9 ms·

House passes bill to limit cost of insulin to $35 a month

67 points by boston_clone 5y ago

nopenopenopeno 5y ago
> ”The bill that passed the House on Thursday would not improve the affordability of insulin for people who lack health insurance.” I hate this country so much.
- CogitoCogito 5y ago
  > While the bill would lower costs for many individual patients who take insulin, it would do nothing to reduce the prices paid to the companies that make it. Instead, insurance companies would simply pay a larger share of the price. The Congressional Budget Office estimated that the bill would increase government spending, since health insurers, including Medicare, would be responsible for a greater share of insulin costs. Yeah it's kind of crazy. So the solution here is not to get companies to charge less, but instead just to put them on government welfare? The insulin companies must have some great lobbyists to have pulled this off.
  - nopenopenopeno 5y ago
    It’s the same pattern as Obamacare. Reinforce the existing private insurer system by injecting more government funding while preserving policy that ensures scarcity. This bill functionally sharpens the consequences of being too poor to afford insurance and too employed to qualify for Medicaid.
    - bombcar 5y ago
      Which shows that there's really no desire on either side to actually address the problem, just to bandaid over it enough so that the status quo can continue.
      - notch656a 5y ago
        No is problem, you can buy pharma stocks and reap the profits yourself. Then use said profits to buy your insulin. s/
      - tzs 5y ago
        ACA was largely responsible for the cutting the number of uninsured in the US in half [1]. For the 28% of the US population with family income below 200% of the Federal Poverty Level, the reduction in uninsured as even bigger. That was hardly just maintaining the status quo. [1] https://www.statista.com/statistics/200957/percentage-of-americans-without-health-insurance/ https://www.statista.com/statistics/200957/percentage-of-ame...
        notch656a 5y ago
        Agree it broke the status quo for percent uninsured. Not quite as much the status quo in the structuring of healthcare in the US, which seems to be ever leaning towards more bureaucracy, regulatory capture, regulatory costs, insane tort/legal risks, and dead weight. Also part of the big drop in uninsured was the lining up of people to the wall with the weapon of the tax-man cocked, saying "pay up or else." When the penalties ended the uninsured rate started to go back up again. Not my favorite way to do things, and I question how much of that was out of benevolence.
        zajio1am 5y ago
        > Also part of the big drop in uninsured was the lining up of people to the wall with the weapon of the tax-man cocked, saying "pay up or else." Yes, but that is also true for (AFAIK) most public health systems. I live in a country with strong public health system where almost everything is 100% paid from public insurance, but if i had stopped paying insurance payments, i would have met debt collectors confiscating my property.
        notch656a 5y ago
        It seems the way to actually make healthcare more affordable is to find ways to make healthcare less expensive. Otherwise you're just playing a game of who pays the outrageous costs.
  - mindslight 5y ago
    > the solution here is not to get companies to charge less, but instead just to put them on government welfare This is the basic summary of the entire topic of "healthcare reform". Political calls for creation or enforcement of sensible market mechanisms are nowhere in sight. Many straightforward market reforms wouldn't even run afoul of any major political ideals - for example the idea that many individuals will seek out routine or elective services on a cash basis, as prevalent throughout every other industry. Instead, the red party is focused on continuing the status quo (a giveaway for "insurance" companies) while the blue party is focused on having the government pay for the financial cancer (a giveaway centered on providers). These are both just doubling down on the same healthcare-denying cartelization at the root of the problem!
    - nopenopenopeno 5y ago
      The problem is the preservation of market mechanisms. Distributing healthcare through market mechanisms is ludicrous, has never worked and will never work.
      - mindslight 5y ago
        > The problem is the preservation of market mechanisms. I don't know what you mean by this. Unless we're talking about a system in which all doctors and drug companies are bona fide government employees, then healthcare is indeed being distributed via market mechanisms. For an analog, take a look at the market for food (a vital necessity for life). The vast majority of people pay for food directly. Competition between grocery stores keeps the prices reasonable. Government programs provide funds to those unable to afford food, and those government dollars benefit from the consumer market mechanic. The idea that you could receive a bill in the mail a month later, for the cashier or counter worker being an unknown "outside vendor" is nowhere in sight. The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around - ie the necessity of insurance. But this still isn't a reason to throw away the overall market in favor of an obtuse cartel that controls access to what should be simple cases.
        5y ago
- toomuchtodo 5y ago
  Offtopic, no email in your HN profile: I'll give you the same advice I give to others who share this sentiment (and I share it as well): find a way to expatriate if you can. The US is unlikely to fix its problems in our lifetime; there are too many people who will continue to vote for representatives who refuse to back sane policy, who will vote against their own interests, as well as those who don't vote at all. Ergo, if you can, you must vote with your feet (remote work, enough savings to qualify for a visa somewhere more developed, a work visa if you're highly skilled, etc). Can't change the direction of the wind, but you can adjust your sails. I recommend either Western Europe, Australia, or New Zealand, but that's personal preference. Canada is fine if you don't mind the cold, Japan is an acquired taste, parts of LATAM are great if you're a tropics kind of person. https://worldpopulationreview.com/country-rankings/happiest-countries-in-the-world https://worldpopulationreview.com/country-rankings/happiest-... https://www.oecdbetterlifeindex.org/ https://www.oecdbetterlifeindex.org/ https://www.socialprogress.org/ https://www.socialprogress.org/
  - sidewndr46 5y ago
