Mark Cuban's Cost Plus Drugs
costplusdrugs.comDiscussed before: https://news.ycombinator.com/item?id=25932233
And two days ago: https://news.ycombinator.com/item?id=31652264
As always the issue with privatized social services is that the goal is to make money, not to provide a service so the incentives are fundamentally misaligned. For-profit care providers make money when the fail to provide care. When they fail to cover procedures. When they can substitute lower-quality or less effective goods and services. When they can sell you catastrophic cover with deductibles and co-pays too high for you to actually afford to use it - the way a gym membership makes money selling subscriptions they know you won't use.
This is by definition an improvement over what America has, so I welcome it. That doesn't change the fact it's an umbrella in a hurricane, so it's really not that interesting.
Socializing the whole thing is significantly better. Remember America already has socialized medicine for 40% of the population. It is long past time to up that to 100%.
> Socializing the whole thing is significantly better.
As a Canadian I highly disagree. And anecdotally many health care providers from Canada agree with my take. People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas.
There is nothing stopping the government from substituting lower-quality, less effective procedures when their MBAs come in an consult about how to reduce costs.
Canada has substantially the same health outcomes, or better, than the US. This is simply not true. I'm also Canadian, and have lived under both systems.
My father fell off a ladder and had a pretty severe head injury, and had both an MRI and a CT scan within a half hour, at no cost. Yes, lower-priority conditions may have to wait, but it's also by definition because they're lower priority - and they'll have to wait in America too.
The idea that the Canadian healthcare system is somehow leaving people to wait and die in a way the American system is not, is a falsehood propagated by major American insurers and their lobbying group AHIP. Here's a Cigna executive apologizing for doing just that. [1]
[1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...
This article has a couple immediately glaring flaws that lead me to not invest the time to deeply analyze it on the whole...
> because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated
That's completely false, Canada has a presupplied quota system set by government forecasting and limited by budgets. If you need treatment you will be treated eventually but you might die or get sicker in the interim.
Using a COVID-19 based article to discuss the merits of single payer single provider completely ignores the massive cultural mentality differences -- the US focuses on individual freedoms, Canada focuses on collective good. This makes a big difference when it comes to adherence things like social distancing and masks. They're taking a multivariate system and claiming it's a single variable that caused the outcome.
Edit: and I might add that it appears that Canada is always intentionally undersupplied such that a moderate wait is guaranteed. Whereas it seems that due to market competition the US system is inherently oversupplied (at least in many areas) such that they can provide to those who can pay essentially on demand.
> This article has a couple immediately glaring flaws that lead me to not invest the time to deeply analyze it on the whole...
Good to know you didn't read the article before replying.
> That's completely false, Canada has a presupplied quota system set by government forecasting and limited by budgets. If you need treatment you will be treated eventually but you might die or get sicker in the interim.
Every system in the entire world has a predefined quota. There's no unlimited supply of healthcare resources in any country - and America is no exception. The only difference here is whether these resources are centrally provisioned or not - and whether you ration it based on who can spend the most, or who needs it the most. I vote for central provisioning and need-based allocation.
You are ignoring that once again, there are wait times in America too. The reason I sent you this article is proof that in fact your assessment of the relative strengths of the system isn't grounded in fact. It's grounded in propaganda about the American system. The system you are imagining in America simply does not exist.
> Using a COVID-19 based article to discuss the merits of single payer single provider completely ignores the massive cultural mentality differences -- the US focuses on individual freedoms, Canada focuses on collective good.
This is irrelevant to the quality of a healthcare system and its outcomes. And you are ignoring that 40% of Americans are already covered by socialized medicine. Old people in America love Medicare and have no interest in getting rid of it. 75% of people on Medicare are either satisfied or greatly satisfied, while only 6% are dissatisfied or greatly dissatisfied. This is higher than the for-profit sector.
> Edit: and I might add that it appears that Canada is always intentionally undersupplied such that a moderate wait is guaranteed.
That's a cool, unfounded opinion.
And again, you have ignored the clearly measured equivalence of the two systems in terms of outcomes - while the Canadian system delivers it at literally half the per capita cost and covers everyone.
If you actually look at the data, it's clear. The private care available in America is more expensive and outcomes are either the same, or significantly worse. America has the worst maternal mortality rate in the developed world, for instance. This is quantifiable and you are not utilizing that data, one has to suspect, because it does not support your position. [1]
https://fee.org/articles/america-outperforms-canada-in-surge...
Saying America spends more is pretty weak claim because Americans are fatter, more often shot, face worse natural disasters (hurricanes, earth quakes)... Of course they spend more. There are hundreds of variables why healthcare per capital would be cheaper in Canada from CoL to quality of doctors (the ones that remain are ones who cannot compete in the highly paid US Market), to greater public safety net or social goods in all areas resulting in fewer high cost outcomes (eg, Canadians take more PTO)...
Overall i think the main difference between what you're interested in and what I'm interested in -- that which we're calling "superior" differ.
To me a system is superior if it gives better outcomes to those who pay for the service. VS you seem to be claiming that a better outcome is something like the average across all citizens.
