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Comment by NoraCodes | Hacker News Reader

I think this is a great "test case", so to speak, for a kind of modern, market-hybrid, computer-enabled central planning. Insulins, even highly effective modern insulins like Lantus (insulin glargine) and Humalog (insulin lispro), are very easy to synthesize in vast quantities, are made from cheap precursors, and are relatively easy to deliver compared to other drugs, requiring only commodity refrigeration. They are expensive literally only due to greed and the inherent inefficiency of the capitalist system in delivering life-critical services.

In addition, the state has an inherent interest in improving the lives of diabetics in this way; many type-1 diabetics rely on state programs to afford their insulin due to price-gouging, so the state may actually save money by doing this.

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> due to greed and the inherent inefficiency of the capitalist system

Cartels, monopoly, and regulatory capture are not inherent to capitalism.

Yes they are, because any intelligent or rational capitalist will want to avoid competition and form monopolies. Some will succeed, because of economies of scale incumbents can easily keep out new entrants in many markets. Saying this isn't inherent to capitalism really sounds like the "that wasn't real communism" people. It's something that appears very frequently (always?) in capitalist economies so not addressing it isn't a very compelling argument

OK, how about this take:

Cartels, monopoly, and regulatory capture are inherent to the human condition.

Not sure, "human condition" is poorly defined and we don't have experience of any true human condition that isn't deeply embedded in our current culture. Do un-contacted tribes have these things?

Either way, it's not really the point whether it's inherent to human condition. It's obviously a failure mode that can happen in lots of circumstances. I think the difference is that in capitalism it's highly incentivized by economics and culture and capitalism as a system doesn't have many great defenses against it. Anti trust legislation is as you pointed out vulnerable to regulatory capture.

I think capitalism stans would have more credibility if they would acknowledge that any complex system for distributing resources will obviously have edge cases and failure modes that need to be addressed. Denying that anything is the system's fault again just sounds like the "that wasn't _true_ communism" people

Who will develop new insulins under this model?

> are very easy to synthesize in vast quantities

Biologics are not synthesized.

> Who will develop new insulins under this model?

Same folks that historically develop most drugs and health advances, academic and national research labs.

These kinds of questions always have this undercurrent that capitalism+pharmaco is the answer to everything. I am not going to litter this with hedges, but to prescribe that solutions need to be solved a certain way is manipulative.

https://www.sciencehistory.org/historical-profile/frederick-...

> Same folks that historically develop most drugs and health advances, academic and national research labs.

As far as drugs are concerned, this is simply not true, not even close. I believe the actual fraction of new drug approvals developed by academic research (including national labs) is more like 20%.

> approvals

Pharma can afford the trials. The molecules are developed by research funding. There isn't anything _special_ about pharma vs public research. They all employ the same folks.

> The molecules are developed by research funding.

Also incorrect. The underlying scientific knowledge driving new therapies is overwhelmingly academic in origin, but academic research does very little actual drug discovery. I think the practice of university PR departments writing stories like "university professor discovers new cancer treatment" every time someone finds an effective in-vitro inhibitor has contributed to the confusion; most of these "drugs" never make it out of trials. Even for major advances like immuno-oncology and CRISPR that originated in academic labs, it takes many years of development (and hundreds of millions of dollars in private funding), most of which will not result in breathless press releases.

There are many good arguments for changing the incentives and IP laws involved in biomedical science, but "academic labs will pick up the slack" is not one of them, and fundamentally misunderstands what academic institutions do well (or poorly).

> drug approvals developed by academic research (including national labs) is more like 20%.

By your own admission, the number is quite high. I am talking about capabilities that can be enhanced. Not the ways things currently are. Nothing precludes the NiH funding drug discovery and manufacture.

Ok but who will fund them, or even just lobby for whatever (comparatively small amount of) public funds to be available?

All we need are immortalized mouse kidney cells of the right flavor, but everybody close to the problem benefits from the GMO Chinese mouse industry. /quantumly uncertain sarcasm/

This debate is tiresome, and is the Ctrl-V'd response to every article that even implies we Americans pay too much for healthcare. I realize this particular subject is insulin, but really Diabetes is just the poster child for the larger issue. Is it not a problem that we bankrupt ourselves for the medical necessity of keeping ourselves alive? I don't understand how you can look at the current situation and say "Not broken, no need to fix"

Americans are bankrupting themselves through a mixture of overeating, substance abuse, and sedentary lifestyles. As a society we are getting sicker every year. We should do more to reduce the prices of insulin and other biologics, but that won't solve the fundamental problem. Much of the insulin used today is by type-2 diabetics, and the vast majority of those cases are caused by lifestyle.

So in your opinion poor type-1 diabetics should die because you think other people are too lazy?

Stop lying. I specifically stated that we should do more to reduce the price of insulin.

You say it "won't solve the root problem" but it literally will solve the root problem for type 1 diabetics - a lack of insulin! The only more "root" you can get there is, like, regrowing beta cells I guess?

this wasn't an answer to a relevant question

The relevant question from philodelta was about how to stay alive without going bankrupt paying for insulin. Excessive insulin prices are a problem, but most type-2 diabetics can greatly reduce or even eliminate their need for exogenous insulin through permanent lifestyle changes. This is much cheaper (and healthier) than paying for insulin.

https://doi.org/10.3389/fendo.2019.00348

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