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At this point literally every other country in the world chimes in about how broken the American healthcare system is. Yup.
by iso1631 4y ago
At this point literally every other country in the world chimes in about how broken the American healthcare system is.
Yup.
- anonuser123456 4y agoThe world should hope we don’t fix it. Most of the R&D is done here because the market opportunity is huge. But if that dries up, then costs will go up for everyone else.
- s5300 4y agoDoesn’t like. Cuba, of all places, have pretty great medical R&D? Don’t think your statement means too much.
- wnevets 4y agohow much R&D are these companies doing for insulin?
- uoaei 4y agoYeah, if anything, the explosive profit opportunity is all the more reason to effectively subsidize insulin for the general public. Since pharma folks are already so greedy, go ahead and get a government contract for it, those are always hugely overinflated anyway!
- anonuser123456 4y agoMost of the markup is not done by big pharma. It’s done by PBMs. The fictional ‘list’ prices exist as a marketing scheme to get private insurance to pay high prices ‘at a discount’. Cash buyers are a casualty caught in the middle of this scheme.
- lotsofpulp 4y agoWhatever amount it is, US politicians are not willing or able to pay for it with US taxpayer’s money.
- lhl 4y agoSounds like anonuser needs to read about the insulin's history: https://en.wikipedia.org/wiki/Insulin#Patent https://en.wikipedia.org/wiki/Insulin#Patent
- anonuser123456 4y agoSnarky comments only work when you are factually correct. Modern insulin analogs were not invented 100 years ago.
- CarbonCycles 4y agoThat is very true...Insulin now of days is very different then when it was first introduced. For example, there are now "long-lasting" and "fast-acting" insulin that has been molecularly modified for different outcomes. Diabetes is a very old disease that ironically is pushing the limits of sensor fusion, but it is very poorly understood by people outside of the Type 1 community. I personally wish these two diseases were completely renamed as it does a disservice to both Type 1 and 2 patients.
- lhl 4y agosigh, sure let's give a more than 1-line answer to your original (pretty worthless, let's be honest) 1 line comment. "Unlike many pharmaceutical markets, which see the entry of generic competitors, no generic or biosimilar insulins have been approved in the United States.68 This is not due to patent protection of the existing products.69 The patents for the majority of human and analog insulin products have expired or are about to expire.70 At the end of 2015, 11 insulin products had no associated patents or exclusivities.71 This number has since risen to approximately 17 by July 2019 (including those products where only the insulin pen device is protected), shown in Table 2." Knox, Ryan. “Insulin Insulated: Barriers to Competition and Affordability in the United States Insulin Market.” Journal of Law and the Biosciences 7, no. 1 (July 25, 2020): lsaa061. https://doi.org/10.1093/jlb/lsaa061 https://doi.org/10.1093/jlb/lsaa061. This is corroborated by Health Access International's deep dive from several years ago: "There are no patents on any formulations of human insulins. Based on the filing date and a 20 year patent period, patents on analogue insulins already on the market in the US and Canada have expired or will soon expire in these countries and elsewhere (Figure 1)." https://haiweb.org/wp-content/uploads/2015/05/HAI_ACCISS_factsheet_insulinpatent.pdf https://haiweb.org/wp-content/uploads/2015/05/HAI_ACCISS_fac... https://haiweb.org/wp-content/uploads/2016/04/ACCISS-PatentReport-FINAL.pdf https://haiweb.org/wp-content/uploads/2016/04/ACCISS-PatentR... And yet, despite this, the US remains alone in having prices not only multiple times the cost of any other country, but increasing at an alarming rate (tripling over the past deacde) while prices stay the same or fall elsewhere. There's zero shortage of analysis and ink spilled in both the popular press or in academic analysis/ peer-reviewed press on why markets are so fucked in the US pharmaceuticals, so I just assume any talk about how R&D cost recovery happens to only be a thing in the US (and somehow accelerating despite new products not being released) to be either extreme low effort or just plain bad-faith (which are