I'm a T1 diabetic, so I've been through this. There's a simple way to buy insulin for 10x cheaper: Drive over the border. Any border will do. The extremely high prices are unique to the United States. Other countries have the same insulin brands, from the same companies, at literally 10x lower prices.
That should make the solution clear: Undo the laws that prevent retailers from driving over the border themselves. If US drug stores could import insulin from Europe, Canada, and Mexico, then it would be impossible to maintain such a large price difference, and the US price would come down.
> Undo the laws that prevent retailers from driving over the border themselves
It's cheaper elsewhere because those countries have set maximum prices. For instance, in Canada, the Patented Medicines Review Board sets maximum prices for pharmaceuticals.
I don't have any kind of philosophical opposition to importing medicines from Canada, but Canada has a practical objection: if we allowed these imports, it's very likely to cause drug import disruptions in Canada. Thus, Canada has asked the US not to do this. [1]
I think this is very likely a legitimate concern. The US is a much larger market, and a _much_ more lucrative market than Canada, since the US does not fix prices. If the US allowed imports from Canada, it's likely the pharmaceutical industry would stop selling to Canada at the rates set by the PMPRB. The industry would sooner miss-out on 100% of sales to Canada than have their pricing power in the US eroded.
Other than the anomaly of Covid vaccines, Pfizer actually has larger sales in the US than the entire rest of the world put together, which tells you something about how much the US is overpaying.
If the US wants to set maximum prices for drugs, and we have the votes to do that via importation, why in the world can't we just have our own Patented Medicines Review Board, rather than relying on Canada to set policy for the US?
Using the word “subsidised” makes it sound like companies are deliberately selling for artificially low prices outside the US, because they can charge more within the US to make up the difference. That’s not usually the case.
Pharma companies generally aim to make as much as they can, everywhere they sell. It’s just that they can make much more in the US than elsewhere. Of course, this is built into their business models, but I’d still argue the term subsidy doesn’t quite fit.
For interest, I had a quick look at a couple of financial statements from three big pharma companies not selling COVID vaccines.
For Q1 2022, pharmaceutical sales only...
AbbVie: 10.345 Bn US vs. 3.19 Bn ex-US [0]
Roche: 5.292 Bn US vs. 5.308 Bn ex-US [1]
BMS: 7.694 Bn US vs. 3.954 Bn ex-US [2]
So US provides at least >= 50% of total revenue, and in some cases considerably more. Also, given the higher prices, it's likely that the US represents a considerably higher proportion of profit than this - and therefore a major change in drug pricing in the US would be hugely disruptive for the industry.
I think the question is, what would happen if the USA passed similar laws like everyone else and the profits plummeted? How would the pharmacy companies react? If nothing changes, the USA is not subsidizing. If things get worse, they are subsidizing.
I’m surprised a company doesn’t sell the product for a lower price... Oh, the US prevents this due to patent laws? Then diminish the patent rights... Oh, that would stifle innovation? Hmm, I imagine mandating lower prices might have the same effect.
I think a pretty strong case could be made that the cost of innovation is not worth it. Would it be better to have revolving door of new medicines with 1% better efficacy or all medicines for 10% the price?
Unfortunately, this requires the intellectual honesty for people to admit that profits do in fact Drive Innovation which seems to be a sticking point for most.
No... it is subsidizing. Developing drugs is expensive and high risk... there has to be a monetary mechanism to incentivize drug development and, right now, that is the promise of high profits, which mostly happens in the US. Therefore, US is carrying most of the incentivizing burden for pharma development.
The rate of innovation would slip for global drug development without the promise of high prices and blockbuster profits in the US market.
I have worked for a couple different Pharma companies, including those HQ'ed in Europe, and this is basically the situation. EU based Pharma companies make most of their profit in the US (almost every pharma company does).
There are other ways to incentivize drug development and/or defray the financial risk of development, of course... but this is situation today... has been for a long time.
Set up a straight forward division of labor. Government serves as incubator, funding basic research, early stage trials, angel investor for promising teams.
Govt then auctions rights to productize drugs. Industry pays govt a royalty. Modulate the royalty to incentivize desired outcomes. eg zero (or negative) royalty for malaria, 3000% for esteem remedies like viagra.
Further, when there is no market demand for obvious public health priorities, govt contracts with industry, paying for mfg, distribution, marketing, training, whatever.
I'm not sure we can accurately predict what would happen, but a few thoughts:
* Clearly, this would hugely disrupt the current pharma business model.
* One obvious initial response would be to limit investment into research. However, this isn't a viable long-term solution, given research is the lifeblood of continuing success in the industry. It would therefore increase pressure for regulatory reform - essentially to reverse the trend of recent years, and make medicines easier/quicker (and therefore cheaper) to develop.
* Other typical business-leader responses: cost-cutting, job losses, mergers, etc.
* Pressure on developed countries outside the US to pay higher prices
* Longer-term, it might disrupt the current model of drug research funding altogether. The industry is already at a point where development of many drugs is close to unprofitable, and that trend is worsening as regulators become ever-more conservative, and of course with each new successful drug, the next one becomes progressively more difficult to find. The change we're discussing might well mean that drug discovery and development is simply no longer an area where profit can be reliably made - and as such shareholders remove their investments, and pharma companies would merge/struggle/fold. Faced with this, governments and regulators would presumably need to work together to find ways to continue the funding of drug development - and make up a overall shortfall in research and development funding similar to the GDP of a decent-sized country.
(To be clear, I'm not disagreeing at all that the US is effectively supporting the industry - just the term subsidy in the way it was used.)
> and of course with each new successful drug, the next one becomes progressively more difficult to find
citation needed
> as regulators become ever-more conservative
... cough
the simple problem is that the drugs that work very well are hard (eg. personalized gene therapy) and there whole healthy-industrial complex is not set up to solve hard problems, it's set up to sell treatments to the market, keep the machine churning, buy promising new formulas from small research labs, do the larger trials, manage the FDA, market the shit out of those that make the cut, rework formulas to keep generics at bay, and so on.
the other trivial problem is that no one wants to confront basic problems affecting health. (obesity comes to mind. nutritional studies are so underpowered it's laughable. also let's say mental health. tinkering with the brain always has the nasty side effect of oh what if the drug accidentally makes you feel funny/good instead of just not-miserable - see the weak results of the esketamine, also see how psychiatrists are afraid to use desoxyn [meth], because oh the paperwork & peer pressure.)
note, I'm not saying that the current setup does not deliver results, and that your predictions are without merit. (they are realistic.) what I'm trying to make explicit is that the industry is already ripe for structural reform. (the easiest no-brainer would be to simply fast track drugs already approved by the EU EMA; tax waste spending [spending that is not R&D or manufacturing - eg. marketing/sales]; make the FDA approval process a lot more standardized and faster; start running publicly funded trials on drugs that are already prescribed by doctors but are not authorized to be marketed)
Look into eroom's law of drug development. There are a lot of papers on the subject. It describes R&D cost, which covers more than just discovery, but gets the point across.
does the slope disappear if we control for the usual cost increases? (Baumol's cost disease for example pushes up everything that involves human time, and running trials is 99% that)
drug development happens all around the world already, a lot of it happens in the US because of the NIH (which is good, but could be a lot lot better: https://newscience.org/nih/)
Keep in mind that development location isn't tied to sale location.
