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Comment by rubyn00bie | Hacker News Reader

This is good because it will actually help people...

... but wow, just woooow. It's so incredibly depressing that I'm calling this "good." Sometimes the sheer insanity of the United States health care system overwhelms me. The fact insulin isn't a few dollars or free is beyond disheartening. It's like the system itself saying the Sackler's just didn't have enough imagination exploiting people, and destroying lives, for profit. "Oh? You don't need to get them addicted if they'll die without it... silly, Sacklers. #BusinessMASTER"

I keep hoping one day folks in the US will get tired of being screwed on their healthcare and living in fear of getting sick... shrug

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I think a lot of us are sick of it (if you look at the polling for single payer, it crosses party lines in support). Unfortunately, our politicians are fairly well captured by entrenched interests.

Politicians aren't "captured," they're "grown."

Captured implies a change in behavior or an outside force acting on them, and that isn't accurate.

Only politicians that fall in line are given the support necessary to succeed.

To me, the term captured reduces the agency which is our responsibility to exercise as citizens (at least in the U.S. where I'm based.)

/steps off soap box.

There is a perspective out there that says our current extremity of partisanship is actually a product of the parties themselves becoming weaker. When parties were strong, they had greater leverage over their members so the party could be whipped more effectively on compromises. Now - the efforts to reduce party influence over their members (smoke filled rooms, etc etc) has led to more and more extreme members and leadership has fewer levers to pull them towards the center.

It doesn't really cross party lines if republicans refuse to vote out politicians who don't want single payer health care.

Who pays the bills is not the problem in healthcare, it's a supply issue.

The various medical cartels have lobbied to artificially decrease the supply of competitors, workers, and companies in the healthcare industry.

Single payer healthcare doesn't magically create more physicians, hospitals, or drug companies.

I don't see how what you've said is related to what I said?

If republican voters aren't willing to replace their politicians with ones that are willing to vote and make a single payer solution, then they don't care about single payer healthcare that much. It has nothing to do with any specific implementation. Republican politicians have never put forward any sort of single payer healthcare implementation

I don't see how medicine can cost less when the supply hasn't changed.

Patents are the same. Residencies are the same. Hospitals are the same.

Do you think the physician cartel is going to stop living in Mansions?

Keep in mind that large segments of US citizens believe both poverty and ill-health are moral judgements.

https://news.ycombinator.com/item?id=27858491

https://news.ycombinator.com/item?id=27858456

>"large segments"

>links to two hn comments

really?

...in the current thread...which is four hours old...and mirrors the comments from others in the US....

>...in the current thread...which is four hours old

Well if we apply your logic to this other thread: https://news.ycombinator.com/item?id=27860162, can we assume that "large segments" of the US population are knowledgeable in debating the merits of the rust programming language?

>and mirrors the comments from others in the US....

Mirrors what? I certainly didn't see any reference.

Insulin prices have increased SO MUCH over the past 50 years, it's disgusting. The manufacturers' margins just keep climbing because they know they can raise prices without consequence.

Well, that's because the insulin has been getting better. You could always buy porcine insulin and shit. It's just not as good (side effects, harder to dose, etc.).

The best new analogs cost about 28 euros per 10ml bottle in Spain without insurance...

Medicine, such as FIASP...

Europe is free riding on the US.

I heard this argument somewhere (not just about medicine but also on defense, why they can have such lavish perks/holidays/etc.) but can't remember where. Do you have any good articles/papers on this?

> can have such lavish perks/holidays/etc

Just look at the difference in taxes on salary between France and the US. Half of what is payed by employers to workers goes to social protection (this is in addition to the company taxes). If you add VAT and income taxes the amount of disposable money is a fraction of what you would get in the US, nothing magic.

And yet living standards are at least as high and quite often higher in most EU countries compared to the US.

Source regarding insulin?

The US is still free riding on Canada when it comes to Insulin development IMO.

Funny you should say that. Let's have a look at what the out-of-pocket costs would be if you live in, say, the Netherlands: https://www.farmacotherapeutischkompas.nl/bladeren/preparaat... because those prices look a hell of a lot more normal than US dependents get squeezed (literally) to death for.

