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Comment by chiefalchemist | Hacker News Reader

Pardon the editorial here but this is a sloppy opinion piece.

- It would be helpful (and honest) if the article discussed the rate of demand in both / any / all countries.

- Why only Germany?

- Why only Insulin?

No doubt, the USA healthcare systems has issues that need to be addressed. However, that's not where the problem starts. The truth is, it's no worse than the (attention to personal) health of the majority people using the system.

BTW, I caught bit of the (new?) PBS feature on Cancer a couple nights ago. At one point, one of the doctors being interviewed said (paraphrasing): "We could reduce the rate of cancer by 50% if we were willing to adopt the changes[1] that have already been recommended. No additional research required. 50%!"

[1] Diet, lifestyle, etc.

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The American lifestyle/diet and healthcare costs are two separate issues that both desperately need to be solved. What a lot of people don't know outside the U.S., is that the obesity crisis exists in upper class and upper-middle class, but is a completely different animal among the poor and working poor. I grew up in a working-poor family, and kept that same social group until about 10 years ago.

The culture around food is completely destroyed. Social gatherings revolve around unhealthy food. There is generally not the understanding that the choices for what you eat is the major reason for obesity. The poor are lied to so much, they don't know what to believe, and the prevailing opinion tends to be that it is mostly due to genetics (how could that be, we have the same genes as 1-2 generations ago) or character (laziness, but I was obese in the past and worked a full time job and two part time jobs). In the past, the poor would get info from cable news, or not at all. Today, they get their news from Dr. Oz feeds on Facebook telling them to lose weight with various forms of snake oil.

While there is quite the gym culture in the U.S. in upper middle class, lower class does not have money for the gym, but mainly their metabolism is so shot from the foods they eat that they don't have the energy to go to the gym.

The government and the medical field in general could do a lot to move the needle on the terrible food culture, but they don't. They in fact made the terrible food pyramid, that tells people to eat grains above all else, and says nothing about the processing of the foods that they eat. And the foods they eat are processed to the nth degree. When I eat with some of my old friends or family that are still a part of my old culture, I am always amazed by how terrible the cheap food is here. It really doesn't even taste like food. Potato chips, rubbery chicken nuggets, soda, Totinos pizza, TV dinners, Hamburger Helper, I could go on...

> "The American lifestyle/diet and healthcare costs are two separate issues that both desperately need to be solved."

I see it (much) differently. Healthcare, is just like everything else. That is, Supply & Demand applies.

Furthermore, the providers can also use "price what the market will bear." Consumers have no choice. Well, they do, but they choose food + lifestyle that makes them ill.

Remove __unnecessary__ (read: preventable) demand and prices will have only one way to go. That is, down. The cost of procedures will fall. Insurance premiums will fall, because they're paying out less.

My point is, we can't keep living such unhealthy lifestyles and keep blaming the healthcare system. That's deceptive and naive.

< sidebar >

Supply & Demand was one of the dirty secrets of the ACA. More people were jammed into the system, but supply was not increased. Sure, in theory these new consumers were said to be younger and healthier. None the less, even if they used the system 25% as much, that was still an increase in demand (and none in supply).

In theory it was "easy money" for the insurance companies, but it did not address S&D. That is, the ACA, to some extend, robbed Peter to pay Paul.

Prices continue to climb, as does the obesity rate, etc.

< /sidebar >

> "The government and the medical field in general could do a lot to move the needle on the terrible food culture, but they don't."

I wanted to reply to this directly.

Yes and no. Nothing is more personal than what you put in your mouth. It's not just to blame others for those decision(s) / action(s). Could more be done? Yup. But gov + med are not the only ones dropping the ball. How many times does a doc have to say "You've got to lose weight" before they give up, and are "forced" to write a script for meds X, Y and Z?

I mean, when you step up to the toilet, you look down and can't see over your belly and see where your pee is coming from, isn't that a red flag? Maybe the trip to the all you can eat buffet isn't a good idea?

It's an illustrative example. An article covering every drug sold in every country would be rather long and difficult to understand! They may have chosen Germany because it presents a similar population in terms of demographics, income, spending parity, etc...

The article fails to mention the average price to the end patient in both countries, but this would still show a gap as in Germany the cost to the patient for their prescription insulin is, I think, about 10 euros.

