Is this 'round-tripping' thing just a fancy term for why my parents' medication costs more than a car payment? Just trying to connect the dots from their balance sheet to my wallet.

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readthenotes1 5 days ago | parent | next [-]

Not at all. It only explains why a pharmaceutical company has an overseas office.

Your parents medication cost more than a car payment because there's no motivation in the US system to reduce prices for most drugs. Quite the opposite for insurers who provide ACA--they're actually incentivized to increase the cost of care so that the 20% they are allowed to spend on marketing, executive compensation, etc can grow as well.

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zamadatix 5 days ago | parent | next [-]

I can't tell if this is trying to say the ACA should have set it to 0% so there is no incentive, if there is supposed to be something special about 20% which makes executives greedy but at 100% they'd have no interest in trying to make a bigger bonus, or if I'm missing something else completely. I feel like it has to be the latter, I just can't figure out what.

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frogulis 5 days ago | parent | next [-]

My read is: it's saying that if your executive compensation (etc.) is capped to a portion of the cost of care, and if your execs want to be paid more (etc.), then the required change is for the cost of care to increase.

Nothing special about the 20% proportion, just that it's proportional to a number which results in perverse incentives.

	▲	zamadatix 5 days ago \| parent [-]
		Actually, thinking through it again fresh, I think it does all hinge on what the percentage is - but some other variables come into play (it's not a single percentage fits all) and then it quickly turns to madness because of the complexity of the system. If the percentage is higher than the unconstrained optimal margin then the cap has no effect. There's no new pressure introduced yet. If the percentage is lower than the unconstrained optimal margin then the only incentive is to increase the cost to raise the cap until right at the point demand decreases enough that any more cost would actually result in less total revenue. Because medical care is often very inelastic, that'd could quickly be a lot of cost inflation even for just a few percentage point constraint off the optimal margin. This is the part you're highlighting, and that makes sense. The main counteracting force to this would be that a single insurer does not (theoretically, at least) set the cost of care directly on their own, they (theoretically, at least) compete with each other to negotiate the best care rates to have the most consumers go through them. There are several things which practically get in the way of that though, like how often you can actually change insurance plans or how competitive the open insurance market is (if you even have multiple options, some states only have a single marketplace option) vs just sticking with whatever your work offers. Between all of that it is where comes back to the common refrains of "and that's why we need to go to a single payer system without profit as the main goal" and "and that's why we need to get rid of the ACA and let the market handle optimal profit naturally". Everybody can't seem to agree which way to go, just that they don't like the current way. Ironically, these approaches effectively map to the 0% cap (single payer, no profit focus) or the 100% (no ACA cap, free insurance market) interpretation options I originally listed. I'm sure there about a billion other nuances not covered or thought about in this... but at least the comment parses now!

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rolisz 5 days ago | parent | prev [-]

I think it's implying that it gives an incentive to make things more expensive, because then they can make more money. If that profit cap didn't exist, they could make more money in other ways, such as lowering costs but keeping prices the same (or lowering them less).

	▲	AuryGlenz 5 days ago \| parent [-]
		Exactly. I firmly believe that was a poison pill put in the bill to try and eventually push insurance prices so high that Americans would acquiesce to single payer. The alternatives are the bill’s authors were so stupid they didn’t see the negatives to that action, they thought it would play well to voters and the rest be damned, or the some big medical players got it put in - which would be risky, considering option A. But yeah, with that in place they have no incentive to pay out less - they simply can’t have it raise higher than their competitors too quickly. I feel like Republicans would have made a bill just to get rid of that one portion but the voters would hate it so much they can’t because people’s grasp on economics is too simple.

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aDyslecticCrow 5 days ago | parent | prev [-]

We should make insurance companies not allowed to negotiate special pricing for drugs and hospital expenses, and make everyone pay the same regardless if it goes through insurance, which insurer, or out-of-pocket.

Then the cost intensive flips. Insurer wants cheap healthcare and drugs so that they won't have to pay as much. This was part of what the original "affordable care act" tried to do, but was ultimately removed from the version that was passed.

It's also how insurance works by default almost everywhere except in the US.

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padjo 5 days ago | parent | prev | next [-]

Not really, that’s mostly down to how your country does a terrible job a negotiating drug prices compared to other countries with socialised healthcare. On the upside if you’re rich you get the best care in the world.