To me this is like saying "We all need food, therefore when we go to the grocery store you will be charged the average bill and given what you absolutely need to not die, but not necessarily what you need to thrive. This is how we keep others from starving..."
For me I want to go to the grocery store and receive the best I can get for my money. It's a just system to receive what you pay for and to not receive what you do not pay for. I do also believe in a separate, external to the government, system of charity to cover cases which are truly unfortunate, but also to keep people accountable for their contributions to their own health when able or
Anyways, it seems you're squarely set your values based opinion, and I am on mine. So there's no longer a reason to discuss further.
> Saying America spends more is pretty weak claim because Americans are fatter, more often shot, face worse natural disasters (hurricanes, earth quakes)... Of course they spend more.
“Fatter“ and “more often shot” are at least in part due to choices about the focus and distribution of physical and mental health care, not independent factors (in fact, the political faction most defensive of the ways in which the US system differs from the less-expensive, comparable overall outcomes systems in the rest of the developed world also is prone to claiming that the elevated risk of being shot is primarily a product of defects in the health care delivery system, though they tend to lose focus on doing something about those deficiencies quickly after pointing to them.) If you've got evidence that the health impacts of natural disasters are greater—in a way explained by the nature of the disasters alone and not choices in the structure of the health care system—in the US than any, much less all, of the other advanced economies in the OECD, please point it out, because that would be interesting.
I actually do agree that part of the gun violence equation is mental health care. That doesn't mean socialized mental health care is the best solution to healthcare needs. Simply that having a society which does not value mental healthcare at all is suboptimal.
Actually my opinions are data driven.
You cannot apply data without values. If I told you X people die every year from Y, it would be your values that suggest if we should do anything about it.
X could be lots or little, Y could be Covid or the death penalty. Data tells you nothing about the justice of a situation.
I don't know man, all the data I see shows the system costs half as much per capita and has similar or better outcomes - and that wait times exist in both countries. So given outcomes are the same or better, the justice level must therefore be roughly the same for half the cost.
You pull out tired narratives like 'care quotas' as though they only exist in one system but not the other. You pull out tired narratives like 'wait times' as though they exist in one system but not the other. I linked you an interview that explains what the industry has been doing to further this narrative, and you didn't read it because again, it doesn't align with your preconceived notions.
What you're telling me is that you don't want to engage on data because the reality on the ground doesn't align with your values and you've been fed a crock.
> Good to know you didn't read the article before replying.
Didn't read the entire article due to quickly findable glaring issues of quality, yes.
> People frequently die, or get sicker, as they wait their turn in months long queues or lack of supply due to government quotas.
There are often months long waits for here too, try getting a dermatology appointment, we just also have the privilege of paying for it out of pocket as preventative skin care checks are not actually classified as preventative medicine so it counts towards your deductible meaning you have to pay the first $2000.
pay out of pocket is the nature of the system, so it's not really a point.
What would be a good point is a discussion about if want a society where the people who pay for a procedure get better outcomes, or if we're willing to say to those who pay "You will get a worse outcome because we're also serving those who cannot pay. This comes down to cultural values and ethics.
Again, you are ignoring that healthcare outcomes in Canada are generally the same or better and that wait times exist in both systems. [1]
> "You will get a worse outcome because we're also serving those who cannot pay
Vs America where you get a worse outcome due to laborynthian beuracratic rent seeking.
Sounds terrible for Canadians to be forced to make things better for poor people if they want to improve things for themselves.
> People frequently die, or get sicker, as they wait their turn
This also happens in the US. Plus, if you do happen to get care you can go bankrupt!
>when their MBAs come in an consult about how to reduce costs.
The US is far far past this point already.
Your experience with the Canadian system is going to vary greatly depending on the kind of care you require and where you are. Frankly, the same is true in the US.
> their MBAs come in an consult about how to reduce costs
You don’t think the big health insurance companies in the US do the same thing?
> You don’t think the big health insurance companies in the US do the same thing?
To the multiple peers who point out the US uses MBAs too. I'm pointing out that both systems use MBAs and come to the same conclusions such as "We can save n% by using n-1% less effective drug."
The US MBAs have figured out that procedures should be expensive. The health insurance industry as a whole would rather collect 15% of trillions spent than 15% of billions spent.
One thing lost on people is the "for-profit" motive is not solely with insurers or plan providers. Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are.
This results in often legitimate procedures being denied. But make no mistake, the care providers billing insurance are just as likely or more likely to try to grab money in any way possible.
I was once involved in a company that would place laboratories and other diagnostic machinery in physician's offices. They would always be very interested in what the insurance reimburses and how many patients they can run it on. There would always be some gimmick like Oh, homocystine we can run on every patient for $5 and be reimbursed $30, and then you would see that ran on every single patient they could to make that money. Eventually insurers would have to shut it down. High sensitivity CRP was another one until medicare locked it to being run once in a patient's lifetime.
> Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are.
