The NY Times has a really interesting article on state-sponsored AIDS drugs for the homeless and poor, and what happens when a state chooses, for whatever reason, not to fund those drugs. It's interesting because it bring into harsh light exactly happens to those whom the private health care industry leaves behind (i.e. those who cannot afford health insurance) - they die. Yet, at the same time, one wonders if paying $885 per month per patient for AIDS drugs is the best use of state resources and taxpayer money. A state is charged with so many different tasks - educating the future, conserving what little wildlife we have left in America, keeping up infrastructure, etc., that state-sponsored health care inevitably drains money from those other resources. What exactly is the best allocation of resources? What do we want our legacy to be? Do we want to fund education at the expense of the health of the less affluent? Do we want to keep as many of our citizens alive at the expense of our environment and our education? Or do we want to do as much as we can with as little as we have, thereby ensuring equal opportunity for all programs, but excellence in none?
We do seem to be moving to the point where health care costs are so out of control that some form of government regulation appears necessary. The market is, frankly, not working. But complete government ownership over the health care system comes with its own massive problems. One need only take a look at the tangled web of Medicare, which doesn't even cover half of American's population, to realize that government health care would have massive systemic problems. But what are the solutions? America has never seemed to wholly believe in social Darwinism - the idea that those who fall by the wayside are better lost, yet America is also firmly against the prospect of wholly shared resources (the bare mention of socialism in some parts of the United States is enough to inspire McCarthy-like gesticulation and spitting). We are capitalists with a conscience, but our problems our bigger than our resources. What is there to do?
4 comments:
Maybe start viewing the market and the government as complimentary rather than opposing forces. The market *is* working (indeed, some would say it's working ovetime), it's just not providing workable solutions for those who need pharmaceutical companies' products more than their profits. Since it seems unlikely that the pharma companies will ever get to a point where they realize, on their own, that saving large slices of the population is good business (unlike those companies that exploit natural resources, where the consumption rate is increasing so quickly that we might, in our lifetimes, see a "holy crap" moment on the part of the investors and they'll decide that conservation might actually be better for profits in the long run).
So the G seems to be the likely candidate for a solution, but, like you say, taxes can't pay for it all.
Maybe there's a way to make the drug companies provide the drugs at a much lower cost. Conditioning patents, perhaps -- for every cash-cow convenience drug (for example, new spins on prilosec), Merck/Pfizer could be required to kick in X tons of AIDS cocktail drugs to be distributed to the people who need it. (who knows, maybe they already do this. I'm not a details person).
Of course, this wouldn't be politically workable right now unless we can marginalize the influence of the pharma industry. Got to get people off the couch and involved in politics for reasons other than making money. Since the Republicans are not interested in doing that, and the Democrats are (right now) only interested in not doing what the Republicans are doing, I'm not seeing a workable plan. But it will probably come around. But only if we start seeing our G as something we can participate in and have an impact upon, and then doing something about that.
I believe the government is complimentary to the free market when the free market fails to work. For example, I believe that government regulation of trusts is important because too much market consolidation prevents the price and value competition necessary to a robust and working market.
Similarly, I believe the health care market (in general) is not working because the business model that insurance companies use to evaluate and manage risk was never designed to wholly control the health care market - it is horribly inefficient at doing so, tends to outprice most consumers, and often bankrupts service providers, such as hospitals. So, in other words, current health care insurance regulation consolidates power at the top, while erasing choice at the bottom. Not exactly a “free” market.
I would tend to think that government should try regulating the health care insurance market before totally ramping up government health care, much the same way that the government regulates antitrust. If that fails to correct market problems, then we could look hard at universal health care, but it would require a fair amount of taxation to accomplish it, which is hard for those in America who already pay 35% of their pay for hardly any social services to stomach.
As for the pharma companies, that’s a bit of a different matter because you have the whole patent system of exclusivity brought in, which automatically throws off the market. And pharma companies do their darndest to make sure that their patents last as long as possible, and do their best to trip up generic manufacturers of drugs. Another option that the government has, besides enticing pharma companies to do good deeds through either tax breaks or regulation, is to enter the market itself, becoming a low-cost manufacturer and distributor of generic drugs. Generics definitely drive down price and inspire creativity in creating new, able-to-be-patented drugs.
Enter the pharma market? Like a space race for drugs? I don't think the pharma companies will continue their R&D as vigorously if the G takes an exemption from the patent and publicly distributes generic versions of the brand-name stuff. If, however, we have some sort of Camelot-era team of scientists developing drugs in government laboratories . . . wait. We've already got that. And the military-industrial complex has a monopoly on the application of that stuff. Nuts.
Also, I agree that health insurance sucks. Actually, all insurance sucks. One salesman told me that I'd be buying "peace of mind." I told him that the problem was "peace of mind" was *all* I was getting for my premium. I'd rather meditate; that's free.
In conclusion, time to drink in the new year.
(drinky drinky)
You can buy Peace of Mind at Origins...it comes in a white ball enclosed in a gum dispenser.
No...I don't think the government should subvert the patent system, but should perhaps become a player in the generic drug market. Or conversely, they could revise the patent system for pharmaceuticals only, so that generics could come in earlier and compete. What the government giveth (monopoly), the government can take away.
Drinky drinky, indeed. Bring it on!
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