Of course ads exist to increase product sales. That doesn't mean that people are unable to actually look at the product label and make informed choices. Ads don't make you do anything. Thinking that they do is a crutch.
If advertising works on average, then there is a discussion about ethics that is worth having.
Falling back on individual responsibility might be popular but it is absolutely a cop out. We're playing a numbers game with public health in an adversarial environment. Relying absolutely on what individuals could or should do isn't going to help us win that game.
It's a cop out to defer to individual responsibility and ignore all the other tools that are available to improve public health. We know that there's a rich corpus of psychological research that provides tools that we know can be used to affect behavior and choices. It's being used to sell us things that are bad for us and that same research should be used to inform regulation policy and public health communications.
Nobody is ignoring the tools that are available to improve public health. Two of those tools, the ingredients list and the nutritional information, are there to support individual responsibility through informed personal choices.
It is best to understand that people can make informed choices. It is very shortsighted to think that everyone is subject to the magical sway of marketing without a conscience or decision making abilities.
The existence of personal choice and individual responsibility don't make anything else that you mention disappear. Are you saying you want to increase behavior modification of people and somehow rob people of personal choice? That's what your words imply.
That's not all there is to the story either. Processed food is generally cheaper in the sense of time and money. Most of us HNers are blessed with great salaries and stable (9-5) work. Millions of consumer, of course, are not.
I would agree with you if we had a decent education system. I bet the amount of high school students that know how to read and make sense ilof a nutrition facts label is staggering low.
Not that those labels are even needed if they were taught to stay away from fast food, sugar drinks and highly processed food. But they are not.
There is also the issue of money, because junk food is usually more calorie dense and cheaper per calorie than healthy food. But government corn subsidies are to blame for that I guess.
I grew up poor in Appalachia in methsville, georgia and I managed to develop an extremely cheap diet of lentils, oats, cheap chicken, and spinach/broccoli at 16 years old. I definitely understand the allure of cheap, processed foods but it's from willful decisions.
The things you describe aren't all cheap in every part of the country. Some parts of the country actually have somewhat limited access to fresh vegetables/meat or have to pay a premium for it.
+1 to this, I'd have to go out of my way, significantly, to find those items for cheap, while fast food is $3 for a calorie-dense burger and easily accessible.
Of course, there are nearby supermarkets too, but you'll be paying like $10/lb for raw chicken and everything is "organic"
I'm kind of using I in third person - it's cheaper, more accessible, easier, faster to get unhealthy food. For many people it is not possible or feasible to make those healthy choices. For example, extensive - both in time and money - travel time to cheaper supermarkets (vs something like Whole Foods) to be able to afford fresh ingredients. There's also the part where working multiple jobs might make it difficult to make it to a proper market before they close, while fast food is nearly universal and available all day and all night.
Quite a lot of people do lack self control and it’s controversial to state this. Also, it is time consuming to read every single label on food that one buys. The labels on the front are often misleading.
I frequently work at state fairs & arts and crafts festivals on the east coast. The amount of very overweight and obese people is simply astounding.
About half of one coke is the average adult’s recommended sugar intake. I know more people than I’d like who have at least one soda every day, and some who have multiple every day.
Nearly everything in our supermarkets has a lot of sugar. Including common things like bread and pasta sauce. Last time I checked at publix, I only found -one- type of bread that didn’t have a lot of sugar in it. Finding a protein bar without tons of sugar was rather difficult. Etc.
Combine this with sitting all day + driving everywhere and we’ve got a huge problem.
>Also, it is time consuming to read every single label on food that one buys. The labels on the front are often misleading.
But only in the short term, right? Once you figured out what products are healthy and switched to them, you can rely on prior memory. It's not like you have to look at the labels of every item you're buying for years.
Ingredients change; how often are you checking and updating what you know? Availability changes; what brand is #2 and #3 on your list? Or the time in your day you have to prepare food may suddenly shrink; do you then have the time and spare cognitive cycles to make a good decision under stress? (You probably don't. Not, like, you specifically, but in aggregate.) We make it difficult on purpose to eat healthily in the West because eating less healthily is more profitable.
I eat pretty healthy, though I also like cheeseburgers so I'm not thin. But I make a very healthy income and have the time, and the resources, and the education to actually have the time and executive function to have an opinion about ingredients in food. It is difficult for me to know these things, let alone to in all cases exert the self-control to act on them--and I make north of five times the median personal income of the United States with which to do it.
I mean, let's think for a second. Blame an Amazon picker or a Wal-Mart cashier or blame the corporate entity with a marketing department designed to overwhelm your attention and to induce the specific action they test and refine for?
>Ingredients change; how often are you checking and updating what you know? Availability changes; what brand is #2 and #3 on your list?
Are the nutrition content for staples (eg. milk, bread, eggs, apples) likely going to change any time soon? As for the processed foods, they might change from time to time, but I doubt they undergo drastic changes that the nutrition profile is entirely different. On the off chance that it does happen, you'll likely notice it on your tongue, and can update your brain accordingly. If you do any sort of research, you'll probably start to notice such processed foods aren't healthy, so you shouldn't be buying them in the first place.
>Or the time in your day you have to prepare food may suddenly shrink; do you then have the time and spare cognitive cycles to make a good decision under stress? (You probably don't. Not, like, you specifically, but in aggregate.)
>[...]
>It is difficult for me to know these things, let alone to in all cases exert the self-control to act on them
People aren't getting diabetes because they accidentally ate mcdonalds one time. It's from bad diet over a long period of time. For that reason your objection doesn't really make sense.
Yeah, and bad diet happens in no small part because of chronic societal stress. It is overwhelming and constant grind on the psyche that makes people reach for the easiest option available because their brains are overtaxed out of the executive function necessary to do the "right thing". So you are correct, it's not one cheeseburger. It's the society that makes the cheeseburger the simplest, easiest, remarkably-cheap solution that fires the right neurons to give people a respite from the sad pressure cooker that is your average late capitalist life.
