4 ms·

why? i don't understand why medicine in US is not priced just like commodities, milk and bread? In india you have 2 major types of medicine. 1. proprietary com

why? i don't understand why medicine in US is not priced just like commodities, milk and bread? In india you have 2 major types of medicine. 1. proprietary combinations which are sold by companies at a market rate "printed maximum retail price" which includes kickbacks to doctors, medical representative salaries and all profits. Other companies also make the combinations so its not like sky high rates with one company, market adjusts itself. The rates are expensive but people have to live with it. 2. Generic medicine. the govt markets generic medicine of around 700 combinations which are priced at usually 10% the proprietary prices because there are no kickbacks to doctors, no reps and stuff. Same is sold by private companies also who find generic medicine profitable. The thing is, in india, medical insurance is still not prevalent. The companies cannot inflate the prices 1000% next month and expect everyone to continue buying the product. In the US, medical insurance companies finance these pharma companies to keep highly inflated prices and its all fine for the consumer only if they are insurance buyers. For others, tough luck

lotsofpulp 6y ago
> why? i don't understand why medicine in US is not priced just like commodities Because the drug manufacturers are trying to make everyone pay as much as they can afford, which means they need to create various methods of procuring the drug with various hurdles/trade offs so the final price is obfuscated. The rich / less price conscious end up paying more. > In the US, medical insurance companies finance these pharma companies to keep highly inflated prices This is not true in any way. Insurance companies regularly deny payment for brand name medications and usually only pay for cheaper generics.
- airstrike 6y ago
  > This is not true in any way. It is somewhat true in one important way: someone is paying for all that Big Pharma R&D, and it ain't developing nations or Western Europe's public healthcare system
  - lotsofpulp 6y ago
    US insurance companies might be paying higher prices for medicines, but they're not doing it for the purpose of keeping the prices of medicines "inflated".
- 2Gkashmiri 6y ago
  shouldnt medicine be priced "without" the assumption that everyone will have insurance? insurance is a benefit given by consumer to themselves by paying for it, not the other way around?
  - lotsofpulp 6y ago
    Many medicines aren't commodities with lots of suppliers, so the seller has a lot of power in the pricing negotiations. Insurers aren't paying higher prices to "keep prices inflated", they're paying them because there is no other choice. Sellers might also want to sell to insurers and others with deep pockets at a higher price than to non-insured or buyers with less money. So they will negotiate one price with an insurer, and the insurer will try stipulate they can't offer anyone a lower price, but then the seller might be able to get around this via rebates or discounts for buyers that can't afford insurance, etc.
    - 2Gkashmiri 6y ago
      my question is why is insurer there in this discussion? from my understanding, pricing should be negotiated between companies and buyers in the market. > they're paying them because there is no other choice. In a free market, alternatives come up because consumers dont want to pay for exorbitant prices, they just cant afford it.
      - lotsofpulp 6y ago
        Pricing can only be negotiated properly when a buyer and seller are sufficiently educated about the market and the products. Very few people are sufficiently knowledgeable about medicine and healthcare to be able to discern an appropriate price (much less determine if what they are buying is even necessary or not). Hence society relies on #1) trust by assuming healthcare providers are acting on good faith and #2) a knowledgeable actor providing a second opinion such as a government healthcare payer like the NHS in the UK or private insurance companies in the USA, who employ teams of doctors and pharmacists to review people’s cases and determine appropriate levels care. For example, if you have a plumbing problem, you can call 5 plumbers and get educated and make an informed decision. With a healthcare emergency, lack of time and lack of healthcare providers and other resources makes that an untenable solution.
selimthegrim 6y ago
Isn’t it true that you have to pay cash or not be admitted to hospitals in India (maybe private only. I am just going by stories my mom told me from PK). So they know you’re not even getting in the door if you can’t afford it which forces price transparency
- 2Gkashmiri 6y ago
  usually depends on how big or unscrupulous the hospital is. The big ones charge you through the nose for every frigging thing, read inr 15K per night for a bed, charges for injection administration and visits by dietician. For the treatment you are told to pay up before the operation so you know generally how much you are getting into before hand. The big problem which comes when a patient has to visit another city for treatment, you usually have to take a couple of relatives for assistance. Air/rail tickets, Hotel room/rented apartment, then food and transport for these people. That is usually more than the actual cost of procedure if the thing goes longer than a few days. Yes. For a non emergency procedure it is common to shop around for either govt hospitals which is cheaper if not free but there is a delay in actual treatment or private which just quote you a figure. Then its just a matter of budget/ recommendations from friends. Insurance is as i said, not prevalent so your savings count and sometimes people draw a credit but that is in exceptional cases.
  - selimthegrim 6y ago
    Isn't there some Prime Minister's scheme for free healthcare that was supposedly extended to J & K but needs your Aadhar
    - 2Gkashmiri 6y ago
      yeah,its apparently called "golden card" thing, i'm not sure myself. it is looking like a in-patient cashless mediclaim policy for 500k INR per family or whatever.
auganov 6y ago
India like many countries uses [selective] price controls. If you cannot meet the stipulated price you cannot sell your drug at all. Many countries can get away with it because manufacturers figure it's better to make a tiny profit than to be completely cut off from a market. And fighting it can be too much effort when you're dealing with small markets. American consumers in a lot of ways are subsidizing the rest of the world. One idea to fix it was to mandate that a drug company cannot sell to non-American consumers at a cheaper price. When it doesn't work as well, drug availability is impacted and criminals make billions illegally exporting these drugs. And pharmaceutical corporations suffer, but that's not a problem for most countries.

