[HN Gopher] The Mark Cuban Cost Plus Drug Company ___________________________________________________________________ The Mark Cuban Cost Plus Drug Company Author : yawnxyz Score : 706 points Date : 2021-01-27 18:53 UTC (4 hours ago) (HTM) web link (costplusdrugs.com) (TXT) w3m dump (costplusdrugs.com) | fireeyed wrote: | My friend recently got admitted to the hospital. There must be 10 | people during the intake who didn't seem to be doing anything. | Some "nurses" were just observers. There were two admin people | who came into to take personal information. 2 medical techs who | just took temperatures and nothing else and finally a real nurse | who did all the vitals and finally the doctor after 2 1/2 hours. | Imagine the efficiencies that could be extracted and passed on to | the patients. | phkahler wrote: | >> There are no hidden costs, no middlemen, no rebates only | available to insurance companies. Everybody gets the same low | price for every drug we make. | | I've been advocating this for a while. Any given provider should | have the same price for a given drug or procedure, regardless of | insurance concerns. Putting this in law would probably help a | lot. | tpmx wrote: | I thought this space was already cornered by companies in India? | That's where most of the world gets it cheap generics from, I | think. | mikeyouse wrote: | Very true - but it turns out they all collude to raise prices - | some actual competition will go a long way: | | https://www.biospace.com/article/justice-department-charges-... | tpmx wrote: | Some actual competition on generics from a US company, with a | _much_ higher salary cost? | | Also, from the web site: | | - "We are hoping to introduce over 100 additional drugs by | the end of 2021." | | - "By 2022, building a pharmaceutical factory of our own in | Dallas, TX" | | I can't shake the feeling it's just a shallow rebranding play | using a billionaire's personal brand. Perhaps many americans | don't trust non-US brands, even when it comes to generics? | tasty_freeze wrote: | I don't care if it is rebranding inexpensive Indian | generics so long as they are vouching for the quality. | tpmx wrote: | Is there a quality problem with generics in the US? There | doesn't seem to one in Europe (or at least Sweden). I | assume you also have regulations and testing protocols | etc? | mikeyouse wrote: | There were actually a number of scandals out of India on | this front as well: | | https://www.npr.org/sections/health- | shots/2019/05/12/7222165... | | It's extremely hard to enforce GMP and QA/QC from across | the world and there's a strong incentive to cheat and lie | when it comes to these costly procedures. Whether it'll | be any better in a US manufacturing facility is of course | up for debate. | tpmx wrote: | I had never before heard the acronym GMP in this context. | It appears to mean: | https://en.wikipedia.org/wiki/Good_manufacturing_practice | | > Because the FDA requires very specific GMP requirements | that differ from those of the EU and other countries, | drugs approved or synthesized without US FDA | certification cannot be legally sold in the U.S. | | Sounds a bit like trade protectionism - but I assume that | goes both ways between e.g. EU and US. | [deleted] | lcall wrote: | There is a similarly interesting, nonprofit drug company that is | trying to resolve shortages and price problems, and where the | founding hospital system is also a nonprofit with a very good, | long-term reputation (and good personal experience--their intake | forms to get a blood sample drawn totaled 2 reasonable pages, | where the next-nearest hospital came out at 11 pages of icky | legalese including documents by reference), and have generally | done friendly good work for a long time as far as I can tell. | | Wikipedia says (lightly edited here for brevity): "Civica Rx is a | nonprofit generic drug manufacturer .... started by national | philanthropies and leading US health systems. By [EO] 2019, over | 45 health systems representing 1200 hospitals were members of | Civica. Member ... pharmacists and clinicians help prioritize the | medications Civica makes.... By the end of 2019 Civica had 18 | medications (28 SKUs) in production, and plans to bring over 100 | medications to market in five years through various manufacturing | approaches such as partnerships, developing ANDAs, and building | its own manufacturing capability. ... The first shipment of | Civica private-label medication was vancomycin, delivered to | Riverton Hospital, a part of Civica founder health system | Intermountain Healthcare, in October 2019." ( | https://en.wikipedia.org/wiki/Civica_Rx ) | | (edit: somebody else here also mentions civica and has a couple | of other links, in their comment.) | yboris wrote: | UI comment: the top banner vibrates (small-large jitter) when you | scroll a few pixels down. | gallegojaime wrote: | The "Find a Pharmacy" option doesn't work for me either. | bluedino wrote: | It's funny how privatizing space travel made costs plummet. | | Privatized healthcare, on the other hand, is a disaster. | bhupy wrote: | Except...it's not obvious that the root cause of the US's | current healthcare disaster is "privatization". I work in the | industry, and by far the #1 most jarring misconceptions I see | floating around forums like this is conflating of "privatized" | with "employer sponsored because of decades of tax incentives | and mandates". The US is not the only country that has a | public-private mix of healthcare, but it is pretty much the | only developed country where private health insurance is | predominately received through employers rather than on the | individual market. | | If you want a true apples-to-apples cost of public vs private | healthcare, you should look at Medicare Advantage vs Original | Medicare. When you turn 65, you have the option to enroll | either in "Original Medicare", which is what we usually think | of when we talk about "single payer healthcare in America", or | you can enroll in Medicare Advantage (aka Medicare "Part C"), | where the premiums that would go to the CMS instead go to | private insurers like Humana, United, Oscar Health, Aetna, | Clover, etc. These plans replace Original Medicare, also cover | Part D prescription drug benefits, and often include | supplemental benefits that Original Medicare doesn't already | cover. There are some interesting findings so far: | | - 39% of Medicare beneficiaries are on private Medicare | Advantage plans instead of the public "Original Medicare". | Because everyone is entitled to "Original Medicare", this is | purely voluntary. This number has been growing so rapidly, that | we expect by 2025, more seniors to be on a private plan than | the public one. There's also great variance by State. In | Florida, Pennsylvania, Wisconsin, Michigan, Minnesota, Oregon, | Alabama, Hawaii, and Connecticut -- nearly 50% of beneficiaries | are on Medicare Advantage. By 2022, we expect more seniors in | those States to be on a private plan than a public one. | https://www.kff.org/medicare/issue-brief/a-dozen-facts-about... | | - For most beneficiaries, Medicare Advantage costs about 39% | less than Original Medicare. | https://healthpayerintelligence.com/news/medicare-advantage-... | | - Medicare Advantage plans are, on average, of higher quality | than the public Original Medicare. | https://healthpayerintelligence.com/news/medicare-advantage-... | | - In Urban areas, Medicare Advantage costs less per capita to | administer than Medicare -- and that's not including the extra | Medicare Part D insurance that you would have to buy if you're | on the Original Medicare plan. | https://www.commonwealthfund.org/publications/issue-briefs/2... | mhh__ wrote: | The US healthcare "market" seems to be the worst of any | imaginable healthcare system combined. | lifeplusplus wrote: | one is a necessity and other one is not. If it's too expensive | to launch stuff to space, most companies won't. If it's | expensive to get a drug, well you will either pay up or suffer | until you die. | DubiousPusher wrote: | Exactly. One market is elastic the other is inelastic. | lifeplusplus wrote: | I had forgotten those terms.. yea nothing mysterious going | on here. This is well understood situation. Everyone should | take micro-economics not matter the profession. | savanaly wrote: | But we have markets in necessities and they work just fine. | What's the difference from healthcare? | atonse wrote: | Well before space X, we did have private companies, but they | were government contractors and a monopoly. So they had no | incentive to reduce prices. | | It's almost like SpaceX took rockets from being a consulting | business to a product business. | macksd wrote: | There's an excellent book (well it had bad reviews, actually, | because it was perhaps overly detailed and tedious, but I | enjoyed it) about the Gemini project called On The Shoulders | of Titans. Reading through the notes of how NASA interacted | with contractors was terrifying: here's some money to study | something. Turns out it was very subtly different from what | NASA had intended them to study. Here's more money to do | another study. Now here's money to build a prototype. Oh | you're 90% done and out of money? Here's twice as much money. | Oh now you're 99% done and out of money? He's the same amount | again. Oh it doesn't work but you can argue it's NASA's | fault? Here's more money to start over. You're done? Actually | we're gonna scrap this particular mission objective now. | | Space X owns something much close to an end-to-end objective: | it's not a study, or a build, it's getting the thing to | orbit, end of story. I think if you could set up the | situation so that a company owns the end-to-end story of your | health, things might be better off. That sounds more like | Kaiser Permanente and my impression is that's exactly what | happened. In reality our healthcare system is typically more | like Gemini: contractors, tons of regulations, but none of | them really own the end result so it's a public/private mix | of bureaucratic mess, misaligned incentives, and buck- | passing. | rtkwe wrote: | Part of that is it was very very hard to know back then | what was needed and what would work. Now a lot of the | fundamentals are well hammered out and the big challenge | for SpaceX was the landing not figuring out how to build | rockets in the first place. | | Also the ACA did have some successes in doing kind of what | you're talking about. There were incentives in there to | avoid readmittance before 30 days and to all appearances | it's been a success. | | https://www.statnews.com/2016/12/27/obamacare-success- | penalt... | goatcode wrote: | Private healthcare existed long before prices skyrocketed. | Health insurance did not. | DubiousPusher wrote: | Not really though. Not in the way it does today. Medicine up | to 1900 was largely ineffective. And most of what we consider | modern medicine has its roots in the 1940s. Which | coincidentally is about the same time employer provided | health insurance started becoming common. | notsureaboutpg wrote: | I agree to some degree about how standardized and effective | medicine is now. | | But it's not at all true that medicine up to 1900 was | largely ineffective... Medicine even way way back in | ancient times was pretty effective (not the level it is now | but neither was it "largely ineffective" that's just not | historically true). | hkt wrote: | Actually, throughout history (at least 500 years in the UK, | since the end of the guild system) people have paid what was | essentially a premium in order to access medical care at the | point of need - effectively insurance, if not always named as | such. | | Most of these organisations were mutuals, eg, member owned, | and would have pre-existing relationships with doctors etc | that would control costs. | | In this way, there were no perverse incentives - people had | "insurance", and they wanted that money to cover as many | eventualities as possible. The bigger the pot of money, the | more resilient the community. | | So actually, health insurance has a long legacy. The problem, | I would suggest, is shareholders who are not the principal | beneficiaries of the service. | | FWIW, in the UK we found that a system of mutuals and | municipally owned hospitals was sufficiently imperfect that | we created the NHS anyway. Probably best to skip to single- | payer in the US, imo. | eloff wrote: | It turns out markets are a great solution to some kinds of | problems and not so much for others. There's a lot of reasons | why healthcare doesn't approximate a free market very well, and | why government intervention here tends to do better than the US | system. Yes I know there is plenty of government intervention | in the US healthcare system - it's just not the right kind of | intervention. | | The US is actually the only developed nation without a public | healthcare system, it also has the highest healthcare costs of | any nation on earth. Coincidence? | | It seems like a pretty big mess at the moment. | starik36 wrote: | The costs are high across the system, including government | sponsored programs like Medicare. It's a systemic problem and | even touches software. | | https://maxwelljordan.medium.com/why-healthcare-in-us-is- | so-... | bhupy wrote: | > The US is actually the only developed nation without a | public healthcare system, | | That's false on multiple counts. First of all, the US does | have a public healthcare system, Medicare and Medicaid. | Second of all, there exists other developed nations with | fantastic healthcare systems that are driven by purely | private systems: namely Switzerland (widely regarded to be | one of the best healthcare systems on the planet) and the | Netherlands. Even more perfectly fine developed nations | operate on public/private mixes, including Germany and | Belgium. | | > it also has the highest healthcare costs of any nation on | earth. Coincidence? | | In this case, it is indeed a coincidence. In order to | attribute "privateness" to the high cost, you have to show a | causal relationship. Unfortunately, there's a lot of evidence | that makes it very difficult to draw that causal line: | private Medicare Advantage plans are about 39% cheaper than | the public "Original Medicare" | (https://healthpayerintelligence.com/news/medicare- | advantage-...), while also being of higher quality | (https://healthpayerintelligence.com/news/medicare- | advantage-...). In urban areas, the private Medicare | Advantage plans cost less to administer per capita than the | public "Original Medicare" | (https://www.commonwealthfund.org/publications/issue- | briefs/2...). | bravo22 wrote: | You are assuming that healthcare is a free market. There is | tremendous regulation, encouraged by incumbants, to keep away | the competition. | | You should look at historical healthcare expenditure by the | US. | | The problem isn't providing healthcare for all... it is the | method and the cost. Universal payer is one way. It is not | the best way and in fact Medicare is one reason costs are | currently high. It is a bit like a car that used to get 30MPG | and now gets 15MPG, and getting worse, and the solution being | offered is for all of us to collectively chip in and buy gas | for those who can't -- which is not tenable in the longterm | because you're spending more and more of the GDP on | transportation. | | There are other ways of giving everyone coverage. One scheme, | would be giving people money. Enough to cover average cost of | healthcare plans and say education plans. The individual is | then responsible for their own healthcare and has the funds | to purchase health insurance. Then you have a healthy market | and have mechanisms for the costs to come down. | eloff wrote: | I'm not assuming anything. I'm starting that even in theory | healthcare isn't very amenable to a market solution. I | think you disagree with that. It's possible to have a | reasonable position on both sides, I don't think it's a | solved problem. | | Where I think we both agree is that the current disastrous | mix of regulation and free markets in the present US system | is a terrible solution. | bravo22 wrote: | I entirely agree with you on the above! | luma wrote: | A free market involves a customer that has the option to | simply not buy what is on offer. Healthcare can never be a | free market in this sense, because the customer is faced | with a choice of "buy service and/or product" or "be dead". | | That is entirely unlike the choice involved in buying | something like a refrigerator and seriously skews the | applicability of traditional free market thinking to the | problem. | bhupy wrote: | > Healthcare can never be a free market in this sense, | because the customer is faced with a choice of "buy | service and/or product" or "be dead". | | What you're referring to here is a high "price elasticity | of demand", and markets are used to provision all sorts | of goods for which this is true. Food, for example, is | predominately provisioned by the market, and consumers | are constantly faced with a choice of "buy food" or | "starve to death". | dogsgobork wrote: | Different types of food are fungible goods. If broccoli | is expensive I can instead purchase carrots and still | survive. If I think chemotherapy is too pricey, I can't | take an aspirin instead to treat the cancer (at least not | with the same prognosis). | bravo22 wrote: | This is very true, and not at all what I mean when I say | "choice". In free market choice means alternative | vendors. Do you have other choices for getting chemo | besides the one hospital? | | You may be surprised to know that 80% of hospitals in the | US are non-profit. The evil profit motive isn't the | reason their bills are so outrages. | | In the 60's US healthcare expenditure was 5% of the | economy and it is close to 20% right now. | dwohnitmok wrote: | I'm curious (you don't come out one way or the other on | this from your comment, but this will help me make sense | of where you're coming from) do you think there are any | domains where a free market doesn't work? Or is your | position that free markets work universally (or less | absolutely, that free markets work for almost all | practical purposes and fail only in very artificial | environments). | bravo22 wrote: | Free markets don't work when the cost of the transaction | isn't paid by the two sides of the transaction but by a | third party. For example the environment where I can buy | a gas guzzler from you and drive away polluting the | environment. There you need intervention but the | framework of intervention and has to meet some specific | criteria. I don't want to digress. | | Other than that I have yet to see a problem that isn't | solved by this scheme: increase the set of choices | available to the person, and in some corner cases give | them money so they are free to choose. | | You have to bear in mind that the alternative to the free | market approach is for someone else to come in an | constrain either the buyer and seller in some way. Ths | may work for a limited time and for a specific set of | buyers and sellers but it won't work beyond that. Given | that people have diverse and evolving needs the forced | solution causes long term harm. Then you'll need some | kind of propoganda machine to either exagerate the good | or down play the harm. | | To be clear I do not believe that we have a free market | in the US in a lot of areas and what people conceive of | as free market -- or rather what has been shoved down | their throat as free market is anything but that. | dwohnitmok wrote: | I think you and I probably would have different notions | of what it means to "solve a problem." In this case I | suspect you have a notion that a free market in many ways | nicely sidesteps needing to even resolve this question in | the first place. It frees one from having to commit to | overarching, centralized value systems and instead allows | for gestalt value systems to arise naturally from the | behavior of people. This nicely avoids the issue of | needing to impose a higher authority's will on a | population and all the authoritarianism that that entails | as well as the inevitable schism between a centralized | value system and what people actually want. (I happen to | disagree with this take and can expand on why if you're | curious, but if this accurately reflects your views, | there's enough commonality at least for me to make the | next point.) | | > increase the set of choices available to the person | | This view abstracts behavior into that which is governed | by "choice" and "coercion." I think this binary | distinction is a fine model for a lot of domains, but a | poor one for healthcare. | | Choice feels much more like a spectrum in the domain of | healthcare than it does in other domains. For a rough | sample of points along this spectrum, you have "do this | or die immediately," "do this or die in the next several | months," "do this or suffer permanent disability," "do | this or suffer great pain," "do this or suffer some | probability of some amount of disability," "do this or | suffer mild discomfort," "do this or be slightly | annoyed." | | The far-"left" part of this spectrum cannot ever | realistically expand its set of choices. The most extreme | version of this is that you're literally incapacitated | and so can never make a choice of e.g. what hospital to | go to and what treatment to administer no matter how many | hospitals or treatments exist. | | However, I think the same problem persists in less | extreme states as well. Health ailments can directly | impact a person's ability to choose to begin with in a | variety of ways apart from just physical or mental | incapacitation or degradation. Various treatments and | healthcare choices impose switching costs that reduce a | person's choice even when they are nominally capable of | making one. For example, if a patient chooses a single | hospital for a bout of appendicitis (when they are in | such pain that they cannot make a choice in that moment | other than to dial 911), even once the acute problem of | surgery passes, they are unlikely to be able to choose a | separate hospital for their post-surgery hospital stay | without jeopardizing their health due to movement and | continuity of care concerns. | | Even in non-emergency cases there is an extreme | information asymmetry and unpredictable path dependence | (certain choices lock into other choices down the line | but the nature of how they lock in may not be apparent at | the beginning) that make it hard to formulate what | "choice" would even look like. | | In some ways, I personally view the need for coercion in | the healthcare space as precisely a way to return to a | world where modelling things as a binary distinction of | "choice" vs "coercion" makes sense again. | | Any plan for regulation of healthcare always must deal | with a distinction between "elective" and "necessary," | "non-essential" and "essential," "covered" and "not | covered." That line is drawn precisely where we have a | best guess that the model of a binary "choice" vs | "coercion" holds vs the model of a spectrum of choice; | the ideal is that care is provided to boost a patient | back into a universe where the binary "choice" model is a | reasonably good approximation. | | More generally there is the problem that healthcare has a | weird squeeze of monopolistic and non-monopolistic needs. | | At a base level, in almost all domains including | healthcare you need some amount of a regulatory framework | to counteract the problem that market participants | generally have an incentive to decrease the number of | choices to the other side. I think you probably agree | with "coercion" at this level (stuff like preventing | collusion among players, certain stances on breaking up | certain kinds of monopolies, etc.). | | But the problem is that in healthcare you do want | powerful players because there are benefits we want to | reap from large players. Large drug makers are the only | ones capable of performing substantial R&D and regional | hospital and transportation networks are really the only | ways you can get the necessary infrastructure and | expertise to treat a lot of things. On the buyer side you | want large insurance pools to even out risk for people. | | But those all have inherent monopolistic tendencies that | are exacerbated by the problems of choice that I | mentioned. | bhupy wrote: | Different types of healthcare are also fungible. And not | all healthcare is cancer! I think the biggest problem | with having any discussion around healthcare policy is | that we automatically assume that we should treat routine | treatments and visits the same way we treat catastrophic | accidents like cancer and brain surgery. | triceratops wrote: | > consumers are constantly faced with a choice of "buy | food" or "starve to death". | | And funnily enough, food is heavily government-subsidized | and regulated. It's not really a free market either. | | Also starving to death isn't really the same level of | urgency as dying of a heart attack. There's a couple | orders of magnitudes difference in the amount of time | available to make a purchase decision, and the level of | physical and mental stress you're under while making that | decision. | dwohnitmok wrote: | Food is much more fungible than healthcare. The loss of | any number of food items can be substituted by an | overwhelming number of any other food items without the | consumer ending up dead. | | Healthcare is not as fungible. Most medications have | single-digit or even no effective alternatives. | | For an illustrative example and the flip side of the | coin, water is a good example of where unregulated | markets do terribly (since you really do need water and | can't substitute it with something else and it's also | geographically heavily monopolistic). Potable water | production and pricing in all developed countries is | heavily regulated for good reason. | bhupy wrote: | The vast majority of healthcare expenditure is preventive | or planned care, which is largely fungible. MRIs are | fungible. Primary care is fungible. Antibiotics are | fungible. | | To the extent that healthcare isn't fungible, it's in | very specific cases like end-of-life care, cancer, | catastrophic surgery, and rare patented drugs. They also | account for a tiny minority of overall health | expenditure. | | We can use different tools across both of those problems. | dwohnitmok wrote: | > The vast majority of healthcare expenditure is | preventive or planned care | | I don't think that's true for the U.S. Preventive care | and planned care (if understood to be stuff like | physicals, blood checks, screening, etc. including your | examples of MRIs and primary care) as far as I remember | is actually a small minority of healthcare expenditures | (< 20% is a number I recall). I can try to root around | for sources if you're curious, but I'm also curious where | you're getting the impression of "vast majority." | | > Antibiotics are fungible. | | Not really. Definitely not in the same way that food is | fungible. I assume you're talking about generics here? | But generics again actually make up a startlingly small | minority of healthcare expenditure costs despite making | up the majority of prescriptions IIRC (again I'm going | off memory but I think it was something like 75% of | medication expenditures are due to medicines with no | allowed generic alternatives). | | Basically the places that you're suggesting the free | market should best apply to are already the smallest | slices of the healthcare expenditure pie (and also | already quite effective in that limited domain). | kgwgk wrote: | I think he includes things like hip replacements which | are "elective" and not of the "pay now or be dead" kind. | dwohnitmok wrote: | Ah, I don't ever remember reading numbers for those so I | can't comment on that (I'd be curious if anyone has a | breakdown of surgery costs by elective, semi-elective, | and emergency). | | But even stuff like hip replacement kind of is on a | sliding scale. How much choice do you have if the | alternative is death? What about cognitive impairment? | What about blindness? What about impaired range of | motion? What about mild discomfort? What about pure | annoyance? | bravo22 wrote: | That's not entirely accurate and that's not even the | meaning of free market. | | Water is also a necessity as is food and you can have a | free market for those. | | The questions are: 1. Does the buyer have enough choices | or alternatives to choose from when it comes to | healthcare? 2. Do those who offer services have a | monopoly on the service? | | When you look at the US market you'll find that it | doesn't meet those criterias. Market forces are | _prevented_ from acting and being able to reduce costs. | | The fact that there is a captive audience, as you | suggest, means that we cannot just shovel money into it. | You end up exactly where you are. Costs go up because it | is a necessity. Same reason food prices go up when there | is a shortage. It is not a luxury. | dwohnitmok wrote: | > Water is also a necessity as is food and you can have a | free market for those. | | What makes you say this (RE water)? | mizay7 wrote: | I think you are making a more articulate defense of | private/market based health care than i usually hear. but | i think fundamentally health care has too many forces | that make it untenable for a market. there is no real | satiation point in care, people are price inelastic, many | services cannot be priced before delivery, there is | little opportunity to do repeated business for most of | the costliest services, comparison between providers is | very difficult, most of the choice happens under | incredible duress when you are your weakest point. health | care is just not a consumer good that responds well to | market mechanisms. | bravo22 wrote: | I suppose it all depends on how you define market | mechanisms. What I've found -- after personally studying | the subject -- is what a lot of people consider free | market is the opposite of what the literature considers | it to be. | | To answer your point: | | Most/all of the issues you raised are met by "pooling" | aka insurance. The need arises at random and when it does | there is a massive cost and you urgently need the | service. This is what insurance is for. | | What I was suggesting isn't that people go and pay the | doctor out of pocket -- although they can. Rather that | they purchase insurance. Those who can't get $$ indexed | to some national average or whatever scheme you prefer. | The point is everyone gets to purchase insurance if they | so prefer. | | The problem is that choice of insurance providers is | artifically limited right now and the choice of | healthcare providers is as well. So you have a system | where you are captive to the need and those who provide | the service have a monpoly. Naturally costs will rise. | Putting political preassure on government to increase | spending is easy way out but that will only shovel more | money from the pockets of the many into the pockets of | the few. In fact this was predicted when Medicare was | first introduced, and here we are. It is not like doctors | and providers magically became greedy capitalists in the | last 40 years. | | Also to be very clear this isn't an issue of "profits". | Insurance companies don't have huge profit margins. They | make their "wealth" by being a monopoly. The execs make | their money on the rise in stock prices which isn't | sensitive to their 3-5% profit margin. | mizay7 wrote: | so you are arguing that many small insurers, with | insurance not bound to employment, would create a healthy | price-quality structure in us health care? akin to the | german model? | | i think that has some merit, but its hard for me to | imagine that having the payer, be disconnected from the | consumer can really create a stable market without heavy | handed regulation. | | i dont think insurance can really get you to an efficient | market. health care is simply not a good where price and | substitution apply as in many other markets. and rather | than jumping through hoops to invent such a market lets | agree that this an ethical part of social contract and | manage it with the best technocratic solutions that our | society can offer. E.G. NHS and NICE | triceratops wrote: | > The fact that there is a captive audience, as you | suggest, means that we cannot just shovel money into it. | | I think the argument for single-payer is that the buyers | of healthcare now have a monopsony to drive down costs | with. | bravo22 wrote: | Sure but that single payer has political motivations and | sources of influence which ensure that won't happen. | | If concentration of power was good we'd just find a few | wise persons to run the country and leave it all up to | them. Other than the little snag, the sinle buyer | argument would work. | | Giving the individual the money to make their choices is | a better way to ensure that people get what they want. A | universal healthcare plan (irrespective of how it is | funded) because different people -- or even the same | person at different stages of their life -- don't have | the same needs and the same risk profiles. | trboyden wrote: | Not accurate and the car insurance market provides the | model health insurance should be based on. In car | insurance you have multiple providers you are free to | choose from with different coverage levels and service | options. If your bad driving history prevents you from | getting standard insurance, government programs provide a | backstop alternative way to get coverage. Yes the | alternative costs more, as it should, because you are | responsible for your driving habits. But there are also | government programs on top of that for low income | drivers. | | The point is, the free market should be plan A, and | government programs should only exist to cover the gaps. | Ultimately, people should be responsible for their own | health, but in special cases, for no fault of their own | issues, government should provide a backstop because it | is the right thing to do. | | Most taxpayers would agree with that. What they don't | want is to be forced into something that is inferior and | on top of that be penalized to subsidize someone else's | premium. | fallingknife wrote: | Privatization doesn't make costs plummet, competition does. In | most cases, our healthcare system is not competitive even when | it is private. e.g. emergency rooms. You will just go to the | closest one. If you look at areas where healthcare actually is | a competitive market, e.g. Lasik surgery, the situation is very | different. | [deleted] | breck wrote: | Healthcare is a disaster because of copyright and patent laws, | not necessarily because of privatization. | | https://longbets.org/855/ | pasabagi wrote: | I think the space successes have far less to do with | privatization, and far more to do with Space X, specifically | the combination of a massive amount of capital sloshing about, | Elon Musk being good at getting his hands on that capital, and | there being an absolute army of engineers who would walk over | coals to build rockets. | | That NASA hasn't been able to capitalize on this situation is | more about NASA's failures than anything else. | maxerickson wrote: | German healthcare has private providers and insurance and so | on. It just has sensible regulation to go with it. | | There are subsidies and everyone is required to pay into the | system, but the administration is privately run. | eatbitseveryday wrote: | Albendazole is given as an example on the page. Last time I was | in China, I purchased a pack of these pills just in a grocery | store pharmacy, no prescription needed. It was something under a | dollar per pill. How does Albendazole still cost $13 / pill to | produce? | newsclues wrote: | Made in America costs more? | alexhwoods wrote: | THANK YOU | mindcrime wrote: | I know it's trendy to hate on billionaires, and by no means do I | think this step makes Mark Cuban the new "Mother Teresa" or | anything. But I have to say, by and large, I feel like Cuban is | legitimately a "good guy" as billionaires go. Yes he's rich, and | he's unabashed about it, but he seems like a normal and | reasonable human being nonetheless. | duxup wrote: | How do you feel you know this? | | I don't know the man either way, and you may be spot on, but | outside folks whose work is largely charitable and etc, how | does anyone feel they know these things? | mindcrime wrote: | _How do you feel you know this?_ | | My impression of Mark Cuban has been built up over the years | from a variety of sources, ranging from a brief in-person | encounter[1] with him, to reading his book, his blog posts, | etc., to seeing him on TV in various forms, interviews he's | done, etc. There isn't exactly one specific thing that stands | out by itself. | | All of that said, it's a very subjective thing, and for all I | know Mark works very hard to cultivate that specific image | for his own ends. I have no problem saying that my impression | could be wrong. But based on the limited evidence I have | available, that's where I'm at with it at the moment. | | [1]: I don't typically hang out with billionaires or | anything. The only reason I've met Cuban is because he was | once a keynote speaker at an event I attended. After his | speech he hung out with the hoi polloi and mingled and | interacted with people. I spent maybe 3 minutes chatting with | him personally about my business, and maybe another 10-15 | minutes listening to him talk to a small crowd that gathered | around him. To be fair, that encounter probably went as far | in shaping my impression of him as anything. I think the | single biggest thing was that he displayed no condescension | or smug superiority or anything towards people who weren't on | his financial level. He was respectful, attentive, and | reasonable even when talking with some rando like me. | brandall10 wrote: | When I found out the a-hole on Silicon Valley was partially | based on him, I had to do a little research | | Couldn't find one negative experience. There are several | threads on Quora for instance detailing how he treats | everyone with respect and is a genuinely good dude. | duxup wrote: | Thank you. I prevaricate your response. | brundolf wrote: | Broken clock, etc. | | (the "broken clock" being the obscenely wealthy as a class, not | necessarily Cuban himself) | andrewon wrote: | not sure if the world can count on his moral value, but more | competition is always good. If the narrative of generic drug | pricing fixing is true, it would be a wonderful business | opportunity as well. | technotony wrote: | He's a major investor in my company, and can 100% attest that's | true. What's most astonishing about him is how responsive he is | even two years after making that investment. He must have so | many companies and he's still always showing up and encouraging | and providing value. He's pretty direct when he thinks we are | doing the wrong things, but that's always appreciated. His | super power is handling all that over email (mostly). | adventured wrote: | I second that sentiment. I was in business with Cuban for | many years, he always responded quickly and could always be | reached via email / messaging in a matter of minutes in most | cases if something came up. An almost ideal investor for an | entrepreneur and his terms are very unusual in the industry, | he often takes common shares with no strings, he's on the | same playing field as the founders. | stretchcat wrote: | The real Mother Teresa was no 'Mother Teresa.' | StavrosK wrote: | What, you aren't a fan of needless suffering? | joachimma wrote: | To be fair, when it was her time, neither was Mother | Teresa. | StavrosK wrote: | For thee, but not for me. | citizenkeen wrote: | I think a lot of that comes down to his background. Mark Cuban | is from a very blue collar background. Compare that to | Bezos/Musk/Gates/Zuckerberg, all of whom were from money. | lawwantsin17 wrote: | If by "very blue collar" you mean his father OWNED a car | upholstery shop. Funny how owners still get to be called | working class like that. Wonder how much that fake news | costs? | phkahler wrote: | Isnt he the one who returned a bunch of Covid stimulus money | after being called out on not needing it? Perhaps an oversite | in his business empire, or perhaps damage control? | tw04 wrote: | There are two options when you're rich like Cuban is (clearly | there's more but to dumb it down). | | You can acknowledge that while it took hard work, and luck to | get where you are, you likely would not have done it if you | hadn't been born into a society that fosters the ability to | move up the social ranks. If Mark Cuban were born in Libya | there's almost no chance he becomes a billionaire for instance. | | Or you can pretend like the reason you're rich is solely of | your own doing, and that the world owes you something. | | Cuban seems to be the former, and while he's not going to | volunteer to just give all his money away, he is trying to help | society collectively improve. It's a stark contrast between his | approach and say, the Koch brothers. | | I guess the best way I'd put it is Cuban is a capitalist who | believes in the social contract. | frongpik wrote: | Off topic. What do you mean by "if he was born to Libya"? | Does it imply prior existence? The official theory is that we | are created during those 9 months, assembled like cars, and | if so, he couldn't be born to libya because the body | assembled in libya would be completely different. In the | unofficial theory, e.g. buddhism, prior existence is a thing, | but even then Mark couldn't be born to Libya: there were only | few choices for him matching his prior achievements and every | path would lead to a billionaire status. | zarkov99 wrote: | By and large this country is very lucky with the billionaires | it continues to produce: Bezos, Cuba, Buffet, Gates, Paul | Allen, Zuckerberg, Dorsey, Musk, etc, all seem to be incredible | people who are committed to do good. I think it has something | to do with the fact that these people are self-made and for the | most part made their billions without having to sell their | souls to the devil. | EForEndeavour wrote: | I legitimately can't tell if this is satire, particularly the | "self-made" part. | | Bezos' parents loaned him a quarter-million dollars in 1995 | [1]. | | Gates' mother, while on the board of directors of United Way, | convinced IBM to invest in MS in 1980 [2]. | | Zuckerberg's parents sent him to the crazy selective and | expensive boarding school Philips Exeter Academy and was | privately tutored in comp sci before college [3]. | | [1] https://www.cnbc.com/2018/08/02/how-jeff-bezos-got-his- | paren... | | [2] https://www.nytimes.com/1994/06/11/obituaries/mary- | gates-64-... | | [3] https://www.newyorker.com/magazine/2010/09/20/the-face- | of-fa... | saberdancer wrote: | It's a long way from quarter of a million to Amazon. | | How many people get quarter of a million in inheritance or | have rich parents? It's silly to call out "self made" just | because someone got a loan. Bezos did not inherit billions | of dollars, he is a billionaire now. By any metric he is a | self made billionaire. | tshaddox wrote: | The point isn't that it wasn't hard work to grow from | $250,000 to billions. The point is that there's a big | difference between saying "anyone who works hard can | build a company like Amazon" and "anyone who works hard | and got $250,000 from their parents can build a company | like Amazon." | 1MoreThing wrote: | It's a lot longer from zero (or negative, in you have | student loans) to a quarter million if you're working | outside the SV/software engineer salary bubble. | Aunche wrote: | This is a straw man. Nobody thinks that "self-made" means | that you literally had no help whatsoever. Bezos was a | hedge-fund SVP before starting Amazon, so it's not as if he | was particularly hurting for more funding. | tshaddox wrote: | It's not a straw man if the first commenter was intending | to use "self-made" to actually mean something to a reader | anywhere close to an average reader. To an average | reader, even on this website which probably skews | American and wealthy, it's just not reasonable to refer | to someone as a "self-made billionaire" when they | received a loan from their parents