12 ms·

> How many years of normalizing and internalizing the utter insanity that is the US medical industrial complex does it take to be able to just say that with a s

• nix23 6y ago
  Not sure why they down-vote you, you didn't said anything about 'free' healthcare, and you are absolute right, the 'customer' does not see much of those layers, but ask any Healthcare-worker that has to work with insurance...they can tell you story's!
  • flumpcakes 6y ago
    Very few people have private health care in Europe, at least in the UK - they are either comparatively very rich or have a job that provides it (again, very rare and probably a job that pays very well to begin with). You will see a lot of buying power from free health care providers as they represent tens-hundreds of millions of people - they will most likely pass on a price gouging drug in favour for others. They won't pay market rate, whatever the drug manufacturers say.
    • mathieuh 6y ago
      The most relevant industry to this board (IT) usually provide private healthcare though. I’ve had BUPA from work since I graduated. Granted this is across only two jobs but when I’ve been applying for jobs in the past private health has always been one of the perks Maybe it’s different in the start up world but larger companies all seem to offer private health insurance.
      • hkt 6y ago
        My experience in IT in the UK is: VC backed companies will sell you private health insurance as a perk. It is rarely useful. I suspect it is a way of funnelling money at low rates of tax to the VC's other holdings in at least one case, but have no proof. It certainly funds the privatisation agenda at low cost to the investor, though. Seniority is signified through leadership or contracting. The latter you can get private insurance as a perk through your own company, but again, it is useless. Most permanent non-lead roles I've had that have been more conventional haven't had it, though.
      • RobertoG 6y ago
        When comparing healthcare costs between USA and Europe, everybody speak about the public systems vs. USA, but I would like to see the cost per person of the private plans in Europe against the cost per person in the USA. For what I read about USA, in HN and in other places, I suspect Americans would be surprised too. Those private plans have a very hard competitor in the public system, so, somehow, at least in my area, they manage to be pretty affordable.
        • pintxo 6y ago
          in Germany, private plans are often 1/2 of the public plan. But only at young age, prices will go up with age and switching back in the public system is legally blocked (for most cases). Also private plans are mostly only available above a certain income level. So the demographics are skewed towards better educated, richer and thereby healthier people in the privat plans.
      • flumpcakes 6y ago
        The only place I've ever had private healthcare in the UK was from an American company (BlackRock).
    • nix23 6y ago
      >Very few people have private health care in Europe, at least in the UK In Europe at least in Switzerland quite many have private health care (the price difference is quite small because the obligatory insurance is tremendously high already), and if you think 'we' are rich..you are wrong.
      • polotics 6y ago
        Switzerland is a complete outlier in this respect, Zürich is much closer to Boston than to Paris.
        • nix23 6y ago
          No not really...that comparison is completely wrong.
      • kgwgk 6y ago
        The obligatory insurance is also private.
        • nix23 6y ago
          From private company yes, but with private we mean the 'luxury' addon...the obligatory is regulated by the state, but administered by private company's.
          • kgwgk 6y ago
            Who is “we”?
            • nix23 6y ago
              We the people.....of Switzerland
              • kgwgk 6y ago
                I don't think I've ever heard anyone say "private insurance" to refer to the "supplementary insurance" (Zusatzversicherung / assurance complémentaire / assicurazione complementare), so if it's used in that sense it's not universal. Supplementary insurance is conceptually different, by definition, from comprehensive private health insurance which provides alternative coverage for what is already covered within the public healthcare system.
• m12k 6y ago
  What do you mean? One of the points of government funded health care is that you get rid of several layers of needless indirection and profiteering. You basically vertically integrate a big chunk of the industry and have it work together to minimize overall costs instead of maximize profit of each individual component.