Perhaps those of us who benefit inordinately from the output of the perpetually stretched class can show some grace in life and not second-guess the folks picking and delivering our consumer goods.
> but I doubt they undergo drastic changes that the nutrition profile is entirely different.
It probably is gradually done, but I recommend looking at the amount of sugar each brand of bread has next time you're at a supermarket. Or milk, lemonade. Or other common groceries. It really is crazy to see just how much of -everything- has added sugar. Including products that are branded as "healthy". AFAIK Naked juice is a great example of this.
As a remote worker with a great schedule, I have the time to do such research. But not everyone is in that situation, particularly if they have a job and have kids, etc. Brands can essentially lie through their teeth and get away with labeling as the regulation can be quite loose.
Many people "know" processed food isn't healthy, but to what extent it's bad for them, maybe not. And it comes down to time and cost. Also, some people don't really grow up knowing what "healthy" food is like.
> It's from bad diet over a long period of time.
It doesn't help that healthy foods are more expensive than food that's absolutely terrible for you.
I think Mexico's new laws around food labeling is the way to go, but time will tell if that's actually effective or not.
"Free markets" require a perfect knowledge of all things about those products that is constantly kept up to date. As soon as a company is bought out, some brand decides to change their ingredients, or any number of other events, then you're back at square one.
Ethical consumerism is a constant treadmill. Even knowing which brands are owned by which corporations is an absolutely exhausting affair.
You honestly expect people to keep up with this? It's as bad as a software dependency chart.
> "Free markets" require a perfect knowledge of all things about those products that is constantly kept up to date. As soon as a company is bought out, some brand decides to change their ingredients, or any number of other events, then you're back at square one.
As mentioned in a sibling comment, while this is theoretically an issue, it doesn't happen often enough in practice that it causes a burden
>Ethical consumerism is a constant treadmill. Even knowing which brands are owned by which corporations is an absolutely exhausting affair.
Why are you mixing ethics into this? We were talking about making healthy purchasing decisions, not boycotting [insert brand here] because they punch kittens or whatever.
The number of times I've specifically selected something because I wanted that exact product and had it substituted when using a service like this... I've lost count.
It's still convenient, so I still do it, but it is not a reliable way of getting __exactly__ what you want.
Reading about all the tricks marketers use to get us to think we need to buy shit we do not need, and honestly I do wonder if self control is an illusion.
I wonder if there are studies looking at whether exposure to advertisements affects self control. I would imagine that certain advertisements reliably decrease self control (as that is their intent). Would be interesting to have data to back this hypothesis up though.
At scale though, it's pretty evident that people don't have either of these with respect to their health. Is this an indictment on humanity as a whole, or someone else? Ultimately the answer doesn't matter because when something like this is this widespread, it has serious problems for society as a whole. Do we want to continue to put up our noses at the unwashed masses (which doesn't help anybody or anything), or do we want to do something about it and potentially help out society and start to get those who have erred on the right path?
Before 18 (or 21, or 16) it's debatable that humans have the capacity to self-control, or make their own decisions understanding the effect on themselves and those surrounding them. I'm not saying that they're completely oblivious, but there is a reason why the law is not applied in the same way for children (non-adults).
Now, it's a mix of societal and economical (and more) that's making people eat a certain way. Changing your eating behavior can be difficult, especially if you've eaten a certain way for the past 16-18 years.
I'm not saying it's Walmart's fault, but it's also not just an individual willingness to change that's in play here. The United States clearly has a problem of obesity, which is related to Type 2 diabetes.
If you mean to say that we should take a libertarian approach and not try to use government for nudging society towards healthier eating and lifestyle standards, you might as well say that we should give up on the health of the US. Because I have 0 faith in purely individual or "grass-roots" societal change fixing our obesity crisis, given the path we're on.
> They sell vast quantities of candy, sugar drinks and food with added sugar
As do all but specialized grocery stores because this is the majority of food produced. How about we go after the food producers instead? Or the subsidies that enable this?
That doesn't really answer the question. There's a lot of subsidies going around, but how much difference does it make to foods at the checkout? Does [junk food item] being 10% more expensive cause a meaningful drop in consumption?
Sure it does. Maybe not to 5 decimal places, but you're not going to get that on an internet forum of non-specialists. You want more? I'm sure there's a dissertation from an economics student or a master's thesis out there for your digestion.
It is well known that Sam Walton held people's mouths open and poured refined sugar into their gullets. He then tied them down to their beds so they could not exercise.
I have shopped at Wal-Mart for groceries many times and the food is no better or worse than any other supermarket. There are perfectly good fresh vegetables and meats etc, alongside the chips and soda you find ay every other store.
This is good because it will actually help people...
... but wow, just woooow. It's so incredibly depressing that I'm calling this "good." Sometimes the sheer insanity of the United States health care system overwhelms me. The fact insulin isn't a few dollars or free is beyond disheartening. It's like the system itself saying the Sackler's just didn't have enough imagination exploiting people, and destroying lives, for profit. "Oh? You don't need to get them addicted if they'll die without it... silly, Sacklers. #BusinessMASTER"
I keep hoping one day folks in the US will get tired of being screwed on their healthcare and living in fear of getting sick... shrug
Insulin prices have increased SO MUCH over the past 50 years, it's disgusting. The manufacturers' margins just keep climbing because they know they can raise prices without consequence.
Well, that's because the insulin has been getting better. You could always buy porcine insulin and shit. It's just not as good (side effects, harder to dose, etc.).
I heard this argument somewhere (not just about medicine but also on defense, why they can have such lavish perks/holidays/etc.) but can't remember where. Do you have any good articles/papers on this?
Just look at the difference in taxes on salary between France and the US. Half of what is payed by employers to workers goes to social protection (this is in addition to the company taxes). If you add VAT and income taxes the amount of disposable money is a fraction of what you would get in the US, nothing magic.
Funny you should say that. Let's have a look at what the out-of-pocket costs would be if you live in, say, the Netherlands: https://www.farmacotherapeutischkompas.nl/bladeren/preparaat... because those prices look a hell of a lot more normal than US dependents get squeezed (literally) to death for.
