[bhupy]

> Amazon claims Prime members will be able to save “up to 80 percent off generic and 40 percent off brand name medications when paying without insurance.

This was buried in the article, but is IMO a bigger deal. In the long run, this could really drive down drug prices.

[dudus]

I'm not surprised, there's some serious shenanigans on medicine pricing and insurances.

Medicine prices are clearly inflated when you can buy at a huge discount using insurance, but then you can get apps like GoodRX, which is free and give you coupons that far exceed my insurance discount on every single time I had to fill a prescription. To the point that I don't even bother going through insurance anymore.

I saved thousands on medicine by just checking on GoodRx before buying it.

[ev1]

I'm curious who or what the end goal of GoodRx is. They pay for expensive ($$$$$$) cloud anti-bot/anti-scraping, captcha you after a few requests if you run adblock, they pay for extensive browser/device (attempting to reidentify a user across multiple devices/multiple browsers) fingerprinting services and Fastly. The site loads a dozen trackers, googletagmanager, branch, segment, what are they doing with this data? How much money are they spending handing out coupons?

The coupons aren't unique or require a login, why go through all of this? All the services they use are "request demo / contact us for enterprise pricing", not free-to-sign-up SaaS either. Just who is paying for all this and with what?

[ineedasername]

Their end-game is collecting user data & collecting a referral fee when people use their "insurance". (The coupons generally are not actual coupons, they present as an insurance coverage policy & code that pharmacies use the same way they would your normal insurance card). That's how they make their money.

Personally, for me, the data they can collect off of me when I go to their site is worth the ~$2,000 I save every month. (actually I don't have to use them: I am prudent, and part of my contingency planning for losing my job is to know exactly what expenses I could strip away, and how (and for how long) I could continue to pay for the bare essentials. GoodRx is part of that planning for the healthcare end of things)

[ev1]

As a European now living in the US, my first thought is that the $2,000 shouldn't even exist to be collected, especially by invasive data broker rent seekers.

[ericmay]

It’s collected (generally speaking) one way or another. Unfortunately right now it’s collected from the lower and middle classes, but no matter what you do drugs, treatments, doctors, hospitals, etc. cost money. It’s never, ever, ever “free”. If a drug costs $2,000/month there are probably some inefficiencies baked into the price, but even if it were $500/month, that $500 has to come from somewhere.

[unclenoriega]

That's not really how it works with drug prices in the US. I don't know exactly how it works behind the scenes, but from the pharmacy perspective, it's basically like this:

The "sticker price" of a drug is called the "usual and customary price" (U&C). This is supposed to be what you charge for a drug, and is generally based on the "average wholesale price" (AWP) of the drug plus a dispensing fee to cover other costs. The AWP, however, may or may not (usually not in the case of generic drugs) be related to the actual acquisition cost of the drug. It tends to be substantially higher.

The pharmacy bills its U&C price to the insurance company (or, more often, a pharmacy benefit manager (PBM) contracted by the insurance company), and the insurance company tells you what it will actually pay you—this can be negative—and how much to charge the patient. Usually the pharmacy gets paid whatever the insurance company/PBM thinks it should cost to fill the prescription, and the patient pays a standard copay/coinsurance. If the patient has a large deductible or doesn't have insurance, this is where GoodRx et al. come in. They act as a PBM, allowing the patient to pay a price lower than the U&C while pocketing ~$5 or so of the "copay" for themselves (plus whatever data they get). Often independent pharmacies will just cut out the middle man and give you a better cash price (although this may violate their PBM contracts), but the big chains will need the coupon.

Depending on the difference between the AWP and the actual acquisition cost of the drug(s), this can be a substantial savings for cash patients or people with large deductibles.

[ericd]

Probably some inefficiencies baked into the price? There are massive inefficiencies at every level. I probably wouldn't share this "it's the way it is because it has to be" reasoning if you've never looked into why US healthcare is as expensive as it is.

For a decent overview: https://www.pbs.org/newshour/economy/why-does-health-care-co...

"Just to give you one example, Duke University Hospital has 900 hospital beds and 1,300 billing clerks."

