4 ms·

One of the biggest problems with the pharmaceutical/insurance hybrid system I experience is the inability to express choice. My family has an insurance plan i

One of the biggest problems with the pharmaceutical/insurance hybrid system I experience is the inability to express choice. My family has an insurance plan in which we pay a set premium cost monthly, and then for some set of health services our insurance promises covers (and thus reduce for us) some of the costs. I think most Americans are in a similar situation. The insurance company is allowed to reject claims for some services. In particular, they frequently reject claims for drugs for which there is a cheaper "preferred" alternative. To some extent, this seems reasonable and wise: if there's a cheaper, completely substitutable version of the drug, then let's use it. The trouble is, things aren't nearly so simple. My grandmother has a strong preference for certain kinds of pain relief medication because some (let's call it Drug A) will knock her out effectively all day, and others (let's call it Drug B) let her function wonderfully and pain-free. However, Drug A is "preferred" to Drug B. As a result, the insurance refuses to cover it. Every single incentive structure in this system is unproductive: * My grandmother is left expressing her preference by voting with her dollars, out of pocket -- punishing her for expressing a preference. Because the price gap between Drug A and Drug B is inflated by the effect of the insurance company, this disincentive is so vicious that many people would be unable sustain this at all. Many consumers are effectively unable to express preference in the market because of the synthetically inflated price gap. * The insurance company feels no pressure whatsoever to cover Drug B, even though the devastating side effects reported by my grandmother are extremely common. There's simply zero incentive for them to behave pro-consumer, or even to bargain the price of Drug B down. * The drug manufactory feels reduced pressure to change the pricing of Drug B, because unless they drop it to below the price of their current high-seller Drug A, the insurance company will powerfully influence the market away from Drug B, despite the fact that it is in almost all cases superior to Drug A and no more difficult to manufacture. By completely failing to align incentives to match good outcomes, we've ended up with a system that's pitted against its own progress. Hackers, can we construct a better market?

meric 11y ago
Establish a government monopoly for purchasing drugs. A painkiller costs maximum X or the government won't subsidise it. A drug to heal a disease costs maximum Y. People will spend everything they have to save their lives, even when it's to the detriment to the rest of society - There's a limited set of medicine available, and it's funnelling society's resources into the pharmaceutical industry because everyone's trying to compete for the best drug. Eventually people will work their whole lives to save up just so their parents can live 2 more years when they're 75, and that's not really good for society. Living out years isn't the end goal, enjoying what time we have is. An appropriate government institution will ensure that happens, while providing sufficient drug supply (but not as much as if everyone spent their life savings on drugs and nothing much else). That's how it works in many countries outside the U.S. For example, https://en.wikipedia.org/wiki/Pharmac https://en.wikipedia.org/wiki/Pharmac
- ascorbic 11y ago
  Also https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence https://en.wikipedia.org/wiki/National_Institute_for_Health_...
abtinf 11y ago
> Hackers, can we construct a better market? No, you can't. Any solution you come up with will be illegal in some key respect. You are dealing with one of the three most heavily regulated industries in the United States. You don't need hackers; you need an army lobbyists of lobbyists powerful enough to overcome entrenched opposition from every corner of the healthcare system.
- toomuchtodo 11y ago
  Can we not lobby hard enough for universal healthcare? Which has been shown to deliver healthcare at a much lower cost per capita? Google, Facebook, and Apple are in front of how many people's faces per day? Sounds like a huge lobbying force to me
Dwolb 11y ago
I did some customer development on these treatment issues. One interesting anecdote was from a gentleman whose family was predisposed to a given disease which had a treatment pathway consisting of drugs A, then B, then C. Patients were not allowed to progress to B unless A had failed and were not allowed to progress to C unless C had failed. Prior family members had been treated on this treatment pathway and had found that only drug C 'worked properly' (define that how you will). Therefore this group created their own protocol they shared amongst the family for how to act and what to say to doctors to rapidly progress from drug A to B and finally to C.

meric 11y ago

Establish a government monopoly for purchasing drugs. A painkiller costs maximum X or the government won't subsidise it. A drug to heal a disease costs maximum Y. People will spend everything they have to save their lives, even when it's to the detriment to the rest of society - There's a limited set of medicine available, and it's funnelling society's resources into the pharmaceutical industry because everyone's trying to compete for the best drug. Eventually people will work their whole lives to save up just so their parents can live 2 more years when they're 75, and that's not really good for society. Living out years isn't the end goal, enjoying what time we have is. An appropriate government institution will ensure that happens, while providing sufficient drug supply (but not as much as if everyone spent their life savings on drugs and nothing much else). That's how it works in many countries outside the U.S. For example, https://en.wikipedia.org/wiki/Pharmac https://en.wikipedia.org/wiki/Pharmac

ascorbic 11y ago
Also https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence https://en.wikipedia.org/wiki/National_Institute_for_Health_...

abtinf 11y ago

> Hackers, can we construct a better market? No, you can't. Any solution you come up with will be illegal in some key respect. You are dealing with one of the three most heavily regulated industries in the United States. You don't need hackers; you need an army lobbyists of lobbyists powerful enough to overcome entrenched opposition from every corner of the healthcare system.

toomuchtodo 11y ago
Can we not lobby hard enough for universal healthcare? Which has been shown to deliver healthcare at a much lower cost per capita? Google, Facebook, and Apple are in front of how many people's faces per day? Sounds like a huge lobbying force to me

Dwolb 11y ago

I did some customer development on these treatment issues. One interesting anecdote was from a gentleman whose family was predisposed to a given disease which had a treatment pathway consisting of drugs A, then B, then C. Patients were not allowed to progress to B unless A had failed and were not allowed to progress to C unless C had failed. Prior family members had been treated on this treatment pathway and had found that only drug C 'worked properly' (define that how you will). Therefore this group created their own protocol they shared amongst the family for how to act and what to say to doctors to rapidly progress from drug A to B and finally to C.