Yep. And if some insulin gets too expensive, at least in Germany they kick it out from the system completely. It's either you can sell your product in the country with a price we think is reasonable, or we will not let you to be in the market.
20 euros per 10ml (about 2 weeks of use for me) is still kind of a good money for a product I cannot stop using...
Sure, there's a price difference across regions. That's nothing new.
The important thing is that insulin prices haven't been going up. You can continue to get the same insulin as 50 years ago for pretty much the same price modulo inflation.
And anyway, the Netherlands getting cheap stuff is a side-effect of innovation here. America builds for America, driven by American needs, and you guys benefit as a result. There's a reason recombinant DNA tech (which backs modern insulin) came from the Bay Area and not the Netherlands. NL has twice the pop of the Bay and a fraction of the inventions. A single university here has like 5x as many Nobel Prize winners as that entire country.
I mean, I'm glad you're able to buy insulin cheap but we're richer and we're the ones driving progress, so we'll keep at it because we want a better life for ourselves (and if you benefit, it's fine). You're not capable of making that for us, yourselves, or anyone really.
gotta love how people apparently don't like facts so much this comment now has zero points. Insuline is cheap, it's cheap to make, and cheap to distribute, and the US doesn't like cheap when it comes to having a steady supply of "you will buy our drugs, or you will literally die".
net price =/= profit. The report also covers what exactly goes into the difference between gross and net price. If you can point out what the accounting tricks are, that'll be great.
If you look at the chart in the link, about 45% of the difference between “list price” and “net price” is discounts or rebates to insurers.
It’s particularly gross and brazen, even by pharmaceutical rent-seeking standards, to justify cocaine-like profit margins because large buyers can negotiate.
Insulin prices are driven by anticompetitive behavior. If you look at metformin, a generic drug treating the same disease, profit margins are tight, driven by competitive economics. A 90-day supply is < $10 retail.
Insulin has actually gotten cheaper; it's the pricing due to customization, branding and applicators that is totally out of control. Coupled with the history of insulin's invention and "open source" nature this is unconscionable .
Don't worry, one day we all end up working for Amazon and they provide Amazon Healthcare at their Amazon Hospitals (wait times decreased to see a doctor based on PPH [picks per hour] minus TOT [time off task]). On your way back to work, don't forget to grab your prescription at the Amazon Pharmacy, where you can buy some Amazon Drugs (side effects might include decreased productivity, please use sparingly).
The depressing part is the realization that it was supposed to be Costco, the good guys in retail, but we will end up with Amazon universities instead :(
Under what moral framework should these people (around 90% of diabetics) receive insulin at others’ expense? I can see at least a first-order argument for having everyone else pay for obligate insulin dependents’ medication, but I struggle to see an argument for foisting the cost of an entirely preventable dependency on everyone else.
Society continues to push back on any regulations on addictive junk food and loading down budget food with excessive amounts of added salt and sugar - so yea, the company's freedom to make a buck exploiting addiction trumps your freedom to live a healthy and happy life.
We're not talking about being fat, but eating suger to the point you neet to start taking medication to keep the suger in your blood from ripping your veins apart. At some point there's some personal responsibility. It takes more than a little suger added to your food to do that.
More recent studies by nhs show ~25% success rate but I bet it's due to compliance. The nejm study (iirc) had strict monitoring, which is impossible at the ~300 patient level
Social security is a savings plan. You don't get social security if you don't work, and it's in proportion to how much you earn. This is, in fact, the point of social security. It came about as a response to old people dying in the streets. It exists for people who either through bad luck or lack of financial education couldn't save enough.
The idea is that if you worked through your life, then shit hits the fan, you shouldn't be knocked down below your contribution to society as measured by your level of success under capitalism.
Most type 2 diabetics have the opportunity to improve their health now and eliminate insulin dependency and continuously choose not to do so. At least SS has the argument that it’s too late for people who failed to save to change their behavior.
That's fine as long as you are willing to forgo the benefits of the things that other people have collectively paid for.
If you want to opt out of taxation you should surely also be morally obliged to opt out of using roads, internet, mobile telephones, clean water, sewerage, police, fire brigades, etc.
I know that it is possible to opt out of fire services in rural US but most of the rest might put a bit of a crimp in your lifestyle.
Not just police, but general societal protection - the fact that you can exploit people for your own profit and not get beaten up when they come back for vengeance is one of the benefits of being in a society. I personally didn't find the depiction of Caeser's Legion in fallout to be the most desirable and free society to live in, but to each their own - maybe you image you'll end up as Caeser (but you won't).
I feel like that's the same thing as arguing that your taxes shouldn't go towards public schooling since any one of those parents could have chosen not to have a child.
If that argument strikes you as problematic, it might be because society is better when it's generally well educated and healthy.
> I keep hoping one day folks in the US will get tired of being screwed on their healthcare and living in fear of getting sick... shrug
As someone with good but very expensive health insurance, any time I bring up health insurance prices, the response from people who get cheap health insurance through their employers is basically, "F* you, got mine"
Unfortunately, the block of people with stable corporate jobs also tend to have a lot of political power and are in no hurry to see their perks upended.
People being squeezed for time and money by soul-crushing, self-grinding subsistence-level employment so that, tapped of executive function for the day, they buy a cheeseburger and fries, maybe collapse in front of YouTube to turn their brains off for a bit--
--those are the people you feel comfortable shitting on for their circumstances?
(And there absolutely is a predisposition to Type 2 diabetes in some populations and not in others.)
I see no need to subsidize their choices. Its not shitting on them, its just not enabling them. The vast majority of type 2 diabetics have a BMI >25. It is a user preventable disease.
If for some reason they still have diabetes with a BMI <25, then subsidize it.
And this is exactly why I don't want universal healthcare in America. We'll need everyone to conform to a rigid interpretation of life. My BMI is 22, so I'm fine, but I also like riding a motorcycle.