    Becoming an expat isn't voting with your feet. Your taxpayers dollars are still going to the US until you find a way to get citizenship elsewhere and pay the exit tax.
    - toomuchtodo 5y ago
      > If you are a U.S. citizen or a resident alien of the United States and you live abroad, you are taxed on your worldwide income. However, you may qualify to exclude your foreign earnings from income up to an amount that is adjusted annually for inflation ($105,900 for 2019, $107,600 for 2020, $108,700 for 2021, and $112,000 for 2022). In addition, you can exclude or deduct certain foreign housing amounts. [1] This allows you to continue to obtain benefit from your US citizenship while minimizing the federal income tax you pay while a tax resident elsewhere. If you're wildly wealthy with a seven figure income, sure, then you might need to speak with tax professionals and structure an exit from US tax requirements depending upon your goals. Otherwise, it's just like paying local property tax, and getting to deduct that against your federal taxes. [1] https://www.irs.gov/individuals/international-taxpayers/foreign-earned-income-exclusion https://www.irs.gov/individuals/international-taxpayers/fore...
- kcplate 5y ago
  Don’t hate the country, hate the politicians. This bill is designed for two things…to try and get favorable headlines for the democrats and to maximize big pharma profits. Most folks “affected” by this bill probably will see zero benefit from it, because the folks with health insurance probably were getting their insulin around that co-pay rate (or lower) anyway.
x13 5y ago
Despite 193 nay votes from Republicans https://clerk.house.gov/Votes/2022102 https://clerk.house.gov/Votes/2022102
- maestroia 5y ago
  Always look at the amendments... The amendment attached to this bill is probably a "poison pill amendment". The bill itself plays well PR-wise. But the amendment probably contains language politically damaging to the opposition party.
  - throw_away 5y ago
    I went to look up the amendments, of which there was only one, which seems to have been accepted: https://www.congress.gov/amendment/117th-congress/house-amendment/186?s=a&r=1 https://www.congress.gov/amendment/117th-congress/house-amen... which, on its face, looks pretty boring, but that amendment includes this bill: https://www.congress.gov/bill/117th-congress/house-resolution/1017 https://www.congress.gov/bill/117th-congress/house-resolutio... which decriminalizes cannabis federally. I'm not saying anything one way or another, but it's rather interesting this hasn't been mentioned.
xkcd-sucks 5y ago
Is this just for plain old insulin or does it cover the fancy new insulin analogues?
- mirntyfirty 5y ago
  Not sure why the downvotes but that’s a crucial question. Unfortunately, products from the 90s have been deemed fancy and had their prices increased by a multiple of around 15, at least in the US.
  - siilats 5y ago
    This is Democratic Party in USA. Headlines look great but if you look into it, the subsidies for electric vehicles exclude Tesla, first Covid bill bailed out the mob pension funds from Italian Job. Problem is it takes a while to notice this, so a lot of europeans love Democrats.
smt88 5y ago
An import note is that a month's supply of insulin costs $2-6 to manufacture and it doesn't need any marketing dollars, so any existing, scaled insulin manufacturer would profit wildly from this price.
- nopenopenopeno 5y ago
  Health insurance companies will too, because the bill does nothing for people who don’t have health insurance.
  - bagels 5y ago
    Time to start an insulin only insurance company.
- 9991 5y ago
  How much does it cost to invent a manufacturing process for synthetic insulin?
  - OldTimeCoffee 5y ago
    Novo Nordisk (the maker of the newest insulin Levemir) spends about 17.8b kroner a year on R&D (or about 12.6% of their revenue). Levemir was introduced in 2005; they've long since made up any R&D costs. The first synthetic insulin (Humulin) is from 1978. These aren't new medications, even Lantus is over 20 years old. The R&D costs don't factor into the price they charge at this point.
    - 9991 5y ago
      Making up the R&D costs is not the appropriate benchmark. The companies need a profit to justify the tying up of that capital for a long time. > (Humulin) is from 1978 Great, so it's off patent now? Serious question: where's the generic humulin?
      - deleted 5y ago
        [deleted]
paxys 5y ago
> The bill attracted unanimous support from Democrats who voted, as well as from 12 Republicans, making it a rare piece of bipartisan policy legislation. What would have been considered a standard party line vote a decade ago is now called "bipartisan". Crazy how far the standards have fallen in such a short time.
- Jcowell 5y ago
  Yeah this is weird, especially for a news paper. Arguably dishonest. It’s like saying if there were two opposite sides for an anti slave bill and the majority of one side says no but 1 member of the opposing side said yes , it makes the bill Bipartisan.
  - oneoff786 5y ago
    If you make it a 12 instead of a 1, sure
- ecf 5y ago
  Affordable insulin is a no-brainer, slam-dunk, overwhelmingly YES piece of legislation. I cannot comprehend the mental gymnastics diabetic republicans must go through on a daily basis.
  - throw10920 5y ago
    This isn't "affordable insulin", it just limits the copay to $35. Pharma companies can keep charging abusively high prices for insulin, and force insurance providers to pay for it[1], which then trickles down to make everyone pay more, while allowing pharma companies to rake in profits. This is socialized medicine + cost disease[2], which I'm surprised and disappointed that anyone voted on at all. [1] https://news.ycombinator.com/item?id=30879824 https://news.ycombinator.com/item?id=30879824 [2] https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost...
    - ecf 5y ago
mc4ndr3 5y ago
Sale! $35/mo subscription to being alive Thank your local representative now!
tempnow987 5y ago
Interesting - companies can still charge what they want, this just forces a big subsidy by insurance companies / medicare. Traditionally if price to consumers / demand is unchanged by price increases, companies should be incentivized by this to increase prices no? The rate you pay stays $35, and demand does not drop, but profits rise up.
- ccooffee 5y ago
