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Comment by radoslawc | Hacker News Reader

I've heard multiple times that medical care in USA is pretty expansive if you don't have insurance. But I had no idea to what extent, until someone posted comments section form amazon's page for fish antibiotics. People are buying those for them self (well, still it's amoxycycline), just check any comment, most of them have something like: my 'fish' is better, $300 saved. That's just inhumane.

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I am not a doctor and don't play one on TV, but it's worth noting that the pills should actually be safe for consumption by humans (I do not encourage this.) A couple of things:

- Many fish antibiotic producers just purchase pills intended for humans, because the cost is so low. Generic amoxicillin for humans can cost less than two cents a pill. The cheapest fish antibiotics I found were $20 for 100 pills at Walmart, so the actual pills could be less than 10% of the cost of the product.

- There aren't any currently USP-certified fish antibiotics, however. As a result, there are no regulations on how they are stored. This could mean they are exposed to heat and/or moisture, which antibiotics are sensitive to. That said, given that they're stored in sealed plastic containers, they should be fine.

- The differences in the actual pills should be limited to fillers and things that do not affect the potency, in the USA. None of these should be harmful however, although they could affect taste.

Again, I don't recommend consuming fish antibiotics, and amoxicillin is actually available cheaper (with a prescription) from online pharmacies.

People also buy fish antibiotics because their doctor won't prescribe antibiotics for common colds.

Most 'common colds' are viral and not treatable with antibiotics. Circumventing the physician and using antibiotics contributes to the growing antibiotic-resistance crisis.

rightly won't prescribe

I think he was commenting on the fact that there are a lot of people self-medicating antibiotics for things they shouldn't be.

Good point, my first thought was that people are doing this from despair not stupidity. Well some of them are.

isn't that a virus?

It is, but there is a lot of confusion. Some respiratory illness invite secondary bacterial infection causing the illness to drag on. I really don't think it's a valid concern with the common cold unless someone is immunocompromised. I think the general consensus is to wait and see if it's a normal disease course or if there is a likelyhood of a secondary infection before prescribing

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481322/ - Secondary Bacterial Infections Associated with Influenza Pandemics

https://www.webmd.com/cold-and-flu/tc/flu-signs-of-bacterial...

There’s only three parts of the economy where prices have consistently outpaced inflation: education, health care (including prescription drugs) and real estate over long periods of time.

These are all sectors in which public policy subsidizes demand and restricts supply.

> education, health care (including prescription drugs) and real estate over long periods of time.

If you're talking about the housing market, the Case-Shiller index indicates that over long periods of time, the value of housing tracks inflation, it does not outpace it. (Which does not exactly help the homeowner caught riding enormous peaks and valleys in pricing, of course.)

https://en.wikipedia.org/wiki/Case-Shiller_index

The other two are interesting. It seems safe to say that as more and more technology becomes available to help people stay healthy and alive, medicine will continue to get more expensive. Or maybe medicine will essentially become an information technology where Moore's Law applies and costs will go down, as Kurzweil predicted.

Maybe education will become less expensive as credentialism collapses under its own weight and online learning becomes more prevalent. Or maybe we will need more and more education as job hopping becomes the norm and wrangling all different sorts of technology becomes the lot of pretty much everyone who wants to earn more than the universal basic income.

The Case-Shiller index doesn’t include income (real, or imputed rent), and the index doesn’t go all that far back.

When you include imputed rent, maintenance, and property taxes, it’s much less clear whether residential real estate or equities have better total returns over century timelines.

I was surprised by this, when I read abstracts of a paper about this recently, but it seems to be at least not as settled as I used to think it is.

I'd be terribly interested in a link to the paper you mentioned. I've never seen anything credible which indicated real estate was as profitable as equities over time (but I've been focused on the United States).

I'm not sure how or why Case-Shiller would involve rent or imputed rent. Are you thinking more of commercial real estate?

You might be putting too much blame on the government for the price increases. The former two, education and healthcare, are also affected by "cost disease" since they've seen little automation relative to other activities.

https://en.wikipedia.org/wiki/Baumol%27s_cost_disease

It is country-specific though. In Europe, there are a few countries with (for example) free education from primary too university level. It hasn't changed in years.

What about food stamps? FDA regulates food.

But really, those are huge sectors of the economy. It's weird to say that they can't keep pace with inflation when its the majority of a lot of pay checks. Wouldn't it be better to say wages have stagnated while the price of other goods have dropped?

About food, thanks Ricardo for making a case in 19th century that free trade of food makes for a more efficient economy.

I wonder what would be the effect if regulations where such that one could easily import and distribute medical drugs. Or the AMA would allows foreign physicians to operate within borders.

If the problem is government meddling then we would expect those things to be much more expensive in other OECD countries, where the government has a much larger role and the system is much farther from a "free market" than the US. And yet that is not the case.

You have countries while they had state monopoly over prescription drugs it was much cheaper than after deregulation. The reason for this was that medical companies was forced to reduce prices if they wanted to sell their drug in that country. They could chose from selling to a country and get a small profit.. or no profit at all. (Here the power lies with the customer)

The reason for high prices is IP. If you are in the choice of getting that expensive prescription drug that treat your hart disease or die.... you will pick the drug. No competition exist. (Here the power lies with the seller).

So to get reasonable prices you either have to remove IP or have a country wide monopoly. Else the free market rule.

I thought that real estate didn't outpace when averaged across the whole country, but specific urban areas have heavily outpaced, bringing up the average?

These are also the most impactful on the quality of life I might add.

Demand for essential healthcare services is inelastic.

> People are buying those for them self (well, still it's amoxycycline), just check any comment, most of them have something like: my 'fish' is better, $300 saved.

