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> ”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

> ”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.
      - kcplate 5y ago
        Yeah ACA was great. I saw it first hand within my own family provide an older quote wealthy family member with some obscenely cheap insurance, compared to young blue collar family member who had to opt out and just pay the tax fine because it made health insurance completely unaffordable for his family.
    - nopenopenopeno 5y ago
      I think that’s being too generous. These efforts have a very distinct goal: reinforce defensives against universal healthcare program to preserve the health insurance gravy train for the ruling class, and preserve the employer-based health insurance system that helps to keep so many Americans in fear of losing their jobs. Health insurance industry’s annual profits havey increased very significantly since Obamacare passed in 2010 [1]. These sorts of efforts effectively make the insurance lobby even stronger that it would be otherwise. [1] https://www.forbes.com/sites/robertlaszewski2/2020/02/05/profitability-in-the-health-care-market-has-never-been-better https://www.forbes.com/sites/robertlaszewski2/2020/02/05/pro...
    - theptip 5y ago
      To be fair, Obama was pushing for single payer in 2008 (“Medicare for all”) and took it off the table to try to get some Republicans on board. And the Sanders/Warren wing of the party is pushing hard for Medicare for all right now. CA is close to implementing a public option. Hillary Clinton also pushed for healthcare reform while a senator IIRC, and I believe some Republican governors have pushed for sensible reforms too. In general I think cynicism in politicians is not misplaced when there are lobbyists involved, but on this issue I don’t think blame is symmetrically justified. The red team won’t even let Medicare use its volume purchase bargaining power to negotiate cheaper prices.
- 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.

> ”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.
    - kcplate 5y ago
      Yeah ACA was great. I saw it first hand within my own family provide an older quote wealthy family member with some obscenely cheap insurance, compared to young blue collar family member who had to opt out and just pay the tax fine because it made health insurance completely unaffordable for his family.
  - nopenopenopeno 5y ago
    I think that’s being too generous. These efforts have a very distinct goal: reinforce defensives against universal healthcare program to preserve the health insurance gravy train for the ruling class, and preserve the employer-based health insurance system that helps to keep so many Americans in fear of losing their jobs. Health insurance industry’s annual profits havey increased very significantly since Obamacare passed in 2010 [1]. These sorts of efforts effectively make the insurance lobby even stronger that it would be otherwise. [1] https://www.forbes.com/sites/robertlaszewski2/2020/02/05/profitability-in-the-health-care-market-has-never-been-better https://www.forbes.com/sites/robertlaszewski2/2020/02/05/pro...
  - theptip 5y ago
    To be fair, Obama was pushing for single payer in 2008 (“Medicare for all”) and took it off the table to try to get some Republicans on board. And the Sanders/Warren wing of the party is pushing hard for Medicare for all right now. CA is close to implementing a public option. Hillary Clinton also pushed for healthcare reform while a senator IIRC, and I believe some Republican governors have pushed for sensible reforms too. In general I think cynicism in politicians is not misplaced when there are lobbyists involved, but on this issue I don’t think blame is symmetrically justified. The red team won’t even let Medicare use its volume purchase bargaining power to negotiate cheaper prices.
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.