But I had a similar condition in my childhood. Many doctors thought it was some form of complicated asthama or something but couldn't figure out what exactly was it.

Then my parents put me in an breathing camp (yoga retreat kind of thing). I was there for six months and we were convinced there that breathing is life. Breathing is the most important thing in and for life. And slowly, the condition disappeared.

The condition was more of an impediment in the brain blocking the breathing command when I got upset unlike some incurable damage to the lungs. Just teaching and reminding us to breath every second for six months made things a lot better.

If there's no such camp/retreat in your country, you could try India.

The tyranny of prescription required isn't worth it.

I'm not sure drug importation will work though, not because it's a bad policy per se, but I'm not sure that other countries will let the US import their low-cost medicines if US law changes in order to protect their domestic supplies.

There's Canada as an example case. We have ~10x the population of Canada, and California alone could use up all of Canada's medicines. Not sure Canada would go for it.

Think it's worth a shot though. I know there are some trial programs going into place in Colorado and Florida around allowing drug importation. Will be cool to follow and see how they play out.

Re-importation shouldn't be illegal, but it shouldn't be necessary - it's really kinda dumb. Other countries have solved this problem by making healthcare universal, and forming a bulk purchasing group which strong-arms providers into charging something the system can bear. The end user doesn't have to care how much that is, because most developed countries simply pay for the drugs people need in the first place.

The ideal way to obsolete this problem is to follow their lead - get Medicare for All to happen and restore Medicare's ability to negotiate the price of drugs directly with manufacturers.

Then nobody has to pay for the drugs directly in the first place.

In effect, it's about 're-importation' of drugs, not so much regular import.

The Government of Ontario negotiates drug prices for it's citizens, as to other entities elsewhere.

By selling to XYZ regime at ABC price, drug companies create a situation wherein 'the resulting price will be the lowest price we sell to any regime' - because of course everyone will want to import from there.

In many cases, the price sold to XYA regime isn't quite a very good measure of net market prices.

Ergo, it's a weird law, but it's rational on a level.

To start - there could be a slew of laws requiring transparency on pricing for everything in the medical domain. That would be a good start.

More challenging - Americans could actually get together and start negotiating hard on prices. This may require some legislation.

So the 're-importation' issue is an artifact of an odd system, not in and of itself the issue.

For example, one thing most other developed countries do is have a central state agency negotiate prices for drugs for the whole country at once, which exerts a lot of buying power to drive costs down.

The idea of Medicare in the US doing that has been proposed several times, but has been blocked, most famously during the initial ObamaCare debate.

The stated reason for blocking that is that decreasing reimbursements would decrease the profit motive for pharma companies to innovate and create new drugs. The more practical reason is.... probably just that lobbyists exist.

But that is just one policy among many. We are simple folk here at the MCCPDC, we just charge less. :-)

Our initial drugs are supplied on "private label" arrangements where other companies actually do the manufacturing, and we just add our labels and our own NDC code so we can set the price. Since we don't go through middlemen, that price can often times be a lot lower.

We'll have to source API (active pharmaceutical ingredients) elsewhere for now. At some point, would like to completely internalize our supply chain, but one step at a time. :-)

I suspect their intended mission is to cover their costs with only a modest profit and thereby drive down prices where they are most inflated.

Given the proliferation of people like Martin Shkreli and companies like Purdue, there's a lot of pharmaceutical fruit out there to be pulled down and made low hanging once more.

God I hate myself for being that guy, but neither of the drugs you’ve listed are actually MAOIs. I’m sure the point still stands though.

Would be looking for folks to help make a more robust consumer facing site as we add products and different types of customers.

We've been focusing mostly on filling roles for the sterile fill-finish facility we are constructing in Dallas (QA, formulation specialists, etc.) and have put building out the dev team for the web sit kind of on the backburner with me just kind of personally managing it at the moment.

While Hacker News is looking though... :-)

Here's a brief video that breaks down some of it though: https://www.youtube.com/watch?v=15IQO_jTMUM

When it was our cat's time too, I was struck by his end of life experience versus that of a human. Whereas a human could have exhausted their life savings on futile treatment or end of life hospice care, Denver cat went quietly into that good night on his favorite blanket surrounded by his loved ones.

