The amendment attached to this bill is probably a "poison pill amendment". The bill itself plays well PR-wise. But the amendment probably contains language politically damaging to the opposition party.
Not sure why the downvotes but that’s a crucial question. Unfortunately, products from the 90s have been deemed fancy and had their prices increased by a multiple of around 15, at least in the US.
This is Democratic Party in USA. Headlines look great but if you look into it, the subsidies for electric vehicles exclude Tesla, first Covid bill bailed out the mob pension funds from Italian Job. Problem is it takes a while to notice this, so a lot of europeans love Democrats.
An import note is that a month's supply of insulin costs $2-6 to manufacture and it doesn't need any marketing dollars, so any existing, scaled insulin manufacturer would profit wildly from this price.
Novo Nordisk (the maker of the newest insulin Levemir) spends about 17.8b kroner a year on R&D (or about 12.6% of their revenue). Levemir was introduced in 2005; they've long since made up any R&D costs. The first synthetic insulin (Humulin) is from 1978. These aren't new medications, even Lantus is over 20 years old. The R&D costs don't factor into the price they charge at this point.
> The bill attracted unanimous support from Democrats who voted, as well as from 12 Republicans, making it a rare piece of bipartisan policy legislation.
What would have been considered a standard party line vote a decade ago is now called "bipartisan". Crazy how far the standards have fallen in such a short time.
Yeah this is weird, especially for a news paper. Arguably dishonest.
It’s like saying if there were two opposite sides for an anti slave bill and the majority of one side says no but 1 member of the opposing side said yes , it makes the bill Bipartisan.
Affordable insulin is a no-brainer, slam-dunk, overwhelmingly YES piece of legislation. I cannot comprehend the mental gymnastics diabetic republicans must go through on a daily basis.
This isn't "affordable insulin", it just limits the copay to $35. Pharma companies can keep charging abusively high prices for insulin, and force insurance providers to pay for it[1], which then trickles down to make everyone pay more, while allowing pharma companies to rake in profits. This is socialized medicine + cost disease[2], which I'm surprised and disappointed that anyone voted on at all.
No it's revoking the EO that limited prices, causing a price spike, subsidizing prices over $35 with taxpayer money, which goes to the same people gouging prices, which goes to lobbyist, which goes to the politicians.
The reason the R's didn't vote for it was the mj poison pill amendment and I guess some didn't get promised the lobbyist payout.
> Replying again because, apparently, HN loves to stifle discussion via keyword matching and auto flagging comments.
There's no such thing. People flag and downvote your comments, usually for breaking the guidelines[1], and 95% of the time I've seen people make complaints like yours, they're definitely breaking them.
> While the bill would lower costs for many individual patients who take insulin, it would do nothing to reduce the prices paid to the companies that make it. Instead, insurance companies would simply pay a larger share of the price. The Congressional Budget Office estimated that the bill would increase government spending, since health insurers, including Medicare, would be responsible for a greater share of insulin costs.
Yeah it's kind of crazy. So the solution here is not to get companies to charge less, but instead just to put them on government welfare? The insulin companies must have some great lobbyists to have pulled this off.
> the solution here is not to get companies to charge less, but instead just to put them on government welfare
This is the basic summary of the entire topic of "healthcare reform". Political calls for creation or enforcement of sensible market mechanisms are nowhere in sight. Many straightforward market reforms wouldn't even run afoul of any major political ideals - for example the idea that many individuals will seek out routine or elective services on a cash basis, as prevalent throughout every other industry.
Instead, the red party is focused on continuing the status quo (a giveaway for "insurance" companies) while the blue party is focused on having the government pay for the financial cancer (a giveaway centered on providers). These are both just doubling down on the same healthcare-denying cartelization at the root of the problem!
> The problem is the preservation of market mechanisms.
I don't know what you mean by this.
Unless we're talking about a system in which all doctors and drug companies are bona fide government employees, then healthcare is indeed being distributed via market mechanisms.
For an analog, take a look at the market for food (a vital necessity for life). The vast majority of people pay for food directly. Competition between grocery stores keeps the prices reasonable. Government programs provide funds to those unable to afford food, and those government dollars benefit from the consumer market mechanic. The idea that you could receive a bill in the mail a month later, for the cashier or counter worker being an unknown "outside vendor" is nowhere in sight.
The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around - ie the necessity of insurance. But this still isn't a reason to throw away the overall market in favor of an obtuse cartel that controls access to what should be simple cases.
>The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around.
I mean, that's kind of a crucial difference, though, isn't it? To use your supermarket metaphor, if I'm starving, it doesn't matter if I buy a fresh-butchered sirloin or a jar of peanut butter. In contrast, a diabetic can't just decide to take aspirin instead of insulin - and that's not that's not even getting into more specialized disorders.
The fundamental problem is that any market solution to drug pricing is going to end up with awful prices because:
* Most drugs, by nature, have extremely small sets of potential clients relative to their cost of development
* For those who need drugs, they have an inflexible demand for the drug (buy it of suffer/die), and the drug is essentially non-fungible with other drugs.
> that's kind of a crucial difference, though, isn't it
It's a crucial difference for emergency situations only, which does not include your insulin example. The sheer majority of insulin use is not from people going from not knowing they need insulin, to needing insulin on an emergency basis. Rather, there is plenty of time for a market dynamic of shopping between suppliers to do its work. The main reason this concept seems so foreign is that we're presently prevented shopping around by "insurance" cartels and opaque pricing, and then we're shown extortionary fake prices on bills. Right now we're essentially designing the whole system around people who cannot afford drugs, while making them directly unaffordable to most everyone. This is not a sustainable system!
> For those who need drugs, they have an inflexible demand for the drug (buy it of suffer/die), and the drug is essentially non-fungible with other drugs.
I'm not making the claim that restoring market mechanics will solve the whole problem. That's the kind of grandiose claim that proponents of governments feeding the cancer usually engage in. Rather, restoring market mechanics is a mere first step towards healthcare sanity, no matter who ends up paying.
Drugs themselves are given government granted monopolies, both by patents and FDA approval. Maintaining these monopolies while allowing a free for all pricing dynamic is obviously a nonstarter. But keep in mind the dynamic is just as broken regardless whether individual users are paying or not!
