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Conversation has been slow here. I feel like the standards have increased to the point where people are afraid to post (except of course for bad faith posters who don't care).
So, let me try a post that's more of a conversation starter and less of a PhD thesis.
According to Bernie Sanders, it costs about $5 to make a monthly dose of Ozempic, the blockbuster-weight loss drug. Americans pay about $1000/month. Canadians pay $155. Germans pay $59.
The stock of the company which makes the drug, Novo Nordisk, has doubled since the beginning of 2023. (I considered buying in 2022 but didn't because I thought I was already too late đź’€) It now has a market cap of nearly $600 billion, making it the most valuable company in Europe.
I assume that if companies were forced to charge the same price in U.S. as they do in Europe, the global pharma industry would become insolvent.
So why is the United States paying for > 100% of global pharma research? And how can we fix the glitch?
The entire US medical system is fucked. Higher drug costs are a substantial input cost, but another huge one is the AMA.
The steps for fixing US healthcare are actually pretty simple:
Smash the AMA cartel by allowing unlimited immigration of doctors trained in Canada, UK, Australia, NZ and Ireland without any licensing requirements, re-doing residency etc. Allow doctors from other Northern European (not southern) countries if they pass a tough English written and oral exam that requires fluency. This will lower US doctors’ salaries (currently 300% or more of what they are in Europe) by half, to a more reasonable rate where surgeons are respectable PMC but not making a million dollars a year solely because the AMA lobbies to restrict residency places. Doctors should be paid $120-300k a year at the cap, with the high figure for the most elite surgeons in tough specialties. Why is the American middle class paying for anesthesiologists to make $700k a year when their equivalents in European countries that are almost as rich are paid like $150k? There are almost a million doctors in America, this overpaying adds up.
Handle drug pricing centrally. Insurers pay a price negotiated by a trade association chartered for that purpose and which represents all US insurers (including the state for the VA etc), exempt from the usual rules around cartels. The trade association negotiates as a bloc and can therefore refuse to accept pricing that is any more than a basket of comparable countries (eg rest of Anglosphere) + 20% (at most). Pharma companies will essentially be forced to comply, since there is no other major wealthy market that would possibly pay more than the US. The reason manufacturers can charge so much is that (much as with doctor pay) so much of the cost is offloaded onto third parties (eg employers for most health insurance) in a way that causes huge economic drag but which is often not immediately visible.
No the answer is to stop gate keeping drugs by requiring a doctor to write a prescription for all of them.
The problem is that just letting people get drugs as they like means that if they're the one in ten thousand who gets the rare but really severe reaction, who ends up getting the blame?
It's risky enough with prescriptions and people taking medication they're not sure of, or there are interactions with drugs they already are prescribed, or the doctor was careless about checking are they safe to take this drug. I've been prescribed things that gave me (fortunately) low side-effects and now have it on record that I can't take X or Y medication. Without some system of doctors and prescriptions, how are you going to manage this?
Simple, the person who took the drug without a prescription. This is no different to how if you park in an open parking lot you have to bear the risk of someone breaking in and stealing your shit.
You really think that's going to happen? "Oh my bad, my mom or brother or kid took that drug and suffered a severe side-effect, their fault for being too dumb to read the label"?
No, it will be Something Must Be Done and they'll sue the government and the drug manufacturer and the hospital and anywhere else they can think of: yes this is legal but someone else is to blame!
Yeah, it doesn't matter how blindingly obvious you make the risks. A lot of people will say they're OK with the risk right up until they lose a roll, at which point they are mad and want something to be done.
Yes, and it is the responsibility of the systems established by society to make sure nothing is done in response to such tantrums. It's fine if they sue, as long as they lose and have to pay the court costs.
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