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Comment by eganist | Hacker News Reader

Pharma strikes me as one of the industries that would benefit heavily from a few congressionally chartered nonprofits being booted up. Same employee comp (with cash substitutes for stock), same general structure, same incentives, but with a mandate to recycle profits back into new drug development rather than paying out to shareholders through buybacks, dividends, etc, all audited by a dedicated regulatory body to ensure that comp and waste don't go into excess. Perhaps with a requirement that some percentage of reinvestment is towards cures rather than treatments.

You see similar models with co-ops and credit unions.

The hope would be that the industry doesn't actually profit off of human suffering but still maintains incentive to continue development.

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A good start would be if the medical industry in the US were run like normal businesses with transparent and consistent pricing. Right now nobody can predict how much something cost because insurances, hospitals, drug companies and a lot of middlemen play all kinds of games. I think we should mandate that all prices are open so people know what's actually going on. Hospitals should also charge the same price for the same procedure to everybody independently of insurance or day of the week or whatever factor makes a procedure cost $5000 sometimes and $50000 another time.

All the excuses like "we need to charge more to insured people because of uninsured people" or "we need to charge 10x as much in the US for drugs than in other countries because of R&D" should be viewed as self serving BS until all the numbers are transparent. If there is an imbalance we should do direct subsidies based on the actual numbers instead of the current mess.

Health care is not regular business in the sense that you don't have to buy a product if it's too expensive and where it's easy to compare competing products. How would I know which hospital is better than another?

Absolutely! The truth is that nobody really knows what medications actually cost. They are often sold in bundles similar to cable tv channels.

For those who are running into coverage / affordability problems for drugs in the US… contact the manufacturer. They often have payment assistance programs or discounts to reduce out of pocket costs. They may be able to help you get costs covered by your insurer.

You should not ever be paying the full “list price” out of pocket. Pharma companies want market share and they would rather sell to you at a discount than lose you as a customer.

Not only that, but insurance companies get to negotiate special rates, but as an individual you have zero opportunity to do so, zero leverage. That is, to your point, the price of the service is 100% flexible. The ambiguity and confusion benefits those who are best positioned to benefit from it, that's not the individual.

It's a system optimized to be self-serving. It's the Healthcare Industrial Complex, that doesn't actually care much about health. Profits over people.

>>A good start would be if the medical industry in the US were run like normal businesses with transparent and consistent pricing.

People keep saying this, but I don't see how that helps in the slightest if you have had an accident and need help now.

Or for non-urgent care - something is wrong, you don't know what, you go to two doctors, one recommends a set of tests for $5000, the other a different set for $10,000, how does price transparency help you here in any way shape or form?

Edit: to be clear, this isn't meant to be a comment against price transparency. My point is that I don't think that's what the issue is. When I go to an NHS doctor here in UK I have absolutely 0 idea how much any of the tests or procedures cost, and yet the system isn't putting people in poverty(it has a lot of other problems, but bankrupting people isn't one of them).

It would provide some incentive to equalize across hospitals and rein in any sort of egregious outliers. Right now no one has any idea what is an outlier.

There was already list pricing published and some hospitals charge wildly different prices for the same tests, never mind with different insurers.

It wouldn’t solve everything but the base of knowledge we have is effectively zero, so something would be better than nothing.

Consumers in the US are also perfectly capable of shopping around for non-urgent care. They already do this for elective dentistry, for example.

Absolutely true for urgent care, but most care isn't urgent. If you need a new hip or cataract surgery, that's very much plannable and if you could save a few thousand by going to a different hospital, definitely something to consider.

Like a kind of Service, for Health, covering the whole Nation... a National Health Service, perhaps! Sorry, brit here, couldn't resist. It's really interesting seeing (in my unscientific view) America slowly realising it needs to reform profit-driven health, while England's government slowly privatises its existing "free at poinnt of use" service and makes it harder for poorer people to access good health care.

https://en.wikipedia.org/wiki/Public_health_insurance_option for those missing the connection.