[93po]

Insulin that costs $500 a month after expensive insurance discounts only costs about $5 to manufacture and sells for $30 a month in Canada

[dageshi]

Usually coupon sites are very profitable because they signal immediate intent to purchase, I assume they have affiliate links for whoever they're providing coupons for, any kind of coupon site is usually in fierce competition.

As for all the bot countermeasures, the reason for that isn't immediately obvious to me, I assume it must be due to that competition.

[ev1]

These are not clickable affiliate links; when you pick your pharmacy it gives you a PDF to print out and hand the pharmacist at time of (IRL) payment.

There appears to be some tracking, as "Member ID" differs on each reload. I assume this is tied to cookies or fingerprints in the backend.

[pkaye]

GoodRx doesn't pay for the medicines. They just offer the copay discount cards already available from manufacturers. The manufacturers have a fake prices they use as a negotiating point with insurance companies to maximize their profit.

[canada_dry]

> what are they doing with this data?

As a company selling via the internet it would be handy to know what drugs/prescriptions a prospective client (via fingerprinting) is taking... it would certainly change what/if I marketed to them.

Of course the concept of retail companies having even the slightest access to a customer's medical/health/drug information for marketing purposes is a compelling plot for Black Mirror.

[ev1]

Amusingly, right as I read this reply, I get a chain of heavily-obfuscated JS loading with the text

Please verify you are a human

Access to this page has been denied because we believe you are using automation tools to browse the website.

Please make sure that Javascript and cookies are enabled on your browser and that you are not blocking them from loading.

[gruez]

Weird. I don't get it even though I use VPN + firefox w/ resistfingerprinting

[bqe]

> They pay for expensive ($$$$$$) cloud anti-bot/anti-scraping, captcha you after a few requests if you run adblock, they pay for extensive browser/device (attempting to reidentify a user across multiple devices/multiple browsers) fingerprinting services and Fastly.

This sounds like a great anti-account takeover program. I imagine with all of the various compliance programs they have to deal with and the legal risk, these are prudent measures.

[ev1]

There is no registration or login.

[dmix]

Just like school tuition. The more gov subsidized debt that can't be bankrupted the more admins they keep hiring and the bigger the cost/shit rolls down hill.

Combine that with a culture that overvalues all university diplomas as equal, while disregarding the economic opportunities of at least half of them are almost nil, and you have a great recipe for massive failure for a big percentage of the young population.

The half baked social programs always do this. Same with how rent control in NYC and Toronto in the 1970s ended up significantly reducing the supply of low-income housing because it stopped incentivizing developers from building cheap houses in cities that had it (they just went elsewhere) while also ghettoizing a bunch of neighbourhoods because there was zero incentive to maintain buildings (which led to mass arsons in places like harlem).

If you're going to socialize it either go all the way and nationalize it/fully fund it or find a way that doesn't fuck the citizens over (like these glorified schemes to hand money over to politicially-connected middlemen like big pharma and diploma mills). OR in most cases just let the market do it's job. Like letting generic drug makers take over markets way sooner, without the multitude of government protection rackets that protect big pharma (including FDAs giant backlog). Meanwhile (social) media blames capitalism for every expensive drug or tuition price... like it actually makes sense for ANY market to charge a working class person $1000/pill.

These flaws seem so obvious to me but are repeated in so many western countries, not just the US. While blame goes in so many randomly misguided directions. Often heavily greased by the people who benefit from these schemes.

[hourislate]

You can probably save more at Walmart

https://www.walmart.com/cp/4-prescriptions/1078664

Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages.

[bhupy]

This is very similar (and really interesting) though I’m not sure if Walmart has a special condition on use of insurance.

Amazon appears to be incentivizing customers to not use insurance to pay for their drugs. I’m not sure if Walmart does the same. If so, that’s also noteworthy.

[dragonwriter]

Discount programs everywhere focus on the uninsured (the insured have the insurance company also paying discounted rates, generally, but those are individually negotiated; the sticker price is just to have a starting point for negotiations with deep pocket public and private insurers.)

