5 ms·

The article talks about people being uninsured, but this is a misunderstanding of the problem. I'm type 1 diabetic, and the reasons for this are pretty straight

The article talks about people being uninsured, but this is a misunderstanding of the problem. I'm type 1 diabetic, and the reasons for this are pretty straightforward. In thus US, insulin (of the types people actually use) is very expensive (~$300/vial), and requires a prescription which expires after one year. In Canada, the exact same insulins from the exact same manufacturers are literally 10x cheaper, and are OTC. Being without insulin takes about two hours to turn into a life-threatening emergency. The prescription requirement creates ample opportunities for logistical errors that turn into life-threatening emergencies. And there's no legitimate reason for prescriptions to expire. And the cost is such that, if travel were free, you'd often be better off paying the full price in another country than just the co-pay in the US; the price is so insanely inflated that insurance is just compensating for the dysfunction, it isn't better than a sane uninsured baseline would be. Insulin is cheap in every country in the world except for the United States. This is completely insane. It needs to be OTC in the US, and the import restrictions need to be removed so that US diabetics can have it at the international price instead of the gouging price.

albuterol 7y ago
Same goes for asthma medication. Epinephrine got removed from OTC options a few years ago, and now it's impossible to treat asthma without getting pushed into steroid treatments with whopping price tags.
- mikecsh 7y ago
  Do you not have access to beta2 agonists such as salbutamol?
  - x86_64Ubuntu 7y ago
    Still need a script to get it.
- ASalazarMX 7y ago
  As a fellow asthmatic, great username.
- bluejellybean 7y ago
  It's actually back as an OTC, I only learned it was made available again after a scary ER visit. Check your local Walgreens!
nickles 7y ago
Although I agree with you that the article misunderstands the problem, I'm not sure it's the cost of insulin that's the issue. Of all diabetics in the United States, ~3% have type 1 diabetes. It looks like 90-95% have type 2 [0], which is highly correlated with obesity. While obesity rates in Canada appear to have stagnated [1], they are steadily increasing in the United States [2]. Additionally, the United States has roughly double the rate of obesity as Canada. Given the relative increase in obesity in the USA versus Canada, it's quite possible the increase in diabetic complications can be attributed to this. [0] http://diabetes.org/diabetes-basics/statistics/ http://diabetes.org/diabetes-basics/statistics/ [1] https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article/14185-eng.htm https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article... [2] https://www.stateofobesity.org/obesity-rates-trends-overview/ https://www.stateofobesity.org/obesity-rates-trends-overview...
- qntty 7y ago
  For young people, the numbers are very different. See my other comment.
  - nickles 7y ago
    The referenced article studied individuals aged 12 to 30. Additionally, while both type 1 and type 2 diabetes rates among youths are rising, type 2 diabetes is becoming more common in that group. [0] https://link.springer.com/article/10.1007/s11606-019-05006-6 https://link.springer.com/article/10.1007/s11606-019-05006-6 [1] https://www.nih.gov/news-events/news-releases/rates-new-diagnosed-cases-type-1-type-2-diabetes-rise-among-children-teens https://www.nih.gov/news-events/news-releases/rates-new-diag...
- ng12 7y ago
  Obesity and Type 2 diabetes have very little to do with this issue. Not all Type 2 diabetics take insulin and not all Type 2 diabetics who take insulin are at risk of DKA. Furthermore, the vast majority of Type 2 diabetics are adults. The article is very clearly referring to Type 1 diabetics.
ordu 7y ago
> there's no legitimate reason for prescriptions to expire. It reminds me a bureaucracy of USSR, where there was a developed system helping to people with disabilities -- medical and social measures, -- but to be a subject of that help you need to prove your disabilities on regular basis. System was not bothered by the fact, that if someone miss a limb, than it will last forever. So a person with a missing limb was forced to "prove" his/her limb is missing every few years.
- pjc50 7y ago
  Ah, the current UK system. It's been condemned by the UN, but the government would far rather lose lawsuits than admit that disabled people aren't lying about being disabled.
vkou 7y ago
> The prescription requirement creates ample opportunities for logistical errors that turn into life-threatening emergencies. And logistical errors with prescription medications in the United States happen all the time. My wife has two simple, common prescriptions, and when she comes in for refills, it's a complete crap-shoot of whether they are in. You'd figure that the free market would find some way to optimize this sort of thing - but apparently, it's incapable of anything but gouging patients.
- BRAlNlAC 7y ago
  The prescription drug market is hardly free.
pjc50 7y ago
> insulin (of the types people actually use) Is this perhaps the key - people being steered off the old patent free insulin and onto more expensive treatments, without really being given the choice?
- cperciva 7y ago
  Modern insulin is vastly superior. The difference between Novolog and Fiasp is small, but the difference between Novolog and Humulin is huge.
  - pjc50 7y ago
    In what way? (Is it better to have a better insulin on the shelf because you can't afford it?
throwing838383 7y ago
the problem with medical service in the US is the prices. We really need cost controls here. The medical industry should be highly regulated in terms of the prices they can charge.
- plainOldText 7y ago
  I’m assuming you’re trolling. Having said that, I will address your comment anyway, as I want to counteract the nefarious forces aimed at oversimplifying complexity. There is never just one “problem”. Prices are just the result of various dynamic forces in the market: supply, demand, regulatory burden, availability of capital, technological development, corruption, etc. A competitive market is much more efficient at establishing what to produce and at what cost & price, since pricing is a dynamic process. Some entity establishing prices artificially will lead to market decay. Sadly, the medical services & products markets in the US are not open to much competition, and one consequence of the regulatory burden is that it prevents other companies from entering the market and allows for all sorts of abuses from existing players. Please note that I’m not arguing for no regulation whatsoever, but regulation of the senseless kind is hard to come by.
  - samfisher83 7y ago
    Medicine isn't like normal supply and demand. If Apple increases the price of an iphone well you can chose not to buy an iphone. If drug x is what is keeping you alive and they have a patent on it its not like you can't buy the drug. It has pretty inelastic demand. I understand that drug R+D is expensive. The US Government is by far the largest spender of drug R+D in this country.
    - plainOldText 7y ago
      > Medicine isn't like normal supply and demand. Indeed it isn’t, and like you’ve correctly identified, demand is inelastic. But it’s still a market subject to competitive forces, provided they exist. > If drug x is what is keeping you alive and they have a patent on it its not like you can't buy the drug. The drug x did not emerge spontaneously. Someone decided to create it because it was a demand for it and it was an opportunity for profit. Had the research not occurred, the drug wouldn’t have been created at all. So the way I see it, having an expensive drug (I will maybe be kept alive) is preferred to not having it at all (I definitely won't be kept alive). Plus, patents do expire as far as I’m aware. Yes, I understand people want drugs at prices they can afford but this is not solvable by simply price fixing without generating unintended consequences.
deleted 7y ago
[deleted]

