5 ms·

If you start a pharmaceutical startup anywhere on earth, your business model is "sell to America". There is no other market. Every other developed country has p

If you start a pharmaceutical startup anywhere on earth, your business model is "sell to America". There is no other market. Every other developed country has price controls and refuses to pay, so the business plan is "sell to America and make whatever pennies we can internationally". Healthcare costs so much in America because we don't have insurance, per se. We have a pay-as-you-go model because the average family of 4 is $25k per year https://www.kff.org/report-section/ehbs-2024-section-1-cost-of-health-insurance/ https://www.kff.org/report-section/ehbs-2024-section-1-cost-... This is absurdly expensive. On top of this most plans have very high deductibles, often $5 to $10k, so a healthy family gets very little of the $25k put into it. This also is what dents salaries and raises, because employers are picking up 10 to 20% annual increases in insurance costs. Furthermore America has very strange anto-competitive practices baked directly into our pay-for-service model, such as paying more for the same procedure done in a hospital, which is the most expensive place to get anything done. This disincentivizes private operators from creating clinics to do things cheaper. I would recommend the following. "Health Insurance" should change to be actual insurance - meaning you pay a small amount to protect yourself from a rare outcome, just like life insurance. This would be like catastrophic coverage against accident or expensive illness. Then, we take the $25k per year, and put it directly into a health savings account, and let customers actually choose hospitals and clinics based on price. There is simply no true competition in American healthcare.

apwell23 1y ago
how can USA make EU pay their fair share for drugs? They seem to be getting a free ride atm.
- ceejayoz 1y ago
  Are they getting a free ride, or are they getting a reasonably cost ride while we get hosed by corporations?
  - apwell23 1y ago
    > If you start a pharmaceutical startup anywhere on earth, your business model is "sell to America". There is no other market. what should these 'corporations' do instead?
    - ceejayoz 1y ago
      Yes, startups tend to be corporations. And really, the model is "sell the startup to American corporations, who then milk Americans". Pfizer bought BioNTech's (Turkish/German) mRNA tech, for example. Insulin's price skyrocketed, despite being a hundred years old. It didn't get harder to make, distribute, sell. They just wanted more. Or Shkreli's purchase of Daraprim (https://www.bbc.com/news/business-34917918 https://www.bbc.com/news/business-34917918), a ~70 year old drug. They hiked the price from $13.50/pill to $750/pill. Did it get 55x harder to make suddenly? Of course not. It still costs $1/pill to make.
      - apwell23 1y ago
        > And really, the model is Thats not the model. You've made this about something completely different that i am not particularly interested in discussing atm. later.
- piva00 1y ago
  Fair share? Why don't you focus on understanding why you pay so much, where the money goes, and other aspects that allow companies to absolutely fleece you? After the data collection you can figure out how you are being exploited. You are being abused, fight that, not trying to force others to patch up the abuse you suffer, we have done the work to not be abused through political will, don't try to fuck with that because you got fucked.
  - apwell23 1y ago
    > Why don't you focus on understanding why you pay so much, where the money goes, and other aspects that allow companies to absolutely fleece you? hope you didn't you invest all your life savings into pharma startups .
- justonceokay 1y ago
  Drag them into the pit with us!
- s_dev 1y ago
  EU manufactures said drugs. Nobody is getting a free ride, Americans are getting shafted by American companies.
ch4s3 1y ago
> There is simply no true competition in American healthcare. This is a point a lot of people miss. We have an deep under supply of both facilities and providers. Then things like CON laws make it even dumber.
rickydroll 1y ago
As I mentioned the last time this topic came up, competition is not feasible in healthcare because there are circumstances that demand immediate treatment. You don't have time to make your choices—you have to take what you get, as well as in situations where there are no other providers within reach, creating a healthcare desert, as it were. The heart attack I had back in 2018 occurred when I was hiking a local mountain. I had to walk out the last couple of tenths of a mile to a road where a ranger could get me. Then I drove myself 40 minutes to the nearest hospital with a cath lab. The local hospital was 20 minutes in the other direction, and they would have seen me, said, "Yep, it's a heart attack," and shipped me to the hospital with a cath lab via expensive ambulance ride, which would have come out of my pocket. From a competitive perspective, the other nearest hospitals with cath labs were 90 minutes and 120 minutes away. This experience with the local hospital, as well as others by myself and family members, is an example of medical care in most of America. However, it is only near a major city, such as Boston, that medical care can be competitive. The heart attack I mentioned was billed to my insurance company at $145,000. If I were on a cash-based medical system as you advocate for, I would have turned to bankruptcy as soon as I got the bill. Some groups would call bankruptcy and income-based payments for crushing medical debt a "moral hazard" and use that as a justification for providing no relief. Fortunately, we don't have to rely on anecdotes. We have a wonderful natural experiment around the world with current medical systems showing how the different systems provide different patient outcomes and give us practical examples of societal and individual costs.
- franktankbank 1y ago
  They aren't advocating for cash based system. They are advocating for insurance against rare life threatening circumstances, and insurance fucking off out of the rest of it e.g. flu treatments, broken bones etc.
  - rickydroll 1y ago
    Then how do you cover expenses that are not covered by insurance, if not by cash? Credit cards?? Personal loan? Making your doctor act as your bank?