that's well over 3 | times the median _household_ income in the United States. | Aunche wrote: | Self-made just means that you made the money with your | own effort as opposed to inherited it. There's nothing in | that comment that attempts to paint them as relatable. If | they wanted to do that, they would talk about Bezo's | teenage mother and adoptive Cuban-immigrant father. For | all we know, that $250,000 could have been money gifted | to Bezo's parents while he was employed at DE Shaw. | chipgap98 wrote: | I think out of the group you named at least Zuckerberg and | Bezos have sold their souls to the devil | desireco42 wrote: | I would separate here, Bezos is evil because he is just | amassing wealth, avoids taxes and pretty much is focused | only on himself. Contrast that with Cuban who is also | amassing wealth, but also is trying to do what is good for | the community. | meowface wrote: | Bezos has donated a lot to charity, including $10 billion | to fight climate change and $100 million to food banks in | 2020. Sure, he could donate more, but % wise that's | probably more than many people reading this have donated | in 2020. And I don't want to start a debate over it, but | I do believe that the primary intention behind Blue | Origin is to benefit humanity. | | The main issue with Bezos is worker conditions at Amazon, | I think. | desireco42 wrote: | These are mostly tax moves, not genuine concern, in my | view. | | https://www.bloomberg.com/news/articles/2020-02-18/jeff- | bezo... | lostapathy wrote: | And in the 90's, many were convinced Gates _was_ the devil. | [deleted] | zarkov99 wrote: | I am conflicted about Zuckerberg, I think I understand | where you are coming from, but Zuckerberg contributes | heavily to charity and perhaps might not have realized the | monster he was creating in Facebook. Similarly Dorsey. I do | not get the Bezos hate. | stretchcat wrote: | Doesn't Zuckerberg still have a controlling interest in | Facebook? Seems to me, that makes him more culpable than | most of the rest. | lancesells wrote: | I'm just looking at what Wikipedia says Zuckerberg is | worth but it's $69B. Looking at what Forbes said his | charity (which does not mean 100% his money) they donated | $410 million in 2018. That's ~0.006% of his wealth | meaning it's not even giving away a penny out of $100. | It's close to half a penny out of $100. | | I understand net worth of $69B is on paper but none of | these guys are philanthropic. | holbrad wrote: | Are you sure it's not 0.594% of his networth as opposed | to 0.0006? | oh_sigh wrote: | You're off by a factor of 100. | [deleted] | lancesells wrote: | Edit: My math was off. Thanks to those correcting me. | meowface wrote: | One of the big issues with Zuckerberg's optics are the | circumstances around Facebook's creation. An app to rate | people's attractiveness, laughing in chat logs that | people would trust him with their personal information, | etc. Combined with the externalities and immense power | they now have, it's not a great look. | | However, I agree that he's probably a better person than | most give him credit for, and I think he's really stuck | between a rock and a hard place on a lot of these issues. | Especially things relating to politics, | mis/disinformation, and free speech. I consider the | proliferation of non-paid online services (who therefore | can only survive by making money in other ways) the true | bane of humanity; not any particular executive. (That | said, I'm also not going to let anyone off the hook once | they deliberately choose to create such a service.) | | I had a high opinion of Bezos until the disclosure of | Amazon's poor working conditions. His making the minimum | wage for workers $15/hour is a good step, but I think | they're going to need to do a lot more before that | reputation changes. Other than that, I admire him. | | Dorsey seems to be the least hated of the bunch, and I | like him, personally. He seems like he still has a kind | of hacker mindset, and I believe he genuinely wants to | make Twitter a force for good in the world. I'm not sure | if he'll be able to accomplish it, though. | rland wrote: | How many more billionaires than those that you've named has | it produced? | | What about Exxon, AT&T, Aetna, AIG, Goldman, DuPont Chemical, | Lockheed, McKinsey? | | There's a pretty obvious bias there: the ones you name do | good because you named the ones who do good. (which, really, | you could examine: how much of that perception is PR?) | | We're not lucky to have billionaires. We'd be just as well if | there were none at all. | antman wrote: | What do you consider most probable: | | - They are all the greatest people ever | | - They all can afford to employ the most expensive personal | marketing teams ever | SeanLuke wrote: | > all seem to be incredible people who are committed to do | good | | Gates and Zuckerberg were far from models of piety in how | they came into their fortune. | wpdev_63 wrote: | Make no mistake Mark Cuban is a snake if you ever lookup his | past business dealings. He made his money by basically pushing | out fellow founders at paypal. | jermaustin1 wrote: | > He made his money by basically pushing out fellow founders | at paypal. | | I wasn't aware he was a founder at PayPal. I didn't even know | he had worked for them. | arrosenberg wrote: | Mark Cuban made his money selling Broadcast.com to Yahoo. | mtgx wrote: | As a society we should have better policies than depending on | the 1 in 100 good-heart billionaires, don't you think? | breck wrote: | Ever since he joined Shark Tank that show has become one of the | best things to happen to our economy in the 2000's. | | He's exposing millions of Americans to the long term benefits | of a value creation, non-linear thinking, honesty is the best | policy, builder/craftmanship mindset. | | When I was a kid growing up far away from Silicon Valley we had | "The Apprentice" to learn from. Shark Tank (especially Cuban, | but really the whole cast), is orders of magnitude better. | skizm wrote: | I believe there was a point when Shark Tank would take some | amount of equity from every business that came on the show | regardless of if one of the sharks invested or not. Cuban | called BS and said he wouldn't be on the show if that was the | case. The policy was removed as a result. | | Smart move too, since you will probably get better companies | on the show without that sort of policy. | breck wrote: | Yes. I can confirm this is exactly what happened (roommate | almost went on the show, pre-Cuban. though I'm sure theres | a lot more to the story that insiders would know). | valarauko wrote: | Curious: does the show take equity IF the sharks invest? I | haven't really seen the show beyond a few episodes. | Judgmentality wrote: | No. The negotiations are real, and while there is a | follow-up due diligence to close (or not) the deal, that | is it. Note that anywhere from 1/3 to 2/3 of deals fall | through in the due diligence phase, depending on the | shark. | | The first season, before they brought on Marc Cuban, the | show took a percentage just for appearing on the show (so | even if you didn't get a deal, you still gave up equity). | The second season, Marc Cuban came on and insisted they | remove that rule. | | https://www.forbes.com/sites/emilycanal/2016/10/21/about- | 72-... | | https://www.cheatsheet.com/entertainment/do-the-deals-on- | sha... | mcculley wrote: | I have attended a few presentations where Phil Dumas, | founder of UniKey, described his experience winning an | investment on Shark Tank. He explained that there were | many unattractive terms in the agreement he received | after the recording that made him ultimately decline the | investment. My takeaway was that it doesn't matter what | happens on the show, the real offer is more complicated. | | (I have never seen the show, so I don't know how the | offers are described. As an investor, I cannot imagine | any offer that can be made verbally in the timespan of a | television episode being meaningful.) | Judgmentality wrote: | The shows are edited for time. Each negotiation, which | airs for about ~10 minutes on the show, takes an average | of 2 hours to shoot (with a surprisingly wide variance). | dylan604 wrote: | It's meaningful in getting future guests/contestants to | be willing to appear on the show. If all of the sharks | only ever said no, nobody would want to go on the show. | They have to at least make the audience think deals are | happening to keep an audience. After that, if the deal | actually completes or not are not relavent to the | producers of the show. They just need to line up the next | round of chum to bring out in front of the sharks. | alistairSH wrote: | _I have never seen the show, so I don 't know how the | offers are described._ | | Usually it's just one of the sharks offering something | like "I'll pump in $500k for a 20% stake." (numbers made | up) No details beyond that. | mmcconnell1618 wrote: | I love when "medical" products with incredible claims show | upon Shark Tank because Cuban usually shreds the owner's | claims in about 2 seconds. He doesn't seem to tolerate | grifters very well. | | This venture seems like a shot across the bow of anyone | trying to squeeze an unfair percentage on top of generic | drugs. Kudos to Cuban for launching this but it is | something the US government should have been doing decades | ago through drug price negotiation for medicare. | Zolt wrote: | I too had a lot of respect for Cuban regarding this. | | Article from Inc: | | Mark Cuban Made Shark Tank Change Its Contracts After | threatening not to return until an equity clause was | removed from contestants' contracts, Mark Cuban finally got | his way. | | Just for appearing on the show, owners agree to give up 5% | of their company or 2% of future royalties. | | ... | | Cuban said the clause was removed retroactively, meaning | every contestant who's appeared on the show since Season | One will be relieved of the commitment. However, how that | will work out logistically remains unclear. | | https://www.inc.com/will-yakowicz/mark-cuban-forces-shark- | ta... | pradn wrote: | You have a rather charitable interpretation of the show. I | saw 4 powerful combative "investors" holding ordinary folks | in their fists, playing with their lives, and sometimes even | verbally abusing them. The show offers a lottery ticket on | top of the lottery ticket out of day-to-day work that is | creating a new business. What invention the participants | bring is commodified a second time, a double grotesquerie. I | absolutely can't stand it, and the show, in teaching viewers | to hold unsuccessful contestants in contempt, also promotes a | sort of circus-like misanthropy. | mattdeboard wrote: | You grew up watching The Apprentice? wow, wild. it started | airing in 2004 | donkeyd wrote: | So.. Someone who was 12 back then is now 29. Doesn't seem | that wild to me. | mattdeboard wrote: | ...Great, thanks for checking in. | breck wrote: | Yup, my mom and I watched it together for years. At least | it was worth it for that QT (now somtimes we still watch | Shark Tank together). This is back when I was still a | script kiddy and lemonade stand entrepreneur. | | I also read "Art of the Deal" or whatever that crap was | called. | | Sometime I can tell you the story of how I sued a Fortune | 50 company after a minor disagreement because I thought | that's how business was done. | | I can only laugh about all that now, and shout "thank you" | to Cuban that we have at least one highly entertaining | business show that also teaches mathematically correct ways | of thinking about business. | m8s wrote: | I think at certain levels of wealth, being "normal" is simply | impossible. But there are people who use their fortunes for | altruistic causes and that should be celebrated. Unfortunately, | most of these cases simply highlight fundamental issues in | other areas of our society. | Eric_WVGG wrote: | This is awesome. I've been daydreaming for years that Bezos | would launch some kind of "CostCo, but drugs" operation, as I | figured he had the infrastructure... but this will do just | fine. | | He should get insulin and epipen factories running ASAP, those | are very high profile scams in the US right now. | | Looks like they could use some web dev help... | yepthatsreality wrote: | Amazon usually waits until it can clone the operations before | it dives into a new territory. Even though they would be set | up for it quite easily as you say, they're approach in the | past has been more EEE...or more politely adopt and optimize. | aj7 wrote: | By the way, Costco's prices are pretty good in the current | environment, especially in large quantities. | criddell wrote: | There was a pretty good thread about insulin on this story | when it was posted to Reddit: | | https://www.reddit.com/r/UpliftingNews/comments/l5vv6m/billi. | .. | maxerickson wrote: | Costco sells a bunch of generics. Their Allegra is super | cheap compared to everyone (or was the last I checked). | perrylaj wrote: | Most in my state (CA) also have fully functional | pharmacies, and the prescription drug prices are much | cheaper much of the time. I shopped around when I went | through a period of poor insurance (years ago) and my | monthly medication costs were $25 at Costco, and the | nearest competitor I could find was just over $100 when | paying cash. Also, I believe that California, you do not | need a Costco membership to purchase from the Costco | pharmacy. | aj7 wrote: | That is correct. Just tell them you're going to the | pharmacy at the entrance. | triceratops wrote: | You also don't need a Costco membership to purchase | alcohol. And a lot of Kirkland liquor is the absolute | bomb. | Larrikin wrote: | What is good besides the vodka being a near identical | done of Grey Goose? I feel like I got kind of burned with | their tequila, which was extremely mediocre. | TylerE wrote: | Their scotch can be good, but look up the specific | bottling. Sometimes it'll be something like a "factory | second" of MacCallan 18... not the prime barrels, not as | good as the stuff actually sold by macallan, but also | about 1/3rd the price. | triceratops wrote: | The gin is pretty good value. I agree about the tequila. | tshaddox wrote: | I've heard that their scotch is extremely competitive at | that (low) price range. | ryneandal wrote: | Not sure if their supplier has changed in the past few | years, but their bourbon is pretty good for the price. | There was speculation it was from Jim Beam, some kind of | Knob Creek barrels. | klondike_ wrote: | This isn't the case everywhere. It depends on which state | you live in | tshaddox wrote: | I think this is only true in a handful of states. In | California, there's apparently an old law that you can't | have members-only alcohol clubs, so Costco technically | has to let you buy alcohol. | | I tried this once last year before I had a membership, | and the person at the entrance told me they would need to | get an employee to escort me, and it might take an hour, | because they're busy. | | Presumably this is the kind of thing that a court would | smack down, since I'm pretty sure they're required to | _actually provide reasonable access_ , but I was just | trying it for fun and didn't make a fuss about it. | CogitoCogito wrote: | > I tried this once last year before I had a membership, | and the person at the entrance told me they would need to | get an employee to escort me, and it might take an hour, | because they're busy. | | > Presumably this is the kind of thing that a court would | smack down, since I'm pretty sure they're required to | actually provide reasonable access, but I was just trying | it for fun and didn't make a fuss about it. | | Also it makes no sense for them to need to escort you. | They scan your card on checkout so how would you buy | stuff other than alcohol anyway? | | Anyway I've never heard of anyone being told that before. | I understand not making a fuss (we are social animals | after all), but it probably should be done so they don't | keep trying BS like that. | Eric_WVGG wrote: | They sell generics, but I don't believe they actually make | them. | | Allow me to clarify: CostCo sells everything at a fixed | profit margin (I believe it's around 18% but I could be | mistaken). I have no idea where their generics come from, I | doubt they manufacture themselves, so before the CostCo | markup they are subject to the same inflated prices you'll | find anywhere else before the pill reaches the drugstore or | your doctor or whatever. | | What I've been imagining, specifically, is generics | manufacturer that applied a fixed profit margin -- "cost | plus" -- to their products. I guess that's not precisely | the CostCo model, but you get my drift now. | jacobriis wrote: | "CostCo sells everything at a fixed profit margin (I | believe it's around 18% but I could be mistaken)." | | You're mistaken no they don't. | Eric_WVGG wrote: | You're right, it's not fixed. It caps at 14% for outside | brands, 15% for "Kirkland" brands, but averages at 11% | (2019). https://www.inc.com/jeff-haden/how-does-costco- | compete-with-... | | Contrast to markups of 25 to 50% for typical retail, and | for generic drugs in the thousands. | https://www.thepharmaletter.com/article/1-000-pharmacy- | mark-... | _underfl0w_ wrote: | Still waiting for the clarification. You nailed the | denunciation, though. | U8dcN7vx wrote: | Didn't Amazon buy PillPack? Not sure I can seem them moving | to manufacture product though it certainly is possible. | nceqs3 wrote: | I like Mark as well but he has had is bad moments. | | Hanging out with Tai Lopez and making vids with him??! Come on. | tomelders wrote: | Imagine you and I share an apartment and we split the rent | between us. It's not a great apartment. There's mould in the | bathroom caused by a lack of ventilation. The carpet is a mess. | The power keeps cutting out if we plug too many things in. | | Now imagine I tell the landlord I'm going to move out unless he | fixes these issues and he then offers me a 50% discount on the | rent. Now imagine he recoups that discount by putting your rent | up by the same amount. And now imagine that I use those savings | to buy a nice big TV for the two of us. The bathroom is still | covered in mould. The carpet is still a mess. The power still | cuts out all the time. And you pay more rent than me. | | But I bought an awesome TV for us. So I'm the good guy right? | dylan604 wrote: | What an unrealistic comparison. No landlord would ever do | that, nor would the roommate agree to the changes that the | landlord would attempt to make even if that is something the | landlord would do. | ficklepickle wrote: | Aren't you in Vancouver? I've had landlords here that would | absolutely do something like that. Many slumlords would do | anything they think they can get away with. | kortilla wrote: | This analogy would work if you were already paying 10000x | more than the roommate in the first place. | | Remember, all of the talk of billionaires "paying less in | taxes than their assistants" is not based on raw collected | amounts, it's based on percentages. A billionaire with an | effective federal tax rate of 15% on 50 million income is | paying 7.5 million in taxes, which is more than all of the | federal tax collected from the bottom 10% of income combined. | [deleted] | kirillzubovsky wrote: | From what I understand generic drugs are currently often made | overseas, and then sold back to American market. Although he | may not be a bad guy, he simply knows how to make money, and | there are many billions left for the taking in this market. | Definite not Mother Theresa, but better done locally, at the | least. | hoopleheaded wrote: | The recent events where he helped Delonte West make for a | pretty uplifting story that helps me believe Cuban is a decent | and empathetic human being. | chad_strategic wrote: | I'm not going to over analyze this good news. | | I'm going to accept that at least one thing in the world seems to | have gone right today. | xiphias2 wrote: | 2 if you look at what's happening with GameStop | offtop5 wrote: | I'm a bit too cynical to believe a benevolent billionaire will | save us. | | Me thinks theirs something else at work here. I could see Mark | Cuban building this company up , selling it for billions at which | point we're back were we started | jawns wrote: | I agree, either there's something else going on or he's | entirely genuine about the mission -- in which case it's | unlikely to thrive. | | While this business model can work in some industries, in this | particular heavily regulated industry, Cuban is either going to | discover that it's harder than it looks and fold in a few | years, or he's trying to sell a grand vision and offload it for | a profit before the cracks in the foundation are discovered. | | I would be more inclined to see the mission as genuine if this | were launched as a public benefit corporation or B corp (but | even then, the promises such companies make of serving the | public good can be overblown). | deelowe wrote: | I believe Mark Cuban is an altruist, but as you alluded to, the | empires he builds are not inherently benevolent and could | eventually end up in the same place over time as ownership | changes. | ksm1717 wrote: | It's easy pickings but putting your name on a generic drug | company seems like an oxymoron. This and the thing in the news | recently with Delonte West's rehab that Mark Cuban sponsored - | not even an attempt to get the stink of PR off of it which rubs | me the wrong way | retrac wrote: | I'm not usually a "market" guy, but some good competition in | generic drug production might actually save us. Presumably, he | sees large potential profits by aggressively undercutting the | non-competitive overpriced generics. If that takes off, it | could be a good thing overall. | wrsh07 wrote: | I'm also pretty cynical about this. It will only work if it | fundamentally changes the pharmaceuticals industry | | They could make up the loss on volume, though. Especially if | selling outside the US | | Or as you say, they might join the incumbents and renege on the | promise painted here | sn_master wrote: | I like to know where those drugs