Comment by kurthr | Hacker News Reader

Comment by kurthr | Hacker News Reader

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Your response to:

    >Was it 'unprofitable' as in 'losing money', or 'unprofitable' as in 'not worth 
   the time'?

was:

   >If you can make more money by not doing X, than doing X, it doesnt matter.

It's confusing, because you certainly seem to imply only doing the most profitable things.

   >The purpose that they serve is to save your life with drugs. If that doesn't mean anything to you and isn't worth any money then I don't think we will find much common ground.

My point was that if their purpose is only to do the things that make marginally more money (while killing significant numbers of people or allowing them to die) such as the Sacklers and Purdue with Oxy, they deserve to be regulated into oblivion. If you think the heavy marketing and distribution of known addictive drugs into disadvantaged areas of the country is in the public interest, then I don't think we will find much common ground.

Frankly, most doctors, biochemists, and pharma-chemists I know have little difficulty seeing this. It is about helping people not just making money, and doing otherwise while selling it as the former, is unethical.

>It's confusing, because you certainly seem to imply only doing the most profitable things.

I thought I was clear, but I will try again. The financial calculus is the same between "losing money" and "not worth it". It doesnt matter if the J&J division of communicable disease is running a positive or negative balance if J&J (or its owners) can more doing something entirely different. The question is do we want to be losing money on this. That is not to say they can't or shouldnt keep doing it as a public service or out of altruism, but the question is the same.

>My point was that if their purpose is only to do the things that make marginally more money.

I dont think that is a valid assumption to make about the industry. 99.9% of the time, the way to make more money is to make a product that saves or cures more people. If your product saves fewer people, People would by the old thing instead of the new thing for 2x the price.

Now, everyone is free to say they dont like the price, which is fair. However, the price is high because rich American customers dont care about the price. IF they did, they could always buy the cheap old thing.

It is like someone who is angry at the butcher for the price of filet minion, but keeps paying ever higher prices, and refuses to buy the tri-tip.

Europeans prices are half the US simply because they stop buying filet minion and get tri-tip when the price gets too high. US prices are twice that because we pay it!

It is crazy to blame the butcher for raising the price when you willingly keep throwing more money at ever higher prices!

No industry anywhere in the world expects the seller to keep prices low when customers keep throwing money at them.

The fundamental problem with US healthcare costs is that not one party in the system is willing to control spending. Nobody will say no to a treatment 1% better for 200% the cost.

Patients will pay anything for the latest drug because they want it, and the costs get spread over everyone's premium. Insurance is happy to see medical costs balloon because their profit is capped as a % of healthcare costs. manufacturers are happy to see costs go up, because that's what they are selling.

> Now, everyone is free to say they dont like the price, which is fair. However, the price is high because rich American customers dont care about the price. IF they did, they could always buy the cheap old thing.

I'm sure Americans that were rationing out their insulin would love to hear more about how they "don't care about the price" and you comparing their need for life-saving drugs to simply choosing to keep buying filet minion over cheaper beef cuts.

That simply isn't the typical American experience. 92% of Americans have health insurance. Even without insurance, Walmart and Amazon sell basic insulin for $25 and $30 for a months supply.

Everyone in America who makes <138% the poverty level qualifies for free insurance.

> Everyone in America who makes <138% the poverty level qualifies for free insurance.

qualifies is kind of a weasel word though, "in theory they qualify, in practice ..."

I'm guessing this is the US Medicaid system that recently

    dropped enrollment by more than 11 million people in the past year, including 4.8 million children, the vast majority of whom were kicked off their healthcare for surprise procedural issues.

https://www.theguardian.com/tv-and-radio/2024/apr/15/john-ol...

Admittedly that's the UK Guardian reporting on John Oliver which is indeed an auto nope for some, but the issues highlighted here seem real.

Indeed, I read the article which was utterly uninformative about what is going on.

Can you explain it?

As I understand it, Medicaid has waived all ongoing requirements for coverage due the pandemic, and people are now required to verify they still qualify. People who make too much will and do not qualify for Medicaid now need to purchase subsidized insurance on one of the markets.

Of course the article does noting to explain what "surprise procedural issues" means. IT seems that the word surprise is an entirely editorial insertion. Based on KFF reporting, it seems that it just means anyone who didnt complete the renewal processes. This includes those that no longer qualify and therefore did not complete complete the renewal process. Of course there is valid concern that some of these people may still qualify and did not complete the paperwork, but it completely unclear how many that is. It could be 0.1% of the 11 million or 99%.

https://www.kff.org/report-section/medicaid-enrollment-and-u...