I've personally found this particularly common and suspect within the Dental industry.
https://health.sunnybrook.ca/navigator/too-many-dental-x-ray...
> Medical practitioners in my experience are extremely motivated to provide as many services as the insurer will pay for regardless of how medically useful they are.
The shitty ones, maybe. I know many physicians who acknowledge that unnecessary tests lead to unnecessary interventions, which is proven to reduce quality of life and decrease outcomes.
A lot of this is also cat and mouse about reimbursements. Medicare has cut payments for a lot of visits to the point they aren't profitable, BUT if you fill out a form and e-file and do X for a visit, then you get a bonus payment and can bill a higher code so the net return is about the same.
All the people complaining that they went in for an included annual checkup and got billed for asking a question are running into this, it's the provider that changes or adds the billing code.
(Maybe not the practitioner directly, the providing organization)
Um, what?
In theory, free market healthcare should improve alignment.
Insurance companies pay procedures and make money when people are less sick. Hospitals make money when they perform procedures. Insurance companies are therefore incentivised to only pay procedures from competent hospitals, the ones that won’t result in more follow-up costs.
The problem is, of course, it’s not a free market - neither on the hospital side (prices are not public) nor on the insurance side (it’s much more affordable through employment)
'A key feature of free markets is the absence of coerced (forced) transactions or conditions on transactions.' [1] Healthcare is not such a market. If you have a stab wound and you're bleeding out, there's no supply and demand, there's no ability for you to have market participants compete for your business. It's 'pay me or die.' Ditto substantially any major medical issue. This is, in my opinion a coerced transaction, and therefore, not a free market.
This is true of prisons (you can't exactly have private prisons compete for your business). Of fire departments (I'm not going to call for quotes while my house burns down). Of police departments.
If it's not a free market, it should be socialized, imo.
I’m a huge advocate for private (non-socialized) healthcare.
People always twist this into “you’d have to pay so much more for healthcare”.
No! I never had to pay anything substantial for healthcare. I pay for insurance. But I prefer private insurance (to improve competition, performance, quality, accessibility, …)
The prices not being public is a problem, but really the big issue is the indirection in payments. No one really knows how much is getting paid to an insurance company for their insurance, and no one really knows how much an insurance company is paying out. Anyone that actually knows these numbers is isolated (and often hidden) from the patient and doctor.
> Insurance companies pay procedures and make money when people are less sick.
It's not as simple as that. Insurers are regulated. They can't keep any more than 20% of the money they collect. It sets up an incentive for them to collect and spend more money.
Just before I ask this question, I want to let it be known I am for base healthcare as a public right, as well as public 4 year universities (4 year community colleges, basically) and a low UBI - I've basically become a hippy, somehow, in my old age... I'm not sure how that happened. But with that out of the way, on to my question...
Do you think that part of the reason that America is so attractive to pharmaceutical innovation is because of the obscene profits that can be made in the prescription space that is not only allowed by our laws, but encouraged by our politicians?
If we were to socialize our pharmaceutical sector, which would involve putting caps on pricing, do you think this would make innovation into treatment which involves huge upfront costs in research a non-starter?
Would neutering the profit motive and corporate greed in our pharmaceutical sectors revert our pharma studies back to university programs and corporate tax write offs/good will programs and the occasional government budget surplus when they've decided to not funnel it towards another uneccessary war?
If for-profit companies keep doing all these awful things, why people keep paying them money?
Because their lives depend on it? Why do people keep paying ransoms? Does it mean that ransoming them is a good thing?
But the point was that they're doing things that either are unneeded or not effective.
If either of those are true, their lives do not depend on those procedures.
Exact same thing as Marketing spend. You cannot split the good from the bad.
I really cannot understand how you can even think about doing healthcare system for profit. Posting this from a Single-pay country, Germany.
Is Germany single provider too?
In my armchair politics I do wonder if single payer, market provider might work. You get the competition of the market, but the tax payer purse. I think technically this is how medicare works but there are a bunch of nuances that make medicare not work (such as negotiation of prices).
I'm not sure if it's matches "single payer". It has mandatory insurance. And you cannot choose most of the things that what you can get covered or not.
I got a "government insurance", which is the most expensive, but also the one with the best cover. There is "private insurances" with cheaper premiums and less cover that are attractive to young people, but it's kind of hard to later in life switch back to the government one.
Most countries in EU have kind of this mixed healthcare, with private, and public ones with the only goal to make sure the private offer competitive enough services... Same thing with hospitals, there is public hospitals, so private ones don't jack up the prices to crazy values...
I see, the American strategy seems to be increase competition to ensure prices are fair. A big problem being the corruption in the government through lobbying having a positive EROI such that companies are blocking good anti-trust policies (such as requiring transparency on prices) .
A lot of people are negative about how America does things, but as far as I can tell most of the issues stem from corruption via money in politics. Capitalism and Market Economies seem to work well, but Crony Capitalism and Citizens United seem to just be friendly names for corruption.
In the case of healthcare, it’s because crippling, inescapable debt that spans multiple generations is still usually preferable to actual death.
where in the US is there inescapable debt that spans multiple generations? What debt (other than IRS and student loans) are not dischargeable via bankruptcy?
