giantg2 wrote:
| Just learn aseptic technique and suture yourself.
|
| I generally agree with your sentiment - regulation and
| insurance overhead are big costs. I do think some people
| should be able to do the basics at home if they wanted. Basic
| sutures are a pretty good example, you could even save that
| $150 that you mentioned.
| munk-a wrote:
| Specialization of labour is what's primarily responsible
| for the industrial revolution - while this is a hyperbolic
| comparison, is the only reasonable way to fix healthcare to
| throw away all specialization and go back to "do it at
| home"?
|
| The service needs to be available in some form at least for
| folks like me that have an essential tremour or otherwise
| are limited in fine motor skills.
| giantg2 wrote:
| I'm not saying do everything at home for everyone. But if
| some people did minor things (first aid type stuff) at
| home, that would free up the system for more important
| cases. Just think of all the people that fo to the doctor
| with a cold. A little education could go a long way.
| rubinelli wrote:
| People keep talking about patients going to the doctor
| for frivolous reasons, but what I see is that it is much
| more common for patients to ignore symptoms or take some
| over-the-counter medicine, and take too long to see a
| doctor.
| giantg2 wrote:
| True, it does go both ways. I would still say it comes
| down to a lack of education/knowledge either way.
| munk-a wrote:
| This, I think, is a natural result of the US insurance
| system. Being sick is quite expensive and not being sick
| but being proven to not be sick is also rather expensive
| so people will naturally tend to avoid formal treatment
| longer in the hope that everything just magically goes
| away.
|
| This also contributes to the amount of emergency room
| treatments that could have been trivially handled with
| earlier intervention. A boil that has gone septic is a
| very serious medical condition, but nearly all boils can
| be trivially resolved with a short regimen of
| antibiotics.
| perseusmandate wrote:
| This is insane. Mess up with this and you could end up with
| a serious infection
| anonAndOn wrote:
| If you really want to be frugal, why not go all John Rambo
| style and just cauterize the wound with some gunpowder?
| It's probably <$2 for enough to make sure you don't bleed
| out.
| giantg2 wrote:
| If you're cauterizing a wound, you wouldn't use
| gunpowder.
|
| A sterile suture kit is about $2 as well.
| dml2135 wrote:
| While I'm usually a DIY kinda guy, giving this advice on a
| large scale is a perfect recipe for disaster and really
| encapsulates the dark-ages dystopia that the current US
| medical system has become.
| chihuahua wrote:
| While looking for moldable plastic material ("Sugru" and
| similar) on Amazon, I was a bit taken aback by the
| reviews for one such substance. Multiple reviewers were
| stating that they were using this stuff to make their own
| dental crowns or some other DIY tooth repair because they
| couldn't afford a dentist. I found this quite shocking
| and I'm not sure if these people were serious.
|
| See the reviews on this product page:
| https://www.amazon.com/InstaMorph-Moldable-
| Plastic-6-oz/dp/B...
| giantg2 wrote:
| If someone self-studies basic things, it shouldn't be a
| big problem. Just look at first aid. There are many
| people who have no idea what to do for minor injuries
| because they never took the time to learn. Suturing is on
| the borderline of of falling into first aid. There are
| people today who learn the basics of it for emergencies
| or because they live in remote locations.
| dkjaudyeqooe wrote:
| No lidocaine?
| giantg2 wrote:
| Nah. It doesn't hurt too bad in most locations.
| tdfx wrote:
| Very similar in developing countries, as well. I've gotten
| stitches in Mexico and Colombia for less than $40 USD each
| time which healed comparably or better to the stitches I've
| paid >$500 for in the US. Consultation for an eye infection
| along with the antibiotics in Mexico was $23 USD.
| tcbawo wrote:
| Veterinary care has been increasing considerably more than
| core inflation (quick search turned up
| https://www.in2013dollars.com/Veterinarian-services/price-
| in...). I'm not sure how that compares to inflation in human
| healthcare.
| missedthecue wrote:
| I feel like the demand for veterinary services has gone up
| drastically. It shocks me how my millennial friends will
| spend $5000 without a second thought to keep a dog alive.
| Older generations often seem to put pets down in that
| situation.
| jsight wrote:
| Hmm, I'm not sure how I feel about that comparison. Most vets
| double up as pharmacies, restrict access to prescriptions,
| and sell at least some prescription drugs at prices that have
| been marked up by at least an order of magnitude by the
| manufacturer.
|
| Some of the bills that I've run into have still managed to
| approach the cost of routine visits at some specialists when
| billed to my HSA.
| majormajor wrote:
| Whatever markups are there are not linear, interestingly.
|
| I had to get an MRI from a vet hospital in the past. It was
| still over a thousand bucks, and in the range of quotes I'd
| gotten for human MRIs before.
|
| I wonder what similar stitches in an urgent care vs a primary
| care office vs an ER for a human would cost.
| rtkwe wrote:
| Part of that is probably the lower volume, so they have to
| amortize the costs over fewer procedures. Most pet injuries
| don't need an MRI or if the injury/illness is that bad the
| euthanasia or palliative only option is more considered.
| dodobirdlord wrote:
| Human MRIs are also pretty expensive, and human MRI
| machines are generally booked solid. MRI machines cost a
| lot and also cost a lot to operate.
| Gibbon1 wrote:
| Last time looked at the costs of imaging I got the
| impression that there are a monopoly and other captive
| market effects at work.
|
| You'll hear medical professionals claim imaging is
| expensive because the machines are expensive. Which just
| says to me that medical professionals aren't accountants.
|
| Consider a dental w-ray machine. $15-30k. That's the cost
| of Prius used as a Taxi. You don't pay a couple dollars
| for a 15 minute Taxi cab ride.
|
| An MRI machine, I forget how much those cost. But
| whatever, lets compare one with a modern passenger
| airliner. Cost is about equivalent on a 'per passenger'
| basis. And an airliner requires highly trained
| professionals to keep it running.
| [deleted]
| TameAntelope wrote:
| As the other reply mentioned, I wonder if this is just the
| human cost insanity infecting veterinary costs -- MRI tech
| could be used for humans, so the machine is absurdly
| expensive, and vets have to charge more to justify the cost
| of having a dedicated pet MRI.
