"Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales."
This describes the biggest problem in US healthcare. No clear and consistent pricing. If we had a real market, you would get a prescription and then go to the seller with the lowest price. And everybody would get the same price. This whole business with PBMs that are owned by the insurance companies, discount cards and other shenanigans just invites corruption.
I just had some bloodwork done, myself. My provider accidentally billed insurance, which had lapsed due to being laid off. I got my "Explanation of benefits" and it was $1000 billed to them, but I was given a $500 "discount." So I only owed $500... Cash cost was $50. Makes no goddamn sense.
Also I went in for a colonoscopy and an endoscopy. Insurance was billed for $14000. I got statements from 4 different doctors, and the facility where it was performed. None of the statements matched the explanation of benefits from the insurance company. And when I called each doctor, to pay them, they all told me that I didn't actually have to pay them what it said I owed. So I just ended up paying $2500 to the insurance company. It again, makes zero sense.
In practice, the whole system is set up in a way that discourages asking questions. Waste of time. It's truly the opposite of the transparent ideal market.
That’s what is insane. I called my insurance to ask if some tests were covered since preventative care is 100% covered.
They couldn’t answer if cholesterol test would count. How is that not automatically classified as preventative? It’s one of the most basic metrics.
So they want me to get the doctor to give me the ICD code and the diagnosis code. Or something. Two different codes. They’ve added so much bureaucracy and crap into the system because they can. Nobody’s stopping them and there’s too many fingers in the pie.
"And everybody would get the same price. This whole business with PBMs that are owned by the insurance companies, discount cards and other shenanigans just invites corruption."
It's hard to say that it isn't racketeering at this point.
"Specifically, a racket was defined by this coinage as being a service that calls forth its own demand, and would not have been needed otherwise."
There's demand for the meds, but the demand for discount cards, forcing people to use specific services/companies, and related programs is all invented by the companies themselves.
Most of the non "cut everything" GOP plans still involve trying to get the consumer to shop around, but shopping around is impossible. The consumer can't be a consumer and impact the market if they don't know what is going on.
The system is fundamentally broken.
I go to the doctor and I have zero clue what will come back on the bills.
And when you get a broken leg you'd go shop around, comparing prices and looking up reviews? You can't have a "real" healthcare market. It is inelastic, people will always pay whatever is asked of them. It requires massive investments, naturally consolidating into a few large actors that are then easily able to join in a cartel, lobby the State for regulatory capture, etc. Price gouging and profiteering are just the end game of a free market functioning normally.
Health insurance in general is the problem; PBMs/discount cards are just a cherry on top. Insurance is fundamentally incompatible with clear and consistent pricing.
Insurance companies do not force the sellers to use complex billing practices, they would benefit from more transparent pricing (since they are seeking to pay less).
The root cause is healthcare is inherently complicated and complex, it has a problem of supply being nowhere near demand, and since prices for things are so high (including liability), there is a lot of cover your ass and fraud prevention going on.
Germany has health insurances and they don’t do that nonsense. They fulfill their task which is to spread the risk over a wide range of people. That’s what insurance is for.
> "Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales."
This sounds like typical negotiating 101. You know you are going to be forced to lower from your starting position, so increase your starting position so when you do negotiate down you are closer to where you wanted to be.
It’s not only a logical negotiating position, it has legal implications.
Way back in the 50-60’s the government put in laws around “usual and customary price” in an attempt to rein in medical costs.
What providers were doing is charging cash customer $10, then when an insured patient came in (back when insurance paid 100%) they charged $100.
So a law was put into place to define what a “usual and customary price” is. The provider could not charge any customer more than this.
Like most well intentioned laws it created perverse incentives to jack up the public price as high as possible - if someone paid it, great, otherwise offer a discount.
As a european living in the US, the idea there is a market at all is laughable. I tried to get price quotes for treatments several time just to get a "well, it's hard to say" or "it's very complicated".
