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Comment by martijn_himself | Hacker News Reader

I'm torn on this subject, could someone explain to my why this is morally wrong? (honest question, equally torn on the Shkreli case). I don't have any knowledge of US medical policy, law and regulations but does the fault not lie squarely with government here? Surely one can not expect a commercial enterprise to price a product as 'fair' (whatever that means) when it is operating in a competitive environment? (I wouldn't have the heart to run such a company but isn't this to be expected?).

There are soccer players here in the UK that get paid £100k per week to do nothing- noone is up in arms to regulate that market?

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> There are soccer players here in the UK that get paid £100k per week to do nothing- noone is up in arms to regulate that market?

Those players aren't being made possible by the patent system and medical regulatory agencies though. If you can play soccer better than them you can go take their position, but if you make a cheaper EpiPen you won't be able to compete. (Though that may be changing, the FDA seems ready to fast track some competitors.)

I agree my comment was a silly attempt to illustrate that a free market will set a price that may be considered 'unfair' in some cases. However the EpiPen market seems to be far from free.

Football fans don't tend to die when they can't afford to watch their favorite players.

This would be my gut reaction too, reading about this in more detail has made me think the issue is more subtle than that. My point is, if you don't regulate a market, can you expect a market to regulate itself?

That is the ideal world of some people, the invisible hand of the market regulating it blah blah. However there's never been a single instance where this has actually happened, markets have to be regulated by an outside power (namely, governments).

EDIT 1: Apologies @pikzen. Edited to agree with you :). I should read more carefully on a Friday morning. EDIT 2: And you :).

I agree, there are plenty of examples where regulation works. The National Health Service in the UK is a shining example of this (it has its own issues but what can you expect when you are running one of the largest organisations in the world?). There are succesful regulations that reward companies (such as with subsidies and other indirect incentives) to choose the 'morally correct' option (this is done for example in the EU to limit environmental impact of industry).

Edit: @martijn_himself, in all fairness, my limited-sleep-friday-morning messages may be a bit unclear too. Cheers and have a good day.

I believe we're saying the same thing. Regulations are needed, and we cannot expect companies or the market to do it themselves.

Regulations? The government itself was buying the stuff! Why are regulations needed for the government to not pay more than it should?

Because Congress deliberately passed bills that prevented the government from bargaining with pharmaceutical companies, because those same companies pay into re-election campaigns.

If anything needs regulation, it's campaign finance.

We're in agreement, then. This is a problem in the governmental apparatus itself, not a lack of market regulations.

No disagreement on the need to regulate campaign finance, either.

If you have to be forced in order to act moral, you're immoral. People can call corporations "amoral" all day long, but they're made of people, and their decision to not be moral also implies the decision to be immoral.

No market will ever regulate itself when the product is life or death. People will always choose life at any price. This is why most civilized countries provide health care for everybody.

US healthcare is natural local monopoly. There is no price transparency for medical treatments. Even surgeons don't know what the patient will be billed.

Plus most patients are not qualified to make medical decisions about whether a procedure is correct.

> Even surgeons don't know what the patient will be billed.

Well, there's a couple reasons for this beyond "Well, fuck even trying to be transparent."

1.) Many physicians, nurses, etc. aren't employed directly by a hospital, but instead come in under contract as part of a physician group. Hospitals charge their own fees for use of their facilities, which are completely opaque from the physicians working there in this case, every specialty contracted by a different group handles their own billing as well - this makes it incredibly challenging to try to even get an estimate when everyone is working on their own.

2.) Medical care is more like visiting a mechanic to fix your car than it is just buying a service. Even if you could try to get a reasonable quote, complications come up, part of an encounter for "I am feeling sick" is diagnosing you in the first place which can have a lot of variety in just how much is done based on the symptoms. I can say it's gonna cost $120 for you to come into an urgent care and see a doctor, but depending on what happens it could very well cost more.

3.) Billing is separate from everything else in most cases. In the first point I mentioned I work for a billing company owned by a physician group, notice the "owned by". We aren't part of our parent company in the day-to-day, in fact we collect our own revenue and the amount of money flowing between us is very one-directional (we take our billing fee and the rest goes straight to them) - the same goes with many other aspects of our operations, there is cooperation but we're still on very different sides of the fence. With that said, our providers have very little to no insight into what we actually do, they just know we code the encounters and send out claims then collect money - some may have an idea what `R10.9` means, but most don't, or which of the ED visit codes (99281-99285) are appropriate. All of this work that goes into coding an encounter is because that is what insurance companies base their allowable charges off, and it's our job to make sure it's coded appropriately so we get appropriate compensation for the services rendered. WE handle all of this work, to the physicians it's just a black box - they treat the patient, they get paid.

If you want price transparency many things need to change in the industry.

Because I won't die if they're paying their players ten times market rates. They're merely entertainers. That's private money, mostly. Making a public service overpay by factors of almost 10 when it's quite literally a matter of life and death is morally wrong, yes.

Putting themselves in almost a situation of monopoly on epipens in the US (which you can't fault the high cost of entry for, I'm quite happy that medical devices have high standards) then yes, they should have a moral obligation to sell Epipens at a fair price.

I admit my example of the soccer player is a bit silly (there are plenty of families that spend half their disposable income on following their favourite team in the UK so I don't think it is entirely beside the point).

I agree it is pretty grim if pricing of a medical device would literally cause death although I'm not sure that is the case.

> Putting themselves in almost a situation of monopoly on epipens

Monopolies are exactly why economic regulation exists.

> paying their players ten times market rates

They're not paying their players ten times market rates. They're paying their players 1x market rates. The market rate for those players happens to be very high. That's the whole point.

Exactly, the sports star/actor arugement is nonsensical. As far as I know the NFL is very profitable. Those players create tons of value.

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