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Comment by psergeant | Hacker News Reader

> Creating a public institution with no pressure to make profit is a disaster waiting to happen.

This is the model many rich country healthcare runs on, and provides measurably better outcomes for less expenditure than the US.

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In addition, the best healthcare system in the world, according the WHO, is in Cuba, where it certainly isn't run on a for-profit basis. Moving medicine away from the private sector allows for a stronger focus on preventative care, which is significantly less profitable.

I think that worrying about removing the profit motive entirely misses that fact that not only is the profit motive not the only motive for doing things, but oftentimes not even the determinate factor.

As much as I wanted this to be true it doesn’t really stand up to scrutiny. Yes “day to day” access to healthcare is far superior but it’s very week on the high end stuff. Even Castro in his final hours was treated in a Spanish hospital. Ideally we would want some kind of reasonable alternative that exists between these two extremes ...

Correlation != Causation

The more likely explanation for Castro seeking treatment in Spain is that Cuba is a relatively small country of only 11 million, and it should be expected that they're not at the very forefront of the world on every area of medical expertise.

My substantial point still stands.

I may be ignorant on this, but don't many of those countries benefit by the r&d funding happening in the US?

https://www.urmc.rochester.edu/news/story/4233/u.s.-slipping...

Interesting that funding only started to fall when the concept of Affordable Care act began to get traction? If I'm an investor, that sort of thing gives me cause for pause.

R&D doesn't happen in non-profit government corporations either (atleast not largely). Most R&D comes from the manufacturers where the state (or relevant institution) buys the drugs from.

However, in a single payer or similar systems, if a drug company decides to hike the price, the state (or institution) can swallow the cost and continue medical services to citizens until the situation is resolved (either by legislation or court cases). Since the state (or institution) is not a for-profit it doesn't matter as much if they sink a lot of cost as long as everyone can get their medical treatment.

Another thing is that people want to measure success in profit or less taxes paid. A proper healthcare system should have it's success measured in how many citizens are able to be productive because they're not chained down with accommodatable disabilities, curable chronic illnesses, and extreme medical debts.

> R&D doesn't happen in non-profit government corporations either (atleast not largely). Most R&D comes from the manufacturers where the state (or relevant institution) buys the drugs from.

IIRC, the research typically comes from state-funded academics, and the development comes from the manufacturers.

The research only comes from academics when it's actually reproducible. Otherwise it is dutifully ignored and companies perform their own research.

They may, but these institutions are keen on cures and not on treatments.

I am completely on the side of having government agencies developing cures and licensing out to companies then. This would avoid the perverse incentive of the OP. It also would stop the pervasive argument that patents are necessary to get new pharmaceuticals developed (I don't believe in patents benefit to society).

Most R&D, in the US as elsewhere, make massive use of public funds.

Which is weird, as that is not factored in the purchase price when buying the product when developed.

yes, you might ask your democratically elected representative about that...

No, that's not true. Private R&D is almost 10x what public R&D is, at least in biotech.

Including the R&D tax credit?

Nope - that's not true.

https://en.wikipedia.org/wiki/Medical_research#Privately_(in...

Private R&D is around 60% - however a large part of that is making minor changes to existing molecules in order to obtain fresh patents.The bigger, riskier research is done by the NIH and other publicly funded bodies. See

https://marianamazzucato.com/entrepreneurial-state/

Also - the quality of privately funded research is much worse, with non-reporting of negative results, data dredging and other dodgy activities being routine - see

https://en.wikipedia.org/wiki/Bad_Pharma

Your source is all medical research. Not biotech specifically.

Intriguing. I've often speculated about how private sector research compared with public research, especially in the context of the reproducibility crisis since I assumed that a lot of pharma companies knew that some research couldn't be replicated behind closed doors. I wonder what the quality of proprietary / unreleased studies is- do the links you provide take that into account?

It compares badly. Unfortunately too much private research is allowed to be kept secret - but what is known indicates it's of poorer quality - judged by the kind of metrics the Cochrane Institute use.

Goldacre's book (he also has a blog) is well worth reading - describing _many_ ways in which drug companies can cheat.

It's all multinational these days. Only 4/10 of the big players are in the US https://www.tharawat-magazine.com/facts/10-largest-pharmaceu... and that's quite logic if you remember that the European market is pretty much harmonized and twice as populated as the US.