The US' main problem (seen from the outside) is that there seems to be no long term strategy just a sports-like us-versus-them mentality, where each team just thinks about how they can win more by making others lose. Winning the points is the goal, while all people forgot this was supposed to be a friendly game ans some even forgot which sport it is supposed to be.
This may well be the end game of capitalism, no pun intended.
Here in Brazil, we have something called 'Genéricos.' These are essentially the same medications as the brand-name versions, produced with the same chemical ingredients, but they often cost half the price, sometimes even cheaper than that.
Interestingly, while on-patent medications in the US tend to be significantly more expensive than elsewhere, generics in the US tend to be less expensive than generics available elsewhere.
> This describes the biggest problem in US healthcare. No clear and consistent pricing.
For anyone not in the US wondering if this is an exaggeration, here is my history of buying prescription drugs.
1. For years, when I had insurance through my employer, I'd go the the nearest in-network pharmacy, which was Rite-Aid, for them. Those insurance plans always had a copay which was typically $10-15.
It was this way across several different insurance providers I had over the years at that employer. (For non-Americans wondering why my insurance company changed so often, it is common for employers to frequently switch providers to try to save money. Besides that being annoying because it means frequently changing coverage limits, it also means frequent changes in what doctors and dentists are in-network).
2. I saw something about Walmart's generic drug program. They were selling many generic drugs for a cash price of $4 for a month supply and $10 for a 3 month supply. Most of my drugs were included, so for those I switched my prescriptions to Walmart and didn't use insurance.
3. Later, for my drugs not in Walmart's generic drug program, I found that the GoodRx app or website could usually provide a discount coupon that would bring the cash price with coupon down below my insurance copay.
The GoodRx discount could vary significantly from pharmacy to pharmacy so I had my prescriptions split across two pharmacies.
4. My employer downsized and could no longer afford to provide insurance. I switched to a plan purchased on my state's Affordable Care Act (ACA) marketplace. I made too much money to get a government subsidy on my premiums, but not enough to afford a marketplace plan in the top two of the three tiers of plans (gold and silver). I had to settle for the third tier, bronze. That basically meant bigger copays and/or bigger coinsurance on everything, including drugs, than I had when I was on plans through my employer. Walmart generics + GoodRx coupons continued to be how I bought drugs.
5. I eventually switched to an HMO plan from the ACA marketplace, when rising costs made it so even the bronze non-HMO plans were too expensive. This meant I had to switch doctors to one that worked for the HMO (Kaiser), and the only in-network pharmacy was the one from the HMO.
It remained cheaper for nearly everything to continue with Walmart and GoodRx. The only drug I regularly got through Kaiser's pharmacy was generic Lipitor. That was $0. I refilled one of my other prescripts at Kaiser once, and my out of pocket came to twice what that drug was at Safeway with a GoodRx coupon.
I didn't try any of the others through Kaiser because there was no way that I could find to get the price other than actually getting the prescription filled there. Even though it was a Kaiser pharmacy, which is located in a Kaiser building and only takes Kaiser plans (and maybe people paying cash), they have no way apparently to answer the hypothetical "If I get drug X and I have Kaiser plan Y and my ID number is 12345678, what will my out of pocket cost be?".
I would have expected that one of the benefits of an integrated system like Kaiser where it is one company basically providing all of your health care except for some special services they contract out for would be that they could tell you the damn costs. I would have expected that when I'm in the doctor's office and he gives me a new prescription that on his terminal it would have the cost of getting it filled in the Kaiser pharmacy that is in the same building.
Nope. So I'd have to waste his time and mine getting out my phone, looking up the drug he's about to prescribe in the GoodRx app, and then decide where I want it. A nice thing about the GoodRx app was for Walmart if they did not have a GoodRx coupon because the drug was in Walmart's generic program GoodRx would still include it in the listing, showing the cash price so I didn't have to separately check Walmart's generics list.
