8 ms·

The EU also has regulations, but somehow it does not make insulin as expensive as in the US. Maybe the existence of a regulation is not the issue here.

0xDEAFBEAD 10mo ago
I'm not against the existence of regulation, nor is the OP. I'm against bad regulation. The US healthcare system is a gigantic regulatory morass.
- mexicocitinluez 10mo ago
  Explain how the "gigantic regulatory morass" led to higher insulin costs?
  - inglor_cz 10mo ago
    Government capture by big players who promote heavy regulation in order to eliminate smaller competition?
    - AnimalMuppet 10mo ago
      I worked for a large company that did devices used in surgery. They regarded FDA regulation as a moat that kept out all but large, established competitors. Note that I am not saying that they tried to push (or worse, capture) regulators to achieve that end. I'm just saying that they didn't mind.
    - mexicocitinluez 10mo ago
      > Government capture by big players who promote heavy regulation in order to eliminate smaller competition? This is a meaningless statement without specifics. It has absolutely nothing concrete in it that would actually inform someone about what drives insulin production. It's a wrong and overly simplifies. Are you really saying the regulations regarding the actual production of insulin is what drives up costs? We've been manufacturing insulin for > 100 years now. And can you find a single resource that agrees with your assessment? When you say "big players", you mean the top 3 right? Would regulating monopolies in the pharmaceutical industry maybe be a good thing? Why do other counties pay less if it costs so much to make? Why does regulation in the US make US consumers pay more but not Europe, for example? Do you think PBM's have any part to play in this? What about over-zealous patents by the monopoly at the top? Do you have any actual experience in this field or are you just parroting talking points?
  - 0xDEAFBEAD 10mo ago
    I don't think there is a simple explanation, that's why I used the word "morass". "From when insulin is produced by the drug manufacturer to when it goes to a pharmacy, profit is extracted at every step of the way. The insulin market is dominated by three large drug manufacturers—Eli Lilly, Sanofi, and Novo Nordisk—that, with little competition, have raised their list prices in lockstep. But there are other players besides the Big Three that are contributing to the problem. Pharmacy benefit managers, or PBMs, contract with insurance carriers and act on behalf of the insurer to negotiate the price of insulin with the drug manufacturers. In negotiating the price, PBMs place a drug higher or lower on their tier of preferred drugs and receive rebates based on a percentage of the list price. This kind of system incentivizes high list prices, which determine the amount of co-insurance patients pay. And if patients have a high deductible or are uninsured, they might pay the entire list price." https://medicine.yale.edu/news-article/the-price-of-insulin-a-qanda-with-kasia-lipska/ https://medicine.yale.edu/news-article/the-price-of-insulin-... My position is simply that it is better to solve problems by taking regulations away than piling them on.
    - mexicocitinluez 10mo ago
      lol did you actually read the quoted text? Because 0% of it backs up your argument
      - 0xDEAFBEAD 10mo ago
        Low regulation means almost anyone can make it, almost anyone can sell it, almost anyone can buy it.
purple_turtle 10mo ago
Existence of specific bad US regulation and overregulation caused this. Bad EU regulations and overregulation caused other problems. For example it is illegal for me to throw old socks full of holes into trash, I am supposed to take it to recycling centre on other side of the city.
- tumdum_ 10mo ago
  Oh yeah, because in the absence of regulation, the insulin producer would sell it at negligible margins, sure! As for the socks - my city has like ~5 locations where old textiles can be recycled, the closest one in slightly less than 1km from where I live. I see no problem with going there twice a year :)
  - Gabrys1 10mo ago
    With lack of regulations, the theory is, there will be many competing manufacturers of insulin, dropping the cost down. Probably not as simple as that, but that's the idea at least
    - cons0le 10mo ago
      Absolutely. With no regulations I could produce/sell it for super cheap. Because I would be cutting it with tap water, and using forced labor
      - sophrosyne42 10mo ago
        Preventing forced labor is a feature of normal contract law and property rights, and has little to do with regulations.
        LinXitoW 10mo ago
        Now, that's all just regulations. What are regulations but laws that restrict/govern the way to do commerce? Anti-slavery is part of that, just like every other concession we've had to pry from the hands of capitalists over the last 100 years, like no child labor, no locking workers into factories, PPE, etc...
u_sama 10mo ago
Yeah but EU regulation makes other things expensive and inefficient (like the labour market, housing, building new companies because incumbents protect their interests trhough regulation). The fact is that with insulin the regulation issues comes from the patchwork system of healthcare the US developped through political concesssionns and lobbying from private firms, which makes the developpment and the subsequent commercialization expensive relative to Europe where centralized national bodies negotiate with the pharma companies. Regulation can be good or bad, in our era it is ineffective because politicians are boomers disconnected from the issues or in the EU a pseudo-technocratic (not really listening to technocrats recommendations) body far from reality This series of posts is a nice forray into managerialism (the source of many regulation issues) https://baazaa.github.io/2024/10/16/managers_p1.html https://baazaa.github.io/2024/10/16/managers_p1.html
- general1465 10mo ago
  > EU regulation makes other things expensive and inefficient (like the labour market, housing, Unlike the US, where federal minimal wage remained flat since 2009 or where Black Rock is buying all available housing to keep the prices as high as possible.
  - 0xDEAFBEAD 10mo ago
    US median wages are higher than most of Europe, especially when adjusted for cost of living: https://ourworldindata.org/grapher/median-income-after-tax-lis https://ourworldindata.org/grapher/median-income-after-tax-l... Regarding BlackRock, I'm disappointed to see what appears to be populist misinformation on HN: https://www.investopedia.com/no-blackrock-isnt-buying-all-the-houses-heres-whats-really-driving-up-your-rent-11811479 https://www.investopedia.com/no-blackrock-isnt-buying-all-th...
  - u_sama 10mo ago
    The real minimum wage is also stuck in many parts of Europe relative to 2008. For example in Spain the average salary didnt increase adusted to inflation. The blackrock thing seems like a myth, but private entities are also buying housing en masse in Spain for exammple
tim333 10mo ago
Website here has the cost of a vial of insulin as $99 USA, $3 Turkey. They could just let people buy it from any regulated country? https://www.visualcapitalist.com/cost-of-insulin-by-country/ https://www.visualcapitalist.com/cost-of-insulin-by-country/ Not sure how the US consumer benefits from being banned from having such choices?