I'm currently in need of some very common medical treatment, but the maze of providers I need to go through in order to get a referral just ain't worth it. Versus, if I were a cat or dog, I could simply go to the area university veterinary hospital and likely get my answer same day.

I had to get an MRI from a vet hospital in the past. It was still over a thousand bucks, and in the range of quotes I'd gotten for human MRIs before.

I wonder what similar stitches in an urgent care vs a primary care office vs an ER for a human would cost.

The vet always guilts me into some sort of stupid test. Usually I walk out of there $300 lighter.

Some of the bills that I've run into have still managed to approach the cost of routine visits at some specialists when billed to my HSA.

What I’m getting at is that for most animals the owner can be compensated for accidental death easily. (How much is a head of cattle at auction?)

Not that this explains all the discrepancy, but it may explain a non trivial percentage.

I generally agree with your sentiment - regulation and insurance overhead are big costs. I do think some people should be able to do the basics at home if they wanted. Basic sutures are a pretty good example, you could even save that $150 that you mentioned.

By contrast your odds of a catastrophic collision have more to do with drivers and driving collisions than they do with whether you got an oil change recently. If they were insuring your cost of major repairs and buying a new car, then they would have an incentive to get involved with routine maintenance as well.

I think the two practical problems with this view are (a) what's routine to you might be catastrophic (or at least seriously detrimental) to someone else, and (b) missing routine care often leads to catastrophic outcomes.

So it's not entirely out of the question that they could give discounts for properly maintaining your vehicle, if that were a major cause of accidents and it could be tracked.

It's a healthcare regulations being used as corporate welfare problem.

Have I ever experienced that "come back in an hour" phenomenon? You bet. Then I went to a different pharmacy.

An equally imaginary number that gets hauled out during debates so that health care providers can pretend that insurance companies are the ones responsible for price inflation. If you actually try to obtain the cash rate, they'll give you a 2% "lol nice try" discount off the billed rate.

(I know this because they screwed up billing the insurance company and got denied, and tried to switch me to cash and bill me the higher amount instead. I love our healthcare system.)

Medicare + Medicaid costs US taxpayers as much per capita as the NHS costs UK taxpayers per capita. Only the NHS provides universal cover for that cost.

US taxpayers are in effect paying twice.

You know how a drug can be tier 2 ($25 copay) or tier 3 (20% coinsurance)? That often the manufacturer offering a lower price in exchange for easier and cheaper access for patients.

Drug companies can also rebate on the back end. If an insurance pays for 1,000 vials of drug, they get a 10% rebate. 2,000 vials, a 20% rebate.

The long term trend is not good; why become a psychiatrist when you can earn more as almost any other specialist? (With exception of pediatry). Jails are collectively America's largest mental health service providers. If there was money in psych work you'd see even private equity pump it up like urgent care chains.

Even with single payer or heavily regulated universal insurance schemes there's often a mental health services gap.

I think that is more a supply/demand issue.

I am not sure why people aren't rushing to become psychologists, it seems like it'd be a profitable field, but there is certainly a huge shortage, at least in major metro areas.

I'd really like to read a proper analysis of the situation...

How is any of this libertarian? The libertarian solution would be that only individuals would be allowed to purchase insurance, that insurance would distribute funds to the individual (not the doctor or pharmacy), all fees would be provided prior to service being rendered and individuals would purchase meds without a prescription.

In general, the US has a problem where it pretends to love free markets, but when you look under the hood there's horrific regulatory capture and crony capitalism.

There is so much regulation around anything even remotely medically related. Just look at the HIPPA mess.

Edit: why are you downvoting without rebuttal? Its utterly false to claim the system is libertarian.

Calling it libertarian shows you know nothing about either healthcare regulation or libertarianism.

We need a lot of doctors, more than what we are producing. It's baffling you need 100s of thousands of dollars to become a Dr in the US.

Remove the undergrad requirement to apply for med school, like most of the world, and fix the college affordability problems.

If the amount of money to produce doctors keeps escalating, it's not surprising medical care only goes up.

During the war the US froze wages in order to try and prevent skyrocketing salaries due to the extreme demand for labor.