you anon?), but for those reading along that might be interested, a few places to start to do their own research if they really care about the topic: Mulcahy, Andrew W., Daniel Schwam, and Nathaniel Edenfield. “Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis.” RAND Corporation, October 6, 2020. https://www.rand.org/pubs/research_reports/RRA788-1.html https://www.rand.org/pubs/research_reports/RRA788-1.html. Hirsch, Irl B. “Insulin in America: A Right or a Privilege?” Diabetes Spectrum : A Publication of the American Diabetes Association 29, no. 3 (August 2016): 130–32. https://doi.org/10.2337/diaspect.29.3.130 https://doi.org/10.2337/diaspect.29.3.130. Schneider, Tyler, Tara Gomes, Kaleen N. Hayes, Katie J. Suda, and Mina Tadrous. “Comparisons of Insulin Spending and Price Between Canada and the United States.” Mayo Clinic Proceedings 97, no. 3 (March 1, 2022): 573–78. https://doi.org/10.1016/j.mayocp.2021.11.028 https://doi.org/10.1016/j.mayocp.2021.11.028. Herman, William H., and Shihchen Kuo. “100 Years of Insulin: Why Is Insulin So Expensive and What Can Be Done to Control Its Cost?” Endocrinology and Metabolism Clinics of North America 50, no. 3S (September 2021): e21–34. https://doi.org/10.1016/j.ecl.2021.09.001 https://doi.org/10.1016/j.ecl.2021.09.001. Luo, Jing, and Aaron S Kesselheim. “Evolution of Insulin Patents and Market Exclusivities in the USA.” The Lancet Diabetes & Endocrinology 3, no. 11 (November 2015): 835–37. https://doi.org/10.1016/S2213-8587(15)00364-2 https://doi.org/10.1016/S2213-8587(15)00364-2.
- anonuser123456 4y agoA lot. Insulin is a category of human insulin analogs. Each analog has unique properties. You can have the ‘old insulin’ for something like 25$ / 1k units. But it’s very hard to use relative to modern analogs, so people prefer modern analogs. Edit: Minus points for facts that disrupt the narrative. I love it.
- zackees 4y agoMy family member uses Humalog and it's patent expired in 2014 yet it's hundreds of dollars: https://medcitynews.com/2019/03/lilly-to-introduce-lower-priced-version-of-insulin-product-humalog/ https://medcitynews.com/2019/03/lilly-to-introduce-lower-pri... The problem is that there isn't competition on the market for this product. The Open Insulin people were trying to make it available to the public but they are stuck trying to get through the regulation. It's entirely possible that if we got rid of the regulation then the whole problem takes care of itself and it becomes a non issue.
- CarbonCycles 4y agoIMO it's not the regulation that is the problem...it's the entire healthcare system we have in the US. Humalog and other types of the same exact insulin are pennies on the dollar in other countries with very different healthcare compensation programs between the vendors and purchases. It's bizarre to say the least.
- anonuser123456 4y agoThis is precisely because the US market pays for all of the risk. Once the risk is paid for by the US market, it’s very cheap to sell extra capacity to other countries. All the fixed costs are already paid for and the risks are low.
- anonuser123456 4y agoYou can buy generic novolog at Walmart for 75$ for 1000 units vs. 550$ list for the same of branded humalog. But basically you are correct that regulation is the largest barrier to price reductions. Patients pay the price of FDA regulation (for better or worse). That’s not really the drug companies fault.
- Afforess 4y agoI wonder how many lives all that R&D costs in the US. Seems like a strange trade to let US citizens die due to lack of healthcare to fund the world's R&D. I doubt anyone here would vote to ratify such a deal, formally.
- anonuser123456 4y agoThe drugs have to be developed, and no other mechanism seems to produce them. Clinical trials are extremely expensive and very risky. In the long run, these drugs go off patent and become low cost and highly available. Yes, people today will struggle, maybe even die today. But in a generation more people will thrive.
- mrguyorama 4y agoAh yes, which is why the US was the only place to quickly develop effective COVID vaccines.
- munch117 4y agoBioNTech SE An der Goldgrube 12 55131 Mainz, Germany I'm all for giving the US credit for healthcare R&D, there's a lot of credit due. But don't just take it for granted, or you'll miss the signs that point in other directions. Specifically with COVID-19, there was a lot of global collaboration.