albuterol 7y ago

Same goes for asthma medication. Epinephrine got removed from OTC options a few years ago, and now it's impossible to treat asthma without getting pushed into steroid treatments with whopping price tags.

mikecsh 7y ago
Do you not have access to beta2 agonists such as salbutamol?
- x86_64Ubuntu 7y ago
  Still need a script to get it.
ASalazarMX 7y ago
As a fellow asthmatic, great username.
bluejellybean 7y ago
It's actually back as an OTC, I only learned it was made available again after a scary ER visit. Check your local Walgreens!

nickles 7y ago

Although I agree with you that the article misunderstands the problem, I'm not sure it's the cost of insulin that's the issue. Of all diabetics in the United States, ~3% have type 1 diabetes. It looks like 90-95% have type 2 [0], which is highly correlated with obesity. While obesity rates in Canada appear to have stagnated [1], they are steadily increasing in the United States [2]. Additionally, the United States has roughly double the rate of obesity as Canada. Given the relative increase in obesity in the USA versus Canada, it's quite possible the increase in diabetic complications can be attributed to this. [0] http://diabetes.org/diabetes-basics/statistics/ http://diabetes.org/diabetes-basics/statistics/ [1] https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article/14185-eng.htm https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article... [2] https://www.stateofobesity.org/obesity-rates-trends-overview/ https://www.stateofobesity.org/obesity-rates-trends-overview...

