That’s an $88,000 treatment for the medication alone. Given the apparent success of the drug, is it expected for the price to drop as the volume of patients spike?
This has nothing to do with research and cost of development anymore (if it even ever did).
What should it cost instead?
> Dude was living off of government research grants.
Let's imagine his work comes to fruition. The drug is expensive but efficacious - is this not a good thing? Should the government have not helped fund this drug because now it's expensive?
The alternative is a world without that drug and without as much incentive to produce the drug. I'm not sure that's a good trade.
Which segues nicely to this pairing of public funding and private enterprise. No, if the drug wouldn't be sold for a profit then the incentive to make it wouldn't exist and the funds would not be applied for and the ironic pairing - if it is ironic, which I don't think it is - wouldn't exist either.
Unless we're going to believe that researchers go through the mill of applying for funding and doing research simply to get the funding and stay in badly paid employment?
Can’t displace Chomsky as a famous linguist if he writes a letter to everyone’s dissertation committee if they criticize him.
> When he was asked what the device would cost, he cheerily replied "whatever the market will bear."
I also do not need to assume that companies undertaking research are doing it for profit as that is their reason for being companies, and even in the case of research being not directly undertaken for profit, that research - if useful - will go into drugs that are then sold with the intention of making a profit. Not solely, whether cynically or altruistically, the hope will be that the drug is effective.
To patients? It should be free.
To society? The initial research cost plus the bare manufacturing cost.
Someone has to pay. Who pays?
> To society? The initial research cost plus the bare manufacturing cost.
And we're back to a society which is poorer in terms of both health and wealth.
If you remove the profit motive then investment falls, new medicines become less likely and lesser in number, and medicines remain higher in cost due to lack of pressure (competition from new drugs, competition from new entrants, new techniques etc).
Altruism, necessary as it is, does not fill that void alone, and it certainly won't be filled by hoping government makes everything "free".
The last 200 years proven otherwise. All basic research around airplanes, semiconductors, satellites, GPS, GSM, fiber optics, CD/DVD and much much more was almost entirely tax funded.
No, the government should set a reasonable price for the product they funded. A high enough price to fund manufacturing, a low enough price to ensure that people who need the treatment have ready access to it. If the upper bound on price is too low for universal access, that's what subsidies are for.
Instead, we have free money to bootstrap extractive capitalists, at cost and detriment to people who need care.
Do the investors at the company you work at set the prices for the products you produce? That would be strange.
> Instead, we have free money to bootstrap extractive capitalists, at cost and detriment to people who need care.
It's "free" money because the capital costs are high and it's risky. I don't think it's the only or the best way but it is a valid way, but it doesn't remove the right to make a profit.
As to it being "detriment[al]" to the people who need care, they're getting a drug that didn't exist before, right? And this also should (generally) make existing drugs cheaper, right?
If he wants to charge "what the market will bear," then he should fund the research through the market.
If he wants government handouts to do the research then the public deserves to get the benefit that it's paying for - we're not funding it to make some guy rich.
I'm not saying it should be free, but he's already opted out of the market, so he loses out on market pricing. Manufacturing cost plus some reasonable percentage for the creator.
The government (which is really a government of and for the people, right?;) gets what it wants - a new drug - and jobs are created, trade happens, taxes are levied, health improves leading to (theoretical) money saved, more hours worked, more taxes… There's no need to punish the creator by not letting them make money off of their creation just because the government was involved, the government is getting plenty out of their investment.
So? Nobody has a right to free money. If investors don't want to fund the research, and the researcher doesn't want to share the results with the public, then no money for them. They can go off and work on something else.
> There's no need to punish the creator by not letting them make money off of their creation just because the government was involved, the government is getting plenty out of their investment.
You're putting words in my mouth. I said the cost of government funded drugs should be the cost of manufacturing plus a percentage for the inventor.
Second, that's not how government funding works. If the public funds a thing, then the public has a right to use that thing. If the inventor doesn't like it, then they shouldn't take funding from the government.
Funny to see a pro-corporate welfare argument on HN.
It's not so that's your mistake.
> > I'm all for cutting subsidies,
You see, I wrote that. However, as we can see when I continue I am able to see the benefits to a system I don't agree with. It's called being reasonable and not strawmanning your opponent.
> > but the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear.
> So?
