Fed Up with Drug Companies, Hospitals Decide to Start Their Own • Hacker News Board

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#201

Post by CabSauce » Fri, Jan 19, 2018, 3:16 PM UTC

shykes wrote: post #86

This article makes it seem like drug companies alone are responsible for predatory pricing in US healthcare, with hospitals being somehow on the consumer's side of the issue. In reality US hospitals are just as guilty of predatory behavior. If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they?

Those hospital systems are non-profit. Not that there aren't ways to spend new revenue on buildings and equipment, but at least there's less profit motive.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#202

Post by Consultant32452 » Fri, Jan 19, 2018, 3:22 PM UTC

selectodude wrote: post #132

Consultant32452 wrote: post #66

Earlier quoted context omitted.

I could design such a system overnight. Starting tomorrow instead of paying for medical care the US Medicare and Medicaid programs will simply cut a check to the people who they were previously funding care for. Then those people may choose to spend the money on anything they wish, healthcare or otherwise. The days of not being able to price shop are over, competition will drop prices through the floor. The hospital…

“Let me price compare my heart attack operation before I decide on which hospital I want this ambulance I found on Expedia to take me to before I die.” I mean this nicely but sincerely, are you high?

The other poster is exactly right, the type of emergency life or death situation you're describing is a very small percentage of medical care, even within hospitals.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#203

Post by mywittyname » Fri, Jan 19, 2018, 3:23 PM UTC

garmaine wrote: post #28

mywittyname wrote: post #13

Earlier quoted context omitted.

Health insurance companies have taken to denying almost every claim that hospitals file. This overtaxes the hospitals claims denial departments and costs hospitals millions in lost revenue because they don't have the staff to properly review and resubmit every claim (which has to be done by a clinical specialist). It's like taking your car to a mechanic, and once it's fixed, refusing to pay, claiming car didn't need…

On the other hand, when I bring my car to an auto shop they give an estimate of cost before actually doing any work.

True story: my partner's department can't just sort denies by highest cost because they literally do not know how much the procedure actually costs and nobody in billing/finance can tell them either.

She came home one day feeling pretty good about overturning a $180k denial. She checked back a few weeks later, and found the paid in full amount to be in the neighborhood of $10k after "negotiated discounts."

The system is fucked. Had the denial gone through, that person would have been on the hook for the full 180k. (Or, to be more accurate, the hospital would have negotiated for $10k from the patient and written the remaining 170k off of their taxes)

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#204

Post by pmyteh » Fri, Jan 19, 2018, 3:39 PM UTC

jonlucc wrote: post #199

pmyteh wrote: post #198

Earlier quoted context omitted.

In Britain, we rely more on guidance from the National Institute for Health and Care Excellence (NICE). It does comparative reviews to make recommendations on the most suitable drugs to use. Motivation is primarily to restrict crazy-expensive drugs to those situations where they're actually going to represent value for (the public's) money, but also to point clinicians towards new approaches which can improve the qua…

That sounds like a fantastic resource that I can not imagine passing in the United States any time soon. Is it funded along with the rest of the NHS?

Yes. In fact, its major remit is to improve value for money by targeting NHS treatments better.

All of its meta-analyses and treatment guidance are available at http://www.nice.org.uk, if you want to explore.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#205

Post by tkahnoski » Fri, Jan 19, 2018, 3:43 PM UTC

roadnottaken wrote: post #196

yequalsx wrote: post #191

Earlier quoted context omitted.

The people who do the actual discovery are not paid an exorbitant amount of money. They mostly just want to do research and solve problems while living a comfortable life. A pharma company making billions in profit isn’t necessary. It’s just the common way it currently is done. There are other ways to accomplish the same goal. We could try to replicate Jonas Salks’ way Of doing things.

I work in drug discovery. You're right that the bench-scientists don't usually get rich. But it's an extraordinarily risky, expensive, and unpredictable business and for every billion dollar drug there's a graveyard of failed companies and projects that didn't make it. The only business reason to take those risks are for a chance at patent-protected profit. And those bench scientists wouldn't have labs to work in if…

I was skeptical of this graveyard because it gets referenced a lot, largely due to how we humans constantly ignore the sunk-cost fallacy all the time.

BUT it turns out the FDA is what prevents that from happening, and yes less drugs are getting approved. https://www.reuters.com/article/us-pharmaceuticals-success/s...

