YC Research: Universal Healthcare

> An alternative scenario might be that drugs would get cheaper in the US, European drug prices stay the same and pharmaceutical companies somehow scrape by with lower (but still positive) profit levels.

You're treating this as if it's a question of "fairness" to the drug companies, and it's not about that at all. If you could drive drug company profits to $0 with no collateral effects, it'd be unambiguously the right thing to do.

The question is, though, what does that do to the market? If you're an investor that has a billion dollars lying around, do you put it into drug development or social media? Both are highly risky, but the former is burdened by a regulatory regime that thinks companies in that sector should just "scrape by," while the latter has unlimited upside.

You're basically sending a signal to the market that the more valuable your business is to society, the less money you're going to make from engaging in it. That's ass backwards.

> Seriously, if drug companies were making a net loss in European and other countries, they'd just stop supplying in those countries and subsequently enjoy higher profits

They continue to sell in European countries because they don't make a marginal loss there. But if their revenue levels in the U.S. were at the level they are in Europe, they absolutely could not justify their enormous fixed costs.

> And prices the US pay are in no way related to what other countries pay: it's simply a function of market power and being in a much weaker bargaining position.

It's true that drug companies are in a much weaker bargaining position in European countries, but only because European governments exercise seller-side market power to artificially drive prices below what they would be in a market with many buyers and many sellers.

> I realise Pfizer (net income: $7.74 billion) and Merck & Co (net income: $4.44 billion)

Fun fact: Facebook's net income is about 30% higher than Pfizer's even though its total revenue is only about half. Obviously Facebook's product is much more valuable to the world and should be incentivized accordingly.

> Every single Advantage patient is enrolled in "oringinal medicare" parts A and B, the only difference is those parts are administered by private insurance

Again, it seems you're confused about what Medicare Advantage is. Medicare Advantage essentially replaces all Medicare coverage - parts A, B, and (usually) D. So no, Part C patients are not enrolled in Original Medicare in any sense. They are enrolled in Medicare, but not Original Medicare.

> Yes it's good but is has nothing to do with insurance creating the market conditions that created the drug coverage,

I'm not talking about drug coverage. Medicare Advantage provides a superior (in every measurable sense) way to obtain Part A and B benefits than Original Medicare does. That has nothing to do with drug coverage.

> its law and subsidies.

It's not a matter of "subsidies". Medicare Advantage is not subsidized by the government. The government pays private insurers a fixed amount that corresponds to what Original Medicare would "receive" for each patient, but that's not a subsidy. And when we say that Medicare Advantage outperforms Original Medicare on cost, we're saying that Medicare Advantage is able to achieve better outcomes for the same amount of money.

If you think that's just a fluke, then look at Medicaid. The same pattern holds with Medicaid, where privately managed plans again consistently outperform the government plans, even though the array of requirements differs widely.

> especially when you already minimized >80% of the patients get mandated drug coverage.

The drug coverage isn't "mandated" for Medicare Advantage patients, any more than it is "mandated" for Original Medicare patients who enroll in a Part D plan or a Medigap plan. Medicare Advantage patients who don't receive prescription coverage can get a Part D plan just like Original Medicare patients can.

Maybe you're trying to say that there's a beneficial selection occurring, but that's also wrong. Part D is well-segemented

That argument would basically boil down to "Medicare Advantage is only better than Original Medicare because most Medicare Advantage patients receive drug coverage", which makes no sense because (a) the same companies provide Medicare Advantage and Part D benefits (and oftentimes using same plans), and (b) Medicare Advantage provides superior coverage and quality (and at a lower price) when compared to Part D enrollees with the same prescription coverage.

Honestly, the existence of Part D is, if anything, proof positive of this effect, because it makes it so easy to tease out the difference between receiving Part A/B coverage through Original Medicare and receiving equivalent coverage through Medicare Advantage.

> Though it will become clearer as the insurance continues to consolidate and Medicare patients will only be able to go to doctors, hospitals and pharmacies owned by the insurer, because that's where it's going for Medicare Avantage patients

That's the way the entire industry is headed as a direct result of the ACA. But even that's still a lot better than Original Medicare where patients struggle to get appointments at all.

The NHS is for the whole of the UK, which has a population of 64 million.

Thank you, that's the first responsive answer I've gotten when I've asked the question of how a subsidy can be relevant to a well paying field; usually, I get a bunch of further confusions in the response and an insistence that I must lack critical domain knowledge (that they can't can't explain either).

With that said, why do you say doctor wages are fixed (and forseeably so)? Is there a variance in pay and legit competition for doctors and so on?

Also, I don't see why the long loan repayment period or anything else suggests doctor wages are hitting the "too low to get people into the field" level. Remember, there are still far more qualified people than med schools are willing to accept, which means there's still excess supply (in the sense that there isn't in SV tech labor).

Plus, being an MD has a level of prestige that doesn't show up in the wage, and which has numerous fringe benefits (like easier loan terms, since they know you'll probably always find employment).

I wonder if hospitals are not pushing for more residency slots due to sufficient labor. Residents generally make barely minimum wage for the number of hours they work (often 60-80 hours per week). They aren't allowed to work more than 80 per week, but apparently for many positions that's done anyway because they don't have time to do all their patient notes at work.