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Re:Illinois governor signs law capping insulin costs at $100... by toomuchtodo on Wednesday January 29, 2020 @11:20AM (#22182186)
I don’t demand my roads, libraries, or other public goods turn a profit. I wouldn’t demand the same of public pharma research (NIH, DARPA).

Perhaps the market is not designed for this sort of endeavor (drug research). Let government stand in where the market has failed.

Re:Illinois governor signs law capping insulin costs at $100... by rayiner on Wednesday January 29, 2020 @11:36AM (#22182435)
Except the market has succeeded fantastically. In my lifetime alone, AIDS and HepC went from death sentences to chronic conditions. Many forms of leukemia went from fatal to highly treatable.

Meanwhile, what has the government done? The trip from DC to New York on Amtrak is slower today than it was in 1960. In 1980, DC’s Metro had self driving trains. They had to shut that down in 2009 due to lack of maintenance and the unions. Spending on public education, adjusted for inflation, per student since 1960. But achievement hasn’t budged one inch. If the drug industry has failed, what words are in the English language for what the government has done?

Re:Illinois governor signs law capping insulin costs at $100... by bildung on Wednesday January 29, 2020 @12:51PM (#22183561)
> Except the market has succeeded fantastically. In my lifetime alone, AIDS and HepC went from death sentences to chronic conditions. Many forms of leukemia went from fatal to highly treatable.

Meanwhile, what has the government done?

Exactly that: "NIH funded the majority of support for HIV/AIDS, infectious disease and oncology research." https://www.thebalance.com/who-funds-biomedical-research-266...

Re:Illinois governor signs law capping insulin costs at $100... by learc83 on Wednesday January 29, 2020 @12:19PM (#22183108)
Of course you can find examples of where the private sector outperforms government. And I can provide counter examples. I just moved to a much smaller city (in the same region) with gigabit municipal internet. For the same price that I was paying comcast for 50 mbps internet, I now have 20 times the speed with no data caps.

The market works great until it doesn't. The interstate system, and the military are 2 prime examples where the market is never going to provide a solution. Affordable medical care for everyone is another.

Re:Illinois governor signs law capping insulin costs at $100... by rayiner on Wednesday January 29, 2020 @12:54PM (#22183608)
I’m not just giving examples. Education and infrastructure are two of the big pillars of why we have government in the first place, and US government bodies have failed miserably on both fronts despite enormous funding.

As to municipal internet—its great until it’s not. Maryland has municipal cable systems that were built a couple of decades ago, and they have struggled to keep up with the DOCSIS upgrade treadmill. Additionally, what problems exist with broadband in the US are largely government created. Comcast has no data caps almost everywhere in Maryland, because it’s in competition with Verizon. The only place that’s not true is Baltimore—where the city legally prevented Verizon from coming in and competing with Comcast. Verizon wanted to wire up Baltimore—the city wouldn’t allow it to do so.

Speaking more generally, DC Metro was snazzy at first too, but was unable to maintain the system long term. It’s interesting you focus on the price point: is $50 sustainable? Charging too little is actually a big problem. A subway ticket in London can cost 2-3x as much as one in New York, despite the two systems being very similar in age and size. Unsurprisingly, the London subway is doing fine and the New York subway is falling apart.

Re:Illinois governor signs law capping insulin costs at $100... by vkou on Wednesday January 29, 2020 @01:54PM (#22184407)
> I’m not just giving examples. Education and infrastructure are two of the big pillars of why we have government in the first place, and US government bodies have failed miserably on both fronts despite enormous funding.

I would posit that the only thing that is a bigger failure than the public school system, is the private school system.

It's numbers look good, but that's largely because private schools are more expensive, and also opt out of educating problem students.

