[HN Gopher] Biden launches action on "Big Tech, Big Pharma, and ...
___________________________________________________________________
Biden launches action on "Big Tech, Big Pharma, and Big Ag" - can
it be real?
Author : horseradish
Score : 444 points
Date : 2021-07-11 18:22 UTC (1 days ago)
(HTM) web link (mattstoller.substack.com)
(TXT) w3m dump (mattstoller.substack.com)
| josh_today wrote:
| Executive orders were a constant theme of the previous
| administration. It was the first time that I've really heard
| about them consistently as a presidential technique and similarly
| as much in the media.
|
| The lower executive order numbers from the previous 2
| administrations before made me think that these were tools used
| for media attention when I kept hearing about them.
|
| Now the current administration is using them (for causes that I
| hope will benefit) and I'm wondering are these going to hold
| weight or is this another media ploy?
| tyre wrote:
| Really? They were a huge topic of conversation when W was
| president and then again for obama.
| josh_today wrote:
| Looking at EO's issued per year to account for 8 vs 4 year
| terms, Trump's administration is the highest
|
| https://www.federalregister.gov/presidential-
| documents/execu...
| jimbob45 wrote:
| Obama dwarfed Trump's number of EOs. Bush Jr. and Clinton were
| extremely high as well. This seems to be a response to
| congressional stonewalling (with varying outcomes).
|
| https://www.presidency.ucsb.edu/statistics/data/executive-or...
| GeneralMayhem wrote:
| >Obama dwarfed Trump's number of EOs.
|
| By your own source, this is so misleading as to be blatantly
| false. Trump issued 220 EOs in 4 years. Obama issued 276 in 8
| years. I wouldn't call that "dwarfing" even looking at the
| raw numbers, and as a rate, Trump was the highest in history,
| nearly twice Obama.
|
| Of course, that's only relevant if you believe a priori that
| (a) EOs are a bad thing, and (b) that all EOs are created
| equal. Neither of those is true, obviously.
| dudul wrote:
| > Trump was the highest in history
|
| Looks like Trump's average is lower than a lot of previous
| presidents'.
| ta2155 wrote:
| I hate anecdotal evidence, but jimbon45 is a perfect example
| showing that inbreeding leads to lower IQ.
| wffurr wrote:
| From your link:
|
| Barack Obama (D) Total 276 Avg/year 35
|
| Donald J. Trump (R) Total 220 Avg/year 55
|
| Hardly "dwarfed". If anything Trump issued 60% more executive
| orders than Obama on an annual basis over his one term.
| apercu wrote:
| So why do we a accept that VC's invest in software tech but we
| don't expect them to do the same in biotech (obviously some do I
| am generalizing) but instead expect Americans (mostly, I live in
| Canada though) to subsidize Big Pharma through taxes and, in many
| many many cases outrageous costs for decades old drugs?
| jfengel wrote:
| Apparently, because Americans tolerate it. A bunch of factors
| lead to higher drug prices here and an almost complete
| inability to agree on a way to fix it.
|
| A lot of it comes down to tribalism: "I'd rather pay higher
| drug prices than lower drug prices your way."
| phendrenad2 wrote:
| If the whole country gets a California-style ban on noncompetes,
| will Silicon Valley start to lose it's hold on tech?
| xenihn wrote:
| imo: yes, absolutely
| YinglingLight wrote:
| Biden vs. the Deep State, oh my (At)Lanta
| deregulateMed wrote:
| Big pharma is significantly less of a problem than the physician
| and hospital cartels.
|
| I have no idea why these groups have survived scrutiny for their
| literal multi-hundred million dollar lobbying/bribery of
| politicians.
|
| My closest guess is that we all know "My" physician or a well
| paid nurse that benefits from the bribery.
| fallingknife wrote:
| I have a medical condition with no cure, yet I still have to
| pay a doctor every 6 months to keep my prescription with no
| changes. Total racket.
| dd36 wrote:
| My contact lens prescription is similar.
| ashtonkem wrote:
| Contact lens prescriptions change though, and bad contacts
| can do subtle damage to the wearer's eye. I have permanent
| scarring in my eyes because I over-wore my 2 week contacts,
| my fault I know, but without an eye doctor appointment I
| would have done even more damage.
| qq4 wrote:
| Wow, no kidding? I used to wear mine for months, maybe
| even close to a year. Anytime I had my eyes examined I
| asked how my eyes looked due to the constant wear and the
| optometrist told me they looked great but frowned at me
| doing so. I figured the disposable contact thing was
| mostly a racket, but I had some doubts. I wear glasses
| now.
| ashtonkem wrote:
| These were the 2 week variety that were on sale between
| 2008 and 2012, after which I changed to 1 month lenses.
| It's possible that newer lenses are better when worn
| outside the recommended range.
| dd36 wrote:
| I've had the same script for 20 years.
|
| I should add that the same thing applies to glasses.
| SignalNotSecure wrote:
| Have you considered stocking up at the Mexican border? So
| many things are available over the counter in Mexico its
| awesome.
| fallingknife wrote:
| Is that legal?
| ashtonkem wrote:
| ... kind of. There are certain personal use exceptions,
| but definitely something you want to speak with a lawyer
| about.
| mixmastamyk wrote:
| Don't need to speak to a lawyer. Millions of folks do
| this every year to save money. Doesn't mean they'll have
| unique drugs in stock however.
| pkaye wrote:
| You can personally import up to 3 months worth of
| medications if you have doctors prescription.
|
| https://www.fda.gov/industry/import-basics/personal-
| importat...
| nostromo wrote:
| You can buy prescription drugs online from India without
| a prescription for super cheap. They arrive in your mail.
|
| This is probably illegal, but not enforced.
|
| I'm insured so it'd actually be cheaper for me personally
| to go in to the doctor and ask for a prescription. But I
| got tired of taking time out of my day for this - these
| are just beta blockers for fuck's sake.
| foolinaround wrote:
| the good pharmacies in India have started asking for
| prescriptions.. so, one is left to go the sketchy/tinier
| ones, where quality can be expected to be lower as well.
| iso1210 wrote:
| > You can buy prescription drugs online from India
| without a prescription for super cheap. They arrive in
| your mail.
|
| And what guarantee do you have of their contents?
| KirillPanov wrote:
| Gas chromatography-mass spectrometry (GC/MS [1]) by an
| independent third-party lab [2]. For unscheduled
| substances they'll even email you the mass plot.
|
| Nearly all of our (US) pharmaceuticals already come from
| India anyways. Manufactured there from Chinese bulk
| precursors.
|
| I trust a third-party GC/MS plot way more than any brand
| slapped on a package.
|
| [1] https://en.m.wikipedia.org/wiki/Gas_chromatography-
| mass_spec...
|
| [2] https://energycontrol-international.org/
| koheripbal wrote:
| I'm confused. Are you saying that every time you receive
| a package of medications from India, you send a sample
| off to for spectrometry?
|
| That seems extremely arduous.
|
| The point is that you don't trust this specific supply
| chain/manufacturer, which is part of the approval
| process.
|
| "India/China" is not some monolithic entity that is
| either good or bad, there are some manufacturers that you
| can trust, and some you cannot.
|
| Quality control in drug manufacturing is what ensures
| that every single pill has the correct dose, and not some
| random batch accidentally having 100x the active drug you
| need - or 0.01%.
| SignalNotSecure wrote:
| Been there done that but from a different continent
| flying in. Nobody cares in general unless you're
| importing scheduled substances. You need to do your
| research but it's a way to beat the racket.
|
| Drive up to the border and walk across on a day trip to
| the pharmacy. I believe the first few miles into the
| country are a NAFTA special economic zone with very
| relaxed paperwork requirements.
| throwaway4220 wrote:
| Sorry to say but you'll have to find a better doctor if all
| you're getting is refills without being seen. It's a sad
| state of medicine but primary care is being rapidly replaced
| by NP/PAs who do a good job but are very regimented in their
| thinking.
| koheripbal wrote:
| Having a doctor verify that you're not having any issues with
| your prescription medication is pretty normal.
|
| Maybe you can find someone that'll do telehealth.
| Spivak wrote:
| When a prescription becomes your baseline you should stop
| having to mother may I except for changes to it.
| AnIdiotOnTheNet wrote:
| I take a medication for a rest-of-your-life condition I've
| had since childhood. The simple blood test used to
| calibrate dosing is about $10 in saner countries. In order
| to get the blood drawn and tested it costs me >$100 out of
| pocket and I also have to see a doctor for a half hour
| ($250) before they'll update my prescription, regardless of
| if there is any change. This is with insurance, and must
| happen every 2 years or so. Medication cost is $10/mo or
| so.
|
| This is completely ridiculous, and yet my situation is
| downright reasonable compared to what a lot of people have
| to deal with.
| perryizgr8 wrote:
| I shouldn't have to take permission from anyone to be able
| to buy the medicines I need. This is a cartel-type
| situation where your pharmacist won't sell you meds unless
| you pay a doctor.
| fallingknife wrote:
| If I'm having issues I'll call the doctor. I don't need a
| babysitter.
| asdff wrote:
| Some people do though. Imagine someone who just lets this
| stuff lapse and they are still being regularly prescribed
| stuff that should have been cancelled 8 years ago.
| fny wrote:
| I'm in the same position my dr is kind enough to let me
| email in for refills.
| R0b0t1 wrote:
| People already die quietly alone all the time. How far do
| we need to go to have everyone have a babysitter,
| especially at their own expense?
| benrbray wrote:
| I think the idea is that the doctor is actively
| intervening in your medical treatment, so they have a
| responsibility to make sure they're getting it right.
| This person is free to stop taking their meds and die
| alone whenever they like.
|
| Visits to the doctor should be cheaper and more
| efficient, but people shouldn't stop going to the doctor.
| TheSpiceIsLife wrote:
| Doctors are the third leading cause of death, after only
| heart disease and cancer.
|
| By many measure: if you see a doctor, cross the street.
| cycomanic wrote:
| I find it fascinating that the HN crowd complains about
| doctors being too expensive. I mean what is the
| comparative value that software developers add to society
| compared to doctors that justify their salaries (which
| are often on the same level or higher)?
| R0b0t1 wrote:
| Most people in IT related fields aren't at doctor level
| pay.
|
| I suspect the sentiment is from commonly interacting with
| absolutely useless doctors. There are a lot of them.
| throwaway4220 wrote:
| I've seen 200k+ salaries as standard here. Look up
| salaries of primary care physicians. Then add on the
| 50k+/year MD debt, and any undergrad debt.
| kelnos wrote:
| False equivalence. Software developers "charge" companies
| (that are very much able to pay) for their services.
| Doctors charge everyone, from the rich to the poor, for
| their services. The poor (and even not-so-poor) get
| screwed by this, more often than not. I haven't heard of
| a bunch of software developers bankrupting people in
| exchange for their health...
| jjk166 wrote:
| Just like how we require people to check in with their
| accountant every 6 months to make sure their finances are
| doing well, check in with a teacher and take a test every
| year to make sure our education is still up to date, and
| we have the cops investigate us biannually to catch any
| signs of legal trouble early.
|
| We don't and we shouldn't require everyone to be nannied
| just because some people might benefit - they can seek
| those services on their own if they wish. Requiring
| someone else's permission to maintain your personal
| health would be considered just as absurd if it weren't
| the status quo.
| throwaway4220 wrote:
| Please, sign a notarized document saying you, your family
| or the DA won't sue because you were (a) lost to follow-
| up, (b) developed a medical condition as you grew older,
| (c) got a side effect because of long term medical use.
| Then, don't waste ER time if you have a stroke or heart
| attack because government can't tell me not to eat trans
| fats.
|
| And, by the way, if you have an accountant, you should
| check in more than once a year. It's not fair to them to
| dump stuff only during tax time. Also, I do have to do
| regular tests to make sure my medical knowledge is up to
| date.
| jjk166 wrote:
| If we could sue hospitals into paying out because we
| developed medical conditions as we aged, there wouldn't
| be any hospitals.
|
| You have to qualify your statement with "if you have an
| accountant" because I don't have to have an accountant,
| it is an optional service I can seek if I want. In my
| case, I do my own taxes, and if I don't get as big a tax
| return as I could've back, it hurts nobody but me.
|
| The requirement for you to do regular tasks for the
| _privilege_ of practicing your profession is forced upon
| you because the the consequences of any lapse in your
| knowledge are borne by others, not you. I too have
| professional requirements, but I can choose a different
| profession and be absolved of all of them.
|
| A chronic condition is not a choice. Dealing with your
| pain is not a privilege, it is a right. The idea that
| people should be forced to forego their right based on
| the idea that some others will benefit (a dubious claim
| for which I can find no evidence supporting) is absurd.
| wellbehaved wrote:
| So? Some people need exercise, does that mean the
| government should force everyone to exercise?
| alphaoverlord wrote:
| There are definitely doctors who will space it out if
| you're stable or do a phone refill
| TearsInTheRain wrote:
| I think some tech health platforms like Capsule will even
| have a pharmacist call your doctor for a refill for you.
| pradn wrote:
| I personally prefer a proactive doctor. Life gets busy
| and I don't always find time to get checkups and such. A
| small nudge from the doctor's office to get a checkup
| pays dividends. People with chronic conditions do need
| monitoring. It shouldn't be absurdly expensive.
| diogenescynic wrote:
| Sutter Health is one of those hospital cartels. They've made it
| so that giving birth in Sacramento is now one of the most
| expensive cities in America. It's all a racket.
|
| Source: https://www.kqed.org/stateofhealth/205822/northern-
| californi...
| throwawayswede wrote:
| They're part of the same mafia, Pharmaceutical Research &
| Manufacturers of America spent $8664000 in 2021 only on
| lobbying.
|
| https://www.opensecrets.org/federal-lobbying/top-spenders
| deregulateMed wrote:
| So much evil in 1 list.
| the-dude wrote:
| That looks like a big number, but it is $8.6M ? Is that a
| lot?
| 8note wrote:
| Its certainly more than I paid in taxes
| dillondoyle wrote:
| No it's not. Lobbying in that reported sense is also a very
| small slice of persuading politicians and regulators and
| bureaucrats.
|
| PHRMA plays _big_ in politics, 501c4 space etc.
|
| They also are known for the revolving door which is hard to
| quantify, but surely it makes a big difference on regs.
| Look at the Purdue, they got the regulator responsible for
| approving the label to actually sit in a hotel room and
| help write their oxy label together...
|
| Here's an article shows "in the US from 1999 to 2018, found
| that the pharmaceutical and health product industry spent
| $4.7 billion, an average of $233 million per year, on
| lobbying the US federal government; $414 million on
| contributions to presidential and congressional electoral
| candidates, national party committees, and outside spending
| groups; and $877 million on contributions to state
| candidates and committees."
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054854/
| perryizgr8 wrote:
| It was purposefully written to mislead, hence the lack of
| commas or the M suffix. So yeah, it is definitely not a
| lot. For comparison, Facebook alone spent $17M on lobbying
| in 2019.
| gregsadetsky wrote:
| I double checked -- another source[0] mentions amounts that
| are a bit higher:
|
| "The Chamber [of Commerce] spent nearly $82 million on
| lobbying in 2020"
|
| But generally in line with the list posted by the GP:
|
| "Facebook and Amazon were the only companies in the top 10
| spending list and spent nearly $19.7 million and more than
| $18.7 million on lobbying in 2020, respectively"
|
| I too, am surprised as how little this is for these
| gigantic companies ($20M for FB? 1/1000th of their
| quarterly revenue?) and more generally, how little money
| this is... in comparison with the entire US government
| budget?
|
| Sorry, this is probably all obvious? Just a bit.. sad?
|
| [0] https://thehill.com/business-a-lobbying/536082-us-
| chamber-nu...
| missedthecue wrote:
| How much do you think lobbyists should earn instead?
| ncphil wrote:
| Really. Who doesn't get how cheap our politicians come?
| Old joke about Spiro Agnew (Nixon's VP who had to resign
| because he took around $30,000 in bribes while Governor
| of Maryland years before): When Armstrong set foot on the
| Moon he would have been set for life if his first words
| had just been "Coca Cola!" Of course if it had been Agnew
| he probably would have said something like, "Fred's
| Tailor Shop, Baltimore!" Point is, US politicians really
| do come cheap. Political favors are a wholesale business,
| they make out on volume.
| bpodgursky wrote:
| Do you think this is a big number? $8mm across a huge
| industry is barely enough to get a legal team out of bed.
| This is really pocket change.
| renewiltord wrote:
| What about $8664000.00? I made it slightly longer. I can
| add some more zeroes.
| Andy_G11 wrote:
| I would think tech is now at the point to undermine micro-
| exploiters who extract punitive payments from people who feel
| that there is no viable alternative provider (e.g. a specialist
| who requires completely unnecessary monthly visits, gives a
| cursory glance, keeps treatment unchanged and charges hundreds
| in the process).
|
| What do you think? - Is this something tech CAN do today, with
| an open source application and publicly available data?
| mpmpmpmp wrote:
| "Well paid nurse"... Now thats a funny one.
| pydry wrote:
| Capital loves to blame labor, capital owns the media and
| we're inclined to believe their stories.
| giantg2 wrote:
| I don't see most physicians being an issue. Many of them are
| fed up with the insurance, pharma, and regulations. Most are
| forced to work for large providers instead of being independent
| just due to the overhead of dealing with digital record
| systems, legal, insurance billing, etc.
| deregulateMed wrote:
| When they spent $400,000,000 on favorable monopolistic
| legislation it helps to aim the spotlight on anyone else.
| giantg2 wrote:
| What organization and legislation was that?
| deregulateMed wrote:
| American Medical Association, aka physicians
| giantg2 wrote:
| And what was the legislation? How was it monopolistic in
| favor of physicians?
|
| The AMA does not really represent physicians. Less than
| 1/4 of doctors belong to the AMA. Many of them do not
| feel the AMA represents them. The AMA also accepts
| substantial donations from other sources, including
| corporate donors and foundations.
|
| https://www.physiciansweekly.com/is-the-ama-really-the-
| voice...
| renewiltord wrote:
| The lobbying to:
|
| A. Limit medical care to being provided by these people
|
| B. Limit number of residencies
| giantg2 wrote:
| "Limit medical care to being provided by these people"
|
| Who else would provide this care? This licensure is
| similar to other professions, like lawyers, and really
| doesn't take very much lobbying since the majority of the
| public want oversight of these sorts of professionals.
|
| Residencies simply haven't kept pace with medical student
| numbers. They have gone up though. The main question is
| "where does the funding come from for residency
| training?". Medicare provides most of that funding, but
| that is a constrained resource. I find it hard to believe
| that the AMA lobbied for this provision.
| CryptoPunk wrote:
| >>the majority of the public want oversight of these
| sorts of professionals.
|
| The majority of the public wants whatever they are
| lobbied to believe they need. The majority also supports
| the War on Drugs and criminalizing the sex trade, and for
| the same reason: fear tactics used to convince them that
| the mere option of doing an ostensibly harmful activity,
| is to the detriment of themselves and society at large,
| even though the activity would harm no one but the party
| engaged in it.
|
| Plenty of medical procedures _could_ be done by nurses
| and other non-physician medical professionals, yet this
| entire option is barred to the public. There should be a
| free market, with consenting adults free to choose for
| themselves who to hire to perform services for them.
| giantg2 wrote:
| "The majority of the public wants whatever they are
| lobbied to believe they need."
|
| Ok, can you show me the lobbying that swayed their
| opinion on this topic then? If they are just gullible
| like you claim, then do you think these incapable people
| will have the capacity to choose well after removing
| license requirements for providers?
|
| "Plenty of medical procedures could be done by nurses and
| other non-physician medical professionals, yet this
| entire option is barred to the public."
|
| This is not banned at all. Physician assistants and nurse
| practitioners exist and can perform some medical
| procedures/tasks. Even pharmacists. Granted I've
| personally had some negative experiences with some PAs
| and try to choose actually physicians for most things.
|
| "There should be a free market, with consenting adults
| free to choose for themselves who to hire to perform
| services for them."
|
| That would be nice in many ways, but I can see a downside
| too. Once someone is found to be incompetent, fraudulent,
| and harmful, how would they be barred from the profession
| to prevent the issue from happening to others? Usually
| things like insurance and bonding are requirements to
| cover any issues for people in this and other licensed
| fields.
| renewiltord wrote:
| You find it hard to believe a thing that the AMA made an
| overt aim of. Fascinating. Well, I'm out of this
| conversation.
| giantg2 wrote:
| Then show me a source.
| long_time_gone wrote:
| I showed you a source earlier in the thread and you
| didn't respond. It is the website of AMA, where they
| celebrate their success in lobbying against any bill that
| would allow other professionals expanded capabilities.
|
| "For over 30 years, the AMA's state and federal advocacy
| efforts have safeguarded the practice of medicine by
| opposing nurse practitioner (NP) and other nonphysician
| professional attempts to inappropriately expand their
| scope of practice."
|
| Here it is again: https://www.ama-assn.org/practice-
| management/scope-practice/...
| giantg2 wrote:
| Ah, that prior comment is dead.
|
| So this is a source just saying they oppose inappropriate
| expansion. That they want PAs and NPs to practice as part
| of a team that includes a physician. I don't really see
| this as an issue. I also see PAs, NPs, and nurses as
| falling into the medical profession and subject to
| licensing, etc. So I see them as being on the inside of
| the system, not one of the "other people".
|
| What I was specifically looking for was a source about
| the second part of this thread - the restriction of
| residency by the AMA.