| apendleton wrote:
| MRI machines also require superconducting magnets and
| liquid helium, high-amperage utility hookups, etc., so
| they might just be expensive regardless.
| [deleted]
| jjoonathan wrote:
| Pets tend to be smaller than humans, so manufacturers
| could ensure that pet MRIs don't drag down human MRI
| prices by making smaller MRI machines that only work for
| pets. They probably do.
| Kalium wrote:
| Tend to be, but it's not that rare for someone to have a
| dog that's a hundred pounds and five feet long. That's in
| the range for an adult human.
| jrowley wrote:
| My dad, a radiologist once had patient that was so large
| that they couldn't fit them on a conventional CT scanner.
| Luckily this was a university town, so they were able to
| access the vet's large animal scanner.
| Kalium wrote:
| Makes sense. Horses and cows get much larger than humans!
| jjoonathan wrote:
| I suppose that does make sense.
|
| Re: the large patient, yikes!
| mattkrause wrote:
| There are "small animal" MRI machines, which are mostly
| intended for research.
|
| The bores are _really_ small: 55mm or so is not uncommon,
| so a mouse would fit, but nothing much bigger. Other
| animals are usually scanned on a machine meant for humans
| (sometimes even the exact same ones, very early in the
| morning or late at night).
| celloductor wrote:
| It can be the opposite as well. I work in a vet clinic, but I
| also am in New Zealand- where there is free/subsidized public
| healthcare. Thus you get people who go to the vet expecting
| things to be free or cheap.
| mcguire wrote:
| It would work fairly well for minimal routine care and
| relatively minor trauma, as long as euthanasia is on the
| table for major long-term care, major trauma, and for those
| who cannot pay.
| ben_w wrote:
| Well that sounds like a Black Mirror episode -- "Crowdfund
| your schoolfriend to _not_ be euthanised"
| skeeter2020 wrote:
| In Canada (at least in my experience) it's the opposite. Vet
| clinics look a lot like US medical centres, including the
| state-of-the-art equipment and corresponding prices.
| Meanwhile the limited for-profit medical services are
| (mostly) affordable because they do general procedures with
| relatively low barriers for competitors. Generic drugs are
| dirt cheap when available; non-generics cost as much as the
| US. Dental care is all over the map from very affordable to
| ridiculously overpriced.
| mikepurvis wrote:
| Another Canadian here with a similar experience-- friends
| with dogs even pay for insurance because of the potential
| for frightfully expensive private surgeries down the road.
| Though I do wonder if there's a psychological thing there
| where dogs form stronger bonds and so people go to greater
| lengths for them, whereas other animals are easier to let
| go of if circumstances indicate that the time has come.
|
| And yes, dental care is all over the map-- it feels very
| much like what I imagine US healthcare to be, with co-pays
| and mystery charges and having to log into my insurance
| company's online portal to do stuff. The NDP made a bunch
| of noise in the last election about a national dental plan,
| though even that effort would only have covered family
| incomes up to CAD$90k [1], so it wasn't anything like the
| universal no-questions coverage we have for core
| healthcare.
|
| 1: https://www.cbc.ca/news/politics/ndp-dental-plan-fact-
| check-...
| adventured wrote:
| Vets vary widely in the US. Vet clinics are wildly
| expensive in many locations here, with veterinarians
| earning well-paid doctor wages and using modern vet
| equipment.
| vondur wrote:
| "Every time I go to the doctor I wish I could take myself to
| the vet instead." Kramer thought that in a Seinfeld episode;
| it was a great episode. Season 8 Episode 10.
| Spooky23 wrote:
| My PPO pays my GP about $75 for a regular visit. A zpack is
| $6.50 at my local grocery store, $15 at CVS.
|
| The vet always guilts me into some sort of stupid test.
| Usually I walk out of there $300 lighter.
| SilasX wrote:
| Not disagreeing, but one factor that complicates it is that
| they're allowed to take bigger risks with pets (both with
| regulations and potential civil liability) than with humans.
| nextos wrote:
| Lot's of private hospitals work like this in Europe and you can
| get really cheap care, plus the standard is quite high.
| codegeek wrote:
| Yea and for people who cannot even afford the lower costs out
| of pocket, subsidize the HSA card for them. This could work
| better than trying the big bang Single payer approach which btw
| I am for if that's the only option. I am desperate to try
| anything other than what we have right now in the US.
| disabled wrote:
| The company sounds predatory.
|
| A lot of countries have much better health systems, with people
| fully insured (this is really designed for people who are
| underinsured), with significantly better outcomes, than the US.
| The US lifespan is also significantly trailing compared to
| other developed countries, and we are not a "normal" country at
| all. It's going to be more appalling by 2040.
|
| Anyways, the place to study this data and information is
| https://www.HealthData.org
|
| You can spend hundreds of hours studying the data on that
| website, along with extreme specifics about medical care. I
| used it to inform my decision of where to live in Europe with
| rare immune mediated neurological diseases and type 1 diabetes.
| deftnerd wrote:
| The problem with drug prices isn't because of the drug
| manufacturers, it's with the middle-men and private insurance
| companies. At least, that's what the manufacturers are saying
|
| For instance, with the manufacturers of insulin, none of them are
| American and they offer to sell the insulin to everyone at the
| same price.
|
| The problem is that the large insurance companies use just three
| middle-men drug buyers called Pharmacy Benefits Managers (PBM)
| who DEMAND growing discounts every year from drug manufacturers,
| so the drug manufactures have to raise the prices to the US
| market every year to keep making a profit.
|
| Novo Nordisk is willing to sell insulin much cheaper, but the
| drug buyers demand about a 75% discount off of the wholesale cost
| or they'll make the product not covered by the insurance
| companies they represent. To compensate, they raise the wholesale
| price in the US so after the forced discounts, they still make
| the same amount of money.
|
| The people who suffer are the ones who don't have insurance.
|
| The solution, at least in the case of insulin, isn't cheaper
| prices from the manufacturer, it's for the US to pass a law that
| prevents insurance companies from dropping a product based on the
| refusal to discount the product if it's under a certain price-
| per-month.
