[bernierocks]

The dirty secret is that for profit healthcare runs the rest of the world. The majority of new drugs are created in the US and nations that have government-run healthcare create generics by ripping off/taking the IP and creating cheap alternatives. This is the only reason drugs are cheaper in other parts of the world.

The R&D, which costs millions (and sometimes billions) still needs to be paid for by someone..and the government just isn't efficient enough to do this effectively and within a decent time frame.

The problem isn't for-profit healthcare. The problem is the insurance companies. They create an un-needed middleman that inflates the cost of everything. A better alternative would be to get rid of insurance for most things, allow doctors and hospitals to charge directly to consumers (which would bring the costs way down).

Surgeries would also come down in cost because of competition. The ones that don't come down are most likely because they are rare and have little competition. These can be covered under insurance.

[Daishiman]

> The majority of new drugs are created in the US and nations that have government-run healthcare create generics by ripping off/taking the IP and creating cheap alternatives. This is the only reason drugs are cheaper in other parts of the world.

So all those Swiss, German and French pharmaceutical companies are a figment of my imagination then.

[malandrew]

I've had this debate on HN many times before. Look at every WHO essential medicine developed in the 21st century. All but one was developed in the US. The only one that wasn't was developed in Japan. That's just pharmaceuticals. The same plays out with other innovations in medical treatment such as medical textiles used in vascular implants or even wound care dressings as simple as Tegaderm from 3M.

https://en.wikipedia.org/wiki/List_of_drugs_by_year_of_disco...

[Daishiman]

I'm not even sure if you even read that list, given that it has tons of medicines that were discovered by researchers working for Roche, Sanofi, Chugai, and GlaxoSmithKline.

And the information on the pharmaceuticals involved fails to mention the feeder research that comes from universities in Cambridge, Zurich, London, Tokyo, etc. Most of this had gigantic participation of state research institutions, and if you look at the American pharma companies, almost all are based and house most of their research efforts in the state of New York and New Jersey, Massachussets, and the Bay Area, to the exclusion of pretty much everywhere else.

That makes for a great case of the utility of the well-funded research universities in forming staff for pharma, but it's not exactly a proof that any particular model of funding for pharma works better than others.

It's also interesting to note that most of these pharmaceuticals target and _incredibly small_ number of people worldwide at outrageous costs. Not to take merit away from the huge research efforts, but honestly it just shows where profit-driven research efforts go instead of rational, nation-wide public health initiatives that are objectively far better at increasing quality of life for entire populations.

[malandrew]

> I'm not even sure if you even read that list > Roche, Sanofi, Chugai, and GlaxoSmithKline

Yes, at their US research labs. Most of these companies do a lot of their research in the US these days and continue to move more R&D to the US. If it's developed in the US by individuals working in the US because the opportunities are in the US, that makes it a US-developed drug. I went through each and every WHO essential medicines drug developed since 2000 and verified where each was developed.

> It's also interesting to note that most of these pharmaceuticals target and _incredibly small_ number of people worldwide at outrageous costs.

As someone that uses an orphan drug developed in the US to improve my quality of life, I'm glad. Do you want to take that option away from me and others like me?

[Daishiman]

> As someone that uses an orphan drug developed in the US to improve my quality of life, I'm glad. Do you want to take that option away from me and others like me?

I don't believe that medicine is a zero-sum game, but I _really_ wonder if a country where thousands of people die from not being able to afford relatively accessible medication is spending its money wisely.

[malandrew]

For what it is worth. I've been taking this medicine for the last 2 decades. It was only recently made available in Canada and Italy. It's available in no other countries.

It's not zero sum, but there absolutely are tradeoffs and everyone championing the national healthcare model used in countries like Canada and those in Europe are being willfully blind to the collateral damage to US-developed medical innovation.

When thousands of people die because treatment doesn't even exist for them, where is that accounted for? My father has a disease that he is likely going to die from and most of the research done on that disease is done in the US and almost everything I read on this disease is published by US-based researchers.

[hokumguru]

The United States spends the lion's share (>50 percent!) of R&D money on pharmaceuticals worldwide.

https://www.abpi.org.uk/facts-and-figures/science-and-innova...

[Daishiman]

Given the marketing budgets of pharma for direct-to-consumer marketing in the US, which is a complete abomination, I'm not exactly convinced that they'll be running out of cash for research. Not to mention that R&D expenditure can be trivially gamed for tax avoidance purposes.

[claudeganon]

Not to mention the hundreds of millions of dollars in NIH funding and public university research that makes any of these drugs possible in the first place.

[thisiswater]

I find the public vs private debate unfolding here extremely interesting, but I have no idea about it. What are your sources? Where can I learn more about the contribution of the private sector to healthcare, the returns on their investments, and how insurance companies affect that equation?