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Everyone in this thread rightfully outraged by insulin prices needs to look into the rebate system and PBMs in America. Its an absurdly complicated environment,

Everyone in this thread rightfully outraged by insulin prices needs to look into the rebate system and PBMs in America. Its an absurdly complicated environment, born out of a desire to drive drug costs down, that paradoxically drives them up. There's plenty of approaches to tackling drug prices, but dismantling the rebate system needs to be included. And frankly, the best way to dismantle the system is through some form of publicly available, universal health insurance. I believe in the power of healthy, free markets as much as anyone, but the current healthcare system is anything but. The lack of a non-profit seeking provider of health care, in a space where customers options are to pay whatever is charged or simply die, is not a functioning market. The rebate system was born out of what was a legislative bandage over this issue. Continuing to try and come up with cute solutions that avoid government provided healthcare for all will see similar results. Its why Americans spend so much more on insulin, and most other forms of healthcare services, than the vast majority of the world.

s3r3nity 5y ago
> ...in a space where customers options are to pay whatever is charged or simply die Look...I agree with the majority of your point, the majority of healthcare doesn't deal with such an obvious binary...and we aren't going to make progress on this issue unless we're willing to also have the conversation about healthcare within your control - e.g. individual responsibility for your healthcare. A number of close family members are doctors / surgeons of various kinds, so I've heard so many issues & complaints about the system. And while I would happily pay taxes to fix healthcare issues that are preventative (e.g. cancer screenings,) educational (e.g. nutrition,) and overall unpredictable (e.g. surprise brain aneurysms or the like,) I have no desire in paying for: - Someone who drank so much and annihilated their liver, requiring significant & expensive surgery - Someone who couldn't stop eating at McDonald's and hasn't touched a vegetable in a decade now wants lifetime insulin and kidney transplant - A hypochondriac who wants to see their doctor for every scratch, off-color skin mark, etc. - Someone voluntarily jumping off planes, doing dangerous sports, etc. without insurance, and expecting someone else will foot the bill - Someone who wants every and any blood test because they coughed once etc. etc. etc. Again...overall I agree with a more central payer system, but you won't get the conversation started with all the groups involved unless you acknowledge that there's some element of individual responsibility that you need to control for as well.
- bart_spoon 5y ago
  Ultimately the choice will come down to creating a system in which the unfortunate are protected at a cost of also subsidizing the irresponsible, or sacrificing the unfortunate for the sake of punishing the irresponsible. None of us want to be taken advantage of, but I weigh protecting the most vulnerable and unfortunate, of whom there are many, more heavily.
  - pessimizer 5y ago
    Ultimately the moral debate is purposeless. Our health care system is designed and run by predators, and propped up by a sentiment that we're willing to pay twice as much to support a system that includes the most vulnerable and unfortunate, and the wealthy, but impoverishes or excludes the working classes. The easiest way to find out if someone lacks health care access is to ask them if they work with their hands.
- majormajor 5y ago
  So how much money are you willing to spend on doctors who are doing nothing but figuring out which patients were "too irresponsible" versus which ones will get covered?
- chadash 5y ago
  I think you are in line with how many people feel. The problem is that whether you like it or not, you are footing the bill for all of these people under the current system. My health insurance is $600/month because I'm in a pool of people who are mostly healthy, but the insurance company runs the risk that one or two of us could cost a fortune. In fact, I'd probably pay a lot less towards healthcare if the government was the payer since they can leverage their size for much better prices.
- joncrane 5y ago
  Sometimes the cost of trying to avoid that type of misallocation of resources costs more than simply paying for it. The classic example is drug testing welfare recipients which was proven to cost more than just giving it out. Sometimes you have to chalk some of this stuff up to "the cost of doing business."
refurb 5y ago
You realize that the rebate system exists in the public systems (Medicaid and Medicare) today? Public healthcare won’t get rid of it.
coredog64 5y ago
There are a number of states where the largest insurer is a not-for-profit organization. There’s not one simple fix for this. If it’s truly going to be fixed, it’s going to require a lot of very tough fights against entrenched interests to eke out 5% here and 3% there.

s3r3nity 5y ago

> ...in a space where customers options are to pay whatever is charged or simply die Look...I agree with the majority of your point, the majority of healthcare doesn't deal with such an obvious binary...and we aren't going to make progress on this issue unless we're willing to also have the conversation about healthcare within your control - e.g. individual responsibility for your healthcare. A number of close family members are doctors / surgeons of various kinds, so I've heard so many issues & complaints about the system. And while I would happily pay taxes to fix healthcare issues that are preventative (e.g. cancer screenings,) educational (e.g. nutrition,) and overall unpredictable (e.g. surprise brain aneurysms or the like,) I have no desire in paying for: - Someone who drank so much and annihilated their liver, requiring significant & expensive surgery - Someone who couldn't stop eating at McDonald's and hasn't touched a vegetable in a decade now wants lifetime insulin and kidney transplant - A hypochondriac who wants to see their doctor for every scratch, off-color skin mark, etc. - Someone voluntarily jumping off planes, doing dangerous sports, etc. without insurance, and expecting someone else will foot the bill - Someone who wants every and any blood test because they coughed once etc. etc. etc. Again...overall I agree with a more central payer system, but you won't get the conversation started with all the groups involved unless you acknowledge that there's some element of individual responsibility that you need to control for as well.

bart_spoon 5y ago
Ultimately the choice will come down to creating a system in which the unfortunate are protected at a cost of also subsidizing the irresponsible, or sacrificing the unfortunate for the sake of punishing the irresponsible. None of us want to be taken advantage of, but I weigh protecting the most vulnerable and unfortunate, of whom there are many, more heavily.
- pessimizer 5y ago
  Ultimately the moral debate is purposeless. Our health care system is designed and run by predators, and propped up by a sentiment that we're willing to pay twice as much to support a system that includes the most vulnerable and unfortunate, and the wealthy, but impoverishes or excludes the working classes. The easiest way to find out if someone lacks health care access is to ask them if they work with their hands.
majormajor 5y ago
So how much money are you willing to spend on doctors who are doing nothing but figuring out which patients were "too irresponsible" versus which ones will get covered?
chadash 5y ago
I think you are in line with how many people feel. The problem is that whether you like it or not, you are footing the bill for all of these people under the current system. My health insurance is $600/month because I'm in a pool of people who are mostly healthy, but the insurance company runs the risk that one or two of us could cost a fortune. In fact, I'd probably pay a lot less towards healthcare if the government was the payer since they can leverage their size for much better prices.
joncrane 5y ago
Sometimes the cost of trying to avoid that type of misallocation of resources costs more than simply paying for it. The classic example is drug testing welfare recipients which was proven to cost more than just giving it out. Sometimes you have to chalk some of this stuff up to "the cost of doing business."

refurb 5y ago

You realize that the rebate system exists in the public systems (Medicaid and Medicare) today? Public healthcare won’t get rid of it.

coredog64 5y ago

There are a number of states where the largest insurer is a not-for-profit organization. There’s not one simple fix for this. If it’s truly going to be fixed, it’s going to require a lot of very tough fights against entrenched interests to eke out 5% here and 3% there.