So… I gave that argument right there. "the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear." If your response to this is "So?" then you've just said "So?" to "the drugs never appear". Strangely unappealing.
> Nobody has a right to free money.
Aside from having not made that argument and it not being relevant, you're arguing that people should get free drugs. Nobody has a right to free drugs. Now you're arguing against yourself.
> > There's no need to punish the creator by not letting them make money off of their creation just because the government was involved, the government is getting plenty out of their investment.
> You're putting words in my mouth.
Which words? Punishment? Ah, the percentage.
> I said the cost of government funded drugs should be the cost of manufacturing plus a percentage for the inventor.
How magnanimous of you. What would you set the percentage at? How would you get companies to manufacture things at cost for you? That's just not how a business survives, and the only people I've ever heard make this kind of argument are people who've never run a business and never will.
> Second, that's not how government funding works. If the public funds a thing, then the public has a right to use that thing.
No, that's not how government funding works, that's how you appear to think it should work in this fantasy you've constructed. Governments often provide funding to private companies that do not create some magical legal right to that company's products.
> If the inventor doesn't like it, then they shouldn't take funding from the government.
I'll repeat, that's not how government funding works. I'm against subsidies in general and in this case but I'd take this dysfunctional way over yours.
Rich people from all around the world travel to American hospitals if they have serious health problems, not to public hospitals even in rich countries like Norway. Public healthcare works (poorly) as a way to distribute existing treatment, but is worthless at incentivizing development. Really, the entire world is unfairly parasitizing on Americans to fund medical research.
One example of cancer outcomes on a per country basis: https://worldpopulationreview.com/country-rankings/cancer-su...
Just google medical outcomes for any disease on a per country basis.
Do you really think the best hospitals in France or somehow worse than the best hospitals in the USA? Especially when the best hospitals in the USA still have the same fundamental problems as the rest of the American system?
I am aware that most of the cutting edge clinical trials in my field occur in the US. I have also seen people travel to the US for treatment of rare diseases. And I know that this isn't a surprising thing for the US in general, just look at our universities.
It's actually pretty funny that the only other response I got was someone saying that this is super obvious/true across fields in the US and thus not an interesting statement.
I don't know if it is a weird American bias or what. I'd take a look at the bias there and this belief in American exceptionalism as it doesn't pan out in the data.
Cutting edge clinical trials and those companies are global in nature. I mean just look at the Moderna team and where they conducted those.
That's basically the case for everything in America, so I'm not sure that it says anything remarkable about the American healthcare system.
Like can you think of anything else in America that you couldn't apply that statement to?
Capitalism works only with competition. But competition is against capital owners short-term extractionism (or rather against ceos who feels need to justify their pay). IMO solution is to let workers vote on CEO pay changes and punish white collar crime better and many problems of capitalism might get solved.
EDIT: IMO it won’t work as long as globalization can be exploited to suppress working class and avoid regulation
Do the drug companies in Europe do any different though?
- that sounds a lot like ransom?
- I think if they adopt a policy of price-discrimination to the point of literally taking you for all (or most) of what you're worth (or projected to be worth), we should turn around and apply the same reasoning to corporate tax rates.
If you're lucky - they have long term care insurance, and that covers most of the expenses for approx 2 to 10 years (depending on how old the insurance is - it's getting harder to find long plans, and they're all getting significantly more expensive as it turns out more folks needed them).
Otherwise... you spend everything, and then your kids pay.
We split my grandmothers down the middle - my mom's had insurance, we covered my dad's.
Vs. a miserable decay for everyone involved at huge expense. It's not worth it. Forget the money. The emotional toll is large and for whose benefit?
In theory you could presumably have some kind of system where a person of sound mind could that said, in effect, "if my condition declines beyond _____ then I want to end it," but doing so would be an incredibly touchy subject even if euthanasia was legalized. Unfortunately there is a very real potential for such a directive to by abused by people motivated by greed (gimmie that inheritance) or who simply don't want to deal with an aging relative who needs more help but hasn't reached the point where their euthanasia directive should be triggered.
It would, but the alternative is to make people live though this mental decline as we currently do. IMO it would be well worth the risks to be able to ameliorate the end of peoples lives.
My plan is to end my life well before I hit severe mental decline (not “if it gets worse”, with all the ambiguities that entails). If that cuts a few years off then a be it!
