Drugmakers raise US prices on 350 medicines despite pressure • Hacker News Board

Re: Drugmakers raise US prices on 350 medicines despite pressure

#111

Post by lotsofpulp » Wed, Dec 31, 2025, 10:46 PM UTC

anthuswilliams wrote: post #88

lotsofpulp wrote: post #24

Earlier quoted context omitted.

Pharmaceutical companies, hospitals, and doctors are free to charge by the medicine, by the night, and by the minute. For example, this place does it: https://surgerycenterok.com/surgery-prices/ Insurance companies do not force the sellers to use complex billing practices, they would benefit from more transparent pricing (since they are seeking to pay less). The root cause is healthcare is inherently complicated and…

Insurance companies absolutely benefit from the higher and opaque prices, because they negotiate rebates with providers. This allows them to maximize patient copays and ensures they hit their deductible, i.e. paying as much as possible under their respective insurance plans. Contrast this with a no-rebate world with cheaper/more transparent pricing. Fewer patients would hit their out of pocket maximum. They can use t…

> Contrast this with a no-rebate world with cheaper/more transparent pricing. Fewer patients would hit their out of pocket maximum.

And premiums would go up. Every insurer has to get their premium approved by every state’s insurance regulator, and every state’s insurance regulator is not going to allow them to have more than a few percent of profit.

> They can use the rebates they get from the providers to subsidize the insured, allowing them to offer lower premiums and gain market share. This is what people mean when they say "In America, the sick people pay to subsidize the health care of the healthy people".

I’ve never heard of this, and it’s legally not allowed. The ACA mandates insurers price plans so that old people only pay at most 3x what young people pay. And the ACA does not allow insurers to charge more to people likelier to need healthcare. Mathematically, that means younger and healthier people pay higher premiums so that older and sicker people can have lower premiums.

NY state goes even further and says all ages pay the same premium, so young subsidizes old even more. MA has a 2x cap, I believe. And then of course, FICA taxes mean the young and working are paying for the healthcare for the old and non working, the vast majority of all healthcare spend in the US (Medicare).

Re: Drugmakers raise US prices on 350 medicines despite pressure

#112

Post by Analemma_ » Thu, Jan 01, 2026, 12:17 AM UTC

metadope wrote: post #93

ck2 wrote: post #10

Why is the supreme-court slow-walking the tariff decision which is crystal clear as lower courts clearly demonstrate only Congress can set taxes/tariffs? It would end inflation within 90 days Even their silly 15% tariff fallback law abuse would be more sane than the 50-150% currently Next few years is going to be insanity

Someone once proposed a National Sales Tax. I think it was suggested that we could eliminate personal income taxes if we imposed a federal sales tax on all purchases. Liberals vehemently opposed the idea, calling it 'regressive', meaning it would be socially backwards, but the idea held appeal as a simple and fair way of "taxing everyone equally". For some reason, a majority of public opinion leaned left on this part…

> Liberals vehemently opposed the idea, calling it 'regressive', meaning it would be socially backwards,

That's not what "regressive" means in the context of taxation. A "regressive tax" is one that takes a successively higher proportion of your income/wealth the poorer you are, while a progressive tax is one which takes a higher proportion of your income/wealth the richer you are. This is standard vocabulary in economics.

Re: Drugmakers raise US prices on 350 medicines despite pressure

#113

Post by StanislavPetrov » Thu, Jan 01, 2026, 2:29 AM UTC

vjvjvjvjghv wrote: post #94

ericmay wrote: post #80

Earlier quoted context omitted.

Well, there is that. But there is also the fact that they charge you or your insurance company to smooth out other costs like $2,000,000.00 cancer treatment or for people who show up to the hospital, don’t have insurance, and the hospital has to treat them. I’m reaching the point where I don’t really care if it’s private or public, but what we are doing today is the worst of both worlds. It either needs to be fully p…

“ But there is also the fact that they charge you or your insurance company to smooth out other costs like $2,000,000.00 cancer treatment or for people who show up to the hospital, don’t have insurance, and the hospital has to treat them” I bet whatever cost these patients cause, the hospital will inflate this by an order of magnitude. It’s the same with charity care. Hey, my sticker price for an aspirin is $1000. I’…

A lot of that is tied into billing in general, even without the people who can't afford to pay for their care. When they send out an invoice for $50,000 for services rendered, even if the insurance company only ends up paying them a fraction of that, when it comes to accounting and taxes you can be sure they are using that $50,000 number for deductions and such when it benefits them.

Re: Drugmakers raise US prices on 350 medicines despite pressure

#114

Post by georgemcbay » Thu, Jan 01, 2026, 2:33 AM UTC

blackbear_ wrote: post #11

KumaBear wrote: post #6

Earlier quoted context omitted.

Why does the US consumer of said medications subsidize many other countries who have access to the same medications for a fraction of the US sticker price?

Because US voters prefer the free market as opposed to government regulation and nationalized healthcare.

> US voters prefer the free market as opposed to government regulation and nationalized healthcare.

Because US voters are dumb. (Just for context, I'm a US citizen).

Free markets don't work when there is inelastic demand for a good or service, and an awful lot of health care (unless you consider 'well, guess I'll just die then' as a reasonable outcome) is inelastic demand.