For example, companies located in EU already develop drugs for the US, and some may not launch in EU or launch much later.
They are generating the largest _profit_ in the US. I wouldn’t say they are subsidizing since afaik they are still selling with some profit in other countries.
If drug X costs 1B to research and you can sell it for a gross margin of $1 in Europe and $100 in US and you expect the lifetime total gross income to be 10.1B it’s a good thing to invest in.
If both countries are limited to a gross margin of $1 and you expect the lifetime gross income to be 0.2B this is now going to be a massive net loss. So you will not invest in it.
If you make an addictive pay to win mobile app, and you make $1/user but have a single whale user who dumps $1000 a month into the game.
If the whale suddenly stops paying, you can continue to profit from regular customers you just don’t make the obscene profit from before.
Can corporations continue to survive with less profit? I think some individuals have to learn to live with less income, so I’m sure a big pharmaceutical company can figure it out, I’ve had to cut out most meat from my diet in lean times, I’m sure pharmaceutical executives can do something similar.
No, you’ve entirely missed the point. There is a large, up front research cost to drugs (and video games). If you have no whales, you might not expect the game to ever achieve enough gross revenue (revenue minus variable costs, sort of) to offset the research costs.
Given you already have the drug, sure, it makes sense to keep selling it. But if you try to research more drugs and make more games with no whales, you will quickly go out of business. The video game analogy is apt. These kinds of video games are only possible because of whales. If whales could not exist due to regulations similar to drugs, they would not be developed / researched
If they could raise the prices they would have already. If they didn't make a profit they wouldn't produce and sell the product. So the reality is, that they would just lose some of the profit but nothing else would change.
As others pointed out, it would affect decisions for future research. Because you can't just rake in the money in the US you must be more wise with spending your research money.
Drugs must be developed before they may be sold. The two choices are develop/not develop. The drug developer may use a spreadsheet to calculate NPV. If negative, the drug is not developed.
Sorry, but how exactly do you know how the finances work out for pharmaceutical development, manufacturing, and distribution around the world? You seem to know an awful lot about this.
1. If you're defending large corporations, always assume that they're adversarial. They're machines made to defend themselves/attack opponents. When posting in their favor, be careful not to become a shill for them, accidentally.
As a general rule, defending the "big guy" on their behalf is generally a losing strategy. They can defend themselves already, no need to stand up for them.
2. I have family working in the medical and pharma fields.
3. I doesn't even matter what and who I know, this tells you everything you need to know:
The profit graphs for most of the Big Pharmas look similar.
They're hugely profitable. For sure they could lose a chunk of that and do fine.
It's just greed. A bit of greed shows ambition. A lot of greed corrodes everything. It's just pathological at some point (money is not points on a mobile game leaderboard!).
Knowing the overall profit of the business doesn’t tell you exactly where the profits are coming from or how margins differ among different product lines and markets. I think we should refrain from claiming specific knowledge of a business’s finances and making confident conclusions unless we have more granular data or are actually employed by the businesses in question.
I have seen revenue projections for go/no go development decisions. US and EU revenue are primary considerations, and heavily weighted to the US.
Some products are never expected to turn a profit in small countries even if the product has already been developed. Passing the regulatory barriers in these cases is done for humanitarian reasons.
> Yes. The US makes up 42% of GLOBAL healthcare spend.
A lot of that healthcare spend is wasted on administrative overhead of the US system.
"U.S. insurers and providers spent $812 billion on administration, amounting to $2497 per capita (34.2% of national health expenditures) versus $551 per capita (17.0%) in Canada: $844 versus $146 on insurers' overhead; $933 versus $196 for hospital administration; $255 versus $123 for nursing home, home care, and hospice administration; and $465 versus $87 for physicians' insurance-related costs. Of the 3.2-percentage point increase in administration's share of U.S. health expenditures since 1999, 2.4 percentage points was due to growth in private insurers' overhead, mostly because of high overhead in their Medicare and Medicaid managed-care plans." https://pubmed.ncbi.nlm.nih.gov/31905376/
When has a large corporation become more efficient with their spending to that degree? From the figures being thrown around, if their profits from the USA suddenly dropped by 90%, that isn’t just becoming more efficient, that is having to severely contract.
You do know that if profits go down, companies don't have to contract, right?
Companies contract when they have losses... (or when their revenue goes down, but only if they predict it will keep going down, while in this case this would be a 1-time shock).
I see a bunch of people defending these corporations, I have to ask: why? Why are you defending corporations with tens if not hundreds of thousands of employees and decades of years of profits in the mid-to-high tens of billions of dollars? Their abuses are well documented, is it Stockholm syndrome?
Because they mostly have a proven track record of advancing human well-being? As do other corporations from railroads to Amazon. Sure, they are not perfect, but the governments you advocate should kneecap them (to echo your other general comment) have a track record of ruining it, /especially/ when they try to decide what's "fair/unfair". You are defending a much larger, more powerful, vastly more evil and harmful entity.
I’ll bite, I think the defense is mostly to the status quo of the industry.
The fact of the matter is these corporations have developed and tested medicines that drastically improve my parents (and many many elderly/retirement age folks) quality of life, and some of these medicines are pretty new. The system is currently working pretty good by the metric of pharmaceutical advances.
I have worked in pharma drug development and manufacturing in the past (and am again as of a month ago) and I would say: "yes... it is moreorless true that the US is subsidizing the cost of pharmaceuticals in other markets."
At one place I worked, our general manager literally said, in a meeting, that if too much Canadian product crossed over into the US market, the company would stop selling to Canada. US prices for our drugs were higher than every other country in world, often times by 3x or more. Almost every other country in the world, besides the US, negotiates price as part of the drug approval process.
It is insane that the US continues with the status quo.
How could you believe that to be true? Western Europe is just 20% or so of global pharma spending. You believe that rd can continue full steam ahead with 20% revenue, dropping the most profitable part?
> You believe that rd can continue full steam ahead with 20% revenue, dropping the most profitable part?
You get what you measure. Americans decided they want to measure profit and so they think their pharmaceutical companies must be working well because of how profitable they are. Sure, the people are miserable, many can't afford medication they need, but there's so much profit that means it's success right?
Nope.
The owner's hilltop mansion and two yachts don't actually make sick children well, or prevent heart failure or anything like that, spending on R&D is not in fact linked to company profits, instead it's necessary for these companies to survive because innovation is their lifeblood. The profits are an excess.
One common measure of the health of the US pharmaceutical industry is approvals per year. Objectively the current system does well on that metric relative to past models; eg the USSR’s and Japan’s.
This metric optimises for more approvable products, which still isn't the thing you actually wanted. Sixteen slightly different approved products which do basically the same thing means sixteen approvals but you only solved one actual problem. Together with favourable treatment for "new" patentable medicines compared to just using the stuff that already worked the result is an American can find their doctor has prescribed them a $1000 per month "new" drug that is basically identical to the $10 per month drug similar patients are given Free At Point Of Use in many countries for a decade, except this one has a patent and so the manufacturer gets exclusivity and $990 profit.
What we actually wanted wasn't richer executives, or more approval paperwork, it was healthier people, and the US scores very badly on that.