Where are people being charged anywhere near $300 for amoxicillin? The highest cash price I have ever seen is $16 per course. Even if you factor in the urgent Care visit to diagnose the need and get the script, and pay cash for that as well, it still comes out less.

$300? I can believe that. It is a fool's wager to ever underestimate what could be charged for the most mundane things at a hospital.

OK, two examples of how this could happen:

A few years ago I was charged $500 for a 1 meter length of IV tubing to connect a saline bag to my IV line. That was the Obamacare "negotiated price" -- it was substantially higher before this "negotiation" though I don't recall precisely, I remember thinking I don't spend that much on food for a month.

When my daughter was young, we took her to the ER due to a particularly severe sore throat. A nurse sweetly asked my daughter if she was thirsty (yes). Nurse went to the soda machine across the hall, selected a ginger ale, poured a bit of it into a small paper cup (disposing of 2/3rds of the drink) and handed it to my daughter. We got the bill a month later. Line item "Glucose - $30"

Medical care is completely, utterly broken in the USA. For those who doubt, just try asking what something will cost before it happens. I'll leave you to discover the punch line for yourself.

> $300? I can believe that. It is a fool's wager to ever underestimate what could be charged for the most mundane things at a hospital.

If that were the situation, buying them off Amazon is not an available alternative.

Amoxicillin is often free at grocery store pharmacies. This has to be an exaggeration.

https://www.goodrx.com/amoxicillin

> Amoxicillin is often free at grocery store pharmacies. This has to be an exaggeration.

You're right. IF the gatekeeper (read: primary care physician) prescribes the drugs, they are cheap or free.

Do you know how much a doctor visit is?

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EDIT: because of braindead HN throttling, responding to you tptacek

I've been there, where I didn't have $20 in my pocket, let alone $100. So have others.

I found this https://www.amazon.com/AmoxFin-500MG-50CT/dp/B077GGQH72/ref=...

"Great product with quick delivery. My fish felt better without having to go to the doctor."

"Everyone healthy now. No need to take the fish to the doctor. Male angelfish learned a good lesson and now healthy again. Great Product."

"Same pill markings as the real ones the fish doctor gives me (only 1 ingredient). Saved me a $300 visit to the fish practitioner who owns his own chain of upscale fish clinics. Who needs single payer? I have amazon PRIME, baby."

"This is exactly what the “Vet” would prescribe. The pills match the correct color and code for the right stuff needed to treat bacterial infection for “fish”."

> You're right. IF the gatekeeper (read: primary care physician) prescribes the drugs, they are cheap or free.

I've been there as well.

Physicians typically have a sliding scale options and payment plans. It is not uncommon for docs to fudge billing codes, give out copious amount of free "samples," and see patients after hours to help patients afford care. They're not all greedy gatekeepers. There are also free clinics for the uninsured.

The best thing is to have a good relationship with a PCP who will pull strings for you. Most people aren't aware what their actual options are, which is a problem that needs to be addressed. The system is broken and that also desperately needs to be addressed. But it's not a straight up binary choice between $300 vs self-treating with fish antibiotics.

$80-$100 at the Walgreens Take Care clinic, or at CVS's equivalent.

I imagine that for the kind of person who does not have health insurance $100 is a pretty substantial out-of-pocket expense.

I'm just answering the question, not making a value judgement.

There's also an app that does $99 housecalls -- heal.com

I suspect you could find "telemedicine" services that would prescribe an antibiotic for less.

I don't know, I'd say that was price with doctor's fee, or just exaggeration

That was part of my point. Even adding the full price of an office visit shouldn't get near $300, unless their idea if an "office visit" is hitting the nearest ER.

I think I had to visit the doctor three times before they prescribed me it. The first time was too early to give me anything (I've had this issue multiple times so I went in the first day I had symptoms). The second time they gave me something less potent. The third time they gave finally gave me it. That comes to around 3x75(doctor visit)+3x10(gas)=$261. I can imagine it costing more if they lived farther from a doctor.

Should add your time to the tally as well.

Plus the cost of the two rounds of drugs that were ineffective. Plus any other incidental expenses, such as OTC meds taken for symptom management because of not getting the drug needed right off the bat, takeout food due to being too sick to cook, etc.

If you don't have the $60-$100 or more to pay for the office visit or urgent care, the ER is one's only choice because they bill you later. It's all well and good to tell folks they should wait, but waiting a month to save the money isn't always an option. And waiting isn't an option if the sick one is your child, lest you get in trouble for neglect.

if I called my doctor today I would be very surprised if I could get an appointment earlier than April

You could probably get an appointment with an NP or something.

Not always - some offices are simply like that. I was shopping for a doctor once (while sick, bad idea). A couple of them couldn't get me in to see anyone in the office for 4-6 weeks. This was not a specialist.

Naturally, I chose another doctor. This is more difficult when a doctor you have seen for a while becomes this busy for whatever reason.

yeah it’s like that at my doctor; if I’m willing to see an FNP or a resident it’s still at least several weeks’ wait. so the alternative is urgent care or the ER, which both mean sinking at least half the day waiting.

In Duff McKagan's book, he says that in early Guns n Roses days, they would get fish antibiotics to treat their STDs. So this goes way back.

See https://smile.amazon.com/Its-So-Easy-other-lies-ebook/dp/B00...

I freaking hate taking antibiotics and would rather not be prescribed something if it's not needed. That 30 day course of levaquin I got stuck on a few years ago was hell (admittidely, it was needed).

A lot of people I think use them to self-treat Lyme's Disease. It's hard to diagnose (and extremely expensive to do so) and many people give up and go their own way.

That's nothing. Look at the prices for hospitalization.

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