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A $20 drug in Europe requires a prescription and $800 in the U.S.

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Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#151

Post by yoyohello13 »

sgerenser wrote: post #141
wang_li wrote: post #75

Earlier quoted context omitted.

The US has a massively progressive tax system. On a net tax basis about 50% of the country pays nothing. Sure, they pay sales tax and employment taxes, but they also receive some mix of earned income tax credits, child tax credits, snap, medicaid, housing, etc. There is no real way for the US to have a single payer tax system without more people actually becoming net tax payers.

Yeah this is something people in favor of single payer healthcare in the U.S. don’t want to acknowledge. In most other countries, the middle 50% of taxpayers pay a much higher percentage of their income than in the U.S. Everyone somehow thinks we can make it work just by raising taxes on “the rich” (where that is usually defined as anyone making more money than them). But if it was that easy, then why does Canada and…

I'm curious what the actual number is. I have health insurance through my work and I pay over $1,500 a month for that (and still have out of pocket costs). That's $18,000 a year. That's a substantial percentage of my income which essentially is just a tax going to the insurance company instead of the government. Now if it cost a couple thousand more a year and I didn't have to worry about getting claims denied for random reasons, I'd take that deal. If it's $5,000-10,000 more a year? Then I'd have qualms.

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#152

Post by rootusrootus »

flumpcakes wrote: post #100
aucisson_masque wrote: post #9

in some part of europe, we have national healthcare so basically people don't think they are paying their medications, like there was some magic money. in that case, you don't care if you drug cost 10€ or 2000€ because you aren't spending a single € from your own wallet, at least if you don't factor in taxes. Contrary to the USA where it's a much more responsible market, people do pay for the medications or they get…

Americans pay multiples more per capita, and receive worse healthcare based on outcomes compared to European nations. The UK on average has better oral health than the USA, but Americans love to joke about British teeth... I think the US believes it's own "free market" propaganda too much. Clearly socialised universal healthcare (which every G20 nation does outside the US) is a better system.

You're painting with a fairly broad brush. Opinions in the US are diverse, and generally more in support of socialized healthcare than against.

We're not far from half the US population having what amounts to universal healthcare already, even without making it official. I sometimes wonder how high it will get before people come to the realization that we're already close enough to that point and going the rest of the way is viable.

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#153

Post by pmontra »

AlexCoventry wrote: post #108
khannn wrote: post #22

Earlier quoted context omitted.

I was on a blood thinner and the medication was very pricey. Didn't have insurance and the "savings card" covered fuck all unless you had insurance. There are three blood thinners on the US market and they all cost a lot.

> There are three blood thinners on the US market and they all cost a lot. What about Warfarin? Its $21 for 30 pills, according to https://www.goodrx.com/warfarin

Warfarin needs blood tests at least every 2 or 3 weeks. I bet those tests are not cheap in the USA. Furthermore you can't have any food with significant amounts of vitamine K or its precursors. There are pills that cost more but don't require any of that. And actually they cost very little or zero, at least in my European country. Prescription only, of course.

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#154

Post by jandrewrogers »

philip1209 wrote: post #38

What's to stop congress from passing a blanket "most favored nation" law for VA + medicare on all pricing, inclusive of insurance rates and discounts? Seems like it would be fair and useful.

This exists throughout government procurement and it is part of the reason list prices are so high.

The overhead of selling to the government is significantly higher than selling to private companies. So the government simultaneously demands the lowest price while having a much higher cost of sales that needs to be covered by that price. A price that would cover the cost of selling to the government would be non-competitive if selling it to a private company because you may be competing with other companies that don't have to anchor their prices to the cost of doing business with the government.

To work around this companies post a very high list price, no lower than what they charge the government as required by MFN regulations. They then effectively steeply discount those prices when selling to other entities via various mechanisms to more accurately reflect the lower cost of sales. The list price is a fiction required to satisfy "most favored nation" pricing laws, no one is expected to pay it.

tl;dr: In many cases the basic economics requires the government to be charged more than average because they are expensive customers with high overhead. MFN regulations don't make this reality go away so companies have to creatively structure their pricing to satisfy regulations without requiring non-government customers to pay for government overhead.

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#155

Post by matt_heimer »

cogman10 wrote: post #137
trashface wrote: post #114

Earlier quoted context omitted.

> FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower. This isn't really true on obamacare/ACA plans, even the high-end ones like gold PPOs. The formularies are much w…

Anyone know what's going on with the ACA marketplace? I like to take a peek at it every so often and it's just stupendously worse than employer healthcare. There is no plan in my market (Idaho) which doesn't have extreme out of network deductibles. The cost is also identical to what I and my employer pay for insurance. Is it just that the ACA is mostly used by sick people or something?