The EU market is far from being harmonized medecines regulation wise. it always takes longer to get approval across all EU countries vs one approval in the US. Pricing of drugs is not harmonized at the EU level either and thats a hard block for any launch.

the US market is the primary market for all big pharma companies regardless of where headquarters are bc it is the biggest

And big pharma companies don't do early stage research. Small companies do. Most of those are in US

"in the US" is a misnomer. It all depends on if the cost allocation (e.g. HR is pharma's largest cost) has and is attributed to the US.

Some of the extra money does go to R&D (though that's somewhat misleading: a lot of "R&D" spending is unnecessary duplication of safety trials because the FDA doesn't recognise any foreign medical safety standards, not even e.g. the EU). But a substantial chunk of it is wasteful inefficiencies due to multiple layers of middlemen (there are typically 5 layers between the insurance company that's paying and the company that makes the drug/device) with opaque pricing structures (there are hidden rebates in both directions at every one of those layers). National healthcare systems still have bureaucratic inefficiencies but they do avoid having intermediaries with a direct incentive to bamboozle each other.

"unnecessary duplication of safety trials because the FDA doesn't recognise any foreign medical safety standards, not even e.g. the EU)"

I would say in some cases that is a good thing. https://en.wikipedia.org/wiki/Thalidomide

It's very hard to argue against a safety trial - of course if you duplicate safety trials then there will be occasional cases where you catch something that the original trial missed. But ultimately far more people have died or suffered because a medicine wasn't available yet than been killed or hurt by medicine being approved too early.

Like what?

Novartis? AstraZenica? Gsk? Bayer? Siemens? Hitachi? Philips? Olympus?

this works quite very much the other way as well..

> This is the model many rich country healthcare runs on, and provides measurably better outcomes for less expenditure than the US.

well I'm living in Germany and I agree with that it is cheaper, but "better outcomes"? I do not think so.

I mean in Germany treating Diabetes means taking Insulin for a life long. However newer studies, actually found out that a treatment where the patient should be dieting and starts to do more sport can actually reduce the needed insulin dose or patients can even completely dismiss insulin or are cured from it completely in rare cases. (not a lot of doctors would actually help the patient or even tell them that this would be beneficial to them, hell not even the public health care sector cares)

However the thing is if you can sell Insulin for a life long to somebody who will probably die earlier you make a profit. On multiple fronts. Treating it means that once the person is cured, he will probably live longer, will have less problems and will probably cost the overall system less (but that's not something that should happen).

So basically in "richer" countries the system is equal to the US, it's just more hidden. care system and government are systems that benefit from each other if patients take treatments over a long time and probably have a reduced life-time. i.e. treatment > healing, at least from a business perspective.

lol you are acting like the rest of the world is developing medecines. The US market is the driving force for 95 percent of drugs developed worldwide, by a very, very wide margin. This is not random.

First: You're not wrong that the U.S. is a leader in pharma.

That being said, the only source I can find for your claim is a throwaway sentence in an op-ed on Forbes (https://www.forbes.com/sites/paulroderickgregory/2012/07/01/...).

I found some more realistic (and sourced) statistics here: http://blogs.sciencemag.org/pipeline/archives/2010/11/09/whe...

That has the U.S. at 47% of drugs developed. Keep in mind those are based on drugs approved by the FDA, so it skews towards the U.S., and especially away from countries like Japan. Adjusted for population (I'm not entirely sure this is fair), that puts us neck-and-neck with the U.K., behind Israel, and far behind Switzerland.

You are talking about providing health care. Not inventing new treatments. Those countries are all using treatments invented developed and funded by the market model which is mostly paid for by us consumers, which is part of why us prices are so high.

The US has the best outcomes in the world if you have money. Which is why rich people from all over the world come here for treatment. We just have lower average outcomes because of access disparities.

[Citation Needed]

The US has average healthcare when money is no object. The weathty often seak treatment outside the US and occasionally wealthy people come to the US on a case by case basis.

The core problem is treatments entail risk, so doing more eventually results in worse outcomes. Further the incentives are around doing more, putting the healthcare system in opposition to heathy patients.

Saldy when you are in need of healthcare, money is the only negotiation power you can have. An insurance company dealing for you has a lot more power, but if you are on your own you have no power to say "right, this vital heart op is too expensive, I'll drive 300 miles for a cheaper provider. ggrrrrl".

That's why universal healthcare is the better solution for everyone.

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