[nikolay]

That's absolutely false. For example, I buy a brand medication in Europe without insurance for price many times lower than the generic drug in the State's copay! There numerous examples, but most recent example is my wife's Levothyroxine. I buy a German-made medication for $1 in Bulgaria. In the States, a generic version made by noname Indian company has a $10 copay. Same with the Metformin I buy. The original brand medication (Glucophage) I get at around $2/month supply. And this is just meds.

The most advanced MRI in Bulgaria costs without insurance cost a fraction of the copay in the States.

Same for labs. I recently got a comprehensive labs including advanced lipid profile (with lipoprotein(A) and ApoB, cholesterol fractions, etc.) for less than $20 out of pocket with no insurance. Same with my wife's thyroid test - full picture, not just TSH for less than $15. All self-ordered by the way! No need for intermediary companies to authorize it - you just go directly to a lab, which keeps the costs low as there's fierce competition for your business unlike in America where Labcorp and Quest keep the prices ultrahigh!

An quantified American (by Abbott) COVID-19 IgM + IgG antibody test in Bulgaria was less than $20 - here a yes/no test starts at $75.

Again, I'm talking about paying pure cost plus hefty private companies' margins here - no subsidy, no insurance, all up-to-date technology and materials.

The margins in America are unimaginable for any humane organization anywhere in the world. Healthcare should never be a business!

[weinzierl]

That's from your privileged position but for the majority of Bulgarians an MRI is equally expensive than an MRI for the average American - simply unaffordable.

For most people health care is expensive no matter where they are.

[nikolay]

I am talking about absolute costs not affordability. MRI costs might be mostly salaries, but it's not the same for drugs, labs, etc. Given the much bigger purchasing power in the US, prices should be lower, not higher. Why the economics of consumer electronics don't apply to health care? TVs and laptops are much more expensive in Bulgaria, but drugs are way, way cheaper and not subsidized - and these are commodities. Levothyroxine is a commodity available around the globe. Why it's so expensive in the States?! Why are American pharmacies buying generics from India, which so often have recalls due to contamination, and don't buy European drugs (such as from BERLIN-CHEMIE [0])? Because they want much bigger margins - I have no other explanation.

[0]: https://www.berlin-chemie.de/en-us/about-us/our-history

[weinzierl]

I take your point and learned something, thank you.

[ploxiln]

> No need for intermediary companies to authorize it - you just go directly to a lab, which keeps the costs low as there's fierce competition for your business unlike in America

> Healthcare should never be a business!

... seems to me like Healthcare should actually be a normal business. Instead of whatever it is in the US - which as you explain, really makes no sense.

[nikolay]

Yeah, because it's already a business but non-competitive like in the States. Pharmacies can still sell me medications without an Rx - it's not allowed, but they still do it, because why do I need to schedule a doctor's visit get a medication thats for life (like my wife's Levothyroxine).

[maxerickson]

The cash price will often be lower than the copay (which isn't a good thing, but it signals that the issue is benefit design rather than cost of provision).

For example, Walmart sells a month supply of levothyroxine for $4 if you don't get your PBM involved.

[nikolay]

Yeah, but Walmart generics are made in India by companies known for recalls due to carcinogen contamination. Not that recalls in Europe don't happen, but I'd rather purchase from a pharmaceutical company in business from the 19th century. If US regulators believe that India has more stringent pharmaceutical standards than Germany, then something is fishy! And there's so much corruption in generics [0]!

[0]: https://www.washingtonpost.com/business/2023/04/04/big-pharm...