| long_time_gone wrote:
| ==Who else would provide this care?==
|
| Nurse practitioners.
|
| AMA has a whole campaign on their website celebrating it:
| https://www.ama-assn.org/practice-management/scope-
| practice/...
| R0b0t1 wrote:
| When asked on the street people always say "yes I want
| healthcare to be safe" but if you actually see who is
| lobbying for certification requirements it is always
| incumbents.
|
| If people wanted and needed licensure for health, hair
| cutting, whatever, you'd expect that they would be at the
| state house. But they're not.
| geogra4 wrote:
| I hate this line that's repeated all the time because its
| simply wrong. Osteopathy has its own residencies and the
| DO is legally equivalent to an MD
| nradov wrote:
| You have that backwards. The AMA is actively lobbying to
| _increase_ the number of residencies.
|
| https://www.ama-assn.org/press-center/press-releases/ama-
| fun...
| renewiltord wrote:
| Haha this is exactly why point source information is so
| damaging. The AMA spent years keeping this tightened down
| by spending money and then they started issuing press
| releases asking for the opposite (but this time,
| conspicuously leaving off the money spending).
|
| This naivete is typical of HN. You'd read a press release
| from ISIS and conclude they've built a paradise. You need
| more knowledge than you can Google up. You need to be
| aware of what they did and do over the last 30 years.
|
| But it's okay, you can believe falsehoods. No skin off my
| back.
| giantg2 wrote:
| Sources?
| throwaway4220 wrote:
| I say this as an MD: AMA can suck it. I don't pay them
| and I don't think they represent me or the profession.
| fma wrote:
| I've heard they're fed up w/ insurance, billing...but the few
| times I've asked "hey what if I pay cash, not through
| insurance, is it cheaper?" (I knew I wont meet deductible...)
|
| It was actually more expensive. I've stopped asking and feel
| it's a urban myth.
| eganp wrote:
| The list price will nearly always be a multiple of your
| cost with insurance. The issue here is that insurers have
| provisions in their network contracts that prevent
| providers from publically advertising lower prices than
| what's charged to the insurer, which mandates discounting.
| In many other industries, these most favored nation
| arrangements are considered anti-competitive and, thus,
| illegal.
|
| Large hospital systems totally separate business and care,
| so it can be difficult to negotiate a discount. Smaller and
| independent providers are often more accommodating.
| However, you need to _ask_ for a discount, you can 't
| simply offer to pay cash (i.e. "If I pay cash, can I get
| 40% off"). The providers can counter your offer, but can't
| discount you off the bat or else they invite legal action
| from insurers.
| fma wrote:
| Good to know! Dang 40% is a lot but I believe it hah!
| whearyou wrote:
| Seen the same
| spaetzleesser wrote:
| I think pretty much all players in the US health system are a
| problem. They all benefit to some degree from this corruption.
| If I had to pick the worst I would name hospitals. But
| everybody else profits handsomely too.
| mpmpmpmp wrote:
| Everyone except for the people who are actually providing
| direct patient care like the nurses and the technicians.
| dv_dt wrote:
| Are you kidding?
|
| https://www.rand.org/news/press/2021/01/28.html
|
| > Prescription Drug Prices in the United States Are 2.56 Times
| Those in Other Countries
| xyzzyz wrote:
| So are the nannies and the landscapers. Are these also a
| racket?
| pkphilip wrote:
| It is just amazing to watch people in the US defend the
| price gouging in healthcare in the US.
|
| The medicine prices are MUCH lower in other parts of the
| world - including in places where the cost of living is
| much higher than in the US such as Norway and Switzerland.
|
| The cost of Insulin is 8x higher in the US than in
| comparable countries around the world.
|
| https://pharmanewsintel.com/news/insulin-prices-8x-higher-
| in...
| stjohnswarts wrote:
| We're talking western countries, not places where you would
| expect it to be less like Mexico, India, Brazil. Basic
| domestic services are going to be about the same across
| various western countries. Drugs and health services in
| general are 2-4x what other western countries pay AT A
| MINIMUM. Most have free health care.
| hnbad wrote:
| Maybe I'm weird but I don't have a nanny or landscaper and
| neither does anyone I know or any of their relatives that
| I'm aware of. But I pay a flat EUR5 for most prescription
| drugs (the rest are free) and my public health insurance
| costs are capped at about EUR700 per month (and I get to
| keep it for free if I become unemployed).
| jacobolus wrote:
| Services from nannies and landscapers are nontradeable
| goods. See https://en.wikipedia.org/wiki/Tradability
| mlindner wrote:
| Drugs are almost non-tradable goods because of all the
| regulations and differences in drug standards between
| countries.
| naasking wrote:
| So they're _artificially_ non-tradeable, not _innately_
| non-tradeable like the other examples.
| throwaway743 wrote:
| Are you that out of touch to not realize those services are
| luxuries and not life saving health treatments?
| wormslayer666 wrote:
| Direct link to the executive order (it's in the article, but
| might as well put here):
|
| https://www.whitehouse.gov/briefing-room/presidential-action...
| ece wrote:
| Here are the remarks he delivered before signing the order:
| https://www.youtube.com/watch?v=6wTlzbKpidU
| sb057 wrote:
| I found this fact sheet more useful than the order itself or
| articles about it:
|
| https://www.whitehouse.gov/briefing-room/statements-releases...
|
| In the Order, the President:
|
| * Encourages the FTC to ban or limit non-compete agreements.
|
| * Encourages the FTC to ban unnecessary occupational licensing
| restrictions that impede economic mobility.
|
| * Encourages the FTC and DOJ to strengthen antitrust guidance
| to prevent employers from collaborating to suppress wages or
| reduce benefits by sharing wage and benefit information with
| one another.
|
| * Directs the Food and Drug Administration to work with states
| and tribes to safely import prescription drugs from Canada,
| pursuant to the Medicare Modernization Act of 2003.
|
| * Directs the Health and Human Services Administration (HHS) to
| increase support for generic and biosimilar drugs, which
| provide low-cost options for patients.
|
| * Directs HHS to issue a comprehensive plan within 45 days to
| combat high prescription drug prices and price gouging.
|
| * Encourages the FTC to ban "pay for delay" and similar
| agreements by rule.
|
| * Directs HHS to consider issuing proposed rules within 120
| days for allowing hearing aids to be sold over the counter.
|
| * Underscores that hospital mergers can be harmful to patients
| and encourages the Justice Department and FTC to review and
| revise their merger guidelines to ensure patients are not
| harmed by such mergers.
|
| * Directs HHS to support existing hospital price transparency
| rules and to finish implementing bipartisan federal legislation
| to address surprise hospital billing.
|
| * Directs HHS to standardize plan options in the National
| Health Insurance Marketplace so people can comparison shop more
| easily.
|
| * Directs the DOT to consider issuing clear rules requiring the
| refund of fees when baggage is delayed or when service isn't
| actually provided--like when the plane's WiFi or in-flight
| entertainment system is broken.
|
| * Directs the DOT to consider issuing rules that require
| baggage, change, and cancellation fees to be clearly disclosed
| to the customer.
|
| * Encourages the Surface Transportation Board to require
| railroad track owners to provide rights of way to passenger
| rail and to strengthen their obligations to treat other freight
| companies fairly.
|
| * Encourages the Federal Maritime Commission to ensure vigorous
| enforcement against shippers charging American exporters
| exorbitant charges.
|
| * Directs USDA to consider issuing new rules under the Packers
| and Stockyards Act making it easier for farmers to bring and
| win claims, stopping chicken processors from exploiting and
| underpaying chicken farmers, and adopting anti-retaliation
| protections for farmers who speak out about bad practices.
|
| * Directs USDA to consider issuing new rules defining when meat
| can bear "Product of USA" labels, so that consumers have
| accurate, transparent labels that enable them to choose
| products made here.
|
| * Directs USDA to develop a plan to increase opportunities for
| farmers to access markets and receive a fair return, including
| supporting alternative food distribution systems like farmers
| markets and developing standards and labels so that consumers
| can choose to buy products that treat farmers fairly.
|
| * Encourages the FTC to limit powerful equipment manufacturers
| from restricting people's ability to use independent repair
| shops or do DIY repairs--such as when tractor companies block
| farmers from repairing their own tractors.
|
| * Encourages the FTC to prevent ISPs from making deals with
| landlords that limit tenants' choices.
|
| * Encourages the FTC to revive the "Broadband Nutrition Label"
| and require providers to report prices and subscription rates
| to the FCC.
|
| * Encourages the FTC to limit excessive early termination fees.
|
| * Encourages the FTC to restore Net Neutrality rules undone by
| the prior administration.
|
| * Announces an Administration policy of greater scrutiny of
| mergers, especially by dominant internet platforms, with
| particular attention to the acquisition of nascent competitors,
| serial mergers, the accumulation of data, competition by "free"
| products, and the effect on user privacy.
|
| * Encourages the FTC to establish rules on surveillance and the
| accumulation of data.
|
| * Encourages the FTC to establish rules barring unfair methods
| of competition on internet marketplaces.
|
| * Encourages the FTC to issue rules against anticompetitive
| restrictions on using independent repair shops or doing DIY
| repairs of your own devices and equipment.
|
| * Encourages DOJ and the agencies responsible for banking (the
| Federal Reserve, the Federal Deposit Insurance Corporation, and
| the Office of the Comptroller of the Currency) to update
| guidelines on banking mergers to provide more robust scrutiny
| of mergers.
|
| * Encourages the Consumer Financial Protection Bureau (CFPB) to
| issue rules allowing customers to download their banking data
| and take it with them.
| mlindner wrote:
| > * Encourages the FTC to restore Net Neutrality rules undone
| by the prior administration.
|
| This is the worst thing in the list. The politicians still
| don't seem to understand how the internet works and how
| different service types cost differently and have different
| effects on the network. A new Netflix-like service is a very
| different thing than a new social-network-like service.
| 542354234235 wrote:
| You don't seem to understand. If I have 100 mbps down
| speed, my ISP should have no say in how I use it. If it is
| Netflix of Facebook, it doesn't matter. It's my 100 mbps.
| That is like saying that my electric provider should have a
| say on what I use my electricity for. That if I use a GE
| brand washer it costs less per kwh than a Samsung, or that
| electricity for a computer is more expensive per kwh than
| electricity for a refrigerator. No. They give me the
| electricity, I decide how to use it. They give me the
| internet bandwidth, I decide how to use it.
| fomine3 wrote:
| It seems to contain many HN topics
| mlindner wrote:
| All the good ideas are under the "Encourages" type of thing.
| How does this actually do anything?
| voidfunc wrote:
| It doesn't and it can all be undone by the next president
| unless Congress acts and makes some of these laws (they
| wont).
| TheHypnotist wrote:
| It's an executive order, there is only so much the
| President can mandate outside of the organizations he
| controls. Look at most of Trump's presidency, feckless EO's
| that in the end were reversed anyway or were blocked by a
| court. My guess is that the goal here is to have the
| regulating authorities be "encouraged" to put the screws to
| some of these big-X companies. In other words, have them
| set their policies based on the general direction given by
| the President. I think that's probably normal operation.
| dfxm12 wrote:
| A more cynical view is that the goal is to make it _seem_
| like the administration is trying to follow through with
| some campaign promises while not doing much of legwork to
| actually do it.
|
| It takes very little to issue an EO. It takes more to
| work with colleagues in congress to actually implement
| some of the stuff laid out here. Biden's predecessor
| really laid the framework here and turned it into an
| artform - issue a worthless EO, get a great photo op and
| some feel good stories in the media, then everyone
| forgets why they can't figure out hospital prices in a
| few weeks again.
|
| For some more context, it is within Biden's power to
| appoint an assistant attorney general for antitrust, but
| as of last week, he still hasn't [0]. I'm not sure how
| serious this rhetoric around strengthening antitrust
| guidance really is, in light of that.
|
| I'd love to be proven wrong, but I think this
| administration has earned my skepticism. Time will tell.
|
| 0 - https://www.politico.com/newsletters/morning-
| tech/2021/07/07...
| Fredej wrote:
| My understanding is that the "encourages" part relates to
| agencies that are independent and are therefore not
| directly under the control of the president. He therefore
| cannot directly order them to do anything.
|
| However, from what I could gather from news interviews,
| this has not been published without the collaboration from
| those agencies, who in general are on board with the
| changes.
| ascagnel_ wrote:
| Correct, the President is actually fairly limited in how
| much control they exert over regulatory agencies -- such
| agencies are created by Congress, commissioners are
| nominated by the President and confirmed by Congress, and
| commissioners report back to Congress.
| ohashi wrote:
| I hope they take a look at VeriSign's monopoly power over
| .com/.net. We saw how dangerously close .ORG got to being turned
| into a rent seeking tax on non profits. .COM/.NET are a licensed
| rent seeking monopoly with increasing prices and decreasing costs
| to serve and no contract competition. Those contracts need to be
| made competitive, there are plenty of registry providers who can
| do it cheaper and VeriSign as a company exists because of those
| no-compete contracts.
| stjohnswarts wrote:
| Why don't they allow insurance companies to operate in all states
| so people can shop around more? Currently they have regional
| rackets.
| dudul wrote:
| This would be a good move, but don't most people get insurance
| through their employer? To me that would really be the thing to
| break asap. Can people really shop around? It's either getting
| an expensive insurance on your own or a much cheaper one via
| employment but extremely limited choice.
|
| The main barrier to getting rid of insurance via employment
| seems to be the very high cost of premiums. Employers are able
| to get much better deal for their employees than a single
| individual would be able to negotiate with a carrier. Maybe we
| would need an electroshock including banning employment based
| insurance and allowing carriers to operate anywhere. This would
| immediately kickoff the competition between carriers.
| cryptica wrote:
| I'm generally skeptical about all such news but a few things make
| me cautiously optimistic:
|
| - Lina Khan: I had heard about her a long time ago before she
| even got into politics. She is known for her academic work on
| antitrust and big tech so she definitely understands how
| monopolies work and how they are unfair.
|
| - Biden saying "Capitalism without Competition is Exploitation";
| simply the acknowledgment by a sitting president that what we
| have today doesn't look like capitalism anymore is in itself a
| huge achievement and lays the groundwork for real improvement.
| Now, everyone knows that something needs to be done and everyone
| knows that everyone else knows that!
|
| - Biden is getting old and probably doesn't care about a second
| term in office. It's possible that he decided to make as many
| powerful enemies as necessary to secure a great legacy for
| himself.
|
| That said, I think that people have such low trust in government
| and media nowadays that I don't expect anyone from the right to
| warm to Biden until we see actual results.
| giantg2 wrote:
| Sort of good, but we'll see how it plays out without other
| policies supporting it. Frankly, many consolidations are not
| malicious but necessary for survival. Economies of scale and
| verticle integration are required to complete with foreign
| companies with lower costs. Look at domestic steel production. No
| way the market can support numerous domestic options that can
| compete with the low cost of foreign imports.
|
| Then there's vertical integration. I don't know if this will
| effect vertical integration. If it does, I wonder how domestic
| companies will compete without it.
|
| As a beekeeper, it's vastly cheaper foreign imports (some of it
| fake) that are more damaging than large domestic producers
| (although there's a healthy variety). The low prices have been
| forcing consolidation, or for some people to switch from
| producing domestically to packing imported honey. It's tough to
| market local honey for even $12/lb when walmart sells honey for
| less than $5/lb.
| tayo42 wrote:
| What are some uses for honey by the pound? Off topic but
| curious, I only ever put it in tea rarely or simmiliarly rarely
| use it as a sugar alternative when cooking.
| giantg2 wrote:
| Price per pound is mostly just a standardized measure used to
| compare prices regardless of container size. The most common
| container size is a one pound jar, but 8oz jars are fairly
| common too. You would buy a jar and use it in tea, other
| drinks, on waffles, etc. You can buy larger quantities to do
| things like baking, making candy, making mead, etc.
| tayo42 wrote:
| I see, yeah I only ever get a the little honey bear ones
| lol, but the big jars at farmers markets look interesting
| but they're always huge and I almost never use honey
| giantg2 wrote:
| As long as they're airtight they stay good for years.
| Some local producers sell small jars too. I mostly sell
| pint jars (1.4 lbs). I will probably switch to standard 1
| lb jars soon.
| dehrmann wrote:
| > they stay good for years
|
| The lifespan is indefinite. If crystals start to form,
| you can heat the honey and it'll return to it's normal(?)
| state.
| giantg2 wrote:
| As long as it's air tight, sort of. They found honey that
| is safe to eat from the pyramids. I wouldn't recommend
| eating it as it probably doesn't taste good at all. The
| flavor will decrease after a while, but that generally
| takes years. Eventually it will taste bad, but that
| should take decades.
| NotSwift wrote:
| Honey stays good for an amazing time. It is due to two
| things. It is mainly sugar, which means that it has a
| high osmotic pressure which kills other organisms like
| bacteria and fungi. The bees make their own antibiotics
| to fight of infections and some of these are present in
| their honey as well.
| [deleted]
| golemiprague wrote:
| With peanut butter instead of jam, in soy honey marinade, on
| green apples, in yogurt or ice cream. There are many nice
| combinations where honey works.
| 1vuio0pswjnm7 wrote:
| "The most interesting pushback was by Google, Facebook, and
| Amazon, as well as Chinese giants DJI and Alibaba. All of these
| firms speak though the trade association Netchoice, which has
| them as key members. Netchoice didn't bother to try and convince
| Democrats. Instead, the big tech trade association used the order
| to lobby Republicans, making the case that Biden's actions
| against monopoly are opening the door to a larger more powerful
| government. Here's the key part of Netchoice's statement:
|
| "Sen. Lee and Rep. Jordan's warnings were right - when
| Republicans back progressive antitrust proposals because of
| concerns about tech, they open the door to progressive antitrust
| activism... By backing hard-left proposals, like nominating Lina
| Khan to the FTC and Rep. Cicilline's antitrust legislation, anti-
| tech Republicans bear responsibility for the damage that will
| result from importing a European-style antitrust framework to all
| sections of the American economy."
|
| Netchoice represents mostly American giants, but also Chinese
| dominant players. So it's interesting is to see the Chinese tech
| giants through their lobbying proxy coming out against Biden's
| anti-monopoly actions, and praising conservative Republicans Jim
| Jordan and Mike Lee in the process. It's clear that both big
| tech, and China's own tech giants, do not want to see anti-
| monopolists like Lina Khan succeed. But conservative Trump-
| supportive ranchers, by contrast, do."
|
| It is almost as if these "tech" companies are trying to sow
| divisiveness. Divide and conquer.
| walkedaway wrote:
| > It is almost as if these "tech" companies are trying to sow
| divisiveness
|
| It's worked in their business model for over a decade. Their
| actions over the last five years have shown they have built up
| operations as core competencies in helping divide our country.
| Although one could argue they are just delivering what their
| customers want (otherwise customers would leave said
| platforms).
| Sophistifunk wrote:
| "Big Pharma" in the eyes of the public is two related but
| separate issues; 1) the weird employment-insurance-hospital loop
| that has developed in the US, and the terrible second-order-
| consequences of all the open-high/settle-low insurer<->carer
| system it led to, and 2) the medicine advertisements, and all the
| terrible consequences thereof.
|
| The second one seems like a much easier thing to get rid of using
| hard government power, and should be the low-hanging fruit.
|
| The first will require a decade of masterful leadership, co-
| operation from competing interests, and delicate undoing over
| time that I don't think any country in the west has right now.
| ampdepolymerase wrote:
| And the Congress mandated monopoly on residency positions and
| building new hospitals. We would have a lot more advances in
| medical science if MD positions were not gate kept by the
| artificially limited residency positions.
| CrimpCity wrote:
| Agreed! Also if residents worked regular hours like normal
| people instead of going after the cokehead who came up with
| the whole residency process. This isn't the military there's
| no reason for that sort of environment.
| deviledeggs wrote:
| The corruption runs deeper than that. Something like 50% of
| drug discovery is funded by US govt, taxpayers. Yet 100% of the
| profits from new drugs goes to big pharma. They're robbing us.
| o8r3oFTZPE wrote:
| ""Big Pharma" in the eyes of the public..."
|
| What the public does not see is how the patent system is gamed
| by generic sellers. How this works is not something that can be
| easily explained in a single paragraph.
|
| The problem is specifically mentioned in the Fact Sheet/Order.
| This is a legitimate antitrust issue but it is exceedingly
| difficult to succeed in the courts.
| runeks wrote:
| > How this works is not something that can be easily
| explained in a single paragraph.
|
| Where can we find the explanation?
| amelius wrote:
| I think they mean that existing generic drugs are
| repurposed for new medical conditions. Where the new
| condition is then patented.
| o8r3oFTZPE wrote:
| https://pubmed.ncbi.nlm.nih.gov/26817958/
|
| Another line of research would be PBMs (Pharmacy Benefit
| Managers). These are another primary means through which
| drug prices are manipulated by Big Pharma, away from public
| scrutiny. Some Big Pharma companies have actually formed
| their own PBMs to provide better secrecy.
|
| https://en.wikipedia.org/wiki/Pharmacy_benefit_management
|
| Understanding what's really going on, i.e., exactly how it
| works, would require reading and understanding a
| significant amount of case law or working for Big Pharma.
| Note that understanding how it all works will not
| necessarily lead to change, unfortunately. PhRMA does a
| reliable job of making sure things stay the same year after
| year. These problems with gaming Hatch-Waxman have been
| around since the 90's. IMO, Big Pharma's lobbyists are far
| more skilled than Big Tech's lobbysists. Time will tell.
