>15% markup plus pharmacy fee plus shipping and handling.
This is the intent, and still cuts out at least 2 middle men between consumers and manufacturers: the insurance company and pharmacy benefit managers.
Or at least allow people to continue to renew their medications after prescribed one time, rather than requiring further doctor's visits.
Most things in medicine are expensive due to legal monopolies/improper regulations. e.g. no reason you shouldn't be able to buy prescription glasses for $10-20 dollars off the shelf. The main problem with medical costs is that it's not a free enough market, with sufficient competition.
And of the big problems in medicine - a prescription for glasses (which isn’t really a medical service in the US - optometry is not a medical profession) just doesn’t register for me - you can order glasses online without a prescription if you are so inclined.
Meanwhile there isn’t any realistic libertarian solution to allocation or access to complex medical care - and just hand waving “free markets” doesn’t make it so.
Contacts would certainly be much cheaper without that hurdle.
And I bring up vision, because it's a common problem and for less well off folk with families it can be a big expense, basically entirely unnecessarily so. Imagine making 20k/year and you have to pay $500-$1000 a year for vision correction for your family. That's 2.5-5% of your pretax compensation
There's no handwaving here. Competitive markets require complete information. Information about costs to the consumer is basically entirely opaque. Over 90% of medical costs are non emergency, so if people could comparison shop, costs would go down. Also requires skin in the game (e.g. marginal cost per visit).
Look at plastic surgery for a good example of how free market/non insurance based medicine can fare. Many procedures are quite cheap, and while many are still expensive, much cheaper than necessary medical care covered by insurance. Also the number of doctors is still limited by the AMA, so even this is not fully competitive. There's an arbitrary cap on number of providers
Fully free markets can lead to negative externalities like monopolies, pollution etc.
What leads to good societal outcomes is competitive markets. It just happens that free and competitive overlap a lot of the time. Information hiding makes a market less competitive, but is permitted under a full free market mentality. This is an area where regulations are warranted and useful.
Competitive capitalism should be the goal for most areas in modern society. Which in almost all cases only requires light regulation.
If you were in another industry, and went to a judge and said "this person defaulted on their agreement to pay me whatever I want." Then I think the judge would basically tell you to get lost. And that is a good thing. The only oddness here is that somehow the medical industry has been getting away with this for a long time.
That is what the fix should be too, IMO. Basically, legislation that states unless someone expressly agrees to a price for a medical procedure, they are not liable for it.
Certainly there's a good case to be made for having safety nets for those that can't afford, but for the vast majority of people, a competitive system would bring down costs substantially. The US actually pays the most for healthcare per capita than any other country, I believe. Largely goes to inefficiencies rather than health outcomes. A truly well structured and competitively designed healthcare system could greatly improve QOL for the public.
Whether it's "libertarian" or not is a matter of semantics. The free market extreme would have no regulations at all... but clearly that can lead to certain negative outcomes (monopoly being classic example). Certainly there are different flavors of libertarian... and I would consider myself one, but am in favor of regulations that encourage competition between businesses. However, not needed in most spaces, healthcare in particular seems very warped/not rationally structured.
A rule of thumb for whether a sector is competitive/efficient are whether margins are broadly high across the board. I'm definitely a capitalist and not anti-business, but in a competitive market you should expect margins to be relatively constrained in the long run. Of course first movers, and those that truly out compete the rest can attain high margins... but over time these advantages should erode as new and better players come along.
Certain SaaS is pretty interesting example, because cost of switching can be high, creating "utility-like" businesses. DocuSign, for example, is really easy to dump for a competitor, low cost of switching. But something like AWS is much more difficult... need to invest potentially millions of dollars and months of time to rewrite your systems/design learn a new cloud environment, very high and painful costs of switching. It's often cheap to choose one of many competitors, but then you're entrenched in that environment.
Anyway, long tangent, but I expect law to recognize these kind of things eventually...
But please link me to a US site where I can legally buy contacts without providing proof of prescription, if there is one!
One province de-regulated dispensing of corrective lenses and anyone could get in the game, and many did!
But good to hear you can in Canada!
The optometrist I went to recently put me in the strongest prescription I'd ever had. Instead of using that prescription, I ordered contacts using the prescription of the glasses that I thought were fine.
There's two numbers on the contacts... diameter of the pupil (doesn't matter for most people I think) and an angle (Edit: 'Base Curve'. The third number is the power of the contact, aka 'sphere'. Glasses prescriptions have power and astigmatism, but don't have diameter or base curve). I got these off my prescription. If you don't already know how to use contacts it's important to get instructions and a followup. I read of a guy who didn't know he had to take the contacts out at night - the contacts had started to grow into his eyes?
(Edit: you can get a set of "trial lenses" from Ebay if you want to try to come up with your own prescription, or to try out your prescription before buying glasses.)
My previous comments on ordering contacts:
https://news.ycombinator.com/item?id=13691768 / https://news.ycombinator.com/item?id=29366816
Edit: I live in the United States.