  Yea, this doesn't seem great. In my opinion, one of the biggest failures of the Affordable Care Act was the guarantee of profit for insurance companies. This bill looks like the same sort of problem. "Insulin capped at $35/month" sounds great, but it buries the point that prices AREN'T actually being fixed. They're just shifting the increased cost from individual patients to the collective (via insurance companies). My insurance costs are going to go up so that pharma corporations can continue to fleece patients, and there's nothing in this bill that would prevent this.
stuckinhell 5y ago
Disgustingly high. I find it furious how american citizens are force to subsidize the entire world. https://www.vox.com/science-and-health/2016/11/30/12945756/prescription-drug-prices-explained https://www.vox.com/science-and-health/2016/11/30/12945756/p... My mother needs insulin to live, and lives off her mediocre pension. I don't find it fair or just at all. Even our National Allies like Germany didn't spend their fair share to NATO until Russia invaded Ukraine. I'm tired how American Citizens don't have healthcare or houses yet our taxes goes to across the world, and the world isn't doing their fair share. We aren't being represented by our government.
- jeromegv 5y ago
  American citizens are not "forced". American citizens vote for politicians that want private healthcare. If you want your own national drug care program, that gives the government an incentive to negotiate large purchases with pharmaceutical companies. Then do it. But you keep electing politicians that choose the free market
  - mywittyname 5y ago
    Policies like 2 senators per state, regardless of population, and the Electoral College ensure that a minority of citizens have the majority of power in the USA.
    - kcplate 5y ago
      Two wolves and a sheep sit down to decide what to have for dinner…
  - notch656a 5y ago
    >But you keep electing politicians that choose the free market Ba ha ha ha ha. Let me tell you how 'free' the market is if I decide to open up Notch's Medical Clinic without a long list of licenses/permits/regulatory compliance. If I manufacture and give you a pill without extensive process of authorization by the FDA to use this pill as a drug. Healthcare is expensive in part because there isn't a free market. A free market would rip the bloated competition currently present into shreds.
Someone1234 5y ago
The title and article is misleading: > US House passes Bill to limit cost of insulin to $35/mo . > fulfilling its promise of lowering drug costs. Insulin costs under $5 to make. If they had in fact limited the price to $35/months that would be fantastic. But what the bill actually does is force insurers to pick up 100% of costs over $35/month, allowing pharma companies to keep charging abusive rates and everyone will indirectly pay for that by increased premiums. Even the bill's own summary[0] is much more clear on what it does than this article: > This bill limits cost-sharing for insulin under private health insurance and the Medicare prescription drug benefit. That's literally the first line. The second line is: > Specifically, the bill caps cost-sharing under private health insurance for a month's supply of selected insulin products at $35 or 25% of a plan's negotiated price (after any price concessions), whichever is less, beginning in 2023. This might seem like a distinction without a difference, but I strongly disagree. Insulin prices themselves are abusive and the underlying problem here, this doesn't even seek to address those and instead just hides the profiteering behind higher insurance premiums. Time to actually fix drug pricing and not keep shoving everything behind an insurance smokescreen and then acting surprise then insurance premium rates are astronomical. [0] https://www.congress.gov/bill/117th-congress/house-bill/6833?s=1&r=1 https://www.congress.gov/bill/117th-congress/house-bill/6833...
- cptskippy 5y ago
  This is politics in America. Politicians obstruct everything meaningful but allow these "wins" through when they do absolutely nothing to fix any of our problems, only obfuscate them.
- koolba 5y ago
  > ... allowing pharma companies to keep charging abusive rates and everyone will indirectly pay for that by increased premiums. That's what always happens with these programs. "Free" physical / wellness visit? Your insurance premiums bake that in. "Free" COVID tests? Your insurance premiums bake that in.
  - throwawayboise 5y ago
    Yes, I'd love to be able to buy health insurance that was truly insurance and not a pre-pay plan for a bunch of stuff I'll never use.
phmagic 5y ago
Naive question: If the insurance providers are the payers, why aren't they incentivized to collectively negotiate down the cost of drugs?
- throwawayboise 5y ago
  Health insurance company profits are capped as a percentage of claims paid. Higher costs for drugs and services means more profit for the insurance companies.
nickpp 5y ago
Price-fixing is the best way to create shortages. How this problem is solved in pretty much any other area of economy: improve supply, or in other words make sure it is as easy as possible to import or create and sell competing products. How easy is to start an insulin providing business tomorrow in the USA? Exactly. But planners gonna plan...
- Edman274 5y ago
  Do you think that if the price of insulin goes down that there's suddenly going to be a huge floodgate of people who will consume a lot more insulin than they're already consuming now? Like, people who were like "yeah, I'll buy insulin at 35 dollars but not at 300 dollars, if it hits 300 then I'll just wait this one out" or that they'd be like "oh, now that the price of insulin has been cut by a factor of ten I'll consume ten times as much"? Like, you know how insulin works - either you get it within 24 hours, or you don't and you go into a coma and die, and how much you take isn't influenced by any factor other than what you eat?
- nradov 5y ago
  This bill doesn't actually fix prices charged by manufacturers, and thus won't cause shortages. It fixes out-of-pocket costs for patients, with insurers (and employers) picking up the difference. We can expect medical insurance premiums to increase as a consequence.
sithadmin 5y ago
While I do think this is a general move in the right direction, the cynic in me can't help but to think this recent spotlight on insulin in particular is a red herring to distract from the Democrats' inability to make headway on prescription drug and general healthcare affordability. I mean, sure, diabetes is a big issue in the US, with type 2 being particularly problematic and prevalent among the least advantaged demographic groups, and efforts to keep insulin affordable will be massively beneficial to a relatively large number of people. But simply ensuring that insulin is affordable does nothing to address the underlying nutrition and healthcare access that lead so many to end up with type 2 diabetes in the first place. The measure also seems woefully inadequate for addressing insulin access for the uninsured, which is going to dampen the effect as well.