- anonuser123456 4y agoI think parent is being sarcastic. But that said, the key point remains; the US is where the money is. The US underwrote the mRNA platforms with a guarantee of 10 billion in revenue while the EU haggled with AZ for like 1 billion. In the process, the US developed an entire scalable delivery pipeline for mRNA that didn’t exist prior.
- noja 4y agoDon't worry, the invisible hand of the market will step in and correct this any time now!
- mariodiana 4y agoI'm pretty sure this comment won't be appreciated, but the amount of government intervention in the market with respect to healthcare in the United States makes it one of our most highly regulated industries, if not the most highly regulated. Some would say that crying "market failure" isn't a legitimate criticism.
- antisthenes 4y agoIt won't be appreciated, because people making the comment that you did don't understand that an unregulated market will naturally lead to a regulated market that protects entrenched interests organically, by itself. There wasn't anyone in government that decided hospitals and insurance companies need to have record profits and price gouge their customers. It happened, because entrenched interests lobbied government officials to enact such legislature. Business is the one that perverse incentives through pressure on government. It doesn't originate in government spontaneously. > Some would say that crying "market failure" isn't a legitimate criticism. Saying market failure isn't a criticism in and of itself, it's a statement of fact. It arises whenever the market is unable (for a multitude of reasons) to distribute the services to the end consumers (e.g. health care recipients) in an effective manner. For example, saying that "tying health care to employment creates perverse incentives, because policymakers automatically assume that more people are covered than actually are, since policymakers themselves are employed" is a criticism (without judging how valid/accurate it is). Broadly saying "market failure" is not.
- mariodiana 4y agoI understand what laissez-faire is.
- monkeybutton 4y agoOh, the invisible hand is definitely there. Though, it's just slipping into your back pocket and lifting your wallet.
- ParksNet 4y agoThe USA doesn't even have ingredients listed out per 100g. Comparing packaged goods is very difficult. The solution is not to tax and spend more money on socialized medicine, its to cut sugar out of packaged food products to reduce diabesity in the first place. Sugar tax of 1c per 1g added sugar is another easy solution. Use the proceeds to reduce sales taxes on food and drink generally.
- CarbonCycles 4y agoThere are two types of Diabetes...type 1 and 2. I don't agree with your comment on reducing obesity as Type 1 is a much different disease than Type 2.
- 1123581321 4y agoType 1s actually benefit from the widespread obesity, since it sends a lot of money into drugs and monitors that both type 1 and type 2 use. :)
- CarbonCycles 4y agoI argue many Type 2 patients do a VERY POOR job on average on monitoring their diabetes. Many Type 2 still have moderately functioning cells that manufacture insulin...Type 1 have no choice. I argue the opposite in that Nightscout and other initiatives that predominately serve the Type 1 community help push the advancement of monitoring, etc. that benefit the rest.
- 1123581321 4y agoNightscout is a great initiative. Monitoring of type 2 is rapidly improving, especially as CGMs aren’t restricted to type 1s on insurance as much as they sued to be. Increasing the market size of CGMs has led to significant competition. Thought on treating type 2 is also evolving in ways that don’t benefit type 1 as much. For example, the trend is for pre-diabetes to be taken seriously and detected earlier.
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- 42e6e8c8-f7b8-4 4y agoAnecdotally, a colleague needed back surgery in the US and was able to get scheduled within 2 weeks. Our Canadian colleagues marveled at that speed.
- tcmart14 4y agoBut it is far from universal. My daughter needs to see a pediatric gastroenterologist in Oregon, she isn't scheduled for an appointment until December (we were told this in May). So she has to wait ~7 months? You can find a case of someone getting into a specialist or a surgery within 2 weeks in the US, but you can also find the opposite.
- ne0flex 4y agoAlso anecdotal, I had a situation in which I needed to get an MRI in 2020. While I was in Canada, the doctor quoted me about 6 months. I had to go to NYC for a week. While in NYC, I went to a walk-in clinic and they got an MRI scheduled for me the same day. With my US health insurance, I was out of pocket about $75 for the whole thing. As much as Canadians like to crap on US healthcare, it does have its perks in certain situations.