Most of the "stuff that used to be new" is long gone. Once the exclusivity expires, there's no reason to make sixteen distinct medicines that are really just a single idea smeared out to score points, so you either invent more or you go back to only supplying the thing everybody actually wanted.
And there's no need for making medicines which merely "used to be new" any more profitable than say, felt tip pens or flour. I take Levothyroxine every morning (for the rest of my life) and they figured out how to synthesize that about a hundred years ago. Nobody who worked on that project is even alive still, let alone relying on some hypothetical profits from their work. But guess what, in the US it'll cost more than it does here because the US values profit for pharmaceutical executives over healthcare for its citizens.
Sounds nice and all until you need a novel vaccine.
The whole point is that the US being profitable allows research for new drugs, not that profits aren’t high in the US. Heck, Pfizer sells stuff at cost to about pretty large portion of the world now.
> It's cheaper elsewhere because those countries have set maximum prices
No, human insulin (or its analogues / biosimilars) is a medicine which should be cheap to produce and therefore inexpensive to purchase.[0] It's cheaper elsewhere because the there's something approximating a free market in operation.
The real issue isn't price controls, it's about $bigPharma and their lobbyists getting the FDA to help protect their profitability.
Because our political and legislative systems are completely gridlocked except to score political points for the upcoming election every two years or so.
But our markets still function, because when it is not so the political elites lose. So let's use a market approach and open the borders to retailers so long as the medicine is labeled as sold in the other country, and guaranteed to their standards. Perhaps the retailers buy some additional insurance policies.
Does the policy have wide democratic support, yes, like many sensible policies, it does.
Does the policy seem likely to survive the lobbying system, where conpanies can just kickback some of the money they extort to the people with the votes, no, like many sensible policies, it doesn't.
I'm curious what the legality would be on a communal trip of some sort. A lot like thr early days of medicinal Marijuana where individual patients would sign over their allotted plants to a caregiver. I wonder if there could be a coyote to use a perhaps not so great but applicable term for it. This coyote would collect a bunch or orders from folks, get the goods (insulin), bring it back.
Now that I've written this I realize that this person has a name, it's not coyote, it's drug trafficker. I'm leaving it because:
How shameful we are. A person whom would drive hundreds of miles to a foreign land to help people get basic medicine they need to survive is called a drug trafficker that is a felony. WTF America.
I live in a state where it is illegal to buy cold medicine with whatever the p-drug is called, without a prescription. But the next state over sells it over the counter. So when someone goes to the next state, people ask them to bring back the good stuff. I guess they are drug runners, though I never thought of it like that.
> Undo the laws that prevent retailers from driving over the border themselves
This is goofy, though. If it's the same product, there's a real reason it's more expensive here. It could be anything from excessive regulatory hurdles to a cash grab, but there's something wrong. Address the underlying issue.
Reducing demand by choosing external sources will indirectly cause a subsequent price drop in the US. That would be the "free market, deregulation" approach to solving the pricing issue.
The UK/CA/AU/NZ all have similar models of an independent review of a drug's overall cost/benefit. In Australia, the Pharmaceutical Review Board reviews a drug for its cost/benefit and expects the pharma company to justify its cost.
If the cost/benefit ratio is sufficient, a recommendation is made to the government, which then decides whether it will subsidize the drug. If it does, then the drug is provided to patients at a capped price (currently ~AUD40 for non-welfare recipients, ~AUD7 for welfare recipients), with the remainder of the cost paid by the government.
This provides a direct incentive to the pharma company to get their drug listed under the PBS, because it ensures that they have a large market available.
Drugs that are not available under the PBS are still available, but at full price to the patient. However, because of the expectations of pricing in our market, the pharma companies have to keep their prices lower overall.
Exactly, maybe it's not a bad start, but it would be better to strike at the heart of the issue. I don't know exactly the story with insulin, but I'm sure it's got something to do with our bad patent laws in the medical world.
One of the main difference between US and Canada is that in canada the government negotiates prices for the entire province. They have a lot of leverage because the contracts are for the entire system, not a single hospital. They have a public bidding process and companies from around will fight for it and offer competitive pricing.
It's not a new concept and it works with almost all commodities. If you need to buy iphones, you are likely to get a better price for them if you call Apple directly and ask to buy a batch of 10M than if you show up to an apple store to get 5 units.
My PBM serves many, many more people than the population of Canada. The Canadian Patent Act permits the granting of compulsory licenses. That is the leverage the Canadian government has.
Very few countries have a single-payer system without health insurance providers, in case you're unaware. It's far from the norm in Europe and the developed world, or anywhere else for that matter. This map seems like a relatively decent source based on my spot-checking:
This isn't necessarily an argument against it, to be clear. I think single-payer systems have certain practical benefits compared to which I quite disliked the system in the last European country in which I lived.
> Very few countries have a single-payer system without health insurance providers, in case you're unaware
I lived in Australia for 23 years, and Canada for 15. Australia has single payer and universal, Canada (apparently according to your map has single payer)
To be honest you're splitting hairs, and in practice it doesn't make any difference.
You live in the country, you get healthcare without paying a cent out of pocket.
Both of those countries spend less on healthcare per capita than the US, and both have measurably better health outcomes.
So it costs less, and it's better. Why would any person not want something that is measurably better and costs less?
> To be honest you're splitting hairs, and in practice it doesn't make any difference.
This seems like a (probably unintentional, and partly due to my lack of specificity) straw man. The spectrum doesn't range from Australia to Canada, considering both offer a single payer system that covers a good amount of care, but rather from something like Switzerland to the UK/Nordics.
> You live in the country, you get healthcare without paying a cent out of pocket.
This is far from true in several/many of these systems, which was the point I was trying to make, but again I do believe I could have been clearer about this. My point was just that plenty of countries have healthcare systems that work well while spending money on health insurers rather than just on healthcare.
Single Payer: eg the NHS in UK. Single payer pays all costs and wages, care is free at the point of contact (GP/Specialist/Hospital), prescription prices capped for pharma approved by NICE.
Scheduled Reimbursement: eg Australia. All services have a set scheduled fee, if "bulk billed" then free at point of contact. If not, then gap is payable for GP/Specialist services, or in private hospitals or as "private patient" in public hospitals. Gap can be covered for hospital care by private insurance, which is subsidized. Prescription prices capped for pharma approved by PBS. Private insurance regulated in terms of what is covered and limits due to pre-existing conditions etc.
Regulated Insurance: eg Germany/other EU. Health insurance is "compulsory" for all residents, with costs split between employee/employer, or picked up by government for unemployed. Insurance companies strictly regulated in terms of margins, "medical loss ratios", coverage etc.
All of these models provide better overall care and better overall outcomes for the country than the current US system. In particular, these aspects of the US system cause a large majority of the issues:
1. Lack of Transparency: Medical providers (hospitals/GPs/Specialists) are not required to publish a fixed price for services delivered, with opaque contractual relationships with payers.
2. Pharma: No regulation on prices, windfall taxes on excessive profit, universal availability, or even the negotiation on prices when government purchases.
3. Insurance Company Profit: The overall limit of 20% margins is excessive. There is no reason that insurance companies should be guaranteed this gross margin, when the actual cost of the service they provide is 10% of that, based on the costs incurred by government equivalents such as Tricare and Medicare.
