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-   -   Glad I don't live in the US of A (https://www.cableforum.uk/board/showthread.php?t=33707498)

007stuart 15-03-2019 17:14
Glad I don't live in the US of A
 
As a major beneficiary of the NHS I am shocked at the cost of Insulin in the US compared to that in other countries.

https://www.bbc.co.uk/news/world-us-canada-47491964

A salutary lesson for those who criticise the NHS and yearn for a free market in the provision of health.


BTW I am not diabetic.

Chris 15-03-2019 17:34
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by 007stuart (Post 35986845)
As a major beneficiary of the NHS I am shocked at the cost of Insulin in the US compared to that in other countries.

https://www.bbc.co.uk/news/world-us-canada-47491964

A salutary lesson for those who criticise the NHS and yearn for a free market in the provision of health.


BTW I am not diabetic.
Almost nobody yearns for an American system in the UK. Those who call for the NHS to be exposed to the market aren’t generally also calling for the dismantling of the principle of free at point of use. They’re calling for market competition at points within the system where it will drive efficiency.

The American system is obscene, and results in startling levels of health inequality in the world’s richest economy, where people ought to have a right to expect the best.

007stuart 15-03-2019 18:14
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Chris (Post 35986847)
Almost nobody yearns for an American system in the UK. Those who call for the NHS to be exposed to the market aren’t generally also calling for the dismantling of the principle of free at point of use. They’re calling for market competition at points within the system where it will drive efficiency.
Yes, just like exposing Royal Mail to the free market, driving efficiencies in that business resulted in the cherry picking of the profitable parts of a universal service and suddenly prices for 1st and 2nd class mail rocket and of course we can "trust" these providers not to make a mistake in setting regulated prices see https://www.bbc.co.uk/news/uk-47331801.

Mr K 15-03-2019 18:51
Re: Glad I don't live in the US of A
 
There are many reasons to be glad not to live in the he US. E.g. The President is obsessed with walls, couldn't give a toss about healthcare....

Chris 15-03-2019 19:20
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by 007stuart (Post 35986853)
Yes, just like exposing Royal Mail to the free market, driving efficiencies in that business resulted in the cherry picking of the profitable parts of a universal service and suddenly prices for 1st and 2nd class mail rocket and of course we can "trust" these providers not to make a mistake in setting regulated prices see https://www.bbc.co.uk/news/uk-47331801.
Letters cost more because the unit cost has skyrocketed, what with us all going paperless. Competition in the small parcels sector has worked brilliantly, even for us out in the sticks where any of half a dozen couriers bring us packages (but hardly any come via the useless Parcel Farce service, which deserves to die on its arse).

richard s 15-03-2019 19:57
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Chris (Post 35986866)
Letters cost more because the unit cost has skyrocketed, what with us all going paperless. Competition in the small parcels sector has worked brilliantly, even for us out in the sticks where any of half a dozen couriers bring us packages (but hardly any come via the useless Parcel Farce service, which deserves to die on its arse).

At least my parcels from PF end up at my local sorting office if I am out, unlike some other private run companies when they deliver e.g. thrown over my rear gate or left by the front door for anyone light fingered to nick it.

Chris 15-03-2019 20:03
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by richard s (Post 35986873)
At least my parcels from PF end up at my local sorting office if I am out, unlike some other private run companies when they deliver e.g. thrown over my rear gate or left by the front door for anyone light fingered to nick it.
Whereas out here, the PF driver is a lazy git who just takes the parcel to the local sorting office and puts the “sorry I missed you” card in the mail bag, so the post man delivers it the next day :rolleyes:

007stuart 15-03-2019 20:13
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Chris (Post 35986875)
Whereas out here, the PF driver is a lazy git who just takes the parcel to the local sorting office and puts the “sorry I missed you” card in the mail bag, so the post man delivers it the next day :rolleyes:
Someone's really got the hump with Parcel Force.

TheDaddy 16-03-2019 02:53
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Chris (Post 35986847)
Almost nobody yearns for an American system in the UK. Those who call for the NHS to be exposed to the market aren’t generally also calling for the dismantling of the principle of free at point of use. They’re calling for market competition at points within the system where it will drive efficiency.

The American system is obscene, and results in startling levels of health inequality in the world’s richest economy, where people ought to have a right to expect the best.
And yet who do we keep exposing our service to, who do we keep inviting to assist with it and who is demanding access to it as part of any trade deal, we might not yearn for them but they're going to have a big say in it's future

nomadking 16-03-2019 02:59
Re: Glad I don't live in the US of A
 
The people in China pay more for Insulin than Australians, so how is a capitalist system to blame?


People are demanding different types (fast/slow acting, long lasting) and different delivery systems.

