5 ms·

there is no legitimate reason the us should be praying at least an order of magnitude more for the same treatments

by make3 9y ago

majormajor 9y ago
I certainly don't like the US having higher prices than elsewhere in the world, but what I would like to see more discussion of there is "where does the funding for the development of the treatments come from" rather than just comparison of absolute cost. I suspect we're subsidizing (especially at the top of the market) a lot of research that the rest of the world is also benefiting from. This isn't necessarily the worst thing in the world, but I would like to see the numbers and, if it is the case, find out why the burden isn't shared more equally? I worry, a bit, that this is an area where other wealthy countries act in somewhat bad faith through their health services, to keep their own costs down while knowing that a corporation will make the deal since it's still greater total income and profit than not selling for full cost overseas. I fear a race to the bottom where new treatments are impractical to pursue much more than I fear a stratified market where new treatments are only available to the rich at first. Look at how totally we've managed to fuck up the incentives for academic research -- I want to tread lightly, in these areas.
- make3 9y ago
  afaik the pharmaceutical industry is one of the industries with the highest profit margins. I am skeptical of your claims.
  - majormajor 9y ago
    http://www.bbc.com/news/business-28212223 http://www.bbc.com/news/business-28212223 Profits seem pretty healthy, but R&D spending is also quite high. I'd expect a high-research growth industry to have much higher profit margins than mature things like oil and gas or media. Boggles my mind why banking is comparable, though. :| Believe it or not, I'm not making claims. I'm trying to get people to go deeper on the issue sooner, rather than later, since a lot could change around it in the US in the near future. > And it's not just cancer drugs - between April and June this year, drug company Gilead clocked sales of $3.5bn for its latest blockbuster hepatitis C drug Sovaldi. This sort of thing - breakthrough new drug being ridiculously expensive at first - doesn't seem necessarily bad to me, as long as the price comes down over time and the drugs deliver the goods. We just need to make sure we know the numbers to watch to make sure we don't either bankrupt ourselves, or kill the motivation for research (jacking up the prices of old drugs is a scary recent trend I want us to crack down on). Here's the core thing: "the pharmaceutical industry is one of the industries with the highest profit margins" is not a policy suggestion. "Costs are too high" is not a policy suggestion. They suggest a few possible things - price controls, or higher taxes, come to mind immediately, but don't do anything beyond that. The US is in dire need of useful policy suggestions (even "medicare for all" is pretty thin, and ignores some disadvantages Medicare has compared to a lot of people's current private coverage), and in even more dire need of people who talk about things with more nuance than "socialize it all!" or "individual liberty is the most important thing!"
- hfourm 9y ago
  Here is more nuance for you: A) Americans need to be more health centric. Half the problem is that a minority of chronic patients account for 50% of the costs. Drive through rural America, fast food is the only option. Grocery shopping at Dollar stores and gas stations. Solving Americas obesity epidemic is step one in fixing US healthcare. B) Big pharma regulations. I like the idea of importing drugs and creating more competition. I also think it should be a national embarrassment that we let drug companies advertise to people. Drug decisions should be between doctors and their patients, not patients and the marketing wing of a big pharma company. C) More access to preventative care. Maybe socializing everything healthcare is way too much to ask right now. But, EVERYONE should have access to regular doctor appointments at least for annual checkups. Earlier recognition of problems will greatly cheapen downstream costs if people aren't waiting till they are having a heart attack to seek care. These are just a few pragmatic approaches imo.
  - majormajor 9y ago
    These are very good and fair points that I was ignoring so far. Personally, to avoid being someone just criticizing but not offering my own ideas, here's my initial recipe at the moment based on what I've learned so far is (subject to change from new information, of course :) ). It actually includes all three: * Government-mandated health insurance coverage at a certain useful minimum level. Insurance companies allowed to offer bettter plans as well, at higher prices. Keeping insurance coverage private reduces transitional shock to the system. * Government subsidies based on income to make the minimum mandated coverage level attainable. * Employer-sponsered plans are banned. Get rid of some corporate power imbalance vs small companies/individuals, and get hidden private subsidies out of the system. * I'd try to take your (A) a bit further: the minimum-coverage plans could have some coverage gaps around self-inflicted conditions, and very little coverage for optional/purely cosmetic/not-necessary treatments. This may not be politically feasible - it could be seen as too cruel, or it could catch on with America's latent "personal responsibility" instincts; either way, I think it's the fairest place to treat as a first-line cost-control location for coverage. I need a second part, here, though, about making healthier options easier to come by for some, though. * Completely agreed on banning drug B2C marketing. Let the drug's effectiveness sell itself to doctors, let that sell it to consumers. * Beyond that, aggressively pro-research pricing and tax incentive policies, both for domestic drug companies and foreign ones - some of this might require policy discussions with other countries, but ultimately it's in everyone's interest if we get a bunch of research funded as in the long run, we'll make way more things treatable and have way more cheap drug options available. I think as long as we have a healthy market that we make sure rewards performance, not marketing we can keep the incentives in the right place. * I think an annual physical is a good thing to include in the individual healthcare mandate as part of the insurance re-up process. Obesity is a particularly tough one, though. Generally, populations that eat less (and less unhealthy simple-carb-based-stuff) and walk more appear to have less obesity, but politically this isn't a big winner, and would run into a lot of resistance if pitched as a "fixable by individual action" thing. And penalties for not meeting certain targets might be impossible - does anyone really want to put someone in jail for not paying a health fine for not getting healthier compared to the previous year? I don't, but if there's no teeth to it, how would it ever work?

