The Best Fix for American Drug Prices Is Already on the Books • Hacker News Board

Re: The Best Fix for American Drug Prices Is Already on the Books

#121

Post by jancsika » Mon, May 14, 2018, 1:29 PM UTC

refurb wrote: post #120

IneffablePigeon wrote: post #104

Earlier quoted context omitted.

I find that kind of astounding. In the UK you pay a flat fee per prescribed medication, and multiple times I've had doctors prescribe me larger amounts on my repeat prescriptions so that I have to pay the flat fee less often - completely unprompted by me.

Docs will do that in the US too sometimes, but one challenge is that the "fee" you owe with private insurance differs from plan to plan. Doctors can't track the hundreds of different plans, so they don't know if the more expensive branded drug will cost you $10 more per month or $100 more per month. If you share that info with your doctor they are more than happy to work with you.

I'm still confused.

Isn't it simply a matter of asking, "Is there a generic for this, doc?"

Both $10 and $100 are greater than $0, the patient almost certainly always wants $0, and a doctor can do that math without referring to your plan.

Or is this a case of this particular method being combined with N other methods such that the doctor has trouble getting the correct information to the patient?

Edit: By $0 I mean "$0 more than the cheapest generic." :)

Re: The Best Fix for American Drug Prices Is Already on the Books

#122

Post by danShumway » Mon, May 14, 2018, 2:21 PM UTC

rayiner wrote: post #113

danShumway wrote: post #64

Earlier quoted context omitted.

Many software developers do take massive pay cuts to make the world a better place. People like Linus Torvalds could be much, much wealthier if they wanted to. Jason Scott is probably the single most important digital archivist alive right now; he's currently running a podcast to help himself get out of debt while he works for a company that doesn't offer a pension plan. I'm not just talking about fringe developers e…

Don’t look at anecdotes, look at the numbers. How many brilliant Stanford graduates are going to work for the advertising industry every year instead of something that’ll make the world a better place? There is no correlation between brilliance and altruism.

> There is no correlation between brilliance and altruism.

That's not really relevant to what was being discussed above. The question isn't whether smart people are altruistic, it's whether there's a correlation between altruism and effectiveness. The question is whether charitable individuals are capable of building better products than profit-driven individuals.

And given that depending on who you ask anywhere from around 60-90% of modern businesses run Open Source software, it does appear that statistically (not just anecdotally) there are parts of the tech industry that are better served by non-commercial, charitable entities. If that wasn't the case, businesses would use closed source software instead.

When Heartbleed came out, nobody suggested "well, maybe we should just all switch to a proprietary for-profit solution instead of using SSL," because a good, proprietary, for-profit alternative doesn't exist and probably never will. It's just not the type of technology that Silicon Valley is good at building.

Note that this is something that seems obvious in hindsight, but it was up for debate early on in the software industry. Companies like Microsoft went so far as to compare Open Source to communism. There was a strong belief that people opening up licenses, giving away software for free, and even (the horror) requiring other licensees to give their software away for free would remove any incentive for businesses to innovate and that in the long run it would strangle new technologies.

Re: The Best Fix for American Drug Prices Is Already on the Books

#123

Post by EliRivers » Mon, May 14, 2018, 2:34 PM UTC

throwaway84742 wrote: post #118

EliRivers wrote: post #116

Earlier quoted context omitted.

Aren't governments meant to be money holes? You put money in, you get governing out. They're not meant to be turning a profit.

They are also not meant to do R&D. For one thing they don’t pay market rate, so their access to top talent is non-existent. For another, there’s no accountability and no “fear of death”, since the government essentially can’t run out of money. Why try to use resources wisely if you can just tax people, or if that doesn’t work, print more money, and thereby tax their children and grandchildren. No, I’d much rather thi…

But there is a lot of beneficial R&D that, were governments not paying for it, would never have been done. Surely the kind of R&D that is beneficial but would never get done privately should be picked up by government? Without that, less modern computers, less modern aerospace, less modern medicine, less modern lots of things.

Re: The Best Fix for American Drug Prices Is Already on the Books

#124

Post by DomreiRoam » Mon, May 14, 2018, 3:35 PM UTC

refurb wrote: post #119

DomreiRoam wrote: post #110

Earlier quoted context omitted.

Under a pure market approach, if a drug is not profitable it will not be produced ans sold. If you have a rare disease, you would probably prefer a mixed approach like a mix public and private medical research.

There is a middle ground where it's profitable for one company to make a drug, but not profitable for two companies to do it.

I agree with you and in a pure profit oriented you will always have rare diseases without remedies. You may even have curable patient that are non-economical to save for for-profit health-care company.

Imagine you have only pure market that provides 80% total availability for disease remedies. If you want to cover the 20% uncovered case by bringing a non-profit player, you may threaten some of the pure market player. At the end you may have a 60% coverage by for-profit and 40% by non-profit.

The end solution may seems to be less economically efficient but it covers more of the population and I think it is a good thing.

