
Americans Cross Border into Mexico to Buy Insulin - howard941
https://khn.org/news/americans-cross-border-into-mexico-to-buy-insulin-at-a-fraction-of-u-s-cost/
======
XaspR8d
If you ever find yourself near Yuma, AZ, and have a sense for "weird travel"
like I do, I'd recommend taking a jaunt into Los Algodones (AKA Molar City)
immediately across the border. You can park at the border station and walk in.
The tiny city is pretty much entirely dedicated to discount medical sales and
is packed to the brim with dentists, pharmacists, opticians, and
cosmetologists. When I was there, salesmen would literally call out "cavity?
cavity?" to the passersby on the street. It's like some eerie alien recreation
of Las Vegas where gambling is replaced with curbside botox and root canals.

We only spent about 20 minutes walking around (probably spent more time in the
border office), but it was a super memorable pit stop for me.

~~~
chiph
The Wynns went there about 5 years ago. To sum it up: It's a dental free-for-
all, and there's no accreditation process or licensing, and everyone there is
trying to sell you something on commission. But if you find a good dentist,
you'll pay about 30-40% of what it'd cost in the US.

[https://www.youtube.com/watch?v=KAECrmAOqy4](https://www.youtube.com/watch?v=KAECrmAOqy4)

------
interlocutor
It is not just insulin. Prices of all drugs have been rising in the US, from
2x to 3x at a minimum, to 1000x in some cases.

The reason is insurance. When individuals are paying for drugs, drug companies
can only charge what individuals can afford. When insurance is paying for
drugs, drug companies charge what insurance companies can afford, and
insurance companies are able to pay much higher prices (and they recover their
costs by raising premiums.) You can't blame pharmaceutical companies for not
leaving money on the table.

The fact that Medicare is legally not allowed to negotiate drug prices (a big
handout by Bush administration to Big Pharma) isn't helping either.

~~~
freeflight
If that'd be the case then any country with a single-payer healthcare system
would suffer from similarly inflated drug prices as the US, but that's simply
not the case [0].

What's stopping US insurers from pressuring drug companies into price
agreements? Shouldn't that be also in their best interest, instead of just
passing the costs along to the patients? If that's all they are doing, what do
you actually need them for?

In Germany, price agreements between drug manufacturers and insurers happen
plenty of times, and it usually works out because drug companies take reduced
profits over no profits, any time of the day. Patients still have the option
to buy the "fancy version", paying out of their own pocket, but the vast
majority of patients are completely fine with whatever their insurance covers.

[0] [https://www.commonwealthfund.org/publications/issue-
briefs/2...](https://www.commonwealthfund.org/publications/issue-
briefs/2017/oct/paying-prescription-drugs-around-world-why-us-outlier)

~~~
Sileni
Insurance companies in the US have to pay out a certain percentage of the
premiums they take in (80% last I checked) [0]. So they're also incentivized
to let prices climb; their 20% for "administration and profit" is inflated
when prices are inflated.

[0] [https://www.healthcare.gov/health-care-law-
protections/rate-...](https://www.healthcare.gov/health-care-law-
protections/rate-review/)

~~~
prostoalex
That makes sense if it’s a monopoly, but presence of many insurance carriers
and variety of plans introduces some price checks.

Insurers routinely exclude drugs that they think are overpriced, they also
switch to generics the day a drug goes off patent, sometimes forcibly.

------
tomca32
Not sure about some of the numbers there. They say that a 3 month supply is
$3700.

Humalog without insurance costs $95 per 3 ml cartridge, let's say it's a $100.
This would mean that this child needs 37 cartridges for 3 months, or 12
cartridges per month, 3 per week.

That's a pretty crazy amount of insulin. I'm a T1 diabetic, that doesn't eat
particularly healthy, and I need 2-3 cartridges a month, almost an order of
magnitude less than the person in the article.

I don't think those numbers are right.

~~~
syn0byte
They say _her_ 3 month supply was $3700. Branding and "format" will affect the
numbers. Pen? Vile? Pump? Humalog? Novalog? did the somewhat vague "3 month
supply" include both short and long acting versions in the price tag?

I don't doubt the numbers, but I do detect some omission/simplification to
make it seem extra stark.

~~~
rfinney
Key phrase from the article is "modern generation of insulin". A good overview
of the design and effects of the new insulins are here :
[https://onlinelibrary.wiley.com/doi/full/10.1111/dme.13692](https://onlinelibrary.wiley.com/doi/full/10.1111/dme.13692)
( "Lessons for modern insulin development" ).

~~~
tomca32
Still even with prices of modern insulins I'm not sure it makes much sense.

Fiasp is an example of one of the most modern ones and still I can't find a
price higher than $125 per 3ml: [https://www.goodrx.com/fiasp?dosage=3ml-
of-100-units-ml&form...](https://www.goodrx.com/fiasp?dosage=3ml-of-100-units-
ml&form=flextouch-pen&label_override=Fiasp&quantity=1)

------
queercode
I didn't know this was news. My mother, a US resident who's lived in the US
for ~30 years, in a border town, goes across every time she needs any sort of
medical care.

The Red Cross only takes cash, but it's so much cheaper (actually affordable).

