EpiPen Price Rise Sparks Concern for Allergy Sufferers • Hacker News Board

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#301

Post by clarkmoody » Tue, Aug 23, 2016, 3:08 PM UTC

grandalf wrote: post #292

clavalle wrote: post #280

Earlier quoted context omitted.

The government has created a moat for the current pen through regulation, particularly the extensive testing needed to bring it to market as a medical device whom people's lives depend on it delivering the right dosage with a low failure rate. This creates something of a small granted monopoly. It makes sense for the government to step in when something goes wrong. There are lots of theoretical arguments for a freer…

> a market trial and error approach seems a little barbaric. The average American earns less in a week than the cost of one epi pen. No, "nonfarm" statistics don't apply since people who work on farms still need epi pens. > It makes sense for the government to step in when something goes wrong. What has gone wrong in this case? The protected cronies of regulators are making a tidy profit after spending years cozying…

Thank you. This is a problem that starts and ends with government, not with the "free market" (which hasn't existed in the healthcare industry in a long time)

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#302

Post by ancap » Tue, Aug 23, 2016, 3:10 PM UTC

hackuser wrote: post #175

ancap wrote: post #140

Earlier quoted context omitted.

I can think of many products which are life-saving which are readily available from countless producers for relatively cheap. The difference here is just as gwright has pointed out and you have a corpus of regulation which makes this particular product more expensive and/or chokes out competition. The only sectors of the economy where significant, lasting shortages occur are the ones most heavily regulated.

> The only sectors of the economy where significant, lasting shortages occur are the ones most heavily regulated That's not what economic theory (and practice) say, I'm pretty sure. For example, unregulated electrical, communication (including Internet service) and transportation markets have resulted in shortages in rural areas. Unregulated food and housing markets (and many other markets, including Internet service…

I would first like to point out that in the context of this conversation the definition for shortage I am using is that there is a shortage of a good or service where it once was readily available. Sure I could, say, take a rocket ship, to mars and denounce the absence of internet connectivity, but that's not what I'm referring to here.

>unregulated electrical, communication (including Internet service) and transportation markets have resulted in shortages in rural areas

Again, according to my above definition this is a slightly different topic, but it seems highly dubious that a lack of regulation is what has resulted in shortages of internet service is some podunk town.

>Unregulated food and housing markets (and many other markets, including Internet service) result in shortages for poor people

The most significant factor limiting the availability of low cost housing is municipal regulation, not the absence of it. I'm not aware of any place in a developed nation which has a shortage of food. It seems what you are getting at is the options may not be affordable for some, but that is a different concept from a shortage. Furthermore, it is a bit of a stretch to refer to the food and housing markets as "unregulated". If there are any shortages in these markets it's certainly not due to a lack of regulation.

>Unregulated fishing creates shortages of fish - a 'tragedy of the commons'

I have commented on the idea of "tragedy of the commons" many times. It generally leads to quite a tangent in the conversation, but if you're truly interested I'd be happy to discuss why the problem does not lie with a lack of regulation.

>Monopolies and oligopolies eliminate whole categories of products.

A true, lasting monopoly is only possible through market regulation which strangles out competition. All the textbook examples of "monopolies" (Standard Oil) were not monopolies at all. In fact in the early days of electricity there was so much competition in the big cities that the big guys lobbied hard to get their monopoly privilege.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#303

Post by Ironchefpython » Tue, Aug 23, 2016, 3:13 PM UTC

WalterBright wrote: post #203

Ironchefpython wrote: post #200

> selling service contracts, [...] The price is still $0 and there are still no regulations on it. I assume at this point that you're being paid to shill some political viewpoint on the internet, because you just explained that the price of software isn't actually zero, because it's unusable (to the customers that buy a service contract) without a service contract, and creating a company that employs the developers t…

You're making quite a vast assumption that service contracts mean the software is unusable without them. Red Hat Linux is just one counterexample. A further vast assumption is that your arguments are so compelling that anyone not convinced must be a paid shill. There are many software consultants who charge over $10,000/day for doing training. Many companies find them worthwhile when amortized over a roomful of engin…

>> it's unusable (to the customers that buy a service contract) without a service contract

> You're making quite a vast assumption that service contracts mean the software is unusable without them. Red Hat Linux is just one counterexample.

No. I'm not. I'm basing that on the tautology that consumers of "free" software who purchase expensive service contracts spend their money purchasing expensive service contracts.

Software is free in the same way that air conditioning at the mall is free, the hugs handed out by the "free hugs" guy are free, the way that the privilege of watching advertisements on TV are free. Somebody is spending time and money making this software, because they think they are going to get more out of it than they put into it (either tangibly or intangibly (except for that TempleOS guy, who does it for the voices in his head))

And this still doesn't change anything about the EpiPen. There's a consumer surplus, and the price is increased to maximize capture of consumer surplus regardless of the cost in human lives. I don't care how free software is, the price on EpiPens is going up to maximize profit.

To frame this as a simple dichotomy, would you rather live in a world where people die to maximize profit, or a world where regulation is applied to reduce human suffering and death?

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#304

Post by maxerickson » Tue, Aug 23, 2016, 3:13 PM UTC

gwright wrote: post #161

rdtsc wrote: post #133

Earlier quoted context omitted.

Why is it protecting a monopoly? Why doesn't it say "this EpiPen can't cost more than $30"?

Perhaps because it actually costs more than $30 and so an edict such of this would guarantee that there are no EpiPens at all? In any case, the current high price is the result of regulatory/legislative actions and so the current price is evidence of regulatory failure, not market failure.