are manufactured. I don't want | to buy from another Ranbaxy... | treelovinhippie wrote: | This is hilariously bizarre from a non-US perspective, but your | country is so primitive in this area that a "Mark Cuban" branded | solution is probably the most viable path out of the mess. | thesausageking wrote: | "The Mark Cuban Cost Plus Drug Company" is a mouthful. Did he | really need to put his name on it? | | I also don't see anyone else listed on the website. No | physicians, no chemists, no engineers. It doesn't inspire | confidence. | xiphias2 wrote: | Actually I like it that an investor gives his name to a | company. Usually problems start when he's not the main owner | anymore though.... | valarauko wrote: | "Cuban Drug Company" would be more fun | dfxm12 wrote: | The CDC? :) | marton78 wrote: | Cuban Drug Dealership | res0nat0r wrote: | I wonder how much of a shakeup between this and whatever Amazon | Pharmacy is doing may have on pricing... | | https://pharmacy.amazon.com/ | athenot wrote: | The name let me to think it was related to Cost Plus World | Market, the home goods store. | | https://www.worldmarket.com | xmichael0 wrote: | Not sure, but albendazole seems over priced still. I bought 6 | tablets less than a year ago in Costa Rica for about $5 | dexwiz wrote: | Mark Cuban must have my conversations bugged. I recently was | talking to a friend about how the rich should realign how they do | large charity spending. | | In previous decades a rich industrialist may have built a library | or a university building. This made sense when education was for | the rich, and knowledge was inaccessible the wider public. But | now knowledge is cheap, and large gifts like this are | disconnected from today's average public person. Also putting a | name on a hospital that still puts people into debt isn't a good | image either. | | Now the wider public needs cheaper pharmaceuticals. In order of | the rich to stay in power for extended periods, they need to give | some amount of handouts. Nuevo rich don't understand this, so | they look to predecessors, and look on how they spent their money | (hospitals, universities, etc), without realizing why they spent | it. Expect to see more charity capitalism aligned with today's | needs: generic drugs, taxi services, even phones and internet | access. | tthun wrote: | is this sort of the "free market" example of disruptions in | healthcare space that could may be move healthcare in US towards | a model where you pay for what it actually costs instead of the | inflated and opaque pricing that private health insurance thrives | on ? | wrsh07 wrote: | In spite of the missing question mark, I think the answer is | yes | | I'm not even particularly bullish about companies being able to | improve transparency (it's a really complicated system, the | incumbents stand to make/lose enormous sums of money, even when | lower cost alternatives exist doctors might be contractually | obligated not to discuss them) | | But I think that this is a really good step | | Similar to toasttab or chownow in the food ordering space | weeboid wrote: | Nice, $GME the fuck out of big pharma | ChuckMcM wrote: | This is great, do Insulin now. | woadwarrior01 wrote: | Everything is relative. The first generic they're launching at | $20 a tablet: Albendazole, retails for less than 50 cents a | tablet in India. | asdfadsfgfdda wrote: | I doubt $.50 is the true cost, there's a program to donate | millions of tablets to developing countries: | | https://mectizan.org/partners/glaxosmithkline/ | georgeecollins wrote: | People in the US can afford to pay a lot more for healthcare | than in India. They just can't afford to pay twice as much as | other industrialized countries. | retrac wrote: | Mebendazole (functionally equivalent to albendazole, as I | understand it) is 4 USD a tablet here in Ontario. So even | with this you're still paying 3x as much. | [deleted] | flowerlad wrote: | Close to $0.03 USD: | | https://www.sastimedicine.com/salt-alternatives/5785-736518/... | aiven wrote: | compare price of labor between usa and india. Outsourcing | everything to asia will be beneficial for company (and probably | consumers since lower prices), but not for americans who work | for cuban rn | markdown wrote: | This isn't the garment industry. Labour costs in drug | manufacturing (as opposed to drug development) are | negligible. | randyrand wrote: | From the original title, i thought the company was called | "Transparent". | | That would have been a better name than this long name. | f430 wrote: | You can shit on billionaires and capitalism all you want but you | can't argue with the benefits of trickle down effect of wealth. | | Somebody has a big ego and wants to put his name on schools, | hospitals? Let him. | | Somebody wants to make a profit by exploiting the inefficiencies | of an industry? Let him. | | Wallstreetbets wants to take out a few hedgefunds by beating them | at their own game? Let's go. | ksm1717 wrote: | "Can't argue with the benefits of the trickle down effect of | wealth"... yes I think decades of economic doctrine have | covered the benefits. Probably should keep in mind other things | like the consequences | Nelkins wrote: | I wonder what the chances are that they take on insulin. | cyokada wrote: | Albendazole can be found for US$ 1 in drugstores in Brazil. | lawwantsin17 wrote: | Wait, who's funding this? Doesn't mention his name. | ttul wrote: | " The first product we are producing is Albendazole. Albendazole | is an antiparasitic drug that currently has a list price of | approximately $225 per tablet (currently listed average cash | price per tablet on goodrx.com)." | | I bought this in Canada for maybe $30 last year. And not just one | pill. An entire course of it. | whitej125 wrote: | For those interested... I thought this was a pretty good book | going over the creation and evolution of the US Healthcare | system. It's equal parts fascinating and infuriating. | | An American Sickness: How Healthcare Became Big Business and How | You Can Take It Back | | by Elisabeth Rosenthal | | ASIN : 1594206759 Publisher : Penguin Press; 1st edition (April | 11, 2017) Language : English Hardcover : 416 pages ISBN-10 : | 9781594206757 ISBN-13 : 978-1594206757 | sitkack wrote: | This needs to get plugged into medicare/medicaid on a national | level. | jimbokun wrote: | Looks like Mr. Cuban is demonstrating that, sometimes, a superior | business plan is the shorter path to justice than waiting for the | Courts and the Legislature to catch up. | | Wiping out their businesses financially might be the most | effective way to fight them, in the short term. | mikepurvis wrote: | Given the name and positioning of this business, I would say | it's partly a PR stunt and partly an act of charity (a non- | charitable approach would be to undercut by only 30-50% instead | of 90%). | | So yeah... it's great that billionaires occasionally step up to | "fix" issues created by corruption and inadequate | regulation/oversight, but I think if you're going to take a | position that this is somehow better than waiting for the | system to fix it, it might be more instructive to look at how | this works in countries with a functioning bureaucracy. For | example the drug given on the homepage is Albendazole, which | they're selling for $20-- well guess what, that pill is $2 in | the UK and has been since the patent expired in the 90s: | | > "In other countries, there are price control methods. The | government steps in to ensure drug prices do not increase by a | certain amount," Alpern says. "There are no price control | mechanisms in the U.S." | | https://www.npr.org/sections/goatsandsoda/2017/12/11/5677534... | JumpCrisscross wrote: | > _a non-charitable approach would be to undercut by only | 30-50% instead of 90%_ | | Not if you're fighting deeply entrenched incumbents. | Switching costs are huge, financially and politically. You | need patients to hammer their providers to give them access | to these drugs through this channel. | | 50% off is big, but it's something incumbents could match. | 90% off leaves you with a profit margin, gets you PR points | and holds the hounds at bay. Bonus: if you work out your | competitors' debt loads and price at a level that they | couldn't, financially, sustain. | mikepurvis wrote: | If the incumbent is a large scale pharmaceutical company | with thousands of drugs in its portfolio, then it can most | definitely afford to lose money under-cutting you when you | only make a small handful. | | And I think that really just underscores why this approach | is the Google Fiber of the US pharma market-- it may be | able to force prices down for a handful of select | customers, and may be helpful for proving a point about | true costs and the need for regulation, but its existence | is most certainly not some kind of proof of the invisible | hand stepping in to solve this problem on its own and that | regulation is therefore unnecessary. | JumpCrisscross wrote: | > _it can most definitely afford to lose money under- | cutting you when you only make a small handful_ | | Which gives you a textbook Sherman Act claim. | | In any case, a loss-tolerant competitor doesn't argue for | a 50% discount versus 90%. | mikepurvis wrote: | Of course not-- it argues for not bothering to enter this | space at all unless you're doing so with ulterior | motives, for example as a PR stunt. | | As for antitrust laws, isn't the whole point that we're | in this mess because the incumbents are all conspiring to | fix prices and the existing consumer protection systems | which should be preventing that have been failing | Americans for decades and thank goodness for the free | market which created the necessary incentives for Mark | Cuban to swoop in and start this business? | JumpCrisscross wrote: | > _incumbents are all conspiring to fix prices and the | existing consumer protection systems which should be | preventing that have been failing Americans for decades_ | | The Sherman Act prohibits monopolies or cartels damaging | competitors. As a competitor, you have standing. As a | consumer, you do not. | | I think this business could be phenomenally cash-flow | positive in short order. It's not dissimilar from the way | Teva started, just further down the pipeline. | at-fates-hands wrote: | Which in turn creates another long term disaster waiting to | happen. | chadlavi wrote: | The "sometimes" there being "when you live in a country that | respects businesses more than humans" | | The market should never be relied on to be the one to fix | injustice. | dnautics wrote: | If by market you mean "for profit companies", that's correct. | But if "market" is taken to mean "marketplace of ideas"... In | free market philosphy there is a lot of sunlight in the gap | between corporate behemoths and government, ranging from | individual action through mutual benefit associations all the | way up to pbcs and ngos. The point is government should also | not be relied upon to correct injustice. In the end justice | is up to the _people_ , and if a for-profit takes the banner | of justice that's decentralization of power at work. | m463 wrote: | robust competition cleans up a lot of problems. | | Also, as an employee having a company that has to actually | compete can really eliminate a lot of BS. If you're in the | 800-lb gorilla, there can be a lot of dysfunction. If you're in | a company with an 800-lb gorilla, there's a good chance what | you do may not matter (unless its really good). | taurath wrote: | Robust competition doesn't exist without strong regulation, | because the natural state of competition is monopoly even | with a medium barrier to entry. Almost all of our companies | nowadays are high barrier to entry. | satyrnein wrote: | In this case, isn't the barrier to entry itself regulatory? | The drug approval process stops new entrants and federal | law stops consumers from buying drugs from other countries. | Otherwise, I imagine there would be a pretty robust market, | given that these are generics and there's no R&D involved. | hh3k0 wrote: | If we'd ban lobbying we wouldn't have to wait for one business | to show up from somewhere else than the depths of depravity. | | If we'd ban lobbying we could have laws against companies that | show nothing but utter disdain for life. | HenryBemis wrote: | "Lobbying" is legitimising bribes from corporations | politicians. It is as simple as that. | | If USA wants to change the game (they don't) they can ban all | corporate donations (aka legalized bribing), allow only | donations by individuals, and then impose/enforce a limit of | $10-25-50k per person (or something reasonable). Anyone | playing tricks to game that rule get a penalty of x20 the | excessive amount donated (e.g. via others). Also put all | donations in public record. As simple as that. | | It makes no sense to me that you (USA) spent $14bn [0] on | this election. | | [0]: https://www.cnbc.com/2020/10/28/2020-election-spending- | to-hi... | h_anna_h wrote: | I think that you are being too optimistic here. | jimbokun wrote: | Sure, but what odds do you give to that happening in the near | future? | ch4s3 wrote: | How do you practically ban lobbying without removing the | ability of private citizens to directly interact with the | legislature? There are good reasons to allow groups of people | to get together and pay someone to go hassle congress on | their behalf. Regular people are busy with their own lives | after all, and most of them live far away from Washington. | And sometimes you want to complain to a representative from | outside of you own district, because they're sponsoring | legislation that would hurt you, or blocking legislation that | would help you. | mikem170 wrote: | We could start by banning political campaign funding from | corporations and unions. | | I took a look at a handful of western democracies and they | all either banned or drastically curtailed this. People | need to be in control of their government, and that | includes campaign funding. | mindslight wrote: | You write the laws to apply to companies but not private | citizens. A major owner of a pharma company could still | lobby privately as themselves, but at least they'd be | paying taxes on that expense rather than having it hidden | as a corporate writeoff. | | (And before anyone chimes in with "but corporations are | just groups of private citizens" - they're explicitly not. | Corporations are fundamentally defined by having a charter | from the government to reduce the owners' liability, and | thus we would expect them to incur additional regulations) | ch4s3 wrote: | I imagine CEOs would just lobby privately and in person | then, but pay a team to do all of the other leg work. | This is trickier issue than people popularly imagine. | | Influencing the leaders of a global super power is | incredibly valuable, and lots of people want to do it for | a lot of reasons. | | In your proposal, would you ban NGOs, non-profits, and | unions from lobbying? Why or why not? | mindslight wrote: | If the CEO were paid an extra $10M salary so they could | turn around and personally spend it on a lobbying firm, | that would at least reduce the efficiency of said | lobbying by 37%. | | The biggest issue is the complete lack of reporting, and | anything that pushes the money flows more into the open | (your hypothetical CEO is then personally responsible) is | a step forward. Take a look at the stark difference | between campaign finance reporting for individual | candidates, and everything else. | | Your last bit is a loaded question. If an entity's | business _is_ lobbying, then obviously they can engage in | lobbying. But they could only be funded by individuals, | not companies whose business is other-than-lobbying. | Judgmentality wrote: | You could limit the amount of money you can make via | lobbying. If it was illegal to make more than $1 MM a year | through lobbying, suddenly the playing field would be | significantly more level. If a corporation can pay you $1 | MM and a group of citizens can pay you the same, suddenly | you care more about the message than the receipt. And the | majority of ultra-rich lobbyists will do something else, | because that's not nearly enough money to interest them. | | I'm not a fan of limiting salaries in general and I do not | believe this is a good solution, but I believe it's likely | to be better than the current situation. This is just me | spitballing on a whim, having put approximately 60 seconds | of thought into a solution. Hopefully people more informed | will reply with better solutions or an informed explanation | of what's wrong with my idea. | dstick wrote: | He forgot "by companies". Your point is valid. It should be | banned for companies. Either directly or indirectly. | tolbish wrote: | Universal health care may be a more pragmatic approach than | "ban lobbying", IMO. | geodel wrote: | Huh, I have seen countries where lobbying is illegal but they | are vastly more corrupt than US. | | Finding one scapegoat and blaming all problems to it seems | cartoonish level simplistic. | hh3k0 wrote: | It's almost like this isn't an either/or type of situation | where a nation either has lobbying banned or suffers from | corruption. | | (And absolutely no one other than you has made this | oversimplification in this comment chain.) | vkou wrote: | > Looks like Mr. Cuban is demonstrating that, sometimes, a | superior business plan is the shorter path to justice than | waiting for the Courts and the Legislature to catch up. | | This is a very bold claim, that we do not currently have the | data to evaluate. | | In ten or twenty years, we can revisit it, and conclude whether | or not it is actually true. | dnautics wrote: | I am super rooting for Mr. Cuban. As I alluded to in a previous | post (not half a day ago), this is something I want to work on: | | https://news.ycombinator.com/reply?id=25925876&goto=threads%... | | If I am not mistaken, the biggest challenge as I see it is that | according to the FDA abandoned (generic drug) program, the Cost | Plus Drug company will not be able to advertise many of its | drugs to advertising monopolies that the FDA has handed out to | companies (e.g. Shkreli, but also many bigger pharma | companies), which according to a doctor friend of mine is a | business killer. However, it's entirely likely that through | sheer force of personality and name recognition, Cuban can | force through a program of "check our company first", without | advertising any particular drug, that gets popular among | doctors. Hopefully that will drive eyes to the company without | running afoul of the FDA's well intentioned but horribly gone | wrong rule. | mikece wrote: | I've wondered for a long time how much money could be saved if | the non-trivial administrative overhead of insurance companies | were removed from all but truly catastrophic cases (where claims | start at $10k or more) and medical, dental, and drug costs were | paid out of pocket (including via an HSA account). There are | numerous cases where cash-only medical clinics are able to offer | up-front pricing for a fraction of what is billed to medical | insurance companies. If Cuban's idea is "we don't do insurance | but you're free to pay with an HSA card or seek reimbursement | from your insurance company" then this could be a huge winner. | giantg2 wrote: | The problem is that most people don't have $10k that they could | pay directly. | | You might find this interesting too. | https://slatestarcodex.com/2020/04/20/the-amish-health-care-... | | Edit: why is this downvoted? | nickff wrote: | The biggest problem is that most of the money in healthcare | actually goes to pay salaries, mostly those of nurses and | doctors, but administrators are up there too. Pharmaceutical | companies are not as profitable as one might imagine, and drugs | are a relatively small fraction of total healthcare costs. | pettusftw wrote: | Pharmaceutical companies are actually far more profitable | than I imagined. | | Pharma companies enjoy a profit margin averaging 26%, medical | device companies 12%, and hospital groups (which includes | non-profits) 8%. Insurance companies are closer to 3%. | | https://www.americanprogress.org/issues/healthcare/reports/2. | .. | Darmody wrote: | Then why the same drugs are incredibly cheaper in other | wealthy countries? They don't pay salaries there? | | Healthcare in the US is a scam. There's no other way to look | at it. | paulmd wrote: | Salaries are certainly a part of it - medical staff are | paid much lower in other countries. | | Because they don't have to pay for their education. | Governments there recognize that having lots of doctors is | a public good and don't saddle them with hundreds of | thousands of dollars of debt from medical school. | | Doctors aren't the ones who pay that medical school bill | (if they get a job). It's their patients who pay the | medical school bills. | | The problem of medical expenses in the US is a very complex | one. It's essentially at the nexus of a whole bunch of | problems with our society. Higher education is too | expensive. We have too many middlemen. Strong intellectual | property laws make drugs and devices expensive. Patent laws | make evergreening more profitable than innovation. Intense | regulatory requirements for approval make competition very | limited for pharmaceuticals. The government doesn't | maintain control of the products resulting from the blue- | sky R&D it funds. etc etc. | munk-a wrote: | This will partially ignore your attribution that the US | problem is a complex multi-faceted issue (I agree with | that but wanted to focus in) - you mention that higher | education is too expensive and suggest that there are | many other societal factors that make the US | noncompetitive. This can cause an effect like we're | seeing with the US healthcare market but the US does well | in a lot of the more transferable industries (like | software development) and I'm not seeing how the factors | you're highlighting for healthcare wouldn't equally apply | to all of those transferable jobs. | munk-a wrote: | That is a pretty vague statement which I've not seen born | out. I work in tech loosely associated with healthcare and | I've needed to learn