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This article makes it seem like drug companies alone are responsible for predatory pricing in US healthcare, with hospitals being somehow on the consumer's side

• icantdrive55 9y ago
  Never forget being charged 14.99 for one Acetaminophen while in a hospital, and this was years ago. My father had good insurance. He went in for a spider bite. He needed to stay the night. I arrived and he thanked me for Teddy Bear, and flowers. I told him I didn't send you anything. He said, "Well someone did?" Weeks later he called me up, and said the gift shop on the hospital send the gift, and charged the Insurance company $230. Billed under something like "psychological affirmations". Any who--they are thieving entities. It kills me when I meet people, with no assets, who pay their inflated hospital bills out of American pride? They are so strong in their convictions, I don't even bring up a chapter 7. I understand they save live, but don't financially ruin patients. One other memory. I went in for something. I had great insurance, so I didn't worry about the bill. They gave me a blood test. A week went by, and I got a bill for $900. I called my union, and they the hospital didn't know I had insurance. My union said my bill would be $10. She said the hospital sent them the bill of $100, and I would pay my 10 percent. I asked, "Why do they only charge you $100?" She said, "It's about Collective Bargaining. Yea--I find it shocking too."
  • Gustomaximus 9y ago
    One of the best rules for US hospitals (other than universal care) would be for all hospitals to publish prices annually and charge one set price, be it a walk in patient or large union. This should be a reasonable rule if people want to keep capitalist system healthcare. Its not stopping them competing, only applying a transparent and level playing field to the market.
    • carlmr 9y ago
      Yep, transparency and charging all patients the same should be regulated. Then it barely matters if the system is private or public, because it would be so cheap that even the uninsured wouldn't go bankrupt from a surgery.
    • jopsen 9y ago
      IMO published prices including all applicable taxes and fees should always be posted. In particularly for consumer facing products. I can't praise the EU enough for making this happen, and making sure said price is written big letters :)
    • lostlogin 9y ago
      Careful, next you’ll have death panels.
  • dx034 9y ago
    I don't understand how charging different prices for the same service is legal. If that would be declared illegal (as it is in many other countries) it would probably already fix a lot. Some insurances would pay more but people without insurance vastly less.
  • AndyMcConachie 9y ago
    Is there a website where people can post their annotated hospital bills and talk about them? If not, someone should make one.
• nkrumm 9y ago
  Even if they do not directly pass this on to patients, cheaper generics will benefit patients in terms of their availability. I recently was involved in a case where a flucytosine (an old, generic anti-fungal) was considered for a patient, but the cost of treatment was $7,000 (as an outpatient) and therefore not considered (despite this being the best option). For an interesting analysis of this, see [1]. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885648/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885648/
  • Symbiote 9y ago
    "Due to generic drug manufacturer monopolization, flucytosine currently costs approximately $2000 per day in the United States, with a 2-week flucytosine treatment course costing approximately $28 000. The daily flucytosine treatment cost in the United Kingdom is approximately $22." Would it be permitted to travel to the UK (or somewhere closer) and buy the medicine, then bring it back? Or even order online, there's at least one British pharmacy that can deliver abroad.
    • manmal 9y ago
      Why not just go on a 2 week holiday :)
      • Maarten88 9y ago
        I was in San Diego some time ago, and went for a walk to Tijuana, Mexico. I noticed a flourishing pharma business there ;-). Not only Viagra but also seemingly normal pharmaceuticals and services like dentists and doctors. They seem to have found a market there... Getting through the border and back on foot was a bit of a hassle, and it's probably not a good idea to "bring" too much stuff, but it was a fun experience anyway :-)
        • zip1234 9y ago
          The free market at work!
        • 9y ago
• siquick 9y ago
  > If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they? As a non-American (UK and Australia citizen) it bewilders me that this is considered a possibility. Why are hospitals doing the opposite to offering the best care possible to all citizens? Are they for-profit in the US?
  • kevin_thibedeau 9y ago
    1) Properly healing people reduces your customer base. 2) Yes (with some exceptions). The other aggravating factor is that most mutual insurance companies have also converted to a for profit model that reinforces the incestuous coupling between pharma and medical providers. There is no voice left who has an interest in lowering costs.