~~~
jfnixon
Huh, who woulda thought paying cash would be cheaper than filing a bunch of
forms with an insurance company, giveing them a hefty discount, then waiting a
few months to get paid.

------
whatshisface
Insulin has been manufactured for decades, and is made by more than one
company. Why are the prices rising?

~~~
echlebek
My understanding is that there are insulin analogs that are vastly better
treatments, due to being faster acting. These analogs are still patented.

However, even considering the patents, insulin prices for the same product are
much higher in the USA than in Mexico or Canada. American prices have
increased by an order of magnitude. [1]

IMO this rampant price gouging can only be explained by the pharmaceutical
lobby, and a political apparatus addicted to their money.

[1]
[https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-i...](https://www.washingtonpost.com/news/wonk/wp/2016/10/31/why-
insulin-prices-have-kept-rising-
for-95-years/?noredirect=on&utm_term=.318cf26db23b)

~~~
whatshisface
It sounds like the solution should be that patients can opt for cheaper, worse
treatments, if they do not like that the more recent treatments are also more
expensive.

~~~
echlebek
Why? Why should people have to pay inflated prices for treatments that have
been standard since the 90s?

Edit: just to be clear, the price of Humalog, a patented analog, has increased
in price by 700% in the last 20 years. This is not simply a case of newer
treatments being more expensive.

------
RileyJames
There seem to be services that mail insulin from Canada already, which is
significantly cheaper.

Is it really cheaper, or necessary to fly to Mexico to pick it up yourself?

[https://www.canadianinsulin.com/](https://www.canadianinsulin.com/)

~~~
sithlord
Since this is technically not legal, i wonder what percent get taken by
customs

------
Havoc
Same with tech actually. Busy flying a family member halfway across the world
because the price diff on a single (!) laptop and cellphone covers the long
haul flight costs.

Literally fly over, crash on my couch and spend a week exploring a different
country for zero additional cost.

~~~
theatraine
What country and tech? I haven't heard of this before and I wonder if it's a
recent phenomenon due to the strength of the US dollar.

~~~
Havoc
South Africa. Just a laptop & cellphone.

------
triplee
What if this whole time the wall is really to keep US residents inside the
country to make sure those hard working pharma execs get their rightful money?
The slats are like those parking garage spikes that go one way -- US residents
stay in, and everyone else can come in but never leave, keeping the easily
exploited workforce from drying up.

Nah, that'd never happen.

------
infocollector
There are five beneficiaries of these prices (or the broken system):
Insurance, Doctors, Hospitals, Suppliers (Drug companies) and Politicians. It
is easy to fix - fix the government (Politicians) - and everything fixes
itself. And once the government is fixed, incentivize them to punish
monopolies.

------
usausa9
because it was haphazardly stitched together we ended up with healthcare that

1\. does not cover everyone 2\. it is rationed by for-profit companies 3\. is
is expensive and can bankrupt you 4\. tied to employment which means you can
lose it easily 5\. confusing since you often have to deal with paperwork and
multiple providers

If you are rich and can afford it the american system is great but it is awful
for everyone else.

~~~
calyth2018
4a. Because US health coverage tied to employment, it serves as golden
handcuffs.

But hey, got to have those profits...

~~~
ggreer
The reason health insurance became an employment perk was because of a tax
loophole created during World War II. From _A History of Employee Benefits and
Taxation_ [1]:

> At the same time, the federal controls on wages was leading to significant
> angst and frustration among the labor market, and the threat of widespread
> strikes and other forms of labor protest became a serious threat to the
> economy and war effort. In response, the War Labor Board implemented a new
> income tax exemption to employers sponsoring employee health plans. This
> made employer contributions deductible on federal returns, while the
> benefits were entirely tax-free, to the employees [3].

> What started as a measure to avert crisis and labor strikes ended up
> becoming an expectation. As more and more employers leveraged these tax-
> benefitted health plans, American workers grew accustomed to getting their
> health insurance through work, rather than as individuals. The end of the
> war and the return home of American GIs exposed more workers to the new
> system, reinforcing its popularity and utilization [3]. By the 1960s,
> employer-sponsored health insurance plans had overwhelmingly displaced the
> formal individual market, a status that has persisted right into the start
> of the 21st century and provided a central tenant of the Affordable Care Act
> of 2008 [4].

In my opinion, this is yet another example of how even the most well-
intentioned legislation can have disastrous consequences if it fails to
account for incentives and second-order effects.