there is no legitimate reason the us should be praying at least an order of magnitude more for the same treatments

by make3 9y ago

there is no legitimate reason the us should be praying at least an order of magnitude more for the same treatments

I certainly don't like the US having higher prices than elsewhere in the world, but what I would like to see more discussion of there is "where does the funding for the development of the treatments come from" rather than just comparison of absolute cost. I suspect we're subsidizing (especially at the top of the market) a lot of research that the rest of the world is also benefiting from. This isn't necessarily the worst thing in the world, but I would like to see the numbers and, if it is the case, find out why the burden isn't shared more equally? I worry, a bit, that this is an area where other wealthy countries act in somewhat bad faith through their health services, to keep their own costs down while knowing that a corporation will make the deal since it's still greater total income and profit than not selling for full cost overseas. I fear a race to the bottom where new treatments are impractical to pursue much more than I fear a stratified market where new treatments are only available to the rich at first. Look at how totally we've managed to fuck up the incentives for academic research -- I want to tread lightly, in these areas.

make3 9y ago
afaik the pharmaceutical industry is one of the industries with the highest profit margins. I am skeptical of your claims.
- majormajor 9y ago
  http://www.bbc.com/news/business-28212223 http://www.bbc.com/news/business-28212223 Profits seem pretty healthy, but R&D spending is also quite high. I'd expect a high-research growth industry to have much higher profit margins than mature things like oil and gas or media. Boggles my mind why banking is comparable, though. :| Believe it or not, I'm not making claims. I'm trying to get people to go deeper on the issue sooner, rather than later, since a lot could change around it in the US in the near future. > And it's not just cancer drugs - between April and June this year, drug company Gilead clocked sales of $3.5bn for its latest blockbuster hepatitis C drug Sovaldi. This sort of thing - breakthrough new drug being ridiculously expensive at first - doesn't seem necessarily bad to me, as long as the price comes down over time and the drugs deliver the goods. We just need to make sure we know the numbers to watch to make sure we don't either bankrupt ourselves, or kill the motivation for research (jacking up the prices of old drugs is a scary recent trend I want us to crack down on). Here's the core thing: "the pharmaceutical industry is one of the industries with the highest profit margins" is not a policy suggestion. "Costs are too high" is not a policy suggestion. They suggest a few possible things - price controls, or higher taxes, come to mind immediately, but don't do anything beyond that. The US is in dire need of useful policy suggestions (even "medicare for all" is pretty thin, and ignores some disadvantages Medicare has compared to a lot of people's current private coverage), and in even more dire need of people who talk about things with more nuance than "socialize it all!" or "individual liberty is the most important thing!"
hfourm 9y ago
Here is more nuance for you: A) Americans need to be more health centric. Half the problem is that a minority of chronic patients account for 50% of the costs. Drive through rural America, fast food is the only option. Grocery shopping at Dollar stores and gas stations. Solving Americas obesity epidemic is step one in fixing US healthcare. B) Big pharma regulations. I like the idea of importing drugs and creating more competition. I also think it should be a national embarrassment that we let drug companies advertise to people. Drug decisions should be between doctors and their patients, not patients and the marketing wing of a big pharma company. C) More access to preventative care. Maybe socializing everything healthcare is way too much to ask right now. But, EVERYONE should have access to regular doctor appointments at least for annual checkups. Earlier recognition of problems will greatly cheapen downstream costs if people aren't waiting till they are having a heart attack to seek care. These are just a few pragmatic approaches imo.
- majormajor 9y ago
  These are very good and fair points that I was ignoring so far. Personally, to avoid being someone just criticizing but not offering my own ideas, here's my initial recipe at the moment based on what I've learned so far is (subject to change from new information, of course :) ). It actually includes all three: * Government-mandated health insurance coverage at a certain useful minimum level. Insurance companies allowed to offer bettter plans as well, at higher prices. Keeping insurance coverage private reduces transitional shock to the system. * Government subsidies based on income to make the minimum mandated coverage level attainable. * Employer-sponsered plans are banned. Get rid of some corporate power imbalance vs small companies/individuals, and get hidden private subsidies out of the system. * I'd try to take your (A) a bit further: the minimum-coverage plans could have some coverage gaps around self-inflicted conditions, and very little coverage for optional/purely cosmetic/not-necessary treatments. This may not be politically feasible - it could be seen as too cruel, or it could catch on with America's latent "personal responsibility" instincts; either way, I think it's the fairest place to treat as a first-line cost-control location for coverage. I need a second part, here, though, about making healthier options easier to come by for some, though. * Completely agreed on banning drug B2C marketing. Let the drug's effectiveness sell itself to doctors, let that sell it to consumers. * Beyond that, aggressively pro-research pricing and tax incentive policies, both for domestic drug companies and foreign ones - some of this might require policy discussions with other countries, but ultimately it's in everyone's interest if we get a bunch of research funded as in the long run, we'll make way more things treatable and have way more cheap drug options available. I think as long as we have a healthy market that we make sure rewards performance, not marketing we can keep the incentives in the right place. * I think an annual physical is a good thing to include in the individual healthcare mandate as part of the insurance re-up process. Obesity is a particularly tough one, though. Generally, populations that eat less (and less unhealthy simple-carb-based-stuff) and walk more appear to have less obesity, but politically this isn't a big winner, and would run into a lot of resistance if pitched as a "fixable by individual action" thing. And penalties for not meeting certain targets might be impossible - does anyone really want to put someone in jail for not paying a health fine for not getting healthier compared to the previous year? I don't, but if there's no teeth to it, how would it ever work?