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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.
Because they graduate with $300k+ in school debt? Doctor salaries are a part of artificially constrained supply, yes, but becoming a doctor in the US requires you take on enormous financial risk.
A decade on from completing undergrad, folks in medical-adjacent fields are still underwater on pretty high interest student loans. Long term they're massively overpaid, but the people who somehow don't pass exams or don't get into medical school are fucked.
$300k in debt isn't that huge when the median physician pay is $350k - at 6% interest and 40% taxes it drops your take-home from $210k to $192k.
The much larger cost for doctors is the opportunity cost of going to medical school and one or more residencies. The median doctor graduates from medical school at age 30 and then still has years of residency(ies) to go. Making peanuts for a decade+ after college for the types of driven/conscientious/smart people who go to medical school is an enormous opportunity cost, dwarfing the literal debt (e.g. discount rate of 5%, forgone earnings of $100k per year, for 10 years = $1.26m at the end.
It's not really an "enormous financial risk". The 6-year graduation rate from medical school is 96%, and virtually all of them find a residency. That is, an admission offer from a medical school is as close to a "golden ticket" as you can get in life. The only risk is whatever time you invest in getting in to medical school beyond undergrad - a risk that, for most people, is 0-4 years.
Finally, re people being underwater. This can happen, but it usually stems from specific decisions - i.e. spending many years trying to get into medical school, switching specialties late in the game, refusing to give up on a very selective specialty, choosing to do academic medicine in a high cost-of-living area, etc.
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