Live data from Hacker News

Illinois governor signs law capping insulin costs at $100 per month

nbc15.com

261–270 of 422 posts

Re: Illinois governor signs law capping insulin costs at $100 per month

#261

Earlier quoted context omitted.

Because, like some other drugs in the US, the drug manufactures will collude to create an artificial shortage?

At which point the government could produce more themselves. Why shouldn't governments own private industry if it still competes through the market?

Just responding to the "Why shouldn't governments" argument, but the obvious counter-response to that is that (at least in its current iteration) the government is pretty bad on slapping its own hand. We see this at the heart of the criminal justice system, and we see its ill effects. That is slowly starting to change, and I think for the better, but it's still pretty bad.

In competitive space, what do we do when the government fails to check itself against anti-competitive behavior?

Re: Illinois governor signs law capping insulin costs at $100 per month

#262
post #187

Earlier quoted context omitted.

This is the classical "tricke down economy" type of solution. Give companies, who are additionally acting unethically, a guaranteed and direct profit increase and _hope_ that it solves itself in the long-term. Surely it depends on the barriers and how much of a cut those actually are in practice. Furthermore, private corps aren't the only way drugs can be invented.

You are completely misunderstanding the argument. Lets say the current price for insulin is $200. I see this margin, and say "I can produce insulin for cheaper, and I'm happy with selling it for $50". The government is placing restrictions on new competitors, so I can't just come in and sell insulin for $50. There is a restriction on competition, which causes artificial prices

The presumption is that it's actually the regulations that prevents the competition, which haven't at all been made clear. How about patents for example? How about the cheap prices of Europe?

Re: Illinois governor signs law capping insulin costs at $100 per month

#263

Earlier quoted context omitted.

because UK subsidizes it. But UK residents pay 33% of GDP in taxes vs US pays only 27%, according to this https://www.oecd.org/tax/tax-policy/global-revenue-statistic... so it comes out of the higher taxes.

Those prices have nothing to do with subsidies. It is showing that the NHS pays a fraction of the US prices for the same insulins. Diabetics are exempt from all out-of-pocket prescription charges though, so that part is subsidized.

Then why isn't US buying insulin from UK's suppliers at a fraction of the current price?

Re: Illinois governor signs law capping insulin costs at $100 per month

#264
post #54

I'm really past the whole "pharma need to charge high prices to fund research" line of argument. Aside from being factually untrue (research funding is dwarfed by marketing for example[0]), it is also arguing for a continued unhealthy relationship with pharmaceutical care. A large amount of research is currently publicly funded. Either via public academic research or directly. When that research bears fruit it is oft…

Ironically, insulin is a great example of why your premise is false: Insulin replacement was developed a century ago, being first discovered by a government entity (U of Toronto). Private companies commercialized the treatments in the 1940s and 1950s, developing long acting forms that could be administered in a single injection per day. Since then, pharmaceutical companies have made continuous improvements with fewer…

It's quite telling what you excluded in your rendition of history.

The original research for the synthesis of insulin was actually done in Europe by a private citizen (not a government entity). That research was followed up on by a surgeon with a private practice in Canada, and only after a time was it taken to the U of Toronto. The work leading to a manufacturable insulin process was done in collaboration with another private citizen (not affiliated with the U of Toronto). The trio only decided to patent the discovery upon literal threat by Eli Lilly to steal it for sale. They then sold it to the U of Toronto for a single dollar because of a strong belief that it would have been ethically bankrupt to profit from the manufacture and distribution of such an important drug. Funny you left that out!

But anyway, to your main point, it's interesting you neglect to mention that the main manufacturers of "generic" insulin (there's actually no such thing, but that's a topic for a different time) are the same companies who manufacture the name brands. They do this for pure price discrimination reasons; the new "generics" you reference (Admelog/Insulin Aspart) are exact chemical duplicates of their higher priced cousins. They prevent other companies from creating their own "generics" through a process called "evergreening" where they change patents in small, insignificant ways while still maintaining the patent on the core product. They then force other manufacturers into pricing and distributorship deals in order to license these patents to prevent cannibalization of their own products. Most of these deals include strict price controls. Have you ever wondered why those regulatory controls are so strict? Maybe it's because of regulatory capture as a part of this complex system to artificially inflate drug prices. That would require more than a skin deep analysis relying on middle school free market ideology though.

This isn't even getting into the "manufacturer rebate" programs most drug companies have for, again, pure price discrimination and marketing reasons. Or the fact that for the same exact chemical formula insulin costs have increased over 10x in the past 20 years. This also doesn't address the fact that we're seeing 20% year over year increases in insulin prices while drug manufacturers post profit increases almost in lock step. Feel free to read their quarterly earnings reports, they state in plain black and white that they purposefully price insulin in accordance with how expensive it is to treat diabetes _without_ the drug. To quote John Lechleiter, the CEO of Eli Lilly, “Yes, they [referring to insulin] can be expensive, but disease is a lot more expensive”. I believe that's called "extortion", I wonder if getting rid of regulatory roadblocks can solve that problem.