Perhaps my whole point would be better phrased in terms of choice. From what I know, there are several different types of insulin of varying effectiveness and convenience. Should people be forced to buy the best gold-plated "insurance" (aka cartel bundle), possibly only available through a specific employer, just to be able to get "approval" for the best kind of insulin for their own medical situation? Or rather should access to each type be openly available, and every individual able to choose to pay a little more to get a type that benefits them better?
I think people reacting negatively to the idea of restoring some market mechanics envision some utopia where everyone easily gets the best version for free, but this is wildly unworkable especially taking into account yet-to-be-developed drugs. In the best case this system gets mediated by doctors and "medical need", which creates its own autonomy-denying paternalistic dynamic.
It’s the same pattern as Obamacare. Reinforce the existing private insurer system by injecting more government funding while preserving policy that ensures scarcity. This bill functionally sharpens the consequences of being too poor to afford insurance and too employed to qualify for Medicaid.
Which shows that there's really no desire on either side to actually address the problem, just to bandaid over it enough so that the status quo can continue.
ACA was largely responsible for the cutting the number of uninsured in the US in half [1]. For the 28% of the US population with family income below 200% of the Federal Poverty Level, the reduction in uninsured as even bigger. That was hardly just maintaining the status quo.
Agree it broke the status quo for percent uninsured.
Not quite as much the status quo in the structuring of healthcare in the US, which seems to be ever leaning towards more bureaucracy, regulatory capture, regulatory costs, insane tort/legal risks, and dead weight.
Also part of the big drop in uninsured was the lining up of people to the wall with the weapon of the tax-man cocked, saying "pay up or else." When the penalties ended the uninsured rate started to go back up again. Not my favorite way to do things, and I question how much of that was out of benevolence.
> Also part of the big drop in uninsured was the lining up of people to the wall with the weapon of the tax-man cocked, saying "pay up or else."
Yes, but that is also true for (AFAIK) most public health systems. I live in a country with strong public health system where almost everything is 100% paid from public insurance, but if i had stopped paying insurance payments, i would have met debt collectors confiscating my property.
It seems the way to actually make healthcare more affordable is to find ways to make healthcare less expensive. Otherwise you're just playing a game of who pays the outrageous costs.
Yeah ACA was great. I saw it first hand within my own family provide an older quote wealthy family member with some obscenely cheap insurance, compared to young blue collar family member who had to opt out and just pay the tax fine because it made health insurance completely unaffordable for his family.
I think that’s being too generous. These efforts have a very distinct goal: reinforce defensives against universal healthcare program to preserve the health insurance gravy train for the ruling class, and preserve the employer-based health insurance system that helps to keep so many Americans in fear of losing their jobs.
Health insurance industry’s annual profits havey increased very significantly since Obamacare passed in 2010 [1]. These sorts of efforts effectively make the insurance lobby even stronger that it would be otherwise.
To be fair, Obama was pushing for single payer in 2008 (“Medicare for all”) and took it off the table to try to get some Republicans on board.
And the Sanders/Warren wing of the party is pushing hard for Medicare for all right now. CA is close to implementing a public option.
Hillary Clinton also pushed for healthcare reform while a senator IIRC, and I believe some Republican governors have pushed for sensible reforms too.
In general I think cynicism in politicians is not misplaced when there are lobbyists involved, but on this issue I don’t think blame is symmetrically justified. The red team won’t even let Medicare use its volume purchase bargaining power to negotiate cheaper prices.
Offtopic, no email in your HN profile: I'll give you the same advice I give to others who share this sentiment (and I share it as well): find a way to expatriate if you can. The US is unlikely to fix its problems in our lifetime; there are too many people who will continue to vote for representatives who refuse to back sane policy, who will vote against their own interests, as well as those who don't vote at all. Ergo, if you can, you must vote with your feet (remote work, enough savings to qualify for a visa somewhere more developed, a work visa if you're highly skilled, etc). Can't change the direction of the wind, but you can adjust your sails.
I recommend either Western Europe, Australia, or New Zealand, but that's personal preference. Canada is fine if you don't mind the cold, Japan is an acquired taste, parts of LATAM are great if you're a tropics kind of person.
Becoming an expat isn't voting with your feet. Your taxpayers dollars are still going to the US until you find a way to get citizenship elsewhere and pay the exit tax.
> If you are a U.S. citizen or a resident alien of the United States and you live abroad, you are taxed on your worldwide income. However, you may qualify to exclude your foreign earnings from income up to an amount that is adjusted annually for inflation ($105,900 for 2019, $107,600 for 2020, $108,700 for 2021, and $112,000 for 2022). In addition, you can exclude or deduct certain foreign housing amounts. [1]
This allows you to continue to obtain benefit from your US citizenship while minimizing the federal income tax you pay while a tax resident elsewhere. If you're wildly wealthy with a seven figure income, sure, then you might need to speak with tax professionals and structure an exit from US tax requirements depending upon your goals. Otherwise, it's just like paying local property tax, and getting to deduct that against your federal taxes.
Thank you, friend. These are some great links! I just recently started a software engineering career largely for this purpose, but I also think it’s important that there is a political revolution in the US.
Don’t hate the country, hate the politicians. This bill is designed for two things…to try and get favorable headlines for the democrats and to maximize big pharma profits. Most folks “affected” by this bill probably will see zero benefit from it, because the folks with health insurance probably were getting their insulin around that co-pay rate (or lower) anyway.
Interesting - companies can still charge what they want, this just forces a big subsidy by insurance companies / medicare.
Traditionally if price to consumers / demand is unchanged by price increases, companies should be incentivized by this to increase prices no? The rate you pay stays $35, and demand does not drop, but profits rise up.
Yea, this doesn't seem great. In my opinion, one of the biggest failures of the Affordable Care Act was the guarantee of profit for insurance companies.
This bill looks like the same sort of problem. "Insulin capped at $35/month" sounds great, but it buries the point that prices AREN'T actually being fixed. They're just shifting the increased cost from individual patients to the collective (via insurance companies). My insurance costs are going to go up so that pharma corporations can continue to fleece patients, and there's nothing in this bill that would prevent this.
