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Comment by camillomiller | Hacker News Reader

Just to frame all this a bit better: in Italy epipens cost… wait for it… ZERO - nil - nada. You have a diagnose of anaphylactic shock risk? You get epipens. Public healthcare pays for it, therefore everyone pays for it with their taxes. Without a prescription, you can get one for around 75€, which is already considered criminally expensive.

This is true for thousands other products. So please now tell me again how r&d and other costs justify the US prices for the same drugs that are sold profitably Yet way cheaper in other western markets.

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The direct cost to the consumer is $0 (or lira, or EU, or whatever), but that's because public healthcare negotiated with the power of a volume customer to agree on a fixed price, which is paid for by the government, which is paid for by people's taxes. So what you're doing is spreading the cost of the drug across the population. I had a similar situation when I had kaiser- no out of pocket costs.

As to why drugs are expensive in the US: because the market bears it. Demand is just elastic enough (or inelastic, I always get it backwards) in the US that providers slowly edge prices up. Sometimes they get it wrong for example aduhelm didn't sell so it had a huge price drop recently.

Inelastic means less price sensitive i.e. people will pay more. You can kind of think of it like immutable vs mutable.

Drugs are expensive partly because there is not a free market. Drugs that have been off-patent for decades which have 20 generics in other countries have none or only a few here. Anti-parasitics for example, that cost a few cents in Africa are $20 a pill here, for no reason at all, other than regulatory hurdles designed to ensure profit.

How much does public healthcare pay for them? That's the crucial question here, not whether the cost is borne by the individual using the good or by the taxpayers as a group. I mean, clearly universal access to healthcare is improved by collectivizing the cost, but it's improved even more by eliminating the cost, or most of it.

I'm confused. Isn't this like saying I bought you lunch with money I took from you last year so your lunch was free?

No. Spreading the costs over millions of taxpayers makes the cost you pay into the system way smaller, plus gives the government a huge contractual power when dealing with pharma companies. It’s really not that hard to comprehend, but I yet have to find a single American that for some reason doesn’t try to justify or straight up defend the US broken and unequal healthcare system.

Yes, medical cost in the US is out of control. No, the government should not be the provider. That doesn't fix the problem. It just makes new ones. Our government is extremely limited by the Constitution on what they are supposed to do. Unless "providing medical services" is added as a power of government to the Constitution there will continue to be a large, vocal opposition to government healthcare.

Apologies in advance if I’m mistaken, but isn’t your Constitution supposed to protect your right to “life, liberty, and the pursuit of happiness?”

How does one have life and liberty if they have a crushing burden of medical bills?

More simply, how does one have life if the medication needed to save you - is $750 a dose? or $300 an injection (and expiries with no refundable “core charge” whether you use it or not)?

> Apologies in advance if I’m mistaken, but isn’t your Constitution supposed to protect your right to “life, liberty, and the pursuit of happiness?”

You are mistaken. But, that's okay, even many Americans get confused about attributes of the Declaration of Independence vs. the Articles of Confederation vs. the Constitution, and tend to misattribute things from the first two to the last one.

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