So the solution is not "Let US pharmacies buy drugs from Canada where its cheaper". The solution is: "Let government programs negotiate with pharma companies to use their purchases to reduce prices" and "Require all medical service providers to publish their actual prices transparently and comparably without being able to negotiate secret reductions based on bulk purchases by insurance companies".
20% goes into R&D,
30% goes into Marketing,
25% goes operating costs,
25% is profit.
Since a lot of Pharma research is done at universities and is funded by the public, this holds true especially for insulin, maybe by cutting the costs of meds the companies optimise their system more.
Less marketing, no Pharma people bribing doctors to use their meds etc. I bet if you cut those unnecessary jobs and expenses before touching R&D or Profit a lot can be done.
At first reading these sentiments felt like I had stepped into some sort of horrible satire, but now I'm starting to think that maybe this is just how it is. Does the average US citizen really think this way?
I guess I'm outing myself as an American here, but what exactly are you referring to by "this way", and what part of the thinking in question is distorted/inaccurate?
How could it possibly be otherwise. If you have a bunch of drugs that are made profitable, net of r&d costs, only because of the American market, then these would never get invested in without American spending in. And remember, you can’t go pointing to single examples because you also need to consider all the funds that go into funding drugs that don’t pass clinical trials.
That's a plausible story for drugs which already exist. The problem, though, is that they wouldn't bother researching new drugs in the first place if it weren't for the prospect of those "absurd profits" in the USA, because that research would never pay off.
Once they have the drug developed it makes sense to sell it wherever they can, at whatever price they can get (above COGS and overhead, of course), as profit is profit—so long as it doesn't cannibalize their much more profitable sales in the USA.
If the USA were to suddenly allow retailers to import drugs at scale from other countries to reduce costs then those countries would find their supply of cheaper drugs drying up. They could either accept prices on par with those in the USA, thus eliminating the arbitrage, or simply go without.
I think this is a backwards solution, or maybe you just dont think that regulation could happen. The price of importing goods would still raise the price beyond what other countries pay. And nothing about your solution guarantees that the prices in other countries stays low, pharma can change their prices on a whim. We can and should regulate the price of life saving medications, directly. We dont have to treat the symptom.
The state has had discussions with other companies, including celebrity investor Mark Cuban’s for-profit drug company, the Mark Cuban Cost Plus Drug Co. It is building its own manufacturing plant, like Civica, but for now sells drugs online to anyone at wholesale cost plus a 15% markup. Founder Dr. Alex Oshmyansky said that the company’s talks with California fizzled out early on but that he’d be open to future discussions. Cuban is the chief investor in the company, Oshmyansky said.
Would be interesting to know why these discussions fizzled.
It seems there's some sort of medium-term mandate to build manufacturing facilities in California.[1] Presumably these preexisting ventures aren't interested in building a facility in California (instead of elsewhere), nor keen on working with a state that may eventually compete directly with them.
[1] It's unclear how strict is this mandate. The 2020 legislation only requires investigating the feasibility of directly manufacturing drugs in-state. See the summary at https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml... as well as section 127694 specifically. I'm guessing Newsom is trying to find a way to justify building an in-state manufacturing facility. It fits into the state's broader policy to develop the biotechnology sector, which is already significant--depending on metric, first in the nation or second to Massachusetts. Not sure it's worth delaying these deals over, but perhaps Civica and others are demanding long-term contracts in an attempt to preempt California building a competitor. (It's understandable why they wouldn't appreciate more competition. Even for a charitable venture, more capacity would impact their financial viability, especially considering that preexisting, for-profit suppliers will aggressively use their pricing and market powers to try to suffocate these new ventures. OTOH, that's exactly why one might want a state-backed facility, so they're not beholden to investors--even beneficent investors--and the ruthless economics of the market. And theoretically a state-owned facility might be more resilient, either legally or politically, to Federal government suppression, which is one of the primary tools the pharmaceutical industry has used to rig the market in the U.S.)
A lot of people seem to be confused about insulin every time it comes up. There are many different forms of insulin. Regular human insulin has been around for decades and is fairly cheap without insurance but difficult/inconvenient to use because it requires planning out your eating schedule.
The extremely expensive insulin that articles are talking about is usually a brand name like Humalog which is an altered form of insulin that is far more convenient to use. It is possible (but rather convoluted) to bring these eye-popping prices down to $99/month without insurance (https://www.admelog.com/savings), or $43-73/vial (https://www.goodrx.com/insulin-lispro or Walmart Novolog). Of course, this is all basically a way for pharma companies to price discriminate to extract as much $$$ from insurance.
All NHS prescription drugs are free in the UK. Some people have to pay prescription fee (currently £9.35 per item) but diabetics get an exemption for that too (for all NHS prescriptions).
The price you see is the cost to the NHS, not the patient.
Indeed, and I think it's important to show those prices because otherwise you'll find people saying "It's not free you still have to pay loads through taxes".
So I find it best to ignore that and show them that the whole system is still only paying a tiny fraction of what they're paying.
Central NHS negotiations for the whole country also saves a lot of money by reducing expenses related to insurance, administration, pharmacy benefit managers etc.
On the other hand, it may take away some choice people have in selecting health care provider. For example, some people are not happy that they don't get semaglutide (which really helps diabetics to lose weight) because they don't qualify according to the NHS criteria (not obese enough). Of course, they always have a chance to go to private health care providers and pay full price (or private insurance) but not many can afford that. Although I suspect that even in the US many insurers will have similar criteria whether they reimburse the drug or not.
The tl;dr: is that there are longer+shorter acting insulins, and you want to mix and match them to roughly match your blood glucose levels (so taking short acting insulin shortly before meals when your blood glucose levels spike)
I will never understand US healthcare. If Mark Cuban's idea was so straightforward, i really wonder what took it so long. Perhaps, all that was needed was an interested billionare who did not want unlimited profits ?
Too many vested interests and rigid regulation that cannot be changed because of those vested interests.
To be honest, the same is true of many countries with socialized medicine, but the snag is not with cost but with availability and speed of care. And some medically solvable problems cannot be solved because changing anything is almost impossible.
Nearly all of US problems can be traced back to the insanely powerful lobbying (citizen united, etc). The gun lobby, the private prison lobby, the healthcare lobby, the tax filing lobby, etc. Corporations not only buying politicians for dirt cheap to keep their own profits high, but also spreading lies and propaganda brainwashing part of the population into believing the bullshit they're peddling.
Just look at the story of Wendell Potter [1], an ex US health exec who basically came out and detailed all the lies he spread about Canadian healthcare. So many people in the US believe those lies still to this day.
It goes back further. Sunshine laws of the 70s enable vote buying and coercion. Addressing the lobbying issue would play a big part, but ultimately the ability to apply public pressure on how representatives vote is going to provide enough leverage to control those votes. Make votes (and many committees) secret like every good election. There will still be corruption, but individual legislators will be less beholden to private interests and the party line.
It seems more likely to be a result of consolidation on the manufacturing side and the monopolizers paying their competitors to stay out of the market (or to just resell the main brand which subsequently rations the supply).