Rate of demand per country makes little difference due to global distribution but apparently Germany has 8.31% of adults with diabetes and USA has 10.79%. Many economists will tell you a larger market should equal more competition and cheaper prices, and not having those is a sign of unhealthy anticompetitive practises.

The exercise comment would only apply to some diabetes patients. It is possible to spontaneously develop diabetes whilst being in peak physical health and diet.

But, more importantly, the cause of a disease does not effect the price of the drugs to treat it.

re: "It's an illustrative example. An article covering every drug sold in every country would be rather long and difficult to understand!"

Or it's an irresponsible cherry-picking of data.

Yeah, could be, but there are a LOT of similar articles out there that have been able to “cherry pick” to show the same problem. After a while cherry picking becomes the harvest.

Insulin is a good example of a medicene that is essential to the patient ( anyone with Type 1 diabetes).

Yes. Agree. But it's the increase in T2D that has driven up the cost for all. And AFAIK nearly all T2D is preventable.

So instead of debating a symptom (i.e., the price of Insulin) let's discuss some of the actual root problems.

"helpful (and honest) if the article discussed the rate of demand"

Why would it make a difference?

I would expect the US to have higher levels of obesity and thus diabetes.

I would expect larger markets to benefit from economies of scale, so would expect to costs in the US to be lower.

You seems to be driving at something else though?

Insulin in Belgium is 48€, I dare you to find something cheaper in the US than in Belgium.

Good luck

Agreed; the US has a healthcare system with terrible deficiencies for the prices you pay, but preventative measures seem to rarely be discussed when these issues are raised.

If the article meant to be impartial it should also have included the rates of obesity and morbid obesity of germans VS americans, as this is one of the causes for adult-onset diabetes.

In Europe, a lot is preventative and cheap ( so people don't have to worry about getting a routine check-up)

Would you charge difference prices for insulin based on the cause of their diabetes?

Of course not, but you can't expect there to be no change in price when demand keeps going up.

That card you just used has two sides: people who are born insulin-dependent are paying more in part because of others who could have avoided developing the illness.

Address the cause of the demand increases, and you're on the way to addressing the price as well as improving peoples' quality of life.

I used to be a heavy smoker and although I've quit, I'm acutely aware that if I ever need a cancer related transplant I'll probably not be given the same priority as someone with a congenital cause - and with good reason.

I made a lifestyle choice that can have serious consequences for my health - and the same goes for people who choose to overindulge on shitty food.

But there isn’t a limited supply of insulin or a sudden spike in demand that would drive a normal market price rise.

If anything the larger market, which is stable over time, with a product that is known and doesn’t require a lot of development & research, should be driving the price down as competitors should be pricing to gain more market share. But that’s not what’s happening, the companies are engaged in anticompetitive pricing.

Insulin supply is unlimited, is it? A larger market that requires the use of more and more animals is "stable over time"?

Like I said, address the cause of the demand increase and you'll address both the price and provide and improvement to peoples' quality of life.

I believe Humalog is insulin produced by bacteria.

There is a scaling issue but my point stands, that demand & its growth are stable and predictable. These are companies with at least 5 & 10 year plans, so they’re able to match production to demand long term.

As far as I know the bulk of insulin for human use is produced using bovine/swine cattle.

And my point still stands that preventative measures will have both a positive impact on peoples' health and on the demand for insulin.

Price gouging is definitely a problem that has to be addressed, but it's not the only one - yet seems to be what everyone focuses on first while glossing over the terrible lifestyles/habits of the population.

FYI: The majority of insulin these days is human insulin produced by GM bacteria or yeasts.

Just because there's more than one obvious problem doesn't mean that you can ignore the others.

More to the point, this isn't just about a single disease or drug, the same story applies to a lot of medication, including those that have zero lifestyle causes.

EpiPens are another example mentioned in the article. In the US if your child is born with a deadly allergy you have to carry around very expensive EpiPens that can cost hundreds of dollars due to co-pay and whatever. In Europe these will cost you directly less than $10 and even to the state will cost a lot less than it does to many US patients. One of the company's responses to hiking the price from $50 to $600 for profit reasons was to introduce a cheaper generic version, which as this article points out, is BS.

Fair enough!

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