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> I often hear, "we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism - we can't let 'those people' beat us. It's ugly, and if you have to stoop to that, is it really worth winning? It's no good living forever if you can't live with yourself.

I don’t think anyone’s complaining about the price due to nationalism or racism... they just want to be able to afford insulin to keep themselves alive like they’d be able to in other countries.

Not certain I succeeded, but I was trying to word it as a general comment rather than an indictment of this particular article, which does a reasonably decent job in that regard. This class of article suffers from that problem often, and something about that has always bugged me but I couldn't clearly express why.

There's a fine line between "France did X and the sky did not fall," and evoking Us-vs-Them emotions. Some people will bring that energy no matter how you state it, but let's try not to invite it in.

> they just want to be able to afford insulin to keep themselves alive like they’d be able to in other countries.

It's a silly argument to compare countries on a single issue though. Insulin is probably cheaper in Germany (I have no clue since I've never bought any), but our taxes are much higher as well. For somebody who has no money to buy insulin, that doesn't matter much, as they wouldn't pay any taxes. For most people however, that means something, as it would cut deeply into their budget.

All of these things are trade-offs, you can't view them isolated and expect to gain any insights.

Drilling down, there's a PDF: https://www.rand.org/pubs/research_reports/RRA788-1.html

Looks like for human insulin Germany is 1/12th the cost.

There's a lot of pricing theater going on in the US too. The MSRP seems to be a game of psychological anchoring the manufactures are playing with the insurance companies, who always get a discount. But that is a whole other kettle of fish.

"First, the manufacturer prices available in the MIDAS data do not reflect rebates or other discounts that might have been applied after drugs left the factory; we expect that, in many countries (and particularly in the United States), the net price paid for drugs was lower than the reported manufacturer prices shown in our results tables."

> ... but our taxes are much higher as well.

Not sure who the "our" is in your comment, but:

"So there you have it, if you are wealthy and live in California you are paying more income tax than people who live in the European Unions’ largest economy. Of course this is only one facet of the tax system. There are many others, like the value added tax of 19% in Germany, but Germany’s corporate tax rate is 15% while ours in 35%. If you live in California and are paying these high rates you can’t even take solace in the fact that you’re working less. In Germany the average work week is 35 hours with 24 paid vacation days and 10 paid holidays!"

http://bvcocpas.com/how-the-united-states-tax-rates-compares...

That quote is about a person with a million dollars in wages in the highest income tax state and it doesn't factor in payroll taxes which contribute to the tax wedge on income. The tax wedge for a single worker with no children earning the nations average wage in 2019 was 49.4% for germany and 29.8% for the united states [0]. That's not to say government provided healthcare is incompatible with lower taxes as there are other countries around the US tax wedge rate with government healthcare but germany is not a good example of that especially for the average person.

[0]: https://taxfoundation.org/publications/comparison-tax-burden...

While the numbers are from a decade or two ago: yes, I'm pretty sure the top 10% in the US pay more taxes than the average person in Germany. But that's really not a large factor for most people because they're by definition not in the top percentage of the country.

> It's a silly argument to compare countries on a single issue though.

If you can't afford to buy drugs you need to keep yourself alive, what other issues matter for you?

> Insulin is probably cheaper in Germany (I have no clue since I've never bought any)

Yeah maybe you shouldn't be making opinions out of pure ignorance of the situation at the factual and emotional level.

Your comment is a mess. You essentially "throw a rock and then hide your hands" by stating that the rest of the world has wildly different quality controls, and then you state that you aren't going to argue about it but leave that point to other readers.

>..."we should be doing better than second and third world countries, so I'll list them too", that's a dangerous gambit. You're effectively appealing to nationalism and/or racism

Not really, what we're really saying is that with our tech resources, talent, governance and supplier pipelines we should be able to do better.

It's gatekeeping regulation under the guise of "quality control". Drug companies don't want competition from the bottom, they're happy with a regulatory framework that keeps small companies from entering the market.

Insulin itself would be simple and cheap to produce, but getting through the approval process is so expensive, it wouldn't make economical sense to then sell the product near cost. Insulin isn't the mass-market product it once was, because it has fallen out of favor for Type II diabetes and Type I diabetes is relatively rare.

The way other countries get around this is price controls. They just tell the companies what drugs are allowed to cost, so profits are limited not by competition, but by fiat.

The same exact products from the same manufacturers are priced in this manner. Quality is not driving the price higher.

I don't think that's true.

There was a job opening I looked at about ten years back where the whole responsibility was writing bin packing algorithms to allocate batches of medications to countries based on the quality control guidelines of that country and the tolerances achieved in manufacturing a particular batch. [Edit] I suspect the rationale is that both products are fine, and the regulations represent overreach, so we're going to mollify them. But the banking and finance industries were complaining about overreach right up until the crash (as they have before every single crash). The money it costs you to comply also costs you your objectivity.

You might be able to overclock the hell out of an Intel processor that was binned several notches down from the top, but that depends on how good the yields were that week. It's possible you just got a slightly shittier processor.

do you really think the Eu and Canada have worse medicine? (seriously). Their stuff is probably better than the one here, as the EU does have tighter controls in substances and what is allowed during manufactoring of medicine, food processing, and beauty products.

They effectvely operate in a 'white list' basis, where a product has to be shown to be safe to be allowed, while the US operates in a 'black list' basis, where anything can be used until it is shown unsafe, and banned, which usually gets banned too late.

That's why you have so many cancerogenic products that are banned in the EU, while they are still used here in the states.

> do you really think the Eu and Canada have worse medicine?

I'm not sure where you got this impression, since I started with the opposite at the top of the thread.

I was always told we pay high prices to support research, which has been proven to be BS time and time again. The drug companies spend way more on marketing.

The capitalist market driven research only creates expensive drugs that treat wealthy people. India is coming up with a cheap paper based covid test, using governemnt backed research. Other countries are leaving us in the dust on results and research.

From my brief time in research, the team that developed the tech often gets royalties for the work that gets commercialized, which pays salaries for future projects. The University where the work was done taxes that revenue, in exchange for having provided facilities (old hand-me-down facilities may have their value considerably overstated), and so they are dis-incentivized to encourage any changes to the status quo, because there's money involved.

You'd have to break that supply chain, and I don't know if there's any easy way to do that.