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Comment by gojomo | Hacker News Reader

It's a good idea... and also already a big thing. Look at all the AdWords for [dental vacation] and similar searches. Amish groups taking train rides to Mexico for dental work paid in cash is also apparently a thing.

It could be much bigger, across more procedures... but often people needing care are, by virtue of both age and their current medical worries (and past experiences with bad providers), less adventurous.

A big breakthrough would be if Congress, as a cost-saving measure, allowed Medicare payments for out-of-country treatment.

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"A big breakthrough would be if Congress, as a cost-saving measure, allowed Medicare payments for out-of-country treatment."

If Congress cared about saving money when it comes to Medicare they wouldn't have passed Medicare Part D, which by design doesn't allow for the negotiation of lower drug prices with pharmaceutical companies like the Department of Vererans Affairs is allowed to do. The fact of the matter is that a lot of palms are getting greased in Washington when it comes to healthcare. Thus why Obamacare doesn't have a public option.

http://en.wikipedia.org/wiki/Medicare_Part_D

Precisely. I worked a little bit for a large pharma company (in a finance capacity) and I saw first hand how incredibly profitable it is for the US government to not have negotiating power on drug prices.

Pharma companies make a wildly disproportionate share of their global profits in the US simply because they don't have to negotiate with a large 'super-buyer" (e.g. medicare).

Now if pharma R&D were productive I wouldn't have a problem with this, but it's notoriously unproductive (and not just because of the admittedly overly burdensome FDA regulations).

I would support a grand compromise: 1) for pharma companies: reduce FDA hurdles for drug approval, but add more aggressive post-approval tracking (to reduce the risks associated with a lower regulatory hurdle) 2) for the rest of us: allow medicare to negotiate aggressively on price, this will have a ripple effect and lead to lower drug prices for all.

It's not accurate to say the gov't doesn't use it's bargaining power to get lower priced drugs. You are correct that it doesn't negotiate lower prices like the DoD does (through an RFP and bid system), however it does:

1. force drug makers to match the lowest price that it offers to anyone else. In other words Medicare gets the same (or lower) price as big insurers like United.

2. force drug manufacturers to discount the cost of drugs for Medicare Part-D once the patient enters the donut hole. Over the next 5 years that discount will increase to 50% of the cost incurred within the donut hole (this will total several billions per year)

3. for Medicaid, force the drug manufacturers to provide a 23.1% discount off the WAC (wholesale price) OR the lowest price offered to anyone else (whichever is lower)

4. for disproportionate share hospitals (hospitals that serve the uninsured), force drug companies to provide the Medicaid discount (at least 23.1%) to those hospitals for all the drugs they buy, whether or not they go to the uninsured

5. if the drug company increases the cost of its drug at a rate greater than the rate of inflation (CPI), they have to pay CPI penalties each year. There are some drugs that Medicaid gets a 90% discount on (far lower than any insurance company could get)

So yes, you are correct that federal gov't doesn't directly negotiate individual drug prices, but it sure as heck uses it bargaining power to get some super sweet deals!

"A big breakthrough would be if Congress, as a cost-saving measure, allowed Medicare payments for out-of-country treatment."

They would never do it. The amount of fraud in Medicare is astounding because the gov't doesn't use a lot of resources to verify claims. Can you imagine what would happen if the services were provided outside of the US? You probably couldn't even sue the provider to recover money from fraudulent claims.

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