how the different companies involved in | the charging process interact and it's super murky - there | are a lot of "preferred rates" offered by HCPs to insurers. | These "preferred rates" end up leading to the outrageous out- | of-network charges some folks have been exposed to. These | only seem to exist to justify the constant spending into | marketing and sales on both sides to make it appear that | negotiations are saving companies 80% of the "cost" in their | partnership - while nobody ever ends up paying full price | except really unlucky patients. Additionally the system of | manufacturer rebates on prescriptions appears to exist solely | to bump up the price to insurer - so a 80$ med sold for 160$ | with an 80$ rebate might trigger the insurer to pay out 80$ | as half the cost of the medication before the patient | receives the medicine for free due to the additional rebate - | this ends up squeezing the insurer who will squeeze the | patient all that much harder when it comes time to settle the | monthly fees. | | The US system is absolutely lousy with corruption and ends up | diverting a large amount of money toward marketing which is | rather baffling - whether a treatment is appropriate or not | is a decision I'd rather my doctor made on the basis of | efficacy - not because one of the companies had a catchy | jingle or because one of them recently took him out to lunch. | | Hospital administration does cost a fair amount, but be | careful here - it's like education - some of those | administrators have moved up the seniority chain to positions | where they essentially do nothing and get paid for having | their ass in a chair - but a lot of that administration goes | to fighting against the extremely aggressive tactics of | insurers and manufacturers. While those administrators would | ideally be unnecessary due to better regulations being in | place they do provide justifiable savings for the hospital | (it's cheaper than not having them in many cases) under the | current system. | | It's all really complicated and murky. | codegeek wrote: | I would bet my life that costs would be lower. Insurance | middleman in everything drives up the cost a lot due to so many | overheads involved. | minikites wrote: | Why do we need a system as complex as this instead of just | funding healthcare through tax dollars and giving it to | everyone like many other developed nations? | giantg2 wrote: | Can you show where the tax funded systems are not complex? It | might remove some issues, but it can create others. I don't | think a simplistic solution exists anywhere in the modern | world. | minikites wrote: | You're right that the back-end of any healthcare system is | complex, but a government-funded single-payer system is | simpler for the end user (every citizen), that was my | point. | giantg2 wrote: | I must be missing something then. | | In the current system you walk in and hand them your card | (insurance, Medicare, medicaid, etc) and they treat you. | You get mailed a bill later. | | Tax funded systems would be similar. Walk in, give them | your ID/card and get treated. Get a bill if it's a | taxable condition (like Italy). | | Obviously there are other non-payment related differences | like scheduling and what's covered. | warkdarrior wrote: | In the current US system, if your employer does not | provide (any|sufficient) insurance coverage, you have to | get your own and there are a million options all ready to | fleece you. It is almost impossible to comparison shop | and choose between 100 bad options. | | Yes, the mechanics are the same (go to doctor, get a | bill), but your purchasing power as individual patient is | really small compared to a whole country. | giantg2 wrote: | I agree many options are bad. Even employer insurance is | expensive. | | Where is the individual's purchasing power a part of that | scenario? Regardless of the group or person paying the | provider, the bill is still substantial. The main money | saver between the types is in system efficiencies like | removing overhead, or instituting restrictions. | minikites wrote: | >The main money saver between the types is in system | efficiencies like removing overhead | | I agree, we should remove the overhead created by the | existence of private insurance companies. | mcguire wrote: | " _In the current US system, if your employer does not | provide (any|sufficient) insurance coverage, you have to | get your own and there are a million options all ready to | fleece you. It is almost impossible to comparison shop | and choose between 100 bad options._ " | | I've been using the ACA marketplace here in good ol' | Alabama, and I've had the opposite problem. There are | four choices, all from BC/BS. | | Note: I love the ACA. I will fight for the ACA unless and | until I'm presented with an actual better option. Prior | to the ACA, I had options from other companies, none of | which covered my major problem. | pjc50 wrote: | The difference is in the NHS everyone is "on the same | side", so the amount of bill inflation and money juggling | that happens is basically zero. | | The NHS does demand management with waiting lists | instead. Basically it's amazing for things that can be | easily identified and given cheap medication for | (insulin, antibiotics etc), amazing for emergencies which | can be resolved with surgery, OK (but variable) for | obstetrics, does a decent job at screening for common | conditions, but tends to leave anything that won't | actually kill you to wait. | | I've never had to think about billing. | lkbm wrote: | Here are some things in the current system I'm hoping a | single payer system would fix: | | * I walk in, and they can tell me right away whether I | will be billed or not. There's no "we'll see" and then | maybe I get a bill in a few weeks. | | * I walk in to a different doctor's office and the answer | as to whether I'm billed or not is the same as at the | other doctor. | | * Because of these first two items, I walk in and they | can tell me ahead of time what my bill will be. | | * We can now replace "walk in" with "check their websites | (or call) and comparison shop". | | Maybe they can't tell me if my treatment is taxed until | I'm diagnosed, but that still gives me the option to find | out my bill before treatment. Once I'm diagnosed, if it's | non-urgent I can shop around. | | Price transparency is non-existent in US healthcare. | There's no big mystery as to why that would cause | inefficiency and absurd costs. | SahAssar wrote: | Have you ever been in an ambulance and had to think about | if the hospital they drive you to is in your coverage? | That's the sort of thing I've been told about from | American colleagues and friends. | mcguire wrote: | " _I must be missing something then._ " | | The part where you are one of the people who doesn't have | a card from insurance, Medicare, Medicaid, etc. | giantg2 wrote: | Is that a real concern though? The ACA provides income- | based funding and expanded Medicaid. | minikites wrote: | >In the current system you walk in and hand them your | card (insurance, Medicare, medicaid, etc) and they treat | you. You get mailed a bill later. | | The thing you're missing is that the current system in | the USA is in no way like this. | giantg2 wrote: | That's completely false. I've had to deal with many | medical bills in the US last year. | minikites wrote: | You must have good insurance if you think your experience | is typical. Most people aren't so lucky. | giantg2 wrote: | It's this way for everyone I know, except for medicaid | recipients. | mcguire wrote: | You are healthy and not self-employed, I take it. | giantg2 wrote: | Do you have insurance? I fail to she how being healthy | and not self-employed affects the scenario as described | (present card, get treated, recieve a bill). | RHSeeger wrote: | That bill can be for an amount that varies wildly based | on your insurance, the doctor, who helps the doctor, what | lab they send things too, and a large number of other | options. If things work out well, your bill could be for | $30. If you don't remember to ask the right questions, | the bill could be $30,000. | admax88q wrote: | Youve skipped the step for obtaining a card in the first | place. Something which is trivial here in Canada (easier | than a drivers license, and free). | | Also theres none of this in-network vs out of network | chaos. Emergency care always covered, doesnt matter where | you go. | | It feels like youre trying not to understand how a public | option could be better. | flyingfences wrote: | That's what insurance is supposed to be: coverage for the | catastrophic cases. This use of insurance for ordinary, | everyday medical care is ridiculous. I have insurance on my car | in case of a catastrophic collision; can you imagine if I had | to deal with them for every oil change and brake job? | codegeek wrote: | I make the same argument and people don't get it. We are so | brainwashed about the whole health insurance thing in | America. Get rid of insurance middleman in EVERYTHING and see | how prices drop. | jfrunyon wrote: | Because it's not valid. Ignoring routine and preventive | care makes those catastrophic cases almost inevitable. | [deleted] | codegeek wrote: | I don't understand your argument. Even on insurance, a | lot of Americans routinely ignore preventive care because | of the hassles, overhead and out of pocket costs even | after insurance. Unless you are lucky to have great | insurance by your employer. The point is that insurance | should NOT be involved in preventive care. It should be a | direct free market cash exchange b/w just 2 parties. | Patient and doctor. That's it. NO premiums, no copays, no | coinsurance, no claim paperwork, no calling insurance | companies to figure out the charges etc etc and most | importantly, no dependency on having a job to be able to | afford going to a doctor even for preventive care. | pkaye wrote: | Until it comes to dental work and hearing aids. Then people | wish the insurance middleman was there. | btilly wrote: | The problem is that your catastrophic costs are likely to be | massively higher if your problems are not caught by routine | checkups and standard screenings. But if we make people pay | the full costs for routine checkups and standard screenings, | they won't bother getting them. So it is in the interest of | your insurance company to make sure you get those checkups | and screenings. | | By contrast your odds of a catastrophic collision have more | to do with drivers and driving collisions than they do with | whether you got an oil change recently. If they were insuring | your cost of major repairs and buying a new car, then they | would have an incentive to get involved with routine | maintenance as well. | throwawayboise wrote: | I have good insurance from my employer but I haven't been | to a doctor in at least 10 years. I don't think it's a | given that people get routine care just because insurance | covers it, or would avoid it if they had to pay (a | predictable, modest amount) for it out-of-pocket. | skybrian wrote: | Auto insurance does give discounts for things like taking a | defensive driving course. Some will give discounts for | installing a tracker on your car to show that you don't | speed. | | So it's not entirely out of the question that they could give | discounts for properly maintaining your vehicle, if that were | a major cause of accidents and it could be tracked. | danepowell wrote: | I fully agree that at least in principle it seems wrong to | have insurance for routine care, when most insurance only | covers catastrophe. | | I think the two practical problems with this view are (a) | what's routine to you might be catastrophic (or at least | seriously detrimental) to someone else, and (b) missing | routine care often leads to catastrophic outcomes. | nathanvanfleet wrote: | I don't know, maybe the government should regulate the | predatory behaviors or business instead of weird libertarian | strategy that is already not working for people who have no | insurance and their life is destroyed when they get sick? | giantg2 wrote: | You really think the current situation is libertarian? | | There is so much regulation around anything even remotely | medically related. Just look at the HIPPA mess. | | Edit: why are you downvoting without rebuttal? Its utterly | false to claim the system is libertarian. | tdfx wrote: | There's nothing libertarian about the US healthcare system. | If anything, it's a great example of regulatory capture by | the AMA and insurance industry. | warkdarrior wrote: | The libertarian angle does not work in real life, even if we | ignore the regulatory capture practiced by insurers. Because | there are not enough doctors/nurses in the country, you as a | patient will always compete for medical attention with other | patients. This will only drive prices up. | lostapathy wrote: | Libertarians would also allow more doctors to be educated. | We don't have enough doctors now because the AMA acts as a | cartel to limit supply of doctors. Libertarians don't like | that either. | paulmd wrote: | The free market has decided that they don't want more | doctors educated though. Guilds are very free market, do | you not believe in freedom of association? | | I guess the true libertarian answer is that we don't | really need certification at all, or that anyone should | be able to start their own certification board. Like Rand | Paul and his fake ophthalmology board he started to give | himself credentials. | | Nothing is ever libertarian enough until we've removed | all the regulations and let quacks practice medicine, is | it? | zepto wrote: | In a free market we'd be able choose a non-guild doctor. | lostapathy wrote: | What about this is the free market? | | https://www.washingtonexaminer.com/thanks-to-doctors- | there-a... | mcguire wrote: | The last time this came up, several people responded that | they would be happy to go to a 'doctor' educated on | YouTube. | | Which is lovely and all, until those doctors tell you | vaccines are worthless and dangerous, and to slather a | mixture of beef tallow, garlic, leek, and honey on your | injuries. | lostapathy wrote: | I'm not sure how you made the jump from the AMA limiting | med school enrollments to "youtube doctors". | | We could split the difference and expand existing med | schools or start new ones with similar standards. | aj7 wrote: | I doubt this. | | To me, libertarianism is simply "might makes right," with | the liberty part being everyone has the opportunity to | grow into a bully. I've never seen a SINGLE libertarian | policy that couldn't be interpreted this way, and I'm | quite open to being corrected. | GurnBlandston wrote: | What? | | Libertarianism basically sees two possible crimes: force | and fraud. Totally incompatible with "might makes right". | satyrnein wrote: | Here's a handful of typical libertarian positions (though | certainly there's some variance): pro-choice, anti-war, | pro-civil rights, pro-immigration, anti-drug-war. They | don't seem to match your description of "might makes | right". | deelowe wrote: | What? I went to a specialist today. My doctor scheduled the | appointment. I had no say in it. This doctor is at one of two | offices that I am allowed to choose from based on my | insurance's negotiated contracts. This is insurance that is | provided by my employer that I had no choice in. When I first | saw the doctor, he prescribed meds that I had no choice in. | The specific meds he prescribed were chosen as these are what | the insurance company would prefer from a clinical | perspective although they were extremely unlikely to help. | And, on top of all of this, not once was I informed of the | cost prior to services being rendered and if I had asked, I | would have been told this wasn't possible. | | How is any of this libertarian? The libertarian solution | would be that only individuals would be allowed to purchase | insurance, that insurance would distribute funds to the | individual (not the doctor or pharmacy), all fees would be | provided prior to service being rendered and individuals | would purchase meds without a prescription. | munk-a wrote: | > The specific meds he prescribed were chosen as these are | what the insurance company would prefer from a clinical | perspective although they were extremely unlikely to help. | | I work close enough to healthcare that I can say that while | insurers do take cost of treatment into account they are | looking to minimize ongoing treatment costs - if there is a | 5$ pill and a 500$ pill available for treatment the insurer | may prefer to trial you initially on the 5$ pill if it's | been proven effective for a good proportion of patients, | but they do use calculations to minimize those ongoing | costs that includes costs from condition escalation (i.e. | if you have a boil you're absolutely going to get | antibiotics covered since dealing with a septic boil is an | emergency room visit. | deelowe wrote: | That's pretty much what I described. I was prescribed | antibiotics for a chronic issue. It made no sense at all, | but the DR said it's what he must to do to follow the | hospitals guidelines (which are determined by what the | insurers want to see). I have gastro issues and modern | antibiotics cause me all sorts of problems, so of course | I had to deal with the pain and discomfort for 2 weeks | all for something that made no difference whatsoever. | RHSeeger wrote: | Did you try saying no, that you weren't comfortable with | this solution, and you'd like to discuss other options? | You can always discuss what options are available with | your doctor and then reach out to your insurance to see | what and why they will do about it. You may not get the | answer you want, and it will use up a lot of your time, | but it is an option. | | Note: I've spent on the order of 30 hours on the phone | over the past couple months trying to get things sorted | out between my doctor, my insurance, and the provider of | the drug that I need for my vision. The folks at the | insurance can't always help, but they've always been | willing to discuss things and see what they _can_ do. | BurningFrog wrote: | Healthcare already _is_ the most regulated industry in the | US. | | Calling it libertarian shows you know nothing about either | healthcare regulation or libertarianism. | mlthoughts2018 wrote: | > If Cuban's idea is "we don't do insurance but you're free to | pay with an HSA card or seek reimbursement from your insurance | company" then this could be a huge winner. | | This is the way it works for a lot of therapy and mental health | services and it's horrible. Prices are absolutely insane, | practitioners are not accommodating to patient schedules, and | patients have absolutely zero bargaining power. | | In some ways doing it through insurance is kind of like a | union. You all agree to accept certain inefficiencies, | bureaucracy, etc., (and associated cost) in order for better | collective bargaining terms. | | Of course people with great jobs usually don't care about | unions. They don't need the collective bargaining power and | thus figure the bureaucracy cost is just a loss they don't | need. | | Same thing with very healthy people and insurance. If you're | healthy you just figure, give me cheap catastrophe insurance, | what do I care? But if you're in the depths of the medical | industrial complex because you need frequent treatment for | chronic conditions, you quickly learn that papering everything | over with lots of bureaucracy to adhere it to better collective | bargaining for patients is way better, and I'd rather take the | nasty, churning quagmire of price inflating insurance than deal | with spartan libertarian mini-insurance that essentially just | results in rich-get-richer (i.e. genetically lucky healthy | people just get to save money while everyone else suffers). | supertrope wrote: | The supply and demand imbalance in clinical psychology and | psychiatry is why they can choose to be out of network. | Demand is not only wanting a good or service but being able | to pay for it. Mentally ill people tend to have less or much | less money. The long term trend is not good; why become a | psychiatrist when you can earn more as almost any other | specialist? (With exception of pediatry). | Analemma_ wrote: | I'm sure individual experiences vary widely, but I know | several people getting frequent treatment for chronic | conditions, and none of them talk about how happy they are | that an insurance company is collectively bargaining on their | behalf. Most of them curse their insurance provider with | every breath, and are firmly of the opinion that it would | shoot them in the head if it thought it could get away with | it. | jfrunyon wrote: | Generic manufacturers don't have anything to do with insurance | companies, though, do they? Other than perhaps trying to | convince insurance companies to put their drug on the | formulary. It would be between the pharmacy & insurance. | fallingknife wrote: | Do drug companies get involved with insurance companies? I | thought the pharmacies purchased the drugs, and then they | handled that at the point of sale. | colechristensen wrote: | There is always an amount "billed" to insurance companies which | is strictly imaginary. There is this billed rate, the | negotiated rate per insurance provider, and a cash rate. | aj7 wrote: | So it winds up you pay for everything. Your "drug plan" too. | SeanLuke wrote: | It depends on the drug. Under my insurance, I get certain | drugs for $0. | colechristensen wrote: | No, there's just a base rate that nobody pays used as a | negotiation tactic that's still published on bills for | whatever reason, you can see what your insurance provider | actually pays as well. | jjoonathan wrote: | > a cash rate | | An equally imaginary number that gets hauled out during | debates so that health care providers can pretend that | insurance companies are the ones responsible for price | inflation. If you actually try to obtain the cash rate, | they'll give you a 2% "lol nice try" discount off the billed | rate. | aj7 wrote: | I've been buying my drugs for cash for a decade. I'm lucky, | I've got 5 prescriptions that run me ~$1000. I