apwell23 1y ago

how can USA make EU pay their fair share for drugs? They seem to be getting a free ride atm.

ceejayoz 1y ago
Are they getting a free ride, or are they getting a reasonably cost ride while we get hosed by corporations?
- apwell23 1y ago
  > If you start a pharmaceutical startup anywhere on earth, your business model is "sell to America". There is no other market. what should these 'corporations' do instead?
  - ceejayoz 1y ago
    Yes, startups tend to be corporations. And really, the model is "sell the startup to American corporations, who then milk Americans". Pfizer bought BioNTech's (Turkish/German) mRNA tech, for example. Insulin's price skyrocketed, despite being a hundred years old. It didn't get harder to make, distribute, sell. They just wanted more. Or Shkreli's purchase of Daraprim (https://www.bbc.com/news/business-34917918 https://www.bbc.com/news/business-34917918), a ~70 year old drug. They hiked the price from $13.50/pill to $750/pill. Did it get 55x harder to make suddenly? Of course not. It still costs $1/pill to make.
    - apwell23 1y ago
      > And really, the model is Thats not the model. You've made this about something completely different that i am not particularly interested in discussing atm. later.
piva00 1y ago
Fair share? Why don't you focus on understanding why you pay so much, where the money goes, and other aspects that allow companies to absolutely fleece you? After the data collection you can figure out how you are being exploited. You are being abused, fight that, not trying to force others to patch up the abuse you suffer, we have done the work to not be abused through political will, don't try to fuck with that because you got fucked.
- apwell23 1y ago
  > Why don't you focus on understanding why you pay so much, where the money goes, and other aspects that allow companies to absolutely fleece you? hope you didn't you invest all your life savings into pharma startups .
justonceokay 1y ago
Drag them into the pit with us!
s_dev 1y ago
EU manufactures said drugs. Nobody is getting a free ride, Americans are getting shafted by American companies.

ch4s3 1y ago

> There is simply no true competition in American healthcare. This is a point a lot of people miss. We have an deep under supply of both facilities and providers. Then things like CON laws make it even dumber.

rickydroll 1y ago

As I mentioned the last time this topic came up, competition is not feasible in healthcare because there are circumstances that demand immediate treatment. You don't have time to make your choices—you have to take what you get, as well as in situations where there are no other providers within reach, creating a healthcare desert, as it were. The heart attack I had back in 2018 occurred when I was hiking a local mountain. I had to walk out the last couple of tenths of a mile to a road where a ranger could get me. Then I drove myself 40 minutes to the nearest hospital with a cath lab. The local hospital was 20 minutes in the other direction, and they would have seen me, said, "Yep, it's a heart attack," and shipped me to the hospital with a cath lab via expensive ambulance ride, which would have come out of my pocket. From a competitive perspective, the other nearest hospitals with cath labs were 90 minutes and 120 minutes away. This experience with the local hospital, as well as others by myself and family members, is an example of medical care in most of America. However, it is only near a major city, such as Boston, that medical care can be competitive. The heart attack I mentioned was billed to my insurance company at $145,000. If I were on a cash-based medical system as you advocate for, I would have turned to bankruptcy as soon as I got the bill. Some groups would call bankruptcy and income-based payments for crushing medical debt a "moral hazard" and use that as a justification for providing no relief. Fortunately, we don't have to rely on anecdotes. We have a wonderful natural experiment around the world with current medical systems showing how the different systems provide different patient outcomes and give us practical examples of societal and individual costs.

franktankbank 1y ago
They aren't advocating for cash based system. They are advocating for insurance against rare life threatening circumstances, and insurance fucking off out of the rest of it e.g. flu treatments, broken bones etc.
- rickydroll 1y ago
  Then how do you cover expenses that are not covered by insurance, if not by cash? Credit cards?? Personal loan? Making your doctor act as your bank?