In many cases, the discounts in the discount programs are subsidized by the drug companies for uninsured patients.

[bhupy]

Yep, for full disclosure, I work in healthcare pricing and payments and adjust claims myself.

While discount programs focus on the uninsured, this is the first time I’m seeing the discount being framed in such a way that it effectively incentivizes paying out of pocket. It’s an important incentive if your goal is to decouple routine drugs from the third-party-payer model of insurance.

Health insurance in the US is actually 3 different services bundled into one: (1) risk sharing for catastrophic care, (2) access to low prices (called "fee schedules"), and (3) tax advantaged pre-payment for non-catastrophic care. 40-80% discount on drug prices essentially competes with insurance company fee schedules, i.e. service (2). By offering what amounts to insurance rates without charging insurance premiums, Amazon is essentially decoupling the fee schedules from risk sharing. That's a really underrated side effect of this product offering, and can have long run impacts on the industry (IMO for the better).

[lotsofpulp]

I would add a 4th service for health insurance in the US to be a way for healthy, young people to pay for the care of sicker, old people due. AKA, a tax, due to the following stipulations of the ACA.

1) Age Rating Factors

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-In...

2) Out of pocket maximums for in network care

3) Elimination of pre-existing conditions, i.e. accepting all lives no matter how costly

4) The recently eliminated mandate to purchase health insurance.

The above conditions mean that premiums from healthy people that don't use healthcare is used to pay for the healthcare for sick people. It gets a little complicated with the ability for employers to silo their employees' lives from the rest of the population, but in general, US health insurance premiums are basically a tax on the healthy to pay for the healthcare for the sick.

[bhupy]

That’s captured by (1) risk sharing. Pooled risk sharing is great for things like fire departments where out of 1000 homes, one might catch fire every few months. It’s also great for societies where out of 1000 people, a small handful suffer from chronic illnesses or tragic accidents and the remaining are healthy. The problem is that it’s just a hammer, and not everything in healthcare is a nail.

[peter303]

You will get old

[Red_Leaves_Flyy]

Or a local pharmacy. Wal-Mart is more expensive than my local pharmacy.

[NikolaeVarius]

Instead of the Govt being the price negotiator, we got giant corporations instead.

yay

[peoplenotbots]

Next up Renaissance style guild wars between rival companies Amazon endorsed candidate vs Walmart endorsed candidates

[joncp]

Snow Crash is coming true.

[lbacaj]

You really believe the government will do a better job?

[alex_anglin]

As a Canadian, I believe that the Patented Medicine Prices Review Board [1] does quite a good job, judging from the cost of medication up here (broadly speaking).

[1]https://www.canada.ca/en/patented-medicine-prices-review.htm...

[jacques_chester]

Australia has a similar mechanism in the Pharmaceutical Benefits Scheme. Drugs are selected based on cost-effectiveness analysis and subsidised price is negotiated with pharmaceutical companies.

If anything, Australia is quite generous to pharmaceutical companies. New Zealand's Pharmaceutical Management Agency has much less negotiating power but still manages to obtain substantially lower prices.

For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price. On the other hand, I have no experience in health economics, so it's possible this is a terrible idea.

[bhupy]

> For myself I can't help but wonder if lump-sum licensing might not be more effective. Pharmaceuticals are a bit like software: very high R&D cost, but the marginal cost to manufacture is very small. A one-time payment to sink a large chunk of R&D for a drug might be quicker and easier than guessing at a price.

You're describing "Prizes", and that's a legit point of view -> https://www.mercatus.org/publications/covid-19-crisis-respon...

[jacques_chester]

I think they're similar but not quite the same. A prize is offered in advance of a solution, a lump-sum license is after the solution is developed.

On reflection I like prizes better, especially if there are multiple tiers (first to reach the target gets the most prize money, second gets less, etc). You want to ensure that multiple pharmaceuticals are developed independently, in case one of them needs to be pulled from the market.

[smeyer]

Don't they do a better job in lots of other countries? I'm not an expert, but my understanding is that a lot of the countries with socialized medicine such that their government is the one negotiating with drug manufacturers pay substantially less for drugs than customers in the US.

