[landryraccoon]

I take issue with the claim that in order to say something is too expensive that you must be able to precisely propose an alternative price.

I have no idea what the correct margin for essential cancer drugs is. I don’t think it should be a 10x markup. Intuitively, it seems that there’s something wrong with price gouging dying cancer patients. If you have an argument why my intuition is wrong, please share it.

[theteapot]

> I take issue with the claim that in order to say something is too expensive that you must be able to precisely propose an alternative price.

If you want to be quantitative of course you do. How hard is it? Margin of error is allowed. If you want to be qualitative, vague and wishy washy, that has its place too, but at some point someone is going to ask for a quantitative assertion, otherwise you get nowhere.

[landryraccoon]

To use a software development analogy, the average person is a user of health care, not a health care project manager or designer.

Just as the user of an App doesn't need to provide an alternative design when they say "this App sucks", the average user of healthcare likewise has no obligation to redesign the healthcare system when they say "this healthcare system sucks."

[theteapot]

Really apples and oranges comparison. But even so, if a certain App user is motivated to have the hostile App developer make a change that doesn't server their interest, they'll need to do better than cry "this app sucks".

[johnnyanmac]

yes. But the more likely action is that they download another app and delete yours. Most apps are "free", so the competition is fierce to keep that market happy. The dev is always beholden to the volatile audience.

It is apples and oranges, though. Because 1) apps are hardly a critical need for the populace and 2) software margins are even more difficult to find that "line" to than physical resources.

I'm sure that medicine needs some higher than average markup in order to make up for R&D, ingredients, and various regulations to get it approved for human patients. But very unlikely 1000%. And only 1000% because of questionable vertical integration that lets UHC charge UHC however much it wants to itself.

[landryraccoon]

It's even worse than you're saying actually, because health care has no price transparency, very little consumer choice, no negotiating power on the part of the user and even the services provided are extremely opaque.

To be honest, I'm quite surprised you're siding with the provider here. Are you personally satisfied with healthcare pricing in the United States? Do you not share my intuition that in general, healthcare is too expensive and inefficient?

[nradov]

Health care now has significant price transparency, although there are still some major gaps and it can be challenging to shop for the best option. Many consumers are still unaware of the tools available.

https://www.cms.gov/priorities/key-initiatives/healthplan-pr...

https://www.cms.gov/priorities/key-initiatives/hospital-pric...

[ceejayoz]

Good luck trying to make sense of it.

https://www.dolthub.com/blog/2023-03-23-illusion-of-transpar...

> Humana published their MRFs across 11,000,000 different files, then rate-limited how fast you could download them

HN discussion: https://news.ycombinator.com/item?id=35347647

[johnnyanmac]

"overcharge" is a qualitative source. If you're not working in the economics, I don't see much worth in finding the exact line between such a qualitative word. The market has some intuitiveness and know that charging 30$ for an item that costs $3 to make is highway robbery. Doesn't matter when or if we start to agree that $5, $6, or even $10 is reasonable (and yes, these are all pretty high markups to begin with compared to typical markups for stores).

We don't need to find the touchdown line when we're already outside of the stadium and the parking lot anyway.

[BugsJustFindMe]

> I have no idea what the correct margin for essential cancer drugs is.

So let's talk about it and think about it and form an idea. There's no universally right or wrong answer, but you should at least be able to decide what answer is right to you.

> I don’t think it should be a 10x markup.

What about 1x markup?

> Intuitively, it seems that there’s something wrong with price gouging

There is, but you're relying on the word "gouging", and without identifying what price you think is gouging vs reasonable profit, stopping at the point where you express that "too much is too much" doesn't get us any closer to having actionable goals.

[johnnyanmac]

So, important question: What problem are we trying to solve here? Is there any benefit to the overall populace for us in HN to debate what we feel is "overcharged"?

----

But to go along with your exercise, I take a look at current market dynamics and compare it from there. Apparently, the typical wholesale markup is 20-40%, and stores will typically markup another 20-50% on top of that. So we're talking roughly a 125% markup on the higher ends from the factory into the consumer's hands as a very rough average (VERY rough, markups vary a lot per product and industry).

That's with two chains of markup, so clearly 1000% feels absurd from one part of such a chain. Outside of factors like drinks (which are easy to scale and can have markups well into the hundreds), it's pretty hard to find any part of the chain as not "overcharged" once we go past 100% markups in any given place.

on the most generous side, Costco famously has markups limited to 14% (albeit they rely on bulk purchases to mitigate that). and subsidized vehicles used to generally be a 10-15% markup price. So I'd say 15% is about the bare bottom of what to expect markups without some kind of twist. e.g. printers selling at a loss, making up for it with high markups for ink (another product that's easy to scale and marked up into the hundreds). or previously, a video game console in order to sell games (software, whose markup is hard to really determine since it's infinitely scalable and costs are more to make up for R&D).

[BugsJustFindMe]

> Is there any benefit

I perceive that one of the reasons that people who want change in the devastatingly perverted system are repeatedly plowed over, cheated, and ignored when it comes to making actual policy is that as a group those with the most reason to be upset are easily swindled into engaging only vague moans about some miniscule ignorable example being bad but not being ready to articulate what should be done instead as a set of categorical rules. And it happens over and over again until the voting public are bred into helplessness, and the way out is to talk about things in actionable ways instead of in vague handwavy ways. And the path to collective dialogue shift has to start somewhere, so it can start with us. Was it painful?

[johnnyanmac]

>And the path to collective dialogue shift has to start somewhere, so it can start with us.

I suppose so. But I have no insight of these concepts outside of the 30 minutes I spent studying various markup strategies. And I have no interest in trying to personally influence policy (especially in something I studied for 30 minutes ". I don't know how many qualified people in this community can influence such stuff (or any that will read HN specifically) , so I simply question the tactic's effectiveness.

[BugsJustFindMe]

Every journey, etc.