|
| This article seems to cover the finger-pointing between the
| manufacturers and PBM's and insurane companies very well:
| https://www.healthline.com/diabetesmine/pharmacy-benefit-man...?
| hn2017 wrote:
| Very informative, thank you!
| temp667 wrote:
| A similar situation in local political health care plans. I did
| medical billing. Our local govt agency (this was for medicaid
| level care) required that they only pay 25% of the price of the
| service. When 90% of your patients are on medicaid, you raise
| the price so that 25% of price is now what price should be.
|
| But very funny when someone comes in and wants to pay cash.
| While that would be SO much easier than dealing with the agency
| - you got to charge them 4x so some politician and HN posters
| can go on about how much money the govt "saves".
|
| I just wish prices (cash paid) had to be posted publicly.
| Antipode wrote:
| How would forcing insurance companies to pay whatever drug
| companies ask not just raise insurance premiums? How do you
| differentiate dropping a drug because they're not willing to
| sell underpriced from dropping a drug because it's overpriced?
| pettusftw wrote:
| How does this square with the pharmaceutical manufacturers
| averaging a 26% profit margin, health insurers averaging 3%,
| and PBMs 2%?
|
| https://www.americanprogress.org/issues/healthcare/reports/2...
| zaroth wrote:
| Two different things entirely. The fake "Discount off MSRP"
| demanded by the PBM has nothing to do with the profit margin
| of the PBM, that would be based on markup they charge to
| their customers above the price they actually pay.
|
| But the regular uninsured consumer sure gets screwed.
|
| I think this is why there are now self-pay "codes" you can
| give a pharmacy to get a significant discount off retail
| price. Sometimes less than your co-pay, but of course then it
| doesn't count toward your deductible.
|
| I wish they would simply ban these pricing gimmicks as part
| of a price transparency law.
|
| There should be one price and one price only the manufacturer
| can charge in the USA per dose of an FDA approved medicine,
| with no ability to do price differentiation, period. No more
| negotiating, no more kickbacks. Insurance should have to show
| you the actual price they paid, and no other. And then you
| pay the patient responsibility of the bill based on your
| standard policy formula.
|
| The same pricing transparency should be applied to labs and
| procedures where it should be illegal for a given facility to
| charge two different patients two different prices for the
| same product or service.
| wefarrell wrote:
| PBMs make the bulk of their money via secretive rebates they
| receive from the drug manufacturers, which would not be
| included in that 2% figure.
|
| https://www.fiercehealthcare.com/payer/industry-voices-
| why-i...
| lotsofpulp wrote:
| All the biggest insurers in the US own their own PBM. The
| profit margins are shown in the 10-K filings.
|
| All the insurers have profit margins in the 3% to 5% range.
| Where is all this extra profit that the middlemen are
| making?
|
| Even if the PBM division is earning more profit than
| others, it's simply offsetting losses elsewhere.
| antonzabirko wrote:
| Yay! Glad he's doing something awesome for the world
| vedtopkar wrote:
| This is cool, but what they're claiming is puzzling. Perhaps
| someone here can clarify.
|
| Making generic drugs is non-trivial. The medicinal chemistry may
| be decades old, but you still need to do trials to demonstrate
| efficacy equivalency to the non-generic version. Are they really
| saying they'll do 100 of these trials by the end of the year?
|
| While this is cool, I'm thinking that this type of initiative
| should be done by the federal government. A generic drug "mint"
| if you will.
| CapriciousCptl wrote:
| You're right. If it was just one drug, I'd think they were
| manufacturing it themselves. Apparently, they plan to have a
| single factory in 2022. Most likely, significantly all of their
| formulary will be copacked.
| enchiridion wrote:
| Why does this generic have to be retested if it's the same as
| the existing generic? Can't they just do composition(?) testing
| to very it meets manufacturing standards?
| vedtopkar wrote:
| I don't have the best answer for you, but there are a number
| of considerations apart from the synthesis of the active
| molecule itself. Delivery vehicle can alter the physiological
| impact of the active substantially, and so the overall
| "package" needs to be tested even though the active is
| already approved.
|
| To my knowledge, generic trials aren't as involved as their
| non-generic counterparts for obvious reasons. But they are
| still non-trivial logistical undertakings.
| enchiridion wrote:
| That makes sense! This is where I feel like I have a
| disconnect between what I think applied science is and what
| it looks like in practice. It seems like they should know
| enough about the molecule, delivery vehicle, etc, to know
| that it will work the same. A medical "proof" if you will.
| I guess we're not quite there yet? Is there work pushing in
| this direction?
| HarryHirsch wrote:
| Mark Cuban is selling Albendazole, the well-known anthelmintic
| that has been at market since 1975.
|
| Current sticker price of Albenzazole in US: several hundred
| dollars. Cost in the developing world: a few pennies, according
| to Wikipedia.
|
| Is this a joke? Would the government rouse itself to negotiate
| prices with manufacturers, like it does in the developed world?
| We'll have to wait four more years, with Mr Joe "Nothing will
| fundamentally change" Biden.
| tomcam wrote:
| > Would the government rouse itself to negotiate prices with
| manufacturers, like it does in the developed world?
|
| Well... the previous occupant of the White House tried to do
| exactly that and was struck down by the courts.
|
| https://www.fiercepharma.com/pharma/fierce-pharma-politics-j...
| HarryHirsch wrote:
| The government isn't just the executive branch, there's also
| the legislative. The courts just interpret current laws. It's
| Congress and the Senate that need to act, but they won't.
|
| The complete disregard for public health actually makes me
| angry. Here's more: https://www.ft.com/content/f0080fe4-c3ad-
| 11e6-9bca-2b93a6856...
|
| A common anthelmintic is somewhere north of 400 dollars in US
| but in Britain it's something like 5 pounds. Profits for the
| well-connected, pinworm for those that can't afford it.
| Pharma markets are funny, of course there is a monopolist,
| given the size and entry requirements, consequently you need
| a monopoly buyer. Can the government please wake up and
| govern?
| codecamper wrote:
| It's lucky we have so many rich people to see us through. /s
| alberth wrote:
| Does this compete with Good RX?
| stakkur wrote:
| I want affordable drugs. But not sure I want to rely on the
| goodwill of a single private enterprise billionaire to get them.