6. It does get better when you get older. When I turned 65 and switched from a marketplace plan to Medicare I had to choose an insurance company that offered a Medicare drug plan. You can enter all your prescriptions on Medicare.gov and you can enter 5 pharmacies and the listing of available plans in your area will show you the annual total (premiums plug drugs) for each plan for both getting your drugs at the cheapest pharmacies on your pharmacy list and for getting them via mail order. By default it sorts the list by lowest total.
You still have the hassle of plans possibly changing each year. My plan on my first year went away. It was a $0 premium and $0 for all my drugs. There is still a $0 premium and $0 for all my drugs plan available for 2026, but I'll have to change pharmacies to one less convenient.
The above is if you choose regular Medicare when you enroll in Medicare. You can instead choose Medicare Advantage. The way Medicare Advantage works is instead of providing your medical coverage itself Medicare pays a private insurance company to do it. The plans offered by those private insurance companies broadly look a lot like the marketplace plans that offer on the ACA marketplaces or the plans they offer through employers.
They are usually pretty cheap, often with no premium from the insurance company (although you still have to pay a premium to the government for Medicare). Some even have negative premium plans. They also have most of the annoyances of ACA marketplace and employer plans, but there are usually ones that include drug coverage similar to the part D plan coverage for people on regular Medicare.
Why is the supreme-court slow-walking the tariff decision which is crystal clear as lower courts clearly demonstrate only Congress can set taxes/tariffs?
It would end inflation within 90 days
Even their silly 15% tariff fallback law abuse would be more sane than the 50-150% currently
Mate, this Supreme Court ruled that the President is immune to prosecution and de facto outside and above the law. I’m honestly not sure what to tell you if you’re still hoping for rule-of-law decisions to come out of it.
The 14th Amendment says all people born or naturalized in the US and subject to its jurisdiction are citizens.
If someone is immune to prosecution and de facto outside and above the law, I wonder if a case could be made that they are not subject to US jurisdiction, and that invalidates prior citizenship by birth or naturalization.
It slowed down Americans because we aren't recently used to it. The rich did adapt relatively quickly by buying up all the housing they could at negative real interest, stocks, gold, and to a lesser extent crypto.
The lesson has been learned by this point though, even a day laborer is holding silver and crypto nowadays because we have in recent memory the COVID shenanigans of mass QE.
People in China and Russia have basically taken for granted so long that their currency is completely manipulated, they all already knew to not be hoodwinked.
Someone once proposed a National Sales Tax. I think it was suggested that we could eliminate personal income taxes if we imposed a federal sales tax on all purchases.
Liberals vehemently opposed the idea, calling it 'regressive', meaning it would be socially backwards, but the idea held appeal as a simple and fair way of "taxing everyone equally". For some reason, a majority of public opinion leaned left on this particular idea, and it never gained a foothold.
When I learned of the blanket tariffs being imposed on everything imported into the US, I think I knew what I was seeing-- this was a National Sales Tax in disguise. This was an attempt to fund the federal government off the backs of people, who will at the very least pay 10% more for everything they buy.
The big lie was told-- that this was an emergency necessary correction for an ongoing American-life-threatening international trade imbalance. But the real lie was bald-faced, right there in front of us-- everybody was going to have to pay more for everything, because this was, and is, a new tax.
I think there's a slim chance the Supreme Court may not even issue a decision addressing the legality of the president's impertnent array of tariffs. Although two full months have passed since oral arguments were made before the court, we may have an even longer wait for a decision, because it sure looks like John Roberts and company can't find/manufacture a reason to uphold/allow the president's seizure of tariff power.
They have demonstrated a preference for empowering the president. The court's character is displayed with quick mute indecipherable decisions from the shadow docket, while unpopular new anti-precedents get leaked ahead of release, delayed until opinion can be spun. So I would not be surprised to see the decision delayed, maybe even all the way to next October.
However it turns out, I'll pay the price and take my medicine, and try to be happy.