Because, in an economic sense, of asymmetry between the parties. You only have a handful of car companies to buy a $30k green 5-door sedan from. But Ford can easily afford to lose you as a customer - Ford is more important to you than you are to them.
An extreme case of this (in some places) is the internet provider. If they know they're the only ones they can basically charge much more than if you were living in an area with healthy competition. What're you gonna do, not use the net?
Ford can easily afford to lose me, individually, but typically things that will cause them to lose me, will also cause them to lose many other customers. In practice, there is no actual asymmetry: if I don’t like Ford, I can just go to dealership next door, and so can millions of other customers, which means Ford needs to be careful.
Ford needs to be careful, yes. But Comcast in this example doesn't need to be. And for you to compete with Comcast by spinning your own ISP and having your own cables is not likely.
Yes, I agree. My point is just that the asymmetry in market strength is not based purely on the size of the company relative to the consumer. In many competitive fields, it is the providers that are in a precarious situations instead of the customers, even if the providers are large corporations. Consider, for example, McDonalds: it’s a huge company, but it would be ridiculous to suggest that it enjoys significant market power over customers. Many such examples.
Because at the moment the only real alternative is “dying”?
This is only true for a fraction of all healthcare that’s actually consumed. For my family, over past 4 years, maybe 10% of our healthcare consumption carried a significant risk of death if we elected to not consume it.
As an explicit example, my wife took our infant daughter to a doctor the other day, because she was coughing and sneezing for a week already, and she wanted him to confirm that it’s most likely nothing to worry about. The doctor agreed. Insurance was billed $200, with $10 paid by us out of pocket. If we had to pay $200 out of pocket, we’d probably wait another week (and ended up not paying anything at all, because the coughing indeed disappeared before the end of the second week).
I have no clue if the bushings in my car really did need replacing. Not even sure what they are. My mechanic sure has an incentive to say they do, as he'll make money that way, but if what he says sounds kinda reasonable and I don't get weird vibes from him, I am not taking a gamble with my 1600kg, 120km/h destroyer-of-pedestrians-and-passengers.
Most people aren't medical doctors, and most aren't gonna gamble with their health. It's a transaction where one side has way more information, less to loose, and therefore more power. Hopefully they use that power for good.
> If for-profit companies keep doing all these awful things, why people keep paying them money?
Healthcare privacy laws make it extremely difficult to evaluate the value proposition of care providers. You can't just, like, look up a list of their previous patients' medical histories.
To not die?
> the goal is to make money, not to provide a service
I think your entire premise is flawed here. Businesses make money by providing services that people want / need.
Businesses also make money by reducing the inputs that go into services (e.g. lowering the quality of the service), thus achieving a higher profit margin.
It's not a flawed premise. It just doesn't occur 100% of the time. It tends to occur in industries with poor competition (mono/oligo-polies)
Let's hope you make a better fist of it than the UK - the NHS is currently unreformable to any significant degree, due to it being weaponised by the left.
UK per capita health expenditure: $4650USD (#17).
US per capita health expenditure: $11000USD (#1).
I don't know what the 'left' is doing there but it seems very efficient.
Don't get me wrong, I think claiming the NHS has been "weaponized by the left" is idiotic, but I don't see how PC expenditures support or refute that point?
I got this terminology straight from the horse's mouth: https://www.theguardian.com/politics/2015/jan/12/labour-refu...
'Labour has defended the way it is campaigning on the NHS – but once again refused to confirm that Ed Miliband told the BBC that he wanted to “weaponise” the NHS in the election campaign.'
'The spokesman said: “I am not going to talk about words used in private conversations. They should not be shared and we will not talk about private conversations.'
Another mention of the term: https://nhsproviders.org/news-blogs/blogs/dont-weaponise-the...
If there were no danger of the NHS being weaponised, the term would go out of common use.
Do you still consider my use of a term coined by the left themselves as 'idiotic'?
Bit weird of you to use that NHS Providers site. Chris is here talking about the Conservative party making misleading claims:
> So here is a challenge to politicians who say they support the NHS. Be clear and straight about the numbers – for example, don’t double count what’s already been announced and don’t confuse five and one year commitments to boost a headline number. Acknowledge the scale of the funding needed to deliver services to meet our growing needs, and to rebuild our NHS, making it fit for the 21st century. That means looking beyond hospitals, important though they are, to other parts of the service which have suffered similar neglect, for which patients are today paying the price.
That "double counting" means that the amount of money being invested is less than claimed; the numbers of new staff being trained & recruited or retained is less than claimed; the numbers of new hospitals being built is less than claimed; etc.
What on earth kind of weapon is it? It's a nonsense statement.
The right would argue something like it's a trojan horse for spreading socialism more widely, or a means of bashing the government with constant attacks based on exaggerating its problems, scaremongering over potential reform/privatisation etc.