| Invictus0 wrote:
| I don't understand the criticism here. A customer of this
| company is not reliant on Cuban at all--if Cuban's company
| raises prices, the customer can switch to another company or
| move to a country with cheaper drugs.
|
| I also don't get the "goodwill" argument. This is designed to
| be a profitable, sustainable business built on the classic
| mantra "your margin is my opportunity".
| mikesabbagh wrote:
| I dont know if manufacturing is the problem. Cant you import
| drugs from India or other country with cheap off label drugs? The
| system is built to prey on the sick, it has nothing to do with
| manufacturing. I like his idea, but doubt it will work
| kube-system wrote:
| IIRC, the drug has to be tested, and it has to be made in a
| facility that meets QA standards, etc.
| pottertheotter wrote:
| Intermountain Healthcare did something similar in 2018 and
| created Civica RX. See:
|
| https://www.fiercehealthcare.com/hospitals-health-systems/dr...
|
| https://civicarx.org/
| lcall wrote:
| ...and it's a nonprofit who has been delivering results.
|
| https://en.wikipedia.org/wiki/Civica_Rx
| StreamBright wrote:
| Can't wait until the government find ways to make this more
| expensive.
| DevX101 wrote:
| For some context on why this cost-plus is necessary and great,
| several generic manufacturers have been colluding and price-
| fixing. There are ongoing lawsuits from the Department of Justice
| and 46 states, and at least one pharma co pled guilty, and was
| fined $200 million.
|
| https://www.biospace.com/article/states-accuse-drugmakers-of...
| brianjunyinchan wrote:
| I heard once that cost-plus is related to the bloating of US
| defense budget and Boeing, Lockheed etc post WW2. Could someone
| familiar share some thoughts on what differences there are w
| this in pharma?
| metiscus wrote:
| What follows is a lengthy explanation of federal contract
| types, awards, and some light commentary on what you posited.
|
| Federal contracts are usually, but not always issued under
| the rules of the FAR. Within the FAR there are several types
| of contracts supported including among others Firm Fixed
| Price (FFP), Cost Plus Incentive, Cost Plus Fixed Fee (CPFF),
| and Time and Materials (T&M). The other way that contracts
| can be issued is via an OTA or (Other Transactional
| Authority) and I won't really discuss those contracts as
| apart from semantics they usually obey the FAR rules as
| pertains to this discussion.
|
| In a Firm Fixed Price contract, the contractor is considered
| to be holding all of the risk. The contractor is responsible
| for fulfilling the terms of the contract and must meet those
| requirements even if in doing so they lose money. When
| bidding a FFP contract, you develop an estimate of the work
| required, determine what the risks are and assign mitigation
| costs and likelihoods, determine what your desired profit
| margin is, and offer the government you best and lowest
| price. Usually these contracts are competitively awarded
| although that is not always the case (a). The "Firm" in FFP
| does not mean that the price can not increase. If the
| government changes what is desired or incurs costs on the
| contractor that were not specified in the original contract,
| the contractor can request equitable adjustment. FFP
| contracts are most commonly used when producing goods with
| known qualities that already exist or require slight
| modification of existing goods in the market.
|
| Cost Plus contracts (Cost Plus Incentive or CPFF) entail cost
| sharing between the government and the contractor. In a Cost
| based contract, the government is considered to hold some of
| the risk. These contracts are generally used as development
| contracts when a new or significant evolution of an existing
| system is required. The government is responsible for
| reimbursing the contractor their costs incurred during
| development. These costs include both direct and indirect
| costs. Direct costs are what you would usually assume is
| meant by cost, e.g. the actual cost of the people and
| equipment used in pursuit of a single contract objective.
| Indirect costs are costs that are incurred in support of
| multiple contract objectives e.g. lighting and power for a
| building, HR and finance people. Significant portions of the
| FAR are involved in cost pooling and I won't get into it much
| more here. Because the government is responsible for
| reimbursing costs the contractor is not under as great of an
| obligation to minimize those costs. Effectively, there is a
| very low risk of losing money on a Cost contract because your
| actual costs are reimbursed. In cost contracts, the
| government can use the allocation of profit (fee) as an
| incentive to have the contractor meet time or total cost
| goals but is still responsible for reimbursing all reasonable
| costs. Most major new systems development happens under the
| guise of Cost contracts although some have been developed
| using FFP or OTA mechanisms. If the contractor fails to
| perform, the government will usually still reimburse the
| costs up to the point where work was stopped. It requires a
| lengthy legal battle to recover costs in a breach of contract
| suit.
|
| Time and Material contracts are the most disfavored by the
| government. They have no performance objective apart from
| labor. The contractor is required to supply labor in a
| desired quantity and place but no actual performance (e.g.
| those 10 guys actually finish digging the ditch) is embedded.
| These contracts are fairly rare but are used occasionally.
|
| To address the asked question regarding budgets post WW2. The
| Department of Defense publishes a daily list of every
| contract awarded above a certain value (I think 2 million)
| here https://www.defense.gov/Newsroom/Contracts/. Contract
| modifications (and new delivery orders under an existing IDIQ
| contract vehicle) Most of the largest of these contracts seem
| to be awarded via the sole-source justification. It is hard
| to put the blame squarely on cost contracts. There are cases,
| say developing a novel weapon system, where the government
| can not fully articulate it's needs at the starting point.
| Over-specification of requirements will cause the bidders on
| an FFP to give higher prices because they must be able to
| account for every requirement in their bids. When developing
| a brand new system, cost contracts can be effective although
| I do agree that the mechanism is over applied. I also believe
| that the sole source justification to avoid competition
| significantly undermines the cost control measures of both
| FFP and Cost contracts.
|
| Now to briefly discuss what I believe is happening with this
| company. They appear to be functioning under rules most
| similar to CPFF, so I will analyze along those lines. Do they
| have a contractual goal? Yes, they have to produce the drugs
| needed based on transactions and contracts they accept. Do
| they have a reason to minimize their costs? Yes, their entire
| existence is predicated on the price differential between
| their products and those of other members of the market. If
| they allow their costs to balloon beyond a certain point, it
| will diminish their marketability. It doesn't mean that the
| stated margin will be over raw material and production costs
| as marketing is also included. I would like to see a public
| commitment to price transparency including all major line
| items in the cost similar to what is done with not for profit
| organizations (they have alluded to doing so with the
| statement "We will let everyone know what it costs to
| manufacture, distribute, and market our drugs to
| pharmacies.")