- bombcar 4y agoThere's a capital utilization story here, even aside from everything else; if the MRI machine was waiting and available, it would have gone unused otherwise; I suspect the Canadian one is running at airline percentages of use.
- mjhay 4y agoAnecdotally, I've got a 6 month wait to see a specialist in the US, and I have very good insurance.
- adamcharnock 4y agoA phrase I've heard said: The rest of the world thinks of the USA in the same way that the USA thinks of Florida.
- SkinTaco 4y ago*rest of the world on twitter Scoreboard says people still want to move to the US
- lucb1e 4y agoI've always wondered why that is. I would guess it's a legend that persisted from previous centuries when north America was the newfound land, the country to start a new life, where you can dig for gold, with a modern legal system (even if that was only by virtue of being recently founded back then), the whole narrative around the USA is still like that. Meanwhile the actual social mobility in the USA is lower than in Europe[1], so you'd be better to stay put or go to Europe. People here don't know what they got. You say twitter, but it might just be people that have access to the internet and better information? I'd be curious if anyone looked into why the USA is seen as so ideal when various metrics are only on par with developing countries. (Of course, it's clearly beyond a developing country, it just doesn't like to admit it -- healthcare, welfare, incarceration rates, income equality, minimum wage, minimum paid time off, university costs, etc. Sources here are OWID and Wikipedia, mainly from memory but feel free to ask for a specific source) Another theory is that the USA generally sees itself as the best country, with e.g. starting every morning of primary school with this "pledge of allegiance" indoctrination (sorry, I have no other word for it and I still have a hard time believing this is real). With English being the lingua franca online, much of what you read online is likely to be written by someone who thinks this way. [1] See figure 1 on the 43rd page which has page number 40 https://docs.iza.org/dp1993.pdf https://docs.iza.org/dp1993.pdf
- bombcar 4y agoInternal mobility doesn't matter as much as the one-time mobility you can get from moving to the US. If you get stuck at a moderate FAANG salary for life, it may still be better than where you started from, for example.
- baisq 4y agoThey should see the waiting times in Europe.
- synu 4y agoWhat are the waiting times in Europe? I live in the Netherlands and have never had a waiting time.
- synu 4y agoSeems the idea that wait times are longer in Europe is a misconception: https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country https://worldpopulationreview.com/country-rankings/health-ca... https://www.oecd-ilibrary.org/sites/242e3c8c-en/1/3/2/index.html?itemId=/content/publication/242e3c8c-en&_csp_=e90031be7ce6b03025f09a0c506286b0&itemIGO=oecd&itemContentType=book https://www.oecd-ilibrary.org/sites/242e3c8c-en/1/3/2/index....
- baisq 4y agoIt must be a misconception that it takes me 2 weeks to see a GP here in Europe, yes.
- synu 4y agoI am not sure how to extrapolate your personal experience into global trends, although I am sorry that you have to go through that. I don’t personally have that experience at all (I am always able to visit a GP the same day) and am also in Europe. My experience lines up with the data in the links, both now here and in the US when I lived there.
- nobody9999 4y ago>I am not sure how to extrapolate your personal experience into global trends, although I am sorry that you have to go through that. I don’t personally have that experience at all (I am always able to visit a GP the same day) and am also in Europe. My experience lines up with the data in the links, both now here and in the US when I lived there. As an American with expensive (~$800/month, rising to over $1000/month next year) insurance, I often have to wait to see a specialist and only go see my GP for regular check-ups. If I have an issue that needs to be addressed immediately, I have two choices: an "urgent care" facility or an emergency room. Urgent care, at least in my experience, is a misnomer as I've (with a small sample size) alternately been refused treatment and been told to go to the emergency room ("we can't handle that sort of thing") while still being charged for something, or given substandard treatment. Which, I guess, is why urgent care is 1/3 the cost (out of pocket) of an emergency room visit. Should I wish to see my GP, I likely would need to wait at least a few weeks, possibly longer. With even longer waits for specialists.
- gamblor956 4y agoThat explains why the world's wealthy come to America for their health treatments. Yep. Because it's broken... America pays more because our health care system is capitalist, and that naturally leads to increased prices because demand is inelastic (meaning, that demand does not decrease based on price).