But anyway, before you attack it - I'm not the one that came up with it - that was the leader of the Labour Party Ed Milliband! It caused a political storm at the time. Clearly the media, political classes etc. did not consider it complete nonsense or they wouldn't have taken it seriously - nor would the government been able to hammer Milliband/the left with it for years.
Would be interesting to compare also with countries like Germany, Sweden, Netherlands, Singapore etc.
I should have linked my source. [1]
[1] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
This may be semi-skewed by the exchange rate power of the dollar
does this include tax payments?
I'd love to see an analysis of proposed reforms since 2010 that have tried to do anything other than move the NHS towards not being socialized medicine. I suspect the list would be vanishingly small.
Maybe this is me "weaponising" the NHS but you're going to have to provide a bit more evidence if you're making such a bold claim.
We all know the answer to this. Every single person in the world.
The way to fix the US system is for the health insurance market to be regulated like the auto insurance market, i.e., break up the state monopolies. Then for our employers to give us the money they're paying on our behalf. Then we could shop for a health insurance plan like auto insurance. Within a couple of years, the market would start sorting out the costs.
But no. We'll get socialized medicine. And it will look much like our disastrous Veterans Health Administration.
That's incredibly naive. I can already shop for health plans in the us, and it's a shitty result. The rest of the wealthy western world has national health insurance and it works really well. The US is the broken system with declining health of its citizens, even before COVID.
> The rest of the wealthy western world has national health insurance and it works really well.
If you talk to people who immigrate to US from those countries with national health insurance, you’ll find that what you claim above is by no means a consensus.
For example, I immigrated to US from Poland, and in my opinion, US healthcare is much superior to Polish socialized healthcare, in terms of quality and availability. Cost wise, it’s more expensive, but my out of pocket costs are too small for me to care about: my employer pays for health insurance, which is a benefit on top of my wages, instead of being subtracted from my wages like in Poland. My deductible is low, and so are my copays and out of pocket maximums. This is opinion shared by most of my Polish friends in US.
Back in Poland, socialized healthcare is held in low regard, lines are long, quality is low, and a lot of people, especially in cities, pay for healthcare from private providers anyway.
I'm in the software world in the US. My friends from the UK, Canada, Germany say they strongly preferred their healthcare in their home country. There are scattered things better here (sometimes wait times are less) but mostly it's a stupid waste of time system with enormous effort figuring out and arguing of EOB statements endlessly where you can never know what something costs until the insurance companies and medical providers stop arguing over the details.
It also costs $2000USD per capita vs the US $12000 per capita. Fund it 6X and see what happens. Heck, fund it 2X and see what happens.
Yeah, it's a shitty result. A family plan costs $25,000/yr. As I alluded to, there are state boundaries that present a pseudo-market of health insurance options. If we'd remove that regulation, and allow companies to sell policies across all 50 states, it would create more competition, and lower prices. If there was real competition here, every other ad on TV would be for Geico, Farmers, and FREAKING Liberty Mutual HEALTH insurance.
Socialized medicine makes the best healthcare systems in the world. Talk about being rational.
That's weird, old people sure do love Medicare. "75% of responses are either very satisfied or satisfied with their Medicare coverage. Only 6% said they’re either dissatisfied or very dissatisfied." [1]
[1] https://www.healthcaredive.com/news/seniors-love-medicare-bu...
I'm not following what aspect of US health insurance you consider a state monopoly, can you be more explicit?
There are a variety of different non-state companies providing health insurance in the US, no? What am I missing, how is this a state monopoly?
Could you share more? Curious to understand the issues of the NHS and why it can't be reformed and what it means to be weaponised by the left
See my comment above - the weaponise term is from a quote that was disavowed by the Labour leader-before-last, but that he certainly seems to have spoken.
Here's an article on the topic - from a socialist source: https://www.sochealth.co.uk/2015/04/28/weaponizing-the-nhs-i...
'many campaigners who want to “Save” the NHS seem to want to do the opposite – to politicise the NHS so far that reform becomes a practical impossibility. They create alarm about cuts to local services, privatization, postcode lotteries and TTIP. They seem more motivated by anger, and fixated on political totems, than on trying to promote progress within the NHS.'
'The problem with Labour’s campaign to “weaponize” the NHS and turn it into a key political battleground, and its politically motivated and gimmicky manifesto pledges, is that it distracts from the real work that is needed: devolved reforms led by clinicians. We could have yet another 2 year hiatus. The NHS can ill-afford that.'
The kneejerk downvotes on HN are so depressing, especially when they are borne out of ignorance (not you btw, your comment is good).
Eh, wasn't it pro-brexit that had banners saying "we're sending hundreds of millions £ to the EU each week, let's fund the NHS instead"?
When you consider the massive reforms carried out by Lansley (a Conservative health minister. These reforms caused huge problems, didn't particularly work, were widely misunderstood even by his own party, and are now being rolled back) and now the Hunt/Hancock/Javid reforms to ICSs it's just plain wrong to say "the NHS can't be reformed".