[bhupy]

In other countries, government “negotiation” is just a euphemism for price controls. An example of this is Canada’s Patented Medicine Prices Review Board, which regulates drug prices. This isn’t “negotiation”, this is just centralized policy-driven price control.

The US could very well institute their own price controls on drugs, but it wouldn’t invalidate the value in services like Amazon’s, especially if the price controls in question do not create a lower bound on prices, but instead focus on setting upper bounds.

[toomuchtodo]

I support price controls in the US, and the government manufacturing generics if necessary (stepping in if the private sector won't due to it not being profitable enough).

EDIT: I removed an unrelated paragraph about Planned Parenthood and drug supply chain I thought was out of scope.

[bhupy]

> stepping in if the private sector won’t due to it not being profitable enough

That’s effectively what government-enforced drug patents are for. I think it’s debatable whether that’s the best implementation of what you’re describing. Government sponsored “Prizes” are another approach that sounds promising -> https://marginalrevolution.com/marginalrevolution/2020/03/pr...

I donate to Planned Parenthood as well, and decoupling drug purchasing from insurance is a reliable way to make sure that everyone can get access to birth control or contraceptive, even if their employer feels strongly opposed to it (eg Hobby Lobby).

[mikeyouse]

The US Pharma market is full of "found $20 bills" that just shouldn't exist if markets were as efficient as people wishcast they would be. I'd love for someone to rationalize PBMs in the same manner they rationalize every other horrible inefficiency in US health care.

[jjoonathan]

These companies are international so they can choose to not do business with a country. It is a negotiation, just one that governments tend to do better at. If Blue Cross North Dakota sits down at the negotiating table and then Aetna New York sits down at the negotiating table and then Canada sits down and then the European Union sits down, who is going to win a good deal and who is going to get screwed?

You can say it's cheating when governments win lower prices for their citizens like this but I'm not much inclined to care. I don't want to subsidize the continuation of our more-market-based-than-usual health care experiment when the results have been clear for decades. Compared to our peers, we're in a hole. Let's stop digging.

[mfer]

I've been reading some books on the medical industry and one of the things pointed out is that the price controls will often not provide enough profit to R&D new drugs. That the US ends up subsidizing a lot of R&D cost that everyone benefits from.

If this is the case, I wonder what would happen to drug development if that goes away.

Note, I'm not saying there's not too much profit from drugs. These statements don't have anything to do with that.

[lostcolony]

So that assertion is only sorta true.

Initial discovery research is pretty much entirely tax payer funded. There's then a second phase, moving from that discovery to POC, that is extremely underfunded, and which a lot of charity and such funding goes toward. It's only the last phase, taking POCs -> product, that companies really invest in. https://www.ncbi.nlm.nih.gov/books/NBK50972/

Now, that capital investment is not a trivial amount of money (about 80 billion in 2018 - https://www.statista.com/statistics/265085/research-and-deve... ), but it still is only 17% of drug company revenues - https://www.investopedia.com/ask/answers/060115/how-much-dru...

Note, too, that private companies tend to fund research toward common first world diseases, since they're profit driven, and far less to niche and/or common third world diseases. So not only do they not fund early discovery (government does that), nor generally moving those discoveries to POCs ('valley of death', and charitable foundations and the like do that), they also leave plenty of potential meds untouched, since the likely profitability is low.

[SuoDuanDao]

I've heard that argument, not sure how much I buy it. Seems the drugs that get developed tend towards niche applications, while common diseases that affect mostly uninsured people are addressed by places like the Gates foundation.

[heavyset_go]

The NIH already funds a significant amount of drug R&D in the US.

[pkaye]

If this is true, what is the point of US consumers subsidizing the R&D is they themselves cannot benefit from it.

[lazyasciiart]

The rich ones can benefit from it, and then it gets added to the claims that the US has the world's best healthcare system that helps convince the rest that the system should be kept.