With UHC, suddenly folks like this will try to deny me care because I'm taking on non-normative risk. Fine, do so if you want, but I want to be tax-exempt. You can have your UHC, but you pay for it.
But folks won't do this. Instead they want to take my money and then give it to themselves by denying me 'subsidies'. No thanks, I'll keep my money and give it to Anthem. No UHC in the USA.
The vast majority of type 2 diabetics--and the vast majority of Americans--live in a existentially threatening mess of financial crisis and mind-melting advertising and pressure on a thousand axes that didn't exist a century ago and are being ground into powder to enable a thin film of the truly rich to live like kings and to enable people in the computing class to live lives of only moderate precarity.
I dunno, it just doesn't seem all that hard to have have some really simple baseline humanity for the grist in the mill trying to find a moment of respite in something bad for them--ingrained literally decades before and in plenty of cases before they had the personal automony to decide for themselves.
Also, false(to the later point), having type-2 still does damage to the beta cells and given time many will require insulin. Also, this still gets back to the OP placing blame on the individual based on ignorance. There are many reasons for an individual having a large mass, low insulin production, and insulin resistance.
Low card can be part of it, but it's not a panacea, once an individual has diabetes, the damage has been done.
It would be really nice if we could actually recognize this issue and address it as a society instead of getting up in arms about a mayor taking away the Big Gulp.
The only people dying of starvation in the western world are people who refuse to accept help or have severe addiction or mental health problems that prevent them from seeking it in the first place.
I understand that many are not sure where their next meal will come from or when it will arrive and I do not deny that is a problem, but that's a far cry from dying over it.
I think a lot of us are sick of it (if you look at the polling for single payer, it crosses party lines in support). Unfortunately, our politicians are fairly well captured by entrenched interests.
There is a perspective out there that says our current extremity of partisanship is actually a product of the parties themselves becoming weaker. When parties were strong, they had greater leverage over their members so the party could be whipped more effectively on compromises. Now - the efforts to reduce party influence over their members (smoke filled rooms, etc etc) has led to more and more extreme members and leadership has fewer levers to pull them towards the center.
I don't see how what you've said is related to what I said?
If republican voters aren't willing to replace their politicians with ones that are willing to vote and make a single payer solution, then they don't care about single payer healthcare that much. It has nothing to do with any specific implementation. Republican politicians have never put forward any sort of single payer healthcare implementation
>...in the current thread...which is four hours old
Well if we apply your logic to this other thread: https://news.ycombinator.com/item?id=27860162, can we assume that "large segments" of the US population are knowledgeable in debating the merits of the rust programming language?
>and mirrors the comments from others in the US....
Mirrors what? I certainly didn't see any reference.
Firstly, for anyone completely out of insulin, please know novonordisk offers a patient assistant program and will cover your insulin free of cost. I used this during college. If you can't even afford a doctor, there should be free health care clinics willing to sign those forms required. I used my college's clinic once to do so as well. The down side is signing away your personal health records.
As a type 1 diabetic myself, Walmart's offerings on R or Regular insulin saved me a few times. Once when I was simply out of insulin and did not have insurance. Then when I was caught in another city for work and ran out due to needing to extend my stay. I am slightly disappointed to see that one, the price is not the same as their human insulin which is around 25 dollars per vial I believe. Two, it will require a prescription. The times I bought their cheapest insulin, this was not required. However, I hope this is the right direction.
I wish more people knew about Walmart's $25/vial regular insulin. Like you said, it's available without a prescription at any Walmart (except in Indiana). Dosing needs to be adjusted relative to insulin analogs, but it's a viable option for anyone in a money pinch who hasn't yet gone through the process of signing up for patient assistance programs for their analog.
Human insulin is the insulin humans naturally produce. Analogs provide the same biologic function as insulin but are engineered to have different properties. Like they can be faster acting or stay in the blood longer. This makes it easier for diabetics to manage their blood sugar.
The GP was bemoaning that Walmart is selling the analogs for $70+ instead of the $25 they sell human insulin for.
I'd love to hear from someone with diabetes if this version of insulin is comparable to the typical high-end modern insulins. I remember at one point Walmart had a $20 insulin, but there was something about it that made the dosing a royal pain compared to other insulins. Is this any better?
It is better but costs more at $72 per vial. Regular/R insulin:
>Regular Human Insulin which has an onset of action of 1/2 hour to 1 hour, peak effect in 2 to 4 hours, and duration of action of 6 to 8 hours.
The insulin they're offering:
>starts to work about 15 minutes after injection, peaks in about 1 hour, and keeps working for 2 to 4 hours.
For example, if you have maybe 15 grams more of carbohydrates than you planned and you did R (old insulin), then you will either have to wait or, what they did for me in school back at that time, send em to P.E for awhile (since exercise _mostly_ and _usually_ lowers blood sugars) ;-).
It’s NovoLog. It’s a very common somewhat modern insulin. It’s not some sort of new thing, it’s just Walmart branding. If you’re a type 1 and use novolog, it’s just more of that.
I really would love it if people contemplated for a moment before posting horrible stuff acting like everyone with type 2 diabetes deserves it, or only has it because they buy food at Walmart. There are all sorts of factors that can contribute to diabetes and some people struggle with it for life. Do a little better.
No one deserves to have a disease, and no one should say that. I'm not from US, but whenever I went there in the past I was amazed at the size of the portions, the size of the cars, and the size of the people.
I would like to live in a world where we can both be sensitive about certain topics, but also be able start hard discussions - for example "don't live an unhealthy lifestyle, exercise, eat better, or you're going to be the only one to blame if you get sick from X, Y, Z".
There's a far cry between the position you advocate (which I still consider victim-blaming, but, okay) and the callousness exhibited by others in this thread.
This is great, but (obviously) not purely benevolent.
A vial of analog insulin costs something like $6-7 to produce, probably less at Walmart scale. The distribution costs probably make the net cost somewhere still in the $7-10 range.
That’s a $60-65 or ~90% margin per Vial.
5-10 million or so insulin users in the US, let’s assume Walmart captures 3 million, at 3 vials per month.
