At this point literally every other country in the world chimes in about how broken the American healthcare system is.
Yup.
Yup.
Scoreboard says people still want to move to the US
Meanwhile the actual social mobility in the USA is lower than in Europe[1], so you'd be better to stay put or go to Europe. People here don't know what they got.
You say twitter, but it might just be people that have access to the internet and better information?
I'd be curious if anyone looked into why the USA is seen as so ideal when various metrics are only on par with developing countries. (Of course, it's clearly beyond a developing country, it just doesn't like to admit it -- healthcare, welfare, incarceration rates, income equality, minimum wage, minimum paid time off, university costs, etc. Sources here are OWID and Wikipedia, mainly from memory but feel free to ask for a specific source)
Another theory is that the USA generally sees itself as the best country, with e.g. starting every morning of primary school with this "pledge of allegiance" indoctrination (sorry, I have no other word for it and I still have a hard time believing this is real). With English being the lingua franca online, much of what you read online is likely to be written by someone who thinks this way.
[1] See figure 1 on the 43rd page which has page number 40 https://docs.iza.org/dp1993.pdf
If you get stuck at a moderate FAANG salary for life, it may still be better than where you started from, for example.
Notably, all but 2 of the European countries in that study have smaller populations than Los Angeles. It's a lot easier to have social mobility for a small group than it is for a much larger group, especially when they can offload a lot of social ills (homelessness, immigration) entirely to other countries. Which is presumably why the study excluded the Mediterranean and Eastern European countries.
Also I didn't hand-pick the source, it's just a piece of info I came across while reading https://news.ycombinator.com/item?id=31705542 which had a link to clearerthinking.org which had a quiz called "Political Bias Test" (wouldn't recommend it btw, at least not for the advertised purpose; it's more of a "do you know random stats about the world" quiz) which had a question about social mobility with the aforementioned source. The website seems to be made by an organisation founded in New York, but it's not clear to me whether a European made this particular quiz question.
At any rate, it seems the European HNers took issue with learning that their tiny homogenous countries do better than a country with a larger population than their entire continent. Which is made possible because the U.S. pays for their defense.
If stats tell you one story but reality tells you a different one, then you should ask why that is, and not say the numbers are right and reality is wrong, or vice versa. There are more possibilities than just the world is getting bamboozled by brainwashed Americans online.
Still, though...
Scoreboard also says many, many people are choosing to move to Florida at the expense of other states - one of the top 10 states IIRC.
Ie I can move with my skillset and languages to most of the world. I did move twice. Didn't consider US, ever, even if I loved common US folks I met when I spent few months there. Society is just not that good - lack of true freedoms, high criminality, class system based on income, messed up medical and school system, too much workoholism. Not a place to raise your child in, if you can stay ie in Switzerland.
You sound like quite the elitist...that would be like me telling those 'poor uneducated and desperate people living in Detroit, they should just move to Naples FL or Beverly Hills to escape the poverty and crime - if only they were smart enough.
https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...
Especially given then title of the article, and that insulin in generally free in Europe AFAIK.
So the rest of the world wants to move to the USA because of the great weather, low income taxes, and the fact that the government doesn’t demand that you stay at home during a health scare?
> the government doesn’t demand that you stay at home
You mean "politely suggest" without any coercion.
Good luck "staying at home" when your home falls into the ocean the day after your last 3 insurance companies decided to close their doors forever.
There wasn't anyone in government that decided hospitals and insurance companies need to have record profits and price gouge their customers. It happened, because entrenched interests lobbied government officials to enact such legislature.
Business is the one that perverse incentives through pressure on government. It doesn't originate in government spontaneously.
> Some would say that crying "market failure" isn't a legitimate criticism.
Saying market failure isn't a criticism in and of itself, it's a statement of fact. It arises whenever the market is unable (for a multitude of reasons) to distribute the services to the end consumers (e.g. health care recipients) in an effective manner.
For example, saying that "tying health care to employment creates perverse incentives, because policymakers automatically assume that more people are covered than actually are, since policymakers themselves are employed" is a criticism (without judging how valid/accurate it is).
Broadly saying "market failure" is not.
You can find a case of someone getting into a specialist or a surgery within 2 weeks in the US, but you can also find the opposite.
As much as Canadians like to crap on US healthcare, it does have its perks in certain situations.
Yep. Because it's broken...
America pays more because our health care system is capitalist, and that naturally leads to increased prices because demand is inelastic (meaning, that demand does not decrease based on price).
https://worldpopulationreview.com/country-rankings/health-ca...
https://www.oecd-ilibrary.org/sites/242e3c8c-en/1/3/2/index....
As an American with expensive (~$800/month, rising to over $1000/month next year) insurance, I often have to wait to see a specialist and only go see my GP for regular check-ups.
If I have an issue that needs to be addressed immediately, I have two choices: an "urgent care" facility or an emergency room.
Urgent care, at least in my experience, is a misnomer as I've (with a small sample size) alternately been refused treatment and been told to go to the emergency room ("we can't handle that sort of thing") while still being charged for something, or given substandard treatment.
Which, I guess, is why urgent care is 1/3 the cost (out of pocket) of an emergency room visit.
Should I wish to see my GP, I likely would need to wait at least a few weeks, possibly longer. With even longer waits for specialists.
Certainly not half a million people a year most of whom are insured.
Sugar tax of 1c per 1g added sugar is another easy solution. Use the proceeds to reduce sales taxes on food and drink generally.
I argue the opposite in that Nightscout and other initiatives that predominately serve the Type 1 community help push the advancement of monitoring, etc. that benefit the rest.
