7 ms·

Ability to pay? Is that a joke? Considering that 40% of Americans can't cover a $400 emergency expense[0], what makes you think they can pay $84,000 for a 12-w

• jacquesm 7y ago
  Maximized for the total bottom line it isn't a joke. That some people die is not a consideration for those that control access to these drugs, the question is how many people should die in order for them to make the most money of the ones that stay alive. Think of the ones that die as marketing.
  • claudeganon 7y ago
    This is the only sincere appraisal of the healthcare industry in the US I’ve seen on HN in months. Thank you for your clarity.
  • lol2143651 7y ago
    The way it generally works for these drugs is the insured get it covered and the uninsured get it cheap or free.
• nkozyra 7y ago
  As with most commercial goods there's a market identified and the goods priced accordingly to maximize profit. This means that somebody is priced out no matter what. Given the state of American healthcare it's easier to reconcile if you remove the emotional part and view a drug treatment as, say, a television. If I make a 50" television and price it at $500, I accept that some people will not buy it and target my television to my intended market. What I'm saying is the drug companies are probably fine saying "ok, some people can't afford it, but we maximize profit by selling at a premium to those that can." All that said, if it's life saving you might be surprised what people can and will do, savings notwithstanding.
  • chmod775 7y ago
    > All that said, if it's life saving you might be surprised what people can and will do, savings notwithstanding. Withholding a life-saving treatment has to be criminal in some way. I just can't imagine a hospital sending people home to die because they can't pay.
    • lotsofpulp 7y ago
      Closest thing is called EMTALA: https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
    • kenneth 7y ago
      Except it isn't. You can debate the moral questions behind drug pricing. But it's entirely legal for pharma companies to set the price for the drugs to maximize their profits. It's logical.
      • chmod775 7y ago
        What exactly is logical about letting someone who figuratively has you by the balls decide the price for a drug? The logical thing would be having your insurance negotiating on your behalf ahead of time. Also "but it's legal!" is not a valid argument in a debate about whether something should be legal.
    • Sacho 7y ago
      You'd be looking to criminalize rational behavior - a difficult and quite often counter-productive endeavour. First, there's survivorship bias. The hospitals that eat the costs of saving lives eventually go under or can't compete with the ones that invest in better doctors, equipment and so on. What you see in the end is lots more hospitals who are willing to withhold life-saving treatments than ones that will treat anyone no matter what. We may in theory want everyone to be treated, but in practice, our market behavior of seeking cheaper treatments and better doctors sways hospital behavior as well. Second, there's unintended consequences. A hospital going under to save some lives can have disastrous consequences on the rest of the community - non-life-threatening issues turn into fatalities with the hospital gone, leading to more lives lost than if the hospital was "cold-hearted" and "calculating". Hospitals are faced with this moral dilemma every time they do their budgeting. Third, there's utilitarianism. Is saving one life no matter how costly the way to go? What if you can save two lives for the same price? Is saving an old person's life the same worth as saving a young one's? What about "saving" someone's life but leaving them functionally crippled, vs dealing with non-fatal conditions in people which might bring them back to full function? How should a hospital spend its finite resources? When you mix in all these concerns with the practicalities of the situation(noone is working with perfect information, and hospital staff often has to make snap judgements), you're bound to get different outcomes, including sending people home to die, depending on how the hospital lands on this balancing act. It's difficult enough to craft a law to deal with the moral issues, but then you also need to think of the legal issues in enforcing it, and how the enforcement could lead to further unwanted consequences. Then, purely from a utilitarian POV, think about funnelling all the costs of enforcement into a charity - which one is more effective?
• ameister14 7y ago
  Most Americans wouldn't end up paying the 84k. Their insurance would pay for most of that, and negotiate it down further - the other day I was picking up a drug that without insurance would cost over $1,000. I paid $34.
  • dpark 7y ago
    That’s garbage. People without insurance are utterly fucked. The uninsured are sacrificed as a negotiating point against insurers. “List price is $5000. We’ll cut you a deal at only $2000!”
    • ameister14 7y ago
      Yep, that's all true. It's worse, actually - the government sets reimbursement rates as well, so when they tell a hospital 'we are only going to pay you 60% of what you charge' what do you think a hospital is going to do in response?
    • sp332 7y ago
      This is a valid thing to be concerned about, but it appears to be false. Gilead has programs that help uninsured people get their drugs, including Harvoni. https://www.gilead.com/purpose/medication-access/us-patient-access https://www.gilead.com/purpose/medication-access/us-patient-...
    • deleted 7y ago
      [deleted]
  • Cyph0n 7y ago
    It depends on your plan. If you’re on a HDHP, chances are that prescriptions are not covered until you hit your deductible.
    • ameister14 7y ago
      Even if that's the case, unless your deductible is $40k, which I have never seen before, the insurance would still cover the majority of the cost. Plus if you have chronic Hep C, you're likely spending thousands a year as it is and will continue to do so indefinitely.
• nradov 7y ago
  The vast majority of Americans have some form of medical insurance so a patient's out of pocket expense would typically be far lower.
  • Retric 7y ago
    Insurance increases net costs via added overhead. So, it’s ~80k * ~1.30 * (number receiving treatment) / (people paying insurance). Aka, it’s both more expensive and more affordable.
    • lotsofpulp 7y ago
      Health insurance in the US has overhead capped at a maximum of 20%, or 15% in large employer groups. https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-...
      • phonon 7y ago
        What percentage of the recepients costs are insurance related overhead as well? (Yes, that includes the time doctors spend arguing with insurers).
        • lotsofpulp 7y ago
          Surely, there is room for optimization, but in the alternative case of taxpayer funded healthcare, I'm sure the government is going to ask doctors for justifications for the same reasons insurers do. Someone needs to provide a second opinion on whether or not procedures and medications are appropriate for accountability purposes.
          • Retric 7y ago
            Governments add far less overhead in this area because they have more data and can thus use random inspection of bills for validation. Further, when setting rates every insurer has a separate negotiation involving even more overhead.
• kaybe 7y ago
  That really should be an argument for collective payment so the mean ability to pay counts and nobody is priced out. I'll never understand how people can support the US health care system.
• ohyes 7y ago
  Americans tend to go into massive medical debt, still they can have that credit extended to them because over their careers they’ll make more than 84,000 and probably pay it off if they live. Collecting part of that amount is still profitable because there’s no basis in the actual cost of treatment rendered. Compare to someone in (poor country) who is lucky to collect a few hundred dollars a year, no one will ever extend that person 84,000 in debt, because they don’t have any chance of making that amount over the course of their entire career. Ability to pay is significantly different from “savings.” The $400 emergency expense number is about having savings (extra money in the bank) which is really a complicated issue relating to financial literacy and debt to income ratios. You could have someone making 6 figures living in an expensive house, driving a nice car, who can’t come up with $400 because he’s overextended himself. It’s a question of liquidity rather than ability to pay. If his wages get garnished, maybe he loses the house and has to sell the car, but the medicine still gets paid for.