[Auracle]

That’s why we should tie our drug prices to the prices other countries pay. I believe Trump did that (or talked about doing it?) for Medicare, but it’s absolutely insane we haven’t done it across the board.

Republicans would be hesitant due to “regulations bad,” and Democrats don’t want to improve our current system because they’d rather throw it out. And of course both sides get donations from pharma.

[Frost1x]

Better than the farce that is "competitive market forces." I have more faith in government than corporate structures delivering optimal cost pricing to consumers as opposed to optimizing their profit margins.

Competive forces only work while there's competition, the second competition declines, rest assured consumer pricing is the first to take a hit.

[efitz]

Competitive forces in the health care market in the US don't function (pretty much at all) because of government induced market distortions and regulatory capture. FDA certification enormously drives up the cost of medicines and medical devices; government bureaucrats have no incentive to balance safety with time to market, price, availability, supply, or diversity of sources; most of these represent risk to the people making the decisions. Most US consumers don't pay for their own medical care, they pay for insurance that pays for their medical care. Often their employer pays some of the costs of insurance. Insurance usually fixes the cost that the consumer has to pay, e.g. a $10 copay. So there's little incentive for consumers to shop around for medical care, meaning that consumers can't drive prices down with normal market decisions. States and the federal government put enormous restrictions on insurance, driving up the cost of insurance. Health insurance doesn't function as in other sectors, where payouts are rare- most insurance is a bet - I'll bet you $3000 a year my house burns down - I'll bet you $400000 it doesn't. Health insurance is more like a discount plan, kind of like a CostCo membership. AMA and insurance companies lobby for limiting supply of doctors and hospitals, respectively, which drives costs up. They do this under state licensure laws purporting to improve quality or safety. Bottom line is that almost every single aspect of the US health care market has had government intervention effectively disable any market based control. The situation would fix itself quickly if we deregulated EVERYTHING regarding healthcare, and restricted insurance to catastrophic event coverage. Businesses would quickly come up with ways to serve the market in a market-friendly fashion. Worried about pre-existing conditions? We'd see businesses like "diabetes maintenance organzations" where you pay a monthly fee and you get all the treatment you need related to that condition. Accidents would still be covered by insurance. You'd pay privately for things like doctor visits for the flu, etc., but supply and consumer choice would drive those costs down, e.g. if I have a sprained ankle I could just use an app on my phone to summon a military vet who was a battlefield medic to treat it, rather than pay for 15-30min of time of someone with 24 years and half a million dollars worth of education. What about quacks/frauds? We know how to deal with them - reputation (AngiesList, Consumer Reports, Google Reviews) on the front-end, courts on the back-end.

[failuser]

Good luck ending up with homeopathy kick off working drugs of the market. If reputation could destroy those, it already would have.

[smabie]

Amazon doesn't have that robust of competition, and the pricing is really good across the board. They could charge a lot more

[jvanderbot]

IMHO, this is the massive problem in the USA. We have one side dug in against corporations, and the other side dug in against the government.

[xtracto]

I think the USA Military branch of the government does a very good job managing their resources.

Why would it be different in other branch?

[smabie]

The pentagon wastes more money than any other government agency. And I don't mean waste as in spending money on something I don't like, I mean waste as in buying one thousand nails and then throwing 999 of them into the lake because they only needed one and they have a quarterly budget they need to burn. Billions and billions of dollars go unaccounted for every year, their books are a mess, and congress just lets them essentially steal from the taxpayer, year over year.

[CWuestefeld]

Why would it be different in other branch?

Lack of choice; the government has captured the "market", and "consumers" can't choose to go anywhere else. Compare to the service (and especially customer service) offered by your cable/internet provider where you have not choice. The cable companies vie for literally worst customer service of all businesses year in and year out.

And we know that the government is doing an awful job in regulation of healthcare. I've got kind of a front-row seat to this and see things that most might not, since my wife's whole career has been in healthcare finance, and in particular around how Medicare reimburses hospitals for services.

She's currently working with one client hospital for whom their Medicare cost report still hasn't been resolved for some years back even before 2010. How can a business operate efficiently when they don't know what their expenses are going to be - not just in the future, but even historically, more than 10 years into the past?