$180 * 12 * 3mil ~~ 6.5 Billion.
Current market cap 400B
Lots of assumptions, but Walmart may have just added 2% of market cap per annum by insulin sales?
Of course it's not purely benevolent. Walmart is a business and this is a business move.
> A vial of analog insulin costs something like $6-7 to produce, probably less at Walmart scale. The distribution costs probably make the net cost somewhere still in the $7-10 range.
Don't forget the R&D costs of getting a generic drug approved and setting up the manufacturing. It may cost <$10 to produce at scale, but getting there isn't free.
Hopefully Walmart's pricing trends downward toward the $25/vial price of regular insulin.
Actually, I hope this move spurs more chain pharmacies to start developing their own analogs, furthering competition in the space. Race to the bottom would be great.
Curious how often the “race to the bottom” versus the “planned price floor” applies to healthcare.
Sure, OTC stuff may differ given the different markets, but I’m highly skeptical of this spurring any sort of race to the bottom that doesn’t also come with large asterisks around quality, qualification to purchase, etc.
>A vial of analog insulin costs something like $6-7 to produce, probably less at Walmart scale
Where are you getting the $6-7 figure from? Artisan insulin makers? Feels like every insulin maker out there operates at walmart's scale, if not bigger. If that's where we're getting the $6-7 figure from, then it's not reasonable to expect it to drop any further.
$5.32-8.87 cost of production depending on the insulin analog.
As noted above, I did not account for R&D and manufacturing capacity.
Regardless, I tried to estimate conservatively at a $12-13 per vial overall cost. My napkin math is certainly wrong.
The point is that Walmart still stands to generate a multi-billion dollar per year profit on the sale of this insulin. (Unless my market capture estimate is wrong by an order of 6+, which it could be)
To be clear, I’m not opposed (in fact grateful) that Walmart is competing in the insulin market. However, I still find it unfortunate that we in the United States pay more for Insulin than any other country in the world, even with this competition.
Great to see more competition in the insulin analogs space.
Walmart is also famous for selling regular insulin for $25/vial for many years now. Regular insulin isn't always as easy to dose as the modern insulin analogs, but it's a viable option for most people who are cost-constrained who don't otherwise have access to insurance.
Please don't do that. The older R/N/L insulins are clearly not as good as the newer insulins, that much is true. But they are sufficient to live a relatively healthy life as a diabetic. You need to be more careful and strict with your diet and activity, but there's nothing inherent in them that causes blindness or death.
The inventors of insulin gave away the patents to specifically not profit off of a life saving drug. This is progress. However, I feel we have regressed as a society on preserving equitable access to life saving drugs.
> The inventors of insulin gave away the patents to specifically not profit off of a life saving drug
This is an insulin analog, which is a more modern patented drug.
Regular insulin is available for $25/vial at Walmart already. Could be cheaper, yes, but at that price it's already approaching their costs of production, distribution, and sales.
I hope the price of this insulin analog trends downward toward the $25 price of regular insulin.
Genuine question (I'm not diabetic): are the analogs actually any better than regular insulin, or were these analogs only created because manufacturers didn't like the margins on regular insulin, allowing them to hold up their hands and justify the price with "R&D"?
The analogs are much more convenient to use. The short acting ones take effect much quicker, for a shorter period, and more consistently. The long acting ones (generally considered ~24 hours, but not really) are much more level in their effect (less spikes in it's efficiency).
Instead of figuring out what you're going to eat, taking insulin for that, and waiting 30-60 minutes before you can eat; you can take them pretty much right as you eat.
Instead of your blood sugar rising or dropping "randomly" over the course of the day, it tends to stay more consistent (though your body may decide otherwise).
That being said, with enough testing (or a CGM, but that can be costly too), the older insulins work just fine; they're just annoying to use. You see your blood sugar going up, you exercise some; you see it going down, you drink some OJ. I tend to have to do the same with the newer insulins AND a CGM; just a lot less so.
How the hell is it "revolutionary" to offer a life-saving product for $70. It's free here in Canada. This is nothing more than a PR play -- if they weren't also able to turn a profit on it, they wouldn't have done it.
Insulin is not produced by insulin fairies. Someone needs to do it. Even if the government foots the bill, it would be better if that bill were 75% cheaper.
This really is one of those great shames of the US. Insulin is 10x what it should cost.
Out of pocket, Fiasp costs 7.50 euro per 3ml, Novorapid costs 6.50, Novomix 30 is 7 euro, Triseba 12 euro, even the ridiculously pricy Xultophy is only 30 euro. The idea that "We halved the price" when the price is literally ten times too high, and not presenting it as "a start, we intend to bring the price down far more over the next few years" but as "and then we stopped, we're undercutting and that's all we're interested in" is... insane?
It varies by patient, but the average monthly costs I've seen seem to gravitate to either 3 vials/month or 10 pens/month. There's 300 units in a pen, 1000 in a vial, so the averages are based on 3000 units/month.
The insulin Walmart is selling is much, much more difficult to use effectively than the fast-acting insulin formulations that Type 1 diabetics rely on to keep them alive, because they work so slowly. Better than nothing, but it's much harder to avoid the highs and lows that cause major damage to the body.
This is the equivalent for Novolog (the fast-acting insulin formulations you're referring to), not for the older R variety they've been selling for a while now.
"Fantastic for customers" is an overstatement IMO. A well-informed customer can stretch their budget without too many compromises by selectively shopping there. But that's exhausting, it's much easier to just run down your list or buy everything you can remember needing while you're there. This usually leads to major compromises in value, function, and the quality of life for everyone involved in the supply chain. Not to mention the chilling effect on the rest of the retail environment in every market they've decided to i̶n̶v̶a̶d̶e̶ enter.
Not meaning to cast any shade at this insulin product; it looks like a substantial improvement over what the US "market" for insulin was offering before.
Considering the number of people dependent on insulin, I wonder if it would be possible for diabetics to form a coop-like structure and purchase it (or make it) at rock-bottom production prices for members.