|
| There is no single factor that is wholly responsible for
| higher drug prices. It is many factors. This is probably
| why it is such a difficult problem to solve.
|
| Here is one example of one Hatch-Waxman "loophole." This is
| the one with antitrust issues that I had in mind when
| making that comment.
|
| https://en.wikipedia.org/wiki/Reverse_payment_patent_settle
| m...
| [deleted]
| Lutger wrote:
| These are all mostly non-issues outside of the US where
| virtually all countries have implemented some form of universal
| healthcare. The US is really unique in this respect, being so
| affluent and having an almost unbridled capitalism with a huge
| influence on politics.
|
| It's always strange to me to read discussions about healthcare
| on somewhat 'global' forums like this, because this is a US
| specific issue. It's healthcare system is such a deviation from
| what is the norm globally.
|
| https://en.wikipedia.org/wiki/Health_care_systems_by_country...
|
| There is, of course, 'Big Pharma' everywhere. However I think
| in the eyes of non-US public it's rather about large
| corporations wielding a disproportionate power. A power that is
| incentivized by profit motivates which don't necessarily align
| with the public health interest.
| hyperhopper wrote:
| There is also a third issue:
|
| The high cost of medicines that are low cost to produce, and
| are sold at low cost elsewhere
| Sophistifunk wrote:
| This is mostly what I meant by the first issue, sorry I
| wasn't clearer. And that was after re-writing that sentence a
| few times, even :-/
| whoooooo123 wrote:
| As a non-American, this is the only thing I think of when the
| prompt is "Big Pharma", and OP's original two points went
| right past me.
| AnthonyMouse wrote:
| This one is particularly prickly because the high cost paid
| in the US funds medical R&D and extremely expensive clinical
| trials which other countries are free riding on by imposing
| price controls. We still need to fund the R&D and clinical
| trials (unless they could be made less expensive somehow), so
| the most obvious solution would be to have other countries
| pay their fair share so the US could stop subsidizing
| everybody else. But that's hard to get.
| Cthulhu_ wrote:
| That does not compute though. If prices are lowered, sales
| volumes will go up because people (and insurance companies)
| can afford it. I'm no economic, but we've seen time and
| time again that lowering prices boosts volume sold to the
| point where eventual profit is much higher.
|
| I mean the government can pitch in via subsidies for
| medicine R&D if it's really necessary, but honestly the
| pharma companies are swimming in money, they can afford to
| funnel money into R&D and pay their taxes instead of
| pushing it upwards to shareholders and foreign bank
| accounts.
| koolba wrote:
| > I'm no economic, but we've seen time and time again
| that lowering prices boosts volume sold to the point
| where eventual profit is much higher.
|
| The current system has whoever can afford it pay the high
| price, whoever can afford less pay a lower price, and
| whoever can't pay anything doesn't pay anything.
|
| Lowering drug costs won't change the number of people
| taking drugs. That already based on need. All that
| changes is the amount of total profits.
|
| The only politically and morally acceptable answer for
| this is to raise the price of drug costs globally to
| soften the change in profits.
| Nasrudith wrote:
| Amusingly I would have expected the opposite in terms of
| what people find acceptable. Trying to charge say $200
| for HIV medication to subsistence farmers in Sudan would
| be viewed as unconscionable.
|
| In a period of unemployment I found that my medications
| basically operated on the afford less lower price - they
| gave coupons usable without insurance to far more
| reasonable prices. I can see clear brand promption and
| price discrimination here - they don't want to surrender
| market mindshare and brand name recognition by giving up
| the low end or their margins by cutting the cost across
| the board. So they give discounts that usually only the
| low end could or would take. Ironically such slightly
| sleazy behavior fits with one hypocratic oath vow to only
| charge what was within their ability to pay.
|
| Or course "globally" probably means more charge other
| first world nations so it would be more "splitting the
| check among coworkers" than "demand the penniless man in
| the breadline pay a dollar". Still a position I expect to
| be US popular only.
|
| As far as I can tell drug prices are driven by mainly one
| thing, realpolitik. Hepatitis C cures are targetted based
| upon organ transplant costs because that is the only
| alternative so it still helps but they make huge profits
| as say $75k drug treatments are still a big improvement
| over $150k of transplant costs. Unified blocs can twist
| arms to a certain degree, tiny blocs pay more for reasons
| beyond just spikey risk pools and meta-insurance, and
| companies will accept lower profits from some sales if it
| helps maintain higher profit sales.
| onethought wrote:
| "Imposing price controls" !? Couldn't the company just not
| sell at that price... it is obviously still profitable to
| them.
| adrianN wrote:
| I wonder why we don't fund drug development directly, using
| tax money and then let companies produce the drugs for a
| reasonable fee. I feel like drug development shouldn't be
| prioritized by the estimated amount of profit one can get
| from the drug.
| nradov wrote:
| Is there reason to think that government bureaucrats
| would do a better job at efficient resource allocation? I
| expect they would channel funding based on politics with
| little regard for outcomes.
| adrianN wrote:
| Is there a reason to think that government bureaucrats
| would do a worse job? I mean, generally I trust the
| government to run things like building roads, or taking
| care of security and education reasonably well. At least
| as well as a private organization would.
|
| "Efficient" resource allocation strongly depends on your
| performance measure. I don't think that "maximize
| shareholder value" is necessarily the best measure to use
| for healthcare.
| amelius wrote:
| > Is there reason to think that government bureaucrats
| would do a better job at efficient resource allocation?
|
| Yes. Government institutions (academia, DARPA, CERN,
| etc.) created the original internet!
|
| And then companies messed it up.
| passivate wrote:
| For vaccines, most major countries want trials repeated
| with their local population before approving them.
|
| Ironically, in the US, many/most(?) core-science phds and
| post-docs are immigrants who are used as "cheap labor". For
| double irony, they're often from countries that have price
| controls on pharma/biotech products.
| slumdev wrote:
| If American drug makers fired all the young ladies whose
| job is to bring coffee and donuts to your internist's
| office, and they stopped sending your internist away for
| golf weekends to learn more about why they should be
| prescribing Rosuvamax instead of Crestulon, I think they
| could probably bring costs in line with those in other
| countries...
| TearsInTheRain wrote:
| Idk why any politicians arent picking up on foreign price
| controls as a means of lowering costs in the US. It should
| be a part of the discussion during any trade talks with
| Europe.
| nemo44x wrote:
| The problem is chemistry isn't that different from
| software. Once you publish the idea it isn't too
| difficult to derive the chemical composition. Replication
| is the easy part. Design and testing cost money.
|
| So in essence we'd have to design drugs and not publish
| the chemistry which would be uncovered soon enough
| anyways. This leads to a situation where investment
| dollars go into other things and human health suffers,
| especially with so-called rare diseases.
|
| Not to mention the USA loses hegemony. The USA provides
| Europe with a great deal of military technology and
| protection as well as medicine but it isn't for free. The
| EU exchanges agency in many ways important strategically
| to American interests. It's mainly a fair deal.
| Glawen wrote:
| How on earth would that happen? It will just be as
| expensive in Europe as in the US.
|
| You really think that nobody outside the US are making
| drugs? Like no drugs are ever developed in Europe??
| perryizgr8 wrote:
| > It will just be as expensive in Europe as in the US.
|
| Cost can be shared among the US and Europe populations.
| So per user cost would come down by a lot.
| dmitriid wrote:
| What you're literally saying is: instead of ending
| predatory pricing, enforce it for the rest of the world.
|
| Here's a novel idea: cut military spending in half, and
| you can provide all the free medicine to all Americans
| for the rest of their lives. All the while making the
| world a safer place.
| l33t2328 wrote:
| Are you aware that the US government already spends far
| more on health care than it does on the military?
|
| Half the US defense budget is no where near the amount
| spent on healthcare in the private sector.
| bryanrasmussen wrote:
| I wasn't, so I went and looked it up and you were right
| from what I found -
|
| Healthcare:
|
| The federal government spent nearly $1.2 trillion in
| fiscal year 2019. In addition, income tax expenditures
| for health care totaled $234 billion.
|
| https://www.taxpolicycenter.org/briefing-book/how-much-
| does-...
|
| Defense:
|
| Defense spending amounted to $714 billion in FY 2020--and
| is expected to increase to $733 billion in FY 2021.
|
| https://www.gao.gov/products/gao-21-415t
| bryanrasmussen wrote:
| although I guess it is true the U.S could cut defense
| spending less than in half and pay 234 billion for
| everyone, so the original comment isn't totally off.
| l33t2328 wrote:
| That's not accounting private insurance, which is more
| than a trillion per year[1]
|
| [1] https://www.cms.gov/Research-Statistics-Data-and-
| Systems/Sta...
| bryanrasmussen wrote:
| thanks! didn't know that.
| [deleted]
| VictorPath wrote:
| > Defense spending amounted to $714 billion in FY 2020--
| and is expected to increase to $733 billion in FY 2021.
|
| A soldier whose leg was blown up in Afghanistan and is
| still in a hospital - is not part of that $714-733
| billion. So the US military budget is only that low if
| your definition of "defense" spending does not cover
| that.
|
| The reality is the US spends over one trillion a year in
| military spending.
|
| Your own link says as much. It puts "Veteran's medical
| care" under the health care entitlement side of the
| equation, as opposed to the military spending side of the
| equation.
| bryanrasmussen wrote:
| >A soldier whose leg was blown up in Afghanistan and is
| still in a hospital - is not part of that $714-733
| billion.
|
| first off I thought it was clear from my comment that I
| had not believed the original comment that healthcare was
| greater than defense spending, but some initial
| investigation seems to confirm it.
|
| The reason that I had not believed it was that I thought
| there was an ideological axe to grind behind the
| statement, so I was surprised.
|
| It seems to me that you maybe are thinking the same thing
| about me, that is to say I have an ideological axe to
| grind proving that U.S defense spending is not that high.
| If so a quick examination of my posting history and the
| posts here should dissuade you of this.
|
| As far as your argument - I agree the medical costs of
| the soldier still in the hospital should probably be
| counted in defense costs somehow but not sure how you
| would do it as I do not believe a veteran out in the job
| market working 9-5 and going to the VA for some medical
| costs should be counted as defense spending. Thus I don't
| think it is possible to just move all the costs of the VA
| over and get any fairer an accounting than one has now.
| l33t2328 wrote:
| > A soldier whose leg was blown up in Afghanistan and is
| still in a hospital - is not part of that $714-733
| billion.
|
| Where are you getting that? From here
| https://fas.org/sgp/crs/natsec/IF11442.pdf and the link
| in the comment you responded to it seems that it is only
| about 80 billion.
|
| Even if you add that to the 700 billion figure for the
| military, and add 200 billion for the entire VA, Medicare
| and Medicade alone account for well over a trillion
| dollars, and that's not even the majority of healthcare
| expenses in the US.
| bryanrasmussen wrote:
| >Medicare and Medicade alone account for well over a
| trillion dollars,
|
| damn, right again. That sure is a mind blowing situation
| the U.S is in.
|
| https://www.cms.gov/Research-Statistics-Data-and-
| Systems/Sta...
|
| Medicare spending grew 6.7% to $799.4 billion in 2019, or
| 21 percent of total NHE.
|
| Medicaid spending grew 2.9% to $613.5 billion in 2019, or
| 16 percent of total NHE.
| dmitriid wrote:
| > Are you aware that the US government already spends far
| more on health care than it does on the military
|
| At least 34% of that is spent on admin alone:
| https://time.com/5759972/health-care-administrative-
| costs/ and most of _that_ is on privately insurers
| overhead.
|
| > Half the US defense budget is no where near the amount
| spent on healthcare in the private sector
|
| It would be way more than enough _if_ there was some
| political will behind it.
| l33t2328 wrote:
| > and most of that is on privately insurers overhead.
|
| It's true that the plurality of healthcare costs are
| private insurance, but medicare and medicade combine to a
| little less than twice the entire defense budget.
|
| The US government could cut significantly into the out of
| pocket expenses if they halved the defense budget. This
| link is interesting: https://www.cms.gov/Research-
| Statistics-Data-and-Systems/Sta...
| tigerBL00D wrote:
| Isn't part of the problem that the US/FDA trial and
| certification process is designed to be very expensive? And
| who benefits from a moat created by high cost of R&D if not
| big pharma? I seriously doubt that pharma lobby would be
| thrilled if costs of bringing new drugs to market suddenly
| fell by several orders of magnitude, so it's not going to
| happen.
| legulere wrote:
| Pharmaceutical companies spend even more on advertising
| than on R&D and still highly profitable though.
| RomanAlexander wrote:
| It could easily be the case that without the advertising
| spend they would not be profitable. Do you think these
| publicly traded companies are wasting tons of money on
| advertising? Where is the shareholder outrage?
| 1auralynn wrote:
| I worked in pharma advertising for a little bit: There
| are two sides, consumer and clinical which I believe are
| about equal spends (might be wrong, but it's significant
| anyway). Clinical advertising is mostly used to recruit
| doctors to recruit patients to take part in clinicial
| trials, and is a necessary component of R&D. Think lots
| of tradeshows with fancy signage, interactive
| touchscreens, apps, etc.
| legulere wrote:
| It could also be tragic of the commons effect though.
| High ad spend is necessitated by the high ad spend of
| competitors.
| nerfhammer wrote:
| According to one google search result total pharma ad
| spend was $6.58 billion in 2020.
|
| According to the CBO pharma R&D was $83 billion in 2019.
|
| References:
|
| https://www.fiercepharma.com/special-report/top-10-ad-
| spende...
|
| https://www.cbo.gov/publication/57126
| diffeomorphism wrote:
| You are off by a factor 10. The 1 billion is in total
| over all the time needed to produce the drug (about 10
| years), while ads are per year.
| nerfhammer wrote:
| ok, so 65 drugs in development, with 6.5 drugs _released_
| per year? does that seem plausible for the entire pharma
| industry?
| nradov wrote:
| The FDA approved 53 novel drugs in 2020. That was
| relatively high; most years have lower totals.
|
| https://www.statista.com/statistics/817534/annual-novel-
| drug...
| diffeomorphism wrote:
| You notice you are off by a factor 10 and don't pause for
| a moment but instead immediately go "ok, so"?
| nerfhammer wrote:
| If it costs a billion dollars to develop a drug and
| pharma spends 6.5 billion on ads, that would mean an
| implausibly small number of drugs being developed, no?
|
| I don't see any reason to believe that pharma spends more
| on ads than R&D. Do you?
| ABCLAW wrote:
| Just to chime in; the poster you're replying to is
| correct regarding your incorrectness related to the
| relative weighting of R&D vs. Marketing spend.
|
| Pull a public filing for these companies and take a look
| at their balance sheets; it's pretty straight forward.
| diffeomorphism wrote:
| > that would mean
|
| No.
|
| > Do you?
|
| The fact that you just reposted your above comment
| without any change despite knowing it was wrong and
| despite being called out on that. That seems like a
| strong point in favor of the opposite of whatever your
| position is.
| snarfy wrote:
| I was under the impression a large amount of medical R&D is
| paid for by taxes and done by university students. We pay
| for it and private industry benefits.
| onion2k wrote:
| I always assumed a fairly significant chunk of that
| research is to find minor modifications to existing drugs
| in order to maintain patents that are about to expire. It
| certainly feels like that happens a lot.
| PaywallBuster wrote:
| are the clinical trials more expensive in the US than
| anywhere else??
|
| Maybe that's part of the reason medicines cost multiple
| times more?
| mucholove wrote:
| The rising price of Insulin is not funding the R&D of new
| drugs.
| cycomanic wrote:
| Do you have any data to back up that claim? Traditionally
| US pharma has had lower R&D budgets than their
| international competitors.
| FooBarWidget wrote:
| I've heard of this argument before but I think it really
| needs some evidence. Is there a study that corroborates
| this claim?
|
| Even if the US really "subsidizes" medicine for the rest of
| the world, what motives do pharmas have to sell medicine at
| lower-than-production/R&D-cost to the rest of the world?
| Couldn't they just sell to the US exclusively, let the rest
| of the world rot, and then sit on a bigger pile of cash as
| a result?
| diffeomorphism wrote:
| That is a common talking point, but I don't know of any
| data actually backing that up. It just sounds nice like
| "they hate freedom". No, nobody does, try again.
| jpttsn wrote:
| Would you know of the data if it existed? Absence of
| evidence is a low bar for disbelieving a proposition.
| [deleted]
| JumpCrisscross wrote:
| I've been a fan of increasing tax credits for medical R&D
| in exchange for price limits along, or simply, with a limit
| on the ratio a drug can be sold domestically versus
| overseas.
| philjohn wrote:
| Not necessarily - look at Valeant Pharmaceuticals.
|
| They bought smaller Pharma co's, gutted R&D, and jacked up
| prices of the medications they sold.
| NicoJuicy wrote:
| Then why is every covid vaccine ouside the US, if other
| countries are "free-riding" the US R&D?
| watwut wrote:
| > This one is particularly prickly because the high cost
| paid in the US funds medical R&D
|
| Most of those money goes on marketing.
|
| Moreover, I think that US citizens did not signed up to pay
| medical R&D for whole world while they are sick. In fact,
| US citizens tend to have issues with paying researcher,
| social support and so on from their money.
|
| R&D paid from taxes or insurance makes way more sense then
| paid by those who already deal with health crisis.
| matt_s wrote:
| We're also funding massive advertisement campaigns, those
| can simply go away with a couple Thanos-like snaps as far
| as I care.
|
| There is zero need to advertise drugs to potential patients
| which need a doctors prescription.
| Notanothertoo wrote:
| Except these companies spend more on marketing than rnd.
| jeeeb wrote:
| I've seen this claim made a few times.
|
| If this is true then surely it would be in the US's
| interest to stop doing it! Stop us freeloaders from
| mooching off your drug development!
|
| Personally I'm doubtful that this claim is broadly true
| though. I think it should at least be backed by some decent
| analysis.
| IfOnlyYouKnew wrote:
| The US does pay about twice as much per capita for
| healthcare, while getting rather mediocre results. No,
| it's not in the country's best interest as any normal
| person would understand it.
|
| But there's a large segment of the US population that has
| very strange priorities. They are willing to pay a bit
| extra to avoid the possibility of, say, poor people
| getting healthcare.
|
| (They also pay 5x as much for their military, compared to
| their NATO peers. It's the export version of their
| particular brand of sadism.)
| andyferris wrote:
| Europe does drug R&D and still manages to sell their drugs
| at a reasonable price to sick people (generally because
| their governments utilize their buying power for the good
| of their citizens).
|
| It seems to me that US people have been sold FUD by there
| own pharma companies, if I'm honest.
| namdnay wrote:
| > Europe does drug R&D and still manages to sell their
| drugs at a reasonable price to sick people
|
| Every European drug firm also sells in the US, so I
| suspect that's taken into account in their business model
| JumpCrisscross wrote:
| > _Europe does drug R &D and still manages to sell their
| drugs at a reasonable price to sick people_
|
| Most novel R&D, in America and Europe, happens in
| biotech. ("Big" pharma does trials, manufacturing scaling
| and distribution.) The investment thesis for most of this
| research does not work without the American market.
|
| This doesn't mean high drug prices are a necessity. Just
| that the funding needs to be replaced if we want to
| preserve innovation.
| m12k wrote:
| But to be fair, the US pharma sector spends roughly as
| much on marketing as it does on R&D. And a huge chunk of
| that R&D budget goes into analogue drugs to either
| sidestep patents from rivals or maintain profit margins
| when their own patents expire (they can then use that
| huge marketing budget to get the newly patented drug to
| take over for the old one with the nearly-expired patent,
| despite small or non-existent benefits from a medical
| perspective). So long story short, there's a pretty good
| case to be made that public research with somewhere
| between 1/10th and 1/5th the budget of big pharma is all
| it takes to match or overtake them in innovation, as
| measured by actual benefit to the patients.
| AnthonyMouse wrote:
| > But to be fair, the US pharma sector spends roughly as
| much on marketing as it does on R&D.
|
| Spending money on marketing lowers prices by increasing
| volumes.
|
| If you spend a billion dollars on R&D and then spend
| nothing on marketing and sell to 200,000 customers, they
| would each have to pay $5000 to fund the R&D. If you
| spend a billion dollars on R&D and two billion dollars on
| marketing and sell to a million customers, they would
| each have to pay $3000 to fund both the R&D and the
| marketing.
|
| And it also does something useful, assuming the new drug
| is actually beneficial, by making people aware of the
| existence of something that would make their lives
| better. It helps no one to invent a great new thing that
| then nobody uses because nobody knows it exists.
|
| > And a huge chunk of that R&D budget goes into analogue
| drugs to either sidestep patents from rivals or maintain
| profit margins when their own patents expire (they can
| then use that huge marketing budget to get the newly
| patented drug to take over for the old one with the
| nearly-expired patent, despite small or non-existent
| benefits from a medical perspective).
|
| It doesn't actually cost that much to do that because you
| already know what you're looking for in that case. It's
| the real R&D that costs money.
|
| > So long story short, there's a pretty good case to be
| made that public research with somewhere between 1/10th
| and 1/5th the budget of big pharma is all it takes to
| match or overtake them in innovation, as measured by
| actual benefit to the patients.
|
| The biggest problem with public research funding is how
| to allocate it.
|
| With a profit motive and market competition, the people
| who allocate research funding inefficiently go out of
| business and the people who allocate it well make a lot
| of money, and then have more money to fund more research.
