5 ms·

> The US is 8% richer than Denmark, 12% richer than Sweden and 40% richer than Germany on a per capita basis. This seems to ignore the obvious discrepancies be

by doktrin 10y ago

> The US is 8% richer than Denmark, 12% richer than Sweden and 40% richer than Germany on a per capita basis. This seems to ignore the obvious discrepancies between income inequality in the US vs. Sweden & Germany. Our Gini coefficient is higher than both, as is our poverty rate. Our high GDP masks the fact that our world's-highest drug prices have a disproportionately negative effect on our poorest citizens.

harryh 10y ago
That is true but it's mostly an argument for higher taxes are more subsidized medical care (including drug purchases) not an argument that the US should pay less overall for drugs than poorer countries.
- doktrin 10y ago
  > not an argument that the US should pay less overall for drugs than poorer countries. I never said that. My point is simply that pointing at nominal GDP paints an inaccurate picture. The US is a complex and extremely heterogenous market, and using a single economic measure to justify nationwide pricing is a bit like taking the temperature average of the man whose head is in the oven and feet in the freezer. It's feasible to imagine a world in which drug companies apply the same adjusted pricing to poorer segments of the US market as they do foreign customers. They don't in practice, allegedly, because of Medicaid regulations enforcing a lowest-in-country price [1]. Regardless of whether that particular explanation holds water, the idea of price discrimination within the highly unequal US market is reasonable. [1] https://object.cato.org/sites/cato.org/files/serials/files/regulation/2016/4/regulation-v39n1-2.pdf https://object.cato.org/sites/cato.org/files/serials/files/r...
  - harryh 10y ago
    Ya, I generally agree that Mississippi run medicaid should probably be paying less for drugs than Connecticut run medicaid. I can see how that might be tricky to get to politically though.
    - maxerickson 10y ago
      The federal share of Medicaid does vary by state: https://www.medicaid.gov/medicaid/financing-and-reimbursement/ https://www.medicaid.gov/medicaid/financing-and-reimbursemen... https://aspe.hhs.gov/basic-report/fy2017-federal-medical-assistance-percentages https://aspe.hhs.gov/basic-report/fy2017-federal-medical-ass...
      - harryh 10y ago
        That's about funding though right? And now about how much the individual state programs pay for things (like prescription drugs). In the end does it work out to be the same thing? Maybe? I'm uncertain.
        maxerickson 10y ago
        It's at least a similar sort of thing. Critical access hospitals and rural health clinics probably overlap too, where Medicare pays out to smaller qualifying facilities using a different formula.

by doktrin 10y ago

harryh 10y ago

That is true but it's mostly an argument for higher taxes are more subsidized medical care (including drug purchases) not an argument that the US should pay less overall for drugs than poorer countries.

doktrin 10y ago
> not an argument that the US should pay less overall for drugs than poorer countries. I never said that. My point is simply that pointing at nominal GDP paints an inaccurate picture. The US is a complex and extremely heterogenous market, and using a single economic measure to justify nationwide pricing is a bit like taking the temperature average of the man whose head is in the oven and feet in the freezer. It's feasible to imagine a world in which drug companies apply the same adjusted pricing to poorer segments of the US market as they do foreign customers. They don't in practice, allegedly, because of Medicaid regulations enforcing a lowest-in-country price [1]. Regardless of whether that particular explanation holds water, the idea of price discrimination within the highly unequal US market is reasonable. [1] https://object.cato.org/sites/cato.org/files/serials/files/regulation/2016/4/regulation-v39n1-2.pdf https://object.cato.org/sites/cato.org/files/serials/files/r...
- harryh 10y ago
  Ya, I generally agree that Mississippi run medicaid should probably be paying less for drugs than Connecticut run medicaid. I can see how that might be tricky to get to politically though.
  - maxerickson 10y ago
    The federal share of Medicaid does vary by state: https://www.medicaid.gov/medicaid/financing-and-reimbursement/ https://www.medicaid.gov/medicaid/financing-and-reimbursemen... https://aspe.hhs.gov/basic-report/fy2017-federal-medical-assistance-percentages https://aspe.hhs.gov/basic-report/fy2017-federal-medical-ass...
    - harryh 10y ago
      That's about funding though right? And now about how much the individual state programs pay for things (like prescription drugs). In the end does it work out to be the same thing? Maybe? I'm uncertain.
      - maxerickson 10y ago
        It's at least a similar sort of thing. Critical access hospitals and rural health clinics probably overlap too, where Medicare pays out to smaller qualifying facilities using a different formula.