padobson 5y ago
Can someone explain to me why insulin, essentially a commodity, can fetch any significant price over cost? Why isn't there more competition? Is barrier to entry for low-cost competitors the difficult of manufacture? Or is it patent enforcement? If it's patent enforcement, wouldn't a bill that reforms the patent protection for insulin makers make a lot more sense than this bill?
- _aavaa_ 5y ago
  If I were to bet, it would be the manufacturing requirements placed on pharmaceutical companies. I am not saying they're unjustified (e.g. sterilization requirements), just that they're onerous.
  - imglorp 5y ago
    Plus they're using insulin revenues for other activities.
- Auracle 5y ago
  When people complain about high insulin costs, they’re complaining about new formulations that work much better. You can get the old stuff at Walmart for (relatively) cheap. The new stuff is probably under patent, although even when that runs out there are roadblocks for generic manufacturing - and that goes for every medication. The fact that patent holders can draw out the process longer than they’re supposed to should be reformed, but that doesn’t get as many political points as capping the price to the consumer.
  - deepnotderp 5y ago
    The flip side of that is that many of the newer formulations are slight tweaks, but doctors will generally prescribe the drug that the latest pharma sales rep to visit was selling (yes really). They also tend to not want to change the way they’ve always done things and prescribe a cheaper formulation.
- s1artibartfast 5y ago
  It's not patents, most early insulin is off patent. Most of the barriers are regulatory and profitability. It is worth noting that bidens 35 is a copay limit, not a limit on what your insurance pays. As a example for profitability, this non profit hopes to bring the total cost down to 30: https://www.google.com/amp/s/amp.cnn.com/cnn/2022/03/03/politics/civica-insulin-affordable-drug/index.html https://www.google.com/amp/s/amp.cnn.com/cnn/2022/03/03/poli...
nirav72 5y ago
Don't think this going to make it through the Senate.
nradov 5y ago
While this bill is imperfect, overall it does improve the situation for diabetics. But for type 2 diabetics we really ought to focus on reducing their need for exogenous insulin. Virta Health has peer reviewed research showing that the majority of patients can put their diabetes into remission using nutritional ketosis. https://www.virtahealth.com/reversediabetes https://www.virtahealth.com/reversediabetes Type 1 diabetics will always need some exogenous insulin, but they can reduce the amount of insulin needed (and the cost thereof) with regular exercise. https://link.springer.com/article/10.1007/s00125-011-2403-2 https://link.springer.com/article/10.1007/s00125-011-2403-2
Auracle 5y ago
This is great news for those that take insulin, for drug manufacturers, Democrat politicians, and (in the short term) for insurance companies. It's terrible for everyone else. If consumers are paying $300 a month they might decide to take a cheaper insulin instead, move to a generic if possible, maybe even get their type 2 diabetes under control before they need insulin, etc. Now that it's capped for them - why should they care? Their insurance will pay for it. Because how much insurance companies can charge is tied to how much they pay out, they now get to raise their prices and profits. Because they all need to compete with each other, they normally couldn't do this all on their own. This is essentially government mandated price fixing - or perhaps another term is better? There's absolutely nothing stopping the insulin manufacturers from raising their prices even more now. They'll want to slowly boil that frog just so they don't come under pressure, but that's fine by them. Finally, this is good for the Democrats because most people don't realize the above and think they price was actually capped to $35. The comments on Reddit about this show it pretty well, calling out Republicans for not voting in favor of it. How dare they? In the end it'll be great for them in two ways, because insurance prices are going to keep going up to ridiculous levels until people decide that we need to move to a socialized system. Medical prices are out of control in our country and the lack of price discovery is exactly why. I've commented before on this, but when I was prescribed testosterone I was put on Androgel. Androgel was $400 a month. Injections are something like $10 a month and work better in every way. There's now a pill you can take for the low cost of $1,000 a month. If people actually had to pay that cost up front, they might decide to go through the hassle of injecting themselves once a week or two. We either need to making insurance in to actual insurance again, meaning a very high deductible, or we need price controls. Anything else is a terrible idea. Mandating high deductibles is probably a no-go politically, but price controls would be easy. Cap the costs of medications and procedures/visits to the average of 5 other first world countries. Bam. Done.
- nsv 5y ago
  I agree completely that better price discovery would help the issues greatly. Many times the doctor's office will not even be able to tell you how much a procedure or medication costs until after you get it, which is nuts. If there were more competition in the medical world practices like this would quickly die out (imagine if a grocery store didn't post any prices for its items!)
boston_clone 5y ago
With all the (certainly fair) criticism of how this doesn't address perhaps the largest / most vulnerable subset of diabetics, I can't help but wonder if there is an opportunity for a non-profit entity to emerge and help somehow. I also imagine the alternative of too much government intervention across public and private sectors in one sweeping bill would likely have much more resistance. Small steps, it seems.
lcall 5y ago
I think insulin will already be less expensive in 2024 anyway, due to efforts by a nonprofit manufacturer started by a nonprofit Utah healthcare chain with many partners. The manufacturer is trying to make many drugs more available and less expensive. It's quite interesting: https://news.ycombinator.com/item?id=30714641 https://news.ycombinator.com/item?id=30714641 Edit: and I don't know if Mark Cuban's company is planning to help with that or how they are doing. There is a link about them, in the above link.

