Insulin Wars: How insurance companies farm out dirty work to doctors patients • Hacker News Board

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#91

Post by Gibbon1 » Tue, Jan 22, 2019, 7:46 PM UTC

conanbatt wrote: post #81

refurb wrote: post #77

Earlier quoted context omitted.

Care to explain why? I know plenty of cancer patients who got referrals to several of oncologists, interviewed them, then selected the one they thought was best equipped to treat their cancer.

Quality is only one of the measures patients use to select a doctors, and it would be fine to doubt patients can even gauge quality. I would tell you location beats quality every day.

Fee like in these threads the people taking the other side of this conversation haven't had to deal with a serious health problem either for themselves or someone else. The whole shipping around bit basically does not work. What are you going to do pester doctors about hypothetical health issues? Change doctors, hospitals in the middle of treatment just to see if you get better treatment. Yeah lets try that a dozen times and then pick the 'best' yeah right. How you make a 'free market' work in a system with so many natural information asymmetries and frictions is beyond me.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#92

Post by conanbatt » Tue, Jan 22, 2019, 7:52 PM UTC

Gibbon1 wrote: post #91

conanbatt wrote: post #81

Earlier quoted context omitted.

Quality is only one of the measures patients use to select a doctors, and it would be fine to doubt patients can even gauge quality. I would tell you location beats quality every day.

Fee like in these threads the people taking the other side of this conversation haven't had to deal with a serious health problem either for themselves or someone else. The whole shipping around bit basically does not work. What are you going to do pester doctors about hypothetical health issues? Change doctors, hospitals in the middle of treatment just to see if you get better treatment. Yeah lets try that a dozen t…

The competition in the current market is not done at that level but at the insurance level.

Its just that insurances are picked by employer, so again, no way to compete.

The economics of the system are complex, but healthcare is far from being a "free market" as it is right now.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#93

Post by tracker1 » Wed, Jan 23, 2019, 5:03 PM UTC

refurb wrote: post #66

rhizome wrote: post #52

Earlier quoted context omitted.

The word "most" doesn't imply an absolute.

I assume OP is talking about “me too” drugs. However, there is an argument that they offer a lot of value too. Incremental improvements is why we have a single pill therapy for AIDS with minimal side effects. It took dozens of “me too” drugs to get to that point.[1] [1] https://www.acsh.org/news/2012/05/10/me-too-drugs-are-innova...

I'm not so much talking about "me too" specifically, that said, I don't feel that minor tweaks to process or formula are deserving of another patent and many years of protections. And, as I said, I don't feel that there should be a single provider at all. The licensing for patents can be worked out, but imho if the sale of the drug required dual, independent sourcing as a requirement there would be at least some push downward on pricing.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#94

Post by talltimtom » Fri, Feb 01, 2019, 7:58 PM UTC

nisa wrote: post #53

Not sure how possible such an idea is, but why not create a public utility that creates essential medication for the lowest possible price? In the end Medicare seems to pay already huge amounts of money for some medications and there must be know-how in the federal government or other public institutions on how to manufacture medications. I'm not trolling. Like clean water, this is maybe an area were society should n…

Let’s say we do this, and you create a state funded company that creates cheap insulin, let’s say they can sell it for 25$ in Walmart. What then happens is that to sell that drug to the insurance companies they negotiate with the Phamacy Benefits Managers they will say to them:”We want a 66% rebate!!” They’ll say errr? At what price? The PBM will say:”we don’t care, insurance covers the price”. So that company ends up putting a list price at 74 but providing a 66% rebate to the PBM so they still get their profit... but then the next year the PBM comes back saying “well, we are going to need a bigger rebate because the competitors where willing to raise their prices even more and thus giving us bigger rebates”

You essentially have a party who’s getting every company to compete on who is willing to sell at the highest list price who’s driving negotiations against the producers who only stand to gain by higher prices.

The American system is rotten to the core.

Re: Insulin Wars: How insurance companies farm out dirty work to doctors patients

#95

Post by talltimtom » Fri, Feb 01, 2019, 8:00 PM UTC

HarryHirsch wrote: post #50

hirundo wrote: post #23

> This pricing is, of course, hidden from most patients, except those without insurance, who have to pay full freight. The rest of the story flows from this. The ordinary price mechanism is broken because the patient isn't the customer, and the customer is paramount to any business. As long as most patients don't care what it costs most of the time, it will stay broken.

* As long as most patients don't care what it costs most of the time, it will stay broken* Say what? With insulin it's "your money or your life".

As a patient, you don’t care if the drug costs 25$ with 20 covered by insurance or 2005$ with 2000$ covered by insurance. That is what he means. List price doesn’t matter to insured patients.