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Comment by miley_cyrus | Hacker News Reader

Sure, if you want much less innovation: "IRA means 40% reduction in new drugs over 10 years, report finds" https://bio.news/health/ira-impact-new-drugs-pharmaceutical-...

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I don't think they're fighting to keep the price on rare lifesaving drugs. They are fighting to keep the price of insulin, cholesterol medication, blood pressure medication, and various other "public good medications" commonly used by medicare recipients as high as possible.

Its the same tactic doctors use when dealing with medicare. I've been to several doctors that won't take it. The reasoning is obvious: your insurance company will just deny you and medicare will fight them to the bitter end on pricing.

Can you name a single large biotech firm that is going to produce a negative yearly profit because insulin is affordable? I sure can't.

Not true: insulin is not a drug whose price is being negotiated here (https://www.jmcp.org/doi/full/10.18553/jmcp.2023.29.3.229). The drugs whose prices are being negotiated are the brand new ones, the ones that took billions of dollars to develop. Without the promise of a payoff, future R&D will be halted, and humanity won't get benefit from the new medicines.

You’re assuming that the return pharma companies get is the absolute minimum they would be prepared to accept in order to do R&D, but I suspect there’s quite a lot of slack that the regulator could take in. The FCC fixed the price that AT&T could charge back in the monopoly days yet Bell Labs continued to churn out research for the benefit of humanity.

Yet many other comparable countries pay substantially lower prices, and presumably the drug companies are still making a profit of that.

"If you don't pay us through the nose with billions we'll stop developing drugs" seems like a rather odd argument; disallowing the government from engaging in the free market on price in pretty much any area it would set of all sorts of corruption red flags. This is why all sorts of regulation around public procurements exist in almost any jurisdiction.

If you need money to develop new drugs: fine, this is why things like grants exist. Right now the drug companies want to have the best of all worlds with none of the obligations and downsides: inflated prices from Medicare are just tax subsidies but without any controls or checks or anything.

Exactly. It’s not like we’re saying people in medicine shouldn’t make good money. I’m glad doctors are paid well for example. What we don’t like is lack of price transparency and needlessly expensive medications. We allow drug companies to patent drugs, creating an inherent monopoly on that drug, then allow them to decide on an arbitrary price, usually a massive mark up over a reasonable profit margin. This has to stop and I love that there has been progress on this recently. But we need much much more

Is there a diabetic in the house?

My understanding (and I don't have the time to look this up) is that insulin is complicated. It's not a single thing - and variations are currently being developed.

>Its the same tactic doctors use when dealing with medicare. I've been to several doctors that won't take it. The reasoning is obvious: your insurance company will just deny you and medicare will fight them to the bitter end on pricing.

I don’t think it’s a “tactic”, at least in that it’s not a maneuver meant to get the other party to do something differently or win a battle or something, it’s just frequently not worth it for the doctor to bother with insurance, in many cases. The insurance companies can make it arbitrarily hard to get paid, and they’ve gotten so far up there on that abusiveness scale that in many cases, it’s better for sanity, business, focus, etc to just lose those patients that have that insurance.

Source: I’ve worked on billing for a small doctor’s office that eventually decided to drop insurance altogether for life enjoyment rather than monetary reasons. It was incredibly painful working with eg some of the Blue Crosses. It made us want to just not deal with them, regardless of the amount of money, and we eventually did, almost purely for happiness reasons. Not dealing with insurance anymore was a big quality of life improvement. The patients could still file claims themselves, which let the insurance purchaser experience the product, and we always steered people towards Aetna when they asked about less horrible insurance companies, away from Blue Cross and UnitedHealthcare.

Then we should:

1) Explicitly fund research with public dollars, then, not make people who need drugs that aren't even very new fund it.

2) Stop paying to fund everyone else's research (I think this is about 90% bullshit, seeing as other developed countries have strong drug research sectors and I doubt that's solely because of their sales in the US, but even if it's not bullshit—why the hell would we do that?)

Every time someone tries to defend the status quo, they seem not to notice that they're defending a very shitty version of what they're advocating for, even if all their claims are true.

Most of the basic research is already publicly funded. Where pharmaceutical companies have huge expenses is in running large scale clinical trials necessary to bring drugs to market. In theory that work could be nationalized but in practice I doubt that government bureaucrats without a profit motive would make good choices. More likely they would operate based on political pressure and focus on whichever diseases have the loudest advocates.

People innovate because the want to, not because they can use that innovation to price gauge sick and dying people.

The only people you are protecting with this idea are the top 1% of the top 1%. We will always value medicine, but we don’t have to line the pockets of billionaires with our cash so they will bestow upon us cures from the ether.

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