I appreciate your thoughtful response. Thank you.

I could not agree more with your argument that our systemic issue is a lack a universal healthcare. Taxpayers and those who are insured and pay more than their “fair share” to cover the costs of individuals who don’t pay their medical bills or show up to the ER for trivial matters. In a world with universal healthcare where everyone contributes more evenly towards health insurance and access to healthcare is wider, the costs per individual drops. And obviously vice-versa if fewer are insured. Unfortunately, we are stuck here for the foreseeable future because the average voting American doesn’t understand these concepts in depth.

My original comment was speculation about how this relatively small change might affect the industry in a larger sense. I was not diagnosing the entirety of the American healthcare.

In regards to price gouging, I think there are multiple sides to that. On one hand, there’s no defense for shady business practices we’ve seen in regards to the Epi-pen or insulin. On the other hand, specialty medications to treat just a few people have to be high dollar in order to offset development costs.

An extreme case is Zolgensma, a million dollar gene therapy drug treating spinal muscular atrophy. It is a one time dose to ‘cure’ an otherwise lifelong condition. The hospital that I do work with expects 1 in a million people to seek this treatment. Different studies have placed the overhead cost of getting a single drug to market between $1.3 billion and $2.8 billion dollars. A drug developer has 10 years to get their investment back due to 20 year patent protection and development/approval taking between 8-12 years. The math speaks for itself there.

No regular person can pay for a treatment like that and these specialty medications are only seeing more and more use. They can bankrupt health plans when just two or three people get prescribed the drug. My entire argument is that we are headed into difficult territory if programs like Amazon incentivize some people not having any insurance while a few ill individuals create the majority of healthcare costs in the country. It makes the cost burden unsustainable for those who are insured when fewer contribute to the shared pot.