started when I | found that open market pricing was lower than my insurance (UHC | Optum) pricing. | rush86999 wrote: | I completely agree with you. That is why we started Tangerine | Health (https://www.tangerinehealth.co). We charge a flat rate | of $25 per visit. With new policy changes to Telehealth, we | also launched virtual primary care with the same pricing model. | If you have insurance we accept Aetna and UHC. We are in the | process of getting Blue Cross as well. I believe also doctor's | office visits are covered by HSA (not 100% sure but here's a | link found: https://www.foley.com/en/insights/publications/2020 | /03/covid...). | gigatexal wrote: | The average American can't afford a 400 dollar expense and you | are advocating a post pay insurance model? That seems very | regressive. | adventured wrote: | > The average American can't afford a 400 dollar expense | | The average American has $432,000 in net assets, is the | second richest in the world (behind Switzerland), and can | trivially afford such an expense. | | Did you mean that around 12-16% of the population can't | afford an immediate out of pocket $400 expense? Because | that's the real figure according to the Federal Reserve study | that's constantly misquoted. | | The median American has a higher net worth than either | Germany or Sweden, and among the highest disposable income of | any nation. | SgtBastard wrote: | Not even remotely accurate: | | https://en.m.wikipedia.org/wiki/List_of_countries_by_wealth | _... | | The US is 22nd by median net wealth. | ashayh wrote: | "Poorer" countries than the US like Portugal, France, | Japan, UK have far better health outcomes including _lower | infant mortality_ , lower chronic diseases, better life | expectancy than the US. | | The US is the only "developed" country where 10 are | uninsured: https://en.wikipedia.org/wiki/List_of_countries_ | by_health_in... | | Another N% are under insured, or hampered by high | deductibles, copays, limits etc. | | Whats the point of having a "high median net worth" if the | basic needs of the people aren't met? | gigatexal wrote: | Now that's just being petty with stats. You knew I was | talking about the majority of Americans not the richest. | Sure if you take the arithmetic average of assets it will | come out very high. But that's because the millionaires and | billionaires skew the numbers. | noir_lord wrote: | Insurance companies are a symptom of the problem but the real | solution is either single payer, something NHS like or | something like the German model (which is probably the most | similar of the major countries to what the US has now - though | it's still three quarters state funded). | | The NHS was to an extent a statistical fluke (right politician | in the right place, just post-WWII) that the right wing has | been trying to dismantle for decades, without WW2 I'd be | surprised if we had anything like the NHS. | | Basically you need politicians to ignore the lobbyists and do | their job of regulating this shit for a better society. | | Sadly I don't see it happening though there are some hopeful | trends. | burlesona wrote: | Ironically, the US Employer-Oriented health insurance _also_ | exists in large part because of the US response to WW2. | | During the war the US froze wages in order to try and prevent | skyrocketing salaries due to the extreme demand for labor. | | To compete, most employers started offering generous benefit | packages in lieu of the raises they were no longer able to | offer. | | After the war, the larger employers found that the generous | benefit packages were more cost-effective at retaining | employees compared to higher pay, so they became "fans" if | you will, and have supported the employer-based benefit | programs in the US ever since. | | One concise reference: | https://www.nytimes.com/2017/09/05/upshot/the-real-reason- | th... | cocoa19 wrote: | I don't buy the single payer/Obamacare/more regulation speech | as the single healthcare fix. NHS has a ton of problems of | their own. | | We need a lot of doctors, more than what we are producing. | It's baffling you need 100s of thousands of dollars to become | a Dr in the US. | | Remove the undergrad requirement to apply for med school, | like most of the world, and fix the college affordability | problems. | | If the amount of money to produce doctors keeps escalating, | it's not surprising medical care only goes up. | noir_lord wrote: | There is no single solution, the world isn't that neat | however the NHS problems and it does have them are a result | in large part to it been a political football for decades. | | Even with those problems we spend about half per capita on | healthcare with about equal outcomes, also the US gov in | one form or another already foots about 50% of the bill | itself. | | > Results The UK spent the least per capita on healthcare | in 2017 compared with all other countries studied (UK $3825 | (PS2972; EUR3392); mean $5700), and spending was growing at | slightly lower levels (0.02% of gross domestic product in | the previous four years, compared with a mean of 0.07%). | The UK had the lowest rates of unmet need and among the | lowest numbers of doctors and nurses per capita. | | https://www.bmj.com/content/367/bmj.l6326 | | They do more for less with less and mostly do it well. | | Compare that to any other major country and it's good, | compared to the US system it's very good. | | Does the US have amazing doctors, hell yeah of course but | do they have a fair system when on average everyone gets | what they need if not always what they want, I'd argue no. | xcskier56 wrote: | From some of the studies that I've seen of primary care | practices moving to a cash only model, I think its in the range | of 15-20% reduction in overhead costs. These were for the most | part smaller independent clinics, so the number is probably | lower for large health systems. | DubiousPusher wrote: | The problem is many people don't have cash either. | | https://www.federalreserve.gov/publications/2019-economic-we... | throwawayboise wrote: | There's a cash-based medical practice in my town. They don't | accept or file insurance claims (they will give you an invoice | with billing codes so you can file your own claim if you want). | Their prices: | | New patient visit: $400 MD or $300 PA | | Follow up visit: $200 MD or $150 PA | | Labs: $25 draw fee + laboratory cost | jfrunyon wrote: | That's significantly more than my doctor - who is part of a | major hospital/healthcare network and works primarily with | insured patients - charges out-of-pocket... | | (I know this because they screwed up billing the insurance | company and got denied, and tried to switch me to cash and | bill me the higher amount instead. I love our healthcare | system.) | tlb wrote: | A good comparison is veterinary medicine in the US. All the | functionality is fundamentally the same, but insurance isn't | common. Prices are vastly lower, and it's all super-convenient. | Typical for an injury requiring stitches: $150, plus $15 for | some antibiotics, which they hand you as you walk out. | | Every time I go to the doctor I wish I could take myself to the | vet instead. | heavyset_go wrote: | My experience conflicts with your assertion. Costs for | veterinary care have sky rocketed over the last 15 years, and | costs for procedures without pet insurance are sometimes 75% | to nearly the same price as the same procedures on humans. | Prices for MRIs, X-rays, surgery and drugs are all very close | to human medical care costs. | poulsbohemian wrote: | FWIW: I wonder if you are in an urban area? When I compare | the cost of vet services with my friends in an urban | setting relative to what we pay here in rural, small-town | America, I'm shocked at the difference. We have a | university about a two hour drive away with a noted vet | hospital - even their services were priced better than | those I've heard anecdotally on the other (more urbanized) | side of the state. | LinuxBender wrote: | Me too. I suspect some of this is regulatory overhead and | compliance. I can give pets injections (inoculations and | antibiotics) without even talking to a vet. The only | exception I ever ran into was antibiotics for a snake, as the | feed store didn't carry that. To get those things for myself | would require a prescription from a doctor. | poulsbohemian wrote: | Even more importantly: When you walk into the vet, they can | estimate what your options will cost, so that you can make an | informed decision. | | When it was our cat's time too, I was struck by his end of | life experience versus that of a human. Whereas a human could | have exhausted their life savings on futile treatment or end | of life hospice care, Denver cat went quietly into that good | night on his favorite blanket surrounded by his loved ones. | | I'm currently in need of some very common medical treatment, | but the maze of providers I need to go through in order to | get a referral just ain't worth it. Versus, if I were a cat | or dog, I could simply go to the area university veterinary | hospital and likely get my answer same day. | mc32 wrote: | Is it the same for studs or thoroughbreds? | | What I'm getting at is that for most animals the owner can be | compensated for accidental death easily. (How much is a head | of cattle at auction?) | | Not that this explains all the discrepancy, but it may | explain a non trivial percentage. | olyjohn wrote: | Also your dog probably needs 1/10th the dose that an adult | needs. | mattkrause wrote: | It's way more complicated than that: there are | differences in metabolism as well as size. It varies from | drug to drug too, but as a rule of thumb an average-sized | dog needs about half of the average-sized human dose. | | Here's some FDA guidance on how to translate doses from | animals to humans: | https://www.fda.gov/media/72309/download | philwelch wrote: | Large dogs can be the same weight as small humans, so I'm | not sure what accounts for 1/10th. Even medium-sized dogs | like labs are about half the weight of a healthy, | average-sized person. | girvo wrote: | Depends on the drug, but their metabolism isnt identical | to ours, and humans can often require significantly | higher doses compared to other animals when controlling | for dosage per weight unit. But again it depends and | there is no hard and fast rule as far as I'm aware. | [deleted] | giantg2 wrote: | Just learn aseptic technique and suture yourself. | | I generally agree with your sentiment - regulation and | insurance overhead are big costs. I do think some people | should be able to do the basics at home if they wanted. Basic | sutures are a pretty good example, you could even save that | $150 that you mentioned. | munk-a wrote: | Specialization of labour is what's primarily responsible | for the industrial revolution - while this is a hyperbolic | comparison, is the only reasonable way to fix healthcare to | throw away all specialization and go back to "do it at | home"? | | The service needs to be available in some form at least for | folks like me that have an essential tremour or otherwise | are limited in fine motor skills. | giantg2 wrote: | I'm not saying do everything at home for everyone. But if | some people did minor things (first aid type stuff) at | home, that would free up the system for more important | cases. Just think of all the people that fo to the doctor | with a cold. A little education could go a long way. | rubinelli wrote: | People keep talking about patients going to the doctor | for frivolous reasons, but what I see is that it is much | more common for patients to ignore symptoms or take some | over-the-counter medicine, and take too long to see a | doctor. | giantg2 wrote: | True, it does go both ways. I would still say it comes | down to a lack of education/knowledge either way. | munk-a wrote: | This, I think, is a natural result of the US insurance | system. Being sick is quite expensive and not being sick | but being proven to not be sick is also rather expensive | so people will naturally tend to avoid formal treatment | longer in the hope that everything just magically goes | away. | | This also contributes to the amount of emergency room | treatments that could have been trivially handled with | earlier intervention. A boil that has gone septic is a | very serious medical condition, but nearly all boils can | be trivially resolved with a short regimen of | antibiotics. | perseusmandate wrote: | This is insane. Mess up with this and you could end up with | a serious infection | anonAndOn wrote: | If you really want to be frugal, why not go all John Rambo | style and just cauterize the wound with some gunpowder? | It's probably <$2 for enough to make sure you don't bleed | out. | giantg2 wrote: | If you're cauterizing a wound, you wouldn't use | gunpowder. | | A sterile suture kit is about $2 as well. | dml2135 wrote: | While I'm usually a DIY kinda guy, giving this advice on a | large scale is a perfect recipe for disaster and really | encapsulates the dark-ages dystopia that the current US | medical system has become. | chihuahua wrote: | While looking for moldable plastic material ("Sugru" and | similar) on Amazon, I was a bit taken aback by the | reviews for one such substance. Multiple reviewers were | stating that they were using this stuff to make their own | dental crowns or some other DIY tooth repair because they | couldn't afford a dentist. I found this quite shocking | and I'm not sure if these people were serious. | | See the reviews on this product page: | https://www.amazon.com/InstaMorph-Moldable- | Plastic-6-oz/dp/B... | giantg2 wrote: | If someone self-studies basic things, it shouldn't be a | big problem. Just look at first aid. There are many | people who have no idea what to do for minor injuries | because they never took the time to learn. Suturing is on | the borderline of of falling into first aid. There are | people today who learn the basics of it for emergencies | or because they live in remote locations. | dkjaudyeqooe wrote: | No lidocaine? | giantg2 wrote: | Nah. It doesn't hurt too bad in most locations. | tdfx wrote: | Very similar in developing countries, as well. I've gotten | stitches in Mexico and Colombia for less than $40 USD each | time which healed comparably or better to the stitches I've | paid >$500 for in the US. Consultation for an eye infection | along with the antibiotics in Mexico was $23 USD. | tcbawo wrote: | Veterinary care has been increasing considerably more than | core inflation (quick search turned up | https://www.in2013dollars.com/Veterinarian-services/price- | in...). I'm not sure how that compares to inflation in human | healthcare. | missedthecue wrote: | I feel like the demand for veterinary services has gone up | drastically. It shocks me how my millennial friends will | spend $5000 without a second thought to keep a dog alive. | Older generations often seem to put pets down in that | situation. | jsight wrote: | Hmm, I'm not sure how I feel about that comparison. Most vets | double up as pharmacies, restrict access to prescriptions, | and sell at least some prescription drugs at prices that have | been marked up by at least an order of magnitude by the | manufacturer. | | Some of the bills that I've run into have still managed to | approach the cost of routine visits at some specialists when | billed to my HSA. | majormajor wrote: | Whatever markups are there are not linear, interestingly. | | I had to get an MRI from a vet hospital in the past. It was | still over a thousand bucks, and in the range of quotes I'd | gotten for human MRIs before. | | I wonder what similar stitches in an urgent care vs a primary | care office vs an ER for a human would cost. | rtkwe wrote: | Part of that is probably the lower volume, so they have to | amortize the costs over fewer procedures. Most pet injuries | don't need an MRI or if the injury/illness is that bad the | euthanasia or palliative only option is more considered. | dodobirdlord wrote: | Human MRIs are also pretty expensive, and human MRI | machines are generally booked solid. MRI machines cost a | lot and also cost a lot to operate. | Gibbon1 wrote: | Last time looked at the costs of imaging I got the | impression that there are a monopoly and other captive | market effects at work. | | You'll hear medical professionals claim imaging is | expensive because the machines are expensive. Which just | says to me that medical professionals aren't accountants. | | Consider a dental w-ray machine. $15-30k. That's the cost | of Prius used as a Taxi. You don't pay a couple dollars | for a 15 minute Taxi cab ride. | | An MRI machine, I forget how much those cost. But | whatever, lets compare one with a modern passenger | airliner. Cost is about equivalent on a 'per passenger' | basis. And an airliner requires highly trained | professionals to keep it running. | [deleted] | TameAntelope wrote: | As the other reply mentioned, I wonder if this is just the | human cost insanity infecting veterinary costs -- MRI tech | could be used for humans, so the machine is absurdly | expensive, and vets have to charge more to justify the cost | of having a dedicated pet MRI. | apendleton wrote: | MRI machines also require superconducting magnets and | liquid helium, high-amperage utility hookups, etc., so | they might just be expensive regardless. | [deleted] | jjoonathan wrote: | Pets tend to be smaller than humans, so manufacturers | could ensure that pet MRIs don't drag down human MRI | prices by making smaller MRI machines that only work for | pets. They probably do. | Kalium wrote: | Tend to be, but it's not that rare for someone to have a | dog that's a hundred pounds and five feet long. That's in | the range for an adult human. | jrowley wrote: | My dad, a radiologist once had patient that was so large | that they couldn't fit them on a conventional CT scanner. | Luckily this was a university town, so they were able to | access the vet's large animal scanner. | Kalium wrote: | Makes sense. Horses and cows get much larger than humans! | jjoonathan wrote: | I suppose that does make sense. | | Re: the large patient, yikes! | mattkrause wrote: | There are "small animal" MRI machines, which are mostly | intended for research. | | The bores are _really_ small: 55mm or so is not uncommon, | so a mouse would fit, but nothing much bigger. Other | animals are usually scanned on a machine meant for humans | (sometimes even the exact same ones, very early in the | morning or late at night). | celloductor wrote: | It can be the opposite as well. I work in a vet clinic, but I | also am in New Zealand- where there is free/subsidized public | healthcare. Thus you get people who go to the vet expecting | things to be free or cheap. | mcguire wrote: | It would work fairly well for minimal routine care and | relatively minor trauma, as long as euthanasia is on the | table for major long-term care, major trauma, and for those | who cannot pay. | ben_w wrote: | Well that sounds like a Black Mirror episode -- "Crowdfund | your schoolfriend to _not_ be euthanised" | skeeter2020 wrote: | In Canada (at least in my experience) it's the opposite. Vet | clinics look a lot like US medical centres, including the | state-of-the-art equipment and corresponding prices. | Meanwhile the limited for-profit medical services are | (mostly) affordable because they do general procedures with | relatively low barriers for competitors. Generic drugs are | dirt cheap when available; non-generics cost as much as the | US. Dental care is all over the map from very affordable to | ridiculously overpriced. | mikepurvis wrote: | Another Canadian here with a similar experience-- friends | with dogs even pay for insurance because of the potential | for frightfully expensive private surgeries down the road. | Though I do wonder if there's a psychological thing there | where dogs form stronger bonds and so people go to greater | lengths for them, whereas other animals are easier to let | go of if circumstances indicate that the time has come. | | And yes, dental care is all over the map-- it feels very | much like what I imagine US healthcare to be, with co-pays | and mystery charges and having to log into my insurance | company's online portal to do stuff. The NDP made a bunch | of noise in the last election about a national dental plan, | though even that effort would only have covered family | incomes up to CAD$90k [1], so it wasn't anything like the | universal no-questions coverage we have for core | healthcare. | | 1: https://www.cbc.ca/news/politics/ndp-dental-plan-fact- | check-... | adventured wrote: | Vets vary widely in the US. Vet clinics are wildly | expensive in many locations here, with veterinarians | earning well-paid doctor wages and using modern vet | equipment. | vondur wrote: | "Every time I go to the doctor I wish I could take myself to | the vet instead." Kramer thought that in a Seinfeld episode; | it was a great episode. Season 8 Episode 10. | Spooky23 wrote: | My PPO pays my GP about $75 for a regular visit. A zpack is | $6.50 at my local grocery store, $15 at CVS. | | The vet always guilts me into some sort of stupid test. | Usually I walk out of there $300 lighter. | SilasX wrote: | Not disagreeing, but one factor that complicates it is that | they're allowed to take bigger risks with pets (both with | regulations and potential civil liability) than with humans. | nextos wrote: | Lot's of private hospitals work like this in Europe and you can | get really cheap care, plus the standard is quite high. | codegeek wrote: | Yea and for people who cannot even afford the lower costs out | of pocket, subsidize the HSA card for them. This could work | better than trying the big bang Single payer approach which btw | I am for if that's the only option. I am desperate to try | anything other than what we have right now in the US. | disabled wrote: | The company sounds predatory. | | A lot of countries have much better health systems, with people | fully insured (this is really designed for people who are | underinsured), with significantly better outcomes, than the US. | The US lifespan is also significantly trailing compared to | other developed countries, and we are not a "normal" country at | all. It's going to be more appalling