There's also no such thing as insulin "side effects"... lower quality/old synthesis method insulin just doesn't work as efficiently which means you have to use more of it or can't use it in modern insulin pumps. Most insulin manufactured today is biologically identical to the insulin manufactured 10 years ago. Most of the quality of life improvements occurred long before the recent price surges.

But then again your post compares iPhones and Netflix with a drug that over a million Americans have to take in order to survive, so I doubt any of this will reach through your armor of specious and unserious speculation.

Re: Illinois governor signs law capping insulin costs at $100 per month

#265
post #172

Earlier quoted context omitted.

I hate the constant misuse of the word "right". How would a country guarantee this right? What if every doctor in the US quit tomorrow? What if I decided to live on the top of a mountain where there is no population? How does the government guarantee my right to healthcare? Rights are around restrictions. I have the right NOT to be killed. I have a right NOT to be silenced. When something requires someone else doing…

Who's going to stop you from having your right not to be killed infringed upon? That requires just as much affirmative action from a society's justice system. Any of our rights only matter as much as society's agreement to help you defend them, and in this case the government of Illinois has agreed to defend this one.

People not killing each other costs nothing. Cost is only incurred when the right to life is infringed. People providing healthcare to one another always has costs. If this "right" is infringed and no healthcare is provided then no cost is incurred.

Whether or not healthcare is a right is a lot less important than whether or not it is affordable.

Re: Illinois governor signs law capping insulin costs at $100 per month

#266
post #107

Earlier quoted context omitted.

https://www.fdareview.org/issues/theory-evidence-and-example... Specific suggestion: get rid of efficacy requirement, keep safety requirement. Let doctors decide what works, as they currently do for off-label uses just fine.

For many medicines, you really can't separate efficacy from safety. As an extreme case, take for example cancer drugs. They typically have high side effects and every year, a certain proportion of the people taking them, die from the side effects. That is an acceptable risk because there is evidence that they are efficacious in treating cancer. If they are not efficacious, that is a completely unacceptable risk. Less…

Should a doctor be making that decision, or should the government?

Or should the government make that decision for on-label uses and doctors make that decision for off-label uses? That's the status quo. Whatever argument you have for one half of that is an argument against the other half.

Re: Illinois governor signs law capping insulin costs at $100 per month

#267
post #172

Best line in the very short article “Health care is a right for all, not a privilege and that is why I am so proud that we created an insulin price cap that successfully puts patients above profit,” according to Gov. JB Pritzker.

I hate the constant misuse of the word "right". How would a country guarantee this right? What if every doctor in the US quit tomorrow? What if I decided to live on the top of a mountain where there is no population? How does the government guarantee my right to healthcare? Rights are around restrictions. I have the right NOT to be killed. I have a right NOT to be silenced. When something requires someone else doing…

There are no natural rights - i.e. the ocean won't push you to shore because you're drowning and have the right to life.

Rights are defined as part of the social contract we create in living close proximity to each other. If the collective people define what their rights are through democratic representation, then it's up to those who have the monopoly on violence to enforce it.

The "Stand in the school house door" is one historical example of this in play: https://en.wikipedia.org/wiki/Stand_in_the_Schoolhouse_Door

Re: Illinois governor signs law capping insulin costs at $100 per month

#268
post #43

Earlier quoted context omitted.

When it costs billions to develop a new drug due to onerous testing regulations, that's what happens. Ultimately returns in every industry tend towards zero. If we made it cheaper to develop new drugs it would extend the lifespan of the industry somewhat but not indefinitely. At some point diminishing returns take over and investment must go down.

How much is spent on marketing in comparison? Only in the US and New Zealand can you market drugs directly to the public. I sense an opportunity to destroy an unnecessary cost.

$6 billion for direct to consumer marketing. Versus $71 billion in R&D.

Re: Illinois governor signs law capping insulin costs at $100 per month

#269
post #259

Earlier quoted context omitted.

No, trickle-down refers very specifically to tax breaks tailored narrowly to the wealthy, in hopes that they will in turn distribute their wealth via increased employment of capital and, ultimately, labor. Since its origins in Gilded Age populist political writing and depression era popular media, it has never meant anything else, and it has nothing to do with the subject at hand. > Give companies, who are additional…

Sigh, this is such a typical HN response, "I read everything literally and need to explain what it _actually_ means". I wrote _type_, as in similar. I know the origin. > This is not a simple analysis, but I think the answer is more often than not, No. Why not? Profit-driven drug companies will obviously focus on things that make money, e.g. superficial/vanity related things, not what's necessarily aligned with public…

Because in most markets, one of the more straightforward ways to make money is to deliver products more efficiently, split the reduced cost basis with the customer, and outcompete incumbents.

You're not doing your argument any favors with this "typical HN response" stuff. Have a discussion with people on the thread or don't; it is fine for you to simply disagree and walk away.

Re: Illinois governor signs law capping insulin costs at $100 per month

#270

Wow, Pritzker is on a roll. Legalizing pot, reviving horse racing, now defending diabetics. Why can't my state have a good governor? Do we need to send a bunch of former governors to prison first? I'm willing to do that! Heck, I think most people would be fine with Greitens in prison...

Do you want our drastically under funded state pension system too? Illinois wants revenue anyway it can it, selling pot, gambling, whatever. What's wrong with Missouri?
Post reply on HN