|
| Without that, research funding turns into defense
| contracting and then we waste trillions of dollars and
| have nothing to show for it. Or worse, politicians say
| we'll only need 1/10th of the budget even though the
| incentives aren't actually there to improve efficiency,
| and then we get 1/10th of the research.
| frenchy wrote:
| > Spending money on marketing lowers prices by increasing
| volumes.
|
| That explains why they do it, but not why it's useful to
| the public. Marketing isn't necessarily a zero sum game,
| but it in the case of direct-to-consumer drug
| advertisments, it's pretty close.
| [deleted]
| simonh wrote:
| That's fair enough, maybe Europeans should pay more than
| they do for pharmaceuticals and get away with paying less
| due to the huge profits Pharma makes out of the US health
| care system.
|
| That's not really on Europe though. It's for the US to
| sort out it's horrifically dysfunctional health care
| system, if it chooses to. Honestly I don't know if what
| Biden plans to do, particularly in relation to Big Pharma
| is reasonable. I suspect it's likely to be treating the
| symptoms with regulation rather than the disease through
| reform, but maybe that's what you do when treating the
| disease runs into insurmountable political resistance.
| guiriduro wrote:
| Political resistance is the disease.
| hellbannedguy wrote:
| China, and Russia, and other countries, are making big
| breakthroughs in biotech, but we are hesitant on
| believing their results--now.
|
| They have the advantage of pushing through Clinical
| trials without much oversight.
|
| I am all for strict Clinical trial protocols, but our
| biotech companies are testing their drugs in countries
| that don't have strict protocols on safety.
|
| I don't get the price increase argument anymore. The
| biotech companies are multinational. It's just Americans
| give them the most money.
|
| I'm getting afraid of the whole, "American biotech will
| cure anything because of the financial perks they get"
| mantra too.
|
| I pay out of pocket for my needs at Costco. Their prices
| are a bit above wholesale. That said, I pay way to much
| for certain drugs. I guarantee their are shinagigans
| going on in the pricing if certain drugs.
|
| Bupenorpine us a generic drug. Why gave I been paying $70
| for a decade?
|
| (This drug is America's answer to the opioid crisis. I
| was prescribed this drug off label for another condition.
| It's the price that has me scratching my head. It's been
| the same price for too long. Other pharmacy's price it
| higher.)
|
| I won't get started on the drugs (new--not genetic)
| prescribed for depression. And then reading Irving
| Kirsch's research. His paper can be found, but you need
| to hunt for it. I'll offer this interview.
|
| https://www.aarp.org/health/drugs-
| supplements/info-05-2010/d...
|
| I am proud of Biden's promise to lower prices. I am so
| glad he's at the helm. I'm not being overly political. I
| just am just at bit hopeful now. Something I haven't been
| in 4 plus years.
| IfOnlyYouKnew wrote:
| To get approval in US and Europe, the trials need to be
| of the same quality no matter where they are run.
| Sometimes it may be cheaper in poorer countries because
| you don't have to pay your volunteers as much. You still
| need to check all the appropriate boxes regarding
| informed consent as anywhere else. And, of course,
| western companies are entirely capable to run trials
| anywhere in the world. The COVID vaccine trials were run
| in Europe, the US, South Africa, Israel, and really any
| place where the incidence was high enough.
|
| And China and Russia are not "making big breakthroughs":
| just look at the vaccines again: BioNTech/Moderna/J&J/AZ
| all work extremely well, all things considered. The
| Russian and Chinese vaccines don't. Just ask/look at the
| charts of Chile. Or any Russian.
| Monory wrote:
| Am Russian, am vaccinated with Sputnik V, would do it
| again. Yes, the study was rushed and details were
| missing, but, eventually, all things got in order.
|
| And it's a real working vaccine, effects of which I see
| basically every day on my friends.
| acdha wrote:
| Yes: unless a vaccine is harmful, it's better to have
| than not. Higher effectiveness is better, of course, but
| if there was ever a time to say "don't let perfect be the
| enemy of good", it's during a raging pandemic.
| madengr wrote:
| Well he seems to be doing the opposite.
|
| https://www.cnn.com/2021/02/01/politics/biden-trump-drug-
| pri...
| BobbyJo wrote:
| > They have the advantage of pushing through Clinical
| trials without much oversight.
|
| This isn't an advantage. What you end up with is a lack
| of clarity on what works well, what doesn't, and why. It
| makes it easy to go from A to B, a hypothesis to a drug,
| but it clouds what C, D, and E should be, as that lack of
| oversight turns into a lack of deeper insight.
| bigbizisverywyz wrote:
| MY understanding (at least in the UK) was that hospitals
| and universities also do a lot of research (often
| cutting-edge), and are often the source of innovation.
| These entities are largely publicly funded.
| pclmulqdq wrote:
| Most drugs appear first in publicly-funded research, but
| so does every other compound that can get past a p value
| of 0.05.
|
| The main value proposition of big pharma is that they
| take those results, find the ones that actually work
| (very few of them do), study them for side effects, and
| characterize them. There is a LOT of work between the
| published research and an actual drug (there is actually
| significantly more risk and cost to go from a paper to a
| drug than to write the initial paper).
| mft_ wrote:
| In the context of this discussion, 'Europe' doesn't do
| 'R&D'.
|
| Biotech/Pharma are international. Irrespective of the
| home location of the organisation, virtually every drug
| trial from phase I onwards will be run in multiple
| countries. Further, virtually every drug found to work
| and filed with regulators for a license, will be filed
| internationally: Europe (EMA), US (FDA), and a whole host
| of smaller independent country regulators: Japan,
| Australia, Switzerland, etc.
|
| So within the overall business model of a given company,
| there's no link between the countries in which research
| is performed, and the prices ultimately set in those
| countries.
|
| Drugs are more expensive in the US simply because there
| aren't any pricing controls (beyond maybe some bargaining
| by providers; I can only assume this is because of the
| power of lobbying over the political process in the US).
| Drugs are cheaper where there's an established process
| for determining or controlling prices.
| acdha wrote:
| > In the context of this discussion, 'Europe' doesn't do
| 'R&D'.
|
| Ever wonder why it's the Pfizer-BioNTech vaccine? It's
| because the simple nationalist narrative you're repeating
| is misrepresenting a far more complicated international
| research story.
|
| https://en.wikipedia.org/wiki/BioNTech
| roenxi wrote:
| > Drugs are more expensive in the US simply because there
| aren't any pricing controls...
|
| There aren't any other markets where "pricing controls"
| are needed. Drugs are more expensive in the US simply
| because it is illegal for a 3rd party to sell them.
|
| If it were legal, anyone could buy the drugs where they
| are cheapest and ship them to America. The problem is
| obviously that competition is banned. If that isn't the
| problem, the entire population of the world is remarkably
| indifferent to a really easy opportunity to make lots of
| money.
|
| And, I suppose almost to obviously to add, if competition
| is illegal then prices go up.
| mft_ wrote:
| I'm not an expert on the import/export side.
|
| When I used the term 'pricing control', I was referring
| to the systems that some countries (eg UK, Germany) have
| in place for determining the price they'll pay for a drug
| based on (roughly) the value it brings to patients. (The
| best known of these is probably NICE in the UK; it's not
| a perfect system, but it's a pretty good attempt.) Other
| countries in turn 'reference' their price from a number
| of similar countries including those with formal
| processes.
|
| Broadly, this is why drug prices are controlled and lower
| in Europe vs. the US.
|
| In the US, even where there are competing drugs in the
| same disease, there's no pressure on prices -
| manufacturers can just keep on racking up their prices
| almost without a concern.
| roenxi wrote:
| Well, ok. But the reason it costs more in the US is
| because it is illegal to go to Germany, buy drugs, ship
| them to the US & sell them.
|
| If that was legal, someone would do it and make bank. And
| it is the US that is responsible for those laws.
| long_time_gone wrote:
| ==There aren't any other markets where "pricing controls"
| are needed.==
|
| The minimum wage rate is a price control.
| [deleted]
| sre79chn wrote:
| This is an unfortunate moral hazard due to the petrodollar.
| wvenable wrote:
| In 2018, the average insulin price in the US was $98.70,
| compared to $6.94 in Australia, $12.00 in Canada, and $7.52
| in the UK. This is a 100 year old drug.
| AnthonyMouse wrote:
| It isn't a 100 year old drug. There are newer
| formulations that are faster acting, longer lasting,
| easier to administer, etc. They're newer so they're still
| under patent so they're a lot more expensive (because the
| rest of the world makes the US pay to develop the newer
| formulations). When insurance is paying for it, people
| prefer the newer formulations.
|
| Then, since most people have insurance, there wasn't
| enough of a market for the older formulations for anybody
| to bother making them for the margins you get for making
| a generic. So the prices were high for people paying out
| of pocket.
| code_duck wrote:
| That was true at one point, but the newer formulations of
| insulin are old enough to mostly have biosimilars, aka
| follow-ons, the equivalent of generics for drugs produced
| by bioengineering. Humalog/Lispro/Admelog,
| Lantus/Basaglar and others, in many cases made by the
| same company as the original.
|
| The prices of insulin have been increased steadily each
| year by about 11% for the past 20 years. There's nothing
| about research or costs that justify that for 20 year old
| drugs.
|
| https://www.businessinsider.com/insulin-price-increased-
| last...
|
| The old formulations (Human insulin, NPH) can be
| purchased without a prescription at Walmart for fairly
| low prices - the price that people pay for modern insulin
| in the rest of the world.
| prestigious wrote:
| At least give the option of the old shit
| AuryGlenz wrote:
| Walmart sells vials of the generic "old shit" for cheap.
| xmprt wrote:
| Do you have a source? I wasn't able to find any mention
| of it on Walmart's website.
| themaninthedark wrote:
| https://diabetesstrong.com/walmart-insulin/
| JumpCrisscross wrote:
| > _At least give the option of the old shit_
|
| It's available. It's just _far_ less convenient and much
| easier to fuck up in a life-threatening way.
|
| The insulin price meme is a particularly bad one.
| watwut wrote:
| It is really not. The price disparity between US and rest
| of world is quite massive.
| kongolongo wrote:
| The often quoted prices do not take into account the
| actual price paid by consumers, the type of insulin being
| compared, or relative purchasing power of the countries.
| I don't actually know how if insulin is actually all that
| much more expensive across the world when taking those
| factors into account. Seems like cherry picking without
| controlling for all of those factors
| hug wrote:
| This doesn't pass the smell test.
|
| Anyone making the decade-old version of insulin and
| selling it for 1% of the price would corner a large
| portion of the market immediately. Anyone without good
| health insurance, which is a large and increasing part of
| the population, would immediately jump on the lower
| priced version.
|
| And since when are insurance companies excited to pay for
| the more expensive drug with limited extra utility
| anyway?
|
| You are giving far too much credit to what is on the face
| of it a broken system.
| Cthulhu_ wrote:
| ^ Exactly this. They can sell the premium version for
| however much they choose to, but the cheaper one - the
| affordable, the one that should be given out for free -
| is simply not available enough, it's being suppressed by
| the pharma industry in favor of their own premium,
| expensive product.
|
| I mean what are people else going to do, die? Oh wait.
|
| I don't understand commenters in this thread coming out
| in defense of pharmacy companies using their monopoly or
| influence to deny health care to people that need it. It
| should be considered a criminal offense. It's anti-
| competitive. I mean with insulin it's a massive hole in
| the market - why hasn't anyone else been able to jump
| into that gap and make a killing?
| brigandish wrote:
| > This doesn't pass the smell test.
|
| We saw something similar happen during the pandemic.
| There has to be infrastructure and people with the skill
| and knowledge to support an industry available, and even
| if you had those people available you can't just ramp up
| production in any old place. That's why there were supply
| chain problems and will continue to be, the UK won't be
| making its own drugs (designing, yes, making, no) just
| because it did in the past, the US won't be making
| computer chips just because it did in the past. There
| being a profit to be made isn't enough.
|
| > You are giving far too much credit to what is on the
| face of it a broken system.
|
| The system may be broken but fixing it takes more than a
| wave of the hand.
| dtech wrote:
| > Anyone without good health insurance, which is a large
| and increasing part of the population, would immediately
| jump on the lower priced version.
|
| Medicine isn't like a supermarket, people usually just
| take what their doctor/hospital prescribes. In addition,
| I think it's likely that those with no/worse health
| insurance are on average less informed.
| coryrc wrote:
| You can buy the old one for cheap now:
| https://diabetesstrong.com/walmart-insulin/
|
| That's 6% not 1% of the cost of new ones, though.
| MagnumOpus wrote:
| Since this month - and it is headline news all over the
| country... It shouldn't be extraordinary that cheap drugs
| needed by millions are available cheaply. (See also: Epi
| Pens.)
| themaninthedark wrote:
| Since 2000.
|
| >McInnis explained since 2000, Walmart has sold ReliOn
| insulin, the only private insulin brand on the market
| retailing at $24.88 per vial.
|
| https://www.wfmynews2.com/article/news/verify-yes-
| walmart-do...
|
| Walmart just started selling analog insulin(the newer
| formulation) just recently.
| https://nypost.com/2021/06/29/walmart-to-launch-its-own-
| low-...
| viraptor wrote:
| > Then, since most people have insurance, there wasn't
| enough of a market for the older formulations for anybody
| to bother making them for the margins you get for making
| a generic.
|
| Is there some research confirming that? It doesn't quite
| match my out-of-us experience with other drugs. I get a
| choice of 2-3 brands of ibuprofen and another 1-2
| generics for it. Why wouldn't the same apply to insulin?
| I expect that it's also not 100% covered? (please correct
| me here)
| code_duck wrote:
| You can buy the original insulins from 80 years ago for
| $35-50. Those are human/porcine insulin and one called
| NPH that has an intermediate duration. Some people who
| used those before the newer long/short/rapid actings were
| developed still prefer them, and others use them for cost
| reasons esp. because they can be obtained in the US
| without a prescription. I only know of one brand, Humulin
| by Lilly.
|
| For modern insulin, they were indeed patented but mostly
| generics called follow-ons or biosimilars are available.
| Lantus has an alternative Basaglar that costs about 1/3
| as a much. Humalog can be replaced with Admelog. The
| manufacturer of Novolog makes a biosimilar of their own
| insulin and sells it for 1/3 as much, if that makes any
| sense.
|
| The various types differ a bit... Lantus has a slower
| absorption and thus longer duration than it's main
| competitor, Levemir. Novolog differs from Humalog in one
| protein on one side of the chain or something. Some
| people can't use one or the other due to allergies to the
| excipients or unexplained resistance to the effects.
| mlindner wrote:
| If it was actually 100 years old the patent would be
| expired. So you're actually seeing newer drugs that use
| the same name.
| cycomanic wrote:
| I encourage you to look up evergreening. Pharmaceuticals
| are playing every (legal and illegal) trick to extend
| patent protection. The purpose of the new formulations is
| often only to extend patent protection. Together with
| extensive advertisement campaigns to get doctors to use
| the new formula not all.
| pkphilip wrote:
| Correct. The price of Insulin has nothing to do with
| "funding research." It is simply price gouging - that's
| it.
| fennecfoxen wrote:
| The price of insulin specifically is largely a
| consequence of perverse regulatory incentives,
| particularly the Obamacare-related expansion of the 340B
| Drug Pricing Program and its mandatory, byzantine, opaque
| rebate structures. Don't think it's just the
| manufacturers who are at the center of this price
| gouging, not by a long shot; hospitals and pharmacies are
| all too happy to ride that gravy train.
| spicyramen wrote:
| Where can I find out more information about it.?
| naasking wrote:
| > This one is particularly prickly because the high cost
| paid in the US funds medical R&D and extremely expensive
| clinical trials
|
| This is what pharma wants you to believe because it's a
| positive spin on their pricing. I suggest watching Rep.
| Porter grilling these pharma CEOs if you want to understand
| the true costs:
|
| * https://www.youtube.com/watch?v=wpdhD4ZLBxc
|
| * https://www.youtube.com/watch?v=n0L0XbnvJ6I
|
| TLDR: marketing alone outweighs R&D investment, and stock
| buybacks often account for more than both combined.
| furyg3 wrote:
| You're putting the cart before the horse here. The reason
| why the other developed nations get cheaper access to to
| medicine is because of collective bargaining from more
| organized insurance schemes (e.g. single payer), or because
| of price capping by governments. Not 'because' the US
| subsidizes R&D through high prices. The US pays high prices
| because it chooses as system in which that's acceptable,
| and the pharmaceutical companies design their own pricing
| around it.
|
| If the US stopped the madness, the companies would
| rebalance their pricing systems. If what you say is true,
| maybe every other developed nation would have to pay more.
|
| I'm skeptical of this entire theory, however. It's not like
| major pharmaceutical companies just barely breaking even,
| and are selling their products at a loss in Europe. There
| is a lot of room for profit margins to be squeezed.
| anthony_barker wrote:
| I would argue Big Pharma free rides its self on research
| from universities around the world which are mostly
| publicly funded and not for profit.
|
| The US represents less than 34% of global research.
| https://pubmed.ncbi.nlm.nih.gov/17354441/
| simonh wrote:
| I'm sure they benefit from public research, lost of
| industries do, but even public Universities are perfectly
| capable of patenting their discoveries and getting paid
| by companies using them. Ours here in the UK certainly do
| this.
| hajile wrote:
| Patents are an attempt to protect risk. If you're getting
| my money to invest without any risk to yourself, you
| don't deserve a patent.
|
| Here's an easy solution:
|
| Patent and copyright times are limited proportionally by
| the percentage of government money invested and at the
| end of that time, the research must be made publicly
| available.
| chii wrote:
| > The US represents less than 34% of global research
|
| and yet, the US has about 5% of the world's population.
| So proportionally, they are punching way above their
| weight.
| hnbad wrote:
| And 25% of the world's prison population. Do we want to
| keep this stats dump going or did you have a point?
| din-9 wrote:
| It would be fairer to compare by wealth, where the USA is
| at 30.2%
|
| https://en.wikipedia.org/wiki/List_of_countries_by_total_
| wea...
| jpadkins wrote:
| if you use wealth, we are a back at why americans spend
| more on per captia than any other countries: because they
| can (because they are wealthier).
|
| Healthcare, especially in older population, starts to
| behave like a luxury good at upper ends of cost / care.
| H12 wrote:
| I think it's fair to characerize this as a symptom of the
| emplyment/insurance/hospital loop outlined in issue #1 of the
| original comment.
|
| That relationship between those three parties is the root
| cause of the messed up incentive model responsible for the
| ridiculously high costs of all products/services in US
| healthcare; pharma included.
| WalterBright wrote:
| Ironically, it's the governments attempts to lower health care
| costs that produced this mess of high prices.
| oblio wrote:
| I highly doubt that even without government intervention
| prices would be lower.
|
| Healthcare is not a free market and yet Americans still try
| to pretend it's one. The information asymmetry is huge and
| nobody's going to negotiate/look around for anything when
| they think they're close to their deathbed.
| WalterBright wrote:
| The rise in health care prices at a faster rate than
| inflation started in 1968, coincidentally with the arrival
| of Medicare/Medicaid (an attempt to reduce costs).
| iso1210 wrote:
| Health care spending in the US was tracking with
| countries like Germany, Denmark, Sweden (increasing from
| 6% of GDP to 8%) throgh the 70s.
|
| After 1980 US really took off though. In 1980 US spend
| 8.2% of GDP, Germany 8.1%, Denmark 8.4%
|
| By 1990 US was 11.2%, Germany and Denmark 8%
|
| US plataued in 1993 about 12%, lasting until 2000 when it
| took off again, reaching 16% in 2009, then was mostly
| flat (slightly reducing) until 2013.
| unishark wrote:
| What are you saying was the cause though? And either way,
| people still got healthcare and negotiated payments
| thinking they were close to their deathbeds prior to that
| era of increase.
|
| Also 1986 was the emergency room mandate, which used
| Medicare payments as leverage. And of course the obesity
| epidemic and the low-fat diet (blaming fat for heart
| disease) started around then. The ACA started in 2010 but
| phased in over four years.
| throwaway0a5e wrote:
| The government's 1940s intervention that ensured white
| collar professionals would be removed from the problems
| for 60yr is generally considered the root cause of the
| current healthcare debacle. Without it we'd likely have a
| system that's more akin to what's the norm
| internationally.
| WalterBright wrote:
| > Healthcare is not a free market
|
| Health care was a free market until the following events:
|
| 1. requirement for government licenses for doctors, which
| was done to drive Jewish and Black doctors out of business,
| and to restrict the supply of doctors
|
| 2. the advent of employer-provided health care during WW2,
| which due to tax policy married health care coverage to
| one's job
|
| 3. the 1962 FDA amendments which required efficacy for drug
| approval (not just safety) leading to a tripling of drug
| costs and a corresponding drop in new drug development
|
| 4. the introduction of Medicare/Medicaid in 1968
|
| 5. ever more regulation and interference in the market,
| like requirements the emergency rooms treat for free
|
| Regardless of whether one thinks these are good things or
| not, they detract from health care being a free market.
| dcolkitt wrote:
| > I highly doubt that even without government intervention
| prices would be lower.
|
| Without government intervention , Amazon Basics would
| assuredly make dirt cheap versions of every major drug.
|
| You can argue that this is bad for other reasons, but
| theres zero doubt that drugs would be cheap as water
| without government intervention (including IP protection
| and FDA mandated trials).