Re:Illinois governor signs law capping insulin costs at $100... by mmhsieh on Wednesday January 29, 2020 @11:59AM (#22182810)
there is a distribution of talent in the government as there is in a private enterprise. the talent is distributed as much across functions as within them. where government "chooses" to be excellent, it is. such pockets of excellence are nurtured by funding, top cover and insulation from the inefficient and less competent parts of government. if policymakers wanted to create an enclave of excellence in public pharma, it could. if.
Re:Illinois governor signs law capping insulin costs at $100... by ska on Wednesday January 29, 2020 @02:39PM (#22184916)
I'll just note that there is a false dichotomy here, because it is impossible to separate government funding and policy from most pharma and biomedical developments. They continue to do much of the heavy lifting, and there is no model really for doing it at all privately.
Re:Illinois governor signs law capping insulin costs at $100... by cat199 on Wednesday January 29, 2020 @12:53PM (#22183594)
> The trip from DC to New York on Amtrak is slower today than it was in 1960.

serious question - does a profitable private passenger railroad company that actually owns/maintains tracks, stations, etc exist without subsidies anywhere at all in the world? And Amtrak itself is nominally public-private and was formed in reaction to purely private railroads collapsing..

> In 1980, DC’s Metro had self driving trains. They had to shut that down in 2009 due to lack of maintenance and the unions.

even if the trains were self driving, for the 10y or so I lived there before this, there was still a conductor, so not sure if this is really a good argument..

Re:Illinois governor signs law capping insulin costs at $100... by rayiner on Wednesday January 29, 2020 @01:03PM (#22183738)
> serious question - does a profitable private passenger railroad company that actually owns/maintains tracks, stations, etc exist without subsidies anywhere at all in the world?

Hong Kong, Japan. But my point is narrower than that. I’m not saying governments in general cannot run decent train service. I’m saying Americans cannot. We’re culturally defective in that respect.

> even if the trains were self driving, for the 10y or so I lived there before this, there was still a conductor, so not sure if this is really a good argument..

They had a conductor for safety. But the self driving trains made the ride very smooth and allowed tighter headways. Even after 10 years, Metro conductors cannot properly stop at stations. To avoid overshooting the platform, they stop way short, and then jerkily inch into position. When I was growing up, headways on the orange line were 6 minutes and the WMATA trip planner was accurate. Today, it’s 8 minutes, because they can’t sustain the 6 minute headways. And they had to revise the trip planner a few years ago to increase the predicted travel time between stations. If you look at Metro advertising from the 1980s, station to station trip times today are 30-50% longer.

Re:Illinois governor signs law capping insulin costs at $100... by selimthegrim on Wednesday January 29, 2020 @12:24PM (#22183163)
How was that market motivated? Did private companies take a leading role in AZT or Sovaldi research (I’m talking about the origins of Sovaldi not the efficacy studies and packaging)
Re:Illinois governor signs law capping insulin costs at $100... by fjp on Wednesday January 29, 2020 @11:30AM (#22182342)
"Markets" are poorly designed for health care/research investment in general. Just like roads, education, general science research, etc... It just doesn't play well with being largely run with a profit motive.

That's not to say there's on place for the private sector there, but there is massive friction between a profit motive in drug research and you know, building a more healthy society. See the "new Adderalls" like Vyvanse that offer no benefits over Adderall, but Adderall's patent is up so it can be made by generics and isn't as profitable anymore.

Re:Illinois governor signs law capping insulin costs at $100... by zip1234 on Wednesday January 29, 2020 @12:02PM (#22182863)
Competition is what drives down costs in a market. If costs are going out of control, perhaps there is something in the current system that is preventing competition? Lack of price transparency?
Re:Illinois governor signs law capping insulin costs at $100... by fjp on Wednesday January 29, 2020 @04:07PM (#22185834)
Lack of price transparency is an issue. There's waaay too many misdirections and misaligned incentives between the price a consumer pays for a drug and the manufacturer's pricing.

But again, market-based solutions are just not appropriate for essential health care. You would pay ANYTHING to not die - there's no price elasticity of demand.

Every other developed country has figured out that this is simply immoral.

Re:Illinois governor signs law capping insulin costs at $100... by conanbatt on Thursday January 30, 2020 @01:55AM (#22189461)
Competition drives down profits, not necessarily costs. If you passed a law that funds pharma startups to produce drugs, you would reduce profits and increase costs (through taxes).

Cost goes down with increased productivity. Competition sometimes brings that, sometimes it doesn't.

Economics can be complex!

Re:Illinois governor signs law capping insulin costs at $100... by learc83 on Wednesday January 29, 2020 @11:31AM (#22182355)
As long as we have effective monopolies on new drugs, (either through patents or trade secrets) the market cannot function to drive down prices. I don't know why people like to pretend that it can. Life saving drugs are as close to perfectly price inelastic as you can get assuming no competition.