7 ms·

I will never understand US healthcare. If Mark Cuban's idea was so straightforward, i really wonder what took it so long. Perhaps, all that was needed was an in

I will never understand US healthcare. If Mark Cuban's idea was so straightforward, i really wonder what took it so long. Perhaps, all that was needed was an interested billionare who did not want unlimited profits ?

ptero 4y ago
Too many vested interests and rigid regulation that cannot be changed because of those vested interests. To be honest, the same is true of many countries with socialized medicine, but the snag is not with cost but with availability and speed of care. And some medically solvable problems cannot be solved because changing anything is almost impossible.
- iancmceachern 4y ago
  "Vested interests" = the insurance company / large corporate caregiver (kaiser, dignity, etc.) industrial complex. It's just like it sounds, it's the military industrial complex but with insurance companies and large corporate hospital systems, etc.
  - ehsankia 4y ago
    Nearly all of US problems can be traced back to the insanely powerful lobbying (citizen united, etc). The gun lobby, the private prison lobby, the healthcare lobby, the tax filing lobby, etc. Corporations not only buying politicians for dirt cheap to keep their own profits high, but also spreading lies and propaganda brainwashing part of the population into believing the bullshit they're peddling. Just look at the story of Wendell Potter [1], an ex US health exec who basically came out and detailed all the lies he spread about Canadian healthcare. So many people in the US believe those lies still to this day. [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
    - zarzavat 4y ago
      The first step is for Americans to stop using the word “lobbying” and call it like it is: corruption. When a politician receives benefits for passing certain laws (often hard cash to their campaign!) they are a corrupt politician. The term “lobbying” is the same kind of linguistic exceptionalism involved in the word “expat” vs “immigrant”.
    - epakai 4y ago
      It goes back further. Sunshine laws of the 70s enable vote buying and coercion. Addressing the lobbying issue would play a big part, but ultimately the ability to apply public pressure on how representatives vote is going to provide enough leverage to control those votes. Make votes (and many committees) secret like every good election. There will still be corruption, but individual legislators will be less beholden to private interests and the party line.
- xenadu02 4y ago
  It seems more likely to be a result of consolidation on the manufacturing side and the monopolizers paying their competitors to stay out of the market (or to just resell the main brand which subsequently rations the supply). Shire pulled this trick with Adderall XR: they signed a deal (can't recall who it was, Teva maybe?) to provide the actual drug that the generic maker stamped with their name. When Shire (bought by Takeda) was getting ready to release Vyvanse they suddenly cancelled the contract and stopped providing the XR to Teva. There was a US-wide shortage for almost a year, during which many patients scrambled to find alternatives... some of them ended up with Vyvanse prescriptions as designed. I don't want to discount what you are saying though: the generic process should be streamlined. For Schedule II medications the extra regulatory burden definitely makes these schemes more profitable. You need a special DEA license to make them and the DEA sets quotas so even if you have a facility certified to make Schedule II drugs you need DEA permission to increase the supply. When Shire pulled the rug out from under everyone it took time for competitors like Teva to start production, get DEA approval, then get approval to manufacture in enough quantity to replace what Shire stopped making. This was well known at the time. To my knowledge no investigation was done whatsoever. The government simply allows companies to manipulate the market as they please. No wonder they have gotten bolder and bolder. I was not shocked in the least when Hedge Fund parasites like Martin Shkreli started looking for drug companies to buy to snap up the rights to single-source or low-volume generics to jack up the price. If a huge manufacturer can commit open market manipulation to the point that millions of people can't get an RX filled _anywhere_ to push them onto a newer expensive drug and the government doesn't even bother pretending to investigate... well there's lots of rent to be extracted!
jedimastert 4y ago
> an interested billionare who did not want unlimited profits? I'd posit that it's almost impossible to get to the point where you can fund something like that without being singularly focused on getting the most money possible
- kevin_thibedeau 4y ago
  The problem is that medical necessities are an inelastic demand. That's how rapacious grifters come along and jack up prices 100x knowing that their pray don't have a choice.
- iancmceachern 4y ago
  It exists, it's just called a non profit.
  - _carbyau_ 4y ago
    Thing is, I am happy for a profit, just not a ridiculous one. We don't really have a class of organisations called "Reasonable Profit".
    - justinclift 4y ago
      Isn't that the purpose of public benefit corporations? eg: https://en.wikipedia.org/wiki/Benefit_corporation https://en.wikipedia.org/wiki/Benefit_corporation also: https://www.bcorporation.net https://www.bcorporation.net
      - _carbyau_ 4y ago
        That's cool! The wikipedia article is a bit light on details. To summarise, it seems that by declaring as Public Benefit Corp they can not be so beholden to the shareholders and the Corporation can declare "some other societal mission". No real details on what limits or benefits though. I mean, what is stopping a Public Benefit Corporation declaring a mission for "yacht transport assistance" to be delivered to the selected "needy" and delivered by profits on business as usual? Obvious blatant point I am trying to make but I assume there are further laws and bylaws that usefully try to limit a corporation in that sense. It seems a bit wishyWashy just going from wikipedia but for a HN discussion is well worth pointing out they exist! Thank you!
PaywallBuster 4y ago
maybe the risk/payoff wasn't good enough unless you had too much money that you could just "gamble it" to make it happen corporations have shareholders and can't make risky moves like that
bpodgursky 4y ago
I really wonder how much of the hangup is that it's a miserable field for a successful billionaire to break into. The problems are political, regulatory, bureaucratic, inscrutable, and you can't win solely on the back of being "cheaper" and "better". You have to both REALLY care, and be willing to wade through immense BS to make a profit comparable to selling smartphone apps.
deleted 4y ago
[deleted]

ptero 4y ago

Too many vested interests and rigid regulation that cannot be changed because of those vested interests. To be honest, the same is true of many countries with socialized medicine, but the snag is not with cost but with availability and speed of care. And some medically solvable problems cannot be solved because changing anything is almost impossible.