Shire pulled this trick with Adderall XR: they signed a deal (can't recall who it was, Teva maybe?) to provide the actual drug that the generic maker stamped with their name. When Shire (bought by Takeda) was getting ready to release Vyvanse they suddenly cancelled the contract and stopped providing the XR to Teva. There was a US-wide shortage for almost a year, during which many patients scrambled to find alternatives... some of them ended up with Vyvanse prescriptions as designed.
I don't want to discount what you are saying though: the generic process should be streamlined. For Schedule II medications the extra regulatory burden definitely makes these schemes more profitable. You need a special DEA license to make them and the DEA sets quotas so even if you have a facility certified to make Schedule II drugs you need DEA permission to increase the supply. When Shire pulled the rug out from under everyone it took time for competitors like Teva to start production, get DEA approval, then get approval to manufacture in enough quantity to replace what Shire stopped making.
This was well known at the time. To my knowledge no investigation was done whatsoever. The government simply allows companies to manipulate the market as they please. No wonder they have gotten bolder and bolder.
I was not shocked in the least when Hedge Fund parasites like Martin Shkreli started looking for drug companies to buy to snap up the rights to single-source or low-volume generics to jack up the price. If a huge manufacturer can commit open market manipulation to the point that millions of people can't get an RX filled _anywhere_ to push them onto a newer expensive drug and the government doesn't even bother pretending to investigate... well there's lots of rent to be extracted!
I really wonder how much of the hangup is that it's a miserable field for a successful billionaire to break into. The problems are political, regulatory, bureaucratic, inscrutable, and you can't win solely on the back of being "cheaper" and "better".
You have to both REALLY care, and be willing to wade through immense BS to make a profit comparable to selling smartphone apps.
> an interested billionare who did not want unlimited profits?
I'd posit that it's almost impossible to get to the point where you can fund something like that without being singularly focused on getting the most money possible
The problem is that medical necessities are an inelastic demand. That's how rapacious grifters come along and jack up prices 100x knowing that their pray don't have a choice.
That's cool! The wikipedia article is a bit light on details.
To summarise, it seems that by declaring as Public Benefit Corp they can not be so beholden to the shareholders and the Corporation can declare "some other societal mission". No real details on what limits or benefits though.
I mean, what is stopping a Public Benefit Corporation declaring a mission for "yacht transport assistance" to be delivered to the selected "needy" and delivered by profits on business as usual? Obvious blatant point I am trying to make but I assume there are further laws and bylaws that usefully try to limit a corporation in that sense.
It seems a bit wishyWashy just going from wikipedia but for a HN discussion is well worth pointing out they exist! Thank you!
Let me guess: they are planning to use the amazing mechanism that proved to be so effective at reducing prices and improving availability for stuff like food, clothes, computing, communications and entertainment: the free market.
Consequently all they have to do is remove the barriers for competition to enter said market and patiently watch as the problem solves itself, thanks to the amazing ingenuity and creativity of the entrepreneurial spirit.
Of course, that would make it clear for everyone that the actual culprits are the politicians who erected said barriers and we'd all be better without their interferences in economy, so... there is a perverse incentive there... let's see what they want to do:
> market failures that plague the pharmaceutical industry
> disrupting monopolistic drug prices requires state intervention and that California can pull it off because the state “has market power.”
Yup. So, any ways to bet on the outcome of this action? Favorite prediction markets?
This is a much repeated but blatantly false trope.
For life saving care you are strictly better off in Canada, Australia or Britain.
For elective surgery you can probably get it done faster in the US if you have money but the standard of care isn't different. There are in-fact places that embrace even more medical capitalism than the US but with less middleman, lobbying and nonsense - take Thailand for instance, or South Korea. Both of which offer elective medical procedures for less than the US, no wait times, equivalent standard of care served with a side of luxury.
So yeah, utter drivel as usual, the US system is inferior by all metrics and insurance lobbyists have duped conservative Americans into voting for something that is strictly against their interests.
Conservative politicians the world over have perfected the art of getting turkeys to vote for Christmas.
> For life saving care you are strictly better off in Canada, Australia or Britain.
I don't remember a single OECD measure that the US falls behind the UK in, perhaps child mortality at birth, so I'd be interested to know which life saving care you're referring to.
Moreover, as the nurse was teaching my class (in London) how to give CPR said "if you're going to have a heart attack, have it in America (because your chances of survival will be higher".
But maternal death (The number of person who die from pregnancy-related causes) is also more than 10 times higher than comparable countries and was raising for 20 years while other comparable countries were lowering it.
It seems an even worse picture of the situation. Adult women dying at 10 times the rate of OECD countries because of pregnancy. It will probably raise again given the new limitations/bans on abortion (accessible abortion is correlated with lower maternal death)
Life expectancy in the US is quite lower than comparable countries and stopped growing (but it might be related to the 8 to 10 times higher homicide rate than other OECD countries)
Death rate from HIV/AIDS is nearly 6 times higher than the UK and it’s not lowering anymore (it has plateaued at a much higher level than comparable countries)
Is there a health measure that you can find where the US is better or at least at the same level than say UK or at least France? (which is sadly for us French not the best in class…)
Not a trick question, I’m curious to see if the US have some outlier health measure that it aces, sometimes it happens!
> Not a trick question, I’m curious to see if the US have some outlier health measure that it aces, sometimes it happens!
I appreciate that, no worries.
Without looking I would go for any cancer statistic, as the UK is often terrible in those[1]. So, I did a search of the OECD Health Care Quality Indicators[2] (as they're the ones used to compare countries) to see if I was right. (As an aside, I look at these every few years and the last time I looked I found some surprising stats, like the ones about child mortality in the States, but occasionally there's a more complex reason behind a poor statistic[3]). Anyway, it seems I was (sadly) right:
## Breast cancer 5 year net survival
France 86.8 87.2 86.7
United Kingdom 79.8 83.8 85.6
United States 88.9 89.8 90.2
## Colon cancer 5 year net survival
France 60.7 63.6 63.7
United Kingdom 52.0 56.5 60.0
United States 64.7 65.5 64.9
Those are the age-standardised survival (%) spread across 3 different time periods (I didn't want to have to reproduce the whole thing so you don't get everything labelled!:)
Anyway, those are the first two I looked at. I've done this before and honestly, the US system holds up very well. I'm sure it does even better if it's adjusted for economic class - which obviously opens up a barrel of probably quite fair criticism. I know that some on here complain about how the US can bankrupt you if you get sick, but I'd take that over the UK's system in a heart beat. Not sure about France, though it does seem to have a more sane system than the UK.
5 year survival is not a particularly useful statistic though. Those people are not living longer, they're being diagnosed earlier. The all cause mortality hasn't been changed. Rates of regret for cancer treatment are quite high - people at the end of their life sometimes wish they'd spent more time doing stuff with family and less time getting unpleasant and painful treatment in hospital.
If you take every man over the age of 55 and provide rigorous diagnosis for prostate cancer, but you then provide zero treatment to anyone, your 5 year survival rates suddenly look really good. This is because you've diagnosed a lot of slow growing cancer that doesn't kill people. But obviously you've done nothing to improve all cause mortality or quality of life.
> Our findings suggest that there are no reliable relationships between changes in 5-year survival and cancer incidence or mortality. Increases in 5-year survival might therefore represent poor indicators of progress in cancer control at the population level. In the absence of over-diagnosis, 5-year survival might only indicate improved diagnosis and treatment in clinical practice.