To compete, most employers started offering generous benefit packages in lieu of the raises they were no longer able to offer.

After the war, the larger employers found that the generous benefit packages were more cost-effective at retaining employees compared to higher pay, so they became "fans" if you will, and have supported the employer-based benefit programs in the US ever since.

One concise reference: https://www.nytimes.com/2017/09/05/upshot/the-real-reason-th...

The Australian private insurance system also works like that. Private insurers have to offer pre-defined tiers with pre-defined coverage.

https://archive.is/WGoir

The average American has $432,000 in net assets, is the second richest in the world (behind Switzerland), and can trivially afford such an expense.

Did you mean that around 12-16% of the population can't afford an immediate out of pocket $400 expense? Because that's the real figure according to the Federal Reserve study that's constantly misquoted.

The median American has a higher net worth than either Germany or Sweden, and among the highest disposable income of any nation.

The US system is absolutely lousy with corruption and ends up diverting a large amount of money toward marketing which is rather baffling - whether a treatment is appropriate or not is a decision I'd rather my doctor made on the basis of efficacy - not because one of the companies had a catchy jingle or because one of them recently took him out to lunch.

Hospital administration does cost a fair amount, but be careful here - it's like education - some of those administrators have moved up the seniority chain to positions where they essentially do nothing and get paid for having their ass in a chair - but a lot of that administration goes to fighting against the extremely aggressive tactics of insurers and manufacturers. While those administrators would ideally be unnecessary due to better regulations being in place they do provide justifiable savings for the hospital (it's cheaper than not having them in many cases) under the current system.

It's all really complicated and murky.

Pharma companies enjoy a profit margin averaging 26%, medical device companies 12%, and hospital groups (which includes non-profits) 8%. Insurance companies are closer to 3%.

https://www.americanprogress.org/issues/healthcare/reports/2...

Healthcare in the US is a scam. There's no other way to look at it.

But the regular uninsured consumer sure gets screwed.

I think this is why there are now self-pay “codes” you can give a pharmacy to get a significant discount off retail price. Sometimes less than your co-pay, but of course then it doesn’t count toward your deductible.

I wish they would simply ban these pricing gimmicks as part of a price transparency law.

There should be one price and one price only the manufacturer can charge in the USA per dose of an FDA approved medicine, with no ability to do price differentiation, period. No more negotiating, no more kickbacks. Insurance should have to show you the actual price they paid, and no other. And then you pay the patient responsibility of the bill based on your standard policy formula.

The same pricing transparency should be applied to labs and procedures where it should be illegal for a given facility to charge two different patients two different prices for the same product or service.

https://www.fiercehealthcare.com/payer/industry-voices-why-i...

So we went sliding scale uninsured, and despite being in the top end of the scale, I ended up paying about 1/3 less than I would have through insurance. I probably still ended up subsidizing some kid who needed fillings worse than I did, which was the only silver lining in that whole stupid affair.

The pharmacist told me that they were having a hard time confirming my insurance. After a ridiculously long delay, I asked how much the drug was to pay for out of pocket... It was $12. My copay was $10 anyway. So both the pharmacist and I wasted a lot of time and hassle trying to save me $2.

  How much?
  30.
  30 dollars?
  30 rupees (~40 cents)

Yes. It is like someone told you a can Coca Cola Coke in US is $220, and their latest innovation is to give you the same for $20.

All while you are picking one up at a convenience Store in EU for $1 and you can get a pack of 8 in a large supermarket for $3.

As you walk out of the convenience Store while drinking your coke, you are left wondering what the hell is going on with people and the world across the pond.

* hospitals run as non profits, so they dont pay federal taxes

* they still pay local taxes, so they need to generate a large loss to offset these taxes

* insurance companies negotiate huge "discounts" on list prices, and then go back to their customers (large corporations) and boast about these discounts, meanwhile the hospital gets its tax writeoff

This entire system is rigged to also grow the number of hospitals/ the overall size of healthcare in america.

Pharma companies play this game too, and anyone who doesnt have insurance can quietly get a "coupon" from them to bring down the cash price to the same as insurance.

No politician will close hospitals, so at this stage any move to "single payer" will just move the boasting role to the government.