67 points by boston_clone 5y ago

> ”The bill that passed the House on Thursday would not improve the affordability of insulin for people who lack health insurance.” I hate this country so much.

CogitoCogito 5y ago
> While the bill would lower costs for many individual patients who take insulin, it would do nothing to reduce the prices paid to the companies that make it. Instead, insurance companies would simply pay a larger share of the price. The Congressional Budget Office estimated that the bill would increase government spending, since health insurers, including Medicare, would be responsible for a greater share of insulin costs. Yeah it's kind of crazy. So the solution here is not to get companies to charge less, but instead just to put them on government welfare? The insulin companies must have some great lobbyists to have pulled this off.
- nopenopenopeno 5y ago
  It’s the same pattern as Obamacare. Reinforce the existing private insurer system by injecting more government funding while preserving policy that ensures scarcity. This bill functionally sharpens the consequences of being too poor to afford insurance and too employed to qualify for Medicaid.
  - bombcar 5y ago
    Which shows that there's really no desire on either side to actually address the problem, just to bandaid over it enough so that the status quo can continue.
    - notch656a 5y ago
      No is problem, you can buy pharma stocks and reap the profits yourself. Then use said profits to buy your insulin. s/
    - tzs 5y ago
      ACA was largely responsible for the cutting the number of uninsured in the US in half [1]. For the 28% of the US population with family income below 200% of the Federal Poverty Level, the reduction in uninsured as even bigger. That was hardly just maintaining the status quo. [1] https://www.statista.com/statistics/200957/percentage-of-americans-without-health-insurance/ https://www.statista.com/statistics/200957/percentage-of-ame...
      - notch656a 5y ago
        Agree it broke the status quo for percent uninsured. Not quite as much the status quo in the structuring of healthcare in the US, which seems to be ever leaning towards more bureaucracy, regulatory capture, regulatory costs, insane tort/legal risks, and dead weight. Also part of the big drop in uninsured was the lining up of people to the wall with the weapon of the tax-man cocked, saying "pay up or else." When the penalties ended the uninsured rate started to go back up again. Not my favorite way to do things, and I question how much of that was out of benevolence.
        zajio1am 5y ago
        > Also part of the big drop in uninsured was the lining up of people to the wall with the weapon of the tax-man cocked, saying "pay up or else." Yes, but that is also true for (AFAIK) most public health systems. I live in a country with strong public health system where almost everything is 100% paid from public insurance, but if i had stopped paying insurance payments, i would have met debt collectors confiscating my property.
        notch656a 5y ago
        It seems the way to actually make healthcare more affordable is to find ways to make healthcare less expensive. Otherwise you're just playing a game of who pays the outrageous costs.
- mindslight 5y ago
  > the solution here is not to get companies to charge less, but instead just to put them on government welfare This is the basic summary of the entire topic of "healthcare reform". Political calls for creation or enforcement of sensible market mechanisms are nowhere in sight. Many straightforward market reforms wouldn't even run afoul of any major political ideals - for example the idea that many individuals will seek out routine or elective services on a cash basis, as prevalent throughout every other industry. Instead, the red party is focused on continuing the status quo (a giveaway for "insurance" companies) while the blue party is focused on having the government pay for the financial cancer (a giveaway centered on providers). These are both just doubling down on the same healthcare-denying cartelization at the root of the problem!
  - nopenopenopeno 5y ago
    The problem is the preservation of market mechanisms. Distributing healthcare through market mechanisms is ludicrous, has never worked and will never work.
    - mindslight 5y ago
      > The problem is the preservation of market mechanisms. I don't know what you mean by this. Unless we're talking about a system in which all doctors and drug companies are bona fide government employees, then healthcare is indeed being distributed via market mechanisms. For an analog, take a look at the market for food (a vital necessity for life). The vast majority of people pay for food directly. Competition between grocery stores keeps the prices reasonable. Government programs provide funds to those unable to afford food, and those government dollars benefit from the consumer market mechanic. The idea that you could receive a bill in the mail a month later, for the cashier or counter worker being an unknown "outside vendor" is nowhere in sight. The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around - ie the necessity of insurance. But this still isn't a reason to throw away the overall market in favor of an obtuse cartel that controls access to what should be simple cases.
      - 5y ago
toomuchtodo 5y ago
Offtopic, no email in your HN profile: I'll give you the same advice I give to others who share this sentiment (and I share it as well): find a way to expatriate if you can. The US is unlikely to fix its problems in our lifetime; there are too many people who will continue to vote for representatives who refuse to back sane policy, who will vote against their own interests, as well as those who don't vote at all. Ergo, if you can, you must vote with your feet (remote work, enough savings to qualify for a visa somewhere more developed, a work visa if you're highly skilled, etc). Can't change the direction of the wind, but you can adjust your sails. I recommend either Western Europe, Australia, or New Zealand, but that's personal preference. Canada is fine if you don't mind the cold, Japan is an acquired taste, parts of LATAM are great if you're a tropics kind of person. https://worldpopulationreview.com/country-rankings/happiest-countries-in-the-world https://worldpopulationreview.com/country-rankings/happiest-... https://www.oecdbetterlifeindex.org/ https://www.oecdbetterlifeindex.org/ https://www.socialprogress.org/ https://www.socialprogress.org/
- sidewndr46 5y ago
  Becoming an expat isn't voting with your feet. Your taxpayers dollars are still going to the US until you find a way to get citizenship elsewhere and pay the exit tax.
  - toomuchtodo 5y ago
    > If you are a U.S. citizen or a resident alien of the United States and you live abroad, you are taxed on your worldwide income. However, you may qualify to exclude your foreign earnings from income up to an amount that is adjusted annually for inflation ($105,900 for 2019, $107,600 for 2020, $108,700 for 2021, and $112,000 for 2022). In addition, you can exclude or deduct certain foreign housing amounts. [1] This allows you to continue to obtain benefit from your US citizenship while minimizing the federal income tax you pay while a tax resident elsewhere. If you're wildly wealthy with a seven figure income, sure, then you might need to speak with tax professionals and structure an exit from US tax requirements depending upon your goals. Otherwise, it's just like paying local property tax, and getting to deduct that against your federal taxes. [1] https://www.irs.gov/individuals/international-taxpayers/foreign-earned-income-exclusion https://www.irs.gov/individuals/international-taxpayers/fore...
kcplate 5y ago
Don’t hate the country, hate the politicians. This bill is designed for two things…to try and get favorable headlines for the democrats and to maximize big pharma profits. Most folks “affected” by this bill probably will see zero benefit from it, because the folks with health insurance probably were getting their insulin around that co-pay rate (or lower) anyway.