Worse, the way the government forces hospitals to report this stuff is extremely specific, and optimized for how Medicare wants to run things - which is why Medicare can claim to spend less on administration: they just force hospitals to do all the administration for them. And hospitals can't say "no", with Medicare (together with Medicaid, which generally rides on Medicare's regulatory coattails) comprising a plurality of the market, if not an outright majority. The result of this is that hospitals have a choice of either running two separate accounting systems (one for what Medicare demands, and another to do rational cost accounting), or more likely, to just do the one for Medicare and muddle along as best they can. And that's a major reason why hospitals can't operate more efficiently.

And my wife's currently involved in a battle with them over some detailed rules they posted early in the summer. She's been working all summer for her client hospitals based on what the government posted on their website. Last week they changed the rules posted (you can even see the "last changed" date). But the change was in a way that contradicts their previous statements, and invalidates much of what she did all summer - and worse, they're lying about it, not admitting to what the previous version of the page said. Unfortunately the wayback machine didn't track that site, and while she's got her own records quoting the page, the gov't won't acknowledge it.

So there's a clear explanation for why it can get bad, and tons of evidence that it really is bad.

[bhupy]

> which is why Medicare can claim to spend less on administration

In addition to this, it's worth pointing out that the idea that Medicare is the solution to all of our problems because of the cost savings of administration is way over-stated.

There's a pretty great breakdown of where per capita costs go in the US vs comparable OECD countries -> https://www.healthsystemtracker.org/brief/what-drives-health...

Administrative costs make up a tiny percentage of the overall cost differential. You could basically zero it out, and it would still hardly make a dent on the overall cost difference.

[bhupy]

You really think that? The US spends more on its military per capita than just about any other country, save for Israel. The F-35 has been one of the US military's more noteworthy embarrassments, chronically behind schedule and over budget.

The US Military runs the VA, and that's also been a noteworthy embarrassment -> https://www.cnbc.com/2018/05/28/va-veterans-affairs-history-...

Outside of raw warfare, the military runs almost entirely on cost-plus, which results in over-spending of contract money for boondoggles that just entrench the military industrial complex.

Outside of the US military, you have systematic inefficiencies like this across most major agencies.

NASA's planned SLS moon mission is a bit of a disaster — way over budget and way behind schedule. Because the boosters aren't reusable, each launch is expected to cost $1B (with a B) dollars — EACH launch! Meanwhile SpaceX's target cost-per-launch is $50M.

In healthcare, Medicare has actually been running a fairly interesting A/B test. When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Clover, etc. These plans replace Original Medicare, also cover Part D prescription drug benefits, and often include supplemental benefits that Original Medicare doesn't already cover. The outcomes are fairly interesting:

- 36% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly, that we expect by 2025, more seniors to be on a private plan than the public one. There's also great variance by State. In Florida, Pennsylvania, Wisconsin, Michigan, Minnesota, Oregon, Alabama, Hawaii, and Connecticut — over 40% of beneficiaries are on Medicare Advantage. By 2022, we expect more seniors in those States to be on a private plan than a public one. https://www.kff.org/medicare/issue-brief/a-dozen-facts-about...

- For most beneficiaries, Medicare Advantage costs about 39% less than Original Medicare. https://healthpayerintelligence.com/news/medicare-advantage-...

- Medicare Advantage plans are, on average, of higher quality than the public "Original Medicare" https://healthpayerintelligence.com/news/medicare-advantage-...

- In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan. https://www.commonwealthfund.org/publications/issue-briefs/2... From this same research, public "Original Medicare" is still cheaper in rural areas, but not by a whole lot.

So yeah, while the governments of a lot of countries are fairly robust and efficient, I think that suspicion is warranted, especially in the US.

[davidwparker]

Check out the book "The Long Fix". It goes into detail on this quite a bit, and yes, the government does a better job by a longshot.

[PaulRobinson]

Yes. Governments do a better job everywhere from Cuba to Britain. Americans do not have the highest life expectancy but do have the highest healthcare costs. Private firms might have a part to play, in the same way contractors can fix roads, but free markets are not efficient when people’s lives are on the line.

