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Comment by kaikai | Hacker News Reader

This is just as true for the European systems in the comment you’re replying to as it is in the American system. The problem is political.

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The problem with the European system is that it is contingent on the American system keeping the status quo. Without high prices in the US, European governments can't negotiate for the same lower prices.

The US is a goldmine for medical corporations, which the EU gets to ride on the coat tails of.

you're suggesting that the entire difference in cost/benefit between the US and EU model is due to research and development? that seems wildly unsubstantiated. the google blurb puts it at 6% of US spending, but its unclear how much of that is actual research and how much is product development and marketing.

Not “due to” in the sense that that’s where the money directly goes, but concerns about slowing medical innovation are one of the big arguments that are raised against reform proposals in the US. In Europe, my understanding is that this is broadly not a concern and few health systems take fully incentivizing new therapies as a design criterion.

It is true for emerging technology such as drugs and devices, but doesnt figure in for most healthcare like getting a broken bone fixed or childbirth.

> Without high prices in the US, European governments can't negotiate for the same lower prices.

This sounds like total Copium. It is also remarkably anti-market, suggesting that negotiating well is actually bad.

I could invent similar argument for why it is people in the global south that deserve credit for democracy in the west. Or for anything really:

The problem with western democracy is that it is contingent on the Global south being totalitarian and penniless. Without cheap raw materials from the non-west, western governments can’t maintain the high standards of living required for a stable democracy.

> I could invent similar argument for why it is people in the global south that deserve credit for democracy in the west..

And you seem very right to me. It is much better than bullshit that some propagate like "we can all be college educated, doing a high paying IT jobs, living in nice house in nice neighborhoods and so on.."

I've heard this bunk before, that if it was not for extortionate pricing in the US, medical R&D would grind to a halt. Putting aside for the moment how inflated drug prices are only a small element of US health industry problems, let's re-examine the claim:

"If you don't pay my exorbitant fee, I will cut the part of my business that you need most.. but leave other parts alone?" - pharma spends more on marketing than R&D [1], but the propaganda never says "drug marketing is only possible thanks to high US prices", or "dividends", it's always "research".

How about this - drug R&D is only possible by high public spending on research, which is only possible because governments save money on healthcare: "Study: Public funding made up 97-99% of the R&D cost of Oxford Astra-Zeneca vaccine" - https://www.theguardian.com/science/2021/apr/15/oxfordastraz...

[1] https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...

You're cherry picking a single vaccine and failing to understand how the "D" part of R&D works. The vast majority of drug development expense comes from large scale phase-3 human clinical trials. Those now cost ~$1B each (necessary to establish safety and effectiveness) and many fail. Outside of rare circumstances like a global pandemic there is little political appetite anywhere in the world for widespread public funding of phase-3 trials. It's just never going to happen, and even if it did there's no evidence that government bureaucrats would make good decisions about which trials to fund.

Are the 9 out of 10 big pharma companies who spend more on marketing than on R&D also "cherry picked"?

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