Yep. And if some insulin gets too expensive, at least in Germany they kick it out from the system completely. It's either you can sell your product in the country with a price we think is reasonable, or we will not let you to be in the market.

20 euros per 10ml (about 2 weeks of use for me) is still kind of a good money for a product I cannot stop using...

Sure, there's a price difference across regions. That's nothing new.

The important thing is that insulin prices haven't been going up. You can continue to get the same insulin as 50 years ago for pretty much the same price modulo inflation.

And anyway, the Netherlands getting cheap stuff is a side-effect of innovation here. America builds for America, driven by American needs, and you guys benefit as a result. There's a reason recombinant DNA tech (which backs modern insulin) came from the Bay Area and not the Netherlands. NL has twice the pop of the Bay and a fraction of the inventions. A single university here has like 5x as many Nobel Prize winners as that entire country.

I mean, I'm glad you're able to buy insulin cheap but we're richer and we're the ones driving progress, so we'll keep at it because we want a better life for ourselves (and if you benefit, it's fine). You're not capable of making that for us, yourselves, or anyone really.

Oh yeah. Where would the world be without the SV innovations in targeted ads, social media and buying cheap stuff over the internet.

Oh those wonderful things too. Truly SV is the crèche for our present Golden Age.

What a truly bizarre thing to say, given where a non-trivial number of the pharmacological companies involved are based.

gotta love how people apparently don't like facts so much this comment now has zero points. Insuline is cheap, it's cheap to make, and cheap to distribute, and the US doesn't like cheap when it comes to having a steady supply of "you will buy our drugs, or you will literally die".

Legal hostage taking in this way is uniquely US.

>The manufacturers' margins just keep climbing because they know they can raise prices without consequence.

They have? According to testimony by Sanofi, even though list price have went up 126%, net price has actually gone down 25%.

https://www.finance.senate.gov/imo/media/doc/26FEB2019BRANDI...

Ah yes, “net price.” Don’t remember my accounting class covering that. What about revenue?

>Ah yes, “net price.” Don’t remember my accounting class covering that

Good thing it's covered in the report

>What about revenue?

Surely your accounting class tell you that rising revenue doesn't necessarily mean that "margins just keep climbing"

And most blockbusters movies never turn a profit. Color me skeptical. There’s probably similar accounting tricks at play.

>And most blockbusters movies never turn a profit

net price =/= profit. The report also covers what exactly goes into the difference between gross and net price. If you can point out what the accounting tricks are, that'll be great.

If you look at the chart in the link, about 45% of the difference between “list price” and “net price” is discounts or rebates to insurers.

It’s particularly gross and brazen, even by pharmaceutical rent-seeking standards, to justify cocaine-like profit margins because large buyers can negotiate.

Insulin prices are driven by anticompetitive behavior. If you look at metformin, a generic drug treating the same disease, profit margins are tight, driven by competitive economics. A 90-day supply is < $10 retail.

Insulin has actually gotten cheaper; it's the pricing due to customization, branding and applicators that is totally out of control. Coupled with the history of insulin's invention and "open source" nature this is unconscionable .

i take comfort in the fact that there's no true ideal system, as long as the good bits find light, it's ok, that's how it had to be

This is the result of prohibition. Many other people wish to manufacture and sell cheaper insulin, it is just illegal to do so.

This is a government problem, not a healthcare system problem.

Are you talking about patents or just regulatory standards?

"Many other people wish to manufacture and sell cheaper alcohol/paracetamol/antibiotics/COVID19 vaccines"

To maintain this standard of living you're always going to be dependent on someone, it's not a government problem.

>The fact insulin isn't a few dollars or free is beyond disheartening

meanwhile there are people dying from lack of food in the richest nations on earth.

don't get me wrong, there is plenty wrong with healthcare.

Is anyone actually starving to death in wealthy nations?

I get that there are people who have to skip meals in the USA, but does anyone really get to the point of dying?

Can almost guarantee the bigger issue is the low quality “food” options, leading to obesity and diabetes.