Even our National Allies like Germany didn't spend their fair share to NATO until Russia invaded Ukraine.
I'm tired how American Citizens don't have healthcare or houses yet our taxes goes to across the world, and the world isn't doing their fair share. We aren't being represented by our government.
American citizens are not "forced". American citizens vote for politicians that want private healthcare. If you want your own national drug care program, that gives the government an incentive to negotiate large purchases with pharmaceutical companies. Then do it. But you keep electing politicians that choose the free market
Policies like 2 senators per state, regardless of population, and the Electoral College ensure that a minority of citizens have the majority of power in the USA.
>But you keep electing politicians that choose the free market
Ba ha ha ha ha. Let me tell you how 'free' the market is if I decide to open up Notch's Medical Clinic without a long list of licenses/permits/regulatory compliance. If I manufacture and give you a pill without extensive process of authorization by the FDA to use this pill as a drug. Healthcare is expensive in part because there isn't a free market.
A free market would rip the bloated competition currently present into shreds.
We have a strong right-wing that will shoot down any attempts at fixing our medical system. The problems we have have absolutely nothing to do with NATO obligations or foreign aid, it has to do with the fact that the scare from Reagan's Welfare Queen and Free-Market ideology has taken hold of medical discussions.
I think we need to disambiguate between the Left-Wing, Right-Wing, the UniParty, and some reformers.
The UniParty, which contains the Establishment of both the Left-Wing and the Right-Wing, is adverse to any changes of status quo.
Both the Populist Right, and the Progressive Left are strongly in favor of reform of the system as we know it. Some Reformers like the Libertarian Right and Libertarian left may be in favor of status quo in this instance though.
But, when someone says
> For like 3 months they had control with the slimmest of majorities.
What really should have been said was
> For like 3 months the Establishment Left-Wing had control with the slimmest of majorities, but the UniParty be controlling shiz since forever.
The US cannot remain the World's Piggie Bank when it comes to Medical Profits.
Are American insulin prices really subsidizing insulin prices for n other countries? Hasn't it been known for long enough that it is not so encumbered with ip problems that might be present for recently developed drugs?
There appears to be a general MO of drug companies.
Make the bulk of your profits in the US market, and subsistence elsewhere.
I am not saying there are not other associated "Medical Industry" problems (lack of pricing transparency, 3rd party billing, EMTALA, EMR/NonClinical time for Doctors, Certificates of Need, disincentives for Cash payment) but this is a big one.
Also, many countries appear to have weaponized their IP in order to force drug company massive discounts.
As much as US Taxpayer $ goes towards much of the industry I am now in favor of outright nationalization for the established bigPharma. Let cutting edge biotech / lab space stay private, and BigPharma go nationalized.
At least maybe then we'll not be paying the world's bills.
> I'm tired how American Citizens don't have healthcare or houses yet our taxes goes to across the world, and the world isn't doing their fair share.
This naively assumes that US spending on its military is some sort of charity, and not something that the US does entirely to further its own aims. A stable global stage does benefit other countries, but it also massively benefits the US. The same applies to the things like US CDC's global disease surveillance programs - famously trimmed back in China a couple years before we had a pandemic that these very programs might've been able to contain.
> I find it furious how american citizens are force to subsidize the entire world.
Come on: the US is already the wealthiest country, and if you look at the underlying reasons why its citizens get more of the world pie, you can find plenty of reasons the rest of the world is “subsidising” the US. Let’s start with IP rights and the abuse of that system to the detriment of any non-US country. There are plenty of systematic biases in favour of the US, often “negotiated” by the US. The US is happy to destabilise whole countries to get what it wants cheaply e.g. oil.
And we are talking about healthcare here, where plenty of other countries seem to have found systems that work better than the US for cheaper.
While I agree with the general premise that the rest of the world subsidizes the US to a degree, I don't think IP is an example of that. Countries are perfectly capable of saying no to US IP laws, but they don't because the trade that comes with saying yes is well worth it to them.
Where the US gets subsidized is our currency. The dollar, for the last 50 years, has been such a stable and useful tool for trade, that demand for it allows the US to run and import/export deficit via its printing. Foreign labor is cheap in dollar denominated terms, which allows US citizens to trade their own labor for several times what it is worth.
I think this is a lesson every US citizen should pay attention to when they advocate radical change: a big part of your lifestyle is paid for by stability.
> but they don't because the trade that comes with saying yes is well worth it to them
Negotiating to give our products/services to the US, in an asymmetric bargaining position.
I am quite the supporter of market driven economies, and I realise how much we gain, but please don’t ignore that the US very strongly negotiates to its own benefit and that small countries have relatively little leverage.
I get your points.
The US isn't wealthy. US oligarchs, corporations, and politicians are wealthy.
Most people in the USA do not have the time or energy to care about IP rights in other countries. Most americans don't want war, it's pushed heavily by pundits.
As for my points about healthcare, I still think medical costs are subsidized by the USA for the world and mainly research costs. The vox article does a good job explaining that.
> US House passes Bill to limit cost of insulin to $35/mo
.
> fulfilling its promise of lowering drug costs.
Insulin costs under $5 to make. If they had in fact limited the price to $35/months that would be fantastic. But what the bill actually does is force insurers to pick up 100% of costs over $35/month, allowing pharma companies to keep charging abusive rates and everyone will indirectly pay for that by increased premiums.
Even the bill's own summary[0] is much more clear on what it does than this article:
> This bill limits cost-sharing for insulin under private health insurance and the Medicare prescription drug benefit.
That's literally the first line.
The second line is:
> Specifically, the bill caps cost-sharing under private health insurance for a month's supply of selected insulin products at $35 or 25% of a plan's negotiated price (after any price concessions), whichever is less, beginning in 2023.
This might seem like a distinction without a difference, but I strongly disagree. Insulin prices themselves are abusive and the underlying problem here, this doesn't even seek to address those and instead just hides the profiteering behind higher insurance premiums.