0xDEAFBEAD 10mo ago

I'm not against the existence of regulation, nor is the OP. I'm against bad regulation. The US healthcare system is a gigantic regulatory morass.

mexicocitinluez 10mo ago
Explain how the "gigantic regulatory morass" led to higher insulin costs?
- inglor_cz 10mo ago
  Government capture by big players who promote heavy regulation in order to eliminate smaller competition?
  - AnimalMuppet 10mo ago
    I worked for a large company that did devices used in surgery. They regarded FDA regulation as a moat that kept out all but large, established competitors. Note that I am not saying that they tried to push (or worse, capture) regulators to achieve that end. I'm just saying that they didn't mind.
  - mexicocitinluez 10mo ago
    > Government capture by big players who promote heavy regulation in order to eliminate smaller competition? This is a meaningless statement without specifics. It has absolutely nothing concrete in it that would actually inform someone about what drives insulin production. It's a wrong and overly simplifies. Are you really saying the regulations regarding the actual production of insulin is what drives up costs? We've been manufacturing insulin for > 100 years now. And can you find a single resource that agrees with your assessment? When you say "big players", you mean the top 3 right? Would regulating monopolies in the pharmaceutical industry maybe be a good thing? Why do other counties pay less if it costs so much to make? Why does regulation in the US make US consumers pay more but not Europe, for example? Do you think PBM's have any part to play in this? What about over-zealous patents by the monopoly at the top? Do you have any actual experience in this field or are you just parroting talking points?
- 0xDEAFBEAD 10mo ago
  I don't think there is a simple explanation, that's why I used the word "morass". "From when insulin is produced by the drug manufacturer to when it goes to a pharmacy, profit is extracted at every step of the way. The insulin market is dominated by three large drug manufacturers—Eli Lilly, Sanofi, and Novo Nordisk—that, with little competition, have raised their list prices in lockstep. But there are other players besides the Big Three that are contributing to the problem. Pharmacy benefit managers, or PBMs, contract with insurance carriers and act on behalf of the insurer to negotiate the price of insulin with the drug manufacturers. In negotiating the price, PBMs place a drug higher or lower on their tier of preferred drugs and receive rebates based on a percentage of the list price. This kind of system incentivizes high list prices, which determine the amount of co-insurance patients pay. And if patients have a high deductible or are uninsured, they might pay the entire list price." https://medicine.yale.edu/news-article/the-price-of-insulin-a-qanda-with-kasia-lipska/ https://medicine.yale.edu/news-article/the-price-of-insulin-... My position is simply that it is better to solve problems by taking regulations away than piling them on.
  - mexicocitinluez 10mo ago
    lol did you actually read the quoted text? Because 0% of it backs up your argument
    - 0xDEAFBEAD 10mo ago
      Low regulation means almost anyone can make it, almost anyone can sell it, almost anyone can buy it.