Walk out to a storm or blizzard not equipped for it. Go fight a bear or lion or crocodile. Go for a swim that you can't come back from. Do some high risk type of adventure that in high age is not even discussed. If you make it, great experience, move to next one.
The list is literally endless and can be done in some form even by quadriplegics. It allows you to plan goodbye and closures, wills etc. The fear and pain and suffering is concentrated into such a tiny sliver of time compared to dying discussed its uncomparable.
It just takes balls to accept that this is it, what mattered for you in life is over, and now its time to think about your closest ones and not yourself. Like a breakup, many will continue living in bad relationship since its a small amount of pain and evil every hour, every day. Instead of standing up and walking off to uncertainty and freedom.
You say that now.
I am close to someone looking at this now after holding that exact view for a lifetime, what I see them actually doing is delaying and delaying and confronting that, even on their darker days when they are thinking hard about doing it, the logistics of zero-risk-of-survival suicide are pretty terrible.
It's sobering to watch because I, too, hold the view you lay out above, and now watching this, I think I'd better work out my logistics while I'm relatively young and healthy.
What I've heard about long term care insurance is you can't really buy a plan with useful coverage anymore. The old plans were good as long as the insurer remained solvent, but many didn't.
I did some math on the premiums he'd paid for the insurance, and the payout. It was a break even.
In other words, putting the premiums into an HSA would have financially worked out a lot better.
That's incorrect. With Medicaid, the recipient is require to spend down their assets to a small amount, then Medicaid will pick up the remainder. The recipient's children aren't on the hook for anything. Of course, they won't receive any inheritance since the estate of the recipient has been drained prior to Medicaid.
IMD over 65 is only offered in some states, and have strict requirements for facilities that accept medicaid (not all that many do near us).
In our case, the waiting time was about 3 years for a room in the facility closest to us. Alternatively, there was an option about 4 hours away.
Worse, both medicaid facilities we looked at were... bad. Frequent complaints about abuse, very high rates of staff turnover, very little stimulation for residents (one was basically a single old tv on the wall in a cinderblock room - it looked basically like prison).
So yes - Medicaid will cover some costs in some cases, but really - the kids end up paying.
One of those cases where US individualism and utter lack of social thinking (completely unrelated to socialism/communism but many simpler folks fail to distinguish that) screws up needful parts of society
American healthcare system is absurdly inefficient.
If you want to learn more about pricing in healthcare the "Pricing, Value, and Ethics" lectures for this course is really interesting.
https://openlearninglibrary.mit.edu/courses/course-v1:MITx+1...
https://www.fda.gov/about-fda/center-drug-evaluation-and-res...
Drug patents are good for 20 years from the filing date, so you have about 10 years to recoup all of your costs, recoup the necessary fraction of your amortized R&D expenses on drugs that didn't go anywhere, and hopefully turn some profit, before your patent expires and generic manufacturers undercut you.
The result is that cutting edge drugs are extremely expensive for the decade or so after they first become available while the patent holder uses their patent-provided monopoly to set prices at the maximum that insurance companies and government health providers will pay. Your link is discussing the period of time after the patent expires and generic manufacturers get into the game, but the drug being discussed here with its $88,000 treatment cost is still in the patent-protected cost-recouping stage, where it's not subject to normal market principles of supply and demand because the supply side is a temporary monopoly.
You will not see a price reduction, if it doesn't require chemotherapy or significantly reduces the number of rounds of chemotherapy, this drug will cost $150k+ for full treatment.
All of this assumes side effects are better than chemotherapy. Given chemotherapy care plans are some of the most arduous, it will be hard to be worse than chemo.
Is that the american price or the "other developed countries" price?
In the current model, pharma only stays in business by recouping all of the during the patent protected period of any drug that makes it to market.
Market dynamics don’t come into play when there’s only one. If competitors appear or after patents expire it may get cheap, but the cost early on will have no relation at all to production costs.
It is a bit like car insurance here, which keeps rising because insurance companies keep edging the cost of a claim upwards (courtesy cars at extortionate rates, repair, ...) because there's no insentive to keep costs down or not profiteer.
With the NHS's buying power for drugs, they can get a little bit nearer a sensible margin from the supplier rather than the insane US costs underwritten by inflationary insurance.