| oblio wrote:
| Do I have to spell it out?
|
| "Cheaper but people die due to lead poisoning" (replace
| "lead" with your favorite toxic chemical) does not count
| as cheaper, for medicine. It needs to be cheaper and
| trustworthy. The Iron Line of medicine, I guess.
| jpadkins wrote:
| vitamins are pretty much unregulated for decades, but
| doesn't have this lead or toxic chemical problem. Why do
| you feel so strongly this would happen in medicine? Do
| you really think companies (who spend a lot of capital
| building a business) will knowingly waste it all away by
| selling medicine that poisons people?
| oblio wrote:
| > vitamins are pretty much unregulated for decades, but
| doesn't have this lead or toxic chemical problem.
|
| Check out John Oliver and see how many problems we're
| having due to unregulated vitamins.
|
| Also vitamins are used by a ton fewer people than
| medicine, and for purposes far, far less risky than
| medicine.
|
| > Why do you feel so strongly this would happen in
| medicine?
|
| Because it would happen for sure without regulation.
| Maybe not to the degree I pointed out, but if they
| wouldn't be forced to go through all those clinical
| trials, etc., I'm 99% sure that bean counters in a
| company would decide: "you know, maybe we could reduce
| the dosage of that super expensive ingredient by 10%, the
| side effects will only be known after 10 years and we're
| here only until we cash in our checks in 2 quarters".
|
| > Do you really think companies (who spend a lot of
| capital building a business) will knowingly waste it all
| away by selling medicine that poisons people?
|
| There are companies that periodically change their name
| to "cleanse" their image. Telecom companies, for example.
| Plus, they'd only have to persuade doctors, not regular
| people. Regular people don't really know who makes their
| specific medicine anyway (don't believe me, go ask your
| grandpa who makes each of his 10 drugs he's taking).
| WalterBright wrote:
| > vitamins are used by a ton fewer people than medicine
|
| Really? Every supermarket has plenty of them for sale.
| The local drug store has whole aisles devoted to them.
| They don't stock items that don't move.
|
| > Because it would happen for sure without regulation.
|
| Poisoning people is not something allowed by the free
| market, any more than hitting people with a baseball bat
| is. Free markets _require_ government to proscribe fraud
| and abusing peoples ' rights.
|
| > Regular people don't really know who makes their
| specific medicine anyway
|
| They do when it turns out to be a problem, like the
| Tylenol murders.
| SV_BubbleTime wrote:
| Perhaps we would look at the donations to see if this is likely
| or not?
| jedmeyers wrote:
| Is buying a son's painting considered a donation or not?
| jjeaff wrote:
| No. In what world does buying setting from an adult relative
| consist of a donation?
|
| And if a foreign government overpaying for hundreds of
| thousands of dollars worth of hotel stays in properties owned
| by the politician is not considered a donation, I can't
| imagine anyone thinking the painting thing would be.
| mathisonturing wrote:
| Elaborate? Out of the loop
| jeffbee wrote:
| It's a game of "Spot the Fox News viewer". If you're a fan,
| you believe the largest ethical quandary facing the nation
| in the last quarter-century is that a person related to the
| President of the United States is selling a painting in an
| anonymous auction.
|
| https://www.foxnews.com/politics/obama-ethics-chief-
| hunter-b...
| zepto wrote:
| > a person related to the President of the United States
|
| The sitting president's son, you mean?
| SV_BubbleTime wrote:
| While I detest bias in all media (Fox included but in no
| way do they have a monopoly on)...
|
| Are you saying Hunter Biden (the son of, not just "a
| person related to") hasn't recently sold his artwork for
| $500,000 a pop to anonymous buyers?
| jeffbee wrote:
| As I understand it from reputable reporting, all such
| sales are hypothetical.
|
| https://www.washingtonpost.com/politics/deal-of-the-art-
| whit...
| specialist wrote:
| I vividly remember when Billy Beer was a scandal. Simpler
| times.
|
| https://en.wikipedia.org/wiki/Billy_Beer
| cabaalis wrote:
| Here's an article from the NYT about how they are trying to
| ethically sell Hunter Biden's artwork. "Ethically sell" was
| a term I chose specifically because Hunter Biden is not an
| artist, and the question of why his paintings are being
| sold for half a million dollars and to whom is substance.
|
| https://www.nytimes.com/2021/07/08/us/politics/hunter-
| biden-...
|
| Edit: Anyone can be an artist of course. Selling artwork
| for such a price would be quite an artist.
| SV_BubbleTime wrote:
| > Anyone can be an artist of course. Selling artwork for
| such a price would be quite an artist
|
| Quite an artist indeed. Here is a Picasso that sold last
| month for $150,000.
|
| https://www.liveauctioneers.com/item/104029896_pablo-
| picasso...
| oh_sigh wrote:
| That's anonymous - there's no way for the Biden's to ever
| know the buyer. Of course, the buyer can just show them a
| picture of the painting in their house or whatever but that
| would be unethical.
| alea_iacta_est wrote:
| It's unethical for the public to know who's the buyer,
| that's what they meant.
| qeternity wrote:
| > Of course, the buyer can just show them a picture of the
| painting in their house or whatever but that would be
| unethical.
|
| Unethical, yes...something which a good chunk of society
| have no qualms with, especially those in the business of
| bribing politicians.
| ErikVandeWater wrote:
| Don't know why your downvoted for asking a basic question.
|
| Career politicians do not betray those who fund their
| campaigns, especially in the highest office.
| anonymouswacker wrote:
| Yeah, like the democrats will bite the hands that feed. This is
| democrat posturing for 2022, that is all.
| Hani1337 wrote:
| The reason we can afford universal health care in my country is
| because there are hard caps to the prices health professionals
| can legally ask, be it for fees or medication prices. If the
| prices are kept closer to their real value, and not inflated
| prices, then it's already much more affordable to consider paying
| for universal health care.
| CountDrewku wrote:
| Yes there's a good argument that insurance in the US has
| artificially increased prices. College loans have done similar.
| This is why the ACA (obamacare) kinda failed to fix most of the
| issues. Care is much too expensive.
| DoreenMichele wrote:
| Well, I hope this does some good, but I'm a bit skeptical. I
| think we need more focus on how to help freelancers, gig workers
| and microbusiness actually succeed as a counterpart to preventing
| big business from preying upon small business.
|
| It's something I personally try to promote but I feel I have
| little in the way of success. I still struggle to make it through
| the month myself and my various projects intended to help others
| seem to mostly kind of languish, with one exception and I have no
| hard data on how much good that is doing.
|
| I think my efforts aren't pointless or fruitless, but it never
| seems to be enough to actually resolve my chronic poverty and I
| don't get enough feedback affirming that the lives of others suck
| less thanks to me.
|
| That kind of thing is maybe part of what helps drive a
| concentration of money and power.
|
| I think we overregulate small business. You need to know a lot of
| laws and regulations to operate at all and if you are one or a
| few people, that's a big burden. It's less of a burden for big
| business to play that game because they make enough money and
| have enough people that it's a relatively small part of what they
| do and I think that regulatory burden is one of the things
| hampering small business, just like it tends to impede the
| development of affordable housing.
|
| I don't know the answers. I just am skeptical that focusing
| exclusively on breaking up monopolies and putting a break on big
| business actually breathes life into small business. It's perhaps
| a necessary but insufficient precondition.
| nr3msd wrote:
| > _I don 't get enough feedback affirming that the lives of
| others suck less thanks to me._
|
| I have always liked your posts a lot over the years here.
|
| I'm in the same boat, I have created a few things that are used
| by actual people but I have not yet thought about trying to
| make a living that way. Ideally I would open source everything
| and go the Patreon / donation route, but I want to get some of
| my work in order and nail at least one of my bigger ideas...
| then it might be feasible, but for now money is absolutely the
| limiting factor and I don't even need much relative to some :(
| sakex wrote:
| The sentence "Capitalism without Competition is Exploitation"
| immediately makes me think about the many monopolies held by the
| government. Will he do something about those too?
| ratsmack wrote:
| I can understand them going after Ag and Pharma in a big way, but
| I'm skeptical about the Tech part. There is just too much to lose
| in political support from that industry for any politician to
| attack them too aggressively.
| AnimalMuppet wrote:
| But, see, if I'm a politician, it's exactly "there is just too
| much to lose in political support from that industry" that
| worries me. I've seen how much weight they can throw against a
| politician they don't like; I've seen them decide to go from
| "not throwing that weight" to "throwing that weight" very
| abruptly; and I realize that such a move can be made against
| _me_ at the drop of a hat. That would worry me. Would it worry
| me enough for me to risk _triggering_ their wrath right now? I
| don 't know.
|
| As a non-politician, here's what I think needs to happen. They
| either need broken up, or they need heavily regulated. (We
| didn't break up the power companies. But we _did_ create the
| Public Service Commissions to heavily regulate them.) I could
| see a Public Network Committee or something, saying: "No, you
| can't make that change your UI to make it even more addictive.
| No, you can't gouge advertisers. No, you can't directly sell
| personal information..."
| fallingknife wrote:
| The Republicans will never go this route because of the risk
| it would work and be used on other industries. The Democrats
| will never go for this because it would open up social media
| to 1st amendment claims which would prevent the censorship
| they depend on.
| boomboomsubban wrote:
| Both health and agriculture have huge lobbying budgets, I'm
| skeptical that tech offers much more political support than the
| other two.
| deregulateMed wrote:
| What does Ag do? "Efficiency Is Everything" eats for $500/year.
| Compare that to medical which is a minimum of a few thousand
| dollars a year if you are perfectly healthy and $20000 if you
| have a 1 day stay at a hospital.
| colordrops wrote:
| Big Ag is responsible for horrible factory farming practices
| growing the wrong crops and producing food lacking nutrients
| while destroying the environment and torturing animals. They
| take huge subsidies and use them to support these
| unsustainable practices.
| arrosenberg wrote:
| Not to mention the fragile state of supply chains for food,
| the food deserts, absurd water usage.
| heavyset_go wrote:
| The fact that one of the largest famines in the Western
| world as of late was caused by an economic system that
| led to people relying on monoculture crops to feed
| themselves[1], the fact that ours results in
| monocultures, as well, should be worrying.
|
| [1] https://en.wikipedia.org/wiki/Great_Famine_(Ireland)#
| Causes_...
| s1artibartfast wrote:
| What part of that is big ag, opposed to ag in general. I
| don't see the difference on those topics personally.
| worik wrote:
| Economies of scale, when viewed from the perspective of a
| cattle beast in a feed lot are a horrible thing in
| agriculture.
|
| Modern industrial agriculture with its expensive inputs,
| ruination of land, and abuse of live stock is a quite
| horrifying thing and is impoverishing the people
| responsible for the base of our food supply.
|
| It is the most efficient in terms of output per input,
| but not by most other measures.
| s1artibartfast wrote:
| But you don't need to be a monopoly or even a big company
| to have an awful feedlots, monocrop farming, ect.
| warglebargle wrote:
| if you have 2 big companies they're "too big to fail" and
| can better whether lawsuits with massive legal teams,
| settlement money, pr firms... if you have a thousand
| smaller companies you can bankrupt 100 and be ok
| s1artibartfast wrote:
| Wanting to avoid companies that are "too big to fail" is
| a perfectly valid reason to favor smaller companies. Most
| of the reasons above are not.
| warglebargle wrote:
| a lot of it can be rolled into "diversity is better" IMO
| - lots of diverse types of leaders, diverse strategies,
| perspectives, risks, failures, etc... mega large
| companies don't give us as much benefit as they'd like us
| to think... I'd even argue that they're worst in _most_
| ways for 99% of the people involved
| s1artibartfast wrote:
| I prefer a more competitive, dynamic, and diverse market
| for almost all products as well. However, most of this
| thread is pie in the sky wishful thinking that busting
| big corps will solve all of societies ills. Attribution
| of these ills to mega corps often ignores the actual
| problem and obfuscates the real solutions.
| warglebargle wrote:
| sure but you also have to consider that big corps often
| lobby against solutions... busting them up isn't the sole
| solution, but it probably helps
| s1artibartfast wrote:
| I think it could help with some issues, and perhaps hurt
| with others.
|
| I grew up in a farming community and even mom and pop
| farms paid into national associations with a strong
| lobbying arm. on the up side, at least these associations
| favor policy that is usually good for the industry at
| large.
|
| That said, I think the real solution is making sure that
| government officials are accountable and not for sale. No
| amount of big company busting would fix that problem.
| colordrops wrote:
| What you say is true in theory but not in aggregate. It's
| no different from any other business in that respect.
| Look at companies in a field you are familiar with and
| you will find that the very large ones are a lot more
| impersonal, ruthlessly efficient, and amoral.
| s1artibartfast wrote:
| That's the huristic I'm pushing back on: Big = bad,
| efficient = bad, ect. Some problems are indeed
| exaserbated at scale, others are not. I think this is
| especially true for the ag industry and the issues
| mentioned up thread. You can bust up the biggest factory
| farms into 100 smaller companies, but they would still
| have the same practices. Same with monocrop farming.
| longwick wrote:
| But at least the concentration of wealth would not occur,
| and right now wealth = power, which often means anti
| competitive practices like simply buying competitors.
| s1artibartfast wrote:
| I'm not sure that true either. All the same people could
| own 100 farms as easily as one. They would just be
| independent companies.
| fallingknife wrote:
| That may be, but no politician is stupid enough to be the
| one who causes food prices to go up.
| postpawl wrote:
| Even in 2019, 2/3 of Americans supported breaking up big tech
| companies: https://www.vox.com/policy-and-
| politics/2019/9/18/20870938/b...
|
| The political support is definitely there. But if you're
| talking about rich Silicon Valley donors, yeah they might have
| a problem with it.
| ardit33 wrote:
| I think for tech, the forks/knifes are out from both parties,
| for different reasons. As for the other industries, I am much
| more skeptical anything significant will be done.
|
| This administration as pushed lots of 'agendas' just for
| political show even though it new it had 0 chance for them to
| pass and wasting everybody's time.
|
| Time will tell if this is just another political show, or they
| will actually accomplish anything.
| throwawayboise wrote:
| Isn't that exactly the reason they should be attacked?
| FractalHQ wrote:
| I hope it's real. We need modern anti trust laws, big tech is
| out of control. You're right though.. sadly. Most importantly,
| we need to get money out of politics to free our government
| from the grips of these corporate conglomerates.
| dkdk8283 wrote:
| We must free ourselves from censorship.
| worik wrote:
| Clearly you are suffering a lot from censorship...
| seattle_spring wrote:
| Moderation is not censorship.
| thoughtstheseus wrote:
| If there is no viable alternative then it's censorship.
| Put the power of moderation in the hands of people,
| create a market for it, that's a winning strategy.
| seattle_spring wrote:
| What are some of your opinions that can't be shared
| freely on at least some platforms? "Conservative
| opinions" don't count, because if they were actually
| censored then I wouldn't have to have them rammed down my
| throat every minute of every day from every angle.
| Bancakes wrote:
| Cut sugar industry subsidies and promote real food. Covid
| pandemic is nothing to the obesity one.
| gautamcgoel wrote:
| He misspells Tyler Cowen as Tyler Cowan.
| throwawayswede wrote:
| No it can't.
|
| Top 10 spenders on lobbying in 2021: "Lobbying
| Client","Total Spent" "US Chamber of
| Commerce","$17590000" "Pharmaceutical Research &
| Manufacturers of America","$8664000" "National Assn of
| Realtors","$7985521" "American Medical Assn","$6520000"
| "American Hospital Assn","$5852623" "Blue Cross/Blue
| Shield","$5774300" "Raytheon Technologies","$5360000"
| "Amazon.com","$5060000" "Facebook Inc","$4790000"
| "Northrop Grumman","$4610000"
|
| Look up more stuff: https://www.opensecrets.org/federal-
| lobbying/top-spenders
|
| Plus, Biden is the last person to be trusted with this. The
| overall lockdowns in the US are basically a joke. Your government
| let big pharma abuse the entire society for more than a year and
| people are still so discombobulated by what happened that they've
| started to develop a stockholm syndrome.
| pjc50 wrote:
| > Your government let big pharma abuse the entire society for
| more than a year
|
| Explain.
| throwawayswede wrote:
| Lockdowns are useless.
| pjc50 wrote:
| Evidence? Also, motivation?
| throwawayswede wrote:
| One of the principles of public health is that you can't
| just look at one disease isolated, you have to look at
| public health as a whole. With lockdowns there's been a
| lot of collateral public health damages: Cancer
| treatments and scanning that were not provided, worse
| cardiovascular disease outcomes, diabetes not being
| properly taken care of, tragic mental health situation,
| education of kids going to school, and other unintended
| side effects. One of the things known from the beginning
| is that, even though anyone can get infected with covid,
| there's a 1000 fold difference in the risk of mortality.
| [deleted]
| MichaelMoser123 wrote:
| here [1] they say that Kamala Harris is seen as a friend of big
| tech and silicon valley, that would imply she is a friend of big
| tech corporations. Does this step signify a rift between Biden
| and Harris, or is that not the case?
|
| [1]
| http://web.archive.org/web/20210206212101/https://www.nytime...
| jjcon wrote:
| That's possible but the article is a year old. This past year
| and a half I think if you polled the HN crowd you would even
| see a dramatic shift in perspective on proper policy for big
| tech antitrust legislation.
|
| It is not unreasonable to assume those same realizations are
| happening or being expressed by government officials as well.
| MichaelMoser123 wrote:
| it makes sense that Biden wants to tax big corporations to
| finance his infrastructure projects. [1] that would make
| sense if Biden is a big fan of president Franklin D.
| Roosevelt, i am not sure if Roosevelt is as attractive to
| someone from the generation of Harris. (however i don't know
| if the generation aspect is a matter of importance, in this
| context)
|
| [1] https://abcnews.go.com/Politics/wireStory/biden-offers-
| tax-d...
| [deleted]
| bilbo0s wrote:
| Finally, they've started attacking big tech on the privacy front.
| The whole "monopoly" and "anti-trust" thing was going nowhere.
| But privacy orders like this are a step in the right direction.
|
| And to put the nail in big tech's coffin, congress should pass a
| law forbidding the sharing of any personal information on any
| resident of the US for any commercial reason whatsoever. With
| draconian penalties assessed per user infraction. That would stop
| these tech companies in their tracks.
| dodobirdlord wrote:
| While ultimately a ban on sharing personal information for
| commercial reasons would be good in the long term, in the short
| term (many years, certainly, maybe forever) it would serve to
| entrench existing big tech companies. Google, for example,
| doesn't directly share personal information with advertisers.
| Where side-channels exist that would enable advertisers to
| extract data from Google, Google has the scale and the
| resources to create technical solutions like having advertisers
| send their entire software stack to run in Google datacenters
| so that Google can ensure nothing is being logged, and force
| advertisers to comply. Facebook, Amazon, and Apple likely have
| the resources and scale to pull of the same feats. Anybody else
| would be put out of business. Hardly a mandate that would make
| sense in the context of encouraging competition.
| bogwog wrote:
| > With draconian penalties assessed per user infraction.
|
| You mean like chopping off a limb/finger for every violation?
|
| Unfortunately, that won't work for a certain lizardman CEO who
| is purported to be able to regrow limbs.
| bilbo0s wrote:
| I was thinking more along the lines of heavy fines.
|
| I'm not a big supporter of violence against pharma, tech, and
| Ag CEOs. I'm not a big supporter of violence against anyone
| where massive fines will serve the same purpose. In fact, the
| fines would work better.
| ratsmack wrote:
| And how do you feel about sharing the collected data of your
| conversations and travel with government agencies?
| bilbo0s wrote:
| I feel there is nothing the government is going to do about
| that. This doesn't mean that I throw up my hands and say, OK,
| I'll let everyone have all of my communications logs since
| the government has them.
| ratsmack wrote:
| I personally believe being targeted with advertising is
| much less intrusive than the government having unfettered
| access to my daily interactions with people and various
| institutions. I would prefer to not have to worry about
| either.
| wincy wrote:
| After all, now that the NSA has all their spy networks set up
| they don't need the tech companies to do the spying anymore.
| Time to crack down.
|
| Makes me think of an abusive relationship where the abuser is
| very jealous and protective of the abused.
|
| "If anyone spies on my citizens, it's gonna be me!"
| bilbo0s wrote:
| I actually agree with this, it is an abusive relationship.
| Only the abuser has a gun to your head so there's nothing you
| can do about it.
| qeternity wrote:
| > And to put the nail in big tech's coffin, congress should
| pass a law forbidding the sharing of any personal information
| on any resident of the US for any commercial reason whatsoever.
|
| At this point, a huge number (majority?) of Facebook et al
| users know what Facebook are doing. They value their own data
| less than Facebook do and are happy to trade it in return for
| free social media service. You may not like it, but free people
| should be able to engage in a transaction if it's not
| infringing on other peoples' rights.
|
| I'm not sure why you would know what's better for them than
| they would.
| laurent92 wrote:
| Some people buy an iPhone just because Apple imposes
| draconian rules on Facebook. People do put a price on
| privacy, thousands of dollars probably.
|
| When you reduce the value of interconnecting people to a
| linear scale, it's unfair. How much value do you put on a
| friendship? How much value do you extract from belonging to a
| Facebook group? It's probably a million dollars per person.
| It doesn't mean the privacy part isn't extracted by coercion,
| taking friendships as hostage, threatening to remove you from
| participation to a lot of the social life if you revoke your
| Facebook account.
