Mark Cuban's Cost Plus Drugs • Hacker News Board

Re: Mark Cuban's Cost Plus Drugs

#141

Post by maerF0x0 » Thu, Jun 09, 2022, 4:06 PM UTC

arcticbull wrote: post #99

maerF0x0 wrote: post #96

Earlier quoted context omitted.

> Socializing the whole thing is significantly better. As a Canadian I highly disagree. And anecdotally many health care providers from Canada agree with my take. People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas. There is nothing stopping the government from substituting lower-quality, less effective procedures when their MBAs come in an co…

Canada has substantially the same health outcomes, or better, than the US. This is simply not true. I'm also Canadian, and have lived under both systems. My father fell off a ladder and had a pretty severe head injury, and had both an MRI and a CT scan within a half hour, at no cost. Yes, lower-priority conditions may have to wait, but it's also by definition because they're lower priority - and they'll have to wait…

This article has a couple immediately glaring flaws that lead me to not invest the time to deeply analyze it on the whole...

> because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated

That's completely false, Canada has a presupplied quota system set by government forecasting and limited by budgets. If you need treatment you will be treated eventually but you might die or get sicker in the interim.

Using a COVID-19 based article to discuss the merits of single payer single provider completely ignores the massive cultural mentality differences -- the US focuses on individual freedoms, Canada focuses on collective good. This makes a big difference when it comes to adherence things like social distancing and masks. They're taking a multivariate system and claiming it's a single variable that caused the outcome.

Edit: and I might add that it appears that Canada is always intentionally undersupplied such that a moderate wait is guaranteed. Whereas it seems that due to market competition the US system is inherently oversupplied (at least in many areas) such that they can provide to those who can pay essentially on demand.

Re: Mark Cuban's Cost Plus Drugs

#142

Post by maerF0x0 » Thu, Jun 09, 2022, 4:08 PM UTC

criddell wrote: post #126

maerF0x0 wrote: post #96

Earlier quoted context omitted.

> Socializing the whole thing is significantly better. As a Canadian I highly disagree. And anecdotally many health care providers from Canada agree with my take. People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas. There is nothing stopping the government from substituting lower-quality, less effective procedures when their MBAs come in an co…

Your experience with the Canadian system is going to vary greatly depending on the kind of care you require and where you are. Frankly, the same is true in the US. > their MBAs come in an consult about how to reduce costs You don’t think the big health insurance companies in the US do the same thing?

> You don’t think the big health insurance companies in the US do the same thing?

To the multiple peers who point out the US uses MBAs too. I'm pointing out that both systems use MBAs and come to the same conclusions such as "We can save n% by using n-1% less effective drug."

Re: Mark Cuban's Cost Plus Drugs

#143

Post by maerF0x0 » Thu, Jun 09, 2022, 4:10 PM UTC

cwmma wrote: post #113

maerF0x0 wrote: post #96

Earlier quoted context omitted.

> Socializing the whole thing is significantly better. As a Canadian I highly disagree. And anecdotally many health care providers from Canada agree with my take. People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas. There is nothing stopping the government from substituting lower-quality, less effective procedures when their MBAs come in an co…

> People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas. There are often months long waits for here too, try getting a dermatology appointment, we just also have the privilege of paying for it out of pocket as preventative skin care checks are not actually classified as preventative medicine so it counts towards your deductible meaning you have…

pay out of pocket is the nature of the system, so it's not really a point.

What would be a good point is a discussion about if want a society where the people who pay for a procedure get better outcomes, or if we're willing to say to those who pay "You will get a worse outcome because we're also serving those who cannot pay. This comes down to cultural values and ethics.

Re: Mark Cuban's Cost Plus Drugs

#144

Post by maerF0x0 » Thu, Jun 09, 2022, 4:12 PM UTC

trident5000 wrote: post #67

arcticbull wrote: post #51

Earlier quoted context omitted.

Indeed there's no reason that Cuban won't, like Uber, wake up one day and 5X prices - or bring in the recently-released Pharma Bro Shkrelli. Good will and brand alone isn't sufficient to build a medical system on.

Maybe, but increased competition never hurt the consumer.

I'm curious if this is literally always true?

I agree that competition often helps improve pricing and quality, of course.

But I wonder if at times competition leads to a net degradation such as "race to the bottom" scenarios?