I'm both in and from Australia and no expert on the US public health system.

My only point of reference is ~4 decades of usenet and web forums routinely having mention of people (in the USofA) being bankrupted by medical incidents (heart attacks, car accidents, sporting injuries, non elective surgeries, etc) that here and in the UK are relatively mundane affairs.

I struggle to fathom a country where there is a need to "renew" health coverage .. here we have 'adequate' and 'private' and essentially everybody has adequate as a fallback with no need to tie basic health coverage to an employment package that is lost when someone fires|quits.

Each to their own, here the ideals of good health and sufficient basic wage have been tied in to social contract since Federation.

To be clear, I'm not a defender of the US system. I vehemently hate it. Im just explaining why costs are so high.

It is high because of the system structure and the fact that most people are willing to tolerate.

I'm pushing back on the moronic idea that prices are high because drug companies are too “greedy“ in the US, but the same exact company is mysteriously less greedy in the EU or AUS. The difference is that insurance in those places negotiate a lower price, so they get one!

Insurance companies in the US operate on a cost plus basis, so they want prices as high as possible.

Medical bankruptcies do happen in the US, at a rate of about 1 per 1,000 people per year.

There seems to be a big problem with the systems not having the capacity to complete the renewal process.

There was no checking for a while thus little need for resources needed for checking (there was still some because people still came into the system.) Now there's a big demand for renewal checking and it's working on a basis of dropping people if they don't complete it even if the problem is on the state's end. And, yes, it's completely unclear how many--because the red states want these failures, they're not keeping track.

It's the usual garbage of putting roadblocks in the way of benefits to keep down the amount paid out.

What do you mean by systems not having the capacity? Are there any many problems on the state side?

I'm new to the issue so I assume it is 99% individuals failing to respond

No, a lot of it is individuals responding and their responses not being processed. They have to prove they are eligible, if that proof isn't processed they are dropped.

Look at the reports of huge backlogs with the IRS. What would happen if they automatically started prosecuting you for failure to file as of June 1st?

> 99.9% of the time, the way to make more money is to make a product that saves or cures more people.

That is laughably optimistic.

so you think newer more expensive products are usually worse?

Did I say that? Putting words in people's mouths is a juvenile debate tactic.

I do think that newer more expensive products provide worse patient outcomes at rates significantly higher than 1 / 1000 times.

However, the comment I objected is discussing "ways to make money" as a pharmacutical company. Which is a generalization that is laughably naive at best. We have plenty of examples of drug companies trying to make money in ways that harm patients from how they fostered the opiod epidemic.

I don't think it is naive, and it matches my experience. It is very rare for a company to try to develop an inferior product for many reasons, but most of all it is impractical.

Without superiority, it you will struggle with investors, trials, approval,and then convincing doctors to to switch to it.

Everyone can come up with an example, and point to per due, but the FDA processes 10s of thousands of device and drug submissions per year. Most are in cutthroat markets with competitors.

If we are talking about individual company actions or statements, and not products, then the numbers are even worse. There are literally millions of actions associated with a product, and I would again argue that >99.9 are made in the favor of patient interest.

Making a inferior product and scamming your way to profit is an exceedingly rare strategy because it is both extremely difficult execute successfully.

I think it is clear that new product development doesn't prioritize optimal patient benefit, but that is a different topic. It needs to be good enough to sell, then it becomes a question of how good vs how much money.

> There are literally millions of actions associated with a product, and I would again argue that >99.9 are made in the favor of patient interest.

That isn't even true at non-profits, let alone for profit companies. You seem to have no idea how the world works.

> 99.9% of the time, the way to make more money is to make a product that saves or cures more people. If your product saves fewer people, People would by the old thing instead of the new thing for 2x the price.

This is a naive statement.

Viagra made a ton of money, while only benefitting a slice of a slice of humanity. It doesn't save lives, it helps some people get erections.

Compare and contrast to real, widespread diseases that affect millions, and are risk factors for billions, but require public research dollars because the pharmaceutical industry doesn't see enough profit compared to a new erectile dysfunction or baldness treatment.

That's not an industry working to the public's benefit. That's an industry working to old white men's benefit. It's helping itself and to hell with anyone else.

Sexual dysfunction is a real, widespread disease.

With that said, Viagra was initially developed for high blood pressure and chest pain. Testing didn’t pan out but it worked wonders for erections so it was rebranded. It is also used in pulmonary hypertension.

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