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[ 2.7 ms ] story [ 62.3 ms ] threadAlso, they are likely to sue walmart for whatever BS reason. But, walmart probably figures they can get through it unscathed.
Falling back on individual responsibility might be popular but it is absolutely a cop out. We're playing a numbers game with public health in an adversarial environment. Relying absolutely on what individuals could or should do isn't going to help us win that game.
This is true even for those people who never question why they are purchasing food in boxes instead of actual food.
It is best to understand that people can make informed choices. It is very shortsighted to think that everyone is subject to the magical sway of marketing without a conscience or decision making abilities.
The existence of personal choice and individual responsibility don't make anything else that you mention disappear. Are you saying you want to increase behavior modification of people and somehow rob people of personal choice? That's what your words imply.
Of course, there are nearby supermarkets too, but you'll be paying like $10/lb for raw chicken and everything is "organic"
I frequently work at state fairs & arts and crafts festivals on the east coast. The amount of very overweight and obese people is simply astounding.
About half of one coke is the average adult’s recommended sugar intake. I know more people than I’d like who have at least one soda every day, and some who have multiple every day.
Nearly everything in our supermarkets has a lot of sugar. Including common things like bread and pasta sauce. Last time I checked at publix, I only found -one- type of bread that didn’t have a lot of sugar in it. Finding a protein bar without tons of sugar was rather difficult. Etc.
Combine this with sitting all day + driving everywhere and we’ve got a huge problem.
But only in the short term, right? Once you figured out what products are healthy and switched to them, you can rely on prior memory. It's not like you have to look at the labels of every item you're buying for years.
I eat pretty healthy, though I also like cheeseburgers so I'm not thin. But I make a very healthy income and have the time, and the resources, and the education to actually have the time and executive function to have an opinion about ingredients in food. It is difficult for me to know these things, let alone to in all cases exert the self-control to act on them--and I make north of five times the median personal income of the United States with which to do it.
I mean, let's think for a second. Blame an Amazon picker or a Wal-Mart cashier or blame the corporate entity with a marketing department designed to overwhelm your attention and to induce the specific action they test and refine for?
Gosh. I wonder.
Are the nutrition content for staples (eg. milk, bread, eggs, apples) likely going to change any time soon? As for the processed foods, they might change from time to time, but I doubt they undergo drastic changes that the nutrition profile is entirely different. On the off chance that it does happen, you'll likely notice it on your tongue, and can update your brain accordingly. If you do any sort of research, you'll probably start to notice such processed foods aren't healthy, so you shouldn't be buying them in the first place.
>Or the time in your day you have to prepare food may suddenly shrink; do you then have the time and spare cognitive cycles to make a good decision under stress? (You probably don't. Not, like, you specifically, but in aggregate.)
>[...]
>It is difficult for me to know these things, let alone to in all cases exert the self-control to act on them
People aren't getting diabetes because they accidentally ate mcdonalds one time. It's from bad diet over a long period of time. For that reason your objection doesn't really make sense.
Perhaps those of us who benefit inordinately from the output of the perpetually stretched class can show some grace in life and not second-guess the folks picking and delivering our consumer goods.
It probably is gradually done, but I recommend looking at the amount of sugar each brand of bread has next time you're at a supermarket. Or milk, lemonade. Or other common groceries. It really is crazy to see just how much of -everything- has added sugar. Including products that are branded as "healthy". AFAIK Naked juice is a great example of this.
As a remote worker with a great schedule, I have the time to do such research. But not everyone is in that situation, particularly if they have a job and have kids, etc. Brands can essentially lie through their teeth and get away with labeling as the regulation can be quite loose.
Many people "know" processed food isn't healthy, but to what extent it's bad for them, maybe not. And it comes down to time and cost. Also, some people don't really grow up knowing what "healthy" food is like.
> It's from bad diet over a long period of time.
It doesn't help that healthy foods are more expensive than food that's absolutely terrible for you.
I think Mexico's new laws around food labeling is the way to go, but time will tell if that's actually effective or not.
Ethical consumerism is a constant treadmill. Even knowing which brands are owned by which corporations is an absolutely exhausting affair.
You honestly expect people to keep up with this? It's as bad as a software dependency chart.
https://i.imgur.com/pnMMj.jpg
As mentioned in a sibling comment, while this is theoretically an issue, it doesn't happen often enough in practice that it causes a burden
>Ethical consumerism is a constant treadmill. Even knowing which brands are owned by which corporations is an absolutely exhausting affair.
Why are you mixing ethics into this? We were talking about making healthy purchasing decisions, not boycotting [insert brand here] because they punch kittens or whatever.
BTW, one advantage of the 'shop online for curbside pick up' trend is that it makes it so much easier to read labels and compare products.
It's still convenient, so I still do it, but it is not a reliable way of getting __exactly__ what you want.
Do we need intelligence licenses that allow to you to purchase unhealthy foods?
Now, it's a mix of societal and economical (and more) that's making people eat a certain way. Changing your eating behavior can be difficult, especially if you've eaten a certain way for the past 16-18 years.
I'm not saying it's Walmart's fault, but it's also not just an individual willingness to change that's in play here. The United States clearly has a problem of obesity, which is related to Type 2 diabetes.
As do all but specialized grocery stores because this is the majority of food produced. How about we go after the food producers instead? Or the subsidies that enable this?
https://economics21.org/html/sugar-subsidies-are-bitter-deal...
and of course the true scandal of sugar
(IMHO the war crime of anti-science)
https://www.npr.org/sections/thetwo-way/2016/09/13/493739074...
Sure it does. Maybe not to 5 decimal places, but you're not going to get that on an internet forum of non-specialists. You want more? I'm sure there's a dissertation from an economics student or a master's thesis out there for your digestion.
You can be a picture of health shopping at Walmart, just as you can be a danger to yourself shopping at whole foods.