> Liberals vehemently opposed the idea, calling it 'regressive', meaning it would be socially backwards,
That's not what "regressive" means in the context of taxation. A "regressive tax" is one that takes a successively higher proportion of your income/wealth the poorer you are, while a progressive tax is one which takes a higher proportion of your income/wealth the richer you are. This is standard vocabulary in economics.
> Liberals vehemently opposed the idea, calling it 'regressive', meaning it would be socially backwards, but the idea held appeal as a simple and fair way of "taxing everyone equally"
I'm not sure what you mean by "socially backwards".
"Regressive" and "progressive" are terms of art in tax law and theory. A tax is regressive if people with less income pay a higher percentage of their income toward that tax than do people with more income. Progressive is the opposite.
Sales taxes are regressive because most people with lower income necessarily spend a higher percent of their income than most people with higher income, and so even if a sales tax is the same percentage of the sale price of items lower income people end up spending a higher percentage of their income on sales tax.
> Drugmakers plan to raise U.S. prices on at least 350 branded medications including vaccines against COVID, RSV and shingles and blockbuster cancer treatment Ibrance, even as the Trump administration pressures them for cuts
Few days ago, Donald Trump pressured Emmanuel Macron to raise the prices of all medicines. The pressure was made with unspoken threats according to several mainstream French media such as this one [1].
It's possible that Americans are all about free markets (I have severe doubts on this point, but let's accept it), but Trump and his MAGAts are far more concerned about fucking with people weaker than them.
If given two options, they will take the one that will hurt more people, every day of the week.
But of a paywall there, can't tell if raw materials and precursors are costing more, or R&D spend is up, or employee wages and salaries have risen. Those are usually the "pressures" on prices. I can't understand what or who might be applying "pressure" to lower prices on oligopolistic pharmaceutical makers.
big Pharma has properties unlike many other business. The R&D is very, very expensive and, income is not directly related to expenses each year. The natural "moat" is such that only a relatively few, giant and wealthy, companies exist over time.
Why does the US consumer of said medications subsidize many other countries who have access to the same medications for a fraction of the US sticker price?
Rueters doesn't show a paywall for me. The source of the pressure described is in the headline though. I'm not sure why OP editorialized it (as it is against hn guidelines): Exclusive: Drugmakers raise US prices on 350 medicines despite pressure from Trump.
The article is about drug pricing, which is the part I found interesting (and by extension thought we’d find interesting). I thought taking it out both saved space and made the comments less likely to veer into flamebait.
There's a character limit on the titles you can submit, probably wasn't intentionally editorializing. I assumed from the HN title that the pressure was from the Trump admin just based on the current state of US politics.
I think its obvious: theres a LOT of love for Trump here in VC circles. So anything speaking ill of his laughable policies, EO's, and other garbage is -1'ed or flagged to oblivion.
"Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales."
This describes the biggest problem in US healthcare. No clear and consistent pricing. If we had a real market, you would get a prescription and then go to the seller with the lowest price. And everybody would get the same price. This whole business with PBMs that are owned by the insurance companies, discount cards and other shenanigans just invites corruption.
Last year I needed to get blood work done, some of which may or may not be covered.
It took me two weeks, dozens of phone calls, and multiple "escalations" to learn what would be covered and what the price would be if it wasn't
Totally insane. The kicker is that after all that, the price I was billed wasn't even the price I was given (thankfully it was less though).
I just had some bloodwork done, myself. My provider accidentally billed insurance, which had lapsed due to being laid off. I got my "Explanation of benefits" and it was $1000 billed to them, but I was given a $500 "discount." So I only owed $500... Cash cost was $50. Makes no goddamn sense.
Also I went in for a colonoscopy and an endoscopy. Insurance was billed for $14000. I got statements from 4 different doctors, and the facility where it was performed. None of the statements matched the explanation of benefits from the insurance company. And when I called each doctor, to pay them, they all told me that I didn't actually have to pay them what it said I owed. So I just ended up paying $2500 to the insurance company. It again, makes zero sense.
