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Congress asks if developing slightly fewer medicines is OK if it lowers prices

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Re: Congress asks if developing slightly fewer medicines is OK if it lowers prices

#51

Post by jeffdavis »

AnthonyMouse wrote: post #43
jeffdavis wrote: post #34

Earlier quoted context omitted.

There is no patent protection on regular insulin, so it's some kind of ordinary monopoly problem, it appears. I suspect a better set of regulations around generics would solve the problem with ordinary market forces. Probably there are quite a few policies that protect the existing drug companies that don't make any sense for generics.

IIRC the issue with insulin is that while "regular" insulin is not under patent, there are better insulin products on the market that are, and those are what everybody prefers. Then, because most people do actually have insurance, the insurance pays for the more expensive version and so that's the only one anybody makes. The market for "regular" insulin is limited to people without insurance, which isn't a big enough…

"What's really needed there is to make it easier for generics manufacturers to get regulatory approval."

That seems like a sensible solution to the extent the quality/safety itself is not compromised. For instance maybe there is difficulty importing from other countries, but there should be no problem importing regular insulin from Germany, for instance.

Re: Congress asks if developing slightly fewer medicines is OK if it lowers prices

#52

Post by bluGill »

jmfayard wrote: post #10
aantix wrote: post #6

[flagged]

The conservative movement keeps insisting than making decent healthcare and education affordable is socialism. That almost never convince anyone that those are bad ideas, but it does a lot to make socialism looks good again!

That is a straw man socialits try to make. Conservatives do not have a common voice. That socialism doesn't work is but one (there are some complex arguments for why it cannot that you are ignoring - though to be fair they are too complex to put into a short post)

Conservatives often point out that we don't have a free market to start with. We have a strictly regulated market (designed by socialists) that cannot help but increase costs because nobody who cares about costs gets a seat at the table. Wanting to get rid of the regulations and allow an actual market is a small point a few conservatives makes.

Re: Congress asks if developing slightly fewer medicines is OK if it lowers prices

#53

Post by LargeWu »

bluGill wrote: post #50
LargeWu wrote: post #18

Earlier quoted context omitted.

The "less capable" Keep in mind, we're not all born with the same socio-economic advantages. The idea that you're more capable because you're successful is merely confirmation bias. Furthermore, your comment necessarily implies that anyone not as "capable", whatever that means, is therefore deserving of poverty and hardship. That's a moral stance I cannot support.

While I believe there is a range of capabilities, there is plenty of research showing that for most people the limit is practice (ie 10,000 hours), not something fundamental in the person. There are very few places where science has found something that makes on person objectivity better at a task once trained. There are those who are clearly less able. Downs syndrome, blind, are a few of the obvious limits that mean…

So your thesis is simply "Poor people are lazy. If they worked harder they wouldn't be poor"?

You're right that the difference between the middle class and the poor isn't luck. The difference between the poor and the middle class is poverty. Poverty isn't just about being poor. It's about being poor BECAUSE you're poor. It's generally cyclical, it can span generations, and is very difficult to break out of.

People don't get ahead when they can't afford to eat. People don't get ahead when they can't afford to go to a school in a better neighborhood. People don't get ahead when they get sick and can't afford health care.

I believe you have a fundamental misunderstanding about why people are poor, and remain poor. The idea that poor people have 'equality of opportunity' in any practical way is not based in reality.

Re: Congress asks if developing slightly fewer medicines is OK if it lowers prices

#54

Post by KirinDave »

AnthonyMouse wrote: post #39
KirinDave wrote: post #31

Earlier quoted context omitted.

In as much as it is a clever bit of propaganda for the corporatist idea that only private industry should be able to arbitrarily decide who does and does not receive life-preserving care, you're right. In principle, there is no difference between this outcome and what HMOs like Kaiser do to this very day.

There is one difference, which is that it creates systemic risk. If there are a hundred HMOs and there is a treatment which cures a disease which ten of them choose not to cover, it still exists and you can pay for it out of pocket or do whatever it takes to switch to a different insurance company etc. If everyone is on the same federal plan and the government chooses not to cover something, the provider isn't going…

> If there are a hundred HMOs and there is a treatment which cures a disease which ten of them choose not to cover, it still exists and you can pay for it out of pocket or do whatever it takes to switch to a different insurance company etc.

This is purely an on-paper difference. In practice, most Americans (where this conversation is relevant) don't actually have the ability to choose between an open market of health care providers. If they have access to it at all, its within the framework of what their workplace has negotiated for them, which may or may not be good. Certainly there is no individual recourse other than to choose between existing plans (which may all be from one provider).

So in that context, its actually exactly the same "systemic risk" problem only without the scrutiny of a general public. Plans are not public, and it is not unheard of for people with health issues to be quietly terminated to get them off plans. Pre-existing condition coverage is all over the map, with only the wealthiest citizens and workers having access to fair treatment. Even for someone like me, I struggle to get good health care when I run my own business because I am a cancer survivor.

So I think this concern you have is valid but the American system actually exacerbates it rather than protects against it. Both my partner and I face the auditing of unaccountable corporate "death panels" every time we go to the doctor.