|
| Source: In a previous life I was heavily involved in the
| bidding and management of DoD contracts.
|
| Also see sections 13-15 of the FAR https://www.acquisition.go
| v/sites/default/files/current/far/...
| icelancer wrote:
| It is definitely related to the bloating of the military
| budget but Cuban's pharma idea is different than the "cost-
| plus" of the military. It's an unfortunate name collision
| that seems like an unforced error by Cuban since people like
| you (and many others) make the same association, even though
| the name is quite descriptive and accurate when used
| correctly.
| ProAm wrote:
| > cost-plus is necessary
|
| I wish cost plus worked but its just as easily gamed. Ive seen
| many industries that contracted cost-plus and the costs
| magically went up a lot. If there is money to be made the
| system can always be gamed/contorted/scammed, etc...
| adrr wrote:
| Yup, cost is easily gamed. We see this in movie industry all
| the time with Hollywood accounting.
|
| https://en.m.wikipedia.org/wiki/Hollywood_accounting
| neltnerb wrote:
| While true, wouldn't the point of such a rule be to provide a
| framework for fighting against exactly that? Without the rule
| they don't even need to try to manipulate the books, so
| there's even less to find as evidence that might be used to
| either improve the rule or enforce it differently.
|
| Of course, market pressure is much simpler if one
| manufacturer just decides to do it according to a consistent
| and justifiable method and stick with it.
| mikemoka wrote:
| OT but always related to a more universal access to medicines:
|
| an opensource covid-19 vaccine is now in progress (supported by
| Harvard University and the Government of India)
|
| https://news.ycombinator.com/item?id=25915546
| brundolf wrote:
| > and was fined $200 million
|
| To which their response was probably, "pleasure doing business
| with you"
| snoshy wrote:
| Quite damning, and that's only the most blatant infractions,
| because it's such a high bar to prove collusion and price
| fixing. The most disingenuous tactics to prevent competition
| that are harder to prove in court continue to cause harm to the
| average consumer nevertheless.
| mikesabbagh wrote:
| It is nice to sue all of those companies for colluding. But
| can't you just import those drugs for less from India or other
| cheap drug producing country? I am not sure the problem lies in
| manufacturing. The system is rigged between the insurance
| companies and the medical system and the middle men!! Offering
| a cheaper cost, means more money for the middle men probably
| parsimo2010 wrote:
| It is not guaranteed that a regular American can get drugs
| from another country. In the past few years, you have been
| able to legally bring a few months of drugs back from Canada
| if you visited in person. But if you order drugs online, the
| drugs are at risk of being seized. Sometimes they get through
| fine, sometimes they are seized for things as silly as
| improper labeling (or the drug being straight up illegal to
| import). You can still save money on many drugs if you can
| accept the risk or you can order far enough in advance to be
| able to reorder if one of your packages gets seized. Ordering
| drugs from another country is a slightly better plan to save
| money than making friends with a veterinarian. But most
| people should just go to the local pharmacy and work with
| their insurance provider or state aid programs if they can't
| afford their prescriptions.
|
| Ironically, the Trump administration recently allowed states
| to import drugs from other countries to enable them to offer
| lower cost drugs through state run programs, but was still
| seizing the same products if they were ordered by
| individuals. While I can't really complain about an
| initiative to lower drug costs, the mental gymnastics needed
| to come up with this plan are pretty incredible. "We don't
| think price controls are compatible with a capitalist
| society, so we won't implement them. But we campaigned on
| lower drug prices (since that will increase our appeal among
| the elderly), so we have to do something. Let's import drugs
| from countries that do have price controls. But people can't
| order the drugs themselves, we have to protect them from
| themselves. We have to order the drugs and repackage them
| with new labels, because we need American instructions and
| American warning labels, not the instructions and warnings
| that the Canadian government is fine with."
|
| Right now, it's better/easier for most people to get their
| drugs from a local pharmacist with our current system. If
| Mark Cuban is willing to throw a lot of capital and break up
| the price collusion between established drug companies, then
| I suppose it's a step in the right direction. We should be
| happy to accept lower prices and get to work on fixing other
| important problems with our healthcare system.
| Shivetya wrote:
| Well its not all about insurance companies but also where
| government drops the ball. Example, doctors will prescribe
| Eliquis because if you have insurance and not medicare its
| downright cheap but if you are on medicare your cost is four
| hundred plus.
|
| Even insulin prices get distorted because you are limited to
| which types you can buy in you are under medicare.
|
| maybe with their majority the Democrats can finally tell
| their union buddies to bugger off and pass a single payer or
| tax high value insurance policies; one major reason ACA was
| so limited as many of those policies which were going to be
| taxed were all on the side of public employee union benefits.
| metiscus wrote:
| I've heard this mentioned a lot and I have always wanted to
| ask: How does tasking high value insurance policies address
| this issue? Does the government take the additional tax
| money and use it to subsidize the drug cost? What would
| prevent the drug company from raising the price to capture
| the subsidy?
| metiscus wrote:
| I have imported Colchicine from overseas pharmacies with
| regularity and never had an issue with it being seized. The
| prices I get are significantly cheaper because of the patent
| issue on that 2000 year old drug. For uncontrolled legacy
| drugs affected by patent issues this is probably viable for
| the tech savvy (and for those who can afford to wait quite a
| while). It would be nice if it could be done on an industrial
| scale instead of as an individual.
| sct202 wrote:
| Those drugs need to be tested and certified by the FDA before
| they're legal in the US. For a lot of lower volume drugs, the
| cost and time to go do that ishigh enough (vs the potential
| gain) that companies don't bother.
| [deleted]
| aj7 wrote:
| Amazon, which should have led this effort long ago, seems to have
| a half-hearted approach. Almost like they want your data as much
| as your business.
| warent wrote:
| Can we just appreciate the level of moral depravity needed to
| price fix medication? In my opinion something this repugnant and
| egregious needs personal executive accountability. I'm willing to
| wager that many human lives have been altered for the worse
| because of this, and there's nobody taking personal
| accountability.