[redisman]

Seems to work in every other country with a modern medical industry.

[EliRivers]

Governments certainly can do, although the US government seems to be permanently hobbled by about half of its leaders having built their identity on the idea that government is incompetent and a bad idea; I'm not surprised it's dysfunctional when the people inside it have their sense of self wrapped up in being shit at their own jobs.

[LanceH]

> the idea that government is incompetent and a bad idea

To be fair, the other side frequently tries to prove them right.

[mhh__]

> price negotiator

Would you prefer the government to negotiate the price of your car for you? Markets are a powerful tool

[dave5104]

If the difference between affording a car and not being able to afford a car would kill me, then maybe I would like the government to step in to negotiate on behalf of all of its citizens.

[bhupy]

Not being able to afford food can also kill you (you would starve to death). Is that a sufficient justification for the government to step in to negotiate food prices on behalf of its citizens?

There are merits to government price controls and there are certainly countries that have employed them successfully. That said, it isn’t the only solution to bending the cost curve, and there are also downsides to price controls. It’s complicated.

[LatteLazy]

I agree on the wider point but in case you or some other reader were unaware...

Government does that in the US (and the EU and Canada and basically every first world nation that's not a city state). The department of agriculture and others spend somewhere between 10s and 100s of billions every year to make sure that food (and other crop) prices stay within carefully set, tightly defined limits.

[ineedasername]

It may not directly negotiate the prices of food, and that's fine: If there's another form of intervention that would provide healthcare to people without directly negotiating the price, I'd be fine with that too. However, the government has not subsidized the healthcare industry to the point where healthcare is as accessible as food.

Healthcare is not just a demand-side issue. There is also constrained supply. I'd be happy to see the government subsidize supply production (building new medical schools etc) in a similar way that it subsidizes food production.

I'm by no means advocating government negotiation or single-payer or medicare-for-all as the thing the government must do on this issue. I'm fine with a form of intervention that allows the market forces to go the last mile in this.

[claudeganon]

> Is that a sufficient justification for the government to step in to negotiate food prices on behalf of its citizens?

Yes? We already do this? For many years directly in the postwar period and now indirectly through agriculture subsidies and programs like SNAP. Making sure everyone has enough to eat is step one of having any kind of functioning society and why it’s always been a source of massive government intervention in the economy.

[bhupy]

Yes, that's the whole point. SNAP and directed subsidies are decidedly NOT the same as government prices-setting. The analog in healthcare is targeted subsidies for poor people that cannot afford care, not government negotiation and price setting.

Making sure everyone has access to healthcare is, for the most part, a universally held goal. The disagreement is whether the only way to achieve that is through government price controls.

[AndrewUnmuted]

I do not think this is the best smell test for government involvement.

Not being able to afford health care in no way condemns one to being killed. It's obviously not advisable, but plenty of people do just fine without regular doctor checkups because they keep healthy and live balanced lives. And, interestingly, given how many each year die in traffic accidents, it's not such a stretch that being _able_ to afford a car would kill you.

We all have really different reasons for wanting health insurance and owning a car. We have different components, considerations, and properties, which we value about these decisions. Given this, it seems ludicrously complex, inefficient, and cruel to subject all citizens of a nation to the same exact process of obtaining and using health care.

We all know how bad of an idea it is to centralize services, but because some linguistic jokesters have gotten the phrase "healthcare is a human right" to be passed around the globe enough times, people seem to drop context when it comes to this discussion.

As soon as youtube-dl got hit with its recent DMCA takedown request, GitHub obliged and the whole dang HN community lost their collective minds. "Decentralize your git repos" we all saw people writing - and they weren't wrong. But for reasons that continue to escape me during these awful lockdowns we're all facing, people don't seem to think that their government-provided healthcare workers and price negotiators will do anything of the sort.

[mhh__]

You can guarantee universal healthcare (and medication) without top-down control of pricing, or at least not total control. Most drugs aren't making headlines, so you can control the x% that matter while still getting cheaper prices for most consumers by letting the outlets compete.

