[zaroth]

So Nordic patients are paying less for the same treatments, and/or getting less aggressive care. (I don't know which or how much of both)

To the extent Norway pays less for the same drugs/treatments, they are funding a smaller share of the profits of biotech & pharmaceutical companies.

The US pays a significantly higher share of pharma/biotech profits than any other country (citation needed). We therefore contribute the most to the new research, new drugs and treatments developed by those same firms. I actually think this is one of the greatest things we do as a country.

Some people call this "overpaying" but I think of it differently.

[kbenson]

Even if this is true, it's a horrible way to fund the companies. If we want the US to fund drug companies, we sould do it through some sort of progressive tax, not through a raised cost in base level care, which affects everyone, and when it gets high enough effectively means poor people can't pay, and the middle class feels it as a large burden.

$3000 or more a year in healthcare costs is not felt the same by someone that makes $50k a year as someone who makes $150k a year. And that's for an individual. Many people are trying to cover a whole family at these rates.

[zaroth]

But that's not how people actually pay for care... Insurance cost, copays, and deductibles are all set based on household income. In Medicaid Expansion states, if you make less than FPL and you pay literally nothing - it's the best insurance money can't buy. As you make more the subsidies taper off and you pay more in premiums and more in OOP costs. The cost is absolutely socialized through progressive taxation.

On the supply side, the price of care is set roughly in the market's ability to compete, but the price is absolutely back stopped by government policies like patents and Medicare reimbursement rates.

Take an inside look at how these firms bring new treatments to market and you know it's intensely competitive. The level of investment is commensurate to the potential payoff.

[kbenson]

> Insurance cost, copays, and deductibles are all set based on household income.

Isn't it more accurate to say discounts to these are all set based on household income? At a certain point, you're paying regular plan costs. All this amounts to is a separate way to tax people for the costs, which means it can use a different schedule than the regular tax code. If the US is funding these companies, there should be a better way to do so that the craziness that is this.

> Take an inside look at how these firms bring new treatments to market and you know it's intensely competitive. The level of investment is commensurate to the potential payoff.

I've yet to be convinced that the massive cost of R&D due to trials and marketing which needs to be recouped by massive prices isn't at least in part the result of a runaway feedback loop. We require lots of testing to protect the populace which necessitates a lot of money to develop the drugs which means that if it's a dud or has negative effects it's in the interest of the company to occasionally cover that up because it cost so much which leads to drugs on the market that cause problems which leads to more stringent testing which leads to increased cost which leads to increased need for success which leads to....

We need to drastically decrease the cost of trials while making the cost of taking a bad drug to the general market more. That's a tall order, but it's what's needed.

[zaroth]

Medicine is really fucking expensive. If you can solve this problem without increasing patient risk you make a dent in the universe.

Or a corollary, the amount of money the market would pay for cheaper methods of safe drug development is immense. Market, meet unsolved problem.

[kbenson]

This is one of those situations where we want the market to solve it, but we probably aren't prepared for what a totally unencumbered market response would be. We've likely over (or at least poorly) regulated drug development, and since most things are cyclical, it will probably swing the other way at some point. That's probably good, as long as it doesn't swing too far. I want a more efficient system, but not necessarily at the expense of a few million casualties from cascading mistakes.

Unfortunately, since it has to do with people being hurt, or the possibility of people being hurt, I think it's unlikely we'll get legislation or a majority of politicians that are willing to look at it rationally. It's too easy to drum up emotional support for some aspect or another for personal gain.