That said, for normal eyeglasses, there are many sites that offer eyeglasses without proof of prescription. I've been buying eyeglasses from Zenni Optical for almost a decade for my whole family. Most recently in 2021. I have never once even been asked for proof of prescription, I just punch in my numbers and hit order.
This is an old trope but hasn’t even been superficially true for years. The AMA does not have the authority to limit the number of doctors. In any event their political influence has become less and less relevant for decades now, so even their ability to influence the number of docs is quite limited - I am not even am AMA member - I was only during medical school to get discounts on test prep. I don’t believe most of my peers are AMA members either - they belong to their specialist groups. Meanwhile the number of medical schools and students in the US has increased substantially in part due to AMA and AAMC. Meanwhile internal medicine residencies still have to fill their ranks with imported talent (foreign medical graduates) - only the lucrative subspecialties are the ones that remain limited and competitive. There are also forces at work to limit the number of MD jobs available that have nothing to do with the supply of MDs (replacement of positions with midlevels). The limit on residency positions is a partisan federal funding issue going on for years and only recently has much headway been made.
On eye care, I can of course self prescribe but even so for contact lenses I usually end up purchasing overseas from reputable retailers because of the price fixing of contact lenses - and I’ve never been asked for a prescription. It’s not that hard to get eyewear without a prescription.
Combine education and free access to everything with reasonable daily unit limits and per-substance licensing. You want meth, you go through meth safety training and get a yearlong endorsement allowing you to buy up to the daily limit at a pharmacy, no prescription involved.
Set up due process that limits or eliminates legal access to substances based on criminal or medical situations.
Drug abuse - using in inappropriate situations leading to misbehavior - can be treated as a medical issue. Misbehavior that rises to the level of criminality is already handled.
It's absurd to think that any adult in a free country has any business whatsoever telling other adults what they can ingest or do in private.
Some variation on these notions are already demonstrated across the world. The current schedule system and drug laws in America serve only the bad guys, whether it's commercial prison slave labor, drug cartels, big Pharma, or the alphabet jackboots.
I believe they were referring to the snake oil craze of the 19th century, not prohibition:
> The term comes from the "snake oil" that used to be sold as a cure-all elixir for many kinds of physiological problems. Many 19th-century United States and 18th-century European entrepreneurs advertised and sold mineral oil (often mixed with various active and inactive household herbs, spices, drugs, and compounds, but containing no snake-derived substances whatsoever) as "snake oil liniment", making claims about its efficacy as a panacea. Patent medicines that claimed to be a panacea were extremely common from the 18th century until the 20th, particularly among vendors masking addictive drugs such as cocaine, amphetamine, alcohol and opium-based concoctions or elixirs, to be sold at medicine shows as medication or products promoting health.
Some medications require regular monitoring to ensure that bad side effects aren't happening; PrEP requires checkups every 90 days to make sure kidney function is not getting impacted.
People can easily seek out prescriptions as it is today, they just need to find a doctor and say the right things. This is common with TRT, Modafinil, Cannabis etc the barrier as it exists today is mostly artificial.
We allow people to drink alcohol, so any drug less dangerous than that shouldn't be gated
Saying that kidney function usually involves Estimated Glomular Filtration Rate which means they measure the creatinine. Now if you happen to supplement with creatine, creatinine being the metabolised form will alter the eGFR! So if a dr doesnt ask you if you are supplementing with vitamins, minerals and other supplements, you could skew some medical tests and end up with a medical condition that doesnt exist!
You can also get quite alot off your pharmacy, but you need to know what to say, so some online pharmacys are better to use to work out what to say.
For example, if you want to get hold of Testogel here in the UK, for males its a nice pick me up and its being used in South Africa for dementia treatment, you need to say your T levels are below a certain amount. If you get rejected, you lower the amount on another website and then you can eventually work out what the level is that lets you have a testogel prescription!
Its not too hard to game the medical system for low risk drugs, for everything else you have various people who already qualify and through word of mouth have been known to sell on their meds because the Dr might sometimes up the dose if there is no response or told there is no response. SSRI's are like this. In theory a blood test measuring the 5-Hydroxyindoleacetic acid from the jugular vein will test if someone is taking SSRI's but they also do other things which go undocumented until some published scientific study highlights it.
To be honest though, the best drugs are vitamins and supplements, the number of medical studies I've read highlighting negative effects is quite shocking. Take https://en.wikipedia.org/wiki/Bisphosphonate#History It was first used for bone problems in the 1960's but the technology wasnt around to explain exactly what it was doing until the 1990's! Loads of studies slate the use of Bisphonates but these are recent like post millennium studies.
In fact you go through Google Scholar, you can see a trend from the first studies published in the 1800's where medicine was largely using what was found in the body, so B12 deficiency was eating raw liver, then from WW1 to WW2 patented drugs started to appear and thats when modern medicine started, but it is a case of medicine is restricted by the technology so AI in medicine is big business.
This gives you an idea of how the medical profession work, drug companies develop something run a battery of tests and then see if they can get it licenced and sold as a treatment.
https://en.wikipedia.org/wiki/Bupropion#History This is another drug designed for one thing but they noticed it had smoking cessation properties so it got relicensed.