Talking about health and healthcare, the facts show the US is at or very near the worst among OECD countries in: infant mortality, child health and safety, life expectancy at birth, healthy life expectancy, disability-adjusted life years, doctors per 1000 people, deaths from treatable conditions, rate of mental health disorders, rate of drug abuse, rate of prescription drug use.
Those measures might not be as damning as they first appear, as the reasons behind them can be complex. For example, rate of mental health disorders may be a case of the diagnosis fallacy, where an increased number of mental health professionals and access to mental health services means there are a greater number of mental health diagnoses. Just as a greater number of mental health diagnoses will occur in hospitals than at home, this does not mean that hospitals are dangerous for your mental health (although they may be;)
Life expectancy at birth is affected greatly by, among other things, gun violence in young men (I already shared in another comment an overview[2] of a paper[1] showing how this works). There is a quote[3] in the Guardian by the paper's lead author:
> “I was surprised by the sheer magnitude of the impact of firearm deaths, that they’re only 1%-2% of deaths in the US but responsible for 20% of the gap in life expectancy between the US and other countries in men,” said Andrew Fenelon, the lead author of the letter.
It's not enough to compare simple, bare statistics and come to a judgement that US healthcare is failing compared to other countries based on just that. I'm not an advocate for the US system but I do get the feeling that it can be unjustly maligned at times.
> Those measures might not be as damning as they first appear, as the reasons behind them can be complex. For example, rate of mental health disorders may be a case of the diagnosis fallacy, where an increased number of mental health professionals and access to mental health services means there are a greater number of mental health diagnoses.
Are you suggesting that the US is a special case among the 38 member countries of the OECD, and is the only one that has this phenomenon?
> Life expectancy at birth is affected greatly by, among other things, gun violence in young men
Which is just another way of saying the US needs better healthcare to deal with this major issue that it alone faces.
A bit confusing because the hospitals in Boston have wings for foreigners with luxury accommodations, and people all over the world fly in to get top-tier procedures done. My son was born with complications and my insurance paid for all of it at such a top-tier Boston hospital (I am a Boston resident and US citizen). So maybe things aren’t so simple.
The existence of very expensive private care in the US isn't counter to my point if anything it's an embodiment of it.
Furthermore it's probably much more expensive than you realize.
Premium contributions and deductibles totaled 11.6% of median income in 2020, compared to 2% Medicare levy in Australia across the income spectrum.
The US system isn't defendable. You can say things like "Well I'm rich so it works for me" but you can't make assertions that it's good as a whole.
I will assert that the US medical system has pros and cons, and I would advocate for significant structural reform.
But such reform has not occurred despite decades of trying, and that’s because the system is not without the pros, and the pros make it infeasible to reform it at this time.
Pretending that the system is completely useless and broken is ignoring basic facts - such as overwhelming majorities of Americans that like their primary care doctor and their current insurance.
So it’s difficult to make such clear statements when the facts disagree with the progressive shrieking.
> When the family of a 35-year-old disabled man who resorted to euthanasia arrived at the care home where he lived, they encountered ‘urine on the floor… spots where there was feces on the floor… spots where your feet were just sticking. Like, if you stood at his bedside and when you went to walk away, your foot was literally stuck.’ According to the Canadian government, the assisted suicide law is about ‘prioritis[ing] the individual autonomy of Canadians’; one may wonder how much autonomy a disabled man lying in his own filth had in weighing death over life.
The world is very complex and nothing is black and white
That is part of the problem, you have taken something that can be measured objectively and instead politicised it. Not a uniquely American phenomenon but definitely practiced most commonly there.
The system is without pros but that doesn't matter because of the existence of lobbyists. The American political system assigns representation proportionally by wealth of interests, that is just how it is.
You can see it play out over and over again from tobacco, oil, healthcare etc. Preservation of outsized corporate profits at the expense of normal people is simply the norm in America and is ingrained in its political system.
It has nothing to do with the pros and cons of actual healthcare provided to people (or the cost at which that care is provided), simply that those that stand to lose from making the system more efficient are willing to spend anything and everything to prevent that from happening.
Unfortunately too much of the American population are happy to be duped into thinking the current system is good in some way AND that they should tie their political identity to it's preservation regardless of the facts.
It's a tragedy tbh but maybe one day logic and economics will win out. Spending this much of GDP on healthcare is just stupidly inefficient, especially when you still have so many simply not seeking care because of the financial ramifications of doing so - cheating the economy out of their productivity.
All doom and gloom. Having experienced some very good treatments and excellent outcomes for my daughter, I have a different opinion than "the system is without pros".
But such reform has not occurred despite decades of trying, and that’s because the system is not without the pros, and the pros make it infeasible to reform it at this time.
This seems like a faulty assertion. It’s possible that this system offers benefits to some subset of people. But you can’t really draw much of a conclusion simply from its continued existence.
If one of your “pro”s is “makes so much profit for insurance companies that they are willing to spend huge amounts of money to fight reform”… well, I can’t imagine that’s really what you mean by “pro”.
It is also a game of super-sub-specialization. The entire field. There essentially numerous subspecialties within each specialty.
Some surgeons do nothing but the same apnea surgery 5 times a day. Some oncologists do nothing but specific neuroendocrine cancers all day. Some diagnosticians are good for a specific area of their field - and utterly useless elsewhere, because they just couldn’t care less and want to work on what they find interesting. Just like anyone else.
If you want to see someone who actually knows what they are doing, sees the same exact issue you are having 10 times per day instead of once per decade, you WILL travel. Of course, you can always settle for the clueless doctor nearby who will do the bare minimum, or maybe even nothing.
Remember: patient outcomes are not part of the standard of care. There are no real incentives to do better than bare minimum, as a physician.
Sometimes the talent is in Switzerland. Sometimes Germany. Korea has some leading talents in niche areas.
It just so happens that the US pays the best, and just like engineers who can write their ticket that move to Bay Area, so do the physicians that move to the US.
Real life example: many neonatal surgeons only begin practising on their own, independently, in literally their late 30s, if not 40s. In training until then, whew. Slightly different than picking up a new JavaScript framework.
Would you seek to maximise your income if you had to study for 20 years after high school?
Neonatal surgery is often $1-2 million per surgery. There are only a handful of such centres. Only some of them operated on a specific condition more than 10 times.
The same really goes for anything else from diagnostic to operators. Even in the US, you’d often have to travel out of state if you want to get a proper opinion. Easier with imaging or biopsies because these can be mailed. Tons of people travel for surgeries.
250k Canadians every year travel to the US to get care they cannot get on time (or at all) at home. I’ve seen it all, even Saudis flying over for dental work.
Next time you see your doctor ask them who would they pick for their surgery: someone who does the procedure 100x per year, or someone who maybe does 1-2 cases per year. Then guess where the most super-specialized talent can maximise their income. Probably not the remote Australia with a population of ~10% of the US.
US simply has the best talent. If you can afford it.
As for Canada/NHS/Australia being better - that’s just laughable. Canada is actually dead last among top 10 richest countries, and happens to have the second highest drug prices after Switzerland. Also has as many beds per capita as Mexico. You’d be better off going literally anywhere else.
