Comment by rdtsc | Hacker News Reader

Comment by rdtsc | Hacker News Reader

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Nah because it would upset the free market.

I mentioned in another comment when someone from Europe or Canada asked something to the effect of "how come everything has to be free market in US even healthcare and such".

And I think the answer is we treat free market as a religion. We don't evaluate what is better, healthier, more rational answer for a problem. Like say, "How do we keep people from dying from anaphylaxis?" We don't answer that. We always answer first, what would free market want? Will it want us to do this? If not, we don't proceed.

We treat it as if it is deity of sorts and if we disobey we'll be punished.

Someone replied and said this idea isn't so outrageous because a similar concept has been defined already in politics:

American Civil Religion (https://en.wikipedia.org/wiki/American_civil_religion)

I am just proposing there is a similar religion in respect to free market.

It is often sold in propaganda terms of course -- we are not communists here, we just want efficiency, we want progress, don't worry stuff will trickle down eventually and so on. So we make it palatable but the main incentive is worshiping the deity.

It sounds crazy but evaluating a lot of things we do as a society through that perspective can be interesting.

That's silly. How do you propose to "evaluate what is better, healthier, more rational"? I suppose some panel of experts could give you their best approximation, but it will always be sub-optimal. Markets exist in order to answer these questions, and they answer them by delegating the decision to every person involved in the decision, not by hoping a designated person can make a guess that's close enough.

It appears that the problem in this case is that there is a single producer who is able to engage in monopolistic pricing, which is certainly not something a market-oriented person would condone.

And the market for healthcare is not a free market. Not anything resembling a free market.

> Markets exist in order to answer these questions,

Well in this case it answered that the price should be $600. This means people, kids, astamatics are going to die at some point in higher numbers because of that.

I say the market is drunk or evil and should not be allowed to make medical decisions.

But because it has a religious following, we don't want to make it angry so we can't say "we mandate EpiPen cost to be $25". Instead we dance around it and say "oh we'll create this health insurance thing, and then that will pay for it". But only if you work. Or ... if you don't you have to buy it anyway, or you have to pay a penalty. But unless you are old, then we kind a let you off the hook a bit and you sign up for this other thing. All of that is done in paper and in how it is presented to the public because we don't want to upset the free market gods.

Setting prices via administrative fiat doesn't eliminate problems. If the price is set to low, there will be shortages or no product at all. If the price is set to high, then the blame for the high price is shifted to the legislature rather than the supplier.

In any case, it is the government that is creating the conditions that allow the price to be set so high in this case. Blaming the 'market' for adjusting to the conditions created by government is confusing cause and effect.

Enough rhetoric.

"Ah, but what do you propose, eh, Mr. Expert?"

-"Oh, maybe this?"

"AHA! This flaw would prevent that from being a workable solution. Keep the status quo!"

As if (a) understanding that there is a problem necessarily means that one must understand the solution, or (b) as if we live in a vacuum and this hasn't been addressed by dozens of other nations.

It has been addressed. In a dozen different ways, with different pros and cons. I can't tell you if the British or German or Japanese method is better, but I can tell you that we're the only schmucks going bankrupt to avoid death by bee-sting.

NICE does a pretty good job in the UK.

https://www.nice.org.uk/

I'm pretty sure you could put together epinephrine and a syringe for a few bucks. And sell it for twenty or so with a healthy profit.

But you can't, can you? Is that because of free market worship, or worship of the regulatory state?

> But you can't, can you?

Yes you can! Believe it or not this completely unregulated free market utopia exists. It is not just a fantasy. Now don't get excited, I imagine after I tell you about you it, you probably won't be headed to the airport to go there -- that's because it is actually horrible.

Unregulated market is what was (and is) happening in any of the post-Soviet republics, Russia, probably China, probably many other countries.

Those countries are better at free market than America. Yes on paper they have their EPAs, FCCs, FDA and other nuisances, but in practice nobody cares.

So you can buy some pills from the street corner shop that sells cigarettes. But chances are they are expired at best, made in a basement from chalk and sugar, or harmful at worst. Of course the claim is, "ah but market takes care of it, next time you won't buy from there and they'll go out of business". Nope, you might be dead next time and no they won't go out of business.

You can go and buy unregulated vegetables from the market. And they look fresh and plump and nice, but they are chock full of horrible chemicals in them. How do I know? My relatives there grow and sell them. They have a separate plot of land for such things and wouldn't let their kids or themselves eat from there.

