3 ms·

Somewhat related: Why is it that the US needs middle-men to negotiate prices - that is, why can't Medicare just negotiate the prices themselves? If I understan

Somewhat related: Why is it that the US needs middle-men to negotiate prices - that is, why can't Medicare just negotiate the prices themselves? If I understand it right, that's what other countries do. Countries with universal healthcare systems are basically the only buyer, and can drive a hard bargain. Yet the US needs for-profit middle-men, that can't seem to get a price as good other countries...but yet they're supposed to perform better than Medicare? Doesn't make any sense (to an outsider)

colinmhayes 5y ago
Congress doesn't allow it. Biden tried to get this into the reconciliation bill, but Manchin rejected it.
- deleted 5y ago
  [deleted]
- notJim 5y ago
  Meanwhile, it was one of the most popular provisions in the bill. https://www.dataforprogress.org/blog/2021/9/17/the-build-back-better-plan-remains-popular https://www.dataforprogress.org/blog/2021/9/17/the-build-bac..., 3rd chart
vmception 5y ago
As you form your observation, a few notes: Other developed countries have a variety of systems, but they typically do at least have a public option (available to all). US middle men are not trying to get a good price. US consensus failures on this are based on fear of the government, entrenched interests, lack of inspiration on what specifically to change, coincidental convenience as the status quo keeps people preoccupied and risk averse, and a large very sick population that really would massively increase taxpayer costs in the first several years no matter how it would equalize in a longer term.
ZetaZero 5y ago
"The Medicare Prescription Drug Act expressly prohibited Medicare from negotiating bulk prescription drug prices." https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act#Bar_to_negotiation_of_prescription_drug_prices https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Im...
- BizarroLand 5y ago
  "Why are we hobbling?" "You shot yourself in the foot" "Oh, yeah, right. I forgot."
wefarrell 5y ago
Not only that, but the middle men are permitted to receive rebates from the manufacturers. Rebates like that are illegal in all other industries except pharma.
quickthrowman 5y ago
> Why is it that the US needs middle-men to negotiate prices - that is, why can't Medicare just negotiate the prices themselves? Pharmaceutical companies bribe—sorry, lobby—members of Congress so those members of Congress vote against letting Medicare negotiate pricing. Since money is speech, (see Citizens United v FEC) the one with the most money wins.
refurb 5y ago
For Part B drugs there is no middle man beyond the doctors themselves. They buy the drugs and then bill Medicare for them. They can sometimes negotiate with drug companies to get discounts. However, the government, by law, demands stiff discounts anyways. Medicare only pays the average of what other customers pay. Then stack on the 340B law and drug companies give the government substantial discounts on the back end.

colinmhayes 5y ago

Congress doesn't allow it. Biden tried to get this into the reconciliation bill, but Manchin rejected it.

deleted 5y ago
[deleted]
notJim 5y ago
Meanwhile, it was one of the most popular provisions in the bill. https://www.dataforprogress.org/blog/2021/9/17/the-build-back-better-plan-remains-popular https://www.dataforprogress.org/blog/2021/9/17/the-build-bac..., 3rd chart

vmception 5y ago

As you form your observation, a few notes: Other developed countries have a variety of systems, but they typically do at least have a public option (available to all). US middle men are not trying to get a good price. US consensus failures on this are based on fear of the government, entrenched interests, lack of inspiration on what specifically to change, coincidental convenience as the status quo keeps people preoccupied and risk averse, and a large very sick population that really would massively increase taxpayer costs in the first several years no matter how it would equalize in a longer term.

ZetaZero 5y ago

"The Medicare Prescription Drug Act expressly prohibited Medicare from negotiating bulk prescription drug prices." https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act#Bar_to_negotiation_of_prescription_drug_prices https://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Im...

BizarroLand 5y ago
"Why are we hobbling?" "You shot yourself in the foot" "Oh, yeah, right. I forgot."

wefarrell 5y ago

Not only that, but the middle men are permitted to receive rebates from the manufacturers. Rebates like that are illegal in all other industries except pharma.

quickthrowman 5y ago

> Why is it that the US needs middle-men to negotiate prices - that is, why can't Medicare just negotiate the prices themselves? Pharmaceutical companies bribe—sorry, lobby—members of Congress so those members of Congress vote against letting Medicare negotiate pricing. Since money is speech, (see Citizens United v FEC) the one with the most money wins.

refurb 5y ago

For Part B drugs there is no middle man beyond the doctors themselves. They buy the drugs and then bill Medicare for them. They can sometimes negotiate with drug companies to get discounts. However, the government, by law, demands stiff discounts anyways. Medicare only pays the average of what other customers pay. Then stack on the 340B law and drug companies give the government substantial discounts on the back end.