Your website suggests you are American, so I recommend taking a look at the various healthcare systems on display in Europe, they're not all made equally (i.e. Some do more on behalf of their citizens than most). In my experience of watching American discussing healthcare in the EU, the subtleties are often lost, sadly.

[ineedasername]

The free market has a tendency to optimize for profit, and fairly often short-term profit. Yes, that necessarily means companies must have customers willing to pay them, and so a certain amount of quality of product & service must be present, but it does not optimize for everyone to own specific product even if everyone wants that product.

Saying the market can solve the problem of healthcare for everyone is a bit like saying it should be able to solve the problem of providing flagship-quality phones for everyone. But in fact, given the "law" of supply & demand, a product like healthcare which is in demand by literally every single person, yet constrained by supply, the solution the market converges on is going to extract the most amount of money it can from however many customers can be served by the available supply.

Supply constraints are also one of the problems I would, given complete faith in market forces, expect the market to solve but it has not done that either. Market forces did not prevent or resolve the dumping of cancer-causing chemicals, or known cancer-causing product like cigarettes to be removed, or any number of other undesirable things whose costs end up being paid by society as a whole rather than a given individual(s) responsible for the problem. When the market fails to solve a problem, some other force needs to intervene.

Maybe a free market purist would say we didn't give it long enough to solve these problems. I don't believe that, but let's say it's true: Saying the market will eventually solve a problem, when human lives or suffering are at risk, is a bit like saying evolution will eventually solve a problem. It may be true, but the timescales involved are sufficiently long to render their eventual solution irrelevant to the people who die or suffer before it materializes.

I don't claim to know the best way to do this, and perhaps my analysis above is incomplete or over-simplified, but the point stands that the market has not solved this problem, and does not show signs of doing so.

[bduerst]

Not everyone needs a car.

I absolutely want the government to negotiate the cost of water, and electricity.

[burnte]

Yes, I would. A single buyer for all 300m Americans would get better deals than Amazon or Walmart could dream of.

[BurningFrog]

Do people remember that someone like Donald Trump would be in charge of that program?

[Dirlewanger]

In the case of the US, the "free market" have utterly failed us with regards to healthcare.

[mhh__]

Most US healthcare is neither free nor particularly a market. Most healthcare in the EU has a significant market element to it, and it works just fine (and usually costs less per capita)

[smabie]

I don't think you'll be able to find a single person who thinks healthcare is a free market.

[burkaman]

Yes, the government has a stronger negotiating position than me, for obvious reasons.

The concept of "markets" is not useful in a discussion about healthcare, because unlike other markets, a participant will often die unless they immediately purchase a good from the seller physically closest to them, regardless of price.

[jedberg]

Walgreens has an insurance plan too. It was cheaper for me to buy Walgreen's insurance and then my drugs than it was to just use my own insurance, and I had Platinum+ insurance at the time.

[macjohnmcc]

When I signed up it estimated that I would be paying whatever my co-pay is for each of my prescriptions which is a great deal more than what I pay just going through Walmart. Like more than double more.

[eli]

Doesn't Walmart already do this?

[DominikPeters]

This is just a shallow wrapper around https://insiderx.com/ which appears to be a GoodRx clone. See https://www.amazon.com/primerx.

[atombender]

Are you sure? The article says this is a rebanding of PillPack, which Amazon acquires a few years ago.

[burnte]

So I signed up to see. As far as I can tell I can't get a quote on my scripts without transferring them. I'm not doing that. Every other pharmacy I can enter my dosages or call someone and get a quote.

[sithlord]

They say that, but then I looked up Insulin price, and it was astronautical. Even compared to normal drug stores.

[Shivetya]

It will be very interesting to see their insulin prices and which types of insulin they sell.

[friedegg]

I took a look, and didn't see any huge price breaks.

[caturopath]

Time will tell how this compares to other pharmacies. Big savings off MSRP are common.

[satya71]

So savings are similar to GoodRx, RxSaver, and WellRx?