1\. [https://taxandbusinessonline.villanova.edu/resources-
taxatio...](https://taxandbusinessonline.villanova.edu/resources-
taxation/article-taxation/a-history-of-employee-benefits-and-taxation.html)

~~~
pessimizer
This quotation carefully skirts around the actual reason why health insurance
became an employment perk _and_ why a tax loophole was created during WWII. In
an intentionally deceptive way (not by the poster, but by the original
author.)

People were getting their insurance through their unions. Before the unions
started doing this, nobody associated health insurance with employment. This
made people grateful and happy with their unions. The government, in order to
weaken the unions, paid employers to give their employees insurance with a tax
break.

Not understanding this makes the first sentence completely unconnected to the
rest of the text. Health insurance was not a raise, heath insurance was an
intentionally union-breaking subsidy to businesses to give bosses more
leverage on wages.

i.e. this was not well-intentioned.

~~~
ggreer
> People were getting their insurance through their unions. Before the unions
> started doing this, nobody associated health insurance with employment. This
> made people grateful and happy with their unions. The government, in order
> to weaken the unions, paid employers to give their employees insurance with
> a tax break.

Do you have a source for this? Nothing I've read has made such a claim. Even
the NYT says that the root cause of employer-based health care was wage
freezes during WWII followed by the tax-exemption of employer-provided health
insurance.[1][2]

1\. [https://www.nytimes.com/2017/09/05/upshot/the-real-reason-
th...](https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-
employer-sponsored-health-insurance.html)

2\. [https://economix.blogs.nytimes.com/2013/07/30/the-
question-o...](https://economix.blogs.nytimes.com/2013/07/30/the-question-of-
taxing-employer-provided-health-insurance/)

------
umeshunni
Related:
[https://news.ycombinator.com/item?id=17778040](https://news.ycombinator.com/item?id=17778040)
[https://news.ycombinator.com/item?id=19053389](https://news.ycombinator.com/item?id=19053389)

------
SamuelAdams
I wonder if drugs are cheaper due to more relaxed regulations? the American
FDA has many strict requirements around manufacturing and distributing drugs,
but Mexico and Cananda do not need to follow the same standards, resulting in
lower operating costs.

Lower operating costs = lower price.

~~~
decebalus1
Nah.. Does the UK have lower standards or more relaxed regulations? What
you're seeing here is the free market without government price control, at
it's 'best'. Things in general are priced at what consumers are willing to
pay. That's basically it.

~~~
danans
"what consumers are willing to pay" is intermediated through health insurance
companies, whose policy premiums have skyrocketed in the US in the last few
decades.

Before relatively recently, most US medication consumers didn't understand
that rising drug prices were a factor in the rise of their health insurance
premiums. Now they are catching on to that, which is why it is becoming a
politically important issue.

------
opless
This doesn’t happen with socialised healthcare that’s free at the point of
service.

A government can negotiate lower prices than a commercial entity. They also
can legislate to force bad actors to be reasonable.

Sadly the UK’s NHS is being slowly converted to the USAs fundamentally broken
system of “what the market can bear”.

Rampant capitalism didn’t work for the banks either. They needed a social
bailout when their markets crashed.

------
Ancalagon
American healthcare is frankly - and I say this as an American - disgusting
and infuriating. It needs to be re-structured from the ground up.

~~~
RcouF1uZ4gsC
Part of this is because the US prices of drugs, subsidize the development of
drugs around the world. Pharmaceutical companies rely on the US market to
offset the R&D of the drugs, while then providing other countries with drugs
above the marginal costs (which is still profitable). In this scheme, the
pharma company benefits (they increase their profits) as do the other
countries (they get cheap drugs). The loser in this arrangement is the US
consumer who gets to pay high costs so everyone else can have ground-breaking
drugs at low cost.

~~~
acdha
Those companies spend far more money on marketing than R&D an they’re heavily
reliant on US funded research — almost every erything they do starts with NIH
funding.

~~~
Varcht
Source?

~~~
acdha
See e.g.
[https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...](https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-
pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/) \-
it’s improved a little since then but it’s still nowhere near an explanation,
especially since it’s not like drugs produced by non-US companies are
massively cheaper in the US.

~~~
Varcht
Not quite the proof I'd like to see. Johnson&Johnson sells a lot of things,
the more purely pharmaceutical companies are closer to 1:1 in the graphic.

Then we have, _Most of this marketing money is directed at the physicians who
do the prescribing, rather than consumers. As Oliver pointed out, drug
companies spent more than $3 billion a year marketing to consumers in the U.S.
in 2012, but an estimated $24 billion marketing directly to health care
professionals._

$27B in marketing but the graphic shows over $65B in R&D?

------
HillaryBriss
this story cites one estimate that, for a certain list of drugs, the savings
from buying in Mexico was 40-60%

that's huge. but -- how can US consumers possibly save any money by going to
another country to buy a product? i thought globalization had brought US
consumers free trade.

~~~
maxxxxx
there is no free trade in drugs,

~~~
HillaryBriss
US trade laws and agreements appear to protect certain sectors. has the US
ever really had "free trade"?

------
decebalus1
How unpatriotic. I hope the border wall will also keep Americans inside to
contribute to the economy instead of spending their money abroad. The health
care industry needs money to survive! Pharma companies need money to do R&D!
Build that wall, Mr. Trump! /s

~~~
maxxxxx
Don't give them any ideas. They may also start not only searching your laptop
and at the border but also for antibiotics.