Angua 16-03-2019 08:06
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Chris (Post 35986847)
Almost nobody yearns for an American system in the UK. Those who call for the NHS to be exposed to the market aren’t generally also calling for the dismantling of the principle of free at point of use. They’re calling for market competition at points within the system where it will drive efficiency.

The American system is obscene, and results in startling levels of health inequality in the world’s richest economy, where people ought to have a right to expect the best.
Also producing the least efficient service at the same time. When 30% of the US health care cost is in Administering insurance payments, the system is borked.

Yet for some reason the Tories seem to love these profit driven health care providers.

Why they cannot look at more cost effective efficient EU systems I do not know?

Hugh 16-03-2019 08:56
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by nomadking (Post 35986915)
The people in China pay more for Insulin than Australians, so how is a capitalist system to blame?


People are demanding different types (fast/slow acting, long lasting) and different delivery systems.
Maybe because 3 companies manufacture 90% of all the world’s insulin, and they set the prices in each market?

https://www.t1international.com/blog...-so-expensive/
Quote:
1. Only 3 Companies Control 90% of the Global Insulin Market

The ‘big three’ insulin producers – Eli Lilly, Novo Nordisk and Sanofi – dominate more than 90% of the world insulin market by value. Often only one of these companies supplies insulin in a country, which means they more or less hold a monopoly there and can set prices as they wish. In some countries, notably China and India, there are domestic insulin companies that can help drive down the price.
The Australian government subsidises their insulin.

https://www.news.com.au/lifestyle/he...2eb3e235657c6a

TheDaddy 16-03-2019 10:16
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Hugh (Post 35986931)
Maybe because 3 companies manufacture 90% of all the world’s insulin, and they set the prices in each market?

https://www.t1international.com/blog...-so-expensive/

The Australian government subsidises their insulin.

https://www.news.com.au/lifestyle/he...2eb3e235657c6a
Frederick Banting gave insulin to the world for free as he recognised the benefit to mankind not so three companies could make fortunes out of sick people

1andrew1 16-03-2019 10:33
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by TheDaddy (Post 35986938)
Frederick Banting gave insulin to the world for free as he recognised the benefit to mankind not so three companies could make fortunes out of sick people
Why don't other companies like GlaxoSmithKline, Merck and Pfizer enter the market then, assuming great profits are to be had if there are monopoly providers setting prices?

Chris 16-03-2019 11:14
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Angua (Post 35986921)
Also producing the least efficient service at the same time. When 30% of the US health care cost is in Administering insurance payments, the system is borked.

Yet for some reason the Tories seem to love these profit driven health care providers.

Why they cannot look at more cost effective efficient EU systems I do not know?
I don’t think proposals to Americanise our health system have ever gone further than the occasional fringe meeting at party conference. You have to bear in mind that “Tories want to privatise the NHS” is a standard, dog-whistle Labour attack line. It has no basis in fact, as is evidenced by the fact that they’ve not done it, nor even proposed it, despite there being a Tory PM and health secretary for 27 of the last 40 years.

Nobody, neither Labour nor Tory, ever proposes looking closely at the various systems operating in Europe because most of them use co-payment, or privately-run hospitals, or both. Despite, as you say, being effective ways of reducing waste and increasing efficiency, such things are shibboleth in British politics, where the NHS is sacrosanct and therefore doomed to struggle valiantly on in more or less its current form.

OLD BOY 16-03-2019 12:36
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by TheDaddy (Post 35986938)
Frederick Banting gave insulin to the world for free as he recognised the benefit to mankind not so three companies could make fortunes out of sick people
So you think they should be manufactured for free?

Hugh 16-03-2019 12:37
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by OLD BOY (Post 35986957)
So you think they should be manufactured for free?
He didn’t say that...

OLD BOY 16-03-2019 12:40
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Hugh (Post 35986960)
He didn’t say that...
Well, that was the implication. As for whether they are over-priced, perhaps they are. But like most things, the reasons for that perception may not take account of all the facts.

Hugh 16-03-2019 12:43
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by 1andrew1 (Post 35986940)
Why don't other companies like GlaxoSmithKline, Merck and Pfizer enter the market then, assuming great profits are to be had if there are monopoly providers setting prices?
From my previous link
Quote:
3. Pay-for-Delay Schemes & Lawsuits

A ‘Pay for delay’ agreement is a patent dispute settlement in which a generic (in the case of insulin, a biosimilar) manufacturer acknowledges the original patent of a pharmaceutical company and agrees to refrain from marketing its product for a specific period of time. In return, the company receives a payment from the patent-holder. This means it is actually legal for one insulin producer to pay another one not to enter the market. A few years ago the company Merck announced plans to sell a biosimilar version of Sanofi’s Lantus. Sanofi sued, and eventually Merck announced that it was no longer pursuing it’s biosimilar, presumably due to payments from Sanofi to stay away. If Pay for delay schemes don’t work, the ‘big three’ can still sue other players, prolonging processes and pushing players out of the market because of legal fees and time-wasting. All of these are win-wins for companies, and lose-lose for patients.