14 replies →
In practice, the whole system is set up in a way that discourages asking questions. Waste of time. It's truly the opposite of the transparent ideal market.
That’s what is insane. I called my insurance to ask if some tests were covered since preventative care is 100% covered.
They couldn’t answer if cholesterol test would count. How is that not automatically classified as preventative? It’s one of the most basic metrics.
So they want me to get the doctor to give me the ICD code and the diagnosis code. Or something. Two different codes. They’ve added so much bureaucracy and crap into the system because they can. Nobody’s stopping them and there’s too many fingers in the pie.
2 replies →
"And everybody would get the same price. This whole business with PBMs that are owned by the insurance companies, discount cards and other shenanigans just invites corruption."
It's hard to say that it isn't racketeering at this point.
"Specifically, a racket was defined by this coinage as being a service that calls forth its own demand, and would not have been needed otherwise."
There's demand for the meds, but the demand for discount cards, forcing people to use specific services/companies, and related programs is all invented by the companies themselves.
Most of the non "cut everything" GOP plans still involve trying to get the consumer to shop around, but shopping around is impossible. The consumer can't be a consumer and impact the market if they don't know what is going on.
The system is fundamentally broken.
I go to the doctor and I have zero clue what will come back on the bills.
> This describes the biggest problem in US healthcare. No clear and consistent pricing.
AIUI, this is one reason Kenneth Arrow argued (in 1963 [1][2]) that healthcare could not really use a market-oriented solution: information asymmetry.
[1] https://assets.aeaweb.org/asset-server/files/9442.pdf
[2] https://pubmed.ncbi.nlm.nih.gov/15042238/
And when you get a broken leg you'd go shop around, comparing prices and looking up reviews? You can't have a "real" healthcare market. It is inelastic, people will always pay whatever is asked of them. It requires massive investments, naturally consolidating into a few large actors that are then easily able to join in a cartel, lobby the State for regulatory capture, etc. Price gouging and profiteering are just the end game of a free market functioning normally.
Health insurance in general is the problem; PBMs/discount cards are just a cherry on top. Insurance is fundamentally incompatible with clear and consistent pricing.
Pharmaceutical companies, hospitals, and doctors are free to charge by the medicine, by the night, and by the minute.
For example, this place does it:
https://surgerycenterok.com/surgery-prices/
Insurance companies do not force the sellers to use complex billing practices, they would benefit from more transparent pricing (since they are seeking to pay less).
The root cause is healthcare is inherently complicated and complex, it has a problem of supply being nowhere near demand, and since prices for things are so high (including liability), there is a lot of cover your ass and fraud prevention going on.
23 replies →
Germany has health insurances and they don’t do that nonsense. They fulfill their task which is to spread the risk over a wide range of people. That’s what insurance is for.
> "Rome said the companies seem to be maximizing prices while negotiating discounts behind the scenes with health and drug insurers and then setting yet another price for direct-to-consumer cash-pay sales."
This sounds like typical negotiating 101. You know you are going to be forced to lower from your starting position, so increase your starting position so when you do negotiate down you are closer to where you wanted to be.
It’s not only a logical negotiating position, it has legal implications.
Way back in the 50-60’s the government put in laws around “usual and customary price” in an attempt to rein in medical costs.
What providers were doing is charging cash customer $10, then when an insured patient came in (back when insurance paid 100%) they charged $100.
So a law was put into place to define what a “usual and customary price” is. The provider could not charge any customer more than this.
Like most well intentioned laws it created perverse incentives to jack up the public price as high as possible - if someone paid it, great, otherwise offer a discount.
As a european living in the US, the idea there is a market at all is laughable. I tried to get price quotes for treatments several time just to get a "well, it's hard to say" or "it's very complicated".