That's pretty much it, but I would add that since medicine in the American sphere of influence is a cornered market the goal is always to deny care, so the patients are more desperate and pay higher prices. Endgame is a billionaire paying his whole billion-dollar fortune for a loaf of bread because he's starving. First you have to corner the market, then deny food, then eventually yes, eventually he will in fact pay a billion dollars for a loaf of bread, I fucking guarantee it.
Indeed there's no reason that Cuban won't, like Uber, wake up one day and 5X prices - or bring in the recently-released Pharma Bro Shkrelli.
Good will and brand alone isn't sufficient to build a medical system on.
And I’m not so worried about Cuban. I’m worried about when he exits. The next owner(s) will certainly have a different agenda.
Maybe, but increased competition never hurt the consumer.
I'm curious if this is literally always true?
I agree that competition often helps improve pricing and quality, of course.
But I wonder if at times competition leads to a net degradation such as "race to the bottom" scenarios?
>> Indeed there's no reason that Cuban won't, like Uber, wake up one day and 5X prices
Perhaps, but until then, I welcome the value he'd create for us
From the time this was posted two days ago:
This keeps showing up but it's total bullshit. Cuban wants to take 15% of the transaction for running a web site and processing payment. They're not manufacturing drugs. They're not buying drugs. They're not shipping drugs. They're not doing anything at all besides taking your order and giving it to someone to do all those things. It's not a charity. It's a profitable business and a very profitable one at that.
Oh yeah, and the prices aren't lower than what you can get using GoodRX.
I'm pretty sure you're free to compete with them if you think it's profitable.
In reality I'd expect that 15% to be necessary if they want the company to survive after some years. There are tons of not so visible overheads and costs, and it (apparently) has taken a billionaire to be able to start such a company (disclaimer: I have no idea what GoodRx is).
>I'm pretty sure you're free to compete with them if you think it's profitable.
If I could generate the amount of free advertising Cuban's getting I would.
Was there someone around previously who could take my order and give me the drugs at those prices? I'm not convinced this is true. I'm not familiar with GoodRx but they appear to be a coupon aggregator which is not the same thing
Depending on the drug, yes. Walmart & Amazon have cheap generics and so do many regional grocery stores.
> Depending on the drug
That seems like the value prop though. The cases where it's not, and the alternatives are absurdly expensive. People seem to be focusing on the median case where it's marginally more expensive or cheaper
I mean if you're old enough to remember broadcast.com I don't think anybody had high expectations.
I'm curious, what was broadcast.com like? What were the issues?
It seems to have worked out for him.
How does GoodRX work?
Part of how the government determines the price it pays for drugs is based on the retail price. That (among other reasons) gives manufacturers incentive to have crazy list prices. A drug that sells for $50 might have a list price of $1,000.
Enter insurance companies. They don't want to pay $1,000 for a $50 drug so they negotiate. But there's too many insurance companies for them to have good leverage and efficiencies in negotiation.
Enter Pharmacy Benefits Managers. They get hired by insurance companies to negotiate with drug companies and pharmacies. Thus the buying power is pooled and they only have to pay people to negotiate one time.
GoodRX is like the last category. Except that instead of getting paid by insurance companies they sell user data and collect some fees from pharmacies and drug manufacturers.
This is such a great, useful explainer (esp. for someone outside the US who don't really know how these systems are set up in the US). Thanks!
They're a deal site, basically
You need <drug> in <area>
They search pharmacy prices in <area> for <drug> + <generic versions of drug>
You get back a list of where it is cheapest to have <drug> fulfilled by a pharmacy in <area>
This isn't correct. GoodRx makes money by partnering with Pharmacy Benefits Managers. It's taking advantage of a loophole in the US's extraordinarily convoluted drug pricing system.
Do you know more about how this works? I know it's not just a coupon scheme or search engine and I'd like to know how it works under the covers.
I think it is a little more than just a drug search engine. If you come to to a local pharmacy the price of a generic drug will $50, but if you show them the GoodRx referral with a price quote they will sell it for $5. Not sure what their relationship with the pharmacies are.
There's a $5 shipping fee that isn't included until check out, so for a lot of cheap drugs it's still cheaper to go thru GoodRX/Walmart/other discount programs.
Are you looking at the right place?
I clicked on the medication's link (just for lookup), and it took me to a page which listed Manufacturing, 15% Markup, Pharmacy Labor and in a circled blue box: "* additional cost at checkout Shipping $5.00".
Yes, you can find information that they will add that to the price, but the prices they list to drive you into that funnel don't include that charge, which is a deceptive pricing practice.
The original point is that if you include that cost, then their prices for many drugs are no longer the cheapest.
That's what I mean, the list price in the big box is just the mfg, markup and labor. You have to add on $5 to the 'Transparent Pricing' that they put in the giant box in the center of the page, you only see that there is an additional shipping fee if you click thru the little slider or submit an order.
Do they discount shipping for multiple items ordered? In that case I personally think having shipping separate makes sense, as 2 $5 items shipped might be e.g. $16 total not $20.