Gun ownership there is restricted. Unless you are friends with the police. Then you can have a special permit for a gun. Oh but you have to pass a psych exam to make sure you are not crazy. But it so happens you are crazy. But, no worries, such regulations are bypassed with a quick $50 gift. And yes, I have seen them shoot their Dragunov sniper rifle, in a village, with houses right next to each other, and nobody cares.

The list goes on. Now maybe I assumed too much that you won't like it. Who knows, maybe you would. Well you are welcome to visit and try it out.

I'm sure there are some people that truly want the unfettered, caveat emptor world that you describe, but I think that is a mischaracterization of what most free-market advocates are actually talking about.

The type of regulations/laws are hugely important. Critical statements regarding existing regulations are not the same thing as advocating for no regulations whatsoever.

I think it is more useful to view calls for a 'free market' to really be calls for a 'minimally regulated market'. For example, regulations and laws that penalize fraud and negligence are well within the scope of a 'minimally regulated market'.

> But you can't, can you?

Why not? It works for glucagon (which is even more complicated, since it has to be reconstituted from a powder).

http://www.childrenwithdiabetes.com/gifs/products/GlucaGenA1...

How is government protecting a monopoly free market exactly?

Why is it protecting a monopoly? Why doesn't it say "this EpiPen can't cost more than $30"?

Perhaps because it actually costs more than $30 and so an edict such of this would guarantee that there are no EpiPens at all?

In any case, the current high price is the result of regulatory/legislative actions and so the current price is evidence of regulatory failure, not market failure.

I don't think it is a massive regulatory failure to have the pharmacy dispense a product with matching use instructions to the product that is prescribed.

So it's the market that has doctors prescribing $600 Epipens instead of the $150 alternative (that has different use instructions and thus cannot be used to fill a prescription for an Epipen).

Isn't this just another example of a problem created by the rules/regulations? A pharmacist is forbidden from providing the $150 alternative even if the customer specifically requests it (because of the prescription requirement and rules).

For those who need epinephrine injectors, can't they just ask their doctors to prescribe Adrenaclick? What prevents that from happening? I'm guessing it is insurance guidelines that are also stuck in the EpiPen-only world but perhaps it is also doctors being too conservative?

It's marketing. I saw some discussion on social media, people expressed a preference for the Epipen because they expected other people to be more aware of how to use it.

Same with parents, they expect the school nurse to be more familiar with the Epipen (and I guess the other way around, the nurses prefer Epipen because they are familiar with it).

If asking the pharmacist for a specific type of injector isn't onerous then neither is asking the doctor.

I'm willing to concede that US medical regulation has lots of problems, but there is also clearly some problems with the way people in this market are behaving. Patients should care about saving $1000-$1500. Doctors should care about saving their patients $1000-1500.

Well in a perverse sort of way, the $600 price tag is certainly one way to motivate patients to demand alternatives from their doctors and insurance companies.

Because then no one will manufacture it. You can't just will things into existence with unrealistic feel good rhetoric.

If the cost is $5 why wouldn't someone manufacture it then?

> You can't just will things into existence with unrealistic feel good rhetoric.

Why not? We've willed wars and consequent huge handouts to the military industrial complex. I am sure if we tried a bit we can will into existance some $30 EpiPens.

You might be able to coerce (by force) the world to give you what you want at the price that you want. But that doesnt mean it comes without a price. There is always a cost and many times, with governmental interference much of it is unintended consequences not immediately seen.

If the pen cost less than $30 to manufacture, there's no reason that no one would manufacture it.

That's what they did in Venezuela for a whole host of products you can no longer find.

EXACTLY

A free market would mean anyone who wanted to to create one of these.

The reason that EpiPens are expensive is because they're patent protected. In this case, regulatory protection that is the explicit issue. Demand for the product is clearly there; supply is not, not because there is nobody willing to provide it, but because the government prevents would-be competitors from doing so.

Why do you and many other characterize this as a free market failure? If anything this is a regulatory failure.

I am in the opposite camp. I characterize this as a free market success and as a failure of a civilized society to provide basic healthcare for its citizens.

Yeah sure. A free market success. Why not.

It's interesting how Americans act horrified at the word collectivism, when a market is nothing if not a collectivist decision making process.

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