NHS comes across to me as government funded healthcare rather than a gov-kickstarted not-for-profit insurance option. Am I missing a nuance? Not familiar with NHS so I could have a wildly wrong impression of what it is.

Healthcare and medication are different things and as long as we continue to conflate the 2 everyone will be talking past each other.

For a market that's so large, there are very few players involved. More than likely several illegal monopolies have formed. We already have laws that are meant to address this issue. We should probably just enforce those.

Pharmaceuticals is a pretty capital intensive industry. Who's providing the capital? The government? Moreover, who's providing oversight? Congress? Given how dysfunctional the government is right now, and the tendency of government programs to turn into jobs/pork barrel programs (eg. F35), I'm skeptical that it's going to work out better.

> Pharmaceuticals is a pretty capital intensive industry.

The larger part of that is sales and marketing. They spend more on sales and marketing than research and development in USA. All that is wasted, publishing lots of manipulative ads and marketing material to get as many as possible to buy the most expensive medicines isn't a good use of our resources.

https://www.ahip.org/news/articles/new-study-in-the-midst-of...

1. The study in question is from ahip, which is a trade association of health insurance providers. They have an incentive to push the blame of high healthcare costs on other companies, so claims by them should be taken with a grain of salt.

2. The above link doesn't actually actually provide the study, or mention the methodology. However searching around[1] it looks like similar claims in the past have issues, mainly due to how expenses are categorized in financial statements. Specifically, advertising/marketing spend is often lumped together with general and administrative spend, which overstates that figure.

[1] https://skeptics.stackexchange.com/questions/16472/do-typica...

Moreover, what happens to all the work in progress when the government "shuts down"? People in publicly funded science have lost work in previous incidents where they were locked out of their buildings and unable to tend to long running experiments. America needs to work on its uptime.

As usual, the biggest factor is ignored:

        Risk

Who takes the risk of exploring a drug candidate that literally no one can predict will succeed or fail?

Let's imagine the Secretary of Drug Development testifying before Congress on why so many of his drugs didn't work. His best strategy is to only pursue safe bets.

you're not aware that government and universities provide half the funding of basic research in the united states?

I'm in agreement here, I think the poster has an idea of the issue with profits, but typically anything the government can do, we can do infinitely better private.

I.e. you want the government to run industry. That never works well.

> all audited by a dedicated regulatory body to ensure that comp and waste don't go into excess

Since when has that ever worked for government run operations?

> The hope would be that the industry doesn't actually profit off of human suffering

I.e. industry works to alleviate suffering by providing the things that suffering people want. Their motivation is to make a profit.

The profit tends to be far less than the waste from the inefficiency of government industry.

BTW, the drug industry would serve us a lot better if they weren't strangled by FDA regulations and a screwed up patent system.

See "Regulation of Pharmaceutical Innovation" by Sam Peltzman:

https://www.amazon.com/Regulation-Pharmaceutical-Innovation-...

Yeah - Europe is basically hell if you have health problems and in the US you get great, affordable and immediate treatment...

Having lived and had health issues in both, I can 100% guarantee that health care in Western Europe is much better than in the US for the average citizen. This is a fact.

I live in Europe. Just not in the nice, posh Western side that benefitted from all those cheap but well trained doctors and nurses who emigrated after their country got accepted in the EU.

Here in the East we thank God for private health care since the socialized state-run one IS basically hell as it kills people routinely.

There was a thread about Chernobyl a while back on reddit, and many survivors were commented on it (a fascinating thread). One remarked that while root canals were free, you had to pay for the anesthetic. One also had to pay bribes to the hospital staff to get things done.

> had to pay bribes to the hospital staff to get things done

This is still common. Patients are routinely ignored (and if elderly often abused) unless throwing bribes around. Countless cases of deceased friends and relatives in the media.

Absolutely no one in the Eastern block would dream to recommend state-run healthcare. It’s a deeply corrupted mafia organization.

The US system is well over 50% run by the government. Obamacare drove my insurance provider out of the state, and I'm stuck with the only one left. Thanks, Obama!

Before 1960 or so, the US health care business was free market and reasonably inexpensive. All government attempts to reduce health care costs cost cost increases.

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