251–260 of 276 posts
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The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be. I'd love for someone to rationalize PBMs in the same manner they rationalize every other horrible inefficiency in US health care.
> The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be This presupposes that the US pharma market (and healthcare writ large) constitute an actual market. It's really not, by just about any measure. The only thing remotely resembling a "market" is the fact that insurance is predominately provided by the private sector for profit. Out…
It really strikes me as a no-true-scotsman's analysis of our health system. Why not just adopt one of the competing alternatives wholesale and admit defeat?
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Don't they do a better job in lots of other countries? I'm not an expert, but my understanding is that a lot of the countries with socialized medicine such that their government is the one negotiating with drug manufacturers pay substantially less for drugs than customers in the US.
In other countries, government “negotiation” is just a euphemism for price controls. An example of this is Canada’s Patented Medicine Prices Review Board, which regulates drug prices. This isn’t “negotiation”, this is just centralized policy-driven price control. The US could very well institute their own price controls on drugs, but it wouldn’t invalidate the value in services like Amazon’s, especially if the price…
You can say it's cheating when governments win lower prices for their citizens like this but I'm not much inclined to care. I don't want to subsidize the continuation of our more-market-based-than-usual health care experiment when the results have been clear for decades. Compared to our peers, we're in a hole. Let's stop digging.
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> The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be This presupposes that the US pharma market (and healthcare writ large) constitute an actual market. It's really not, by just about any measure. The only thing remotely resembling a "market" is the fact that insurance is predominately provided by the private sector for profit. Out…
No offense to you in particular - but every time something changes in US Healthcare to make it more "free", costs continue to rise apace and people exclaim, "If it were just a bit freer market, everything would be cheaper and things would be better." It really strikes me as a no-true-scotsman's analysis of our health system. Why not just adopt one of the competing alternatives wholesale and admit defeat?
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> For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price. You're describing "Prizes", and that's a legit point of view -> https://www.mercatus.org/publications/covi…
I think they're similar but not quite the same. A prize is offered in advance of a solution, a lump-sum license is after the solution is developed. On reflection I like prizes better, especially if there are multiple tiers (first to reach the target gets the most prize money, second gets less, etc). You want to ensure that multiple pharmaceuticals are developed independently, in case one of them needs to be pulled fr…
I see the benefit for things like a covid vaccine where the economic benefit is so large we can afford to drop exorbinant sums. But what's the right prize for a newer better lipitor or xanax, or a treatment for malaria or Huntington's?
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Instead of the Govt being the price negotiator, we got giant corporations instead. yay
You really believe the government will do a better job?
Just a heads up, if you use this service PillPack and Amazon Employees have full access to your entire prescription history. Full name, social everything - it was common for employees to look up the info of celebrities / other employees for fun. Any prescription / healthcare info you give them will be sold back to SureScripts and used to sell you more garbage from Amazon ;) https://www.wsj.com/articles/amazon-mail-or…
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It’s collected (generally speaking) one way or another. Unfortunately right now it’s collected from the lower and middle classes, but no matter what you do drugs, treatments, doctors, hospitals, etc. cost money. It’s never, ever, ever “free”. If a drug costs $2,000/month there are probably some inefficiencies baked into the price, but even if it were $500/month, that $500 has to come from somewhere.
Probably some inefficiencies baked into the price? There are massive inefficiencies at every level. I probably wouldn't share this "it's the way it is because it has to be" reasoning if you've never looked into why US healthcare is as expensive as it is. For a decent overview: https://www.pbs.org/newshour/economy/why-does-health-care-co... "Just to give you one example, Duke University Hospital has 900 hospital beds…
Don’t mistake what I’ve said as support for the current system.
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> The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be This presupposes that the US pharma market (and healthcare writ large) constitute an actual market. It's really not, by just about any measure. The only thing remotely resembling a "market" is the fact that insurance is predominately provided by the private sector for profit. Out…
No offense to you in particular - but every time something changes in US Healthcare to make it more "free", costs continue to rise apace and people exclaim, "If it were just a bit freer market, everything would be cheaper and things would be better." It really strikes me as a no-true-scotsman's analysis of our health system. Why not just adopt one of the competing alternatives wholesale and admit defeat?
It’s important to have that discussion because it has implications on what approach we take. I think there’s generally broad agreement that the status quo is bad...there’s just violent disagreement as to why it’s bad. There are a number of ways to fix it (and not just the one proposal you keep hearing about).
Simply decoupling healthcare from employment while keeping it private is one approach. We know that this is efficient, because it’s what Medicare Advantage is, and that’s actually cheaper and better than Original Medicare.
Providing universal catastrophic care with savings accounts is another approach that has shown empirical success. It’s how Singapore’s health care system works, and it is widely regarded to be the most efficient healthcare system among the advanced economies.
> Why not just adopt one of the competing alternatives wholesale and admit defeat?
I agree! If it were up to me, we would adopt Singapore’s system wholesale. Either that, or, Switzerland’s. Or we would just have everyone in the US be on Medicare Advantage.