qntty 7y ago
For young people, the numbers are very different. See my other comment.
- nickles 7y ago
  The referenced article studied individuals aged 12 to 30. Additionally, while both type 1 and type 2 diabetes rates among youths are rising, type 2 diabetes is becoming more common in that group. [0] https://link.springer.com/article/10.1007/s11606-019-05006-6 https://link.springer.com/article/10.1007/s11606-019-05006-6 [1] https://www.nih.gov/news-events/news-releases/rates-new-diagnosed-cases-type-1-type-2-diabetes-rise-among-children-teens https://www.nih.gov/news-events/news-releases/rates-new-diag...
ng12 7y ago
Obesity and Type 2 diabetes have very little to do with this issue. Not all Type 2 diabetics take insulin and not all Type 2 diabetics who take insulin are at risk of DKA. Furthermore, the vast majority of Type 2 diabetics are adults. The article is very clearly referring to Type 1 diabetics.

ordu 7y ago

> there's no legitimate reason for prescriptions to expire. It reminds me a bureaucracy of USSR, where there was a developed system helping to people with disabilities -- medical and social measures, -- but to be a subject of that help you need to prove your disabilities on regular basis. System was not bothered by the fact, that if someone miss a limb, than it will last forever. So a person with a missing limb was forced to "prove" his/her limb is missing every few years.

pjc50 7y ago
Ah, the current UK system. It's been condemned by the UN, but the government would far rather lose lawsuits than admit that disabled people aren't lying about being disabled.

vkou 7y ago

> The prescription requirement creates ample opportunities for logistical errors that turn into life-threatening emergencies. And logistical errors with prescription medications in the United States happen all the time. My wife has two simple, common prescriptions, and when she comes in for refills, it's a complete crap-shoot of whether they are in. You'd figure that the free market would find some way to optimize this sort of thing - but apparently, it's incapable of anything but gouging patients.

BRAlNlAC 7y ago
The prescription drug market is hardly free.

pjc50 7y ago

> insulin (of the types people actually use) Is this perhaps the key - people being steered off the old patent free insulin and onto more expensive treatments, without really being given the choice?

cperciva 7y ago
Modern insulin is vastly superior. The difference between Novolog and Fiasp is small, but the difference between Novolog and Humulin is huge.
- pjc50 7y ago
  In what way? (Is it better to have a better insulin on the shelf because you can't afford it?

throwing838383 7y ago

the problem with medical service in the US is the prices. We really need cost controls here. The medical industry should be highly regulated in terms of the prices they can charge.

plainOldText 7y ago
I’m assuming you’re trolling. Having said that, I will address your comment anyway, as I want to counteract the nefarious forces aimed at oversimplifying complexity. There is never just one “problem”. Prices are just the result of various dynamic forces in the market: supply, demand, regulatory burden, availability of capital, technological development, corruption, etc. A competitive market is much more efficient at establishing what to produce and at what cost & price, since pricing is a dynamic process. Some entity establishing prices artificially will lead to market decay. Sadly, the medical services & products markets in the US are not open to much competition, and one consequence of the regulatory burden is that it prevents other companies from entering the market and allows for all sorts of abuses from existing players. Please note that I’m not arguing for no regulation whatsoever, but regulation of the senseless kind is hard to come by.
- samfisher83 7y ago
  Medicine isn't like normal supply and demand. If Apple increases the price of an iphone well you can chose not to buy an iphone. If drug x is what is keeping you alive and they have a patent on it its not like you can't buy the drug. It has pretty inelastic demand. I understand that drug R+D is expensive. The US Government is by far the largest spender of drug R+D in this country.
  - plainOldText 7y ago
    > Medicine isn't like normal supply and demand. Indeed it isn’t, and like you’ve correctly identified, demand is inelastic. But it’s still a market subject to competitive forces, provided they exist. > If drug x is what is keeping you alive and they have a patent on it its not like you can't buy the drug. The drug x did not emerge spontaneously. Someone decided to create it because it was a demand for it and it was an opportunity for profit. Had the research not occurred, the drug wouldn’t have been created at all. So the way I see it, having an expensive drug (I will maybe be kept alive) is preferred to not having it at all (I definitely won't be kept alive). Plus, patents do expire as far as I’m aware. Yes, I understand people want drugs at prices they can afford but this is not solvable by simply price fixing without generating unintended consequences.

deleted 7y ago

[deleted]