Hacker News Reader

Comment by Fuxy | Hacker News Reader

And this is why most companies would rather treat a disease then cure it.

It has been so long since a disease has been cured that the current american system isn't designed to handle it.

I have to say the European state sponsored medicare looks way superior from this point of view.

They are not worried about the high upfront cost since every citizen is paying taxes for that.

Plus they can drive prices down since if the government buys from you you make a lot of money if it doesn't you have to sell it a lot cheaper for regular people to buy it with their own money.

It's not perfect it's open to manipulation however it's better that anything a dynamic corporate sector could offer.

View on HN

> They are not worried about the high upfront cost since every citizen is paying taxes for that.

Not only that, but that they can look very clearly at cost vs benefit. With a citizen, who is unlikely to move anywhere else, you can look at lifetime care costs and reduced earning ability (at least in the average case), and say outright that it is sensible to pay $100,000 to save many times that on a lifetime of ineffective care and reduced potential. You can also look at the public health impacts - treating one patient might reduce the risk of wider infection in society, which can also be placed in the cost-benefit analysis.

This is more difficult with American states (because people move between them much more- the payment comes from one state, but the benefit is spread out), and more difficult for insurers (because they are subject to much greater short term pressures, and can't look at wider benefits).

From the article:

“If it is cost-effective from a societal standpoint, it is not necessarily going to be cost-effective from a health plan standpoint,” said Dan Mendelson, chief executive of Avalere Health, a health care consulting company.

In the US one way to help mitigate this problem is to start shifting some of the risk from the insurance plans on to the provider networks. As mentioned people can change insurance plans frequently so investing in their health can be difficult. While they change plans frequently, the providers they see would be slower change. There are times when a change in plans will cause in change in PCPs. But that should still be less frequent then the change in insurance.

But we would need to reward provider networks for keeping people healthy, not just treating them when sick.

> This is more difficult with American states (because people move between them much more- the payment comes from one state, but the benefit is spread out)

Simple: make it federal. Scale it up until you get controlled borders.

Because the American Federal System handles health care AND borders so well. rolls eyes

As a healthy Veteran, I can say I'm glad I haven't had to dip into my benefits...

> rolls eyes

Instead of rolling your eyes, work on a solution ;-)

Are you suggesting America join the rest of the first world? Socialist! (shakes wrinkled fist)

"rather treat than cure" is falsified by the fact that if you have a cure, you corner the market, raking in cash and hurting your competitors' mere treatments.

..and that pharamceutical companies aren't run by complete monsters.

It is more profitable. That is why relatively little R&D money goes into finding cures or creating new type of antibiotics.

Pharmaceutical companies have a long history of despicable behavior.

"Pfizer Bribed Nigerian Officials in Fatal Drug Trial, Ex-Employee Claims" (http://www.cbsnews.com/news/pfizer-bribed-nigerian-officials...)

I think your first point is much stronger. People organized into large groups can behave in completely monstrous ways even if none of the individuals are monsters. It just takes widespread application of "just doing my job". The individuals often don't even realize what they're helping to perform.

What diseases have been 'cured', in a way that you can strictly say the cure targetted the disease rather than just treated the symtoms and waited for the body to deal with it.

I know we have a broad range of vaccines against once common ailments, and anti-bacterial agents but I don't think we've ever had good viral 'cures' so its not as if cures are being held back. I think the fundamental research just isn't there.

The argument here is that the response that Solvadi is receiving now is the reason why that research isn't there - if you're afraid that the market may reject your pricing it's going to be very hard to justify doing the research in the first place, because you have no idea what the final value of it will be.

the response that Solvadi is receiving now is the reason why that research isn't there

This sword cuts both ways. Implicit in your response is that it's the potential income from American medical spending that's driving the investment in research: even if (or maybe because?) the income from other nations that structure health care expenses is used more wisely, it's not sufficient incentive to induce such research.

> They are not worried about the high upfront cost since every citizen is paying taxes for that.

Well, the UK has DEATH PANELS (as some people call them) which is probably the National Institute for Health and Care Excellence (they had a name change which makes the acronym a bit weird, but their still called NICE).

So if a medication can't show efficacy and is very expensive it's not going to get NHS funding.

We used to allow people to spend their own money if they wanted to on medication. We still do - IVF has limited provision as one example - but there was a spate of drug companies releasing very expensive and not very efficacious meds. When they got turned down for NHS funding those companies paid money to patient groups to campaign for changes in the decision. (Pretty fucking sleazy - using the desperation of dying people to promote your ineffective medication) The government at the time decided to change the rules around a small number of medications. You would be able to buy those yourself, but you would then have to pay for the rest of your care too. I'm not convinced that was the right decision.

If they were going to add "health", why didn't they go for NICHE: National Institute for Care and Health Excellence?

They started as health in 1999 - National Institute for Clinical Excellence.

I meant adding H to the NICE acronym should clearly make NICHE.

Doesn't this drug actually cure Hepatitis C?

Even though there is a big upfront cost (in the US), isn't the treatment with this drug a lot less expensive than not treating someone with Hep C? So shouldn't the overall costs go down?

Reply on news.ycombinator.com