So maybe you can tell me how if I suffer from this condition while being within the top percentile of earners in the US, the market approach has done anything to fix it. I have a history of successful Startup participation (and I've exited my own in a profitable fashion), but as I get older the health care situation is so bad, I'm forced out of participating in startups because their health coverage is so bad. Is this outcome better than what other public options have got?

Re: Congress asks if developing slightly fewer medicines is OK if it lowers prices

#55

Post by eyko »

vonmoltke wrote: post #48
zbyte64 wrote: post #33

Earlier quoted context omitted.

Also surprised by the lack of mention of reformulating existing drugs to extend their patents. The poster child of this practice is insulin, where Americans pay absurdly higher amounts for something where generics are abundant.

> Also surprised by the lack of mention of reformulating existing drugs to extend their patents. Reformulation does not extend patents, it creates a new patent on the new substance. The substance in the existing patent can be manufactured as a generic after the existing patent expires. The wrinkle is that the new and existing substances are not equivalent, and thus cannot be substituted for one another. Thus, if a do…

Can't a patient ask a doctor to prescribe a generic, when it exists? It seems like that would be an easy fix: a law that requires doctors to give you the alternative name for a generic, and make the sponsored version an optional upgrade.

I'm European and the whole concept of a doctor prescribing a "brand" sounds alien to me.

Re: Congress asks if developing slightly fewer medicines is OK if it lowers prices

#56

Post by bluGill »

LargeWu wrote: post #53
bluGill wrote: post #50

Earlier quoted context omitted.

While I believe there is a range of capabilities, there is plenty of research showing that for most people the limit is practice (ie 10,000 hours), not something fundamental in the person. There are very few places where science has found something that makes on person objectivity better at a task once trained. There are those who are clearly less able. Downs syndrome, blind, are a few of the obvious limits that mean…

So your thesis is simply "Poor people are lazy. If they worked harder they wouldn't be poor"? You're right that the difference between the middle class and the poor isn't luck. The difference between the poor and the middle class is poverty. Poverty isn't just about being poor. It's about being poor BECAUSE you're poor. It's generally cyclical, it can span generations, and is very difficult to break out of. People do…

In the US, as well as most of Europe (this list is not complete): there are essentially zero poor. What well call poor are really lower middle class. Even the bad schools are good enough to break out of - it might not get one generation from poverty to rich, but it can get to middle class.

I wouldn't pin remaining in lower middle class (which we consider poor) on just lazy though. Some are, but I've also met poor people who are not lazy, they just don't see how their hard work isn't in the right areas to get out. There is a lack of examples, and parents often don't teach their the basics of how to get ahead (in part because they don't know). The opportunity to get out of those bad neighborhoods exists for anybody. (Note that systematic racism in previous generations is mostly gone, but the after effects are still with us)

The poor elsewhere do lack opportunities and so cannot break out. I will grant that.

Re: Congress asks if developing slightly fewer medicines is OK if it lowers prices

#57

Post by jmfayard »

bluGill wrote: post #52
jmfayard wrote: post #10

Earlier quoted context omitted.

The conservative movement keeps insisting than making decent healthcare and education affordable is socialism. That almost never convince anyone that those are bad ideas, but it does a lot to make socialism looks good again!

That is a straw man socialits try to make. Conservatives do not have a common voice. That socialism doesn't work is but one (there are some complex arguments for why it cannot that you are ignoring - though to be fair they are too complex to put into a short post) Conservatives often point out that we don't have a free market to start with. We have a strictly regulated market (designed by socialists) that cannot help…

It's trivially true that no system is purely capitalistic it socialist.

The delusion is to not see that going more "socialist" is both hugely popular and supported by the evidence from other countries.

Going more capitalist is unpopular and supported by Ayn Rand fictions.

Re: Congress asks if developing slightly fewer medicines is OK if it lowers prices

#58

Post by vonmoltke »

eyko wrote: post #55
vonmoltke wrote: post #48

Earlier quoted context omitted.

> Also surprised by the lack of mention of reformulating existing drugs to extend their patents. Reformulation does not extend patents, it creates a new patent on the new substance. The substance in the existing patent can be manufactured as a generic after the existing patent expires. The wrinkle is that the new and existing substances are not equivalent, and thus cannot be substituted for one another. Thus, if a do…

Can't a patient ask a doctor to prescribe a generic, when it exists? It seems like that would be an easy fix: a law that requires doctors to give you the alternative name for a generic, and make the sponsored version an optional upgrade. I'm European and the whole concept of a doctor prescribing a "brand" sounds alien to me.

> Can't a patient ask a doctor to prescribe a generic, when it exists.

Yes, but it requires the patient (or their pharmacist) to request such.

> It seems like that would be an easy fix: a law that requires doctors to give you the alternative name for a generic, and make the sponsored version an optional upgrade.

> I'm European and the whole concept of a doctor prescribing a "brand" sounds alien to me.

The issue is that the two drugs are not equivalent, and is not about prescribing a "brand". Occasionally, a doctor insists on the brand for some reason (seems to be most common with Synthroid for some reason), but generally the prescription is treated as a prescription for the compound, even if the doctor uses a brand name.

The trouble with reformulation patents is that there is no generic for the reformulated compound. It is sufficiently different from the previous that it cannot be substituted by the pharmacist (otherwise it wouldn't have been patentable). In that case, the "brand" is the only thing available.

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