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terminalshort 5 days ago | parent | prev [-]

Your parents medication costs more than a car payment because developing medication is expensive. Developing medication is expensive partly because it's just innately expensive, but mostly because going through the bureaucracy of getting it approved is really expensive. You want cheaper medicine? Then make that faster and cheaper. But there are tradeoffs.

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aDyslecticCrow 5 days ago | parent | next [-]

The us spends more money on healthcare per capita than any European nation (including those with tax funded healthcare). Yet the very same drugs are cheap over here. The very same drugs Europe produce, put in airplanes and fly over to the US for the US market.

Are Europe just better at R&D then? Does Europe have more lax medication regulations? That is what your argument would suggest. But i somehow doubt that.

Looking at the share prices of the top medical industry companies in the US, from insurance to medicine production to private hospitals, it would seem there is plenty of margin going elsewhere for some reason.

Are we also ignoring that a lot of medical R&D is funded by grants and government investment? Its odd how the pharmaceutical companies are sooooo strained for money from the (partially already paid for) R&D that they have to take out a 600% margin on the product to cover it for decades after the drug has been on the market.

But it's clearly the famously harsh American bureaucracy that cripples the US market compared to Europe and Asia (the very same bureaucracy that created a self inflicted opioid crisis by being overly swayed by pharmaceutical lobbying)

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bfg_9k 5 days ago | parent | next [-]

I think you'll find if you spend a quick second googling, that Pharma is by and large the biggest spenders of money on R&D out of every major industry as a % of revenue.

https://www.strategy-business.com/feature/What-the-Top-Innov...

And what you're failing to account for, is all of the failed research that they do that goes nowhere. Yes, they charge big margins on old drugs, however what do you think happens to all the money that gets spent on drug research that doesnt do anything?

	▲	aDyslecticCrow 5 days ago \| parent [-]
		Most medical research doesn't go up in smoke if it didn't lead to a production drug. And i don't argue R&D isn't a larger portion of what pharmaceutical companies do. Although the statistics is old (2017), its interesting to compare the $2.2 billion total spent by all US healthcare companies listed (2017) compared to the $38 billion tax money spent by the NHS on research grants to medical research 2024. (80% of their budget of $48 billion) Even assuming very generous increase of the medical research budget since 2017, makes N.H.S. research grants a significant portion of medical research that the expensive drugs supposedly cover? https://www.nih.gov/about-nih/organization/budget And again, this is somehow only an issue in the US. Why does European and Asian pharmaceutical companies produce cheaper drugs and cutting edge medical research as a competitive rate, if the high cost of the drugs is to needed to keep them afloat? The statistics you sent also seem to show non-us pharmaceutical companies regularly spent more % of their revenue on R&D. What gives? --- And again, i didn't single-out pharmaceutical companies specifically. I blamed all of US medical industry, from the hospital to the insurance. The pharmaceutical companies seem to charge quite reasonable prices to the insurance companies. Odd how much more it costs to buy it without insurance though (the cost is to cover R&D right?.... right?) --- I'll be even more spicy. If your goal it so save as many people as possible, and R&D truly is single-handedly the reason drugs and drugs and medical care is so expensive (which i think is blatantly incorrect); The US should just stop doing R&D entirely. You could save vastly more lives with the drugs already in existence, which is prevented because the US healthcare system is so fundamentally broken. But i don't think it would do squat because there are a lot of other things affecting the price of drugs and healthcare than that. Cutting out R&D not do squat on healthcare costs.

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terminalshort 5 days ago | parent | prev [-]

You may want to look at the financial statements of pharma companies before making claims like that.

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anonymous_user9 5 days ago | parent | prev | next [-]

The perverse incentives of insurance companies and an equal if not greater factor than regulator burden.

Insurance companies are not incentivized to lower costs, because it allows them to charge more. Pharmacy Benefit Managers eliminate the price bargaining power of even the largest pharmacy chains. Healthcare is complex, expensive, and required for life, which make it inherently susceptible to market distortions.

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khalic 5 days ago | parent | prev | next [-]

Absolute bullshit, drug prices are set according to how much they can squeeze out of it. It’s borderline dishonest to pretend the prices correspond to R&D expenditure

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dokyun 5 days ago | parent | prev [-]

Bullshit.