Mayo at Rochester has a larger diagnostic antibody library than anything in those three countries combined, and can arrive at your diagnosis within two days instead of two decades. Guess where your tertiary centre in Canada/Aus/Uk often mails your blood work and biopsies once they are at the end of the rope?
Medicine isn't a business as far as a government is concerned.
It's a utility that exists to protect the investment in it's citizens such that their full productivity can be achieved.
It's in a country's best interest to achieve the highest possible standard of care for all citizens, not just those that can "afford it".
Treating medicine as a business only works for the very top of the totem pole and over time leads to increasing degradation of the labor force. i.e what you are seeing in America right now.
Nobody in Australia ever wonders if they should call an ambulance if they are injured or worried they could be very ill, they just pick up the phone and dial 000. They are guaranteed as citizens of Australia to have access to life saving care whenever and wherever in our borders. They do so with no fear that they will financially ruin themselves.
In Australia we would go as far to call this a basic human right.
What you are writing about is aspirational utopian fantasy.
What I wrote is harsh reality informed by two decades of being elbow deep in bodily fluids.
You may not like it, but you aren’t getting the best physician just because you developed some far out ideas how the best talent in the world must fix your problems.
Guess what, physicians are free people too, even free to refuse any patient for any reason.
They just want top dollar, and move where the pay is best, that’s all.
You wouldn’t move for a 10x higher salary? You would deny everything that would bring to your family?
What exists in Australia is exactly what the US has: private payers that get preferential access, and then Medicare for the poor/everyone else. People avoiding appointments they cannot afford. Psi service refusing to take Medicare patients. Unavailable pharmaceuticals in Australia that one can easily access in the US. You even have US-style HMOs.
It’s just a US-lite system compared to Canada (which like Cuba outlaws private healthcare, but has a grey healthcare market because the public system is broke), and NHS(which is broke like Canada, but at least you can pay private).
1) Patients avoiding appointments due to costs, just like the US:
“Almost impossible to get bulk billed’: patients avoid seeing doctors due to out-of-pocket costs”
2) Private healthcare where cash suddenly trumps virtue-signalling on the internet.
Paying cash money? Jump the queue! The poor can languish and die while on waitlists.
“Public patients requiring elective surgery for cancer, heart conditions and other serious health issues face longer waiting times than their privately insured counterparts in public hospitals, according to a new report. ”
In some cases, physicians don’t even take any Medicare patients -at all-.
Let’s take a rather relevant specialty for this thread, psychiatry:
“Psychiatry costs in particular are prohibitive. One reader reported paying $300 for 20 minutes with a psychiatrist, while another said they paid $900 for the first session and $500 for subsequent sessions. Another reader said her one-hour psychiatry session cost $435, and the Medicare rebate “didn’t even cover half”. Another reader, Jamie, said she had paid $220 and received $76 back from Medicare, but that her initial appointment was $600.”
Congrats! You are paying American rates! Good job Australia!
My goodness, isn’t this a huge surprise! Highly trained people want to get paid even in Australia, news at 11. Who could’ve guessed.
Money talks. It’s that simple. Why is that so hard to accept?
Engineers used to move to Bay Area to get the best possible salaries, but we should suppress doctors who even as much attempt to move overseas for bigger pay checks, lol?
What you've mentioned is objectively wrong and has nothing to do with reality. The US is not leading in healthcare outcomes or anything of the sort. And even then, there's more to life than just strictly salary. Things like retirement benefits, socialized healthcare, safety nets etc all contribute to reasons why this occurs.
Also as a side note: US doesn't have a physician surplus: It has a physician shortage. By your logic, we should see no issue in finding physicians, doctors etc because they should all want to relocate to the US where the salary is the highest.
Anyone who keeps talking about averages or statistical outcomes does not understand the first thing about medicine: there is no averages.
Because of deep sub-specialization you only have an agglomeration of outliers that are really good at what they do, and then the plankton, just like in every profession.
You can either have someone that knows exactly what he’s doing, or someone who rarely does it. A large part of medicine is guesswork, and you want someone who’s seen enough to be doing the guessing.
There is no shortage of physicians if you have the money. You can see the absolute best physician of your choice literally tomorrow if you have enough money to name a hospital wing. They’ll just see you while they eat their lunch, or come in an hour earlier.
The shortage you are talking about, is a shortage of competent, qualified saints willing to forego compensation after spending a decade in training to treat the poor.
If your expectation is that the top talent should for peanuts - do you really think there can be no shortages? You are literally asking for saints and miracles.
P.S.
>there's more to life than just strictly salary. Things like retirement benefits, socialized healthcare, safety nets etc all contribute to reasons why this occurs.
$2-3 million/year solve all of the above. There is more to life, but 90% of every graduating class are there for money, nothing less.
No, I'm talking about a very literal shortage of physicians in the US. Not a shortage of saints or whatever tangent you're going on. The US has a physician shortage. I will repeat under your argument there should be no physician shortage in the US because the US has among the highest salaries for physicians. This should not happen by the argument you keep repeating.
The fact that someone can see a physician tomorrow with enough money is irrelevant because with enough money they are no limited to the US. Experts are not located entirely within the US, hence why many millionaire/billionaires will travel for medical aid because other countries might have people with more expertise in XYZ.
The rest of your comment is completely irrelevant to the argument I'm making.
Can you please edit the swipes out of your comments? You've posted good things but unfortunately they're interspersed with hostile/inflammatory bits, and we're trying to avoid the latter here. It's not what this site is for, and it destroys what it is for.
You get paid what you can negotiate, not what you deserve.
Any politician that would propose serious enough cuts to physicians pay would suddenly find that their own GP has dropped him, and his oncologist forgot how treat the politician’s cancer. Sounds extreme? Happened several times in the US.
If they’d succeeded, you’d just have waves of immigration to richer countries that can pay higher, called brain drain. The US has the financial resources to attract the best talent. Not just salaries, but resources mean you get to work on things you find interesting, and ignore things you don’t.
Regarding “best”. I never said all US physicians are “best”.
What I said was, that because of higher pay, the best talent can be appropriately rewarded in the US.
How many public single payer systems can afford a physician that bills $10 million per year? More common than you think in the US.
They are most certainly outliers, and not the average physicians.
The issue is that due to super-specialization game that is medicine, anyone sufficiently experienced is going to be an outlier. Once it comes to something more involved than simple fracture, you want someone who does nothing but works on the specific issue you have, and preferably nothing else.
Real example: triple board certified (max fax, ent, trauma) surgeon Kasey Li in the US bills something like 100k per operation. Top talent from Hollywood and top Silicon Valley execs go to him. you’ve seen his work multiple times on several personalities.
There is literally not a single surgeon in Australia that is equally as well trained and as experienced as Li. He only works in one area and one issue only.
He pioneered an entire new field, changed numerous lives, including some execs that frequent this board, lol.
Who are you to decide how much he charges? You not even qualified to assess any his work to begin with, maybe 5-10 people in the world are.
> Remember: patient outcomes are not part of the standard of care.
LMAO, what? It's literally, and defined as the end product of an acceptable standard of care, and used to judge whether a standard of care was given to a patient.
> Probably not the remote Australia with a population of ~10% of the US.