There is a market but you aren't part of it :-)
The US' main problem (seen from the outside) is that there seems to be no long term strategy just a sports-like us-versus-them mentality, where each team just thinks about how they can win more by making others lose. Winning the points is the goal, while all people forgot this was supposed to be a friendly game ans some even forgot which sport it is supposed to be.
This may well be the end game of capitalism, no pun intended.
Prices should be transparent, yes. But supply and demand isnt going to take down an oligopoly.
Here in Brazil, we have something called 'Genéricos.' These are essentially the same medications as the brand-name versions, produced with the same chemical ingredients, but they often cost half the price, sometimes even cheaper than that.
Insanely comical.
Interestingly, while on-patent medications in the US tend to be significantly more expensive than elsewhere, generics in the US tend to be less expensive than generics available elsewhere.
in the US, we call these 'generics'
Now look into the places that manufacture these generic versions. Not all factories are equal, and some are not of the best of reputations.
1 reply →
Those are available in America too
7 replies →
> This describes the biggest problem in US healthcare. No clear and consistent pricing.
For anyone not in the US wondering if this is an exaggeration, here is my history of buying prescription drugs.
1. For years, when I had insurance through my employer, I'd go the the nearest in-network pharmacy, which was Rite-Aid, for them. Those insurance plans always had a copay which was typically $10-15.
It was this way across several different insurance providers I had over the years at that employer. (For non-Americans wondering why my insurance company changed so often, it is common for employers to frequently switch providers to try to save money. Besides that being annoying because it means frequently changing coverage limits, it also means frequent changes in what doctors and dentists are in-network).
2. I saw something about Walmart's generic drug program. They were selling many generic drugs for a cash price of $4 for a month supply and $10 for a 3 month supply. Most of my drugs were included, so for those I switched my prescriptions to Walmart and didn't use insurance.
3. Later, for my drugs not in Walmart's generic drug program, I found that the GoodRx app or website could usually provide a discount coupon that would bring the cash price with coupon down below my insurance copay.
The GoodRx discount could vary significantly from pharmacy to pharmacy so I had my prescriptions split across two pharmacies.
4. My employer downsized and could no longer afford to provide insurance. I switched to a plan purchased on my state's Affordable Care Act (ACA) marketplace. I made too much money to get a government subsidy on my premiums, but not enough to afford a marketplace plan in the top two of the three tiers of plans (gold and silver). I had to settle for the third tier, bronze. That basically meant bigger copays and/or bigger coinsurance on everything, including drugs, than I had when I was on plans through my employer. Walmart generics + GoodRx coupons continued to be how I bought drugs.
5. I eventually switched to an HMO plan from the ACA marketplace, when rising costs made it so even the bronze non-HMO plans were too expensive. This meant I had to switch doctors to one that worked for the HMO (Kaiser), and the only in-network pharmacy was the one from the HMO.
It remained cheaper for nearly everything to continue with Walmart and GoodRx. The only drug I regularly got through Kaiser's pharmacy was generic Lipitor. That was $0. I refilled one of my other prescripts at Kaiser once, and my out of pocket came to twice what that drug was at Safeway with a GoodRx coupon.
I didn't try any of the others through Kaiser because there was no way that I could find to get the price other than actually getting the prescription filled there. Even though it was a Kaiser pharmacy, which is located in a Kaiser building and only takes Kaiser plans (and maybe people paying cash), they have no way apparently to answer the hypothetical "If I get drug X and I have Kaiser plan Y and my ID number is 12345678, what will my out of pocket cost be?".
I would have expected that one of the benefits of an integrated system like Kaiser where it is one company basically providing all of your health care except for some special services they contract out for would be that they could tell you the damn costs. I would have expected that when I'm in the doctor's office and he gives me a new prescription that on his terminal it would have the cost of getting it filled in the Kaiser pharmacy that is in the same building.
Nope. So I'd have to waste his time and mine getting out my phone, looking up the drug he's about to prescribe in the GoodRx app, and then decide where I want it. A nice thing about the GoodRx app was for Walmart if they did not have a GoodRx coupon because the drug was in Walmart's generic program GoodRx would still include it in the listing, showing the cash price so I didn't have to separately check Walmart's generics list.