| qeternity wrote:
| > thousands of dollars probably.
|
| > How much value do you extract from belonging to a
| Facebook group? It's probably a million dollars per person.
|
| No idea what you're on about. The average person doesn't
| buy Apple products, they have a small percentage of market
| share. You're just throwing absurd numbers around.
|
| You've argued my point: people value socialization
| (millions, according to you) more than they value privacy
| (mere thousands, again according to you).
|
| Nobody forces anybody to use Facebook. Yet billions use it.
| It boggles my mind when people feel they should dictate
| other people's personal choices.
| tomschlick wrote:
| Nit: Apple has 52% of the US mobile market share:
| https://www.statista.com/statistics/266572/market-share-
| held...
| qeternity wrote:
| And has about 15% market share globally...
| tomschlick wrote:
| This entire thread is about the US taking action. Global
| market share doesn't matter in this case.
| jeffreygoesto wrote:
| It is infringing other's peoples rights. Shadow profiles are
| and even if you paid for subscriptions everywhere in the net,
| you could not get away untracked and being targeted for ads
| you neither want nor need.
| qeternity wrote:
| I'm not saying I agree with it, but what rights are being
| violated by shadow profiles?
| Mountain_Skies wrote:
| Facebook shares lots of data about people who have never
| signed up for a Facebook account. Everyone is a Facebook
| "user" whether they want to be or not.
| qeternity wrote:
| Well, I guess this makes sense because you can be a
| Facebook user without an account...
| Supermancho wrote:
| > Facebook shares lots of data about people who have never
| signed up for a Facebook account. Everyone is a Facebook
| "user" whether they want to be or not.
|
| Same with Twitch/AMZ, YouTube/GOOG, Target, Wall Street
| Journal, etc. It's basically the state of digital
| advertising today, which is not remotely limited to or
| monopolized by FB. I've worked on the adservers, across
| multiple companies, for over 15 years now.
| jbluepolarbear wrote:
| Source because I'm pretty sure that's not true. If that was
| true GDPR wouldn't exist in the EU. California has CCPA in
| the works which is similar/same. People don't like how big
| tech is using their data and actions are being done to
| counter it.
| LatteLazy wrote:
| A lot more people support action than support any given outcome.
| I worry that the majority will be disappointed by the outcome
| because of this.
|
| Take the big tech action: some people support it because they
| want less censorship (that's me), others because they want more.
| The same applies in other aspects of peoples' issues with big
| tech (fake news, hate groups, grooming and CP, privacy, foreign
| election meddling etc). We can't all be happy with whatever the
| FTC does to social media sites can we, given we mostly want
| different things.
| dukeofdoom wrote:
| Is he really in a position to keep doing this? Biden recorder the
| most votes in history, while winning the fewest counties. That's
| a head scratcher. The fact remains most of the geographic area of
| the country voted red. If he keeps this up, states are going to
| start ignoring his executive orders. That's not how democracy is
| supposed to work. Laws get passed by legislature, not by dictate
| of the King.
| jbluepolarbear wrote:
| Go home QAnon.
| jbluepolarbear wrote:
| Since my other got flagged, you're clearly a confused person.
| You post videos of trumps lies and defend some narrative that
| does harm to our democracy. The election was won by Biden.
| SV_BubbleTime wrote:
| > Biden recorder the most votes in history, while winning the
| fewest counties.
|
| Say what now? That doesn't seem right.
| dukeofdoom wrote:
| "Biden won 81 million votes and 509 counties in the Nov. 3
| election, while Trump won 74 million votes and 2,547
| counties, according to data aggregated by think tank the
| Brookings Institute. Obama won 69 million votes and 873
| counties in 2008. " https://www.usatoday.com/story/news/factc
| heck/2020/12/23/fac...
| ModernMech wrote:
| > Biden recorder the most votes in history, while winning the
| fewest counties. That's a head scratcher.
|
| Why is that a head scratcher? 40% the us population lives in
| just 100 counties (of 3000)
| dukeofdoom wrote:
| The stacking of improbabilities is a head scratcher. 12
| million vote increase over Obama with 300+ fewer counties.
| Must be wildly more popular. Yet was losing the nomination of
| his own party. Can't 10k views on youtube, but somehow more
| black people turned out to vote for him in Detroit than
| Obama. I, like 40%+ of Americans have doubts about this
| Election.
| dragonwriter wrote:
| > The stacking of improbabilities is a head scratcher. 12
| million vote increase over Obama with 300+ fewer counties.
| Must be wildly more popular.
|
| Counties are a meaningless, nonuninform unit, and even if
| they were the exact same counties minus 300, so what? That
| just means bigger margins in the counties he won, which
| would be consistent with greater regional polarization.
|
| > Yet was losing the nomination of his own party.
|
| Biden was the clear winner much sooner in the process than
| Obama was.
|
| > more black people turned out to vote for him in Detroit
| than Obama.
|
| Why is it surprising that more black people turned out to
| vote _against_ Trump than McCain? (That votes in a two-
| party system are quite often more against the oppoaing
| major party than really "for" the partt marked is well-
| known.)
| ModernMech wrote:
| I just don't understand why you're focusing on the
| counties. Obama's win was over a decade ago. People move
| around and concentrate in cities.
|
| What would have been wildly improbable was Biden's opponent
| winning. The man was deeply unpopular, failed to win the
| popular vote _twice_ , couldn't crack 50% approval for 4
| years, was impeached, was being blamed for the terrible US
| government pandemic response, and had some of the deepest
| most consistent unpopular ratings of any president since
| that kind of sentiment has been tracked. Talk about
| stacking improbabilities.
|
| > I, like 40%+ of Americans have doubts about this
| Election.
|
| I can understand having some doubts after the election --
| it was a very tumultuous time. But why do you still have
| doubts today? The dust has settled, the results have been
| looked at in Wisconsin, Michigan, Pennsylvania, Georgia,
| and Arizona, and no systemic fraud was found. Just read
| this report by Michigan Republicans [1]. They earnestly
| looked at everything alleged and found _nothing_.
| Absolutely nothing. What exactly are you having doubts
| about except vague feelings of improbability related to
| counties? Improbable things _do_ happen, yes?
|
| [1] https://misenategopcdn.s3.us-
| east-1.amazonaws.com/99/doccume...
| alessandroetc wrote:
| It's not actually real. The lobbying firm behind most of the fact
| sheet is made up of people on the boards of different tech firms.
| [deleted]
| chelmzy wrote:
| Do you have a source for this? I'm extremely curious.
| seriousquestion wrote:
| Related? "WestExec represented major corporations throughout
| the Trump years. Now it's in the White House."
|
| https://theintercept.com/2021/07/06/westexec-biden-administr...
| nojs wrote:
| Betteridge's law of headlines strikes again :)
| landryraccoon wrote:
| What fact sheet are you referring to? I'm curious what names
| are on it.
| epistasis wrote:
| This is a very serious accusation, but I can't find any
| substance to it, and it doesn't make much sense. What tech firm
| have lobbyists on their board?
|
| Presumably you're talking about this fact sheet?
|
| https://www.whitehouse.gov/briefing-room/statements-releases...
|
| If a lobbying firm is behind official White House
| communications, and not WH-employed staff, that alone would be
| a serious allegation. But to say that tech is behind this is
| even worse.
|
| Where is the evidence?
| ampdepolymerase wrote:
| How about Big Telecom and Big Fintech and Banking? Or is it
| simply because the rest did not pay enough to the lobbyists?
| bilbo0s wrote:
| The ISPs have been getting hit in this series of orders.
|
| That said, yes, fintech and banking are conspicuously absent.
| Which kind of lets you know that they are just too powerful.
| fastssd wrote:
| And people say crypto is bad. Sad world we live in.
| TheRealPomax wrote:
| Or that you really, really need to establish precedent (and
| ideally, a pttern) by first successfully going after the
| "easier" targets. It's much easier to go after fintech and
| banking if you can go "what's the problem, you're just next
| in line, your industry's hardly getting singled out"
| dodobirdlord wrote:
| Banking is getting impacted in this series of executive
| orders, there's a mandate that banks make customer financial
| history portable so that customers aren't locked into
| continuing to use their current bank to keep their financial
| records. Aside from that issue that stops customers from
| being likely to _switch_ banks, there's a ton of competition
| in banking. There are many consumer banks, they all provide
| essentially the same services, and they compete on things
| like branch density, customer service, and saving /loan
| rates. Aside from that, consumer banking is already one of
| the most regulated industries.
|
| Fintech consumer products and services are rare with the
| exception of tax preparation. E-trading is becoming more
| popular, but existing consumer banks and brokerages are
| stepping up to compete across the board. Intuit's TurboTax
| product is really the only example I can think of in the
| fintech industry that needs antitrust attention.
| kyawzazaw wrote:
| when you say fintech, which companies are you referring to
| jeffbee wrote:
| There's much more in the actual order addressed toward banks
| and telcos and ISPs than there is language directed at "big
| tech".
|
| https://www.whitehouse.gov/briefing-room/presidential-action...
| summerlight wrote:
| This executive order is really comprehensive, it touches
| literally every economical areas where competitions are
| withering away. To be specific, I think this part addresses
| your concern on big telecoms. > (l) To promote
| competition, lower prices, and a vibrant and innovative
| telecommunications ecosystem, the Chair of the Federal
| Communications Commission is encouraged to work with the rest
| of the Commission, as appropriate and consistent with
| applicable law, to consider:
|
| The following also partially addresses big banks, though I'm
| not sure it's sufficient enough to tame them. Better than
| nothing though. > (e) To ensure Americans have
| choices among financial institutions and to guard against
| excessive market power, the Attorney General, in consultation
| with the Chairman of the Board of Governors of the Federal
| Reserve System, the Chairperson of the Board of Directors of
| the Federal Deposit Insurance Corporation, and the Comptroller
| of the Currency, is encouraged to review current practices and
| adopt a plan, not later than 180 days after the date of this
| order, for the revitalization of merger oversight under the
| Bank Merger Act and the Bank Holding Company Act of 1956
| (Public Law 84-511, 70 Stat. 133, 12 U.S.C. 1841 et seq.) that
| is in accordance with the factors enumerated in 12 U.S.C.
| 1828(c) and 1842(c). > (t) The Director of the Consumer
| Financial Protection Bureau, consistent with the pro-
| competition objectives stated in section 1021 of the Dodd-Frank
| Act, is encouraged to consider:
| Animats wrote:
| We need to bring back the Glass-Stegall Act, which kept banks
| and brokerages separate. It's not really about competition,
| though; it's about isolating broker failures from bank
| failures. That was in Trump's plaform, by the way.
| nr3msd wrote:
| There is nothing concrete in any of those three points.
|
| I read through the whole thing, there are some decent ideas
| but a lot of filler.
| justbored123 wrote:
| Well, the Obama admin that included him was fully in the pocked
| of the bankers as revealed by Wikileaks. They chose 29 of 31
| cabinet positions. Seems that not much has changed there.
|
| https://newrepublic.com/article/137798/important-wikileaks-r...
| ergocoder wrote:
| I have no idea why big tech is in there.
|
| If you think Google, apple, Microsoft, and Facebook are evil,
| then other kinds of business like Pharma, insurance, bank,
| agriculture are 10x Satan reborn combined.
| mlindner wrote:
| Well those haven't had a couple decades of time working with
| the government to build regulations that suit them. They're
| early stage still.
| Apocryphon wrote:
| > Facebook and Amazon are now the two biggest corporate
| lobbying spenders in the country.[9]
|
| > Big Tech has eclipsed yesterday's big lobbying spenders,
| Big Oil and Big Tobacco. In 2020, Amazon and Facebook spent
| nearly twice as much as Exxon and Philip Morris on
| lobbying.
|
| > Big Tech's lobbyists are not just numerous, they are also
| among the most influential in Washington. Among the 10
| lobbyists who were the biggest contributors to the 2020
| election cycle, half lobby on behalf of at least one of the
| four Big Tech companies. Together, just these five
| lobbyists contributed over $2 million to the 2020
| elections.
|
| https://www.citizen.org/article/big-tech-lobbying-update/
| noelherrick wrote:
| This is more about power and reach. I'm going to pick on
| Facebook since they are easy to dislike. They are the medium
| of disinformation that is hurting the US and the world.
| First, people are joining extremist groups due to FB
| recommendations [0]. Second, vaccine misinformation has been
| spreading on FB. [1] Those are two horrific examples, but
| there's more.
|
| 0. https://foundation.mozilla.org/en/campaigns/facebook-stop-
| gr... 1. https://www.vox.com/recode/22319681/vaccine-
| misinformation-f...
| Jenk wrote:
| Some is better than none.
| annadane wrote:
| No, this is Hacker News, where we have to gripe about every
| single little thing until it loses all fucking meaning
|
| Edit: you downvote me because you know this is exactly how it
| goes around here
| Notanothertoo wrote:
| Yes and that's a good thing. Politics is mostly a game of
| pretend and therefore bullshit, as uhh.. engineers we like
| to be more practical. We simply see the bullshit they are
| selling regardless of political affiliation. If they wanted
| to actually solve problems the approach and results would
| be totally different.
| jfengel wrote:
| _Politics is mostly a game of pretend and therefore
| bullshit, as uhh.. engineers we like to be more
| practical._
|
| I've found that when engineers talk about politics,
| they're no more practical than anybody else. On HN I see
| a ton of uninformed and simplistic overbroad solutions.
| They imagine it's pragmatism, but they don't actually
| know any of the real problems.
| momento wrote:
| The irony of griping on HN about griping on HN.
| specialist wrote:
| Around 2005, I asked Kevin Phillips:
|
| Me: According to your book, America's political parties have
| flipped every ~70 years. It should have happened around the time
| of Ross Perot, so I guess we're overdue. Do you think another
| realignment is emminent?
|
| Phillips: No. It won't happen while Wall St. and finance remains
| in control of our political discourse.
|
| --
|
| It'll be amazing if Biden Admin is able to uncork the next cycle.
| But I'm not holding my breath.
|
| Wealth and Democracy: A Political History of the American Rich
| [2003] https://www.amazon.com/Wealth-Democracy-Political-History-
| Am...
|
| Here's a more recent account:
|
| Lobbying America: The Politics of Business from Nixon to NAFTA
| [2015] https://www.amazon.com/Lobbying-America-Politics-Business-
| So...
|
| Edit: I changed "Last decade" to "Around 2005". Time flies. My
| bad.
| the-dude wrote:
| > hospital price transparency,
|
| Wasn't this already put in place by the previous administration?
| ryanSrich wrote:
| Of course it was, also see "value based care". It's all
| bullshit.
|
| Hospitals have zero incentive to be transparent, and all the
| incentives to be opaque. So long as you're a non-
| Medicare/Medicaid patient you'll continue to suffer.
|
| The American healthcare system is completely fucked (there's no
| better word).
| o8r3oFTZPE wrote:
| Is it fscked for physicians and various healthcare
| professionals (e.g., paid higher wages than other countries
| with different systems). Is it also fscked for wealthy
| patients who do not really care about costs.
| adventured wrote:
| > Is it fscked for physicians and various healthcare
| professionals
|
| It's an underappreciated point. The US healthcare system is
| one of the largest wealth transfer systems ever invented.
| It's a heavily protected cartel that plunders wealth from
| the top 2/3 and lines the pockets of a few million
| employees in the system.
|
| There is an excess cost bounty of $1.2 trillion (or more)
| being plundered and redistributed every year to the
| healthcare cartel.
|
| There are millions of people working artificially high
| paying jobs in the healthcare cartel in the US courtesy of
| the hyper inflated costs in the system. From nurses to
| doctors to pharma sales reps to scientists to management
| and everything inbetween.
|
| Nobody ever talks about the need to slash the pay of nurses
| & doctors though, it's far too unpopular of a subject, it's
| downright taboo. Just a notch below slashing the pay of
| teachers. They'd all go on strike tomorrow morning if a
| serious attempt were made to bring their pay in-line with
| other developed nations.
|
| The US has to remove a minimum of $1.2 trillion in cost
| from its healthcare system (which would produce an end cost
| structure still far above that of eg Britain). Only about
| 10-15% of that can come from slashing costs out of the
| pharma drug price side. The bulk of it has to come out of
| inflated salaries of millions of workers in healthcare
| across the board.
|
| When politicians talk about universal healthcare in the US,
| they always, without exception, go far out of their way to
| dodge this epic scale problem of inflated salaries in
| healthcare and of where to find $1.2 trillion in costs to
| slash (they primarily focus on high drug prices as a matter
| of political convenience; that segment by itself won't
| remotely cut it though). This is why every time a state
| decides it's going to look at doing universal healthcare,
| it immediately runs away after the cost study is completed,
| it's impossible until you remove a dramatic amount of cost
| from the system. Now someone go tell all the nurses and
| doctors in California they get to make 25%-35% less money
| (good luck).
| AussieWog93 wrote:
| About 50% of that $1.2 trillion is in unnecessary admin.
| FlyingLawnmower wrote:
| Do you have some sources where I can read up more on
| this? I have always believed that the cost of front line
| worker salaries (Doctors/Nurses) was a relatively small %
| of the total cost of healthcare.
|
| Studies like this [1] led me to believe that massive
| rises in administration costs and inefficiencies due to
| insurance structure are bigger culprits than doctor/nurse
| salaries. But I am admittedly not very well informed in
| this area.
|
| [1] https://pubmed.ncbi.nlm.nih.gov/31905376/
| pininja wrote:
| Do you have an example of a cost study? I'm curious, but
| don't know how to find one.
| hamandcheese wrote:
| I mean, someone is paying the price anyways, right? Why
| cant we as a society continue to pay the same (inflated)
| price now, but give the government the leverage it needs
| to fix the problem over several decades?
| borski wrote:
| I see your point, but I will raise you that medical
| training in other countries doesn't also put you in
| hundreds of thousands of dollars of debt before you've
| even begun to practice. The cost of a medical education
| has a _large_ impact on why salaries are "artificially"
| inflated.
| hn_acc_2 wrote:
| Sure, high salaries are justified for this minority.
|
| The people mentioned specifically in the comment are of
| more concern; sales, admin, etc. salaries in this field
| are also inflated compared to other industries.
| borski wrote:
| Got it. Thanks for the clarification. I think I agree on
| that.
| r0m4n0 wrote:
| Removing insurance companies from the equation saves
| billions. There are hundreds of thousands of insurance
| employees working on complex payer software, business
| workflows, payments, clearing houses, membership, plan
| negotiations, sales, actuarial, claims, member support
| etc. Also on the hospital side all the people that
| interface with the insurance companies.
|
| There would be some overhead for single payer but it
| would be much more efficient and simple.
|
| Massive insurance company dissolution might also be an
| unpopular reality for folks to come to terms with as well
| though
| sethammons wrote:
| A couple years past, def under Obama, I went in for a retina
| exam. They absolutely could not tell me the price for the
| appointment. "It depends on services rendered" - "what if it is
| a standard appointment with no extra services, how much (ball
| park) should I expect? $50? $500? $5k?" - "I couldn't tell you,
| I can't imagine that high."
|
| There is no price transparency. Sure would like it since I have
| a high deductible plan.
| ClumsyPilot wrote:
| If the customer won't be told the price and can't opt out,
| it's not market, it's a racket.
| bushbaba wrote:
| Price transparency plus high deductible plans would drive the
| cost of health insurance down.
|
| Health insurance is supposed to cover you for catastrophic
| health issues that were previously unknown. For some reason
| it changed to also cover all your recurring or minor
| illnesses.
| riverlaw2 wrote:
| I agree with your take. I work in the industry. The for
| some reason has partly to do with the U.S. tying insurance
| to your employer and not charging taxes. It makes sense to
| offer as much as possible pretax.
| acdha wrote:
| It'd help a little but it'd still be a long way from an
| Econ 101 market. Preventative care is hugely effective at
| reducing costs but high-deductible plans ensure that many
| people will not get it.
|
| Many people simply aren't capable of shopping around,
| either: emergency care, cognitive impairments, limited
| geographic options, and the conflicts of interest inherent
| to for-profit medicine all make it hard for people to know
| what they need and whether it's worth the money. As with
| preventative care, making it harder to get treatment is
| certain to lead to many people not getting problems treated
| prior to them becoming major.
| warble wrote:
| You don't need everyone shopping around. You just need
| enough to drive the market, it isn't even necessarily a
| majority.
| acdha wrote:
| Kind of like how list price means everyone pays the same
| price for a car? What would happen is more of what we
| already see: tons of addons being pushed, rebates or
| other ways to adjust prices for some people without
| lowering them, random specialists and unnecessary
| services being pulled in relying on the fact that most
| people don't realize they can and should say no, and a
| whole industry of people finding ways to say you had some
| obscure complications not covered by the standard price.
|
| Look at it from an economic incentive standpoint:
| Americans pay 2-3 times more for the same service. That
| is a huge amount of money, and it ensures that rooms full
| of smart people will be working to ensure that their
| employers continue to get it.
| bushbaba wrote:
| Flip side you can actually shop around for the best car
| price. Can't even do that at us hospitals
| acdha wrote:
| Exactly - it's not a normal market and there are hard
| limits preventing it from ever working like that, no
| matter how many people desperately try to pretend
| otherwise because it's personally profitable for them.
| epistasis wrote:
| I'm not so sure. There's a lot of waste in _all_ of our
| health care system, and many areas are served by few care
| providers. Transparency on prices without effective
| competition won 't change much.
| spaetzleesser wrote:
| You have to start somewhere. Knowable prices are the
| first prerequisite for markets.