Re: Mark Cuban's Cost Plus Drugs

#145

Post by [deleted] » Thu, Jun 09, 2022, 4:16 PM UTC

maerF0x0 wrote: post #96

arcticbull wrote: post #48

As always the issue with privatized social services is that the goal is to make money, not to provide a service so the incentives are fundamentally misaligned. For-profit care providers make money when the fail to provide care. When they fail to cover procedures. When they can substitute lower-quality or less effective goods and services. When they can sell you catastrophic cover with deductibles and co-pays too high…

> Socializing the whole thing is significantly better. As a Canadian I highly disagree. And anecdotally many health care providers from Canada agree with my take. People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas. There is nothing stopping the government from substituting lower-quality, less effective procedures when their MBAs come in an co…

[deleted]

Re: Mark Cuban's Cost Plus Drugs

#146

Post by [deleted] » Thu, Jun 09, 2022, 4:26 PM UTC

maerF0x0 wrote: post #142

criddell wrote: post #126

Earlier quoted context omitted.

Your experience with the Canadian system is going to vary greatly depending on the kind of care you require and where you are. Frankly, the same is true in the US. > their MBAs come in an consult about how to reduce costs You don’t think the big health insurance companies in the US do the same thing?

> You don’t think the big health insurance companies in the US do the same thing? To the multiple peers who point out the US uses MBAs too. I'm pointing out that both systems use MBAs and come to the same conclusions such as "We can save n% by using n-1% less effective drug."

[deleted]

Re: Mark Cuban's Cost Plus Drugs

#147

Post by knubie » Thu, Jun 09, 2022, 4:40 PM UTC

arcticbull wrote: post #48

As always the issue with privatized social services is that the goal is to make money, not to provide a service so the incentives are fundamentally misaligned. For-profit care providers make money when the fail to provide care. When they fail to cover procedures. When they can substitute lower-quality or less effective goods and services. When they can sell you catastrophic cover with deductibles and co-pays too high…

> the goal is to make money, not to provide a service

I think your entire premise is flawed here. Businesses make money by providing services that people want / need.

Re: Mark Cuban's Cost Plus Drugs

#148

Post by treis » Thu, Jun 09, 2022, 4:44 PM UTC

criddell wrote: post #86

treis wrote: post #53

From the time this was posted two days ago: This keeps showing up but it's total bullshit. Cuban wants to take 15% of the transaction for running a web site and processing payment. They're not manufacturing drugs. They're not buying drugs. They're not shipping drugs. They're not doing anything at all besides taking your order and giving it to someone to do all those things. It's not a charity. It's a profitable busin…

How does GoodRX work?

Part of how the government determines the price it pays for drugs is based on the retail price. That (among other reasons) gives manufacturers incentive to have crazy list prices. A drug that sells for $50 might have a list price of $1,000.

Enter insurance companies. They don't want to pay $1,000 for a $50 drug so they negotiate. But there's too many insurance companies for them to have good leverage and efficiencies in negotiation.

Enter Pharmacy Benefits Managers. They get hired by insurance companies to negotiate with drug companies and pharmacies. Thus the buying power is pooled and they only have to pay people to negotiate one time.

GoodRX is like the last category. Except that instead of getting paid by insurance companies they sell user data and collect some fees from pharmacies and drug manufacturers.

Re: Mark Cuban's Cost Plus Drugs

#149

Post by treis » Thu, Jun 09, 2022, 4:45 PM UTC

user_7832 wrote: post #103

treis wrote: post #53

From the time this was posted two days ago: This keeps showing up but it's total bullshit. Cuban wants to take 15% of the transaction for running a web site and processing payment. They're not manufacturing drugs. They're not buying drugs. They're not shipping drugs. They're not doing anything at all besides taking your order and giving it to someone to do all those things. It's not a charity. It's a profitable busin…

I'm pretty sure you're free to compete with them if you think it's profitable. In reality I'd expect that 15% to be necessary if they want the company to survive after some years. There are tons of not so visible overheads and costs, and it (apparently) has taken a billionaire to be able to start such a company (disclaimer: I have no idea what GoodRx is).

>I'm pretty sure you're free to compete with them if you think it's profitable.

If I could generate the amount of free advertising Cuban's getting I would.

Re: Mark Cuban's Cost Plus Drugs

#150

Post by treis » Thu, Jun 09, 2022, 4:47 PM UTC

spywaregorilla wrote: post #88

treis wrote: post #53

From the time this was posted two days ago: This keeps showing up but it's total bullshit. Cuban wants to take 15% of the transaction for running a web site and processing payment. They're not manufacturing drugs. They're not buying drugs. They're not shipping drugs. They're not doing anything at all besides taking your order and giving it to someone to do all those things. It's not a charity. It's a profitable busin…

Was there someone around previously who could take my order and give me the drugs at those prices? I'm not convinced this is true. I'm not familiar with GoodRx but they appear to be a coupon aggregator which is not the same thing

Depending on the drug, yes. Walmart & Amazon have cheap generics and so do many regional grocery stores.