x13 5y ago

Despite 193 nay votes from Republicans https://clerk.house.gov/Votes/2022102 https://clerk.house.gov/Votes/2022102

maestroia 5y ago
Always look at the amendments... The amendment attached to this bill is probably a "poison pill amendment". The bill itself plays well PR-wise. But the amendment probably contains language politically damaging to the opposition party.
- throw_away 5y ago
  I went to look up the amendments, of which there was only one, which seems to have been accepted: https://www.congress.gov/amendment/117th-congress/house-amendment/186?s=a&r=1 https://www.congress.gov/amendment/117th-congress/house-amen... which, on its face, looks pretty boring, but that amendment includes this bill: https://www.congress.gov/bill/117th-congress/house-resolution/1017 https://www.congress.gov/bill/117th-congress/house-resolutio... which decriminalizes cannabis federally. I'm not saying anything one way or another, but it's rather interesting this hasn't been mentioned.

xkcd-sucks 5y ago

Is this just for plain old insulin or does it cover the fancy new insulin analogues?

mirntyfirty 5y ago
Not sure why the downvotes but that’s a crucial question. Unfortunately, products from the 90s have been deemed fancy and had their prices increased by a multiple of around 15, at least in the US.
- siilats 5y ago
  This is Democratic Party in USA. Headlines look great but if you look into it, the subsidies for electric vehicles exclude Tesla, first Covid bill bailed out the mob pension funds from Italian Job. Problem is it takes a while to notice this, so a lot of europeans love Democrats.

smt88 5y ago

An import note is that a month's supply of insulin costs $2-6 to manufacture and it doesn't need any marketing dollars, so any existing, scaled insulin manufacturer would profit wildly from this price.

nopenopenopeno 5y ago
Health insurance companies will too, because the bill does nothing for people who don’t have health insurance.
- bagels 5y ago
  Time to start an insulin only insurance company.
9991 5y ago
How much does it cost to invent a manufacturing process for synthetic insulin?
- OldTimeCoffee 5y ago
  Novo Nordisk (the maker of the newest insulin Levemir) spends about 17.8b kroner a year on R&D (or about 12.6% of their revenue). Levemir was introduced in 2005; they've long since made up any R&D costs. The first synthetic insulin (Humulin) is from 1978. These aren't new medications, even Lantus is over 20 years old. The R&D costs don't factor into the price they charge at this point.
  - 9991 5y ago
    Making up the R&D costs is not the appropriate benchmark. The companies need a profit to justify the tying up of that capital for a long time. > (Humulin) is from 1978 Great, so it's off patent now? Serious question: where's the generic humulin?
    - deleted 5y ago
      [deleted]

paxys 5y ago

> The bill attracted unanimous support from Democrats who voted, as well as from 12 Republicans, making it a rare piece of bipartisan policy legislation. What would have been considered a standard party line vote a decade ago is now called "bipartisan". Crazy how far the standards have fallen in such a short time.

Jcowell 5y ago
Yeah this is weird, especially for a news paper. Arguably dishonest. It’s like saying if there were two opposite sides for an anti slave bill and the majority of one side says no but 1 member of the opposing side said yes , it makes the bill Bipartisan.
- oneoff786 5y ago
  If you make it a 12 instead of a 1, sure
ecf 5y ago
Affordable insulin is a no-brainer, slam-dunk, overwhelmingly YES piece of legislation. I cannot comprehend the mental gymnastics diabetic republicans must go through on a daily basis.
- throw10920 5y ago
  This isn't "affordable insulin", it just limits the copay to $35. Pharma companies can keep charging abusively high prices for insulin, and force insurance providers to pay for it[1], which then trickles down to make everyone pay more, while allowing pharma companies to rake in profits. This is socialized medicine + cost disease[2], which I'm surprised and disappointed that anyone voted on at all. [1] https://news.ycombinator.com/item?id=30879824 https://news.ycombinator.com/item?id=30879824 [2] https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost...
  - ecf 5y ago

mc4ndr3 5y ago

Sale! $35/mo subscription to being alive Thank your local representative now!

tempnow987 5y ago

Interesting - companies can still charge what they want, this just forces a big subsidy by insurance companies / medicare. Traditionally if price to consumers / demand is unchanged by price increases, companies should be incentivized by this to increase prices no? The rate you pay stays $35, and demand does not drop, but profits rise up.