Victor Chang (https://en.wikipedia.org/wiki/Victor_Chang) would have liked a word with you. Trained in the US. But still set up shop in Australia. Considered the world's leading heart transplant surgeon, with survival rates well into the 90%s.
> Guess where your tertiary centre in Canada/Aus/Uk often mails your blood work and biopsies once they are at the end of the rope? That’s right. USA.
Because of course you mention tertiary centres as if any of those three don't actually have primary research facilities. A tertiary hospital in Australia isn't mailing shit to the US for diagnostics. In the event that they can't figure it out, there's many many state of the art facilities available.
All of this reads like some weird xeophobic libertarian fever dream, and the notion of Canadian, Australian healthcare systems as some primitive backwater barely discovering modern medicine is laughably ignorant.
Even in formerly communist countries bribes got you better access.
As soon as you can figure out how to prevent people trying to leverage every resource they have and try to outcompete others to avoid death, let us know. you might get a Nobel.
produce its own brand of generic insulin and sell it at below-market prices to people with diabetes like Sabrina Caudillo
But why? Diabetics don't want generic insulin, it's not as good as the newer insulins.
And if they want cheap generic insulin, Walmart already sells generic insulin for cheap. Why not just buy it from Walmart and subsidize it? Why would you actually try and make it yourself and sell it for below market prices? That seems like a hard way to accomplish the same thing.
What problem are they trying to solve?
I mean, the LA Times reported on Walmart's cheap insulin not a year ago.
Diabetics don't want generic insulin because it is slow acting and difficult to control. It takes a long time to start working and then a long time to stop, making dangerous highs and lows more likely.
Generic fast-acting insulin is now legal because patents have expired. But generic insulin is still quite expensive in the US.
I sure do. I use Humalog now and it's out of patent. There just isn't a generic available for it because it's just not all that cost effective to do. Creating and producing a generic for biologics (like insulins) is not simple like it is for simple chemicals. As I understand it, they need to undergo trials and the like, which drastically raises the price of creating them.
Sorry, I meant to say that diabetics don't want the slow-acting generic insulin Walmart sells, which the parent was discussing (except as a last resort). My wife is type 1 diabetic.
Both short acting and long acting insulin is available as genetics. However the newer insulin’s allow for better control - that’s why diabetics want it.
But regardless, how does that change my argument?
Why is CA getting into generic insulin manufacturing when they could just have someone who knows what they are doing make it?
Evidently, according to the article, the plan is to contract with a drug manufacturer (so, "someone who knows what they are doing"). Since any new generic has to go through trials, I guess the state would put up the money for this.
By "make it" I mean all the way to finished product. There is a ton of expense and time to create a biosimilar insulin, not just clinical trials, but regulatory approvals and updates, safety monitoring.
Why not just find an existing seller and negotiate some pricing deal and then subsidize it for people in CA?
> “Who is going to write the prescriptions for this magic insulin?” she asked.
I don't get this, but I'm not in the US. Over here the prescriptions are for the active ingredient unless something specific is required and then you get both the name and the "no substitutions" box is ticked. The pharmacy will just ask "are you ok with a generic" otherwise.
Is it much different? Why wouldn't people be prescribed "insulin" in this case?
Even then the question seems weird - people will know about this happening, they will ask for it. How would it not be prescribed?
Lately I am reading into the cause of the diabetic pandemic. It's kind of shocking to read that our food is to blame and food companies are blocking change.
Somehow this 'fat is bad' lie came into the world. We have been eating fat for thousands of years. Fat is full of all kinds of stuff the body needs. The brain can tell us when we ate enough fat so we feel full. The body can handle fat very well so it doesn't get stored and we won't grow fat.
But no, fat became wrong and was removed from our food making it tasteless. So sugars are added. This is good news for the food industry because the brain doesn't register when we have enough sugars. So we keep eating.
And this item on HN continues the trend. There is no solution but it's about companies making huge profits over insulin.
For some people (Type I diabetics) changing food is not a solution. They don't have the β-cells that make insulin, so they're reliant on synthetic insulin. Even replacing the pancreas is only a stopgap measure, and their immune system enforces that. Yes, they're 5% to 10% of all diabetics but don't simply dismiss this as continuing the trend.
The appeal to naturalism is kind of iffy, though. The kinds and amount of fat we eat might be substantially different than many of our ancestors. I'm not making an argument either way, just that I doubt modern food resembles ancient diets.
Every example I'd seen publicized of someone who "can't afford insulin because it costs $300/bottle, so they died" has been a blatant lie. Every single one of them, without exception, could have switched to L/R/N, which are on the order of $25 per bottle. Are they as good? No, certainly not. But they do work, and they are certainly better than dying. Heck, you don't even need a prescription for them.
Don't get me wrong; insulin prices are out of control, and something should be done. But these stories about people dying because they couldn't afford $300 for a vial of insulin are misinformation; and propagating them weakens the argument to get insulin prices reduced; because it gives people a factually correct way to push back against it (what with it being factually incorrect and all). Please don't spread those stories.
Side note: People will comment about how awful R/N/L are, and say you'll always feel sick, etc. I was on R/L for on the order of a decade. It's annoying because it's effectiveness curve (of the R) means you need to take it 20 minutes (give or take; it's been a while) in advance of eating.. and if you wind up not being hungry, you have to eat anyways. But they are plenty effective for controlling blood sugar.
It's not easy to do gene therapy? All the editing systems, have off targets that are yet to be studied.
Even then, let's say that they work, what about cases like gestational diabetes? Are you going to do gene therapy on a pregnant person to resolve diabetes that tends to normally vanish off once the baby is born? What about the impact on the baby?
Not a critical point here, but typically gestational diabetes is treated with diet, exercise, and drugs like metformin. The same for type 2 diabetes. It’s best to avoid using insulin when possible because insulin dosing is fairly high risk. People who require treatment with insulin mostly have type 1, and there’s currently no other option.
Kind of. That money comes from somewhere. It's like saying that I have car insurance so I don't have to pay for a new windshield. Really I already paid for that windshield via my insurance premiums.
what a weird way to justify it. the patents on insulin expired decades ago so why does it cost $400 for uninsured? it doesn't cost pharma companies $400 to produce a vial (or $200 or $100). this is pure greed.
edit: say their insurance covers 80% of the cost, the patient still has to pay $80 (at $400). if the cost of a vial was $20, they only pay $4 which is more reasonable.
In a similar analogy: Starting up your own ISP is cheap. So why don't more people start ISPs rather than being limited to a small selection of providers?
Lobbying, start-up costs and more can all be contributing factors. Something can be exceedingly cheap to manufacture, but then you gate others from manufacturing through other fashions. Or they just outright buy out your manufacturing capabilities for pennies, then turn around to sell the insulin at massive profits again.
Patents are only one of the varieties of monopolies which apply in the field of medicine. The FDA imposes several more. Even after the patents have officially expired and you've developed your own safe & effective alternative you may not be able to get it certified because the FDA has a prior agreement with the existing manufacturers to guard their product from competition.
That should make the solution clear: Undo the laws that prevent retailers from driving over the border themselves. If US drug stores could import insulin from Europe, Canada, and Mexico, then it would be impossible to maintain such a large price difference, and the US price would come down.