  • thaumaturgy 9y ago
    > Are they for-profit in the US? Yes, with few exceptions. Here's how this goes: "But if they weren't for-profit, then it would be more like Canada's or England's health care, and I've heard you have to wait months for anything over there. Also it would mean they wouldn't have as much money for innovation, and, y'know, the US has the best health care technology in the world. Oh, sure, only the rich can afford it, but if you're poor you can still go to a hospital and they won't turn you away." There, that's every single defense of our system, in one paragraph. I don't think I missed anything. Now, pardon me, I need to go throw up.
    • lostlogin 9y ago
      One issue with the above. > England You mean Britain. It wouldn’t be HN without a rant correction.
      • tonyedgecombe 9y ago
        > You mean Britain. At the moment.
      • matthewmacleod 9y ago
• intopieces 9y ago
  For one, a significant number of of hospitals are non profit. Excess earnings must be invested into hospital itself in the form of capital improvements and additional staff. Controlling costs is a way of reducing their own need to spend this excess money.
  • kgwgk 9y ago
    Giving themselves huge salaries is another way for non-profit CEOs to put into good use the excess money.
• eksemplar 9y ago
  Drug prices is an increasing problem everywhere. Now I’m European so bare with me and my “Stalinist” ways, but I don’t see why something so essential to society is in the hands of corporations rather than the public. Research? You could buy a lot of research for the amount of money we’re currently spending on medicine in healthcare and right now we’re really just paying a corporate tax to save lives so that some 1%’et can get even richer.
  • mft_ 9y ago
    Assuming you're referring to the general development and supply of all drugs (in particular new drugs, as well as generics) the simple answer is that the process of discovering and developing new drugs is both high-risk and also heinously expensive. As such, whoever approaches it needs to have many billions to spend and --very likely-- lose. The current capitalist Pharma model has developed to suit: investors in Pharma essentially take on the risk, and the 'downside' is high drug prices to pay back the investors for their investment and its risk. Are there alternatives? Well... * Large charities (the Gates Foundation, for example) might be able to fund development of drugs, but would be most likely to focus on a limited number of high-return, lower-risk opportunities. The Foundation's annual total spend ($4.6Bn in 2016) is roughly half of one large Pharma company's R&D spend (https://www.roche.com/research_and_development.htm https://www.roche.com/research_and_development.htm), so they've clearly not got the clout to enter general drug development. * Governments might be able to enter this space, but then you're betting that a government can do it cheaper/better than big Pharma, which is a major gamble, even before you get into arguments about public- vs. private-sector efficiency. You then also run into the challenge of governments not being great at making major long-term visionary investments in a 4/5-year election cycle, the electoral unpopularity of such an approach if drugs fail, and the ethical requirement of firewalling the government development arm from the drug approval (i.e. public-health-safeguarding) arm. And again, you've got to find the money: sure, Roche's drug development spend per year is only ~a tenth of the UK NHS's annual budget... but that's a super-cash-strapped health service - diverting 10% of its budget to maybe improve things in 10 years would be a tough sell. Any avenues I'm missing? (Now... fully agree that it would be possible for government or non-profits to enter the generic space, but... the majority of generics make pennies, if anything, and are certainly not cash cows. For every one 'bad' case that's brought to the public attention, be it a rare antibiotic, or the price of adrenaline pens, there are countless thousands of other examples which aren't a problem. So you'd need a very flexible generics strategy to only focus on these rare 'problem' cases... and this might not even always be scientifically or legally possible.)
• thinkcontext 9y ago
  Its probably necessary but not sufficient for there to be more competition in this area. That there are nationwide shortages of saline bags and sodium bicarbonate indicates massive market failure, without evening considering more complex drug politics. You raise a good point about drug companies not being the sole source of predatory pricing in US healthcare. US healthcare is in the neighborhood of $3T whereas drug spending is around $300B, though drug spending is going up faster than health spending overall.
• CabSauce 9y ago
  Those hospital systems are non-profit. Not that there aren't ways to spend new revenue on buildings and equipment, but at least there's less profit motive.
• danvoell 9y ago
  Medical Devices use the exact same play book. Small improvements + patents and new FDA approvals. You can use the old design, but there may be a flaw. Not to mention distribution strongholds and salespeople in the operating room with doctors.