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Comment by _p3fk | Hacker News Reader

It’s unfortunate that debt must be seen in the United States as a precursor to getting healthy. Most of the western world has long ago moved past such notions, and the concept of any kind of medical debt is foreign in many European countries, for example.

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Capitalism is weird. Competition does nothing to reduce costs in healthcare. Perhaps demand outweighs supply several times over? Instead, doctors are treated like royalty (and they deserve it after what they’ve been through/sacrifices they’ve made). But it feels a bit like renting a Lamborghini to do grocery shopping.

We need more layers below doctors that can very effectively treat typical healthcare conditions. We need more NPs and PAs. Perhaps more doctors too - if we can lower the rigor and regulation for family doctors. Make it easier to become one - preferably without losing one’s shirt.

An analogy to healthcare today would be to only allow someone to code once they reach Staff Eng (MD) skill level. Most of them spend the majority of their time fixing bugs that a Jr. Eng (PA in training?) could fix with guidance, or a SE 3/4 (PA/NP) could fix on their own.

So, no - filling the work with Staff+ Eng (MD+) is not the most optimal or cost effective way of dealing with this.

Staff (pun) aside, there’s also the whole drug price gouging situation. I don’t know how will we fix that.

Competition does nothing to reduce hospital prices because in many cases it's illegal to start a competitor and either way insurance companies are footing the bill so you have no incentive to price-shop.

Competition does nothing to reduce isolated under-patent drug prices because it's not supposed to.

Competition does nothing to reduce one of a couple of specific generic drug prices like insulin and epinephrine because of some very, very stupid FDA policies that make it like they're under patent without any of the drawback of the patent actually expiring.

Competition is incredibly good at bringing down the prices of generic drugs, competing separate under-patent drugs like depression treatments, and things you do mostly pay for yourself like glasses.

Re: doctors, we don't need less-skilled doctors, we need less-debted doctors so doctors are less likely to seek high pay despite less fulfillment. We currently require a four-year degree in literally anything before you can start medical school; Ireland does not and just pads med school with a single extra year for GE, and their doctors are about as good as ours. Competition also doesn't work when it would drive your prices below cost, and medical school debt makes it effectively like that.

There's not a whole lot of capitalism happening in American healthcare: medical systems, insurers and the AMA all act as cartels to limit competition in their respective areas. There is no price transparency, and the captive market has inelastic demand.

Once a company in the US has figured out a treatment for eclampsia, Europe can steal this knowledge for free (i.e. price-control them according to cost) while the US company must price-gouge against the manufacturing cost to recoup the R&D costs. This factors heavily into how much healthcare costs in the US (not to be interpreted as 'it's the only reason'); it's the same dynamic as 'world police'. If under-patent drug prices went up in Europe they would go down in America.

> Once a company in the US has figured out a treatment for eclampsia, Europe can steal this knowledge for free (i.e. price-control them according to cost) while the US company must price-gouge against the manufacturing cost to recoup the R&D costs. This factors heavily into how much healthcare costs in the US (not to be interpreted as 'it's the only reason')

Recouping R&D costs has been disproven time and again. Medical companies spend far more on average on marketing (and lobbying) than on actual R&D.

In theory then a bunch of pharma startups that have nailed their marketing costs should then flood the market with cheap new stuff. Why haven't they?

What incentive is there to do that? Is there anything preventing them from being gobbled up by current giants?

Being gobbled up at a premium is a reasonable exit strategy.

Well yea, but OP wondered where are these cheap drugs.

First time I’ve ever heard such a strange story. Do you have any evidence for your sweeping radical claims?

All other evidence I’ve heard of points to the USA being the only major country without public healthcare and price controls in place, but maybe you can blow my mind with facts.

So you're agreeing with him based on your second paragraph?

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