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Comment by ro_bit | Hacker News Reader

> It’s not worth the risk when patient trust and health are on the line.

Ah yes, the patient's trust in the company to rip them off on lifesaving drugs

Patients seem to trust that Eli Lilly's drugs work. The price point may not be trusted, but its efficacy is trusted.

Patients don't have real choice. Options are either you die or spend hundreds* of dollars on a drug that everywhere else on the planet costs few bucks.

That doesn't contradict the point above

Patients seldom have a choice in any aspect of their care. We could flood the market with dirt cheap insulin using an older formulation but surprise you can’t actually do that without one of the oligarchs buying your company just to stop you.

Or the dirt cheap insulin does not work as well as the newer patented insulin that a private company paid to do R&D for.

There is nothing stopping Congress from passing a bill to fund insulin R&D that provides the newest insulin technology without being patented, but the fact that they do not and would rather sit in their pulpit and “grill” private company representatives proves that it is all a show.

We (sufficient voters) want to pay for nothing, but expect everything.

The patents on lispro (the stuff that costs $300/vial) expired several years ago.

The fact is, Lilly isn't even the largest profiteer. The insane margins of insulin are actually split between Lilly, PBMs (like optumRX and CareMark) and insurance companies, through an incredibly complex system of rebates and vouchers. Turning over that rock reveals more writhing maggots than anyone cares to see.

> The insane margins of insulin are actually split between Lilly, PBMs (like optumRX and CareMark) and insurance companies, through an incredibly complex system of rebates and vouchers. Turning over that rock reveals more writhing maggots than anyone cares to see.

Health insurance companies (parent companies of PBMs) have low single digit profit margins, and medicine manufacturers like Eli Lilly have 20%+ profit margins. If health insurance companies are getting any piece of the "insane" profit margin, then it is being eaten up by losses of other healthcare spend.

Health insurance company profit margins:

https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...

https://www.macrotrends.net/stocks/charts/ELV/elevance-healt...

https://www.macrotrends.net/stocks/charts/CVS/cvs-health/pro...

https://www.macrotrends.net/stocks/charts/CI/cigna/profit-ma...

https://www.macrotrends.net/stocks/charts/HUM/humana/profit-...

Versus medicine manufacturers' profit margins:

https://www.macrotrends.net/stocks/charts/JNJ/johnson-johnso...

https://www.macrotrends.net/stocks/charts/LLY/eli-lilly/prof...

https://www.macrotrends.net/stocks/charts/PFE/pfizer/profit-...

https://www.macrotrends.net/stocks/charts/NVO/novo-nordisk/p...

https://www.macrotrends.net/stocks/charts/ABBV/abbvie/profit...

Why is there no black market for insulin? Like build capacity in Mexico/Canada and smuggle the product in the US? Seems like the multiplier would still be pretty good.

There is plenty of gray market for insulin near both borders. No large players (just individuals going over the border to buy).

Why do you assume there isn't one already? The "War on Drugs" was never just about illegal drugs across borders, and US Customs will try to stop many legal ones too, especially at volume.

The Bush admin basically made a point of ending crossing the boarder to buy cheap drugs.

Which still doesn’t mean that patients aren’t trusting Eli Lilly. Given the fact that they are choosing to spend a lot of dollars buying its drugs indicates that they do trust the efficacy of the drugs.

Also, the fact that the drug costs a few bucks everywhere else on the planet but not in the U.S. suggests this isn’t as much of an Eli Lilly problem as it is a USA problem.

Not true. You can buy generic insulin in the US for a reasonable price, it's the new stuff that lasts longer that is expensive.

I looked it up and a fifty percent savings is pretty good, but that is still a pretty high price for something that has to be taken forever and is twice as expensive as non generic in every other country. https://www.fda.gov/news-events/press-announcements/fda-appr...

I believe Walmart is the only place that does this, and there is some state this is not true in (thinking Indiana, but I'd have to look it up).

The patients also aren't actually paying for it, so mostly don't care. Insurance, Medicaid, or Medicare is paying.

And insurance companies get that money from thin air? Isn't this "Exhibit A" for why health insurance in the US is unaffordable to many?

I think insurance companies don't actually pay the "sticker price" but negotiate for substantial discounts.

This has nothing to do with patients. These are pharma companies existing for the sole purpose of maximizing shareholder value by eking out very last drop of profits. They are just bullying Twitter with whatever leverage they have because Twitter is in unfortunate position where it doesn't provide value at the level where they are the one with leverage. These guys would have not dared this move on Google, for example.

You are freee to keep your money and die if you prefer.

> You are freee to keep your money and die if you prefer.

Just to be clear, you're proposing that "freedom" means "do what this corporations wants you to do or die".

If this were anywhere but Hacker News, I'd think you were joking, but... you're being serious, aren't you?

And let me guess: if a government says, "do what we want you to do, or die", that's regulation and therefore bad, because it's a government doing it, not a corporation?

SMH.

It's scary how many people legitimately see this as "freedom".

Well, if it's any comfort, it's usually not this bad. I only usually come across this on Hacker News, which is why I have to limit my time here for my own mental health. Some people are so dogmatic about capitalism here that they become indistinguishable from sociopaths.

It's why I call this[1] "The Hacker News Trolley Problem".

[1] https://i.redd.it/d9fnppk1p6771.jpg

> If this were anywhere but Hacker News, I'd think you were joking, but... you're being serious, aren't you?

How did you come to that conclusion? I mean, there is a lot of earnest extreme libertarianism on HN, but not nearly so much that you can assume a comment like the GP isn't sarcastic.

The correct interpretation is somewhere between "sarcastic" and "too ambiguous to tell" without digging into comment history.

HN downvotes enough unmarked sarcasm as a culture that most regular "non-green name" commenters on HN prone to (good) sarcastic tones learn quickly to try to mark it (/s, ~, </sarcasm>, however you prefer). I know I also generally assume that unmarked text is not sarcasm nor ambiguous on HN.

Hell I can clear it up.

> the patient's trust in the company to rip them off on lifesaving drugs

So is it dont trust the company to a) have drugs that will save your life (i.e. rip you off by giving you sugar pills) b) make you pay a price that is "not worth it" (i.e. a higher price than your life is worth).

My reference to freedom is literal, nothing to do with government or any other agenda - perhaps other interpretations are loaded with an agenda. IF you dont trust a product, dont use it. You dont have to - you are free to make theses choices. Many people, especially at very advanced ages or sickness opt to forgo expensive treatments that would offer them an extra 6 months of life because it 'isnt worth it'. Some people dont believe that conventional treatments will cure them - see Steve Jobs.

As for my personal political view which seems to be the real attack vector here - for those that fall into neither category, i.e believe the medication will save their lives, feel it is worth it but do not have the money for it. Well in the civilized world, their countries agree with them that their life is worth it and that is how they get their medication and we collectively have healthcare.

> My reference to freedom is literal

Yes, and that's the problem.

If your options are "do what someone else wants you to do" or "die", that's not freedom. Literally not freedom. Whether you trust or don't trust the person, is completely irrelevant to the fact that your very survival is conditioned on obedience.

And sure, it does seem like somehow you arrive at the conclusion that people who can't pay for life-saving healthcare should have collective help.

But, in a way, not understanding what freedom is, is actually more fundamental than that. Even if people can pay for life-saving treatments, why is it acceptable that they would have to? In what context would it be acceptable to threaten to kill someone if they don't pay you a ransom?

Freedom does not exist if all the options are obviously terrible.

Well, admittedly it was a guess, but it was an educated guess based on past experience with HN, and as you can see from blitzar's followup post, I guessed correctly.

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