Prices have jumped, see:

    * https://news.ycombinator.com/item?id=44604365
    * https://news.ycombinator.com/item?id=44989706

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#156

Post by bluedino »

cogman10 wrote: post #137
trashface wrote: post #114

Earlier quoted context omitted.

> FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower. This isn't really true on obamacare/ACA plans, even the high-end ones like gold PPOs. The formularies are much w…

Anyone know what's going on with the ACA marketplace? I like to take a peek at it every so often and it's just stupendously worse than employer healthcare. There is no plan in my market (Idaho) which doesn't have extreme out of network deductibles. The cost is also identical to what I and my employer pay for insurance. Is it just that the ACA is mostly used by sick people or something?

Many people that use the Marketplace plans don't have employer sponsored health plans available.

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#157

Post by dpkirchner »

eszed wrote: post #117
christkv wrote: post #67

Earlier quoted context omitted.

Most countries have both public and private. In Spain I have public and then private on top of that which 220 eur a month for a family of four all services included and no co-pay. The public option works to set a roof on what private insurance can charge.

> The public option works to set a roof on what private insurance can charge. Exactly! This is what no one in the US seems to understand. My encounters with private clinics and hospitals in the UK (all 10+ years ago, at this point) were unbelievably luxurious, at prices that (totally, completely free-market driven, mind you) were affordable on middle-class incomes. Or, yeah: there's private medical insurance, also fr…

Unfortunately a lot of us do understand this, but our representatives (who definitely know this) don't care or are actively opposed to making improvements other than reducing taxes (which hurts more than helps, IMO).

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#158

Post by bluedino »

zuppy wrote: post #42
Aurornis wrote: post #8

FYI for anyone who isn't familiar with the wacky US insurance situation: Nobody in the US actually pays $800 for the drug. That's the "list price" for insurance companies to pay. Even insurance companies don't pay that price because they negotiate their own rates with the drug companies, which are lower. Then the drug companies come in and offer a "savings card" which you apply at the pharmacy like another layer of i…

what about the poor people? the ones that can't really afford insurance. i've heard multiple times that epipen prices are crazy expensive and that's a really basic drug.

If you're really poor you end up going to the emergency room and get a $20k bill that you never end up paying

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#159

Post by autoexec »

Beijinger wrote: post #50
jaggederest wrote: post #3

It's a very interesting drug. There are a lot of concerns right now around PFAS in water supplies, for example, and Miebo/Evotears are pure PFAS (perfluorohexyloctane) that's instilled directly in the eye, giving you a dose somewhere around a million times higher than levels of concern in drinking water. But it is absolutely revolutionary if you have dry eyes. Quotes include "I feel like my eye is actually too wet no…

You could try this: Visomitin (Emoxipine/Mexidol) eye drops are a Russian-developed antioxidant medication known for treating dry eyes, fatigue, radiation damage, and improving vision, working to protect eye cells from damage (oxidative stress), but it's not widely available or FDA-approved in the US, requiring international purchase or specific prescriptions, often used for cataracts or post-surgery recovery, focusi…

> Visomitin (Emoxipine/Mexidol) eye drops are a Russian-developed antioxidant medication known for treating dry eyes, fatigue, radiation damage, and improving vision

I wouldn't recommend it. A quick search shows that it's not proven to do anything at all but it's also advertised as being the cure for parkinson's, asthma, back pain, high cholesterol levels, anxiety, blood clots, glaucoma, and Huntington’s disease while also making you smarter and improving your memory. This sounds like classic snake oil. Something I'd expect to see being sold alongside Horny Goat Weed and kratom at a gas station rather than an actual medication dispensed by a pharmacist. As fucked up as the American healthcare system is I guess you really have to hand it to Russia sometimes.

Re: A $20 drug in Europe requires a prescription and $800 in the U.S.

#160

Post by stefan_ »

philip1209 wrote: post #38

What's to stop congress from passing a blanket "most favored nation" law for VA + medicare on all pricing, inclusive of insurance rates and discounts? Seems like it would be fair and useful.

"Most favored nation" is to the Trump addled brain like sugar water to a bee. It sounds vaguely like "Go USA" while having nothing to do with the actual problem at hand. Just wait for those 400% 500% price reductions to kick in then. The problem is the fuckup that is your domestic healthcare market, not anything to do with international trade.
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