It would be really nice if we could actually recognize this issue and address it as a society instead of getting up in arms about a mayor taking away the Big Gulp.

The only people dying of starvation in the western world are people who refuse to accept help or have severe addiction or mental health problems that prevent them from seeking it in the first place.

Yup.

> severe addiction problems that prevent them from seeking it in the first place.

... and we're right back at health care.

https://ourworldindata.org/hunger-and-undernourishment

https://www.feedingamerica.org/hunger-in-america/facts

(disclosure: food bank logistics and tech volunteer in the sunbelt)

undernourished =/= "dying from lack of food "

Hard to be specific as death from undernutrition/malnutrition isn’t going to show up on death certificates.

I understand that many are not sure where their next meal will come from or when it will arrive and I do not deny that is a problem, but that's a far cry from dying over it.

Starving? Doubt it. Malnutrition? Probably plenty.

Don't worry, one day we all end up working for Amazon and they provide Amazon Healthcare at their Amazon Hospitals (wait times decreased to see a doctor based on PPH [picks per hour] minus TOT [time off task]). On your way back to work, don't forget to grab your prescription at the Amazon Pharmacy, where you can buy some Amazon Drugs (side effects might include decreased productivity, please use sparingly).

The depressing part is the realization that it was supposed to be Costco, the good guys in retail, but we will end up with Amazon universities instead :(

https://www.youtube.com/watch?v=Z8zNsUTWsOc

> I keep hoping one day folks in the US will get tired of being screwed on their healthcare and living in fear of getting sick... shrug

As someone with good but very expensive health insurance, any time I bring up health insurance prices, the response from people who get cheap health insurance through their employers is basically, "F* you, got mine"

Unfortunately, the block of people with stable corporate jobs also tend to have a lot of political power and are in no hurry to see their perks upended.

I would support it being free for Type 1 diabetics. They had no say in their genetic lottery.

Type 2 can pay for it themselves. Their condition was caused by themselves.

That's not true. Type-2 is genetic too and there are high performance athletes suffering from it. Just as you have very obese people without it.

An obese person has 2x the probability of developing type 2 as a person of normal weight.

Regardless of obesity, Type 2 can be managed with a low carb diet.

Also, false(to the later point), having type-2 still does damage to the beta cells and given time many will require insulin. Also, this still gets back to the OP placing blame on the individual based on ignorance. There are many reasons for an individual having a large mass, low insulin production, and insulin resistance.

Low card can be part of it, but it's not a panacea, once an individual has diabetes, the damage has been done.

People being squeezed for time and money by soul-crushing, self-grinding subsistence-level employment so that, tapped of executive function for the day, they buy a cheeseburger and fries, maybe collapse in front of YouTube to turn their brains off for a bit--

--those are the people you feel comfortable shitting on for their circumstances?

(And there absolutely is a predisposition to Type 2 diabetes in some populations and not in others.)

I see no need to subsidize their choices. Its not shitting on them, its just not enabling them. The vast majority of type 2 diabetics have a BMI >25. It is a user preventable disease.

If for some reason they still have diabetes with a BMI <25, then subsidize it.

And this is exactly why I don't want universal healthcare in America. We'll need everyone to conform to a rigid interpretation of life. My BMI is 22, so I'm fine, but I also like riding a motorcycle.

With UHC, suddenly folks like this will try to deny me care because I'm taking on non-normative risk. Fine, do so if you want, but I want to be tax-exempt. You can have your UHC, but you pay for it.

But folks won't do this. Instead they want to take my money and then give it to themselves by denying me 'subsidies'. No thanks, I'll keep my money and give it to Anthem. No UHC in the USA.

The vast majority of type 2 diabetics--and the vast majority of Americans--live in a existentially threatening mess of financial crisis and mind-melting advertising and pressure on a thousand axes that didn't exist a century ago and are being ground into powder to enable a thin film of the truly rich to live like kings and to enable people in the computing class to live lives of only moderate precarity.

I dunno, it just doesn't seem all that hard to have have some really simple baseline humanity for the grist in the mill trying to find a moment of respite in something bad for them--ingrained literally decades before and in plenty of cases before they had the personal automony to decide for themselves.