|
| Imagine if Epstein wasn't personally charged, instead just his
| business was fined. To me, that's actually the level of crime
| we're approaching here. If you think this is tenuous, at least
| consider the fact that it is proven that poverty is correlated
| with human trafficking (due to desperation and vulnerability) and
| illegally high medical bills force people into poverty.
| iancmceachern wrote:
| I agree - let's.
|
| Someone should make a list of the companies and executives
| implicated in generic drug price fixing. Shame is a very
| powerful tool...
| merpnderp wrote:
| Maybe people would have less problems with "corporations are
| just groups of people working together" if the people of a
| corporation were ever held accountable.
| usrusr wrote:
| Sell your shares before it's getting caught and you won't
| even be affected by the heaviest fines. Absence of
| information asymmetry is a fiction.
| kortilla wrote:
| > least consider the fact that it is proven that poverty is
| correlated with human trafficking (due to desperation and
| vulnerability) and illegally high medical bills force people
| into poverty.
|
| This is pretty tenuous and would implicate a lot of other
| behaviors. You know what else causes poverty?
|
| - the ability to hire based on skill and lay off people when
| you don't need them
|
| - alcohol
|
| - charging for housing
|
| - charging for food
|
| - charging for utilities
|
| - property taxes
|
| - charging for transportation
|
| If, "does something that could cause poverty" is the bar, then
| a huge chunk of market exchange of goods and services needs to
| stop.
| f-securus wrote:
| You're comparing the basics of a capitalism based society to
| a large company actively breaking the law (price fixing) on
| products that affect people's lives and health directly.
| tehwebguy wrote:
| Price doesn't even have to be fixed for it to be depraved!
|
| Good time to remind everyone that Shkreli is in prison for
| financial crimes largely unrelated to the pharma side of his
| businesses, the rest of the pharma industry continued doing the
| same things as him as usual.
| [deleted]
| fastball wrote:
| That was kinda the point, no? Shkreli was made into a
| bogeyman, but he was just doing in the open what every other
| pharma was smart enough to keep secret (pricing things higher
| than necessary). He also did it an excessively bombastic way.
|
| Don't hate the player, hate the game.
|
| Fix the root causes, not the symptoms.
| cforrester wrote:
| "Don't hate the player" is the kind of thing you say about
| people scraping by at a day job, who hold no real power
| over the business practices. He wouldn't have gone hungry
| if he'd behaved acceptably, so he had a choice free of
| influence by the immediate need to survive. I wouldn't
| characterize Shkreli's moral failure as a symptom of "the
| game," but rather one of several root causes of its
| perpetuation to begin with. In my view, fixing the problem
| includes denouncing powerful people who fail to abide by
| the ethical standards that we want them to hold.
| ericb wrote:
| I find fault in your reasoning. Let me explain.
|
| This is a game theory problem with perverse incentives
| where regulation and law enforcement are needed. If CEO A
| (in this case Martin Shkreli) were to take the "moral
| high ground" and behave acceptably, the board of
| directors would look at similar companies performing 10x
| better, _fire him_ and replace him with someone less
| moral.
|
| If the board were to take the "moral high ground" the
| shareholders would value the company many times lower,
| and they'd be bought out for pennies by an acquirer
| willing to take the low road because that would be a
| super profitable move.
|
| If moral shareholders refuse to buy the shares of low-
| road companies, the value of the shares fall, but the
| profits don't, and suddenly being "amoral" is super
| profitable for stock investors, and there are always
| some, and they will be richer than moral shareholders. As
| amoral investors amass riches, they will deploy greater
| amounts of capital using amoral valuations, which will
| then dominate.
|
| So the whole system is broken, and personal ethics does
| nothing to fix the game. In a nutshell, this is also why
| libertarianism is broken.
| cforrester wrote:
| I see what you're saying from a business perspective.
| From a social perspective though, I don't consider that a
| reason to withhold my ire towards people like Shkreli.
| Choosing to be a bad person because someone else might be
| worse is still a choice to be a bad person, so while your
| pragmatic reasoning might work well when it comes time to
| determine a legal response, I don't feel that encouraging
| people not to hate Shkreli is helpful in encouraging good
| social norms.
| ericb wrote:
| Your ire is not necessarily directed at a personal
| preference to be a bad person, though. Attributing it to
| him "wanting to be evil" is easy, especially because he
| is abrasive.
|
| Due to the incentives above, it might be said we are
| annoyed by their lack of willingness to be fired in a
| futile effort to obstruct a system which will carry on
| regardless--we are annoyed they won't do something
| pointless.
|
| I have a feeling most people would have trouble taking
| food out of their family's mouth and literally becoming
| unemployed in order to tilt at a windmill where your
| effort cannot win. That's a pretty impossible standard to
| expect. If Shkreli found morals and got fired, Shkreli2
| would take over.
|
| So instead, I say, the problem is the system. Pretending
| it is about moral failing _enables the system_ to go on
| by wasting time blaming moral failings instead of fixing
| it. The system produces bad behavior. We can tut tut each
| individual person it produces, or we can change the
| incentives and fix the system.
| cforrester wrote:
| I really appreciate your reply, you've definitely got the
| gears turning in my head.
|
| Something to clarify, I'm not really trying to say that
| people like that want to be evil. People like Shkreli
| make bad choices not because they like to be bad, but
| because they're indifferent to the indirect consequences
| of their choices. I'm extremely skeptical that someone in
| a position like Shkreli was would be in any serious risk
| of losing access to essentials like food and shelter if
| they were to behave more ethically, so I think it's
| important to set the standard that choosing a job like
| that when you have alternatives is wrong.
|
| All that being said, I do agree with you that the primary
| problem by far is the exploitative structure that enables
| these people to exist in these positions, in the first
| place. If someone's analysis of the situation ended at
| Shkreli, I'd encourage them to think deeper. However, I
| do strongly believe that we don't have to choose between
| one or the other -- encouraging others to look down on
| those who choose to be a part of this system can have a
| significant influence by discouraging others from
| entering it, themselves. The more voices we have saying
| "this is not something to aspire to," the more pressure
| we can build to effect meaningful systemic change.