• hkt 6y ago
  In the UK we pay a fraction of what companies in the US do. See also, our nightmarish trade negotiations with the US: https://www.theguardian.com/politics/2019/nov/01/nhs-drugs-bill-could-soar-if-johnson-signs-trump-trade-deal-report https://www.theguardian.com/politics/2019/nov/01/nhs-drugs-b... Not a scholarly article, intentionally. I wanted to give a flavour of the existential (to our health system) nature of the problem of US style drug pricing. There's also the small matter of pricing varying highly by country. Another more emotive example: https://www.drugwatch.com/featured/us-drug-prices-higher-vs-world/ https://www.drugwatch.com/featured/us-drug-prices-higher-vs-... See also: https://www.drugwatch.com/featured/us-drug-prices-higher-vs-world/ https://www.drugwatch.com/featured/us-drug-prices-higher-vs-... So actually, it is substantially better in Europe.
  • kenhwang 6y ago
    Europe is one of the primary reasons US drug pricing is so messed up. Many European countries negotiate drug pricing on cost to manufacturer (practically nothing) with a negotiated slim profit margin. Then the drug companies just offload the rest of the R&D cost onto the US consumer. But, almost the entire cost of a drug is in the R&D. Imagine if the rest of the world only paid for CPUs based on the per unit cost of silicon but none of the fab or engineering cost. So $20 CPUs for the rest of the world and $20k CPUs for the US since the US consumer has to cover the 10s of billions for fab/R&D cost while the rest of the world only pays for the silicon. That's what happening with drug pricing right now. People _need_ medicine, which is how we got into this mess of drug pricing since it's frowned on to price people out of medicine. But European countries aren't exactly poor struggling post-war economies anymore. They can afford to shoulder more of the R&D cost instead of laughing at the US subsidizing the world.
    • flumpcakes 6y ago
      You're subsidising paying other Americans extremely high salaries. You're also subsidising share holders and C-level people's luxury lifestyle. The same drug wouldn't cost $2b to create in any other country. It's not Europe's fault you treat basic healthcare like any other business to make money from.
• quietbritishjim 6y ago
  Please back up such an unlikely sounding claim with several excellent sources. Here in the UK, there is exactly one layer: the NHS. It negotiates prices directly with drug suppliers, and as the sole buyer (monopsony) is able to get a great deal. It also sets the prices paid by consumers (the prescription price), which is a flat price charged for all drugs (yes really all of them) and is currently £9.15 (about 11 USD) for a prescription (i.e. a full course of multiple tablets of the drug). If you are given drugs in a hospital as part of an inpatient treatment the charge is usually nil.
  • splintercell 6y ago
    Are these drug companies British?
    • hkt 6y ago
      Some. American drugs companies too, though. They want our bargaining power to be mediated by the coming UKUSA trade agreement so we have to pay through the nose like Americans do. At the moment they either sell to us or lose out on our custom (the NHS is not above refusing to buy a drug on expense grounds). They're trying to make this impossible for us to do by levering political power, because single payer healthcare doesn't permit them to abuse their market power over here.
      • votepaunchy 6y ago
        > They're trying to make this impossible for us to do by levering political power, because single payer healthcare doesn't permit them to abuse their market power over here. You’re saying that if you joined some sort of union that you could negotiate from a much stronger position, similar to single-payer healthcare?
        • splintercell 6y ago
          Have you ever looked at the amount of money we spend on pharmaceuticals a percent of our total Healthcare spending?
• furyg3 6y ago
  Not here in NL. My monthly premium for myself and child is around €130 for a premium plan with a €500 yearly deductible, and most normal costs and doctors visits are excluded fro this. I had an injury that required surgery and physical therapy and did not hit this deductible. Someone I know had cancer which required two years of therapy and also somehow did not hit their yearly deductible. A friend had a burnout and needed therapy over a long period of time, also very little personal costs. This premium that I pay is more or less matched by my employer, that money goes into a fund to balance out insurers who have more risky demographic coverage. The government does offer subsidies for people who cannot afford the monthly premium, this obviously comes from taxes. That’s pretty much it for funding the system. Personal premium + employer premium + tax subsidies for the poor. Dutch people complain about costs ‘spiraling out of control’, and it is true that over the years healthcare has gotten more expensive, but these criticisms are laughable when compared to the US. It’s possible to fix the US healthcare system. Just pick any other western developed nation at random and do what they do. You’ll be better off.