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#206

Post by zip1234 » Fri, Jan 19, 2018, 3:50 PM UTC

Maarten88 wrote: post #172

manmal wrote: post #154

Earlier quoted context omitted.

Why not just go on a 2 week holiday :)

I was in San Diego some time ago, and went for a walk to Tijuana, Mexico. I noticed a flourishing pharma business there ;-). Not only Viagra but also seemingly normal pharmaceuticals and services like dentists and doctors. They seem to have found a market there... Getting through the border and back on foot was a bit of a hassle, and it's probably not a good idea to "bring" too much stuff, but it was a fun experience…

The free market at work!

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#207

Post by HarryHirsch » Fri, Jan 19, 2018, 4:02 PM UTC

roadnottaken wrote: post #188

steiger wrote: post #182

Earlier quoted context omitted.

I live in Brazil and generics for drugs which patents are expired are widely available, accounting for 30~40% of all drug market. If I'm not mistaken, we even broke patents in some cases (HIV drugs), which is cool.

Why is that cool? Intellectual property law is necessary for industries like Pharma. No IP, no new drugs.

It's difficult. On one hand, the pharmco needs to make money to continue on their mission. (What their mission is is another difficult problem, I believe is isn't "shareholder value", that is a cancer on society.) On the other hand, the product alleviates human suffering, sometimes on a large scale.

A case study that everyone should be aware of is the story of Praziquantel in South Korea.

Here's a reference: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/480/20...

Praziquantel is about the only thing that works against schistosoma, a very debilitating condition. The compound was discovered in the early 1970s in a joint venture between Bayer and Merck KGA. At that time South Korea had a major schistosoma problem, but Merck could not supply at a price Korea was willing to pay (at that time Park Chung-Hee was in power, it was a military dictatorship).

Korean leadership declared praziquantel a national security issue (true) and started manufacturing their own, and in a collaboration between KIST and Shinpoong Pharmaceuticals developed their own process, which was much cheaper than the original Merck isoquinoline route.

The effort was a major part of the development of a domestic pharmaceutical industry. Shinpoong still hold 50 % of the market in praziquantel.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#208

Post by Symmetry » Fri, Jan 19, 2018, 4:49 PM UTC

rtpg wrote: post #125

tacon wrote: post #103

For a fantastic discussion about the Byzantine process for generic drug approval, I recommend a recent episode of EconTalk[0]. The guest wrote a book called "Drug Wars: How Big Pharma Raises Prices and Keeps Generics off the Market"[1]. When up to half a billion dollars of revenue is at stake, the drug companies have incredible incentives to delay or prevent generics coming to market. Believe or not, they often simpl…

Is this a worldwide problem? Or is this really an American failing?

It's definitely a US only problem. There are, for instance, multiple competing competing brands of EpiPen competitors in Europe. In the US the FDA's mandate concerns safety only and private entities can sue it to force it to do its job if they think it isn't. Which makes it easy for big companies to launch lawsuits alleging that their potential competition can't prove that they can produce drugs as safely as the incumbents.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#209

Post by SAI_Peregrinus » Fri, Jan 19, 2018, 4:50 PM UTC

WalterBright wrote: post #137

selectodude wrote: post #131

Earlier quoted context omitted.

Your car needs to be certified to not spew shit everywhere in the same way your drug needs to be certified to not harm people who take it. For obvious reasons, one is far more expensive to test and certify.

Is the food in your local supermarket certified to not harm people to eat it? It's regulated, and the FDA can inspect to verify compliance with regulations, but suppliers do not have to get approval from the FDA to ship.

Actually quite a lot of food is inspected by the USDA.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#210

Post by Symmetry » Fri, Jan 19, 2018, 4:52 PM UTC

nradov wrote: post #71

WalterBright wrote: post #67

When there's lack of competition, one needs to look for artificial barriers. Ah, found it: "Intermountain executives said that they would seek approval to manufacture the products from the Food and Drug Administration, which has vowed to give priority to companies that want to make generics in markets for which there is little competition."

I certainly hope you're not suggesting that we dispense with FDA approval for drug manufacturers just for the sake of increasing competition.

No, but a more reasonable level of regulation like the EMA uses would make things a lot better. There are levels of regulation between Anarchy and Stalinist 5 year plans.