| fastball wrote:
| Morality is not objective.
|
| If you want people to stop doing something, make it
| illegal.
|
| If you can't muster the political will to do so, clearly
| not enough people agree with your view of morality
| (assuming a functional democracy).
| scarby2 wrote:
| This is something people often forget, nothing is
| objectively good or bad as they are social/individual
| constructs. Even things like killing or theft could be
| seen as good looking through the right lens.
| cforrester wrote:
| I made no statement about "objective" morality. I
| explained my own morals, and why I'm comfortable
| encouraging people to blame the wealthy for the harms
| they perpetuate. Could you please elaborate on how you
| think this reply is relevant to that?
|
| As slow as it seems to be, my perception is that societal
| attitudes towards wealth have been shifting over the past
| few decades. I'm hopeful that one day, the tolerance for
| their misdeeds continue to dropbenough to inspire
| progressively more social and legal change, as you
| suggested.
| fastball wrote:
| Innocent until proven guilty, etc. etc.
|
| Public witch hunts are called "witch hunts" for a reason,
| and it's not a pretty one. It's also known as "mob
| justice", which despite the name is generally considered
| to be not justice at all.
| cforrester wrote:
| It seems poorly considered to characterize social
| pressure as a witch hunt. It is acceptable to encourage
| others to share your moral convictions, there is a vast
| gulf between that and a pitchfork mob.
| fastball wrote:
| You would characterize the response to Shkreli as more
| "societal pressure" than "pitchfork mob"?
|
| That... doesn't seem true to reality. Maybe I'm
| remembering it incorrectly.
| freeone3000 wrote:
| The root cause, in that, medicine is a for-profit endeavor
| and people are not only profiting, but seeking to maximize
| their profits on other people's basic needs?
| sbarzowski wrote:
| You could say the same about bakeries ("seeking to
| maximize their profits on other people's basic needs").
|
| IMO the problem is more about (very) imperfect
| competition. Also medicine is very special in many ways
| (desperate buyers, doctors making decisions for them,
| moral and emotional weight, etc.), so it's hard to have
| incentives aligned.
| freeone3000 wrote:
| The entire food pipeline is heavily subsidized by the
| government, from advantageous loans to crop price
| insurance to direct cash subsidies to a sales tax
| exemption, to SNAP to people who can't afford food. I
| agree wholeheartedly with the bakery comment, that they
| try to maximize profits, but, bread is less than a dollar
| a loaf and significant expense and effort is taken to
| ensure everyone is fed. There seems to be no will to do
| the same for healthcare.
| fastball wrote:
| Pretty much. Other things that don't help (somewhat US
| specific):
|
| 1. Layer of indirection created by the entire insurance
| system, which at this point is clearly not a good model
| for healthcare. _Everyone_ needs /should have some amount
| of healthcare, so a system built entirely around the idea
| that only a minority of people should need to take
| advantage of the system is silly.
|
| 2. The half-assed government intervention of
| Medicare/Medicaid/ACA/etc - worst of both worlds in that
| when a government just injects shittons of money into the
| private sector (without very strong controls on price and
| behavior), what you end up with is ballooning costs...
| and that's about it. See also the govt. guaranteeing
| student loans for another example of the same. Or the
| Military Industrial Complex. And so on.
| chongli wrote:
| It's a bit more complicated than that. Health care costs
| have skyrocketed in the US. One of the big contributors
| to that has been the explosion in testing, both routine
| and diagnostic. These large costs aren't always shared to
| the same degree with other countries that have socialized
| medicine.
|
| One example is with MRI scans. MRI machines, and the
| technicians and doctors who work with them, are insanely
| expensive. The US is, of course, not the only country
| with MRI machines. However, in countries with socialized
| medicine there may be a much longer wait for people to
| get an MRI scan for a non-critical issue. What about in
| the US? If you've got the money, you can get one right
| away. As a Canadian, I've seen tons of advertisements
| over the years targeting Canadians for MRIs as a cross-
| border service.
|
| So the question is: is getting an MRI now instead of
| waiting 6 months a basic need? Private MRI clinics are
| definitely profiting from it. It definitely seems
| frustrating for people on the waiting list who can't
| afford to cross the border and pay out of pocket.
| However, it doesn't seem nearly as bad as a company
| price-gouging people on life-saving insulin, for example.
| Animats wrote:
| Too much of that is markup. The cost of MRI machines is
| down, and the cost of CT scanners is way down. But
| charges for those services have not dropped to match.
| [deleted]
| jonny_eh wrote:
| There are many root causes, one of them being execs with
| decision making abilities, like Shkreli, making greedy
| decisions at the cost of people's health. It's ok to hold
| them accountable.
| bradlys wrote:
| This is really presuming people need to feel any kind of morals
| around healthcare or its costs to begin with. In America -
| barely enough people give a shit. If they did - we'd have
| universal healthcare. But because capitalism and strong
| individualistic spirit of Americans, there is no reason to
| care. Stonks must go up.
|
| If you think anyone should feel any kind of moral obligation to
| not do this kind of stuff - you're just out of touch with
| American society. It's a survival of the strongest capitalistic
| machine and you get away with as much as you can.
| dang wrote:
| Please don't take HN threads into ideological flamewar or
| nationalistic flamewar (this is a bit of both). Those paths
| just lead to internet hell, and we're clinging to little
| clumps of grass and the occasional rock trying to stave off
| the downward slide into that abyss.
|
| https://news.ycombinator.com/newsguidelines.html
|
| https://hn.algolia.com/?query=stave%20by:dang&dateRange=all&.
| ..
| jjeaff wrote:
| Part of it may be lack of compassion but that it certainly
| not all. Part of it is that Americans have been led to
| believe that government can do nothing right and that the
| free market is all that is needed to solve the problem. Which
| is incorrect, but here we are.
| ksdale wrote:
| Certainly government is competent in many places, but the
| performance of the American national and many state
| governments throughout the pandemic hasn't exactly been
| confidence inspiring. I don't think Americans who believe
| that their government isn't capable of many simple tasks
| are delusional.
| jjeaff wrote:
| They aren't delusional about the government. But there is
| some delusion that private business or the "free market"
| can necessarily handle all these same problems entirely
| better.