Of course, market pressure is much simpler if one manufacturer just decides to do it according to a consistent and justifiable method and stick with it.

https://en.m.wikipedia.org/wiki/Hollywood_accounting

Federal contracts are usually, but not always issued under the rules of the FAR. Within the FAR there are several types of contracts supported including among others Firm Fixed Price (FFP), Cost Plus Incentive, Cost Plus Fixed Fee (CPFF), and Time and Materials (T&M). The other way that contracts can be issued is via an OTA or (Other Transactional Authority) and I won't really discuss those contracts as apart from semantics they usually obey the FAR rules as pertains to this discussion.

In a Firm Fixed Price contract, the contractor is considered to be holding all of the risk. The contractor is responsible for fulfilling the terms of the contract and must meet those requirements even if in doing so they lose money. When bidding a FFP contract, you develop an estimate of the work required, determine what the risks are and assign mitigation costs and likelihoods, determine what your desired profit margin is, and offer the government you best and lowest price. Usually these contracts are competitively awarded although that is not always the case (a). The "Firm" in FFP does not mean that the price can not increase. If the government changes what is desired or incurs costs on the contractor that were not specified in the original contract, the contractor can request equitable adjustment. FFP contracts are most commonly used when producing goods with known qualities that already exist or require slight modification of existing goods in the market.

Cost Plus contracts (Cost Plus Incentive or CPFF) entail cost sharing between the government and the contractor. In a Cost based contract, the government is considered to hold some of the risk. These contracts are generally used as development contracts when a new or significant evolution of an existing system is required. The government is responsible for reimbursing the contractor their costs incurred during development. These costs include both direct and indirect costs. Direct costs are what you would usually assume is meant by cost, e.g. the actual cost of the people and equipment used in pursuit of a single contract objective. Indirect costs are costs that are incurred in support of multiple contract objectives e.g. lighting and power for a building, HR and finance people. Significant portions of the FAR are involved in cost pooling and I won't get into it much more here. Because the government is responsible for reimbursing costs the contractor is not under as great of an obligation to minimize those costs. Effectively, there is a very low risk of losing money on a Cost contract because your actual costs are reimbursed. In cost contracts, the government can use the allocation of profit (fee) as an incentive to have the contractor meet time or total cost goals but is still responsible for reimbursing all reasonable costs. Most major new systems development happens under the guise of Cost contracts although some have been developed using FFP or OTA mechanisms. If the contractor fails to perform, the government will usually still reimburse the costs up to the point where work was stopped. It requires a lengthy legal battle to recover costs in a breach of contract suit.

Time and Material contracts are the most disfavored by the government. They have no performance objective apart from labor. The contractor is required to supply labor in a desired quantity and place but no actual performance (e.g. those 10 guys actually finish digging the ditch) is embedded. These contracts are fairly rare but are used occasionally.

To address the asked question regarding budgets post WW2. The Department of Defense publishes a daily list of every contract awarded above a certain value (I think 2 million) here https://www.defense.gov/Newsroom/Contracts/. Contract modifications (and new delivery orders under an existing IDIQ contract vehicle) Most of the largest of these contracts seem to be awarded via the sole-source justification. It is hard to put the blame squarely on cost contracts. There are cases, say developing a novel weapon system, where the government can not fully articulate it's needs at the starting point. Over-specification of requirements will cause the bidders on an FFP to give higher prices because they must be able to account for every requirement in their bids. When developing a brand new system, cost contracts can be effective although I do agree that the mechanism is over applied. I also believe that the sole source justification to avoid competition significantly undermines the cost control measures of both FFP and Cost contracts.

Now to briefly discuss what I believe is happening with this company. They appear to be functioning under rules most similar to CPFF, so I will analyze along those lines. Do they have a contractual goal? Yes, they have to produce the drugs needed based on transactions and contracts they accept. Do they have a reason to minimize their costs? Yes, their entire existence is predicated on the price differential between their products and those of other members of the market. If they allow their costs to balloon beyond a certain point, it will diminish their marketability. It doesn't mean that the stated margin will be over raw material and production costs as marketing is also included. I would like to see a public commitment to price transparency including all major line items in the cost similar to what is done with not for profit organizations (they have alluded to doing so with the statement "We will let everyone know what it costs to manufacture, distribute, and market our drugs to pharmacies.")