6. It does get better when you get older. When I turned 65 and switched from a marketplace plan to Medicare I had to choose an insurance company that offered a Medicare drug plan. You can enter all your prescriptions on Medicare.gov and you can enter 5 pharmacies and the listing of available plans in your area will show you the annual total (premiums plug drugs) for each plan for both getting your drugs at the cheapest pharmacies on your pharmacy list and for getting them via mail order. By default it sorts the list by lowest total.
You still have the hassle of plans possibly changing each year. My plan on my first year went away. It was a $0 premium and $0 for all my drugs. There is still a $0 premium and $0 for all my drugs plan available for 2026, but I'll have to change pharmacies to one less convenient.
The above is if you choose regular Medicare when you enroll in Medicare. You can instead choose Medicare Advantage. The way Medicare Advantage works is instead of providing your medical coverage itself Medicare pays a private insurance company to do it. The plans offered by those private insurance companies broadly look a lot like the marketplace plans that offer on the ACA marketplaces or the plans they offer through employers.
They are usually pretty cheap, often with no premium from the insurance company (although you still have to pay a premium to the government for Medicare). Some even have negative premium plans. They also have most of the annoyances of ACA marketplace and employer plans, but there are usually ones that include drug coverage similar to the part D plan coverage for people on regular Medicare.
http://archive.today/Gxx7p
Why is the supreme-court slow-walking the tariff decision which is crystal clear as lower courts clearly demonstrate only Congress can set taxes/tariffs?
It would end inflation within 90 days
Even their silly 15% tariff fallback law abuse would be more sane than the 50-150% currently
Next few years is going to be insanity
Mate, this Supreme Court ruled that the President is immune to prosecution and de facto outside and above the law. I’m honestly not sure what to tell you if you’re still hoping for rule-of-law decisions to come out of it.
The 14th Amendment says all people born or naturalized in the US and subject to its jurisdiction are citizens.
If someone is immune to prosecution and de facto outside and above the law, I wonder if a case could be made that they are not subject to US jurisdiction, and that invalidates prior citizenship by birth or naturalization.
1 reply →
There was a lot of inflation before tariffs, and it didn't even have the effect of slowing China down economically or Russia militarily.
It slowed down Americans because we aren't recently used to it. The rich did adapt relatively quickly by buying up all the housing they could at negative real interest, stocks, gold, and to a lesser extent crypto.
The lesson has been learned by this point though, even a day laborer is holding silver and crypto nowadays because we have in recent memory the COVID shenanigans of mass QE.
People in China and Russia have basically taken for granted so long that their currency is completely manipulated, they all already knew to not be hoodwinked.
Inflation is low (relative to the last few years) and so far tariff related inflation hasn't manifested.
Someone once proposed a National Sales Tax. I think it was suggested that we could eliminate personal income taxes if we imposed a federal sales tax on all purchases.
Liberals vehemently opposed the idea, calling it 'regressive', meaning it would be socially backwards, but the idea held appeal as a simple and fair way of "taxing everyone equally". For some reason, a majority of public opinion leaned left on this particular idea, and it never gained a foothold.
When I learned of the blanket tariffs being imposed on everything imported into the US, I think I knew what I was seeing-- this was a National Sales Tax in disguise. This was an attempt to fund the federal government off the backs of people, who will at the very least pay 10% more for everything they buy.
The big lie was told-- that this was an emergency necessary correction for an ongoing American-life-threatening international trade imbalance. But the real lie was bald-faced, right there in front of us-- everybody was going to have to pay more for everything, because this was, and is, a new tax.
I think there's a slim chance the Supreme Court may not even issue a decision addressing the legality of the president's impertnent array of tariffs. Although two full months have passed since oral arguments were made before the court, we may have an even longer wait for a decision, because it sure looks like John Roberts and company can't find/manufacture a reason to uphold/allow the president's seizure of tariff power.