by 2040. | | Anyways, the place to study this data and information is | https://www.HealthData.org | | You can spend hundreds of hours studying the data on that | website, along with extreme specifics about medical care. I | used it to inform my decision of where to live in Europe with | rare immune mediated neurological diseases and type 1 diabetes. | deftnerd wrote: | The problem with drug prices isn't because of the drug | manufacturers, it's with the middle-men and private insurance | companies. At least, that's what the manufacturers are saying | | For instance, with the manufacturers of insulin, none of them are | American and they offer to sell the insulin to everyone at the | same price. | | The problem is that the large insurance companies use just three | middle-men drug buyers called Pharmacy Benefits Managers (PBM) | who DEMAND growing discounts every year from drug manufacturers, | so the drug manufactures have to raise the prices to the US | market every year to keep making a profit. | | Novo Nordisk is willing to sell insulin much cheaper, but the | drug buyers demand about a 75% discount off of the wholesale cost | or they'll make the product not covered by the insurance | companies they represent. To compensate, they raise the wholesale | price in the US so after the forced discounts, they still make | the same amount of money. | | The people who suffer are the ones who don't have insurance. | | The solution, at least in the case of insulin, isn't cheaper | prices from the manufacturer, it's for the US to pass a law that | prevents insurance companies from dropping a product based on the | refusal to discount the product if it's under a certain price- | per-month. | | This article seems to cover the finger-pointing between the | manufacturers and PBM's and insurane companies very well: | https://www.healthline.com/diabetesmine/pharmacy-benefit-man...? | hn2017 wrote: | Very informative, thank you! | temp667 wrote: | A similar situation in local political health care plans. I did | medical billing. Our local govt agency (this was for medicaid | level care) required that they only pay 25% of the price of the | service. When 90% of your patients are on medicaid, you raise | the price so that 25% of price is now what price should be. | | But very funny when someone comes in and wants to pay cash. | While that would be SO much easier than dealing with the agency | - you got to charge them 4x so some politician and HN posters | can go on about how much money the govt "saves". | | I just wish prices (cash paid) had to be posted publicly. | Antipode wrote: | How would forcing insurance companies to pay whatever drug | companies ask not just raise insurance premiums? How do you | differentiate dropping a drug because they're not willing to | sell underpriced from dropping a drug because it's overpriced? | pettusftw wrote: | How does this square with the pharmaceutical manufacturers | averaging a 26% profit margin, health insurers averaging 3%, | and PBMs 2%? | | https://www.americanprogress.org/issues/healthcare/reports/2... | zaroth wrote: | Two different things entirely. The fake "Discount off MSRP" | demanded by the PBM has nothing to do with the profit margin | of the PBM, that would be based on markup they charge to | their customers above the price they actually pay. | | But the regular uninsured consumer sure gets screwed. | | I think this is why there are now self-pay "codes" you can | give a pharmacy to get a significant discount off retail | price. Sometimes less than your co-pay, but of course then it | doesn't count toward your deductible. | | I wish they would simply ban these pricing gimmicks as part | of a price transparency law. | | There should be one price and one price only the manufacturer | can charge in the USA per dose of an FDA approved medicine, | with no ability to do price differentiation, period. No more | negotiating, no more kickbacks. Insurance should have to show | you the actual price they paid, and no other. And then you | pay the patient responsibility of the bill based on your | standard policy formula. | | The same pricing transparency should be applied to labs and | procedures where it should be illegal for a given facility to | charge two different patients two different prices for the | same product or service. | wefarrell wrote: | PBMs make the bulk of their money via secretive rebates they | receive from the drug manufacturers, which would not be | included in that 2% figure. | | https://www.fiercehealthcare.com/payer/industry-voices- | why-i... | lotsofpulp wrote: | All the biggest insurers in the US own their own PBM. The | profit margins are shown in the 10-K filings. | | All the insurers have profit margins in the 3% to 5% range. | Where is all this extra profit that the middlemen are | making? | | Even if the PBM division is earning more profit than | others, it's simply offsetting losses elsewhere. | antonzabirko wrote: | Yay! Glad he's doing something awesome for the world | vedtopkar wrote: | This is cool, but what they're claiming is puzzling. Perhaps | someone here can clarify. | | Making generic drugs is non-trivial. The medicinal chemistry may | be decades old, but you still need to do trials to demonstrate | efficacy equivalency to the non-generic version. Are they really | saying they'll do 100 of these trials by the end of the year? | | While this is cool, I'm thinking that this type of initiative | should be done by the federal government. A generic drug "mint" | if you will. | CapriciousCptl wrote: | You're right. If it was just one drug, I'd think they were | manufacturing it themselves. Apparently, they plan to have a | single factory in 2022. Most likely, significantly all of their | formulary will be copacked. | enchiridion wrote: | Why does this generic have to be retested if it's the same as | the existing generic? Can't they just do composition(?) testing | to very it meets manufacturing standards? | vedtopkar wrote: | I don't have the best answer for you, but there are a number | of considerations apart from the synthesis of the active | molecule itself. Delivery vehicle can alter the physiological | impact of the active substantially, and so the overall | "package" needs to be tested even though the active is | already approved. | | To my knowledge, generic trials aren't as involved as their | non-generic counterparts for obvious reasons. But they are | still non-trivial logistical undertakings. | enchiridion wrote: | That makes sense! This is where I feel like I have a | disconnect between what I think applied science is and what | it looks like in practice. It seems like they should know | enough about the molecule, delivery vehicle, etc, to know | that it will work the same. A medical "proof" if you will. | I guess we're not quite there yet? Is there work pushing in | this direction? | HarryHirsch wrote: | Mark Cuban is selling Albendazole, the well-known anthelmintic | that has been at market since 1975. | | Current sticker price of Albenzazole in US: several hundred | dollars. Cost in the developing world: a few pennies, according | to Wikipedia. | | Is this a joke? Would the government rouse itself to negotiate | prices with manufacturers, like it does in the developed world? | We'll have to wait four more years, with Mr Joe "Nothing will | fundamentally change" Biden. | tomcam wrote: | > Would the government rouse itself to negotiate prices with | manufacturers, like it does in the developed world? | | Well... the previous occupant of the White House tried to do | exactly that and was struck down by the courts. | | https://www.fiercepharma.com/pharma/fierce-pharma-politics-j... | HarryHirsch wrote: | The government isn't just the executive branch, there's also | the legislative. The courts just interpret current laws. It's | Congress and the Senate that need to act, but they won't. | | The complete disregard for public health actually makes me | angry. Here's more: https://www.ft.com/content/f0080fe4-c3ad- | 11e6-9bca-2b93a6856... | | A common anthelmintic is somewhere north of 400 dollars in US | but in Britain it's something like 5 pounds. Profits for the | well-connected, pinworm for those that can't afford it. | Pharma markets are funny, of course there is a monopolist, | given the size and entry requirements, consequently you need | a monopoly buyer. Can the government please wake up and | govern? | codecamper wrote: | It's lucky we have so many rich people to see us through. /s | alberth wrote: | Does this compete with Good RX? | stakkur wrote: | I want affordable drugs. But not sure I want to rely on the | goodwill of a single private enterprise billionaire to get them. | Invictus0 wrote: | I don't understand the criticism here. A customer of this | company is not reliant on Cuban at all--if Cuban's company | raises prices, the customer can switch to another company or | move to a country with cheaper drugs. | | I also don't get the "goodwill" argument. This is designed to | be a profitable, sustainable business built on the classic | mantra "your margin is my opportunity". | mikesabbagh wrote: | I dont know if manufacturing is the problem. Cant you import | drugs from India or other country with cheap off label drugs? The | system is built to prey on the sick, it has nothing to do with | manufacturing. I like his idea, but doubt it will work | kube-system wrote: | IIRC, the drug has to be tested, and it has to be made in a | facility that meets QA standards, etc. | pottertheotter wrote: | Intermountain Healthcare did something similar in 2018 and | created Civica RX. See: | | https://www.fiercehealthcare.com/hospitals-health-systems/dr... | | https://civicarx.org/ | lcall wrote: | ...and it's a nonprofit who has been delivering results. | | https://en.wikipedia.org/wiki/Civica_Rx | StreamBright wrote: | Can't wait until the government find ways to make this more | expensive. | DevX101 wrote: | For some context on why this cost-plus is necessary and great, | several generic manufacturers have been colluding and price- | fixing. There are ongoing lawsuits from the Department of Justice | and 46 states, and at least one pharma co pled guilty, and was | fined $200 million. | | https://www.biospace.com/article/states-accuse-drugmakers-of... | brianjunyinchan wrote: | I heard once that cost-plus is related to the bloating of US | defense budget and Boeing, Lockheed etc post WW2. Could someone | familiar share some thoughts on what differences there are w | this in pharma? | metiscus wrote: | What follows is a lengthy explanation of federal contract | types, awards, and some light commentary on what you posited. | | Federal contracts are usually, but not always issued under | the rules of the FAR. Within the FAR there are several types | of contracts supported including among others Firm Fixed | Price (FFP), Cost Plus Incentive, Cost Plus Fixed Fee (CPFF), | and Time and Materials (T&M). The other way that contracts | can be issued is via an OTA or (Other Transactional | Authority) and I won't really discuss those contracts as | apart from semantics they usually obey the FAR rules as | pertains to this discussion. | | In a Firm Fixed Price contract, the contractor is considered | to be holding all of the risk. The contractor is responsible | for fulfilling the terms of the contract and must meet those | requirements even if in doing so they lose money. When | bidding a FFP contract, you develop an estimate of the work | required, determine what the risks are and assign mitigation | costs and likelihoods, determine what your desired profit | margin is, and offer the government you best and lowest | price. Usually these contracts are competitively awarded | although that is not always the case (a). The "Firm" in FFP | does not mean that the price can not increase. If the | government changes what is desired or incurs costs on the | contractor that were not specified in the original contract, | the contractor can request equitable adjustment. FFP | contracts are most commonly used when producing goods with | known qualities that already exist or require slight | modification of existing goods in the market. | | Cost Plus contracts (Cost Plus Incentive or CPFF) entail cost | sharing between the government and the contractor. In a Cost | based contract, the government is considered to hold some of | the risk. These contracts are generally used as development | contracts when a new or significant evolution of an existing | system is required. The government is responsible for | reimbursing the contractor their costs incurred during | development. These costs include both direct and indirect | costs. Direct costs are what you would usually assume is | meant by cost, e.g. the actual cost of the people and | equipment used in pursuit of a single contract objective. | Indirect costs are costs that are incurred in support of | multiple contract objectives e.g. lighting and power for a | building, HR and finance people. Significant portions of the | FAR are involved in cost pooling and I won't get into it much | more here. Because the government is responsible for | reimbursing costs the contractor is not under as great of an | obligation to minimize those costs. Effectively, there is a | very low risk of losing money on a Cost contract because your | actual costs are reimbursed. In cost contracts, the | government can use the allocation of profit (fee) as an | incentive to have the contractor meet time or total cost | goals but is still responsible for reimbursing all reasonable | costs. Most major new systems development happens under the | guise of Cost contracts although some have been developed | using FFP or OTA mechanisms. If the contractor fails to | perform, the government will usually still reimburse the | costs up to the point where work was stopped. It requires a | lengthy legal battle to recover costs in a breach of contract | suit. | | Time and Material contracts are the most disfavored by the | government. They have no performance objective apart from | labor. The contractor is required to supply labor in a | desired quantity and place but no actual performance (e.g. | those 10 guys actually finish digging the ditch) is embedded. | These contracts are fairly rare but are used occasionally. | | To address the asked question regarding budgets post WW2. The | Department of Defense publishes a daily list of every | contract awarded above a certain value (I think 2 million) | here https://www.defense.gov/Newsroom/Contracts/. Contract | modifications (and new delivery orders under an existing IDIQ | contract vehicle) Most of the largest of these contracts seem | to be awarded via the sole-source justification. It is hard | to put the blame squarely on cost contracts. There are cases, | say developing a novel weapon system, where the government | can not fully articulate it's needs at the starting point. | Over-specification of requirements will cause the bidders on | an FFP to give higher prices because they must be able to | account for every requirement in their bids. When developing | a brand new system, cost contracts can be effective although | I do agree that the mechanism is over applied. I also believe | that the sole source justification to avoid competition | significantly undermines the cost control measures of both | FFP and Cost contracts. | | Now to briefly discuss what I believe is happening with this | company. They appear to be functioning under rules most | similar to CPFF, so I will analyze along those lines. Do they | have a contractual goal? Yes, they have to produce the drugs | needed based on transactions and contracts they accept. Do | they have a reason to minimize their costs? Yes, their entire | existence is predicated on the price differential between | their products and those of other members of the market. If | they allow their costs to balloon beyond a certain point, it | will diminish their marketability. It doesn't mean that the | stated margin will be over raw material and production costs | as marketing is also included. I would like to see a public | commitment to price transparency including all major line | items in the cost similar to what is done with not for profit | organizations (they have alluded to doing so with the | statement "We will let everyone know what it costs to | manufacture, distribute, and market our drugs to | pharmacies.") | | Source: In a previous life I was heavily involved in the | bidding and management of DoD contracts. | | Also see sections 13-15 of the FAR https://www.acquisition.go | v/sites/default/files/current/far/... | icelancer wrote: | It is definitely related to the bloating of the military | budget but Cuban's pharma idea is different than the "cost- | plus" of the military. It's an unfortunate name collision | that seems like an unforced error by Cuban since people like | you (and many others) make the same association, even though | the name is quite descriptive and accurate when used | correctly. | ProAm wrote: | > cost-plus is necessary | | I wish cost plus worked but its just as easily gamed. Ive seen | many industries that contracted cost-plus and the costs | magically went up a lot. If there is money to be made the | system can always be gamed/contorted/scammed, etc... | adrr wrote: | Yup, cost is easily gamed. We see this in movie industry all | the time with Hollywood accounting. | | https://en.m.wikipedia.org/wiki/Hollywood_accounting | neltnerb wrote: | While true, wouldn't the point of such a rule be to provide a | framework for fighting against exactly that? Without the rule | they don't even need to try to manipulate the books, so | there's even less to find as evidence that might be used to | either improve the rule or enforce it differently. | | Of course, market pressure is much simpler if one | manufacturer just decides to do it according to a consistent | and justifiable method and stick with it. | mikemoka wrote: | OT but always related to a more universal access to medicines: | | an opensource covid-19 vaccine is now in progress (supported by | Harvard University and the Government of India) | | https://news.ycombinator.com/item?id=25915546 | brundolf wrote: | > and was fined $200 million | | To which their response was probably, "pleasure doing business | with you" | snoshy wrote: | Quite damning, and that's only the most blatant infractions, | because it's such a high bar to prove collusion and price | fixing. The most disingenuous tactics to prevent competition | that are harder to prove in court continue to cause harm to the | average consumer nevertheless. | mikesabbagh wrote: | It is nice to sue all of those companies for colluding. But | can't you just import those drugs for less from India or other | cheap drug producing country? I am not sure the problem lies in | manufacturing. The system is rigged between the insurance | companies and the medical system and the middle men!! Offering | a cheaper cost, means more money for the middle men probably | parsimo2010 wrote: | It is not guaranteed that a regular American can get drugs | from another country. In the past few years, you have been | able to legally bring a few months of drugs back from Canada | if you visited in person. But if you order drugs online, the | drugs are at risk of being seized. Sometimes they get through | fine, sometimes they are seized for things as silly as | improper labeling (or the drug being straight up illegal to | import). You can still save money on many drugs if you can | accept the risk or you can order far enough in advance to be | able to reorder if one of your packages gets seized. Ordering | drugs from another country is a slightly better plan to save | money than making friends with a veterinarian. But most | people should just go to the local pharmacy and work with | their insurance provider or state aid programs if they can't | afford their prescriptions. | | Ironically, the Trump administration recently allowed states | to import drugs from other countries to enable them to offer | lower cost drugs through state run programs, but was still | seizing the same products if they were ordered by | individuals. While I can't really complain about an | initiative to lower drug costs, the mental gymnastics needed | to come up with this plan are pretty incredible. "We don't | think price controls are compatible with a capitalist | society, so we won't implement them. But we campaigned on | lower drug prices (since that will increase our appeal among | the elderly), so we have to do something. Let's import drugs | from countries that do have price controls. But people can't | order the drugs themselves, we have to protect them from | themselves. We have to order the drugs and repackage them | with new labels, because we need American instructions and | American warning labels, not the instructions and warnings | that the Canadian government is fine with." | | Right now, it's better/easier for most people to get their | drugs from a local pharmacist with our current system. If | Mark Cuban is willing to throw a lot of capital and break up | the price collusion between established drug companies, then | I suppose it's a step in the right direction. We should be | happy to accept lower prices and get to work on fixing other | important problems with our healthcare system. | Shivetya wrote: | Well its not all about insurance companies but also where | government drops the ball. Example, doctors will prescribe | Eliquis because if you have insurance and not medicare its | downright cheap but if you are on medicare your cost is four | hundred plus. | | Even insulin prices get distorted because you are limited to | which types you can buy in you are under medicare. | | maybe with their majority the Democrats can finally tell | their union buddies to bugger off and pass a single payer or | tax high value insurance policies; one major reason ACA was | so limited as many of those policies which were going to be | taxed were all on the side of public employee union benefits. | metiscus wrote: | I've heard this mentioned a lot and I have always wanted to | ask: How does tasking high value insurance policies address | this issue? Does the government take the additional tax | money and use it to subsidize the drug cost? What would | prevent the drug company from raising