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Comment by SlowRobotAhead | Hacker News Reader

>The government should be giving this away for free.

The government has no money. So you're saying the tax payers should be paying $2000/mo/recipient.

In this scenario you've made nothing cheaper. You've only externalized the costs on to us. You could argue this is for my/public good, but you didn't ask me, you didn't get a representative vote from me. In your scenario you've just decided how to spend my money. I hope you understand you've only just made the problem worse because nothing has preventing it from being $4000/mo now that they know the gov will buy an unlimited supply.

edit: To be clear since posts below don't seem to get it... You're missing a step. You've done nothing to solve the $2000/mo problem, just shifted the costs to everyone. This is the issue with healthcare, the off the cuff solutions don't actually fix the root problems.

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> The government has no money. So you're saying the tax payers should be paying $2000/mo/recipient.

The government is able to achieve economies of scale that the private sector can't. I think you know damn well "the government should be giving this away for free" is just a simplified way to describe the economics.

> You could argue this is for my/public good, but you didn't ask me, you didn't get a representative vote from me. In your scenario you've just decided how to spend my money.

Right, you got yours, so you're rationalizing away your part of the cost burden.

You're participating in a society. The consent is implied. If you don't like the terms of the contract, feel free to stop enjoying all the fruits of civilization.

>Right, you got yours, so you're rationalizing away your part of the cost burden.

No. I earned mine. And now here you want to come along and have it spent on something we all agree is a scam at $2000/mo/user.

I reject the premise that any money spent on the social good is money well spent by default. I argue that money spent wisely the goal, GP had no plan for wisely, just spend to spend. That is why ACA failed, it did nothing to adjust costs, just signed everyone up into a broken system.

At the same time most people here are just saying "it's been invented, patent expired and should be free now!" which is another way to say "I want remove incentives for new drug research by making it very high risk and low reward". So I disagree with that too. I wonder how many people understand why the USA is the center of pharmaceutical research and in general healthcare research?

Feel free to attack me for just not caring about people selfishly, surely I'm a greedy monster. That seems ineffective to me, but what do I know!?

Uh, no. Truvada is a generic drug in many countries around the world and cost maybe $10/month not $2000/month. The US just allows Gilead to profit massively from something that is generic and in the public health interest of all Americans to be as cheap as possible. In fact, Gilead agreed to speed up the expiration of their exclusivity so that it will become generic in 2020 due to public outcry, but the fact that a life saving drug will still be $2000/month for a year or more when it could be $10 tomorrow is terrible.

> a life saving drug

I think you are technically correct that Truvada is a life saving drug but I feel you are being dishonest. If you exclude occupations where you could be exposed to HIV, most of the US users of Truvada could choose to change their behaviors and reduce their chance of contracting HIV to <1%.

There is also the general trend that US companies pay large amounts of money to develop drugs, charge US customers enough to cover R&D costs and then sell the drugs at cost internationally. Does that suck for us? Yes, but it helps the rest of the world significantly.

Wow, this is a bad take. You could literally say that about any disease. Why don’t all obese people just change their behavior and then we don’t need to worry about cheap insulin anymore! Why don’t men stop having sex with each other and then they won’t be at risk for HIV?

>Why don’t all obese people just change their behavior and then we don’t need to worry about cheap insulin anymore!

For type 2 diabetics, behavior changes should be a part of the treatment plan. That said, if you currently have diabetics and you don't get insulin you will die thus it does qualify as life saving medicine.

>Why don’t men stop having sex with each other and then they won’t be at risk for HIV?

While it is not pleasant, people are not going to die just because they have to stay abstinent. You don't even have to be abstinent, you can find a group of 10 or even 50 guys, make sure everyone is HIV negative and then you can do what ever you want, as often as you want, with no need for drugs.

Calling it a "life saving drug" is correct in many cases (NGO worker in parts of Africa) using the term "life saving drug" to advocate for people to be able to cheaply have unprotected sex with strangers is dishonest rhetoric.

If those filthy citizens would just wash their hands, we wouldn’t need to waste money developing flu treatment either. You’re a genius! We can save so much money.

And we can stop working on making cars safer - all we have to do is tell everyone to follow the rules of the road and almost all collisions will be prevented!

While you are taking the idea to the extreme to make a point, I agree with the underlying argument that we should work to modify behavior to improve outcomes.

A lot of money has been spent reducing tobacco use which has paid for itself in better health outcomes.

When there are multiple cost-effective public health measures that can achieve the same end, we should pursue all of them.

In the case of Truvada, we already did the hard part (inventing it). Now it’s just a chemical that can be infinitely duplicated a low cost. It would be a huge wasted opportunity, a moral crime really, not to give it away for free to everyone that can benefit from it.

And the same is true for the flu vaccine, the birth control pill, the seat belt, etc. These are miraculous technological advances. If you support the use of these advances, but not Truvada, I would take a hard look at what factors might be playing into that.

> Why don’t men stop having sex with each other and then they won’t be at risk for HIV?

OK, you seem to have some misunderstandings about HIV. Through an accident of history, HIV in the US spread through the gay population first. That is not the case for HIV generally, and any thought that not having sex with other men is going to protect you is totally wrong.

The overwhelming majority of new HIV infections are men having sex with men. Having unprotected anal sex with a man is absolutely the highest risk category for HIV.

https://www.cdc.gov/hiv/group/msm/index.html

The second risk factor is using intravenous drugs. Stay away from these two things and you are very safe.

It’s also not so much historical factors as the fact that anal sex is a little more than 30x more likely to spread HIV than vaginal sex.

USA also does a huge majority of the research and development for most drugs and developing new drugs is insanely expensive. The profit is the reason why there is incentive to do this research and there also won't be any money left to research and develop new ones. If there was no profit to be made, there would be no reason to develop new drugs.

It is out of patent, the government could manufacture it. These manufacturers are cutting deals with generic manufacturers to delay the introduction of generic drugs to the market in order to maintain a monopoly.

It also cheaper to put people on prep than to pay for their HIV treatment. Who is paying for all the HIV treatment to opiate addicts? Medicaid is which is the government.

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