Time to actually fix drug pricing and not keep shoving everything behind an insurance smokescreen and then acting surprise then insurance premium rates are astronomical.
This is politics in America. Politicians obstruct everything meaningful but allow these "wins" through when they do absolutely nothing to fix any of our problems, only obfuscate them.
Alright, here's what I don't understand: Why isn't the market working here? Why doesn't someone sell insulin at cheaper price, steal the ~ whole market, and make a killing? Is there some sort of cartel gentlemen's agreement? Is it impossible to get licensed to sell insulin? Something else?
According to this article, the market was working. Various generic insulin was approved and the price for some insulins was dropping or holding steady:
>> Like generics, follow-on products have also helped to bring down insulin prices overall. Generics contain the exact replicas of the active ingredients in a brand-name medication. But biologic drugs like insulin are nearly impossible to recreate. So sometimes, manufacturers make close copies of them instead, known as “follow-ons” or “biosimilars.” Biosimilars tend to be more expensive than generics but less expensive than brands.
>> For example, Admelog was approved as the follow-on to Humalog in 2017. The average retail price for a 3mL vial of Admelog is now $54, compared to $123 for the same-size vial of Humalog. Lantus has a follow-on, too: Basaglar, approved in 2016. By price per insulin unit, Basaglar is 23% cheaper than Lantus. In July 2021, the FDA also approved insulin glargine, a biosimilar to be used interchangeably with Lantus. In its first quarter, retail prices for a unit of insulin glargine were about 60% lower than retail prices for a unit of Lantus.
IMO the article does not claim the market is working. Insurance companies are not including those generics in their plans so people can't use them. I bet if congress cap'd how much they could charge for insulin they might be incentivized to get people to pick a cheaper (generic) option.
> However, we’ve seen that limited insurance coverage [1] can prevent some patients from accessing these savings.
Depends on the word directly but the article touches on that. "insulin lispro" is a generic.
> they discovered that insulin lispro was not available at 83% of pharmacies. Among those pharmacies, 69% of them said that they could not order insulin lispro even if the patient did not need it right away. Pharmacies’ inability to offer or order the cheaper generic most likely contributed to the low fill rate for insulin lispro.
> Additionally, one of the nation’s largest pharmacy benefit managers, Express Scripts, announced in their 2019 formulary exclusions that insulin lispro would not be covered by their plans. They instead listed the brand Humalog as their preferred insulin drug. This decision may also have contributed to the low fill rate of insulin lispro since Express Scripts is responsible for 24% of the nation’s prescription drug insurance claims.
Health insurance company profits are capped as a percentage of claims paid. Higher costs for drugs and services means more profit for the insurance companies.
How this problem is solved in pretty much any other area of economy: improve supply, or in other words make sure it is as easy as possible to import or create and sell competing products.
How easy is to start an insulin providing business tomorrow in the USA? Exactly. But planners gonna plan...
Do you think that if the price of insulin goes down that there's suddenly going to be a huge floodgate of people who will consume a lot more insulin than they're already consuming now? Like, people who were like "yeah, I'll buy insulin at 35 dollars but not at 300 dollars, if it hits 300 then I'll just wait this one out" or that they'd be like "oh, now that the price of insulin has been cut by a factor of ten I'll consume ten times as much"? Like, you know how insulin works - either you get it within 24 hours, or you don't and you go into a coma and die, and how much you take isn't influenced by any factor other than what you eat?
This bill doesn't actually fix prices charged by manufacturers, and thus won't cause shortages. It fixes out-of-pocket costs for patients, with insurers (and employers) picking up the difference. We can expect medical insurance premiums to increase as a consequence.
While I do think this is a general move in the right direction, the cynic in me can't help but to think this recent spotlight on insulin in particular is a red herring to distract from the Democrats' inability to make headway on prescription drug and general healthcare affordability.
I mean, sure, diabetes is a big issue in the US, with type 2 being particularly problematic and prevalent among the least advantaged demographic groups, and efforts to keep insulin affordable will be massively beneficial to a relatively large number of people. But simply ensuring that insulin is affordable does nothing to address the underlying nutrition and healthcare access that lead so many to end up with type 2 diabetes in the first place.
The measure also seems woefully inadequate for addressing insulin access for the uninsured, which is going to dampen the effect as well.
Can someone explain to me why insulin, essentially a commodity, can fetch any significant price over cost? Why isn't there more competition? Is barrier to entry for low-cost competitors the difficult of manufacture? Or is it patent enforcement?
If it's patent enforcement, wouldn't a bill that reforms the patent protection for insulin makers make a lot more sense than this bill?
If I were to bet, it would be the manufacturing requirements placed on pharmaceutical companies.
I am not saying they're unjustified (e.g. sterilization requirements), just that they're onerous.
When people complain about high insulin costs, they’re complaining about new formulations that work much better. You can get the old stuff at Walmart for (relatively) cheap. The new stuff is probably under patent, although even when that runs out there are roadblocks for generic manufacturing - and that goes for every medication.
The fact that patent holders can draw out the process longer than they’re supposed to should be reformed, but that doesn’t get as many political points as capping the price to the consumer.
The flip side of that is that many of the newer formulations are slight tweaks, but doctors will generally prescribe the drug that the latest pharma sales rep to visit was selling (yes really).
They also tend to not want to change the way they’ve always done things and prescribe a cheaper formulation.
Insulin isn't one single medication. The basic generic (commodity) forms are already fairly cheap. WalMart sells it for $25, and most patients with insurance coverage pay less. I do understand that this expense can be a burden for low income patients, and it would be reasonable to subsidize them.
The really high prices are for patented, branded forms of insulin which have different release profiles. Those are often preferred because they do a better job of maintaining the patient's blood glucose in the correct range. Depending on the formulation they may start acting faster, or require less frequent injections.
While this bill is imperfect, overall it does improve the situation for diabetics. But for type 2 diabetics we really ought to focus on reducing their need for exogenous insulin. Virta Health has peer reviewed research showing that the majority of patients can put their diabetes into remission using nutritional ketosis.
Type 1 diabetics will always need some exogenous insulin, but they can reduce the amount of insulin needed (and the cost thereof) with regular exercise.