| epistasis wrote:
| That's an excellent point! It can't hurt, and might help.
| I don't know why I felt negatively about it at first,
| anything to start disrupting the bad parts of the system
| should be welcome.
| alasdair_ wrote:
| Part of that is because it's far cheaper to catch (say)
| cancer at an early stage and treat it than it is to catch
| it at stage 3 or 4 and spend potentially millions on a
| possibly preventable catastrophe.
|
| There is fairly strong evidence that if the cost of routine
| preventative care isn't paid by insurance, quite a lot of
| people opt to skip it because they can't afford it, leading
| to worse outcomes.
| jdlshore wrote:
| > leading to worse outcomes.
|
| Do you have evidence of this part specifically? Because
| the Oregon Experiment found no improvement in health
| outcomes in a large randomized trial of low-income
| recipients of Medicaid. (Partly because their health was
| generally good in the first place.)
|
| https://en.wikipedia.org/wiki/Oregon_Medicaid_health_expe
| rim...
| t-writescode wrote:
| It's the entire model to Kaiser Permanente, so it's
| working for someone.
| WillPostForFood wrote:
| _It's the entire model_
|
| It is part of large complicated model. If it was their
| entire model they wouldn't be operating medical offices
| and hospitals. It is the whole package that helps them
| control costs.
| [deleted]
| t-writescode wrote:
| It is my understanding that obligatory routine care is a
| major component of Kaiser's model. In the experience of
| those I know who use Kaiser, effectively, if they come in
| for something and their routine checkups are out of date,
| they're obligated to get that routine checkup (at the
| same time due to streamline of service), before they can
| get what they came in for.
|
| From this, I derived the argument that routine checkups
| are a *major* component of Kaiser's system, to the point
| that, given the flow of discussion, I felt it appropriate
| to call it "their whole model". I'm sorry my hyperbole
| was too far.
| recursive wrote:
| I've been on a Kaiser plan for years. I don't think I've
| ever had a "routine checkup", but have had other
| services.
| ak217 wrote:
| Kaiser has no specific preventative care requirements and
| does not withhold care if you are not up to date on some
| schedule. In fact Kaiser works pretty much exactly like
| any other HMO with the main difference being that
| insurance is in-house (but a different department, so
| insurance screwups still happen, but at least the
| hospital and the insurance are not constantly fighting
| each other with you stuck in the middle).
|
| Well that and with Kaiser it's a lot easier to tell who
| is in network (they never commingle in and out of network
| care).
| t-writescode wrote:
| That's interesting. The person I'm familiar with wasn't
| allowed to get meds for their strep throat until they
| went through their regular exams since it had been a year
| or over one or something. It was all very, very quick,
| but they were quite serious about getting their regular
| checks in. The patient in particular was in her 50s at
| the time, so perhaps that's where the difference comes
| in?
| nradov wrote:
| You're not getting the whole story from that person.
| Competent providers will strongly recommend preventative
| care services but patients can always refuse.
| co_pilates wrote:
| If we had socialized medicine like my local Kaiser, I
| would be so excited. I honestly haven't been treated
| anywhere else with the same level of care and concern. I
| used to hate doctors because of bad experience, but the
| Kaiser system convinced me to take care of myself on a
| routine basis. Just one opinion, but thought I'd share.
| ak217 wrote:
| Glad it worked for you. I've had both good and terrible
| experiences at Kaiser (in pretty serious circumstances
| such as major op and post-op experiences), and a similar
| spectrum at other HMOs. I don't think Kaiser is a
| panacea, although I agree single-payer looks like the
| only way to fix the systemic economic issues and Kaiser
| is a bit closer to that model than other HMOs.
| hanniabu wrote:
| I had no health insurance so put off on a specialist i
| needed to see until i could sign up for medicaid (can
| only apply at the end of the year for some retarded
| reason). Just putting my issues off for 4 months turned
| an easy thing to fix into needing to spend the past 8
| months in and out of the doctors and hospital.
| Volundr wrote:
| If the plural of anecdote is data, when the ACA was first
| rolled out, someone close to me discovered they had colon
| cancer. They had been having symptoms for quite some
| time, but had been managing them with home treatment, the
| first day the had insurance they went to get it checked
| out. Lucky they did, as devastating as it was (and
| continues to be, turns out your chemo is brutal and
| having large sections of your colon removed isn't great
| either) their doctors already weren't sure they could
| treat it effectively.
|
| While they credit the ACA with saving their life, had we
| had some form of socialized medicine from the start, this
| likely would've been caught much earlier, treated much
| more easily, and with significantly less long term
| effects.
|
| I couldn't easily find studies on preventative care
| leading to better outcomes, but given how many diseases
| (like cancer for example) can go from easily treatable to
| a catastrophic nightmare depending on how early they are
| detected, I find it hard to believe that easy, cheap (or
| free) access screenings would have no effect on outcomes,
| though I realize how treacherous it can be to rely on
| instinct instead of data.
| jdlshore wrote:
| Counterintuitive as it may be, the Oregon Experiment
| showed _increased_ costs.
|
| It did show an improvement is psychological outcomes, I
| presume due to peace of mind, because their wasn't a
| corresponding increase in psychiatric medication.
| freeone3000 wrote:
| Did the increase in cost also come with an increase in
| outcomes? I don't think it's counterintuitive that people
| who couldn't afford healthcare see a doctor, you'll see a
| lot of issues; did we see a decrease in medical issues
| across the population?
| jdlshore wrote:
| No, there was no increase in health outcomes.
| nradov wrote:
| The Accountable Care Act (Obamacare) requires most health
| plans to cover several screening services at no cost to
| the patient.
|
| https://www.healthcare.gov/coverage/preventive-care-
| benefits...
| giantg2 wrote:
| Only for billing cost of procedures. It's still a mess.
|
| Did you know that hospitals make money by using name brand
| medications? They will get a contract with a brand, like
| Motrin, and charge you full price at $8 a pill. Then Motrin
| will will evaluate how much the hospital used and give them a
| big rebate to bring the hospital's cost down under $1 per pill.
| You can literally buy a bottle of ibuprofen for what they
| charge for a single pill, but of course in the name of safety
| (and really kickbacks too) they won't allow the cheaper outside
| medication. It's effectively an internal monopoly.
| revscat wrote:
| I'm not sure what your point is. These contracts between
| seller and merchant were voluntary. There are other hospitals
| available should you choose, and if not then you have no one
| to blame but yourself.
| pfisch wrote:
| Is this supposed to be satire or are you so disconnected
| from reality that you think this makes sense?
| LimaBearz wrote:
| I love how conservatives still make this argument. You're
| arguing for the free market in a system that literally
| isn't, and doing it in such a way that it tries to be a
| thought-terminating cliche.
|
| If you get into a car accident tomorrow driving to work,
| the ambulance/paramedics aren't going to ask you to do your
| research prior to shuttling you to a hospital to get life
| saving treatment. Even if you could how would you be able
| to tell which hospital has what price structure, what
| services you'll actually need given your medical condition,
| and what arrangements they have with various drug
| manufacturers and how that relates to what you require to
| help your condition. Save it.. "no one to blame but
| yourself" is so incredibly idiotic is comical.
|
| Take something even more benign, like someone falling and
| breaking/straining something. Wanna still do your research
| first? Is it a sprain, fracture, break? How do you know? Is
| it clear cut? What pain medication will you need? Will you
| require surgery? What lab work will you need? How many
| tests will you need? X-rays? CAT scan? MRI? What kind of
| surgeon? How many nurses? Will you require blood? Whats the
| recovery like? What about follow up visits? Do you expect
| us all to practice free market principles and know all that
| crap in advance for price discovery before deciding to seek
| treatment?
|
| True free market principles require an asymmetry of
| information for the system to work, and even "fathers" of
| the theory understood that and acknowledge the need for
| regulation when its absent.
| Karsteski wrote:
| I agree with the premise of your argument, but why did
| you have to start it with "I love how conservatives still
| make this argument"?
|
| You have no idea what that person's thoughts or beliefs
| are...
| ozfive wrote:
| Because this is the premise of the conservative argument.
| The thoughts are clearly conveyed.
| visualradio wrote:
| Price transparency regulations could also be used to
| implement public price controls or public fines on
| monopolies engaging in price discrimination.
|
| For instance if a provider billed a patient over 100% of
| their stated price or over 120% the minimum price for the
| same item published by comparable providers, there might
| be some public fine or tax on the biller and rebate to
| the patient in proportion to the entire amount by which
| the patient was over-billed regardless of their insurance
| status.
|
| This would possibly amount to something similar to
| universal public price negotiation.
|
| But yes the idea of using pricing transparency to
| suppress over-billing by monopolies could possibly be
| interpreted as suggesting a rejection of the alternative
| idea of centrally fixing all consumer facing prices using
| a public office and then determining all government
| facing prices from external suppliers providing necessary
| inputs for the public healthcare system through minimum
| bid.
| borski wrote:
| Parent is not labeling the poster as conservative; he is
| labeling the argument as the underpinning of the same
| argument conservatives often make. That's a nuanced
| difference.
| visualradio wrote:
| If we are concerned with nuance, there's probably at
| least 2 different conservative arguments.
|
| There is the hyper-libertarian argument which says that
| if someone arrives at a hospital unconcious, and the
| hospital bills them the maximum amount they estimate the
| patient can pay before bankruptcy, so the hospital can
| maximize initially reported earnings before writing down
| unpaid debts, that this is somehow a voluntarily market
| price as long as the hospital is private and not owned by
| the government, because value is purely subjective and
| has no relation to cost.
|
| Then there is the other argument which says if hospitals
| are over-billing people which are under duress, that this
| is bad and we want to do something about it, but we don't
| want to immediately nationalize healthcare and ban
| private health insurance. This second type of
| conservatism usually focuses on price controls or
| regulation of monopolies.
|
| With pricing transparency regulations, it's probably
| possible to implement universal public price negotiation
| by fining non-elective healthcare providers which bill
| patients over 100% of their previously published price or
| 120% of the minimum price published by comparable
| providers. Then rebate patients the entire amount they
| were over-billed regardless of their insurance status.
|
| With over-billing rebates there is less need to collect
| payroll tax to finance social insurance premiums. Need
| based assistance could be financed from more progressive
| property taxes on the rich, and the actual price controls
| could be implemented relatively cheaply by randomly
| auditing providers to ensure compliance, by allowing
| patients to manually submit invoices whenever they felt
| they were over-billed, and by financing rebates to
| patients entirely from fines on providers.
|
| It's certainly possible that other systems would work
| better. However if we want to be nuanced there are many
| different strands of U.S. conservatism. Historically U.S.
| conservatives subscribed to some form of cost or labor
| theory of value. The kind of hyper-libertarian
| conservative movement which says private prices are
| always fair is probably less than 100 years old.
| bobthechef wrote:
| > and even "fathers" of the theory understood that and
| acknowledge the need for regulation when its absent.
|
| I would emphasize that traditional forms of conservatism
| were never opposed to all regulation and never embraced
| this libertarian worship of the unregulated market. They
| were opposed to collectivism, but the only remaining
| option isn't radical individualism. Neither are good for
| the individual or for society.
| nick__m wrote:
| I think you meant : True free market
| principles require a symmetry of information for the
| system to work
|
| But great post otherwise!
| ozfive wrote:
| Why is this being downvoted?!?!
| epistasis wrote:
| Too political without basis, I would guess.
| nr3msd wrote:
| The basis is so completely obvious though, if your health
| is badly compromised then you will be much less able to
| make good decisions in any circumstances, let alone
| dealing with the current for-profit healthcare system in
| the US.
|
| You Americans are getting so screwed... I got 4 separate
| X-ray scans done for $40 recently, modern machine, sent
| home with physical copies and USB, etc.
| BuyMyBitcoins wrote:
| I've actually tried to "shop around" for hospitals and it's
| basically impossible. Just about everything is hidden
| behind some barrier and there's just no way to effectively
| compare prices. Additionally, you really have no idea what
| products or services you'll end up receiving while at the
| hospital.
|
| Most importantly, ALL of this planning and sense of choice
| goes out the window when you have a true emergency. When
| that happens all that matters is getting to an ER, fast.
| to11mtm wrote:
| > Most importantly, ALL of this planning and sense of
| choice goes out the window when you have a true
| emergency. When that happens all that matters is getting
| to an ER, fast.
|
| Yep. I was a victim of this in the -worst- way. 11 years
| ago I was hospitalized, and it 'just so happened' that
| the only doctor that would take me while I was admitted
| was out of network.
|
| BCBS of Michigan in fact later settled out of court in a
| class action over this behavior, although the 50 or 100$
| I would have gotten certainly did not make up for the
| hundreds of dollars that the out of network provider cost
| me.
| lumost wrote:
| Not to mention that for scheduled procedures nearly every
| doctor will require their own imaging for 40-50k a pop at
| list price before even discussing treatment options and
| cost.
| giantg2 wrote:
| What kind of imaging? That seems really high.
| alisonkisk wrote:
| Are you trolling?
|
| A hospital has even more lock in than the App Store. They
| can literally legally lock you in.
| raspasov wrote:
| At least in the US, that would have to go through a
| court. I don't think a hospital can force you to stay in.
| giantg2 wrote:
| They mean lock you in to their services only. Once you're
| in there you're forced to pay for whatever services they
| provide, which could be a lot in an emergency or if your
| unconscious. I think they were also referencing the idea
| that you are forced to pay a high amount for Motrin, when
| an alternate source would be much cheaper.
| giantg2 wrote:
| Not everywhere has multiple hospitals to choose from. Even
| if there are multiple hospitals, your insurance might
| influence your choices too. And at the end of the day, if
| you're incapacitated, they will just take you to wherever
| is closest.
|
| The point was that the hospitals are doing things behind
| the scenes that are not well known that affect the pricing.
| In this example, they charge you more for using name brand
| medication and then get a kickback to make money for
| themselves.
| ModernMech wrote:
| > These contracts between seller and merchant were
| voluntary.
|
| I'm guessing you've never been placed on an involuntary
| psych hold, or woken up at a hospital after an accident
| left you incapacitated.
| jwilber wrote:
| This may be the most uninformed comment I've ever read in
| this site. Ever.
|
| Just completely clueless as to how things are/operate
| regarding healthcare in the real world.
| dralley wrote:
| The hospital you end up in is not a free market and usually
| it's not even a choice. Anyone who who gets in a car
| accident, falls off a roof, has a heart attack will be
| lucky to still be conscious when the ambulance picks them
| up, much less in a state of mind to be considering the
| relative merits.
| dantheman wrote:
| Yet emergency care is relatively small portion of health
| care costs - so maybe deal with that last. It'd be hard
| for hospitals to make the case that emergency care is
| substantially more costly than similar procedures they
| offer.
| unishark wrote:
| Even for ER visits alone, it's not true that patients are
| "usually" incapacitated or on the verge of death.
| Something like a third aren't even urgent and only a
| small percentage are admitted to the hospital. And the
| most common reasons for visits are mostly pain complaints
| with a conscious patient. On average people get triaged
| to the waiting room to wait for 40 minutes or whatever.
|
| There was a thread here a while back about something like
| an emergency-mode uber for replacing ambulances for most
| ER trips. Something similar might also be done for
| shopping for cheaper urgent care too perhaps. Say a
| clinic that is open late and will check out your scary
| rash/cough/pain without charging so much.
| vletal wrote:
| In Czechia we have sufficient capacity of ambulances and
| other emergency services. What happens is that off peak
| they serve to help move old people to hospital, like a
| super expensive taxi. In these cases I can see how
| "emergency Uber" could help. On the other hand the
| doctors serving in these ambulances are usually extremely
| well prepared, the best MD students go to study to serve
| there. Even if it is one in a hundred cases, they will
| recognize the stroke from a random chest pain. Replacing
| them would surely increase the death rate in these
| cases...
| unishark wrote:
| Sure but you can make such an argument about every single
| medical issue. People can drop dead in a few days due to
| an unexpectedly aggressive toe infection. At some point
| we need to compare risks to costs.
|
| There will always be a trade-off between quality and
| cost. If you accept nothing less than highest quality
| (enforced by law and an extremely litigious society),
| then you get the US hyper-inflation of healthcare prices.
|
| Also in the US, I think ambulances typically only have
| EMT's and paramedics. Though sometimes it can cost as
| much as the ER itself.
| spaetzleesser wrote:
| As far as pricing goes I view US hospitals basically as money
| grabbing scam operations. What they are doing is just insane.
| It's hard to believe Americans are putting up with this
| nonsense or even defend it.
| ytdytvhxgydvhh wrote:
| It was, but apparently we're not there yet in terms of
| compliance: https://www.axios.com/hospitals-price-transparency-
| costs-reg...
| Black101 wrote:
| yes... One of the good things Trump did
| cirrus3 wrote:
| no one took or will take that chump b*itch seriously
| crawsome wrote:
| definitely not trump
| TheHypnotist wrote:
| I actually think this was maybe one of the few things Trump's
| admin did that roundly was viewed as good.
| stuart78 wrote:
| Would "Small Pharma" have gotten us our COVID vaccines faster?
|
| I get the complaints, but so much of these actions feel like they
| don't start with an understanding of the benefits large can
| bring.
| Black101 wrote:
| My health insurance is buying hospital company stocks.
| jbluepolarbear wrote:
| Vile
| Black101 wrote:
| it is not my fault that they are being let run free
| jbluepolarbear wrote:
| Oh I'm not calling you vile. The insurance companies are.
| Mine is already very intertwined with the hospitals in my
| area.
| ambicapter wrote:
| I think you misunderstood GP. I don't think he was
| claiming that the insurance company was literally buying
| stocks, he is saying his manner of insuring his health is
| buying hospital stocks (in the hope that their value will
| go up high enough to pay off any medical procedures he
| needs in the future).
| Black101 wrote:
| that is correct
| throwawayboise wrote:
| "Hearing aids cost thousands of dollars apiece, for no other
| reason than there is a cartel established by government that
| prevents firms from selling hearing aids without a prescription."
|
| An example of how many (most?) monopolies are able to exist
| because of some sort of legal authorization or protection.
| Regulatory capture.
|
| There are dozens of companies who would no doubt start making
| inexpensive hearing aids tomorrow. Absent government regulation,
| they already would be.
| ISL wrote:
| Queue "overpowered OTC aids destroyed my hearing" pushback...
| oliv__ wrote:
| Queue private agency testing, evaluating and rating products
| on the market
| antifa wrote:
| https://github.com/auchenberg/volkswagen
| rtkwe wrote:
| Cue rating agencies passing anything because hearing aid
| companies can go to another rating company if they don't,
| like what happened with mortgage securities in the 00s...
| watwut wrote:
| Yeah, it is totally impossible to have competition on
| regulated market. Monopoly is only possible solution.
|
| Or something.
| heavyset_go wrote:
| Credit rating agencies and the subprime crisis: https://en.
| wikipedia.org/wiki/Credit_rating_agencies_and_the...
| giantg2 wrote:
| Is that really going to be a thing? Earbuds have been out for
| a long time and are easily capable of destroying hearing.
| PoignardAzur wrote:
| As someone with a relative who install these: yeah, it can
| be a thing.
|
| The gap between "too soft, doesn't help you hear" and "too
| loud, damages your hearing" can be narrow.
|
| Usually it's more of a problem in the other direction, with
| doctors playing it safe and tamping down the aid to the
| point of uselessness.
| im_down_w_otp wrote:
| Total aside, in this context I think it's "cue". Like a cue
| card.
| toomuchtodo wrote:
| Bose's hearing aids were recently approved by the FDA, and
| they're only $850. The APM Marketplace program recently
| covered this development and the hearing aid monopoly. The
| sky isn't going to fall.
|
| https://www.npr.org/podcasts/381444600/marketplace
|
| https://www.bose.com/en_us/products/headphones/earbuds/sound.
| ..
| mgerdts wrote:
| $850 each and as of a month or so ago only available in 3
| states.
|
| At Costco you can get what seem to be high end hearing aids
| for $699 each. The current generation are rechargeable and
| support bluetooth. This includes the free hearing test free
| fitting ("real ear", which is current best practice) and
| followup so long as you have a membership.
|
| The key thing that is lacking is a decent app or api for me
| to write my own. Oh, that and phone conversations using the
| hearing aid's bluetooth is pretty bad.
| toomuchtodo wrote:
| Half seriously, Medicare should consider including a
| Costco membership with their coverage for the elderly.
| the_third_wave wrote:
| > Bose's hearing aids were recently approved by the FDA,
| and they're only $850.
|
| _Only_ $850? That is a new use of the word _only_ as far
| as I 'm concerned. These things, which are in many ways
| similar to if not identical with bluetooth earbuds should
| not cost more than those - and given the fact that Apple
| managed to convince people that $200 is a normal price for
| these things that should leave more than enough margin for
| an unhealthy profit margin seeing as how the ones I'm using
| cost [?] of that while achieving a longer battery life.
| SamuelAdams wrote:
| Hi, I wear hearing aids full time and have been wearing
| them all my life. They are not identical to Bluetooth
| earbuds. The sound is completely different. Hearing aids
| need to be able to be adjusted to the wearer's particular
| hearing loss. For example I need more amplification on
| high frequency pitches and less amplification on lower
| pitches.
|
| Good hearing aids are also environmentally aware. They
| will adjust the amplification to be different in a car,
| bus, and quiet conference room. Cheap hearing aids rarely
| do this well. There is a very drastic difference between
| 800 dollar hearing aids and 10,000 aids. Trust me, I've
| tried both of them.