ccooffee 5y ago
Yea, this doesn't seem great. In my opinion, one of the biggest failures of the Affordable Care Act was the guarantee of profit for insurance companies. This bill looks like the same sort of problem. "Insulin capped at $35/month" sounds great, but it buries the point that prices AREN'T actually being fixed. They're just shifting the increased cost from individual patients to the collective (via insurance companies). My insurance costs are going to go up so that pharma corporations can continue to fleece patients, and there's nothing in this bill that would prevent this.

stuckinhell 5y ago

Disgustingly high. I find it furious how american citizens are force to subsidize the entire world. https://www.vox.com/science-and-health/2016/11/30/12945756/prescription-drug-prices-explained https://www.vox.com/science-and-health/2016/11/30/12945756/p... My mother needs insulin to live, and lives off her mediocre pension. I don't find it fair or just at all. Even our National Allies like Germany didn't spend their fair share to NATO until Russia invaded Ukraine. I'm tired how American Citizens don't have healthcare or houses yet our taxes goes to across the world, and the world isn't doing their fair share. We aren't being represented by our government.

jeromegv 5y ago
American citizens are not "forced". American citizens vote for politicians that want private healthcare. If you want your own national drug care program, that gives the government an incentive to negotiate large purchases with pharmaceutical companies. Then do it. But you keep electing politicians that choose the free market
- mywittyname 5y ago
  Policies like 2 senators per state, regardless of population, and the Electoral College ensure that a minority of citizens have the majority of power in the USA.
  - kcplate 5y ago
    Two wolves and a sheep sit down to decide what to have for dinner…
- notch656a 5y ago
  >But you keep electing politicians that choose the free market Ba ha ha ha ha. Let me tell you how 'free' the market is if I decide to open up Notch's Medical Clinic without a long list of licenses/permits/regulatory compliance. If I manufacture and give you a pill without extensive process of authorization by the FDA to use this pill as a drug. Healthcare is expensive in part because there isn't a free market. A free market would rip the bloated competition currently present into shreds.

Someone1234 5y ago

The title and article is misleading: > US House passes Bill to limit cost of insulin to $35/mo . > fulfilling its promise of lowering drug costs. Insulin costs under $5 to make. If they had in fact limited the price to $35/months that would be fantastic. But what the bill actually does is force insurers to pick up 100% of costs over $35/month, allowing pharma companies to keep charging abusive rates and everyone will indirectly pay for that by increased premiums. Even the bill's own summary[0] is much more clear on what it does than this article: > This bill limits cost-sharing for insulin under private health insurance and the Medicare prescription drug benefit. That's literally the first line. The second line is: > Specifically, the bill caps cost-sharing under private health insurance for a month's supply of selected insulin products at $35 or 25% of a plan's negotiated price (after any price concessions), whichever is less, beginning in 2023. This might seem like a distinction without a difference, but I strongly disagree. Insulin prices themselves are abusive and the underlying problem here, this doesn't even seek to address those and instead just hides the profiteering behind higher insurance premiums. Time to actually fix drug pricing and not keep shoving everything behind an insurance smokescreen and then acting surprise then insurance premium rates are astronomical. [0] https://www.congress.gov/bill/117th-congress/house-bill/6833?s=1&r=1 https://www.congress.gov/bill/117th-congress/house-bill/6833...

cptskippy 5y ago
This is politics in America. Politicians obstruct everything meaningful but allow these "wins" through when they do absolutely nothing to fix any of our problems, only obfuscate them.
koolba 5y ago
> ... allowing pharma companies to keep charging abusive rates and everyone will indirectly pay for that by increased premiums. That's what always happens with these programs. "Free" physical / wellness visit? Your insurance premiums bake that in. "Free" COVID tests? Your insurance premiums bake that in.
- throwawayboise 5y ago
  Yes, I'd love to be able to buy health insurance that was truly insurance and not a pre-pay plan for a bunch of stuff I'll never use.

phmagic 5y ago

Naive question: If the insurance providers are the payers, why aren't they incentivized to collectively negotiate down the cost of drugs?

throwawayboise 5y ago
Health insurance company profits are capped as a percentage of claims paid. Higher costs for drugs and services means more profit for the insurance companies.

nickpp 5y ago

Price-fixing is the best way to create shortages. How this problem is solved in pretty much any other area of economy: improve supply, or in other words make sure it is as easy as possible to import or create and sell competing products. How easy is to start an insulin providing business tomorrow in the USA? Exactly. But planners gonna plan...

Edman274 5y ago
Do you think that if the price of insulin goes down that there's suddenly going to be a huge floodgate of people who will consume a lot more insulin than they're already consuming now? Like, people who were like "yeah, I'll buy insulin at 35 dollars but not at 300 dollars, if it hits 300 then I'll just wait this one out" or that they'd be like "oh, now that the price of insulin has been cut by a factor of ten I'll consume ten times as much"? Like, you know how insulin works - either you get it within 24 hours, or you don't and you go into a coma and die, and how much you take isn't influenced by any factor other than what you eat?
nradov 5y ago
This bill doesn't actually fix prices charged by manufacturers, and thus won't cause shortages. It fixes out-of-pocket costs for patients, with insurers (and employers) picking up the difference. We can expect medical insurance premiums to increase as a consequence.

sithadmin 5y ago

While I do think this is a general move in the right direction, the cynic in me can't help but to think this recent spotlight on insulin in particular is a red herring to distract from the Democrats' inability to make headway on prescription drug and general healthcare affordability. I mean, sure, diabetes is a big issue in the US, with type 2 being particularly problematic and prevalent among the least advantaged demographic groups, and efforts to keep insulin affordable will be massively beneficial to a relatively large number of people. But simply ensuring that insulin is affordable does nothing to address the underlying nutrition and healthcare access that lead so many to end up with type 2 diabetes in the first place. The measure also seems woefully inadequate for addressing insulin access for the uninsured, which is going to dampen the effect as well.

padobson 5y ago

Can someone explain to me why insulin, essentially a commodity, can fetch any significant price over cost? Why isn't there more competition? Is barrier to entry for low-cost competitors the difficult of manufacture? Or is it patent enforcement? If it's patent enforcement, wouldn't a bill that reforms the patent protection for insulin makers make a lot more sense than this bill?

