Providing a chain of reasoning to support a logical conclusion is not “pro bono PR for those companies”. Claiming that someone doing that seems like an emotional kneejerk reaction to an idea that does not jive with the model of the world you would like to have.

I even provided an example of a healthcare provider choosing to be more transparent. It is always Eli Lilly’s choice to sell their medicine at a flat price to everyone. But it is also in Eli Lilly’s benefit to engage in price discrimination, so that they get paid more by people who can pay more:

https://en.wikipedia.org/wiki/Price_discrimination

Another example of this was when I was in college, US textbooks cost multiple times more than the international version of the textbook I could buy on Abe books or whatever website. Or, coupons for grocery stores. The insurance company has no hand in this.

To be clear, insurance companies also cause waste, because the government does not audit them, and the insurance companies are not staffed appropriately to resolve disputes in a timely manner.

> it has a problem of supply being nowhere near demand,

Get rid of the patents and this will solve itself in no time.

> The insurance company has no hand in this.

False. Insurance companies in the US own stock in big pharma firms like Pfizer, Johnson & Johnson, Eli Lilly, etc. They maintain substantial investment portfolios and generate returns on premiums and reserves. They also have voting rights as institutional investors.

Yes, no one is stopping US (or other countries’) taxpayers from paying for all the drug trials so that the resulting medicines are in the public domain.

> False. Insurance companies in the US own stock in big pharma firms like Pfizer, Johnson & Johnson, Eli Lilly, etc. They maintain substantial investment portfolios and generate returns on premiums and reserves. They also have voting rights as institutional investors.

This is a wild assertion. The sum total of all 7 publicly listed insurance companies’ market caps is less than Eli Lilly, just one pharmaceutical company. I would need some evidence before believing that health insurance company leaders have any influence on pharmaceutical companies.

I would also be surprised to learn insurance companies hold specific stocks, seems like a risk insurance companies would not take, especially ones that have lots of routine cash expenses. They spend ~85% of their premiums on medical expenses, and probably at least 5% to 10% on their own staff, so they shouldn’t even have much extra cash left to invest for the long term.

https://www.oliverwyman.com/our-expertise/insights/2023/mar/...

> This is a wild assertion. The sum total of all 7 publicly listed insurance companies’ market caps is less than Eli Lilly, just one pharmaceutical company

Why are we using market cap as a metric ? Look at investment value.

From the NAIC report at https://content.naic.org/sites/default/files/capital-markets..., common stock holdings alone of U.S. insurance industry is roughly ~$1.2 trillion.

"Over the past 20 years, health care companies spent 95% of their net income on shareholder payouts, totaling up to $2.6 trillion, according to the research findings. Shareholder payouts also tripled over this period - a trend largely shaped by a few powerful pharmaceutical companies, the research team noted."

https://medicine.yale.edu/news-article/health-care-company-p...

The U.S taxpayer already pays for this. ~40% of FDA-approved drugs have direct NIH funding behind them. Nearly all modern drugs rely on NIH-funded foundational science. Taxpayer money additionally also floats through BARDA, DOD and DARPA.

COVID mRNA vaccines (Pfizer-BioNTech, Moderna) got billions in public funding. Yet, patents usually belong to the private company and prices are not capped as a condition of public funding. It is gross corruption begging for heads to be put on pikes.

Correct, people should be asking their federal politician why the US federal government is not spending the few billion dollars on drug trials to avoid having to pay extra to pharmaceutical companies.

But instead, people rail at health insurance companies and pharmaceutical companies and others who can’t or won’t make a difference.

> But instead, people rail at health insurance companies and pharmaceutical companies and others who can’t or won’t make a difference.

Because this is the Corrupt Evil Nexus that continues to ensure that taxpayer funds and exclusive patents keep flowing to them, while keeping prices high. They buy political power via campaign financing by the bucketload and the congressman/woman changes their vote to kill bills that would make a difference. You can find dozens of examples. Do your own research. Look at what happened to the bill to permit Medicare to negotiate drug prices. Look at who received bribes and from whom to vote "No".

Which bill are you referring to? The 2022 Inflation Reduction Act passed with a provision allowing Medicare to negotiate drug prices.

(Although it is, of course, true that having special drug rates for Medicare trends against rather than towards "clear and consistent pricing".)

I am talking about the "Medicare Prescription Drug Price Negotiation Act of 2021", then "Medicare Drug Price Negotiation Act", then "Elijah Cummings Lower Drug Costs Now Act". They all had MUCH stronger drug-pricing proposals, all got stalled shamefully, with a watered-down version in BBB, which was further diluted in IRA that big pharma laughed at and accepted.

More specifically, the stronger acts which were killed by Big Pharma bribes would have

- Tied U.S. prices to international reference pricing (e.g., prices paid in Europe)

- Broad Medicare negotiation for many high-cost drugs - including dozens of new drugs.

- Applied negotiated prices beyond Medicare in the commercial market. (Private Insurance too!)

- Imposed strong penalties on drug companies that refused to comply

- Generated large federal savings. Also would have had faster rollout. Remember IRA pricing is YET to come into effect.

PS: Look at the Senators who diluted drug-pricing in BBB even further to a bad JOKE. (lol at price reduction for 10 drugs in 2026). Look at whom they received bribes oops..donations from.

> US textbooks cost multiple times more than the international version of the textbook

I mean, I think a lot of the incentives behind textbook pricing in the US are honestly not that dissimilar to the ones in healthcare. I know Pearson is particularly egregious for price gouging students because they have exclusive deals with schools to provide the textbook for some specific class or subject. They raise prices because f*ck it why not, they won’t get pushback, which is not a valid reason to do so in most other countries.

"they raise prices because f*ck it why not, they won’t get pushback"

This applies to more and more businesses these days. Textbooks, hospitals, colleges, veterinarians and so on. They basically have a captive audience so they do whatever they want.

What you gave us wasn’t a chain of reasoning: you just regurgitated the industry’s preferred excuses (“it’s complicated”, “people will use too much healthcare if it’s cheaper”, “liability!”) while begging the questions of whether those are true or why they affect the United States far more than any other advanced country. If you wanted to construct a logical chain of reasoning, that would be far more interesting than repeating another round of simply asserting that the status quo is inevitable.

If you need proof that delivering cutting edge services requiring split second decisions and multiple highly qualified people who are liable to the tune of millions of dollars for each decision is not complicated, then we are living on different planets.

> If you wanted to construct a logical chain of reasoning, that would be far more interesting than repeating another round of simply asserting that the status quo is inevitable.

You are welcome to explain why an insurance company would want to make things so complicated. They don’t make it so complicated for claims on a vehicle or a house. They are earning meager profit margins with the situation as is. There is literally nowhere they could go except up…why are they choosing not to?

And if you can come up with a more efficient system to administer insurance, I’m sure a few rich people like Dimon and Buffett and Bezos would be interested in your services. These two “titans” of industry couldn’t figure out how to make it better.

https://www.forbes.com/sites/brucejapsen/2021/01/04/amazons-...