I don't think it is a massive regulatory failure to have the pharmacy dispense a product with matching use instructions to the product that is prescribed.

So it's the market that has doctors prescribing $600 Epipens instead of the $150 alternative (that has different use instructions and thus cannot be used to fill a prescription for an Epipen).

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#305

Post by clavalle » Tue, Aug 23, 2016, 3:14 PM UTC

grandalf wrote: post #292

clavalle wrote: post #280

Earlier quoted context omitted.

The government has created a moat for the current pen through regulation, particularly the extensive testing needed to bring it to market as a medical device whom people's lives depend on it delivering the right dosage with a low failure rate. This creates something of a small granted monopoly. It makes sense for the government to step in when something goes wrong. There are lots of theoretical arguments for a freer…

> a market trial and error approach seems a little barbaric. The average American earns less in a week than the cost of one epi pen. No, "nonfarm" statistics don't apply since people who work on farms still need epi pens. > It makes sense for the government to step in when something goes wrong. What has gone wrong in this case? The protected cronies of regulators are making a tidy profit after spending years cozying…

So, what is the market solution? All I see is a restatement of the problem.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#306

Post by curiousgeorgio » Tue, Aug 23, 2016, 3:15 PM UTC

mikeash wrote: post #279

curiousgeorgio wrote: post #171

Earlier quoted context omitted.

Gathering a group of neighbors and telling him to knock it off doesn't have any teeth either, I'm afraid. He can still say "screw you, I'm not breaking any laws, so you can't do anything to stop me." I do agree about upset customers having teeth. That's exactly how a free market operates. If they're upset enough, they'll stop buying the product and look for alternatives. Except there aren't any suitable alternatives…

Yes, your neighbor can just ignore you, but he usually won't. Social pressure tends to work. That's just as true of companies as it is for bad neighbors. If your argument is merely that it might not work, then we're completely in agreement.

You can try the social pressure route every time this happens (and if you haven't noticed, this seems to be a recurring issue in health care), but unfortunately that's going to take more effort in the long run with fewer results. Many companies - whether morally justified or not - just won't respond to social pressure.

Or, redirect those efforts into fixing the issue through legislation (either to open up the market to more competition, or to restrict price gouging). That's a battle you only have to win once, so in my opinion, it's a far more effective use of one's time.

But if you prefer to cry out that life isn't fair every time people do things that aren't illegal, that's entirely acceptable. I'm glad to see we still have the liberty to speak our minds, regardless of ideology.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#307

Post by Ironchefpython » Tue, Aug 23, 2016, 3:15 PM UTC

eropple wrote: post #204

Ironchefpython wrote: post #200

> selling service contracts, [...] The price is still $0 and there are still no regulations on it. I assume at this point that you're being paid to shill some political viewpoint on the internet, because you just explained that the price of software isn't actually zero, because it's unusable (to the customers that buy a service contract) without a service contract, and creating a company that employs the developers t…

> I assume at this point that you're being paid to shill some political viewpoint on the internet I don't agree with Walter on this issue, but a cursory Google of who you're talking to should indicate how ridiculous this statement is. You are profoundly out of line and you owe him an apology. (You'd owe anyone an apology, but this is particularly silly of you.)

> but a cursory Google of who you're talking to

Right, there's more than one person on the planet with that name, and surely the actual inventor of the D language has better things to do with his time than go all Liberatard on the Internet arguing economics with strangers.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#308

Post by clavalle » Tue, Aug 23, 2016, 3:15 PM UTC

dleslie wrote: post #282

clavalle wrote: post #280

Earlier quoted context omitted.

The government has created a moat for the current pen through regulation, particularly the extensive testing needed to bring it to market as a medical device whom people's lives depend on it delivering the right dosage with a low failure rate. This creates something of a small granted monopoly. It makes sense for the government to step in when something goes wrong. There are lots of theoretical arguments for a freer…

Seems to me that less testing is necessary for an established product. Are there patents involved?

Even if previous designs are followed, there are questions of materials and construction that need a significant amount of testing.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#309

Post by clavalle » Tue, Aug 23, 2016, 3:19 PM UTC

clarkmoody wrote: post #301

grandalf wrote: post #292

Earlier quoted context omitted.

> a market trial and error approach seems a little barbaric. The average American earns less in a week than the cost of one epi pen. No, "nonfarm" statistics don't apply since people who work on farms still need epi pens. > It makes sense for the government to step in when something goes wrong. What has gone wrong in this case? The protected cronies of regulators are making a tidy profit after spending years cozying…

Thank you. This is a problem that starts and ends with government, not with the "free market" (which hasn't existed in the healthcare industry in a long time)

The problem is how does the free market test these kinds of things when there is every incentive to cut corners? We're not talking about toasters. How many people have to die before the market reacts? How much research into individual company's testing should a person do in order to buy an epipen?

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#310

Post by clarkmoody » Tue, Aug 23, 2016, 3:21 PM UTC

norea-armozel wrote: post #264

ascorbic wrote: post #232

Meanwhile, in single-payer Britain the NHS pays £26 ($35). https://www.evidence.nhs.uk/formulary/bnfc/current/3-respira...

You know what's weird about this situation is that often I've been told by people here in the US that the price NHS and other single payer systems pay is only possible because we here in the US supposedly pay for it at the free market price. I don't believe that myself since it wouldn't make much sense to say that the prices would plummet to such a degree as to be unprofitable. But I do wonder how much of the price w…

> we here in the US supposedly pay for it at the free market price

The free market price system does not work in American healthcare because we do not have a free market. Healthcare is one of the most heavily regulated industries and the third-party payment system means that consumers are divorced from the price mechanism.