Re: The Best Fix for American Drug Prices Is Already on the Books

#125

Post by AnthonyMouse » Mon, May 14, 2018, 3:47 PM UTC

mikeash wrote: post #111

rayiner wrote: post #61

Earlier quoted context omitted.

Pharmaceutical expenditures are about $1,000 per capita. Turning $1,000 of revenue into $300 in R&D compares very favorably to other tech industries.

I’m not sure how that’s related. My point is that pharma R&D is not a significant cause of high insurance premiums or high health care costs in general.

> My point is that pharma R&D is not a significant cause of high insurance premiums or high health care costs in general.

It's the same issue across the industry. There are patents on medical devices, diagnostic tests, imaging equipment, etc. It's a major source of costs. And nobody is claiming that it's the only one.

Re: The Best Fix for American Drug Prices Is Already on the Books

#126

Post by basch » Mon, May 14, 2018, 4:31 PM UTC

khazhoux wrote: post #19

Crazy idea: all pharmaceutical research should be publicly funded and publicly-owned. No private ownership of drug patents, period. "But this will disincentive research!" Maybe. Or, tax people more in order to fund the research. The tax revenue would go directly to researcher salary, equipment, expenses. Even a large tax increase can't be worse than today, where people have to pay huge $$$ anyway, of which a large cu…

Public/Private hybrids are not uncommon. Let research universities and private drug companies compete for grants. The rub is to make it ok to fail, and reward treating causes not just symptoms.

You are right though, it does require some government intervention to incentivize long term gambles with huge up front costs. NASA and The Manhattan Project are no different. Spend lots of money now, knowing you wont reap benefits for years. Our current system of using temporary intellectual property ownership of the formula is broken.

Re: The Best Fix for American Drug Prices Is Already on the Books

#127

Post by rayiner » Mon, May 14, 2018, 4:53 PM UTC

danShumway wrote: post #122

rayiner wrote: post #113

Earlier quoted context omitted.

Don’t look at anecdotes, look at the numbers. How many brilliant Stanford graduates are going to work for the advertising industry every year instead of something that’ll make the world a better place? There is no correlation between brilliance and altruism.

> There is no correlation between brilliance and altruism. That's not really relevant to what was being discussed above. The question isn't whether smart people are altruistic, it's whether there's a correlation between altruism and effectiveness. The question is whether charitable individuals are capable of building better products than profit-driven individuals. And given that depending on who you ask anywhere from…

Most open source development is done by for profit companies. Not through altruism, because software just happens to be an input into more profitable businsss activities. If Google licenses Android to smart phone manufacturers, maybe it gets $5-10 once every two years. But by giving it away for free and creating an Android user, Google makes that much every month.

Re: The Best Fix for American Drug Prices Is Already on the Books

#128

Post by pwinnski » Mon, May 14, 2018, 5:13 PM UTC

AnthonyMouse wrote: post #25

torpfactory wrote: post #7

Here’s the rub with developing something as important as a medicine. If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. We ought not look at it through our normal understanding of goods in a free market. Take, for example, Sovaldi, a drug which cures Hepatits C. After discovering this drug and confirming it…

> If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. It is very much like many other products. If you don't have food you will die of starvation, if you don't have shelter you will die of exposure, etc. The real issue is drug patents. Nobody is complaining about the price of ibuprofen any more than they com…

If you don't have food, you will die of starvation.

You don't need one particular food that is only available from one manufacturer. Not the same at all.

Re: The Best Fix for American Drug Prices Is Already on the Books

#129

Post by d0lph » Mon, May 14, 2018, 5:37 PM UTC

pwinnski wrote: post #128

AnthonyMouse wrote: post #25

Earlier quoted context omitted.

> If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. It is very much like many other products. If you don't have food you will die of starvation, if you don't have shelter you will die of exposure, etc. The real issue is drug patents. Nobody is complaining about the price of ibuprofen any more than they com…

If you don't have food, you will die of starvation. You don't need one particular food that is only available from one manufacturer. Not the same at all.

I think patents are anti-capitalistic, perhaps we should just get rid of them.

Re: The Best Fix for American Drug Prices Is Already on the Books

#130

Post by d0lph » Mon, May 14, 2018, 5:47 PM UTC

danShumway wrote: post #20

tomohawk wrote: post #4

One of the biggest reasons is that the US essentially subsidizes drugs for many other countries, such as Canada, that impose price controls, and threaten to allow other manufacturers to provide the drugs in their countries if the companies don't accept the imposed price. This enables these countries to get access to new medicine without paying the cost of developing the new medicine. Its time to end the trade war on…

This argument always strikes me as kind of odd. As far as I can tell, it boils down to "other countries like Canada are better negotiators than us, and our companies give them better prices." But if that's the case, it just seems like really good evidence that squeezing drug companies and making aggressive demands drives down drug costs and encourages them to move R&D costs out of the country. Why wouldn't the US be…

Wouldn't this cause the US to just end up subsidizing medicines for other countries?