_aavaa_ 5y ago
If I were to bet, it would be the manufacturing requirements placed on pharmaceutical companies. I am not saying they're unjustified (e.g. sterilization requirements), just that they're onerous.
- imglorp 5y ago
  Plus they're using insulin revenues for other activities.
Auracle 5y ago
When people complain about high insulin costs, they’re complaining about new formulations that work much better. You can get the old stuff at Walmart for (relatively) cheap. The new stuff is probably under patent, although even when that runs out there are roadblocks for generic manufacturing - and that goes for every medication. The fact that patent holders can draw out the process longer than they’re supposed to should be reformed, but that doesn’t get as many political points as capping the price to the consumer.
- deepnotderp 5y ago
  The flip side of that is that many of the newer formulations are slight tweaks, but doctors will generally prescribe the drug that the latest pharma sales rep to visit was selling (yes really). They also tend to not want to change the way they’ve always done things and prescribe a cheaper formulation.
s1artibartfast 5y ago
It's not patents, most early insulin is off patent. Most of the barriers are regulatory and profitability. It is worth noting that bidens 35 is a copay limit, not a limit on what your insurance pays. As a example for profitability, this non profit hopes to bring the total cost down to 30: https://www.google.com/amp/s/amp.cnn.com/cnn/2022/03/03/politics/civica-insulin-affordable-drug/index.html https://www.google.com/amp/s/amp.cnn.com/cnn/2022/03/03/poli...

nirav72 5y ago

Don't think this going to make it through the Senate.

nradov 5y ago

While this bill is imperfect, overall it does improve the situation for diabetics. But for type 2 diabetics we really ought to focus on reducing their need for exogenous insulin. Virta Health has peer reviewed research showing that the majority of patients can put their diabetes into remission using nutritional ketosis. https://www.virtahealth.com/reversediabetes https://www.virtahealth.com/reversediabetes Type 1 diabetics will always need some exogenous insulin, but they can reduce the amount of insulin needed (and the cost thereof) with regular exercise. https://link.springer.com/article/10.1007/s00125-011-2403-2 https://link.springer.com/article/10.1007/s00125-011-2403-2

Auracle 5y ago

This is great news for those that take insulin, for drug manufacturers, Democrat politicians, and (in the short term) for insurance companies. It's terrible for everyone else. If consumers are paying $300 a month they might decide to take a cheaper insulin instead, move to a generic if possible, maybe even get their type 2 diabetes under control before they need insulin, etc. Now that it's capped for them - why should they care? Their insurance will pay for it. Because how much insurance companies can charge is tied to how much they pay out, they now get to raise their prices and profits. Because they all need to compete with each other, they normally couldn't do this all on their own. This is essentially government mandated price fixing - or perhaps another term is better? There's absolutely nothing stopping the insulin manufacturers from raising their prices even more now. They'll want to slowly boil that frog just so they don't come under pressure, but that's fine by them. Finally, this is good for the Democrats because most people don't realize the above and think they price was actually capped to $35. The comments on Reddit about this show it pretty well, calling out Republicans for not voting in favor of it. How dare they? In the end it'll be great for them in two ways, because insurance prices are going to keep going up to ridiculous levels until people decide that we need to move to a socialized system. Medical prices are out of control in our country and the lack of price discovery is exactly why. I've commented before on this, but when I was prescribed testosterone I was put on Androgel. Androgel was $400 a month. Injections are something like $10 a month and work better in every way. There's now a pill you can take for the low cost of $1,000 a month. If people actually had to pay that cost up front, they might decide to go through the hassle of injecting themselves once a week or two. We either need to making insurance in to actual insurance again, meaning a very high deductible, or we need price controls. Anything else is a terrible idea. Mandating high deductibles is probably a no-go politically, but price controls would be easy. Cap the costs of medications and procedures/visits to the average of 5 other first world countries. Bam. Done.

nsv 5y ago
I agree completely that better price discovery would help the issues greatly. Many times the doctor's office will not even be able to tell you how much a procedure or medication costs until after you get it, which is nuts. If there were more competition in the medical world practices like this would quickly die out (imagine if a grocery store didn't post any prices for its items!)

boston_clone 5y ago

With all the (certainly fair) criticism of how this doesn't address perhaps the largest / most vulnerable subset of diabetics, I can't help but wonder if there is an opportunity for a non-profit entity to emerge and help somehow. I also imagine the alternative of too much government intervention across public and private sectors in one sweeping bill would likely have much more resistance. Small steps, it seems.

lcall 5y ago

I think insulin will already be less expensive in 2024 anyway, due to efforts by a nonprofit manufacturer started by a nonprofit Utah healthcare chain with many partners. The manufacturer is trying to make many drugs more available and less expensive. It's quite interesting: https://news.ycombinator.com/item?id=30714641 https://news.ycombinator.com/item?id=30714641 Edit: and I don't know if Mark Cuban's company is planning to help with that or how they are doing. There is a link about them, in the above link.