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by tptacek18 hours ago |
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upvoteby sudopsuedo18 hours ago|
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The 9.2% figure is pharma's direct share of NHE, but drugs are a net-positive externality. Cheap statins can stave off cardiac surgeries, GLP-1 can stave off bariatric surgeries, etc. It's ridiculous to conclude we would only save 9.2% on costs--this is not zero-sum.

No comment on drug pricing and its incentives, the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap.

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upvoteby onraglanroad18 hours ago|
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> the existence of America's prescription drug markets drives the new innovative drugs that the rest of the world picks up for cheap.

That's the ludicrous propaganda that you've been fed but you really should be intelligent enough to dismiss it.

The world would get along just fine without you overpaying for your drugs. You pay for marketing costs.

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upvoteby nine_k17 hours ago|
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Mostly not marketing (still large), but the R&D costs and clinical trial costs. The latter are in hundreds of millions to billions range for the entire journey from a promising discovery to an FDA-approved medicine.
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upvoteby dv_dt13 hours ago|
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Every time Ive looked into it marketing is more than half of the costs of US pharma companies - and I would suspect even more as don't know if there has much work to unmask even more of that spending via channels that can occur in ways not obviously marked as marketing or at least are really not core to research and manufacturing.

e.g. is all the "discount coupon" pharmacy rigamarole considered marketing or administration.

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upvoteby mdorazio9 hours ago|
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This is not correct. Here's Pfizer's 2025 annual report [1]. Total expenses for the year were $55.1 billion. Advertising expenses were $2.7 billion of that, or just under 5%. R&D expenses were $12.1 billion, or just under 22%. They do have a lot of SG&A, but the large majority of that is not going to marketing.

[1] https://d18rn0p25nwr6d.cloudfront.net/CIK-0000078003/908eb6a...

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upvoteby dv_dt9 hours ago|
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Advertising is only a subset of marketing. From that doc, look at operating costs: SGA was ~$11B and R&D ~$12B - basically 50/50. Pfizer is very international, so is pretty difficult to break out US operating costs and what marketing vs R&D is for just the US. But one can also assume US marketing is higher than any other nation as direct-to-consumer advertising is primarily only allowed in the US.
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upvoteby thrwaway5515 hours ago|
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Why not just research it outside of the US if the problem is the FDA cost
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upvoteby phyzix576113 hours ago|
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You still need the same FDA approval and process to sell it in the US
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upvoteby thrwaway5513 hours ago|
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Cost cut them. You think the administration won't take a bribe at that point?
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upvoteby estearum6 hours ago|
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Because the problem isn't the FDA cost

The problem is proving your drugs work

It's very hard and expensive to do

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upvoteby standardUser15 hours ago|
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Right, but the idea that Americans specifically should pay higher prices is beyond propaganda. It's Stockholm Syndrome-level delusion. Big Pharm has thrived for generations on our research universities (for the time being anyway) and had a front row seat to expanding foreign markets under US-led globalization. In return, we get the world's most expensive healthcare system and the privilege of paying too much for meds because our leaders won't cut a deal. All they have to lose is the "hundreds of millions to billions range" in annual lobbying expenditures by Big Pharma.

In a sane world - or literally any other country - that $300-$500 million in annual lobbying would be the literal difference that makes medicine accessible for those who need it. Instead, it goes to expensive lunches.

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upvoteby mlmonkey3 hours ago|
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Agreed. I mean, where did the COVID mRNA vaccine come from? Which company makes the GLP-1 inhibitors like Ozempic and Mounjaro? Are these American companies?
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upvoteby tptacek18 hours ago|
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That's an interesting argument --- that massively increased access to pharmaceuticals would have knock-on impacts on other cost areas in the NHE.

I think if we dig into the numbers we're likely to find those effects, even if we maximize them, are marginal, unless we do other structural things to untangle the provider pricing system and do price transparency. Like: you could posit a material impact on CVD costs by making statins more widespread, and that should make a dent somewhere, but I don't know that CVD costs in non-Medicare-insured patients are really that big a line item, and non-Medicare is important here because people already Medicare-qualified generally have all the statins they want already. Meanwhile, providers are still ripping patients (and insurers) faces off for shoulder impingements, stents, and spinal fusions.

It's a super interesting comment. Thanks!

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upvoteby duped16 hours ago|
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Even if it's 10% in aggregate it could be much higher for individuals and families that are screwed over by drug pricing.

But anyway we really do need to go after providers and end the racket that is employer provided health insurance.

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upvoteby tptacek16 hours ago|
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Wait, I hate employer-provided health insurance and think it's a terrible policy but what does that have to do with providers charging everyone --- including Medicare! --- way too much for services?
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upvoteby kasey_junk11 hours ago|
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It’s a round about recognition of the agency problem in the medical industry.

If people chose and directly paid for there own medical bills and insurance then extra fees and extra diagnostics would be born directly by the person paying for it, who would have the freedom to make other choices, like picking insurance providers who were better at preventing it.

At least that’s an argument you can reasonably make. I’m not sure it would hold up in practice given how different medicine is from other markets.

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upvoteby dv_dt12 hours ago|
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The health insurance industry drives highly increased administrative costs - costs which the insurance companies are happy to foist off onto non insurance channels?
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upvoteby rexroad6 hours ago|
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[dead]
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