Painkillers even the common ones like ibuprofen and paracetamol are also dangerous drugs. Paracetamol will destroy your bones and your kidneys dont like ibuprofen.
This is the history of Ecstasy aka molly aka mdma TLDR,
1912 German pharma Merck developed the compound for blood clotting, didnt work so got shelved.
1950's US Army dust off the compound and get university of Michigan to study it.
1973 results declassified.
1978 https://twitter.com/DrAShulgin a former Dow chemicals chemist into his psychoactive drugs looks at it and publishes a report "the drug appears to evoke an easily controlled altered state of consciousness with emotional and sensual overtones. It can be compared in its effects to marijuana, to psilocybin devoid of the hallucinatory component, or to low levels of MDA"
Psychotherapists start using it.
1980's its getting popular and DEA start to take notice.
1985 DEA get it banned, people having too much fun! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931692/
Medicine is like chemical hacking of the body.
My clinic’s backend used to have a slightly easier ‘refill prescription’ form but they changed it to only work with their integrated pharmacies. The closest one is an hour away.
If you look up details about his factory it's supposed to be built sometime next year. On Google maps, looking at the address, I wasn't able to see any evidence of this place existing. It's also supposed to employ 60-80 people, which, seems small to take on drug manufacturing.
I listed two, do you disagree that they are removed?
You can usually pay cash at a pharmacy, skipping insurance
These may all be standalone operations, or one corp with its hands in each pocket: PBM, pharmacy, insurer and distributor.
> "People always ask, well why didn't somebody do this before? The reality is there's so much money there, it's hard not to be greedy," Mr. Cuban said
> "But I won't. I've got enough money. I'd rather f— up the drug industry in every way possible."
Some people like to max their points in videogames. Other like to max their $ in real life.
The beauty of capitalism is that the effort of the latter end up benefiting us all.
The US has a particularly horrible hyper regulated, government shielded, cartel-based healthcare system and has for decades - the time during which its healthcare costs have skyrocketed out of control.
The US could hardly be further away from Capitalism in how its healthcare system is structured.
Countries with more regulation and more control by the state have... prices that are a fraction of the US. Surprise. Just like countries with stricter environmental restrictions have fewer clear-cut forests, less polluted water, etc. Unbridled capitalism means more money at the top at the cost of everyone else. There's a balance to be found between making money and having some restraints.
Funny enough, the quality and ease of access (delays for procedures etc) also "are a fraction of the US"
As an American, my longest waits and worst care were all in the US. I pay just a couple bucks in Japan and get far better, far faster care. Pissing blood from a major kidney infection and hospitals politely turning me away because my insurance was out of network and "oh this is too expensive for you. Try (next hospital that rejected me)" wasn't fun. Never had an experience like that outside the US. Here it’s “Do you have an appointment? No? Okay, we’ll see you in a few minutes.”
Not sure why Americans believe this meme, but it's very apparent that someone hasn't spent any significant time outside the country and is informed exclusively by facebook fearmongering when they say that. It's always "yeah, I know a guy who knows a guy who read an article saying the UK is worse!" America has massive delays for procedures already--the excuse doesn't work anymore.
But yes, the delays in Japan and the cost are a fraction of the US, and it's because there's more regulation. It's wonderful.
Well I guess now I know a person on hackernews with a story?
Most of these regulations don't exist in countries because there are top down price negotiations and/or universal healthcare.
The US regulation is the worst of both worlds.
Per Wikipedia:
> Capitalism is an economic system based on the private ownership of the means of production and their operation for profit. Central characteristics of capitalism include capital accumulation, competitive markets, price system, private property, property rights recognition, voluntary exchange, and wage labor.
All of these things are true of the US healthcare market.
Why the government hasn’t stepped in, is pure corruption.
That's just what capitalism is. There is no ideal world where people max out their earnings and say "haha i'll be a friendly competitor and work for the benefit of the people :))))". People with vested interests will always push for less regulation, and the consequence of a successful push is never "everyone is better off and paying less!" Other developed countries have more regulation and lower prices. That's simply a fact.
I also spend all of my time and energy trying to get more points.
There are countless examples of that not being the case. At best, it benefits some other people most of the time and, arguably most people only some of the time.
Keep in mind that all of the current issues with US healthcare are also caused by individuals trying to maximize their personal dollars - at the expense of the general public.
I like that sentiment!
I also like it's coming from a capitalist VC, with a profit incentive!
And I love I won't have to bother with insurance and stuff: yes, I could save $5 here and there, but no, I don't really care, and I'm not sure it's worth dealing with the insurance company who'll gather the information and look for various creative ways to compile and use the information against their clients (say, if you take tobacco cessation drugs, birth control, etc)
Yes, I know there are various laws on the books that in theory protect patients against that, but as we've seen with the consequences for say Experian data leaks, the reputational risk for Cuban himself look like a much stronger incentive that for say, Walmart or Costco or whatever company doesn't bear the investor name.
So I think Cuban will have my business!