They have demonstrated a preference for empowering the president. The court's character is displayed with quick mute indecipherable decisions from the shadow docket, while unpopular new anti-precedents get leaked ahead of release, delayed until opinion can be spun. So I would not be surprised to see the decision delayed, maybe even all the way to next October.
However it turns out, I'll pay the price and take my medicine, and try to be happy.
> Liberals vehemently opposed the idea, calling it 'regressive', meaning it would be socially backwards,
That's not what "regressive" means in the context of taxation. A "regressive tax" is one that takes a successively higher proportion of your income/wealth the poorer you are, while a progressive tax is one which takes a higher proportion of your income/wealth the richer you are. This is standard vocabulary in economics.
> Liberals vehemently opposed the idea, calling it 'regressive', meaning it would be socially backwards, but the idea held appeal as a simple and fair way of "taxing everyone equally"
I'm not sure what you mean by "socially backwards".
"Regressive" and "progressive" are terms of art in tax law and theory. A tax is regressive if people with less income pay a higher percentage of their income toward that tax than do people with more income. Progressive is the opposite.
Sales taxes are regressive because most people with lower income necessarily spend a higher percent of their income than most people with higher income, and so even if a sales tax is the same percentage of the sale price of items lower income people end up spending a higher percentage of their income on sales tax.
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> Drugmakers plan to raise U.S. prices on at least 350 branded medications including vaccines against COVID, RSV and shingles and blockbuster cancer treatment Ibrance, even as the Trump administration pressures them for cuts
Few days ago, Donald Trump pressured Emmanuel Macron to raise the prices of all medicines. The pressure was made with unspoken threats according to several mainstream French media such as this one [1].
[1]: https://www.tf1info.fr/international/trump-se-vante-d-avoir-...
That's like pressuring a politician to commit seppuku. French would be rioting in the streets if he would even try that.
Furthermore how Macron can increase prices of drugs? I was thinking that Americans are all about free market.
It's possible that Americans are all about free markets (I have severe doubts on this point, but let's accept it), but Trump and his MAGAts are far more concerned about fucking with people weaker than them.
If given two options, they will take the one that will hurt more people, every day of the week.
Hmm, I heard they’re down 1500%.
But of a paywall there, can't tell if raw materials and precursors are costing more, or R&D spend is up, or employee wages and salaries have risen. Those are usually the "pressures" on prices. I can't understand what or who might be applying "pressure" to lower prices on oligopolistic pharmaceutical makers.
big Pharma has properties unlike many other business. The R&D is very, very expensive and, income is not directly related to expenses each year. The natural "moat" is such that only a relatively few, giant and wealthy, companies exist over time.
ref- The Billion Dollar Molecule
> big Pharma has properties unlike many other business. The R&D is very, very expensive and, income is not directly related to expenses each year
Isn’t this any capital-intensive business with variable demand?
Why does the US consumer of said medications subsidize many other countries who have access to the same medications for a fraction of the US sticker price?
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Except many (most?) pharmas spend more on marketing and sales than R&D. Lobbying is another big expense for most of them.
Rueters doesn't show a paywall for me. The source of the pressure described is in the headline though. I'm not sure why OP editorialized it (as it is against hn guidelines): Exclusive: Drugmakers raise US prices on 350 medicines despite pressure from Trump.
> not sure why OP editorialized it
The article is about drug pricing, which is the part I found interesting (and by extension thought we’d find interesting). I thought taking it out both saved space and made the comments less likely to veer into flamebait.
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There's a character limit on the titles you can submit, probably wasn't intentionally editorializing. I assumed from the HN title that the pressure was from the Trump admin just based on the current state of US politics.
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I think its obvious: theres a LOT of love for Trump here in VC circles. So anything speaking ill of his laughable policies, EO's, and other garbage is -1'ed or flagged to oblivion.
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