This is great news for those that take insulin, for drug manufacturers, Democrat politicians, and (in the short term) for insurance companies. It's terrible for everyone else.
If consumers are paying $300 a month they might decide to take a cheaper insulin instead, move to a generic if possible, maybe even get their type 2 diabetes under control before they need insulin, etc. Now that it's capped for them - why should they care? Their insurance will pay for it.
Because how much insurance companies can charge is tied to how much they pay out, they now get to raise their prices and profits. Because they all need to compete with each other, they normally couldn't do this all on their own. This is essentially government mandated price fixing - or perhaps another term is better?
There's absolutely nothing stopping the insulin manufacturers from raising their prices even more now. They'll want to slowly boil that frog just so they don't come under pressure, but that's fine by them.
Finally, this is good for the Democrats because most people don't realize the above and think they price was actually capped to $35. The comments on Reddit about this show it pretty well, calling out Republicans for not voting in favor of it. How dare they? In the end it'll be great for them in two ways, because insurance prices are going to keep going up to ridiculous levels until people decide that we need to move to a socialized system.
Medical prices are out of control in our country and the lack of price discovery is exactly why. I've commented before on this, but when I was prescribed testosterone I was put on Androgel. Androgel was $400 a month. Injections are something like $10 a month and work better in every way. There's now a pill you can take for the low cost of $1,000 a month. If people actually had to pay that cost up front, they might decide to go through the hassle of injecting themselves once a week or two.
We either need to making insurance in to actual insurance again, meaning a very high deductible, or we need price controls. Anything else is a terrible idea. Mandating high deductibles is probably a no-go politically, but price controls would be easy. Cap the costs of medications and procedures/visits to the average of 5 other first world countries. Bam. Done.
I agree completely that better price discovery would help the issues greatly. Many times the doctor's office will not even be able to tell you how much a procedure or medication costs until after you get it, which is nuts. If there were more competition in the medical world practices like this would quickly die out (imagine if a grocery store didn't post any prices for its items!)
I had my nose cauterized recently for bloody noses - just one side as the doctor said we couldn't do both at once. Nearly $300 for the visit, and another $300 for the "procedure," which entails the doctor sticking a stick with some silver nitrate up your nose.
So, $600 for (at most) 10 minutes of work for the doctor, and maybe another 10 minutes for the nurse. Someone making $15 an hour would have to work an entire week for that, and for me it's over a day's worth.
People should be disgusted. The only reason they aren't is because their insurance usually covers things.
Thanks for the thoughtful analysis of the potential implications. I'd consider adding a policy mechanism that ranks all procedures and medications in terms of their necessity and cost/benefit; and cutting off what's covered at whatever point is required to keep the system financially solvent. This was proposed 10+ years ago by Oregon's Governer at the time who is a physician.
Relevant excerpt... "The state maintains a list of nearly 700 medical procedures ranked in order of priority. Right now only the top 502 items on that list are covered by the Oregon Health Plan."
> maybe even get their type 2 diabetes under control before they need insulin, etc. Now that it's capped for them - why should they care?
You seem to be suggesting a perception that having insulin-managed diabetes is okay. That injecting yourself multiple times a day, monitoring your blood sugar constantly for fear of losing limbs or vision is ... what? Not as scary as not being able to afford the insulin?
If you need a stick to make people look after themselves, perhaps there's something else that's wrong.
With all the (certainly fair) criticism of how this doesn't address perhaps the largest / most vulnerable subset of diabetics, I can't help but wonder if there is an opportunity for a non-profit entity to emerge and help somehow.
I also imagine the alternative of too much government intervention across public and private sectors in one sweeping bill would likely have much more resistance. Small steps, it seems.
I think insulin will already be less expensive in 2024 anyway, due to efforts by a nonprofit manufacturer started by a nonprofit Utah healthcare chain with many partners. The manufacturer is trying to make many drugs more available and less expensive. It's quite interesting:
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[ 6.5 ms ] story [ 187 ms ] threadThe amendment attached to this bill is probably a "poison pill amendment". The bill itself plays well PR-wise. But the amendment probably contains language politically damaging to the opposition party.
https://www.congress.gov/amendment/117th-congress/house-amen...
which, on its face, looks pretty boring, but that amendment includes this bill:
https://www.congress.gov/bill/117th-congress/house-resolutio...
which decriminalizes cannabis federally.
I'm not saying anything one way or another, but it's rather interesting this hasn't been mentioned.
> (Humulin) is from 1978
Great, so it's off patent now? Serious question: where's the generic humulin?
What would have been considered a standard party line vote a decade ago is now called "bipartisan". Crazy how far the standards have fallen in such a short time.
It’s like saying if there were two opposite sides for an anti slave bill and the majority of one side says no but 1 member of the opposing side said yes , it makes the bill Bipartisan.
[1] https://news.ycombinator.com/item?id=30879824
[2] https://slatestarcodex.com/2017/02/09/considerations-on-cost...
The reason the R's didn't vote for it was the mj poison pill amendment and I guess some didn't get promised the lobbyist payout.
But it’s SOMETHING, which is a refreshing thing after years and years of the do-nothing R-controlled senate.
And, yes it's something, it's LAUNDERING. It's going to be more expensive, but it spreads costs around to hide it.
You'll end up paying big pharma just as much, if not more, just lobbyist and politicians are getting a cut in the transaction.
Since the insurers are held liable for the cost, government healthcare plans like medicare will be paid by taxpayers.
Private insurers will increase their premiums to cover their cost, so you take a hit both ways.
Coordinate with big pharma to charge medicare huge costs, have the taxpayers pay them, they pay lobbyist to funnel to politicians. Free $$$ stream!
There's no such thing. People flag and downvote your comments, usually for breaking the guidelines[1], and 95% of the time I've seen people make complaints like yours, they're definitely breaking them.
[1] https://news.ycombinator.com/newsguidelines.html
I hate this country so much.
Yeah it's kind of crazy. So the solution here is not to get companies to charge less, but instead just to put them on government welfare? The insulin companies must have some great lobbyists to have pulled this off.
