7 ms·

The 9.2% figure is pharma's direct share of NHE, but drugs are a net-positive externality. Cheap statins can stave off cardiac surgeries, GLP-1 can stave off ba

The 9.2% figure is pharma's direct share of NHE, but drugs are a net-positive externality. Cheap statins can stave off cardiac surgeries, GLP-1 can stave off bariatric surgeries, etc. It's ridiculous to conclude we would only save 9.2% on costs--this is not zero-sum. No comment on drug pricing and its incentives, the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap.

tptacek 6mo ago
That's an interesting argument --- that massively increased access to pharmaceuticals would have knock-on impacts on other cost areas in the NHE. I think if we dig into the numbers we're likely to find those effects, even if we maximize them, are marginal, unless we do other structural things to untangle the provider pricing system and do price transparency. Like: you could posit a material impact on CVD costs by making statins more widespread, and that should make a dent somewhere, but I don't know that CVD costs in non-Medicare-insured patients are really that big a line item, and non-Medicare is important here because people already Medicare-qualified generally have all the statins they want already. Meanwhile, providers are still ripping patients (and insurers) faces off for shoulder impingements, stents, and spinal fusions. It's a super interesting comment. Thanks!
onraglanroad 6mo ago
> the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap. That's the ludicrous propaganda that you've been fed but you really should be intelligent enough to dismiss it. The world would get along just fine without you overpaying for your drugs. You pay for marketing costs.
- nine_k 6mo ago
  Mostly not marketing (still large), but the R&D costs and clinical trial costs. The latter are in hundreds of millions to billions range for the entire journey from a promising discovery to an FDA-approved medicine.
  - standardUser 6mo ago
    Right, but the idea that Americans specifically should pay higher prices is beyond propaganda. It's Stockholm Syndrome-level delusion. Big Pharm has thrived for generations on our research universities (for the time being anyway) and had a front row seat to expanding foreign markets under US-led globalization. In return, we get the world's most expensive healthcare system and the privilege of paying too much for meds because our leaders won't cut a deal. All they have to lose is the "hundreds of millions to billions range" in annual lobbying expenditures by Big Pharma. In a sane world - or literally any other country - that $300-$500 million in annual lobbying would be the literal difference that makes medicine accessible for those who need it. Instead, it goes to expensive lunches.
  - thrwaway55 6mo ago
    Why not just research it outside of the US if the problem is the FDA cost
    - phyzix5761 6mo ago
      You still need the same FDA approval and process to sell it in the US
      - thrwaway55 6mo ago
        Cost cut them. You think the administration won't take a bribe at that point?
    - estearum 6mo ago
      Because the problem isn't the FDA cost The problem is proving your drugs work It's very hard and expensive to do
  - dv_dt 6mo ago
    Every time Ive looked into it marketing is more than half of the costs of US pharma companies - and I would suspect even more as don't know if there has much work to unmask even more of that spending via channels that can occur in ways not obviously marked as marketing or at least are really not core to research and manufacturing. e.g. is all the "discount coupon" pharmacy rigamarole considered marketing or administration.
- mlmonkey 6mo ago
  Agreed. I mean, where did the COVID mRNA vaccine come from? Which company makes the GLP-1 inhibitors like Ozempic and Mounjaro? Are these American companies?
  - phil21 6mo ago
    Mounjaro and the next generation of soon-to-be best in class GLP-1 (Retatrutide) are Ely Lilly based out of the US. Novo makes Ozempic, and is out of Denmark. The mRNA stuff is a bit more murky, depends on how you squint. Best assignment there would be a split between the US and Germany I suppose?

tptacek 6mo ago

That's an interesting argument --- that massively increased access to pharmaceuticals would have knock-on impacts on other cost areas in the NHE. I think if we dig into the numbers we're likely to find those effects, even if we maximize them, are marginal, unless we do other structural things to untangle the provider pricing system and do price transparency. Like: you could posit a material impact on CVD costs by making statins more widespread, and that should make a dent somewhere, but I don't know that CVD costs in non-Medicare-insured patients are really that big a line item, and non-Medicare is important here because people already Medicare-qualified generally have all the statins they want already. Meanwhile, providers are still ripping patients (and insurers) faces off for shoulder impingements, stents, and spinal fusions. It's a super interesting comment. Thanks!

onraglanroad 6mo ago

> the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap. That's the ludicrous propaganda that you've been fed but you really should be intelligent enough to dismiss it. The world would get along just fine without you overpaying for your drugs. You pay for marketing costs.

nine_k 6mo ago
Mostly not marketing (still large), but the R&D costs and clinical trial costs. The latter are in hundreds of millions to billions range for the entire journey from a promising discovery to an FDA-approved medicine.
- standardUser 6mo ago
  Right, but the idea that Americans specifically should pay higher prices is beyond propaganda. It's Stockholm Syndrome-level delusion. Big Pharm has thrived for generations on our research universities (for the time being anyway) and had a front row seat to expanding foreign markets under US-led globalization. In return, we get the world's most expensive healthcare system and the privilege of paying too much for meds because our leaders won't cut a deal. All they have to lose is the "hundreds of millions to billions range" in annual lobbying expenditures by Big Pharma. In a sane world - or literally any other country - that $300-$500 million in annual lobbying would be the literal difference that makes medicine accessible for those who need it. Instead, it goes to expensive lunches.
- thrwaway55 6mo ago
  Why not just research it outside of the US if the problem is the FDA cost
  - phyzix5761 6mo ago
    You still need the same FDA approval and process to sell it in the US
    - thrwaway55 6mo ago
      Cost cut them. You think the administration won't take a bribe at that point?
  - estearum 6mo ago
    Because the problem isn't the FDA cost The problem is proving your drugs work It's very hard and expensive to do
- dv_dt 6mo ago
  Every time Ive looked into it marketing is more than half of the costs of US pharma companies - and I would suspect even more as don't know if there has much work to unmask even more of that spending via channels that can occur in ways not obviously marked as marketing or at least are really not core to research and manufacturing. e.g. is all the "discount coupon" pharmacy rigamarole considered marketing or administration.
mlmonkey 6mo ago
Agreed. I mean, where did the COVID mRNA vaccine come from? Which company makes the GLP-1 inhibitors like Ozempic and Mounjaro? Are these American companies?
- phil21 6mo ago
  Mounjaro and the next generation of soon-to-be best in class GLP-1 (Retatrutide) are Ely Lilly based out of the US. Novo makes Ozempic, and is out of Denmark. The mRNA stuff is a bit more murky, depends on how you squint. Best assignment there would be a split between the US and Germany I suppose?