purple_turtle 10mo ago

Existence of specific bad US regulation and overregulation caused this. Bad EU regulations and overregulation caused other problems. For example it is illegal for me to throw old socks full of holes into trash, I am supposed to take it to recycling centre on other side of the city.

tumdum_ 10mo ago
Oh yeah, because in the absence of regulation, the insulin producer would sell it at negligible margins, sure! As for the socks - my city has like ~5 locations where old textiles can be recycled, the closest one in slightly less than 1km from where I live. I see no problem with going there twice a year :)
- Gabrys1 10mo ago
  With lack of regulations, the theory is, there will be many competing manufacturers of insulin, dropping the cost down. Probably not as simple as that, but that's the idea at least
  - cons0le 10mo ago
    Absolutely. With no regulations I could produce/sell it for super cheap. Because I would be cutting it with tap water, and using forced labor
    - sophrosyne42 10mo ago
      Preventing forced labor is a feature of normal contract law and property rights, and has little to do with regulations.
      - LinXitoW 10mo ago
        Now, that's all just regulations. What are regulations but laws that restrict/govern the way to do commerce? Anti-slavery is part of that, just like every other concession we've had to pry from the hands of capitalists over the last 100 years, like no child labor, no locking workers into factories, PPE, etc...

u_sama 10mo ago

Yeah but EU regulation makes other things expensive and inefficient (like the labour market, housing, building new companies because incumbents protect their interests trhough regulation). The fact is that with insulin the regulation issues comes from the patchwork system of healthcare the US developped through political concesssionns and lobbying from private firms, which makes the developpment and the subsequent commercialization expensive relative to Europe where centralized national bodies negotiate with the pharma companies. Regulation can be good or bad, in our era it is ineffective because politicians are boomers disconnected from the issues or in the EU a pseudo-technocratic (not really listening to technocrats recommendations) body far from reality This series of posts is a nice forray into managerialism (the source of many regulation issues) https://baazaa.github.io/2024/10/16/managers_p1.html https://baazaa.github.io/2024/10/16/managers_p1.html

general1465 10mo ago
> EU regulation makes other things expensive and inefficient (like the labour market, housing, Unlike the US, where federal minimal wage remained flat since 2009 or where Black Rock is buying all available housing to keep the prices as high as possible.
- 0xDEAFBEAD 10mo ago
  US median wages are higher than most of Europe, especially when adjusted for cost of living: https://ourworldindata.org/grapher/median-income-after-tax-lis https://ourworldindata.org/grapher/median-income-after-tax-l... Regarding BlackRock, I'm disappointed to see what appears to be populist misinformation on HN: https://www.investopedia.com/no-blackrock-isnt-buying-all-the-houses-heres-whats-really-driving-up-your-rent-11811479 https://www.investopedia.com/no-blackrock-isnt-buying-all-th...
- u_sama 10mo ago
  The real minimum wage is also stuck in many parts of Europe relative to 2008. For example in Spain the average salary didnt increase adusted to inflation. The blackrock thing seems like a myth, but private entities are also buying housing en masse in Spain for exammple

tim333 10mo ago

Website here has the cost of a vial of insulin as $99 USA, $3 Turkey. They could just let people buy it from any regulated country? https://www.visualcapitalist.com/cost-of-insulin-by-country/ https://www.visualcapitalist.com/cost-of-insulin-by-country/ Not sure how the US consumer benefits from being banned from having such choices?