This is the basic summary of the entire topic of "healthcare reform". Political calls for creation or enforcement of sensible market mechanisms are nowhere in sight. Many straightforward market reforms wouldn't even run afoul of any major political ideals - for example the idea that many individuals will seek out routine or elective services on a cash basis, as prevalent throughout every other industry.
Instead, the red party is focused on continuing the status quo (a giveaway for "insurance" companies) while the blue party is focused on having the government pay for the financial cancer (a giveaway centered on providers). These are both just doubling down on the same healthcare-denying cartelization at the root of the problem!
Distributing healthcare through market mechanisms is ludicrous, has never worked and will never work.
I don't know what you mean by this.
Unless we're talking about a system in which all doctors and drug companies are bona fide government employees, then healthcare is indeed being distributed via market mechanisms.
For an analog, take a look at the market for food (a vital necessity for life). The vast majority of people pay for food directly. Competition between grocery stores keeps the prices reasonable. Government programs provide funds to those unable to afford food, and those government dollars benefit from the consumer market mechanic. The idea that you could receive a bill in the mail a month later, for the cashier or counter worker being an unknown "outside vendor" is nowhere in sight.
The only fundamental difference with healthcare is that you might suddenly need a lot of it and not be able to shop around - ie the necessity of insurance. But this still isn't a reason to throw away the overall market in favor of an obtuse cartel that controls access to what should be simple cases.
I mean, that's kind of a crucial difference, though, isn't it? To use your supermarket metaphor, if I'm starving, it doesn't matter if I buy a fresh-butchered sirloin or a jar of peanut butter. In contrast, a diabetic can't just decide to take aspirin instead of insulin - and that's not that's not even getting into more specialized disorders.
The fundamental problem is that any market solution to drug pricing is going to end up with awful prices because:
* Most drugs, by nature, have extremely small sets of potential clients relative to their cost of development
* For those who need drugs, they have an inflexible demand for the drug (buy it of suffer/die), and the drug is essentially non-fungible with other drugs.
It's a crucial difference for emergency situations only, which does not include your insulin example. The sheer majority of insulin use is not from people going from not knowing they need insulin, to needing insulin on an emergency basis. Rather, there is plenty of time for a market dynamic of shopping between suppliers to do its work. The main reason this concept seems so foreign is that we're presently prevented shopping around by "insurance" cartels and opaque pricing, and then we're shown extortionary fake prices on bills. Right now we're essentially designing the whole system around people who cannot afford drugs, while making them directly unaffordable to most everyone. This is not a sustainable system!
> For those who need drugs, they have an inflexible demand for the drug (buy it of suffer/die), and the drug is essentially non-fungible with other drugs.
I'm not making the claim that restoring market mechanics will solve the whole problem. That's the kind of grandiose claim that proponents of governments feeding the cancer usually engage in. Rather, restoring market mechanics is a mere first step towards healthcare sanity, no matter who ends up paying.
Drugs themselves are given government granted monopolies, both by patents and FDA approval. Maintaining these monopolies while allowing a free for all pricing dynamic is obviously a nonstarter. But keep in mind the dynamic is just as broken regardless whether individual users are paying or not!
Perhaps my whole point would be better phrased in terms of choice. From what I know, there are several different types of insulin of varying effectiveness and convenience. Should people be forced to buy the best gold-plated "insurance" (aka cartel bundle), possibly only available through a specific employer, just to be able to get "approval" for the best kind of insulin for their own medical situation? Or rather should access to each type be openly available, and every individual able to choose to pay a little more to get a type that benefits them better?
I think people reacting negatively to the idea of restoring some market mechanics envision some utopia where everyone easily gets the best version for free, but this is wildly unworkable especially taking into account yet-to-be-developed drugs. In the best case this system gets mediated by doctors and "medical need", which creates its own autonomy-denying paternalistic dynamic.
s/
[1] https://www.statista.com/statistics/200957/percentage-of-ame...
Not quite as much the status quo in the structuring of healthcare in the US, which seems to be ever leaning towards more bureaucracy, regulatory capture, regulatory costs, insane tort/legal risks, and dead weight.
Also part of the big drop in uninsured was the lining up of people to the wall with the weapon of the tax-man cocked, saying "pay up or else." When the penalties ended the uninsured rate started to go back up again. Not my favorite way to do things, and I question how much of that was out of benevolence.
Yes, but that is also true for (AFAIK) most public health systems. I live in a country with strong public health system where almost everything is 100% paid from public insurance, but if i had stopped paying insurance payments, i would have met debt collectors confiscating my property.
Health insurance industry’s annual profits havey increased very significantly since Obamacare passed in 2010 [1]. These sorts of efforts effectively make the insurance lobby even stronger that it would be otherwise.
[1] https://www.forbes.com/sites/robertlaszewski2/2020/02/05/pro...
And the Sanders/Warren wing of the party is pushing hard for Medicare for all right now. CA is close to implementing a public option.
Hillary Clinton also pushed for healthcare reform while a senator IIRC, and I believe some Republican governors have pushed for sensible reforms too.
In general I think cynicism in politicians is not misplaced when there are lobbyists involved, but on this issue I don’t think blame is symmetrically justified. The red team won’t even let Medicare use its volume purchase bargaining power to negotiate cheaper prices.
I recommend either Western Europe, Australia, or New Zealand, but that's personal preference. Canada is fine if you don't mind the cold, Japan is an acquired taste, parts of LATAM are great if you're a tropics kind of person.
https://worldpopulationreview.com/country-rankings/happiest-...
https://www.oecdbetterlifeindex.org/
https://www.socialprogress.org/
This allows you to continue to obtain benefit from your US citizenship while minimizing the federal income tax you pay while a tax resident elsewhere. If you're wildly wealthy with a seven figure income, sure, then you might need to speak with tax professionals and structure an exit from US tax requirements depending upon your goals. Otherwise, it's just like paying local property tax, and getting to deduct that against your federal taxes.
[1] https://www.irs.gov/individuals/international-taxpayers/fore...
Thank your local representative now!
Traditionally if price to consumers / demand is unchanged by price increases, companies should be incentivized by this to increase prices no? The rate you pay stays $35, and demand does not drop, but profits rise up.
