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Comment by a_humean | Hacker News Reader

Or you could do what literately every other country in the world does, and have price controls.

There's a huge hidden cost to price controls through - they don't promote innovation as much as markets do. The US develops over half the world's new pharmaceuticals, if we imposed price controls today, we would have fewer life saving medications tomorrow because the companies couldn't afford to do as much R&D.

well considering we already subsidize the early R&D for these companies with our University system, and insulin hasn't changed in 50 years, I see no reason we can't price control certain drugs. Could even use this as a guide https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Me...

> insulin hasn't changed in 50 years

That is false. The insulins sold today are MUCH better than the ones sold 50 years ago. They're much better than the ones sold 25 years ago. Admittedly, the ones sold 25 years ago are effective, but it is much more convenient using an insulin that kicks in in 15-20 minutes and has a relatively short peak than one that kicks in in 30-60 minutes and has a long peak. It's doable either way, but the quality of life is much different.

Pretty sure people who's only other alternative is death would be fine with the old and slightly less effective insulin

I agree with you 100%. I was only addressing the statement that insulin hadn't changed in 50 years.

Trivially untrue, right? Recombinant DNA technology is younger than 50 years so we used porcine insulin before that. It'll still work, honestly, if you're up for it.

Let's make sure people in their 20s aren't dying because they can't afford insulin before we start worrying about how to promote innovation in the insulin market.

If drugs are too expensive, then at some point more lives/quality of lives are lost because people can't access them than are saved from more drug development.

A balance must be found between ensuring fair access at affordable prices, and ensuring fair returns to the pharma industry. This is precisely the goal of pharmaceutical price regulation in the UK:

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

I think that there are Americans who don't feel like volunteering to pay money they don't have food drugs they need for that.

What innovation does insulin production for diabetics require?

Much of drug R&D is funded through the NIH.

You're talking about introducing another layer of complexity on top of an already Byzantine system. Price controls come with many issues, such as incentivizing lobbying & corruption, as well as dis-incentivizing market entry & long-term investment, resulting in a lack of capital expenditures which causes inefficient production.

Healthcare is complicated, and we need to simplify it as much as possible; this is a great example of a situation where we could use 'simple rules for a complex world'.[1]

[1] https://hbr.org/2012/09/simple-rules-for-a-complex-world

Your comment and the one higher in this chain makes it sound like a hard problem when it's only a problem for the United States and no other (1st world) country. I don't really understand how that's possible.

It's a well-established pattern.

https://www.theonion.com/no-way-to-prevent-this-says-only-na...

>"When disagreeing, please reply to the argument instead of calling names. "That is idiotic; 1 + 1 is 2, not 3" can be shortened to "1 + 1 is 2, not 3." "

>" Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith. "

https://news.ycombinator.com/newsguidelines.html

Someone (skipants) did respond that way:

> Your comment and the one higher in this chain makes it sound like a hard problem when it's only a problem for the United States and no other (1st world) country. I don't really understand how that's possible.

Yes, healthcare is byzantine in the US, but it's not less complex in any other first world country, yet America is a dramatic outlier -- in a bad way -- in terms of price to performance. Countries that do markedly better on such measures are also countries which tend to have some kind of price controls built into their healthcare system.

While I understand the temptation to bristle at the more needling comment, it's hard not to see debating over whether someone whose username is "Asshat" is being unfairly sarcastic as a bit beside the point. (Also, the good admiral did not, as far as I can tell, attack you, he attacked what he perceived to be your argument.)

I can assume good faith while still believing your comment is driven by the same American Exceptionalism mentality that leads to the mindset echoed by The Onion article. If your concern is that the reply comes across as mocking rather than engaging: the article was more concise and more eloquent than the potential diatribe I had written up, so I used it.

I am not an American, and I do not believe in American Exceptionalism.

Sure, our healthcare system is crazy. But is healthcare really inherently complicated? This is a solved problem basically everywhere else in the world.

Germany has had universal healthcare since the 1880's under Otto von Bismarck. This has been a solved problem for more than a century.

The problem is that everywhere else in the world doesn't have the delusion that unfettered capitalism and healthcare are compatible.

The US manages to pick and choose socialistic policies in some areas, and I'm more or less just waiting for them (us) to come around to the view that basic healthcare is just one of those things that everyone needs in order to have a decent shot at life so you might as well just provide it as a blanket service.

The US system is far from perfect, but blaming its dysfunction on 'unfettered capitalism' is absurd.

The US healthcare system is among the most heavily regulated industries in the US economy. Among those regulations are FDA policies that give Big Pharma monopolies on new drugs. The FDA extends these monopolies for decades, allowing companies to operate as state-created monopolies. Once the state-created monopoly times out, competitors face a years-long approval process before they can market a generic version of an already approved drug.

You're absolutely right, "unfettered" is hyperbole. I just get a bit weary of the "free market will fix it" attitude, because it's only really free market if all involved parties are free to set the terms of the transactions, and most consumers of healthcare do not actually have much power to do that (or even to know the terms before "purchase"). So the "free market," to the extent that it exists, optimizes for those participants who do have that power, to the detriment of the end user. In my opinion, of course.

That’s true. But given the relative success of socialized healthcare in most other countries, I’m not sure why you’re seizing on the “unfettered” part rather than the “capitalism” part.

Perhaps you should be arguing against lobbying instead of arguing “well, if we try to stop big pharma they’ll just fuck us so might as well roll over and die”.

Somehow, every other country on earth seems to be managing.

Corruption in the British NIH seems a non-problem. The newspapers would be full of it if it were.

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