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

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

#51
post #44

Earlier quoted context omitted.

Manufacturers that can't (or won't) sell a month's worth of insulin for $100 will be replaced by those who can.

You misunderstand. I'm not saying "If the manufacturers decide it costs $110". I mean, if it costs $110. You can't force someone to create things at $110 and sell them at $100... or at least, you can't for very long. Others are observing that the current prices are not currently anywhere near $100. That's completely unrelated to what I'm explaining. I'd also point out that is a temporary fact, not a permanent fact. I…

An inflexible cap can always be suspended via state of emergency declaration in the scenarios you're positing.

Hell, via state of emergency declaration the state can use tax money to buy the insulin.

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

#52
post #44

Earlier quoted context omitted.

Manufacturers that can't (or won't) sell a month's worth of insulin for $100 will be replaced by those who can.

You misunderstand. I'm not saying "If the manufacturers decide it costs $110". I mean, if it costs $110. You can't force someone to create things at $110 and sell them at $100... or at least, you can't for very long. Others are observing that the current prices are not currently anywhere near $100. That's completely unrelated to what I'm explaining. I'd also point out that is a temporary fact, not a permanent fact. I…

> That's completely unrelated to what I'm explaining.

Then this is a https://en.wiktionary.org/wiki/if_my_aunt_had_balls,_she%27d... scenario.

If IL were capping below cost, that'd be a problem. They're not, though.

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

#53
post #21

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…

You're looking at the wrong data. You need to look at return on capital. Right now the return on capital in pharma is below the cost of capital and it's trending towards zero. The inevitable result is significantly lower funding for research. https://endpts.com/pharmas-broken-business-model-an-industry...

I believe they like to call that "Hollywood accounting."

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

#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 side effects: https://www.hopkinsmedicine.org/news/media/releases/why_peop...

Note that nobody is proposing to give people the versions of the drugs developed by public entities, or even the long out-of-patent earlier versions of the drugs. That’s strong evidence of the fact that the improvements developed by private companies were really important.

Moreover, the only thing stopping companies from making cheap generic insulin is the government itself:

> Patents on the first synthetic insulin expired in 2014, but these newer forms are harder to copy, so the unpatented versions will go through a lengthy Food and Drug Administration approval process and cost more to make. When these insulins come on the market, they may cost just 20 to 40 percent less than the patented versions, Riggs and Greene write.

Instead of “scrapping” the industry, wouldn’t it make more sense to, as a first step, get rid of regulatory roadblocks that prevent competitors from producing out of patent drugs?

Moreover, as to your claim that “other countries” do things differently—your only example is India, which does essentially no pharmaceutical R&D. Western European countries also rely on for-profit pharmaceutical development. Pharmaceutical spending as a percentage of GDP is about 2% in the US and Japan, 1.8% in Canada, and 1.5-1.6% in Germany or France: https://data.oecd.org/healthres/pharmaceutical-spending.htm. European countries negotiate hard on drugs like insulin, but for the most part they pay a lot too.

As to your broader point of “why do we need private businesses to do this?” It’s a mistake to mix up the products being made with the process by which the products are developed. Just because people need drugs more than search engines doesn’t mean that the government is more qualified to develop drugs than search engines. It’s two completely different things. Drug development is high tech work. If the government could do it well, while squeezing out the profit margins, there would be no reason for the government not to run Google or Netflix.

After all, why do we need a “private business” like Apple to develop iPhones with 50% margins “when the tax payer could do it at nearly 0% margin?”

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

#55
post #43
post #33

Earlier quoted context omitted.

This suggests that something is very wrong with the market. The costs of development and production (even ignoring failures) are way below revenue, which means that return on capital should be very positive. Somehow most of the money is going into overhead. One might debate whether the overhead constitutes corruption, but it should be able to be reduced.

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.

> When it costs billions to develop a new drug due to onerous testing regulations, that's what happens.

This does not explain the increase in cost of insulin, which was invented in 1923.

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

#56

Earlier quoted context omitted.

I am really anxious for the people that will lose their insulin because of this...

Why would they?

Because the manufacturers can decide to stop selling insulin in Illinois completely.

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

#57
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.

If you believe the market is choosing to waste money on ineffective marketing, sure. Do you have any particular reason to think that? Why would you expect return on capital to go up without marketing?

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

#58

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.

So the next step is to nationalize the facility that manufactures it, the testing of it, the distribution of it. All taxpayers will pay for it. And the ubiquitous govt will have to compensate the drug companies for the taking of their intellectual property. Welcome to Venezuela.

You're aware that (AFAIK) every single other OECD state uses implicit (monopsony) or explicit price controls as a key part of controlling healthcare costs and maintaining access to healthcare, right? In fact it's maybe the one factor that pretty much every non-US healthcare system shares. Even friggin' Singapore, the usual "look, the market can work!" example for healthcare, does it.

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

#59

Earlier quoted context omitted.

It doesn't cost anywhere near $100 to produce a month's supply. https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-expe... > The US is a global outlier on money spent on the drug, representing only 15 percent of the global insulin market and generating almost half of the pharmaceutical industry’s insulin revenue. According to a recent study in JAMA Internal Medicine, in the 1990s Medicaid paid between $2.36 and…

> It doesn't cost anywhere near $100 to produce a month's supply Is the $100 indexed to inflation? Separately, this is a supply-side problem. Why can’t I start a business that manufactures insulin while selling it at a reduced—but profitable—margin? Those barriers to entry are a fundamental issue.

> (g) On January 1 of each year, the limit on the amount that an insured is required to pay for a 30-day supply of a covered prescription insulin drug shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index of the Bureau of Labor Statistics of the United States Department of Labor.

Yes.

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

#60
post #33

Earlier quoted context omitted.

This suggests that something is very wrong with the market. The costs of development and production (even ignoring failures) are way below revenue, which means that return on capital should be very positive. Somehow most of the money is going into overhead. One might debate whether the overhead constitutes corruption, but it should be able to be reduced.

I don’t demand my roads, libraries, or other public goods turn a profit. I wouldn’t demand the same of public pharma research (NIH, DARPA). Perhaps the market is not designed for this sort of endeavor (drug research). Let government stand in where the market has failed.

"Markets" are poorly designed for health care/research investment in general. Just like roads, education, general science research, etc... It just doesn't play well with being largely run with a profit motive.

That's not to say there's on place for the private sector there, but there is massive friction between a profit motive in drug research and you know, building a more healthy society. See the "new Adderalls" like Vyvanse that offer no benefits over Adderall, but Adderall's patent is up so it can be made by generics and isn't as profitable anymore.

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