lotsofpulp 6y ago

> why? i don't understand why medicine in US is not priced just like commodities Because the drug manufacturers are trying to make everyone pay as much as they can afford, which means they need to create various methods of procuring the drug with various hurdles/trade offs so the final price is obfuscated. The rich / less price conscious end up paying more. > In the US, medical insurance companies finance these pharma companies to keep highly inflated prices This is not true in any way. Insurance companies regularly deny payment for brand name medications and usually only pay for cheaper generics.

airstrike 6y ago
> This is not true in any way. It is somewhat true in one important way: someone is paying for all that Big Pharma R&D, and it ain't developing nations or Western Europe's public healthcare system
- lotsofpulp 6y ago
  US insurance companies might be paying higher prices for medicines, but they're not doing it for the purpose of keeping the prices of medicines "inflated".
2Gkashmiri 6y ago
shouldnt medicine be priced "without" the assumption that everyone will have insurance? insurance is a benefit given by consumer to themselves by paying for it, not the other way around?
- lotsofpulp 6y ago
  Many medicines aren't commodities with lots of suppliers, so the seller has a lot of power in the pricing negotiations. Insurers aren't paying higher prices to "keep prices inflated", they're paying them because there is no other choice. Sellers might also want to sell to insurers and others with deep pockets at a higher price than to non-insured or buyers with less money. So they will negotiate one price with an insurer, and the insurer will try stipulate they can't offer anyone a lower price, but then the seller might be able to get around this via rebates or discounts for buyers that can't afford insurance, etc.
  - 2Gkashmiri 6y ago
    my question is why is insurer there in this discussion? from my understanding, pricing should be negotiated between companies and buyers in the market. > they're paying them because there is no other choice. In a free market, alternatives come up because consumers dont want to pay for exorbitant prices, they just cant afford it.
    - lotsofpulp 6y ago
      Pricing can only be negotiated properly when a buyer and seller are sufficiently educated about the market and the products. Very few people are sufficiently knowledgeable about medicine and healthcare to be able to discern an appropriate price (much less determine if what they are buying is even necessary or not). Hence society relies on #1) trust by assuming healthcare providers are acting on good faith and #2) a knowledgeable actor providing a second opinion such as a government healthcare payer like the NHS in the UK or private insurance companies in the USA, who employ teams of doctors and pharmacists to review people’s cases and determine appropriate levels care. For example, if you have a plumbing problem, you can call 5 plumbers and get educated and make an informed decision. With a healthcare emergency, lack of time and lack of healthcare providers and other resources makes that an untenable solution.

selimthegrim 6y ago

Isn’t it true that you have to pay cash or not be admitted to hospitals in India (maybe private only. I am just going by stories my mom told me from PK). So they know you’re not even getting in the door if you can’t afford it which forces price transparency

2Gkashmiri 6y ago
usually depends on how big or unscrupulous the hospital is. The big ones charge you through the nose for every frigging thing, read inr 15K per night for a bed, charges for injection administration and visits by dietician. For the treatment you are told to pay up before the operation so you know generally how much you are getting into before hand. The big problem which comes when a patient has to visit another city for treatment, you usually have to take a couple of relatives for assistance. Air/rail tickets, Hotel room/rented apartment, then food and transport for these people. That is usually more than the actual cost of procedure if the thing goes longer than a few days. Yes. For a non emergency procedure it is common to shop around for either govt hospitals which is cheaper if not free but there is a delay in actual treatment or private which just quote you a figure. Then its just a matter of budget/ recommendations from friends. Insurance is as i said, not prevalent so your savings count and sometimes people draw a credit but that is in exceptional cases.
- selimthegrim 6y ago
  Isn't there some Prime Minister's scheme for free healthcare that was supposedly extended to J & K but needs your Aadhar
  - 2Gkashmiri 6y ago
    yeah,its apparently called "golden card" thing, i'm not sure myself. it is looking like a in-patient cashless mediclaim policy for 500k INR per family or whatever.

auganov 6y ago

India like many countries uses [selective] price controls. If you cannot meet the stipulated price you cannot sell your drug at all. Many countries can get away with it because manufacturers figure it's better to make a tiny profit than to be completely cut off from a market. And fighting it can be too much effort when you're dealing with small markets. American consumers in a lot of ways are subsidizing the rest of the world. One idea to fix it was to mandate that a drug company cannot sell to non-American consumers at a cheaper price. When it doesn't work as well, drug availability is impacted and criminals make billions illegally exporting these drugs. And pharmaceutical corporations suffer, but that's not a problem for most countries.