More competition in this space is good and for certain drugs may be a huge boon but for the average prescription, consumers should probably stick to goodrx to find the best deal. In my case, Cuban offers a very reasonable $7.50 for a 90 ct of a drug I searched (not including shipping, which others here say is $5?)
On GoodRx I see the same drug at a local grocery store for $6.84, (Costco is $8.49) and online pharmacies like geniusRx are $4.50 (s/h unknown). My health insurance through a local pharmacy would cost $14.38
I don't like all the advertising on costplus about how they're saving you like $490 out of $500 on Rx, because everyone else is doing that to. There is literally nothing new here. My local grocery store beat his price by 10%+. But as long as you know that the "pricing reduction" is total bunk and not a competitive advantage and just an explanation of the current state of the industry that EVERYONE is doing, then it's one more option that could be the lowest for you.
In my case, it didn't help me.
I switched to this after the 3rd time getting abused by Walgreens. In my area they dont even acknowledge you when you walk to the counter and forget your refills. The pharmacists just blatantly lie to you that it will be ready at this point. They are overwhelmed and Walgreens doesnt want to pay for more pharmacists while not limiting how much business they can reasonably take. Ordering has made things easier for me and I feel like less of a buffoon standing there in that dumpster fire.
Walgreens has their own prescription plan with a $10/year fee that offers significant savings on generics (I've used it between jobs). But they seem to treat their pharmacists like crap so some locations are really terrible to deal with.
Makes sense. Yeah its not the pharmacists fault, its corporate who has no pulse on whats going on. Or they just dont care.
Heads up, I think your autocorrect converted "generics" to "genetics".
Thanks, fixed!
I hate to be so cynical if it helps people, but with his name plastered in the company and site like this, it feels like prep for a presidential run or some other political office.
If I'm understanding their basic message, the pitch is "we can get you cheaper prescriptions because we're a well run business that's making a rational but not exorbitant profit" and linking your branding to someone already famous for running businesses seems to be a very reasonable way to add credibility to that message.
In other words, I don't think Cuban puts his name on all businesses he's involved in like this, but for this case specifically it seems fairly obvious that using his name furthers their message.
Also it's a sketchier industry, so having a recognizable name certainly would assuage my fears about using it.
That said I have to assume Cuban is also getting a PR benefit here.
I assumed it was to help add legitimacy to the company. Some random company selling drugs for cheap on the internet? Sounds very sketchy, stick with your local pharmacy. That same company, run by a famous figure? Maybe worth giving a shot
Naming a company for a founder is common
If you're Michael Scott Paper Company.
Or Disney or Ford or McDonald's or Goldman Sachs or 1000s of others. Even in pharmacy, Johnson & Johnson, Pfizer and many others are named after founders.
Cuban isn’t a founder. He just paid to have his name associated with the company (or rather, the company gave him an ownership stake to use his name).
Yeah it just dawned on me that the first name was added because "Cuban Drugs" probably doesn't sound too nice, ha.
He wasn’t one of the original founders, he was an early investor.
Walmart certainly comes to mind.
And Taco Bell
I didn't know that Bell was the founder's name. Thanks for that tidbit!
Welcome. It’s one of my favourites!
Who cares. Honestly. Maybe it burnishes just image. Maybe he dominates the market and makes a mountain of money. Let’s make that trade 1000 times.
Yeah, hope it is a stepping off point for launching a better private insurance company as well.
I feel like he has a shot. But from what I know about him I don't think he'd want the headache.
I just found out that insulin is ten times more expensive in the US compare to Europe. This can hardly be explained without the existance of a price cartel and something seems to be really rotten in the US drug market. Let's hope that efforts like this will help bring prices down to a more reasonable level.
also, supply and demand to a degree. y'all have some catching up to do before you're doing novalog shooters with deep fried dr pepper balls.
At ten times the market price of Europe margins must be huge and supply should skyrocket in a free market.
Listen, Im no phlebotomist or anything, I just calls it how I sees it.
After having looked up "phlebotomist" on Wikipedia I can assure you that I did not have the intention to accuse you of being one.
I looked up a few of the medications I take and the prices were about even with what I pay at Costco. This is great if it is more accessible for more people
Just for confirmation and clarification:
When you say the prices were about even with what you pay at costco is that comparison with or without healthcare insurance paying part of it?
If your insurance paid part of it and its comparable then Cubans pharmacy is a win for those without healthcare insurance.
Costco doesn’t take insurance either
ahh thanks for the clarification, I wasn't aware that they didn't take insurance.
I noticed they have Famotidine and says it requires a prescription for the 20mg but you can buy that amount otc. Their 60ct is only 9 cents cheaper than the Target brand. So I guess you definitely would want to cross-shop a bit.
I still think this is a great service regardless.
So is the cost actually low? The last time this came up on HN people agreed the costs are standard and the other pharmacies do not charge the high prices on the comparisons.
It depends on the drug. Shipping is enough to make it more expensive than Costco or GoodRX in some cases. YMMV.
It would seem to me the appeal of this service is not saving x% on average but avoiding paying x000% more for some niche needs.