Thought on treating type 2 is also evolving in ways that don’t benefit type 1 as much. For example, the trend is for pre-diabetes to be taken seriously and detected earlier.
Modern insulin analogs were not invented 100 years ago.
Diabetes is a very old disease that ironically is pushing the limits of sensor fusion, but it is very poorly understood by people outside of the Type 1 community.
I personally wish these two diseases were completely renamed as it does a disservice to both Type 1 and 2 patients.
"Unlike many pharmaceutical markets, which see the entry of generic competitors, no generic or biosimilar insulins have been approved in the United States.68 This is not due to patent protection of the existing products.69 The patents for the majority of human and analog insulin products have expired or are about to expire.70 At the end of 2015, 11 insulin products had no associated patents or exclusivities.71 This number has since risen to approximately 17 by July 2019 (including those products where only the insulin pen device is protected), shown in Table 2."
Knox, Ryan. “Insulin Insulated: Barriers to Competition and Affordability in the United States Insulin Market.” Journal of Law and the Biosciences 7, no. 1 (July 25, 2020): lsaa061. https://doi.org/10.1093/jlb/lsaa061.
This is corroborated by Health Access International's deep dive from several years ago:
"There are no patents on any formulations of human insulins. Based on the filing date and a 20 year patent period, patents on analogue insulins already on the market in the US and Canada have expired or will soon expire in these countries and elsewhere (Figure 1)."
https://haiweb.org/wp-content/uploads/2015/05/HAI_ACCISS_fac...
https://haiweb.org/wp-content/uploads/2016/04/ACCISS-PatentR...
And yet, despite this, the US remains alone in having prices not only multiple times the cost of any other country, but increasing at an alarming rate (tripling over the past deacde) while prices stay the same or fall elsewhere. There's zero shortage of analysis and ink spilled in both the popular press or in academic analysis/ peer-reviewed press on why markets are so fucked in the US pharmaceuticals, so I just assume any talk about how R&D cost recovery happens to only be a thing in the US (and somehow accelerating despite new products not being released) to be either extreme low effort or just plain bad-faith (which are you anon?), but for those reading along that might be interested, a few places to start to do their own research if they really care about the topic:
Mulcahy, Andrew W., Daniel Schwam, and Nathaniel Edenfield. “Comparing Insulin Prices in the United States to Other Countries: Results from a Price Index Analysis.” RAND Corporation, October 6, 2020. https://www.rand.org/pubs/research_reports/RRA788-1.html.
Hirsch, Irl B. “Insulin in America: A Right or a Privilege?” Diabetes Spectrum : A Publication of the American Diabetes Association 29, no. 3 (August 2016): 130–32. https://doi.org/10.2337/diaspect.29.3.130.
Schneider, Tyler, Tara Gomes, Kaleen N. Hayes, Katie J. Suda, and Mina Tadrous. “Comparisons of Insulin Spending and Price Between Canada and the United States.” Mayo Clinic Proceedings 97, no. 3 (March 1, 2022): 573–78. https://doi.org/10.1016/j.mayocp.2021.11.028.
Herman, William H., and Shihchen Kuo. “100 Years of Insulin: Why Is Insulin So Expensive and What Can Be Done to Control Its Cost?” Endocrinology and Metabolism Clinics of North America 50, no. 3S (September 2021): e21–34. https://doi.org/10.1016/j.ecl.2021.09.001.
Luo, Jing, and Aaron S Kesselheim. “Evolution of Insulin Patents and Market Exclusivities in the USA.” The Lancet Diabetes & Endocrinology 3, no. 11 (November 2015): 835–37. https://doi.org/10.1016/S2213-8587(15)00364-2.
You can have the ‘old insulin’ for something like 25$ / 1k units. But it’s very hard to use relative to modern analogs, so people prefer modern analogs.
Edit: Minus points for facts that disrupt the narrative. I love it.
https://medcitynews.com/2019/03/lilly-to-introduce-lower-pri...
The problem is that there isn't competition on the market for this product. The Open Insulin people were trying to make it available to the public but they are stuck trying to get through the regulation.
It's entirely possible that if we got rid of the regulation then the whole problem takes care of itself and it becomes a non issue.
Humalog and other types of the same exact insulin are pennies on the dollar in other countries with very different healthcare compensation programs between the vendors and purchases. It's bizarre to say the least.
But basically you are correct that regulation is the largest barrier to price reductions. Patients pay the price of FDA regulation (for better or worse). That’s not really the drug companies fault.
Are you actually suggesting people are going into debt [1] and killing themselves[2] just because they prefer modern analogs?
[1] this post
[2] https://www.independent.co.uk/news/world/americas/us-politic...
The new stuff lets you eat a wider range of foods without having to time everything precisely or worry as much. about hypoglycemic events.
I don’t know if that’s a preference or if it reflects the way Drs treat T1 patients.
>I don’t know if that’s a preference
so which one is it?
Cuba, of all places, have pretty great medical R&D?
Don’t think your statement means too much.
In the long run, these drugs go off patent and become low cost and highly available.
Yes, people today will struggle, maybe even die today. But in a generation more people will thrive.
BioNTech SE
An der Goldgrube 12
55131 Mainz, Germany
Specifically with COVID-19, there was a lot of global collaboration.
But that said, the key point remains; the US is where the money is. The US underwrote the mRNA platforms with a guarantee of 10 billion in revenue while the EU haggled with AZ for like 1 billion.
In the process, the US developed an entire scalable delivery pipeline for mRNA that didn’t exist prior.