This bill looks like the same sort of problem. "Insulin capped at $35/month" sounds great, but it buries the point that prices AREN'T actually being fixed. They're just shifting the increased cost from individual patients to the collective (via insurance companies). My insurance costs are going to go up so that pharma corporations can continue to fleece patients, and there's nothing in this bill that would prevent this.
I find it furious how american citizens are force to subsidize the entire world. https://www.vox.com/science-and-health/2016/11/30/12945756/p... My mother needs insulin to live, and lives off her mediocre pension. I don't find it fair or just at all.
Even our National Allies like Germany didn't spend their fair share to NATO until Russia invaded Ukraine.
I'm tired how American Citizens don't have healthcare or houses yet our taxes goes to across the world, and the world isn't doing their fair share. We aren't being represented by our government.
Ba ha ha ha ha. Let me tell you how 'free' the market is if I decide to open up Notch's Medical Clinic without a long list of licenses/permits/regulatory compliance. If I manufacture and give you a pill without extensive process of authorization by the FDA to use this pill as a drug. Healthcare is expensive in part because there isn't a free market.
A free market would rip the bloated competition currently present into shreds.
The UniParty, which contains the Establishment of both the Left-Wing and the Right-Wing, is adverse to any changes of status quo.
Both the Populist Right, and the Progressive Left are strongly in favor of reform of the system as we know it. Some Reformers like the Libertarian Right and Libertarian left may be in favor of status quo in this instance though.
But, when someone says
> For like 3 months they had control with the slimmest of majorities.
What really should have been said was
> For like 3 months the Establishment Left-Wing had control with the slimmest of majorities, but the UniParty be controlling shiz since forever.
The US cannot remain the World's Piggie Bank when it comes to Medical Profits.
Make the bulk of your profits in the US market, and subsistence elsewhere.
I am not saying there are not other associated "Medical Industry" problems (lack of pricing transparency, 3rd party billing, EMTALA, EMR/NonClinical time for Doctors, Certificates of Need, disincentives for Cash payment) but this is a big one.
Also, many countries appear to have weaponized their IP in order to force drug company massive discounts.
As much as US Taxpayer $ goes towards much of the industry I am now in favor of outright nationalization for the established bigPharma. Let cutting edge biotech / lab space stay private, and BigPharma go nationalized.
At least maybe then we'll not be paying the world's bills.
This naively assumes that US spending on its military is some sort of charity, and not something that the US does entirely to further its own aims. A stable global stage does benefit other countries, but it also massively benefits the US. The same applies to the things like US CDC's global disease surveillance programs - famously trimmed back in China a couple years before we had a pandemic that these very programs might've been able to contain.
Come on: the US is already the wealthiest country, and if you look at the underlying reasons why its citizens get more of the world pie, you can find plenty of reasons the rest of the world is “subsidising” the US. Let’s start with IP rights and the abuse of that system to the detriment of any non-US country. There are plenty of systematic biases in favour of the US, often “negotiated” by the US. The US is happy to destabilise whole countries to get what it wants cheaply e.g. oil.
And we are talking about healthcare here, where plenty of other countries seem to have found systems that work better than the US for cheaper.
Where the US gets subsidized is our currency. The dollar, for the last 50 years, has been such a stable and useful tool for trade, that demand for it allows the US to run and import/export deficit via its printing. Foreign labor is cheap in dollar denominated terms, which allows US citizens to trade their own labor for several times what it is worth.
I think this is a lesson every US citizen should pay attention to when they advocate radical change: a big part of your lifestyle is paid for by stability.
Negotiating to give our products/services to the US, in an asymmetric bargaining position.
I am quite the supporter of market driven economies, and I realise how much we gain, but please don’t ignore that the US very strongly negotiates to its own benefit and that small countries have relatively little leverage.
Most people in the USA do not have the time or energy to care about IP rights in other countries. Most americans don't want war, it's pushed heavily by pundits.
As for my points about healthcare, I still think medical costs are subsidized by the USA for the world and mainly research costs. The vox article does a good job explaining that.
If I buy a car for 10x what it's worth, it's not because I'm subsidizing other buyers - it's because I got ripped off.
> US House passes Bill to limit cost of insulin to $35/mo
.
> fulfilling its promise of lowering drug costs.
Insulin costs under $5 to make. If they had in fact limited the price to $35/months that would be fantastic. But what the bill actually does is force insurers to pick up 100% of costs over $35/month, allowing pharma companies to keep charging abusive rates and everyone will indirectly pay for that by increased premiums.
Even the bill's own summary[0] is much more clear on what it does than this article:
> This bill limits cost-sharing for insulin under private health insurance and the Medicare prescription drug benefit.
That's literally the first line.
The second line is:
> Specifically, the bill caps cost-sharing under private health insurance for a month's supply of selected insulin products at $35 or 25% of a plan's negotiated price (after any price concessions), whichever is less, beginning in 2023.
This might seem like a distinction without a difference, but I strongly disagree. Insulin prices themselves are abusive and the underlying problem here, this doesn't even seek to address those and instead just hides the profiteering behind higher insurance premiums.
Time to actually fix drug pricing and not keep shoving everything behind an insurance smokescreen and then acting surprise then insurance premium rates are astronomical.
[0] https://www.congress.gov/bill/117th-congress/house-bill/6833...
That's what always happens with these programs.
"Free" physical / wellness visit? Your insurance premiums bake that in.
"Free" COVID tests? Your insurance premiums bake that in.
Alright, here's what I don't understand: Why isn't the market working here? Why doesn't someone sell insulin at cheaper price, steal the ~ whole market, and make a killing? Is there some sort of cartel gentlemen's agreement? Is it impossible to get licensed to sell insulin? Something else?
Gotta be something, right?!
https://www.goodrx.com/healthcare-access/research/how-much-d...
>> Like generics, follow-on products have also helped to bring down insulin prices overall. Generics contain the exact replicas of the active ingredients in a brand-name medication. But biologic drugs like insulin are nearly impossible to recreate. So sometimes, manufacturers make close copies of them instead, known as “follow-ons” or “biosimilars.” Biosimilars tend to be more expensive than generics but less expensive than brands.