Re: Drugmakers raise US prices on 350 medicines despite pressure

#115

Post by grafmax » Thu, Jan 01, 2026, 2:38 AM UTC

vjvjvjvjghv wrote: post #4

"Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales." This describes the biggest problem in US healthcare. No clear and consistent pricing. If we had a real market, you would get a prescription and then go to the seller with the lowest price. And everybody would get th…

Prices should be transparent, yes. But supply and demand isnt going to take down an oligopoly.

Re: Drugmakers raise US prices on 350 medicines despite pressure

#116

Post by quietsegfault » Thu, Jan 01, 2026, 3:07 AM UTC

prirun wrote: post #89

why-o-why wrote: post #79

Earlier quoted context omitted.

>> I don't think the hospital expects to actually ever get paid what they bill out OH YES THEY ABSOLUTELY DO! When I was in-between jobs I had a medical emergency and I was on the ACA around the first year it was offered. I was billed above medicare rates so I was on the hook for ~40k after out of pocket max. They told me this limit is what insurance has to cover but hospitals can still bill above it. First they told…

This is called "balance billing" and the No Surprises Act usually prevents it, especially in emergency cases. https://www.healthinsurance.org/glossary/no-surprises-act/

Not for ambulances!

Re: Drugmakers raise US prices on 350 medicines despite pressure

#117

Post by quietsegfault » Thu, Jan 01, 2026, 3:11 AM UTC

Uvix wrote: post #91

lotsofpulp wrote: post #24

Earlier quoted context omitted.

Pharmaceutical companies, hospitals, and doctors are free to charge by the medicine, by the night, and by the minute. For example, this place does it: https://surgerycenterok.com/surgery-prices/ Insurance companies do not force the sellers to use complex billing practices, they would benefit from more transparent pricing (since they are seeking to pay less). The root cause is healthcare is inherently complicated and…

Pharmaceutical companies, hospitals, and doctors are free to charge like that. But if I'm using insurance, it's irrelevant; that's the price to the insurer . It's the insurance company who determines the price I pay, using whatever arcane rituals they've chosen.

Unless the anesthesiologist is mysteriously out of network, or you failed to get some silly pre-approval, or…

Re: Drugmakers raise US prices on 350 medicines despite pressure

#118

Post by refurb » Thu, Jan 01, 2026, 3:18 AM UTC

dylan604 wrote: post #59

vjvjvjvjghv wrote: post #4

"Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales." This describes the biggest problem in US healthcare. No clear and consistent pricing. If we had a real market, you would get a prescription and then go to the seller with the lowest price. And everybody would get th…

> "Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales." This sounds like typical negotiating 101. You know you are going to be forced to lower from your starting position, so increase your starting position so when you do negotiate down you are closer to where you want…

It’s not only a logical negotiating position, it has legal implications.

Way back in the 50-60’s the government put in laws around “usual and customary price” in an attempt to rein in medical costs.

What providers were doing is charging cash customer $10, then when an insured patient came in (back when insurance paid 100%) they charged $100.

So a law was put into place to define what a “usual and customary price” is. The provider could not charge any customer more than this.

Like most well intentioned laws it created perverse incentives to jack up the public price as high as possible - if someone paid it, great, otherwise offer a discount.

Re: Drugmakers raise US prices on 350 medicines despite pressure

#119

Post by anthuswilliams » Thu, Jan 01, 2026, 8:15 AM UTC

lotsofpulp wrote: post #111

anthuswilliams wrote: post #88

Earlier quoted context omitted.

Insurance companies absolutely benefit from the higher and opaque prices, because they negotiate rebates with providers. This allows them to maximize patient copays and ensures they hit their deductible, i.e. paying as much as possible under their respective insurance plans. Contrast this with a no-rebate world with cheaper/more transparent pricing. Fewer patients would hit their out of pocket maximum. They can use t…

> Contrast this with a no-rebate world with cheaper/more transparent pricing. Fewer patients would hit their out of pocket maximum. And premiums would go up. Every insurer has to get their premium approved by every state’s insurance regulator, and every state’s insurance regulator is not going to allow them to have more than a few percent of profit. > They can use the rebates they get from the providers to subsidize…

> And premiums would go up.

Yes. As I wrote above, insurers compete on premiums, and they do do so by using rebates to subsidize those premiums by spreading patients' deductibles across the insured population. As far as profits go, I can't speak to regulatory issues since they will vary by state, but in any case the same critique would apply if insurers are pocketing a fixed percentage of a larger amount.

Re your second point, it completely twists my point and is largely irrelevant. Yes, older people paying the same premiums as younger people is a counter-argument in that older people are more likely to need healthcare, but the central point is that people who have to USE their insurance (i.e. sick people) subsidize the premiums of people who don't (healthy people), and this critique applies regardless of age. Now, one could argue that the structural factors that control costs across age cohorts counterbalances this phenomenon. And I'd agree with you! But that doesn't negate the original point that insurance companies benefit from, and advocate for, high sticker prices.

Re: Drugmakers raise US prices on 350 medicines despite pressure

#120

Post by atoav » Thu, Jan 01, 2026, 8:43 AM UTC

vjvjvjvjghv wrote: post #4

"Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales." This describes the biggest problem in US healthcare. No clear and consistent pricing. If we had a real market, you would get a prescription and then go to the seller with the lowest price. And everybody would get th…

The US' main problem (seen from the outside) is that there seems to be no long term strategy just a sports-like us-versus-them mentality, where each team just thinks about how they can win more by making others lose. Winning the points is the goal, while all people forgot this was supposed to be a friendly game ans some even forgot which sport it is supposed to be.

This may well be the end game of capitalism, no pun intended.