the price to capture | the subsidy? | metiscus wrote: | I have imported Colchicine from overseas pharmacies with | regularity and never had an issue with it being seized. The | prices I get are significantly cheaper because of the patent | issue on that 2000 year old drug. For uncontrolled legacy | drugs affected by patent issues this is probably viable for | the tech savvy (and for those who can afford to wait quite a | while). It would be nice if it could be done on an industrial | scale instead of as an individual. | sct202 wrote: | Those drugs need to be tested and certified by the FDA before | they're legal in the US. For a lot of lower volume drugs, the | cost and time to go do that ishigh enough (vs the potential | gain) that companies don't bother. | [deleted] | aj7 wrote: | Amazon, which should have led this effort long ago, seems to have | a half-hearted approach. Almost like they want your data as much | as your business. | warent wrote: | Can we just appreciate the level of moral depravity needed to | price fix medication? In my opinion something this repugnant and | egregious needs personal executive accountability. I'm willing to | wager that many human lives have been altered for the worse | because of this, and there's nobody taking personal | accountability. | | Imagine if Epstein wasn't personally charged, instead just his | business was fined. To me, that's actually the level of crime | we're approaching here. If you think this is tenuous, at least | consider the fact that it is proven that poverty is correlated | with human trafficking (due to desperation and vulnerability) and | illegally high medical bills force people into poverty. | iancmceachern wrote: | I agree - let's. | | Someone should make a list of the companies and executives | implicated in generic drug price fixing. Shame is a very | powerful tool... | merpnderp wrote: | Maybe people would have less problems with "corporations are | just groups of people working together" if the people of a | corporation were ever held accountable. | usrusr wrote: | Sell your shares before it's getting caught and you won't | even be affected by the heaviest fines. Absence of | information asymmetry is a fiction. | kortilla wrote: | > least consider the fact that it is proven that poverty is | correlated with human trafficking (due to desperation and | vulnerability) and illegally high medical bills force people | into poverty. | | This is pretty tenuous and would implicate a lot of other | behaviors. You know what else causes poverty? | | - the ability to hire based on skill and lay off people when | you don't need them | | - alcohol | | - charging for housing | | - charging for food | | - charging for utilities | | - property taxes | | - charging for transportation | | If, "does something that could cause poverty" is the bar, then | a huge chunk of market exchange of goods and services needs to | stop. | f-securus wrote: | You're comparing the basics of a capitalism based society to | a large company actively breaking the law (price fixing) on | products that affect people's lives and health directly. | tehwebguy wrote: | Price doesn't even have to be fixed for it to be depraved! | | Good time to remind everyone that Shkreli is in prison for | financial crimes largely unrelated to the pharma side of his | businesses, the rest of the pharma industry continued doing the | same things as him as usual. | [deleted] | fastball wrote: | That was kinda the point, no? Shkreli was made into a | bogeyman, but he was just doing in the open what every other | pharma was smart enough to keep secret (pricing things higher | than necessary). He also did it an excessively bombastic way. | | Don't hate the player, hate the game. | | Fix the root causes, not the symptoms. | cforrester wrote: | "Don't hate the player" is the kind of thing you say about | people scraping by at a day job, who hold no real power | over the business practices. He wouldn't have gone hungry | if he'd behaved acceptably, so he had a choice free of | influence by the immediate need to survive. I wouldn't | characterize Shkreli's moral failure as a symptom of "the | game," but rather one of several root causes of its | perpetuation to begin with. In my view, fixing the problem | includes denouncing powerful people who fail to abide by | the ethical standards that we want them to hold. | ericb wrote: | I find fault in your reasoning. Let me explain. | | This is a game theory problem with perverse incentives | where regulation and law enforcement are needed. If CEO A | (in this case Martin Shkreli) were to take the "moral | high ground" and behave acceptably, the board of | directors would look at similar companies performing 10x | better, _fire him_ and replace him with someone less | moral. | | If the board were to take the "moral high ground" the | shareholders would value the company many times lower, | and they'd be bought out for pennies by an acquirer | willing to take the low road because that would be a | super profitable move. | | If moral shareholders refuse to buy the shares of low- | road companies, the value of the shares fall, but the | profits don't, and suddenly being "amoral" is super | profitable for stock investors, and there are always | some, and they will be richer than moral shareholders. As | amoral investors amass riches, they will deploy greater | amounts of capital using amoral valuations, which will | then dominate. | | So the whole system is broken, and personal ethics does | nothing to fix the game. In a nutshell, this is also why | libertarianism is broken. | cforrester wrote: | I see what you're saying from a business perspective. | From a social perspective though, I don't consider that a | reason to withhold my ire towards people like Shkreli. | Choosing to be a bad person because someone else might be | worse is still a choice to be a bad person, so while your | pragmatic reasoning might work well when it comes time to | determine a legal response, I don't feel that encouraging | people not to hate Shkreli is helpful in encouraging good | social norms. | ericb wrote: | Your ire is not necessarily directed at a personal | preference to be a bad person, though. Attributing it to | him "wanting to be evil" is easy, especially because he | is abrasive. | | Due to the incentives above, it might be said we are | annoyed by their lack of willingness to be fired in a | futile effort to obstruct a system which will carry on | regardless--we are annoyed they won't do something | pointless. | | I have a feeling most people would have trouble taking | food out of their family's mouth and literally becoming | unemployed in order to tilt at a windmill where your | effort cannot win. That's a pretty impossible standard to | expect. If Shkreli found morals and got fired, Shkreli2 | would take over. | | So instead, I say, the problem is the system. Pretending | it is about moral failing _enables the system_ to go on | by wasting time blaming moral failings instead of fixing | it. The system produces bad behavior. We can tut tut each | individual person it produces, or we can change the | incentives and fix the system. | cforrester wrote: | I really appreciate your reply, you've definitely got the | gears turning in my head. | | Something to clarify, I'm not really trying to say that | people like that want to be evil. People like Shkreli | make bad choices not because they like to be bad, but | because they're indifferent to the indirect consequences | of their choices. I'm extremely skeptical that someone in | a position like Shkreli was would be in any serious risk | of losing access to essentials like food and shelter if | they were to behave more ethically, so I think it's | important to set the standard that choosing a job like | that when you have alternatives is wrong. | | All that being said, I do agree with you that the primary | problem by far is the exploitative structure that enables | these people to exist in these positions, in the first | place. If someone's analysis of the situation ended at | Shkreli, I'd encourage them to think deeper. However, I | do strongly believe that we don't have to choose between | one or the other -- encouraging others to look down on | those who choose to be a part of this system can have a | significant influence by discouraging others from | entering it, themselves. The more voices we have saying | "this is not something to aspire to," the more pressure | we can build to effect meaningful systemic change. | fastball wrote: | Morality is not objective. | | If you want people to stop doing something, make it | illegal. | | If you can't muster the political will to do so, clearly | not enough people agree with your view of morality | (assuming a functional democracy). | scarby2 wrote: | This is something people often forget, nothing is | objectively good or bad as they are social/individual | constructs. Even things like killing or theft could be | seen as good looking through the right lens. | cforrester wrote: | I made no statement about "objective" morality. I | explained my own morals, and why I'm comfortable | encouraging people to blame the wealthy for the harms | they perpetuate. Could you please elaborate on how you | think this reply is relevant to that? | | As slow as it seems to be, my perception is that societal | attitudes towards wealth have been shifting over the past | few decades. I'm hopeful that one day, the tolerance for | their misdeeds continue to dropbenough to inspire | progressively more social and legal change, as you | suggested. | fastball wrote: | Innocent until proven guilty, etc. etc. | | Public witch hunts are called "witch hunts" for a reason, | and it's not a pretty one. It's also known as "mob | justice", which despite the name is generally considered | to be not justice at all. | cforrester wrote: | It seems poorly considered to characterize social | pressure as a witch hunt. It is acceptable to encourage | others to share your moral convictions, there is a vast | gulf between that and a pitchfork mob. | fastball wrote: | You would characterize the response to Shkreli as more | "societal pressure" than "pitchfork mob"? | | That... doesn't seem true to reality. Maybe I'm | remembering it incorrectly. | freeone3000 wrote: | The root cause, in that, medicine is a for-profit endeavor | and people are not only profiting, but seeking to maximize | their profits on other people's basic needs? | sbarzowski wrote: | You could say the same about bakeries ("seeking to | maximize their profits on other people's basic needs"). | | IMO the problem is more about (very) imperfect | competition. Also medicine is very special in many ways | (desperate buyers, doctors making decisions for them, | moral and emotional weight, etc.), so it's hard to have | incentives aligned. | freeone3000 wrote: | The entire food pipeline is heavily subsidized by the | government, from advantageous loans to crop price | insurance to direct cash subsidies to a sales tax | exemption, to SNAP to people who can't afford food. I | agree wholeheartedly with the bakery comment, that they | try to maximize profits, but, bread is less than a dollar | a loaf and significant expense and effort is taken to | ensure everyone is fed. There seems to be no will to do | the same for healthcare. | fastball wrote: | Pretty much. Other things that don't help (somewhat US | specific): | | 1. Layer of indirection created by the entire insurance | system, which at this point is clearly not a good model | for healthcare. _Everyone_ needs /should have some amount | of healthcare, so a system built entirely around the idea | that only a minority of people should need to take | advantage of the system is silly. | | 2. The half-assed government intervention of | Medicare/Medicaid/ACA/etc - worst of both worlds in that | when a government just injects shittons of money into the | private sector (without very strong controls on price and | behavior), what you end up with is ballooning costs... | and that's about it. See also the govt. guaranteeing | student loans for another example of the same. Or the | Military Industrial Complex. And so on. | chongli wrote: | It's a bit more complicated than that. Health care costs | have skyrocketed in the US. One of the big contributors | to that has been the explosion in testing, both routine | and diagnostic. These large costs aren't always shared to | the same degree with other countries that have socialized | medicine. | | One example is with MRI scans. MRI machines, and the | technicians and doctors who work with them, are insanely | expensive. The US is, of course, not the only country | with MRI machines. However, in countries with socialized | medicine there may be a much longer wait for people to | get an MRI scan for a non-critical issue. What about in | the US? If you've got the money, you can get one right | away. As a Canadian, I've seen tons of advertisements | over the years targeting Canadians for MRIs as a cross- | border service. | | So the question is: is getting an MRI now instead of | waiting 6 months a basic need? Private MRI clinics are | definitely profiting from it. It definitely seems | frustrating for people on the waiting list who can't | afford to cross the border and pay out of pocket. | However, it doesn't seem nearly as bad as a company | price-gouging people on life-saving insulin, for example. | Animats wrote: | Too much of that is markup. The cost of MRI machines is | down, and the cost of CT scanners is way down. But | charges for those services have not dropped to match. | [deleted] | jonny_eh wrote: | There are many root causes, one of them being execs with | decision making abilities, like Shkreli, making greedy | decisions at the cost of people's health. It's ok to hold | them accountable. | bradlys wrote: | This is really presuming people need to feel any kind of morals | around healthcare or its costs to begin with. In America - | barely enough people give a shit. If they did - we'd have | universal healthcare. But because capitalism and strong | individualistic spirit of Americans, there is no reason to | care. Stonks must go up. | | If you think anyone should feel any kind of moral obligation to | not do this kind of stuff - you're just out of touch with | American society. It's a survival of the strongest capitalistic | machine and you get away with as much as you can. | dang wrote: | Please don't take HN threads into ideological flamewar or | nationalistic flamewar (this is a bit of both). Those paths | just lead to internet hell, and we're clinging to little | clumps of grass and the occasional rock trying to stave off | the downward slide into that abyss. | | https://news.ycombinator.com/newsguidelines.html | | https://hn.algolia.com/?query=stave%20by:dang&dateRange=all&. | .. | jjeaff wrote: | Part of it may be lack of compassion but that it certainly | not all. Part of it is that Americans have been led to | believe that government can do nothing right and that the | free market is all that is needed to solve the problem. Which | is incorrect, but here we are. | ksdale wrote: | Certainly government is competent in many places, but the | performance of the American national and many state | governments throughout the pandemic hasn't exactly been | confidence inspiring. I don't think Americans who believe | that their government isn't capable of many simple tasks | are delusional. | jjeaff wrote: | They aren't delusional about the government. But there is | some delusion that private business or the "free market" | can necessarily handle all these same problems entirely | better. | at-fates-hands wrote: | > Can we just appreciate the level of moral depravity needed to | price fix medication? | | First thing I thought of: | | Valeant Pharmaceuticals | adolph wrote: | In evolution adaptation prevails over customary behaviors | thought of as morals. The question is why have the generic | makers continued to cooperate instead of defect? How is the | cartel protected? | | In this thought I am reminded of the Econtalk podcast's | discussion of Martin Shkreli in the interview about the High | Cost of Cancer Drugs with Vincent Rajkumar. | | http://www.econtalk.org/vincent-rajkumar-on-the-high-price-o... | | http://www.econtalk.org/extra/the-high-cost-of-cancer/ | ficklepickle wrote: | One tactic pharma companies use is playing games so generic | makers can't get samples of the medication. These samples are | required for making a generic version. | | I read this somewhere but don't have a link. | dang wrote: | We detached this subthread from | https://news.ycombinator.com/item?id=25932516. | ksec wrote: | Excuses my ignorance. | | Does _Tablet_ , mean _one_ , single pill? ( Just making sure ) | | And they sell Albendazole for $225 Per tablet in US? | | And quote | | > _our cost to make and distribute the drug is approximately | $13.00 per tablet_ | | It _cost_ $13 to make one Tablet, or one pill? | | And this is _low_ _cost_? | | Anyone from Europe or UK living in US could sort of explain a | little bit here. I know US medication are expensive, but this | is... something else. I cant comprehend what I am reading here. | HarryHirsch wrote: | It costs a few pennies to manufacture. The rest is profits for | Marc Cuban. | annoyingnoob wrote: | The company claims a fixed 15% markup. Something doesn't add | up... | banana_giraffe wrote: | I'm reminded of the time I was in the EU, in an area tourism | isn't common. Due to a lack of planning on multiple levels, I | had to stay an extra two weeks. I went to get a refill for a | prescription I need. | | The pharmacist was clearly unconformable with the discussion | that needed to happen. They informed me there would be a charge | for the medicine. After some back and forth because neither of | us was fluent in the other's language, it turned out they were | asking me to pay the cost of the drug, an amount of money less | than my normal copay, and something like 5% of what my | insurance claimed the drug normally cost. | | The pharmacist was most confused why I was happy to pay. I | don't think believed me when I tried to explain how much it | normally cost me. | nostromo wrote: | In the US I've had this happen for a generic. | | The pharmacist told me that they were having a hard time | confirming my insurance. After a ridiculously long delay, I | asked how much the drug was to pay for out of pocket... It | was $12. My copay was $10 anyway. So both the pharmacist and | I wasted a lot of time and hassle trying to save me $2. | biggestdummy wrote: | Yes, a tablet is a single pill. Sometimes you'll split the | pill, so a tablet might be 2 doses. But 1 pill. | | Note that retail pricing is an unreliable indication of actual | cost to consumers. They jack it up so that they various plans | can claim huge discount policies. Some of these plans are free, | so there's very few people who are paying this "retail" price. | | The pill makers get paid by the consumers and, in most cases, | by the plan-owners. And such agreements are made exceedingly | complicated. IMO, only to make them more opaque and more | difficult to regulate. | | Unfortunately, such a system is highly regressive as the | richest tend to have the best plans, the poorest tend to have a | meager plan, and the transient have no plan other than showing | up at a hospital. | cavisne wrote: | The US system works like this | | * hospitals run as non profits, so they dont pay federal | taxes | | * they still pay local taxes, so they need to generate a | large loss to offset these taxes | | * insurance companies negotiate huge "discounts" on list | prices, and then go back to their customers (large | corporations) and boast about these discounts, meanwhile the | hospital gets its tax writeoff | | This entire system is rigged to also grow the number of | hospitals/ the overall size of healthcare in america. | | Pharma companies play this game too, and anyone who doesnt | have insurance can quietly get a "coupon" from them to bring | down the cash price to the same as insurance. | | No politician will close hospitals, so at this stage any move | to "single payer" will just move the boasting role to the | government. | freeone3000 wrote: | Prices can go as low as $300 for two tablets, if you have a | GoodRx annual subscription. I think the $13 is actually a | wholesale substitution price, as there are lower prices | available for this drug for the same dosage through veterinary | channels. | Griffinsauce wrote: | I'm also confused by this. | | ~This medicine is for sale here in the Netherlands, over the | counter, for $3.3 dollars. No that period is not a mistake.~ | | ~That's for a pack of 6 tablets. How the heck do they end up at | $13 cost?~ | | Edit: Google autocorrected to a similar drug. This specific | drug is actually $4.50 per tablet here and prescription only. | That's still a massive difference. | | Relevant sidenote: it's fully covered as well so I wouldn't | even get a bill. | xmichael0 wrote: | yup, confirmed, bought a 6 packet about a year ago for about | $5 in costa rica. | ksec wrote: | >This specific drug is actually $4.50 per tablet here and | prescription only. | | Yes. It is like someone told you a _can_ _Coca Cola_ _Coke_ | in US is $220, and their latest innovation is to give you the | same for $20. | | All while you are picking one up at a convenience Store in EU | for $1 and you can get a pack of 8 in a large supermarket for | $3. | | As you walk out of the convenience Store while drinking your | coke, you are left wondering what the hell is going on with | people and the world across the pond. | marcell wrote: | Isn't the whole issue with drugs the fact that they have a huge | upfront cost in terms of research, and then they are basically | free to produce? | | If you just do cost plus, then the research can't get | (retroactively) funded. | | This is similar to software, where the marginal cost is zero. | apendleton wrote: | Sure, that's what patents are for: to guarantee exclusivity to | whoever bore the R&D cost so they can charge a lot for long | enough to recoup their investment. This service is selling | generics, though, so they'll be off-patent at this point. ___________________________________________________________________ (page generated 2021-01-27 23:00 UTC)