Source: In a previous life I was heavily involved in the bidding and management of DoD contracts.

Also see sections 13-15 of the FAR https://www.acquisition.gov/sites/default/files/current/far/...

Even insulin prices get distorted because you are limited to which types you can buy in you are under medicare.

maybe with their majority the Democrats can finally tell their union buddies to bugger off and pass a single payer or tax high value insurance policies; one major reason ACA was so limited as many of those policies which were going to be taxed were all on the side of public employee union benefits.

Ironically, the Trump administration recently allowed states to import drugs from other countries to enable them to offer lower cost drugs through state run programs, but was still seizing the same products if they were ordered by individuals. While I can't really complain about an initiative to lower drug costs, the mental gymnastics needed to come up with this plan are pretty incredible. "We don't think price controls are compatible with a capitalist society, so we won't implement them. But we campaigned on lower drug prices (since that will increase our appeal among the elderly), so we have to do something. Let's import drugs from countries that do have price controls. But people can't order the drugs themselves, we have to protect them from themselves. We have to order the drugs and repackage them with new labels, because we need American instructions and American warning labels, not the instructions and warnings that the Canadian government is fine with."

Right now, it's better/easier for most people to get their drugs from a local pharmacist with our current system. If Mark Cuban is willing to throw a lot of capital and break up the price collusion between established drug companies, then I suppose it's a step in the right direction. We should be happy to accept lower prices and get to work on fixing other important problems with our healthcare system.

Smart move too, since you will probably get better companies on the show without that sort of policy.

https://www.reddit.com/r/UpliftingNews/comments/l5vv6m/billi...

My impression of Mark Cuban has been built up over the years from a variety of sources, ranging from a brief in-person encounter[1] with him, to reading his book, his blog posts, etc., to seeing him on TV in various forms, interviews he's done, etc. There isn't exactly one specific thing that stands out by itself.

All of that said, it's a very subjective thing, and for all I know Mark works very hard to cultivate that specific image for his own ends. I have no problem saying that my impression could be wrong. But based on the limited evidence I have available, that's where I'm at with it at the moment.

[1]: I don't typically hang out with billionaires or anything. The only reason I've met Cuban is because he was once a keynote speaker at an event I attended. After his speech he hung out with the hoi polloi and mingled and interacted with people. I spent maybe 3 minutes chatting with him personally about my business, and maybe another 10-15 minutes listening to him talk to a small crowd that gathered around him. To be fair, that encounter probably went as far in shaping my impression of him as anything. I think the single biggest thing was that he displayed no condescension or smug superiority or anything towards people who weren't on his financial level. He was respectful, attentive, and reasonable even when talking with some rando like me.

Bezos' parents loaned him a quarter-million dollars in 1995 [1].

Gates' mother, while on the board of directors of United Way, convinced IBM to invest in MS in 1980 [2].

Zuckerberg's parents sent him to the crazy selective and expensive boarding school Philips Exeter Academy and was privately tutored in comp sci before college [3].

[1] https://www.cnbc.com/2018/08/02/how-jeff-bezos-got-his-paren...

[2] https://www.nytimes.com/1994/06/11/obituaries/mary-gates-64-...

[3] https://www.newyorker.com/magazine/2010/09/20/the-face-of-fa...

- They are all the greatest people ever

- They all can afford to employ the most expensive personal marketing teams ever

What about Exxon, AT&T, Aetna, AIG, Goldman, DuPont Chemical, Lockheed, McKinsey?

There's a pretty obvious bias there: the ones you name do good because you named the ones who do good. (which, really, you could examine: how much of that perception is PR?)

We're not lucky to have billionaires. We'd be just as well if there were none at all.

Gates and Zuckerberg were far from models of piety in how they came into their fortune.

Remember, all of the talk of billionaires “paying less in taxes than their assistants” is not based on raw collected amounts, it’s based on percentages. A billionaire with an effective federal tax rate of 15% on 50 million income is paying 7.5 million in taxes, which is more than all of the federal tax collected from the bottom 10% of income combined.

I wasn't aware he was a founder at PayPal. I didn't even know he had worked for them.