This is where it is difficult to judge from where I see it. The last company I worked for had great insurance, really great insurance and this CostPlus in most areas can't beat what I would pay through insurance. However, I am in a new job where the insurance isn't as great, so maybe CostPlus may come out to be cheaper? I havn't delved too much into my current insurance to know yet, but it definitely isn't as good as the insurance I got through my last employer.
"this CostPlus in most areas can't beat what I would pay through insurance"
But are you taking into account how much a month you are paying into that insurance when comparing the two?
If CostPlus is coming close to what you are getting your prescription for with a paid into insurance plan, than I would call that a win for those without insurance.
Might be worth looking at lowering my own insurance coverage to one that might not be that great for prescription, as long as costplus and costco type places come close to after insurance priced meds.
I order a steroid cream and its significantly less than Walgreens for the exact same thing. Just my 1 data point.
Why is this keep getting spammed on HN?
It is being spammed all over the internet (reddit, twitter, tiktok) every few weeks, so my guess is an internet marketing firm.
Because it made the front page of Reddit.
It's an easy way to karma-farm on HN.
So does this work by essentially bypassing the PBM rebates process, and directly negotiating with the manufacturers?
On the homepage they say they markup the manufacturing cost by 15%, include $3 for pharmacy labor, and finally apply shipping and handling based on location. It seem even with such healthy margins they're still an order of magnitude cheaper for some medications. Big Pharma looks obscene sometimes.
"big pharma" aren't cut out of the line, it's the distribution company that sits between the manufacturer and the pharmacy.
> Big Pharma looks obscene sometimes.
Sometimes? The medical industrial complex's MO is to squeeze as many people (in the USA) as they can for every penny they have. The American sheeple have been duped to vote against their own best interest (a single-payer system). We don't have the best medical care in the world and we pay at least 10x for it.
Why do you use the word "sheeple"? What is the intended effect you wish to have on the reader? Is it supposed to be half insulting and half funny like people saying "no shit sherlock", or does the word have a more profound meaning to you?
Your single payer system would end up as yet another bloated inefficient government bureaucracy that never goes away. NHS would pale in comparison. No thanks.
As someone living in a country with first-world healthcare I think it's insane that you have to pay out of your own pocket for medicines, and doubly so that it takes a private company run by someone trying to make *less* money off people to do the job the government should be doing.
The FAQ question I was hoping to see, but did not, was "How is this different from GoodRX?"
From the faq;
> Why are your prices so cheap?
Not native English, but that is not English right?
Edit; guess my school English told me that is wrong ;
- prices are low
- this medicine is cheap
So learned something ;) thanks
It may not be proper, but I'd say it fits for common language. Alternative would be "How are you able to sell for such a low cost?", but that's almost double the number of words.
Could’ve said; why are the prices so low? Not so different.
It just sounds weird to me, because I think I was thought this is wrong a long time ago in school.
Unless it's just because it's early, I can't find anything wrong with it and I've been reading it over for minutes now trying to find what someone might think is wrong with it.
EDIT: As an American, "Why is it so cheap?", and any variant, is completely normal.
> Why is it so cheap
That seems different ; ‘it’ refers to the goods, not ‘price’.
Didn’t know it was common, like said, not native english.
Not sure on the technicalities but as a brit I'd read that without pause, it's perhaps informal at worst.
I am a native English speaker and that is a grammatical sentence.
It is
How is the cost so low? we bypass the pharmacy middleman.
ooooh okay that is really neat
How do I get the drugs? order it from our pharmacy.
Wat?
They bypass the people who sell drugs to existing pharmacies by operating their own D2C pharmacy themselves.
Instead of:
Pharma co -> Distribution -> Pharmacy -> You
It's:
Pharma co -> Cost Plus -> You.
Cost plus is still a pharmacy by definition.
From their site:
"We work with Truepill pharmacy, our trusted fulfillment partner to fill your prescriptions. Truepill has a team of accredited pharmacists who will ensure your medication is safe and delivered to your doorstep on time."
Oh, and guess who owns most of TruePill???
Hint - https://www.optumventures.com/portfolio
There is very little new in the PBM/Pharmacy world from what I've seen, just more layers of redirection and subterfuge :)
Yeah, I'm very familiar with Truepill. They're the secret sauce behind many companies: Hims, Nurx, Roman, etc. Truepill is a _dominant_ supplier of drugs to many companies at this point.
Why is this being pushed multiple times on Reddit and on Hacker News? Seems like a marketing campaign for clout.
Please don't post insinuations about astroturfing, shilling, bots, brigading, foreign agents and the like. It degrades discussion and is usually mistaken. If you're worried about abuse, email hn@ycombinator.com and we'll look at the data.
Anytime I see celebrity name, I assume marketing campaign. Reddit is simply unusable, everything is an ad outside of posts on technical topics.
As was said fondly of computer magazines during the era when they were the size of telephone books and you could shake a rainforest's worth of inserts out of them:
> Everything is an advertisement, and some of it is clearly marked as such.
With the repostings, does this hint that they're looking for additional funding/investment or attempting to further scale the business.