| at-fates-hands wrote:
| > Can we just appreciate the level of moral depravity needed to
| price fix medication?
|
| First thing I thought of:
|
| Valeant Pharmaceuticals
| adolph wrote:
| In evolution adaptation prevails over customary behaviors
| thought of as morals. The question is why have the generic
| makers continued to cooperate instead of defect? How is the
| cartel protected?
|
| In this thought I am reminded of the Econtalk podcast's
| discussion of Martin Shkreli in the interview about the High
| Cost of Cancer Drugs with Vincent Rajkumar.
|
| http://www.econtalk.org/vincent-rajkumar-on-the-high-price-o...
|
| http://www.econtalk.org/extra/the-high-cost-of-cancer/
| ficklepickle wrote:
| One tactic pharma companies use is playing games so generic
| makers can't get samples of the medication. These samples are
| required for making a generic version.
|
| I read this somewhere but don't have a link.
| dang wrote:
| We detached this subthread from
| https://news.ycombinator.com/item?id=25932516.
| ksec wrote:
| Excuses my ignorance.
|
| Does _Tablet_ , mean _one_ , single pill? ( Just making sure )
|
| And they sell Albendazole for $225 Per tablet in US?
|
| And quote
|
| > _our cost to make and distribute the drug is approximately
| $13.00 per tablet_
|
| It _cost_ $13 to make one Tablet, or one pill?
|
| And this is _low_ _cost_?
|
| Anyone from Europe or UK living in US could sort of explain a
| little bit here. I know US medication are expensive, but this
| is... something else. I cant comprehend what I am reading here.
| HarryHirsch wrote:
| It costs a few pennies to manufacture. The rest is profits for
| Marc Cuban.
| annoyingnoob wrote:
| The company claims a fixed 15% markup. Something doesn't add
| up...
| banana_giraffe wrote:
| I'm reminded of the time I was in the EU, in an area tourism
| isn't common. Due to a lack of planning on multiple levels, I
| had to stay an extra two weeks. I went to get a refill for a
| prescription I need.
|
| The pharmacist was clearly unconformable with the discussion
| that needed to happen. They informed me there would be a charge
| for the medicine. After some back and forth because neither of
| us was fluent in the other's language, it turned out they were
| asking me to pay the cost of the drug, an amount of money less
| than my normal copay, and something like 5% of what my
| insurance claimed the drug normally cost.
|
| The pharmacist was most confused why I was happy to pay. I
| don't think believed me when I tried to explain how much it
| normally cost me.
| nostromo wrote:
| In the US I've had this happen for a generic.
|
| The pharmacist told me that they were having a hard time
| confirming my insurance. After a ridiculously long delay, I
| asked how much the drug was to pay for out of pocket... It
| was $12. My copay was $10 anyway. So both the pharmacist and
| I wasted a lot of time and hassle trying to save me $2.
| biggestdummy wrote:
| Yes, a tablet is a single pill. Sometimes you'll split the
| pill, so a tablet might be 2 doses. But 1 pill.
|
| Note that retail pricing is an unreliable indication of actual
| cost to consumers. They jack it up so that they various plans
| can claim huge discount policies. Some of these plans are free,
| so there's very few people who are paying this "retail" price.
|
| The pill makers get paid by the consumers and, in most cases,
| by the plan-owners. And such agreements are made exceedingly
| complicated. IMO, only to make them more opaque and more
| difficult to regulate.
|
| Unfortunately, such a system is highly regressive as the
| richest tend to have the best plans, the poorest tend to have a
| meager plan, and the transient have no plan other than showing
| up at a hospital.
| cavisne wrote:
| The US system works like this
|
| * hospitals run as non profits, so they dont pay federal
| taxes
|
| * they still pay local taxes, so they need to generate a
| large loss to offset these taxes
|
| * insurance companies negotiate huge "discounts" on list
| prices, and then go back to their customers (large
| corporations) and boast about these discounts, meanwhile the
| hospital gets its tax writeoff
|
| This entire system is rigged to also grow the number of
| hospitals/ the overall size of healthcare in america.
|
| Pharma companies play this game too, and anyone who doesnt
| have insurance can quietly get a "coupon" from them to bring
| down the cash price to the same as insurance.
|
| No politician will close hospitals, so at this stage any move
| to "single payer" will just move the boasting role to the
| government.
| freeone3000 wrote:
| Prices can go as low as $300 for two tablets, if you have a
| GoodRx annual subscription. I think the $13 is actually a
| wholesale substitution price, as there are lower prices
| available for this drug for the same dosage through veterinary
| channels.
| Griffinsauce wrote:
| I'm also confused by this.
|
| ~This medicine is for sale here in the Netherlands, over the
| counter, for $3.3 dollars. No that period is not a mistake.~
|
| ~That's for a pack of 6 tablets. How the heck do they end up at
| $13 cost?~
|
| Edit: Google autocorrected to a similar drug. This specific
| drug is actually $4.50 per tablet here and prescription only.
| That's still a massive difference.
|
| Relevant sidenote: it's fully covered as well so I wouldn't
| even get a bill.
| xmichael0 wrote:
| yup, confirmed, bought a 6 packet about a year ago for about
| $5 in costa rica.
| ksec wrote:
| >This specific drug is actually $4.50 per tablet here and
| prescription only.
|
| Yes. It is like someone told you a _can_ _Coca Cola_ _Coke_
| in US is $220, and their latest innovation is to give you the
| same for $20.
|
| All while you are picking one up at a convenience Store in EU
| for $1 and you can get a pack of 8 in a large supermarket for
| $3.
|
| As you walk out of the convenience Store while drinking your
| coke, you are left wondering what the hell is going on with
| people and the world across the pond.
| marcell wrote:
| Isn't the whole issue with drugs the fact that they have a huge
| upfront cost in terms of research, and then they are basically
| free to produce?
|
| If you just do cost plus, then the research can't get
| (retroactively) funded.
|
| This is similar to software, where the marginal cost is zero.
| apendleton wrote:
| Sure, that's what patents are for: to guarantee exclusivity to
| whoever bore the R&D cost so they can charge a lot for long
| enough to recoup their investment. This service is selling
| generics, though, so they'll be off-patent at this point.
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