|
| At best these Bluetooth headphones / earbuds you mention
| can just make all noises louder, across all environments.
| That helps a bit but it is not the same as what a good
| pair of hearing aids can do today.
| fshbbdssbbgdd wrote:
| Is there an earbud costs $30 with active noise
| cancelation and transparency mode? I want this.
| toomuchtodo wrote:
| Traditionally, the cost for hearing aids runs in the
| thousands of dollars. Perfect is the enemy of good
| enough, progress takes time.
| the_third_wave wrote:
| The only progress needed here is for the protection
| racket to be broken down, this can be done with the
| stroke of a pen. Allowing it to "take time" only gives
| those who seek to extract as much money as possible from
| the artificially limited market more time to do so.
| toomuchtodo wrote:
| I encourage you (and others) to actively engage with your
| Congressional representatives and regulators in this
| regard.
| the_third_wave wrote:
| Being European I think they will pay even less attention
| to me than they would to their constituents. Hearing aids
| are expensive on this side of the Atlantic as well though
| - although less expensive than in the USA - so it is
| still worth finding a way to open up this market. Just
| like intrepid hackers managed to turn routing appliances
| into versatile network components by creating OpenWRT,
| DD-WRT and similar "hacks" it would be refreshing to see
| something like this happening by someone creating new
| firmware for earbuds. While this would not be a real
| solution - hearing aids need longer battery life than
| earbuds for starters - it would give lie to the defence
| of high hearing aid prices. Any earbud with active noise
| cancellation probably has enough DSP capacity to
| implement the equaliser necessary to function as a
| hearing aid so the hardware should be available for such
| a hack.
|
| There was an IndiGogo project aiming to produce 2-in-1
| earbuds/hearing aids, it was funded in 15 minutes...
|
| https://www.indiegogo.com/projects/olive-
| pro-2-in-1-hearing-...
| pkaye wrote:
| The high price for hearing aids in the US is due to that
| independent providers need to mark up their hearing aids
| to pay for their overhead. So a $4k/pair hearing aid
| might have cost $2k/pair for them. Here Costco also sells
| hearing aids so they private label the same top end
| hearing aids for $1.4k/pair. They are a lot cheaper
| because they make profits through their overall
| membership base. Also they can negotiate a volume
| discount. Based of talking to the audiologist, I'd say
| the supplier sells them for $1.3k/pair tops.
|
| Having hearing aids myself, the big thing is amplifying
| the sound without the noise. The device needs to figure
| out what to focus on. If I'm in a restaurant with lots of
| background noise and people talking, what should be
| amplified. Most hearing aids use multiple microphones and
| program settings to identify what to focus on. And there
| are different kinds of noise like car engine noise or
| HVAC noise. And don't forget the wind noise on the
| microphone when you are walking. Also hearing aids
| compress the dynamic range and frequencies to extend the
| range of hearing to improve comprehension. And if there
| is a sudden loud noise it shouldn't go beyond a
| comfortable power level.
| the_third_wave wrote:
| > <list of hearing aid functions/>
|
| Yes, a hearing aid is not the same as a noise-cancelling
| earbud, they use different algorithms and the former
| needs to be more configurable than the latter. Then
| again, this functionality is implemented in firmware and
| uses common audio processing algorithms on off-the-shelf
| low-power DSPs, just like those noise-cancelling earbuds.
| The IndieGogo example I mentioned seems to be able to
| sell a pair of multi-purpose buds for around $250 a pair,
| $600 for 3 pairs. Assuming they are actually making a
| profit on these sales - and I don't see why they
| wouldn't, the hardware seems quite standard for noise-
| cancelling earbuds - this is proof of what I stated
| before and gives lie to the "overhead" excuse for the
| high mark-up, especially given the small size of the
| company behind the things. Of course I do not know
| whether the buds sold through IndieGogo are as capable
| hearing aids as "regular, overpriced" ones and I do
| notice that the stated running time (18 hours) is that of
| the buds and the charging case together - the buds
| themselves last for 7 hours between charges. They're
| specified for "mild ~ moderately-severe hearing loss" and
| seem to have the required amplification and equalizing
| capabilities [1]. Maybe give them a try? I don't need
| hearing aids myself but my mother does use them so I'm
| thinking about getting her a pair of these once her
| current pair is in need of replacement.
|
| [1] https://c1.iggcdn.com/indiegogo-media-prod-
| cld/image/upload/...
| odiroot wrote:
| *Cue
| mschuster91 wrote:
| > There are dozens of companies who would no doubt start making
| inexpensive hearing aids tomorrow. Absent government
| regulation, they already would be.
|
| And with the lack of certification requirement, someone _will_
| start cutting corners to make an extra chunk of profit. Just
| imagine a faulty hearing aid that fails while a person is
| driving, and the person causing an accident as a result. Good
| luck suing anyone over that one. Or people mis-tuning hearing
| aids leading to more damage than before.
|
| Another thing I can easily imagine is unscrupulous
| manufacturers using banned chemicals to manufacture the hearing
| aids. We have enough of this sort of shenanigans with nickel
| allergies in jewelry.
| alisonkisk wrote:
| Hearing is not required to safely operate a vehicle.
|
| And why wouldn't someone be able to sue successfully?
| tomc1985 wrote:
| What? Driving with headphones is forbidden where I am. And
| at minimum you need to be able to hear a carhorn.
| throwawayboise wrote:
| Are deaf people forbidden to drive where you are?
| mlindner wrote:
| They're not, but it's still illegal to drive with
| headphones.
|
| Deaf people still are unable to properly hear so are more
| unsafe when driving. They're legally allowed to do so
| because of deaf people lobbying legislators to force them
| to be allowed to do so.
| jdavis703 wrote:
| And emergency sirens/bullhorns, motorcycles, train horns
| at unguarded railroad crossing gates, etc.
| comex wrote:
| Even assuming that's true, if your hearing suddenly cuts
| out, and you decide to pull over in response, the chance
| you'll encounter one of those objects in the few seconds
| it takes to pull over is rather low.
|
| For this to be a real danger, either the driver would
| have to not notice that they suddenly couldn't hear
| anything, or the faulty hearing aid would have to pass
| through some sounds but not others. Both of those
| scenarios seem pretty unlikely.
|
| Meanwhile, from some quick googling, it seems to be
| common for completely deaf people to drive; apparently
| there are devices that can translate sirens and such into
| visual cues, but such devices are not universally used.
| To be fair, it's a bit different if you're not expecting
| it or practiced at it.
| [deleted]
| giantg2 wrote:
| "monopolies are able to exist because of some sort of legal
| authorization or protection"
|
| The entire point of patents...
| throwaway5752 wrote:
| It was not great before patents when a big company could
| steal your work and put you out of business after you put in
| the R&D effort.
| alisonkisk wrote:
| what big business was doing that before 1789?
| ModernMech wrote:
| Now they just file the patent before inventing it, let you
| do the R&D for them to make it a reality, and sue your for
| patent infringement when you go to market.
| Notanothertoo wrote:
| As someone who started a business only to get a bullshit
| suit that I was unable to afford by one of the largest re
| insurance providers in the world (#1/2), the idea that the
| ip/patent legal framework as it is today helps the little
| guy is a slap in the face.
|
| They preemptively sued me in a state I've never worked in
| or entered for that matter because the favorable corporate
| law there, and that is why they have their hq there. They
| would file a bullshit motion, get everyone in front of the
| judge. Somebody would point it out, they would retract it,
| and immediately file a new one and request everyone have
| time to review it. All the while bleeding me dry at 500$ an
| hour for litigation on top of travel expenses plus the
| regular legal fees of multiple lawyers across two states.
|
| The whole thing was bullshit, lots of red flags but I
| lacked the capital to assert my agency legally..
|
| The ip/patent framework as it is today helps nobody but big
| co and promotes regulatory capture. It prevents the kind of
| reverse engineering you see in China and why we don't have
| things like removable battery cell phone mods and other
| "hacks" here. It's why the right to repair is an issue at
| all, if they didn't have this legal framework they wouldn't
| be able to enforce any of it legally. Somebody would come
| along and offer a service to do it at a fraction of the
| cost. Why do I have to keep buying the same media over and
| over again on different formats. It's amazing to me seeing
| the most authoritarian regime in modern history leverage
| the free market better than the "capitalists". Sorry for
| the rant but this shit is imo the reason for most of the
| corporate bullshit today. It's what empowers the lawyers.
| throwaway5752 wrote:
| If you tossed out the patent system, would you get any
| less screwed? Or just screwed in a different way, or
| worse?
|
| I really don't know. Your experience is awful and clearly
| unjust and an abuse of the system. You didn't mention
| Texas, but I'm guessing Texas. What happens there is a
| national disgrace.
| giantg2 wrote:
| The court system is a joke. It has nothing to do with
| justice. On the criminal side, you can get a citation for
| a $500 fine and it's better to just plead guilty because
| a lawyer will cost you at least that much. It's a
| financial punishment even if you are innocent. If you
| don't hire a lawyer the judge won't take you seriously
| and call you names like "sovereign citizen". The number
| of mistakes and the amount of ignorance by the people
| running the system is repulsive and leads to violations
| of rights.
|
| As _just one_ laughable example, I had a magistrate think
| that requesting the case to be dismissed with prejudice
| was me calling him prejudice. You dont even need to have
| a law degree or pass the bar to be a magistrate.
| giantg2 wrote:
| Yeah, that used to be the point of patents. Now it seems
| it's mostly to squeeze as much out of people by capturing
| the majority of the market by not allowing similar
| products.
|
| I mean, we have CEOs of biomedical companies admitting that
| they aren't basing prices off of what it costs to research,
| develop, and deliver a therapy, but rather base it off of
| what a deaparare person is willing to pay for it. This is
| the very thing antitrust laws were supposed to prevent, but
| the patent system is used to create a similar environment.
| throwaway5752 wrote:
| Agreed? Patents are being misused. We should fix that.
| Patents fixed gross injustices when they were created,
| and we shouldn't forget that, either. Software is
| probably the worst example of a field for patents and I
| think the case for patenting algorithms or design is
| dicey. But if you sink 100M into drug R&D, a novel type
| of medical device, or a new type of semiconductor CVD
| process you should have some protection against reverse
| engineering from competition for a period of time.
|
| Since the problem seems to come a lot, maybe the problem
| is the role of money in politics and we should address
| the root cause. Just a thought.
| Notanothertoo wrote:
| No you shouldn't.. The idea that your idea is so novel it
| should be legally enforced as "yours" is pretty
| egotistical imo. How do you credit the millions of ideas
| you are basing yours off of. It's also information, it's
| not "stolen" in the sense that multiple people can't use
| it at the same time.
|
| Benefit of rnd is being first to market. You will capture
| much of the market while everyone else catches up and you
| are in a better position to innovate.
|
| Also without these legal barriers if somebody can improve
| on it and make it better that's better for the community
| and consumer at large and allows for constant iteration.
|
| Also there is a lot of bad behavior and things encouraged
| by the patent system. You have judges giving patents over
| technical nuances they can't possibly learn in a
| courtroom. You have companies like Intel spending
| millions on legal teams to enforce things rather then
| engineering innovation, which is great until you are no
| longer the dominant player and global players don't play
| by those rules.
| giantg2 wrote:
| Drug companies spend more on marketing than on R&D. Much
| of the research is done with grants and government money.
| The vast majority of medical devices use the 510K process
| for approval, which means they are substantially similar
| to existing device (to bypass testing).
|
| Sure some protection is necessary. You could make it
| based on development costs and have much shorter times
| for things that were cheap to do.
|
| "maybe the problem is the role of money in politics and
| we should address the root cause. "
|
| There are a lot of problems in politics that should be
| fixed - rules for thee but not for me (rule of law
| ignored), basically insider trading, high lifetime
| pensions, long careers, two party system, media
| bias/lies, and even problems in the voter base (us v
| them). Money is an issue, but it's really only good if
| the constituents are gullible or believe in the ends
| justifying the means. The real root of all of this is
| that politicians are a separate class from the rest of us
| and aren't accountable to anyone unless their
| transgressions are egregious, and then only sometimes.
| Rule of law has become a joke.
| throwaway5752 wrote:
| Drug companies are just similar to software in that
| regard. They acquire a bunch of companies that do basic
| R&D and get drug pipelines. Those founders get rich
| because they have patent protection. Just look at
| biosimilars for a taste of what might happen without
| patent protections.
|
| I am more familiar with the 510(k) that most people are.
| It bypasses _some_ testing, but there is still a fair
| amount of work. It has nothing to do with R &D
| expenditures that may or may not be behind an submission.
| giantg2 wrote:
| 510K is faster and cheaper in regards to studies given
| that it doesn't necessarily require human data nor
| clinical trials, which can be fairly large costs.
| em3rgent0rdr wrote:
| There are good arguments for abolishing or limiting patents.
| The cost of monopoly may exceed any benefit.
| akira2501 wrote:
| > The entire point of patents...
|
| Well, if that were so, you would expect them to be secret and
| to never expire. The fact that are published and expire after
| a relatively short period belies the simplicity of that
| statement.
| giantg2 wrote:
| In today's world, 20 years could mean the patented object
| is obsolete by the time it is public domain. Having
| exclusive use of the technology for the duration of it's
| useful life expectancy seems like a monopoly to me...
| throwawayboise wrote:
| Yes, there is probably a good argument to be made that
| many patents should have a shorter protected period. Also
| the "non obvious" requirement for an invention seems to
| need more emphasis, when an idea like "one click
| ordering" can be patented.
| giantg2 wrote:
| I really feel like ideas shouldn't be patented at all,
| just their implementation.
| Notanothertoo wrote:
| Ever greening patents is standard practice today. This is
| why insulin is so expensive. Another good example is
| Disney's bs. They have kept thinks out of public domain for
| over a hundred years.. The 20 years thing is for the little
| guy, if he can ever afford the 50k patent and legal fees in
| the first place.
| giantg2 wrote:
| Disney is copywrite, not patent. Copywrite lasts 50 years
| past the creators death (was shorter, but Disney lobbied
| to have it extended).
| Johnny555 wrote:
| _There are dozens of companies who would no doubt start making
| inexpensive hearing aids tomorrow. Absent government
| regulation, they already would be._
|
| There are already dozens of companies making them:
|
| https://www.amazon.com/Hearing-Amplifiers/b?ie=UTF8&node=377...
| fshbbdssbbgdd wrote:
| If it's true that hearing aids shouldn't need a prescription
| and can be made cheaply, shouldn't it be easy for anyone who
| needs one to buy online from overseas? The same way you can get
| grey market viagra.
| notriddle wrote:
| The problem is that you don't want zero regulation. That's
| how you get fire hazard USB chargers from no-name Amazon
| sellers. You want minimal safety regulations -- and no more.
| slg wrote:
| >An example of how many (most?) monopolies are able to exist
| because of some sort of legal authorization or protection.
| Regulatory capture.
|
| To be clear this "legal authorization or protection" is not
| necessarily over regulation. Depending on the market, sometimes
| monopolies are the result of too much government regulation and
| sometimes they are the result of not enough government
| regulation. For example, most of the big tech monopolies do not
| exist because of regulatory capture. They exist because the
| government never put in enough effort to stop the monopolies
| from forming.
| Notanothertoo wrote:
| Big tech wouldn't have the silos or platform lock downs (ie
| power/user capture) they have today without the ip legal
| framework. People would be able to legally circumvent their
| bs and offer services around gaps in their platforms and
| would encourage more competition and result in a less
| monopolistic practice.
|
| I think all monopolies are violence enforced or they are
| competitive otherwise somebody would step in and undercut
| their costs and the government has a monopoly on violence
| so...
| WalterBright wrote:
| Software patents are a failure. Software shouldn't be
| patentable. I bet software innovation would increase, not
| decrease, without patents.
| walkedaway wrote:
| > do not exist because of regulatory capture
|
| It's reasonable to conclude that Facebook and Twitter have
| benefitted greatly by not having expenses to properly monitor
| their platform due to section 230 safe harbor exemption. They
| are able to get away with selective enforcement on their
| platform and not pay a monetary penalty for doing so.
| ipaddr wrote:
| Some exist because of copyright otherwise Microsoft would
| have been legally cloned out of business back in the day.
| lotsofpulp wrote:
| > For example, most of the big tech monopolies do not exist
| because of regulatory capture. They exist because the
| government never put in enough effort to stop the monopolies
| from forming.
|
| Is it possible they exist because the immense economies of
| scale and near zero marginal cost that software provides
| makes for a winner take all market?
|
| As a customer, why would one use the 2nd best option, when
| the best option is available at no extra cost or very little
| cost?
| slg wrote:
| Well yes, that is the "Depending on the market" part I
| mentioned in the sentence before the one you quoted. Some
| markets have traits that are more likely to lead to natural
| monopolies. A government acting in the best interest of its
| citizens would usually work on creating regulation in these
| markets to discourage monopolies.
| lwouis wrote:
| You make an implicit assumption that a monopoly can't be
| the best way to organize an industry, and that
| competition is always better.
|
| I'm not convinced by this assumption as i've seen
| contrary evidence. I've seen monopolies doing a great
| job, and i've seen competition destroy quality of service
| and price.
|
| I would agree that the government needs to mitigate
| private actors. This regulation can take the form of
| splitting a monopoly but it can also take the form of
| keeping it a monopoly and regulating it by having a
| presence on the Board or through law.
|
| The idea that we need multiple groups of people working
| on solving the same goal concurrently doesn't strike me
| of a one-size-fits-all approach. Multiple competing
| restaurants in a town is probably the way to go. Having
| virtual operators on the back of one physical infra as is
| the case with phone carriers for instance I would say is
| probably causing lots of overheads. I've seen it first
| hand from the inside. Turns out it's really complex to
| virtualize infra and have tenant-based billing. The only
| real difference is now you have 5 companies competing on
| marketing and offers on top of the same physical reality.
| Marketing costs can't vanish so the consumer is losing
| that money one way or another
| cD2nmRoHAbI wrote:
| Quoting: 'Markets have traits'
|
| [sings] IN REAL LIFE WE ARE ALL ZONED IN SPACES (-:
| foota wrote:
| I don't know if I would argue it applies to tech, but the
| economic term for this is a "natural monopoly", a market
| where the most efficient outcome is to have a single
| supplier. A common example is electrical transmission,
| since it wouldn't make sense to have 3 separate overlapping
| distribution networks. These are typically allowed to exist
| by regulation and controlled in some way, for example there
| is the common carrier concept for electrical transmission.
| nicoburns wrote:
| That and lack of anti-trust action (or other deterrents
| against large businesses) on the part of the government.
|
| A consumer shouldn't chhose the second if they don't want
| to. But governments should step in to ensure that the
| market remains competetive.
| 8ytecoder wrote:
| That assumption doesn't go well with what we saw in the
| case of Instagram and then Snapchat. Both took significant
| share out of Facebook but Facebook was able to buy
| Instagram and copy Snapchat to retain its monopoly. The
| Instagram acquisition shouldn't have been possible is what
| the parent seems to be alluding to.
| disgruntledphd2 wrote:
| Instagram had 10mn users and a one week old Android app
| at the time it was acquired.
|
| Their ad system was pretty much ported from FB, one
| assumes, and their ads were sold by FB reps as part of a
| package.
|
| I honestly don't know if they would have made it
| independently (and we'll never know, I guess).
|
| The snapchat thing was different. Snap had a policy of
| focusing on iOS, while FB, IG and Whatsapp (all of which
| cloned their core feature) were available on Android. I
| personally think Snapchat shot themselves in the foot
| with bad product strategy.
|
| And look at TikTok. They are definitely the biggest
| competitor FB have ever faced, so I'd imagine that the
| future competitive landscape for them looks much more
| difficult than the past.
| stevetodd wrote:
| > I personally think Snapchat shot themselves in the foot
| with bad product strategy.
|
| Seems to have worked out poorly for them.
| maxk42 wrote:
| The only problem I see with allowing anyone to offer hearing
| aids is the hypothetical problem that a malfunctioning product
| may harm someone's hearing further.
|
| That's a real issue to be addressed, but generally I agree that
| making it easier for people to help other people is better than
| throwing up obstacles.
| yissp wrote:
| A huge number of everyday products have the potential to
| cause serious harm if they're defective, but they generally
| aren't regulated to the extent that hearing aids are. As a
| sibling comment points out, the threat of law suits keeps
| manufacturers in check.
| nostromo wrote:
| Earphones can damage someone's hearing. Should those require
| a prescription too?
| BurningFrog wrote:
| In the pre-regulatory system, you could sue the manufacturer
| in those cases.
|
| I think that was better for most cases.
| BurningFrog wrote:
| I assume there are countries where you can already buy hearing
| aids without prescription?
| stevespang wrote:
| Big corporations are better organized and better lawyer equipped
| than the Gov't, and can generally outspend the Gov't in legal
| proceedings.
|
| The best and brightest lawyers don't work for the lower paying
| Gov't - - they work for the best paying huge corporations.
| chiefalchemist wrote:
| It's about control. These "Big" companies are in a position to
| collect plenty of data about the market - companies and
| individuals. They are now able to do what previously was
| exclusive (read: monopoly) to the government.
|
| I'm not defending "Big *", simply noting that historical context
| is mostly irrelevant. The game is different now. The rules also
| different. It's not about markets and dominance. It's not about
| economic monopolies. It's about control. Control of the future.
| Control of the narrative.
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