... but wow, just woooow. It's so incredibly depressing that I'm calling this "good." Sometimes the sheer insanity of the United States health care system overwhelms me. The fact insulin isn't a few dollars or free is beyond disheartening. It's like the system itself saying the Sackler's just didn't have enough imagination exploiting people, and destroying lives, for profit. "Oh? You don't need to get them addicted if they'll die without it... silly, Sacklers. #BusinessMASTER"
I keep hoping one day folks in the US will get tired of being screwed on their healthcare and living in fear of getting sick... shrug
Medicine, such as FIASP...
Just look at the difference in taxes on salary between France and the US. Half of what is payed by employers to workers goes to social protection (this is in addition to the company taxes). If you add VAT and income taxes the amount of disposable money is a fraction of what you would get in the US, nothing magic.
20 euros per 10ml (about 2 weeks of use for me) is still kind of a good money for a product I cannot stop using...
The important thing is that insulin prices haven't been going up. You can continue to get the same insulin as 50 years ago for pretty much the same price modulo inflation.
And anyway, the Netherlands getting cheap stuff is a side-effect of innovation here. America builds for America, driven by American needs, and you guys benefit as a result. There's a reason recombinant DNA tech (which backs modern insulin) came from the Bay Area and not the Netherlands. NL has twice the pop of the Bay and a fraction of the inventions. A single university here has like 5x as many Nobel Prize winners as that entire country.
I mean, I'm glad you're able to buy insulin cheap but we're richer and we're the ones driving progress, so we'll keep at it because we want a better life for ourselves (and if you benefit, it's fine). You're not capable of making that for us, yourselves, or anyone really.
Legal hostage taking in this way is uniquely US.
They have? According to testimony by Sanofi, even though list price have went up 126%, net price has actually gone down 25%.
https://www.finance.senate.gov/imo/media/doc/26FEB2019BRANDI...
Good thing it's covered in the report
>What about revenue?
Surely your accounting class tell you that rising revenue doesn't necessarily mean that "margins just keep climbing"
net price =/= profit. The report also covers what exactly goes into the difference between gross and net price. If you can point out what the accounting tricks are, that'll be great.
It’s particularly gross and brazen, even by pharmaceutical rent-seeking standards, to justify cocaine-like profit margins because large buyers can negotiate.
Insulin prices are driven by anticompetitive behavior. If you look at metformin, a generic drug treating the same disease, profit margins are tight, driven by competitive economics. A 90-day supply is < $10 retail.
https://www.youtube.com/watch?v=Z8zNsUTWsOc
This is a government problem, not a healthcare system problem.
To maintain this standard of living you're always going to be dependent on someone, it's not a government problem.
90-95% of type diabetics have type 2 diabetes. Of those, around 95% can completely eliminate insulin dependency by straightforward dietary modifications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104272/
Under what moral framework should these people (around 90% of diabetics) receive insulin at others’ expense? I can see at least a first-order argument for having everyone else pay for obligate insulin dependents’ medication, but I struggle to see an argument for foisting the cost of an entirely preventable dependency on everyone else.
> Forty percent (31/78) of CCI participants who began the study with insulin prescriptions … eliminated the medication
The idea is that if you worked through your life, then shit hits the fan, you shouldn't be knocked down below your contribution to society as measured by your level of success under capitalism.
There's a second-order argument of the form "We will all be better off if we invest in healthcare. Society is not zero-sum."
If you want to opt out of taxation you should surely also be morally obliged to opt out of using roads, internet, mobile telephones, clean water, sewerage, police, fire brigades, etc.
I know that it is possible to opt out of fire services in rural US but most of the rest might put a bit of a crimp in your lifestyle.
Enabling unhealthy diets is not “investing in healthcare”.
If that argument strikes you as problematic, it might be because society is better when it's generally well educated and healthy.
As someone with good but very expensive health insurance, any time I bring up health insurance prices, the response from people who get cheap health insurance through their employers is basically, "F* you, got mine"
Unfortunately, the block of people with stable corporate jobs also tend to have a lot of political power and are in no hurry to see their perks upended.
Type 2 can pay for it themselves. Their condition was caused by themselves.
--those are the people you feel comfortable shitting on for their circumstances?
(And there absolutely is a predisposition to Type 2 diabetes in some populations and not in others.)
If for some reason they still have diabetes with a BMI <25, then subsidize it.
With UHC, suddenly folks like this will try to deny me care because I'm taking on non-normative risk. Fine, do so if you want, but I want to be tax-exempt. You can have your UHC, but you pay for it.
But folks won't do this. Instead they want to take my money and then give it to themselves by denying me 'subsidies'. No thanks, I'll keep my money and give it to Anthem. No UHC in the USA.
I dunno, it just doesn't seem all that hard to have have some really simple baseline humanity for the grist in the mill trying to find a moment of respite in something bad for them--ingrained literally decades before and in plenty of cases before they had the personal automony to decide for themselves.
Even if their BMI is over 25, heaven forfend.
Regardless of obesity, Type 2 can be managed with a low carb diet.
Low card can be part of it, but it's not a panacea, once an individual has diabetes, the damage has been done.
meanwhile there are people dying from lack of food in the richest nations on earth.
don't get me wrong, there is plenty wrong with healthcare.
I get that there are people who have to skip meals in the USA, but does anyone really get to the point of dying?
> severe addiction problems that prevent them from seeking it in the first place.
... and we're right back at health care.
https://www.feedingamerica.org/hunger-in-america/facts
(disclosure: food bank logistics and tech volunteer in the sunbelt)
Captured implies a change in behavior or an outside force acting on them, and that isn't accurate.
Only politicians that fall in line are given the support necessary to succeed.
To me, the term captured reduces the agency which is our responsibility to exercise as citizens (at least in the U.S. where I'm based.)
/steps off soap box.
The various medical cartels have lobbied to artificially decrease the supply of competitors, workers, and companies in the healthcare industry.
Single payer healthcare doesn't magically create more physicians, hospitals, or drug companies.
If republican voters aren't willing to replace their politicians with ones that are willing to vote and make a single payer solution, then they don't care about single payer healthcare that much. It has nothing to do with any specific implementation. Republican politicians have never put forward any sort of single payer healthcare implementation
Patents are the same. Residencies are the same. Hospitals are the same.