>> For example, Admelog was approved as the follow-on to Humalog in 2017. The average retail price for a 3mL vial of Admelog is now $54, compared to $123 for the same-size vial of Humalog. Lantus has a follow-on, too: Basaglar, approved in 2016. By price per insulin unit, Basaglar is 23% cheaper than Lantus. In July 2021, the FDA also approved insulin glargine, a biosimilar to be used interchangeably with Lantus. In its first quarter, retail prices for a unit of insulin glargine were about 60% lower than retail prices for a unit of Lantus.
> However, we’ve seen that limited insurance coverage [1] can prevent some patients from accessing these savings.
[1]: https://www.goodrx.com/classes/insulins/generic-insulins-see...
Are they not available to patients directly?
> they discovered that insulin lispro was not available at 83% of pharmacies. Among those pharmacies, 69% of them said that they could not order insulin lispro even if the patient did not need it right away. Pharmacies’ inability to offer or order the cheaper generic most likely contributed to the low fill rate for insulin lispro.
> Additionally, one of the nation’s largest pharmacy benefit managers, Express Scripts, announced in their 2019 formulary exclusions that insulin lispro would not be covered by their plans. They instead listed the brand Humalog as their preferred insulin drug. This decision may also have contributed to the low fill rate of insulin lispro since Express Scripts is responsible for 24% of the nation’s prescription drug insurance claims.
Like an OTC you buy at the store or shipped to your home without insurance
How this problem is solved in pretty much any other area of economy: improve supply, or in other words make sure it is as easy as possible to import or create and sell competing products.
How easy is to start an insulin providing business tomorrow in the USA? Exactly. But planners gonna plan...
I mean, sure, diabetes is a big issue in the US, with type 2 being particularly problematic and prevalent among the least advantaged demographic groups, and efforts to keep insulin affordable will be massively beneficial to a relatively large number of people. But simply ensuring that insulin is affordable does nothing to address the underlying nutrition and healthcare access that lead so many to end up with type 2 diabetes in the first place.
The measure also seems woefully inadequate for addressing insulin access for the uninsured, which is going to dampen the effect as well.
If it's patent enforcement, wouldn't a bill that reforms the patent protection for insulin makers make a lot more sense than this bill?
The fact that patent holders can draw out the process longer than they’re supposed to should be reformed, but that doesn’t get as many political points as capping the price to the consumer.
They also tend to not want to change the way they’ve always done things and prescribe a cheaper formulation.
Most of the barriers are regulatory and profitability.
It is worth noting that bidens 35 is a copay limit, not a limit on what your insurance pays.
As a example for profitability, this non profit hopes to bring the total cost down to 30:
https://www.google.com/amp/s/amp.cnn.com/cnn/2022/03/03/poli...
https://www.diabetesselfmanagement.com/blog/relion-insulin-f...
The really high prices are for patented, branded forms of insulin which have different release profiles. Those are often preferred because they do a better job of maintaining the patient's blood glucose in the correct range. Depending on the formulation they may start acting faster, or require less frequent injections.
https://www.goodrx.com/healthcare-access/research/how-much-d...
https://www.virtahealth.com/reversediabetes
Type 1 diabetics will always need some exogenous insulin, but they can reduce the amount of insulin needed (and the cost thereof) with regular exercise.
https://link.springer.com/article/10.1007/s00125-011-2403-2
If consumers are paying $300 a month they might decide to take a cheaper insulin instead, move to a generic if possible, maybe even get their type 2 diabetes under control before they need insulin, etc. Now that it's capped for them - why should they care? Their insurance will pay for it.
Because how much insurance companies can charge is tied to how much they pay out, they now get to raise their prices and profits. Because they all need to compete with each other, they normally couldn't do this all on their own. This is essentially government mandated price fixing - or perhaps another term is better?
There's absolutely nothing stopping the insulin manufacturers from raising their prices even more now. They'll want to slowly boil that frog just so they don't come under pressure, but that's fine by them.
Finally, this is good for the Democrats because most people don't realize the above and think they price was actually capped to $35. The comments on Reddit about this show it pretty well, calling out Republicans for not voting in favor of it. How dare they? In the end it'll be great for them in two ways, because insurance prices are going to keep going up to ridiculous levels until people decide that we need to move to a socialized system.
Medical prices are out of control in our country and the lack of price discovery is exactly why. I've commented before on this, but when I was prescribed testosterone I was put on Androgel. Androgel was $400 a month. Injections are something like $10 a month and work better in every way. There's now a pill you can take for the low cost of $1,000 a month. If people actually had to pay that cost up front, they might decide to go through the hassle of injecting themselves once a week or two.
We either need to making insurance in to actual insurance again, meaning a very high deductible, or we need price controls. Anything else is a terrible idea. Mandating high deductibles is probably a no-go politically, but price controls would be easy. Cap the costs of medications and procedures/visits to the average of 5 other first world countries. Bam. Done.
https://www.cms.gov/nosurprises/consumers/understanding-cost...
So, $600 for (at most) 10 minutes of work for the doctor, and maybe another 10 minutes for the nurse. Someone making $15 an hour would have to work an entire week for that, and for me it's over a day's worth.
People should be disgusted. The only reason they aren't is because their insurance usually covers things.
Article here... https://www.npr.org/templates/story/story.php?storyId=133446...
Relevant excerpt... "The state maintains a list of nearly 700 medical procedures ranked in order of priority. Right now only the top 502 items on that list are covered by the Oregon Health Plan."
You seem to be suggesting a perception that having insulin-managed diabetes is okay. That injecting yourself multiple times a day, monitoring your blood sugar constantly for fear of losing limbs or vision is ... what? Not as scary as not being able to afford the insulin?
If you need a stick to make people look after themselves, perhaps there's something else that's wrong.
I also imagine the alternative of too much government intervention across public and private sectors in one sweeping bill would likely have much more resistance. Small steps, it seems.
https://news.ycombinator.com/item?id=30714641
Edit: and I don't know if Mark Cuban's company is planning to help with that or how they are doing. There is a link about them, in the above link.