Even if their BMI is over 25, heaven forfend.

> The fact insulin isn't a few dollars or free is beyond disheartening

90-95% of type diabetics have type 2 diabetes. Of those, around 95% can completely eliminate insulin dependency by straightforward dietary modifications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104272/

Under what moral framework should these people (around 90% of diabetics) receive insulin at others’ expense? I can see at least a first-order argument for having everyone else pay for obligate insulin dependents’ medication, but I struggle to see an argument for foisting the cost of an entirely preventable dependency on everyone else.

Great. Restrict the handouts to Type-1 diabetics. They certainly didn't get the disease by choice.

I think society has largely given up on the concept of a not awful diet being a reasonable thing to ask of people.

Society continues to push back on any regulations on addictive junk food and loading down budget food with excessive amounts of added salt and sugar - so yea, the company's freedom to make a buck exploiting addiction trumps your freedom to live a healthy and happy life.

We're not talking about being fat, but eating suger to the point you neet to start taking medication to keep the suger in your blood from ripping your veins apart. At some point there's some personal responsibility. It takes more than a little suger added to your food to do that.

Can you clarify where that 95% figure came from? From your link:

> Forty percent (31/78) of CCI participants who began the study with insulin prescriptions … eliminated the medication

Not op, but it's not unreasonable. There was a nejm study where 800 calorie diet reversed t2d in 11/12? Patients?

More recent studies by nhs show ~25% success rate but I bet it's due to compliance. The nejm study (iirc) had strict monitoring, which is impossible at the ~300 patient level

Why should I have to contribute to Social Security for people who didn't bother to save for retirement? /s

What is sarcastic about that? Why should I pay for the retirement of people who neglected to save for it?

Social security is a savings plan. You don't get social security if you don't work, and it's in proportion to how much you earn. This is, in fact, the point of social security. It came about as a response to old people dying in the streets. It exists for people who either through bad luck or lack of financial education couldn't save enough.

The idea is that if you worked through your life, then shit hits the fan, you shouldn't be knocked down below your contribution to society as measured by your level of success under capitalism.

Because not everyone is able to or can?

Lots of couples are infertile. Should they be able to conscript anyone off the street to have a baby for them?

You really shouldn't, that's the entire point.

Let them eat cake!

Most type 2 diabetics have the opportunity to improve their health now and eliminate insulin dependency and continuously choose not to do so. At least SS has the argument that it’s too late for people who failed to save to change their behavior.

I can only see a first-order argument in saying "I will not pay for anyone else."

There's a second-order argument of the form "We will all be better off if we invest in healthcare. Society is not zero-sum."

There's difference between investing out of your own volition and being forced to by threat of violence.

That's fine as long as you are willing to forgo the benefits of the things that other people have collectively paid for.

If you want to opt out of taxation you should surely also be morally obliged to opt out of using roads, internet, mobile telephones, clean water, sewerage, police, fire brigades, etc.

I know that it is possible to opt out of fire services in rural US but most of the rest might put a bit of a crimp in your lifestyle.

Not just police, but general societal protection - the fact that you can exploit people for your own profit and not get beaten up when they come back for vengeance is one of the benefits of being in a society. I personally didn't find the depiction of Caeser's Legion in fallout to be the most desirable and free society to live in, but to each their own - maybe you image you'll end up as Caeser (but you won't).

I'm more than okay with paying for these things; in fact, I already pay for majority of them.

> We will all be better off if we invest in healthcare.

Enabling unhealthy diets is not “investing in healthcare”.

I feel like that's the same thing as arguing that your taxes shouldn't go towards public schooling since any one of those parents could have chosen not to have a child.

If that argument strikes you as problematic, it might be because society is better when it's generally well educated and healthy.

I should get a $100k rebate at retirement for not having kids.

That "rebate" is called those other well educated and well functioning kids working to keep the world running when you retire.

The median HN user having kids is a net positive social externality. You shouldn’t be rewarded for not gifting that externality.

Educating children has a positive externality. Eating diabetes-inducing food does not.

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