iancmceachern 4y ago
"Vested interests" = the insurance company / large corporate caregiver (kaiser, dignity, etc.) industrial complex. It's just like it sounds, it's the military industrial complex but with insurance companies and large corporate hospital systems, etc.
- ehsankia 4y ago
  Nearly all of US problems can be traced back to the insanely powerful lobbying (citizen united, etc). The gun lobby, the private prison lobby, the healthcare lobby, the tax filing lobby, etc. Corporations not only buying politicians for dirt cheap to keep their own profits high, but also spreading lies and propaganda brainwashing part of the population into believing the bullshit they're peddling. Just look at the story of Wendell Potter [1], an ex US health exec who basically came out and detailed all the lies he spread about Canadian healthcare. So many people in the US believe those lies still to this day. [1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-former-cigna-executive-praises-canadas-health-care-system https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
  - zarzavat 4y ago
    The first step is for Americans to stop using the word “lobbying” and call it like it is: corruption. When a politician receives benefits for passing certain laws (often hard cash to their campaign!) they are a corrupt politician. The term “lobbying” is the same kind of linguistic exceptionalism involved in the word “expat” vs “immigrant”.
  - epakai 4y ago
    It goes back further. Sunshine laws of the 70s enable vote buying and coercion. Addressing the lobbying issue would play a big part, but ultimately the ability to apply public pressure on how representatives vote is going to provide enough leverage to control those votes. Make votes (and many committees) secret like every good election. There will still be corruption, but individual legislators will be less beholden to private interests and the party line.
xenadu02 4y ago
It seems more likely to be a result of consolidation on the manufacturing side and the monopolizers paying their competitors to stay out of the market (or to just resell the main brand which subsequently rations the supply). Shire pulled this trick with Adderall XR: they signed a deal (can't recall who it was, Teva maybe?) to provide the actual drug that the generic maker stamped with their name. When Shire (bought by Takeda) was getting ready to release Vyvanse they suddenly cancelled the contract and stopped providing the XR to Teva. There was a US-wide shortage for almost a year, during which many patients scrambled to find alternatives... some of them ended up with Vyvanse prescriptions as designed. I don't want to discount what you are saying though: the generic process should be streamlined. For Schedule II medications the extra regulatory burden definitely makes these schemes more profitable. You need a special DEA license to make them and the DEA sets quotas so even if you have a facility certified to make Schedule II drugs you need DEA permission to increase the supply. When Shire pulled the rug out from under everyone it took time for competitors like Teva to start production, get DEA approval, then get approval to manufacture in enough quantity to replace what Shire stopped making. This was well known at the time. To my knowledge no investigation was done whatsoever. The government simply allows companies to manipulate the market as they please. No wonder they have gotten bolder and bolder. I was not shocked in the least when Hedge Fund parasites like Martin Shkreli started looking for drug companies to buy to snap up the rights to single-source or low-volume generics to jack up the price. If a huge manufacturer can commit open market manipulation to the point that millions of people can't get an RX filled _anywhere_ to push them onto a newer expensive drug and the government doesn't even bother pretending to investigate... well there's lots of rent to be extracted!

jedimastert 4y ago

> an interested billionare who did not want unlimited profits? I'd posit that it's almost impossible to get to the point where you can fund something like that without being singularly focused on getting the most money possible

kevin_thibedeau 4y ago
The problem is that medical necessities are an inelastic demand. That's how rapacious grifters come along and jack up prices 100x knowing that their pray don't have a choice.
iancmceachern 4y ago
It exists, it's just called a non profit.
- _carbyau_ 4y ago
  Thing is, I am happy for a profit, just not a ridiculous one. We don't really have a class of organisations called "Reasonable Profit".
  - justinclift 4y ago
    Isn't that the purpose of public benefit corporations? eg: https://en.wikipedia.org/wiki/Benefit_corporation https://en.wikipedia.org/wiki/Benefit_corporation also: https://www.bcorporation.net https://www.bcorporation.net
    - _carbyau_ 4y ago
      That's cool! The wikipedia article is a bit light on details. To summarise, it seems that by declaring as Public Benefit Corp they can not be so beholden to the shareholders and the Corporation can declare "some other societal mission". No real details on what limits or benefits though. I mean, what is stopping a Public Benefit Corporation declaring a mission for "yacht transport assistance" to be delivered to the selected "needy" and delivered by profits on business as usual? Obvious blatant point I am trying to make but I assume there are further laws and bylaws that usefully try to limit a corporation in that sense. It seems a bit wishyWashy just going from wikipedia but for a HN discussion is well worth pointing out they exist! Thank you!

PaywallBuster 4y ago

maybe the risk/payoff wasn't good enough unless you had too much money that you could just "gamble it" to make it happen corporations have shareholders and can't make risky moves like that

bpodgursky 4y ago

I really wonder how much of the hangup is that it's a miserable field for a successful billionaire to break into. The problems are political, regulatory, bureaucratic, inscrutable, and you can't win solely on the back of being "cheaper" and "better". You have to both REALLY care, and be willing to wade through immense BS to make a profit comparable to selling smartphone apps.

deleted 4y ago

[deleted]