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I have mixed feelings about it. I would hope that the doctors keep up with the latest developments and would know the options available. But I also like the i

I have mixed feelings about it. I would hope that the doctors keep up with the latest developments and would know the options available. But I also like the idea of patients having agency to advocate for themselves to do their research and talk to doctors and they can’t do that without knowing what they don’t know. On the other hand, if it weren’t for marketing, could costs come down? As you can tell, these are weak opinions weakly held instead of strong opinions weakly held

AnthonyMouse 2y ago
> I would hope that the doctors keep up with the latest developments and would know the options available. One of the issues is that people often go to the doctor and find out the existing treatment doesn't require a prescription or doesn't exist, so they have no more reason to interact with the doctor and the doctor learning about it only matters if the patient knows to go back to the doctor. > On the other hand, if it weren’t for marketing, could costs come down? Probably not, since drugs under patent (which are nearly all of the ones advertised) are sold for the monopoly price until the patent expires. The biggest problem there is that a drug company can produce something which is 2% better than a non-patented alternative but then patients will choose it over the existing thing even it it costs 100 times more, because it's 2% better and the insurance is paying for it, and the drug companies are great at getting the media to yell at insurance companies that refuse to cover things. The thing that would really help here is to make copays a percentage of costs, so instead of the insurance paying $10,000 for something 2% better, the patient has a 10% copay and can say "wait, I'm not paying a $1000/year higher copay for this negligible improvement" whereas if it's really worth it then they do pay it and the insurance is still covering 90%. But then people don't like that, so instead of paying $2000 in premiums and $1000 in copays they end up paying $8000 in premiums because there is nobody saying "no" to things that are overpriced.
- scarface_74 2y ago
  > Probably not, since drugs under patent (which are nearly all of the ones advertised) are sold for the monopoly price until the patent expires. Doesn’t that get back to if you got rid of marketing and let both the government negotiate drug prices (which it legally can’t do now) you could reduce prices and not spend less on research? Other countries seem fine with restructing advertising on prescription drugs
  - AnthonyMouse 2y ago
    > Doesn’t that get back to if you got rid of marketing and let both the government negotiate drug prices (which it legally can’t do now) you could reduce prices and not spend less on research? "Negotiate drug prices" is a monopsony buying from a monopoly. It's like divide by zero, there's no pricing mechanism there. This drug is already developed so if the government makes up a lowball price they have no real choice, but if the government offers them less then they cut research for new drugs because now it has a poor ROI. It's effectively price controls and government officials using a ouija board to make up drug prices when what you actually want is some kind of market to determine how much it's worth to people in order to supply that much incentive for developing drugs like that. And a lot of countries do use price controls because then they still get the drug as long as the US market is picking up the tab to fund the R&D. But that doesn't work if everybody does it, so now the problem is the tragedy of the commons. The US is being cheated into shouldering the burden for the whole world, but if they stop without everyone else starting to pay their share then the research funding collapses, so what do you want to do?

AnthonyMouse 2y ago

> I would hope that the doctors keep up with the latest developments and would know the options available. One of the issues is that people often go to the doctor and find out the existing treatment doesn't require a prescription or doesn't exist, so they have no more reason to interact with the doctor and the doctor learning about it only matters if the patient knows to go back to the doctor. > On the other hand, if it weren’t for marketing, could costs come down? Probably not, since drugs under patent (which are nearly all of the ones advertised) are sold for the monopoly price until the patent expires. The biggest problem there is that a drug company can produce something which is 2% better than a non-patented alternative but then patients will choose it over the existing thing even it it costs 100 times more, because it's 2% better and the insurance is paying for it, and the drug companies are great at getting the media to yell at insurance companies that refuse to cover things. The thing that would really help here is to make copays a percentage of costs, so instead of the insurance paying $10,000 for something 2% better, the patient has a 10% copay and can say "wait, I'm not paying a $1000/year higher copay for this negligible improvement" whereas if it's really worth it then they do pay it and the insurance is still covering 90%. But then people don't like that, so instead of paying $2000 in premiums and $1000 in copays they end up paying $8000 in premiums because there is nobody saying "no" to things that are overpriced.

scarface_74 2y ago
> Probably not, since drugs under patent (which are nearly all of the ones advertised) are sold for the monopoly price until the patent expires. Doesn’t that get back to if you got rid of marketing and let both the government negotiate drug prices (which it legally can’t do now) you could reduce prices and not spend less on research? Other countries seem fine with restructing advertising on prescription drugs
- AnthonyMouse 2y ago
  > Doesn’t that get back to if you got rid of marketing and let both the government negotiate drug prices (which it legally can’t do now) you could reduce prices and not spend less on research? "Negotiate drug prices" is a monopsony buying from a monopoly. It's like divide by zero, there's no pricing mechanism there. This drug is already developed so if the government makes up a lowball price they have no real choice, but if the government offers them less then they cut research for new drugs because now it has a poor ROI. It's effectively price controls and government officials using a ouija board to make up drug prices when what you actually want is some kind of market to determine how much it's worth to people in order to supply that much incentive for developing drugs like that. And a lot of countries do use price controls because then they still get the drug as long as the US market is picking up the tab to fund the R&D. But that doesn't work if everybody does it, so now the problem is the tragedy of the commons. The US is being cheated into shouldering the burden for the whole world, but if they stop without everyone else starting to pay their share then the research funding collapses, so what do you want to do?