4. Patents

Why aren’t we seeing more companies making insulin? There are many reasons for this, but patent evergreening is a big one. Patents give a person or organization a monopoly on a particular invention for a specific period of time. In the USA, it is generally 20 years. Humalog, Lantus and other previous generation insulins are now off patent, as are even older animal based insulins. So what’s going on? Pharmaceutical companies take advantage of loopholes in the U.S. patent system to build thickets of patents around their drugs which will make them last much longer (evergreening). This prevents competition and can keep prices high for decades. Our friends at I-MAK recently showed that Sanofi, the maker of Lantus, is no exception. Sanofi has filed 74 patent applications on Lantus alone, that means Sanofi has created the potential for a competition-free monopoly for 37 years.


---------- Post added at 12:43 ---------- Previous post was at 12:41 ----------

Quote:
Originally Posted by OLD BOY (Post 35986962)
Well, that was the implication. As for whether they are over-priced, perhaps they are. But like most things, the reasons for that perception may not take account of all the facts.
That’s your implication, not (necessarily*) his.

I read from it that it was to be produced at low/reasonable profit margin - differing views provide different implications.

My brother-in-law currently works as a research VP for a US biosimilar company, and has been on medical drugs research for nearly 40 years (including over 20 years as a research Director/VP at Pfizer and Teva, two of the biggest drugs companies in the world), and he said that Insulin is used by the 3 drug companies as a cash cow, as the manufacturing costs haven’t risen that much in the last 20 years, but the market price has increased by 8-10 times the original price in 2000.

(*I’m not a mind reader, so it’s only my interpretation of his interpretation...)

nomadking 16-03-2019 13:22
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Hugh (Post 35986931)
Maybe because 3 companies manufacture 90% of all the world’s insulin, and they set the prices in each market?

https://www.t1international.com/blog...-so-expensive/

The Australian government subsidises their insulin.

https://www.news.com.au/lifestyle/he...2eb3e235657c6a
The study I was using came a year before that announcement, and if I reading this correctly they used the unsubsidised prices, ie what the Australian government pays.

Quote:
Prices were expressed as a Median Price Ratio (MPR) i.e. a ratio of the local price to a standard set of international reference prices (IRPs). Thus, MPRs describe how much greater or less the price of an insulin product is compared to the IRP. The WHO/HAI methodology recommends Management Sciences for Health’s International Drug Price Indicator Guide as the source of the international reference price (IRP). However, the Guide does not include prices for analogue insulins so was of limited value. Therefore, prices from the Australia Pharmaceutical Benefit Scheme (PBS) [27] were used as IRPs. PBS prices represented reimbursement prices paid by the Australian government. We standardized all prices (PBS and the prices collected in Hubei) to US$ for 1000 IU insulin then calculated the MPRs.

Taf 16-03-2019 16:52
Re: Glad I don't live in the US of A
 
Whilst Big Pharma plays its games, it's the USA health insurance companies that are the real villains.

TheDaddy 16-03-2019 22:24
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by OLD BOY (Post 35986962)
Well, that was the implication. As for whether they are over-priced, perhaps they are. But like most things, the reasons for that perception may not take account of all the facts.
No it wasn't...

jonbxx 18-03-2019 09:05
Re: Glad I don't live in the US of A
 
Quote:
Originally Posted by Hugh (Post 35986963)
From my previous link

---------- Post added at 12:43 ---------- Previous post was at 12:41 ----------

That’s your implication, not (necessarily*) his.

I read from it that it was to be produced at low/reasonable profit margin - differing views provide different implications.

My brother-in-law currently works as a research VP for a US biosimilar company, and has been on medical drugs research for nearly 40 years (including over 20 years as a research Director/VP at Pfizer and Teva, two of the biggest drugs companies in the world), and he said that Insulin is used by the 3 drug companies as a cash cow, as the manufacturing costs haven’t risen that much in the last 20 years, but the market price has increased by 8-10 times the original price in 2000.

(*I’m not a mind reader, so it’s only my interpretation of his interpretation...)
Interestingly, insulin is not regarded as a biological, along with human growth hormone under the Public Health Service Act in the US even though technically, they are. Because of this, the biosimilar abbreviated approval process cannot apply for insulin which means that a pharma company has to go through the whole drugs approval process including clinical trials etc.

This is hoped to change in 2020. Here's the FDAs position - https://www.fda.gov/NewsEvents/Newsr.../ucm628121.htm


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