Do you think the physician cartel is going to stop living in Mansions?
https://news.ycombinator.com/item?id=27858491
https://news.ycombinator.com/item?id=27858456
>links to two hn comments
really?
Well if we apply your logic to this other thread: https://news.ycombinator.com/item?id=27860162, can we assume that "large segments" of the US population are knowledgeable in debating the merits of the rust programming language?
>and mirrors the comments from others in the US....
Mirrors what? I certainly didn't see any reference.
As a type 1 diabetic myself, Walmart's offerings on R or Regular insulin saved me a few times. Once when I was simply out of insulin and did not have insurance. Then when I was caught in another city for work and ran out due to needing to extend my stay. I am slightly disappointed to see that one, the price is not the same as their human insulin which is around 25 dollars per vial I believe. Two, it will require a prescription. The times I bought their cheapest insulin, this was not required. However, I hope this is the right direction.
I wish more people knew about Walmart's $25/vial regular insulin. Like you said, it's available without a prescription at any Walmart (except in Indiana). Dosing needs to be adjusted relative to insulin analogs, but it's a viable option for anyone in a money pinch who hasn't yet gone through the process of signing up for patient assistance programs for their analog.
The GP was bemoaning that Walmart is selling the analogs for $70+ instead of the $25 they sell human insulin for.
Just... die?
>Regular Human Insulin which has an onset of action of 1/2 hour to 1 hour, peak effect in 2 to 4 hours, and duration of action of 6 to 8 hours.
The insulin they're offering:
>starts to work about 15 minutes after injection, peaks in about 1 hour, and keeps working for 2 to 4 hours.
For example, if you have maybe 15 grams more of carbohydrates than you planned and you did R (old insulin), then you will either have to wait or, what they did for me in school back at that time, send em to P.E for awhile (since exercise _mostly_ and _usually_ lowers blood sugars) ;-).
Insulins are interesting.
I would like to live in a world where we can both be sensitive about certain topics, but also be able start hard discussions - for example "don't live an unhealthy lifestyle, exercise, eat better, or you're going to be the only one to blame if you get sick from X, Y, Z".
A vial of analog insulin costs something like $6-7 to produce, probably less at Walmart scale. The distribution costs probably make the net cost somewhere still in the $7-10 range.
That’s a $60-65 or ~90% margin per Vial.
5-10 million or so insulin users in the US, let’s assume Walmart captures 3 million, at 3 vials per month.
$180 * 12 * 3mil ~~ 6.5 Billion.
Current market cap 400B
Lots of assumptions, but Walmart may have just added 2% of market cap per annum by insulin sales?
> A vial of analog insulin costs something like $6-7 to produce, probably less at Walmart scale. The distribution costs probably make the net cost somewhere still in the $7-10 range.
Don't forget the R&D costs of getting a generic drug approved and setting up the manufacturing. It may cost <$10 to produce at scale, but getting there isn't free.
Hopefully Walmart's pricing trends downward toward the $25/vial price of regular insulin.
Actually, I hope this move spurs more chain pharmacies to start developing their own analogs, furthering competition in the space. Race to the bottom would be great.
Sure, OTC stuff may differ given the different markets, but I’m highly skeptical of this spurring any sort of race to the bottom that doesn’t also come with large asterisks around quality, qualification to purchase, etc.
Benevolent? It's not exactly hard to be more benevolent than the medical establishment.
Where are you getting the $6-7 figure from? Artisan insulin makers? Feels like every insulin maker out there operates at walmart's scale, if not bigger. If that's where we're getting the $6-7 figure from, then it's not reasonable to expect it to drop any further.
$5.32-8.87 cost of production depending on the insulin analog.
As noted above, I did not account for R&D and manufacturing capacity.
Regardless, I tried to estimate conservatively at a $12-13 per vial overall cost. My napkin math is certainly wrong.
The point is that Walmart still stands to generate a multi-billion dollar per year profit on the sale of this insulin. (Unless my market capture estimate is wrong by an order of 6+, which it could be)
To be clear, I’m not opposed (in fact grateful) that Walmart is competing in the insulin market. However, I still find it unfortunate that we in the United States pay more for Insulin than any other country in the world, even with this competition.
Walmart is also famous for selling regular insulin for $25/vial for many years now. Regular insulin isn't always as easy to dose as the modern insulin analogs, but it's a viable option for most people who are cost-constrained who don't otherwise have access to insurance.
This is an insulin analog, which is a more modern patented drug.
Regular insulin is available for $25/vial at Walmart already. Could be cheaper, yes, but at that price it's already approaching their costs of production, distribution, and sales.
I hope the price of this insulin analog trends downward toward the $25 price of regular insulin.
Instead of figuring out what you're going to eat, taking insulin for that, and waiting 30-60 minutes before you can eat; you can take them pretty much right as you eat.
Instead of your blood sugar rising or dropping "randomly" over the course of the day, it tends to stay more consistent (though your body may decide otherwise).
That being said, with enough testing (or a CGM, but that can be costly too), the older insulins work just fine; they're just annoying to use. You see your blood sugar going up, you exercise some; you see it going down, you drink some OJ. I tend to have to do the same with the newer insulins AND a CGM; just a lot less so.
If nothing else, this may cause something foreign to the medical industry- Competition.
Out of pocket, Fiasp costs 7.50 euro per 3ml, Novorapid costs 6.50, Novomix 30 is 7 euro, Triseba 12 euro, even the ridiculously pricy Xultophy is only 30 euro. The idea that "We halved the price" when the price is literally ten times too high, and not presenting it as "a start, we intend to bring the price down far more over the next few years" but as "and then we stopped, we're undercutting and that's all we're interested in" is... insane?
There is no financial burden to diabetes, there is a financial burden to living in the US where healthcare is a privilege.
I wonder if every company was like this, what would happen to the world.
Not meaning to cast any shade at this insulin product; it looks like a substantial improvement over what the US "market" for insulin was offering before.