Thanks to Susan Voss for her thoughtful essay about the complexities of our health care system, and how difficult it is to reduce costs. (See link to Register essay below.) I don’t claim to have “the answer”, but I do suggest that the following cost saving ideas be given serious consideration.
Medicare, Medicaid and private insurance should not be required to cover every new drug, product, or procedure that is approved by the FDA. Some are very high cost but provide only marginal improvement over alternatives that cost much less. Also, at least some covered products and procedures would likely be considered not medically necessary by most people.
Consider shortening the amount of time that government grants a monopoly for patents. Patents are not natural property: humans have copied one another since the beginning of time. Our U.S. Constitution allows patents to be granted to encourage inventiveness, but there is no objective reason why a patent must be granted for 20 years. Why won’t five or ten years work? Maybe the length of the patent should be based on the cost to develop the patented item and whether or not government funds were used to help develop the item.
Don’t require limits on out-of-pocket payments such as co-payments, especially for very high cost items. A person should have “skin-in-the-game” if they expect their insurance to cover very high cost items. Today, we see the opposite: drug companies offer to help pay people’s out-of-pocket costs so there won’t be so much political pressure on them to lower their prices.
Allow both pharmacies and individuals to purchase drugs from sellers in other countries that are “deemed” to have sufficient safety procedures in place. If drug companies are free to charge lower prices in other countries, then pharmacies and individuals should be free to purchase the drugs from those other countries.
Allow Medicare and Medicaid to negotiate with drug companies on prices they pay for the drugs that are covered by the programs. Right along with that, Medicare and Medicaid should be allowed to develop formularies (lists of drugs that are preferred over other therapeutically similar drugs), that give beneficiaries a financial incentive to use the preferred drugs and a penalty for using higher cost drugs.
Our health care wants are unlimited. Our ability to pay is not. We, as citizens, should not expect private insurance or our government health care programs to cover everything, regardless of cost. We should expect our government to NOT do things that increase costs, or reduce our choices.
The Des Moines Register recently reported that 36 Iowa counties have joined in a law suit against opioid makers. (See link to Register article below.) Two law firms are enlisting counties across the country to go after drug manufacturers and others for the costs of the opioid crisis. There is no cost to the counties. If successful, the “Lawyers will be awarded a portion of the settlement, …” (Interesting that the word “settlement” is used instead of “judgment”.)
What is often missing in much of the opioid crisis discussion is how our government’s policy of prohibition has made a bad situation even worse. When a person becomes physically addicted to opioids, they will do almost anything to get the drugs they want. If the drugs are not available legally, or if legal drugs cost too much, addicts will find illegal alternatives. According to the CDC, 60% of opioid deaths do not involve prescription opioids. That is, in 60% of opioid deaths the person who died was using illegal opioids. (See CDC reference below.) A significant problem with illegal drugs is that is no way to assure the quality and potency of the drugs. In the case of opioids, that leads to inadvertent over-doses because the illegal drug was much more powerful than thought.
If opioid addicts were able to readily get prescription methadone or other FDA approved opioids at reasonable costs, many deaths would be prevented. That would also take the profit out of the illegal opioid drug trade. If opioid addicts were treated under a medical model rather than a criminal model, it is likely that more opioid addicts would seek help to solve their addiction problem. But as it is, under our drug war, prohibition policy, addicts have good reason to not seek help.
As The Des Moines Register reported on 10/13/2016, “Black Iowans are seven times more likely to be arrested for drug possession than white Iowans…” (See link below.) Drug possession. A crime without a victim. Arrests that create a criminal record that seriously negatively affects a person’s ability to get a job.
Even if blacks do possess illegal drugs at a rate seven times more than whites, which I very much doubt, treating possession of any drug as a crime is clearly unfair, if not racist. Why don’t people get arrested for “possession” if they are caught with a six pack of beer? Why aren’t people be arrested and charged with “intent to deliver” if they are caught with more than a case of beer? Why aren’t people charged with a more serious crime if they are caught with high alcohol content distilled spirits, which are surely more dangerous?
We need to end the immoral and impractical drug wars. The correct and reasonable thing to do is to legalize and regulate the manufacture, sale and use of all drugs, just like alcohol, tobacco, and prescription drugs. Just like with alcohol, fair regulations would include protecting our children, and prohibiting driving vehicles while intoxicated. In any case, we need to end prohibition.
Link to Register article: http://www.desmoinesregister.com/story/news/crime-and-courts/2016/10/12/iowa-ranks-2nd-worst-racial-disparities-drug-arrests/91958452/
Our government, not free market capitalism, is to blame for this situation which has allowed Mylan Pharmaceutical company to jack-up prices for its EpiPen. The FDA is has created a huge delay in approving generic epipens. This has effectively given Mylan a monopoly. Established drug companies should have some type of fast-track authority to manufacture generic products without having to get advance approval from the FDA. Don’t blame private enterprise for problems created by government.
The Register, in a recent editorial, advocated for letting people order their medications from other countries. A bill introduced into Congress by Senator John McCain would allow people to legally buy their prescriptions from properly licensed Canadian pharmacies. A better idea would be to allow U.S. prescription drug wholesalers and retail pharmacies to buy from Canadian manufacturers and wholesalers. To only allow individuals to buy from Canadian pharmacies would be to pull the rug out from underneath U.S. pharmacies. It would be simply unfair to allow individuals to purchase from Canadian pharmacies but not allow U.S. pharmacies to do the same. The best answer is to allow free trade in prescription drugs at all levels.
Link to Register article: http://www.desmoinesregister.com/story/opinion/editorials/2015/03/08/editorial-easy-way-lower-cost-medications/24629749/
The U.S. has made many great advances in the fight against racism since the “I have a dream” speech by Martin Luther King, Jr. 50 years ago. One area where we have failed miserably is the drug wars. Blacks have been arrested, convicted and incarcerated for non-violent drug related offenses in numbers way out of proportion to their drug use when compared to whites. To add insult to injury, once a person has been convicted of a drug offense, they are prohibited by law from getting certain federal benefits including military and other federal employment, federally subsidized student loans and grants, food stamps, federal housing assistance and more. Finally, and even more devastating, most employers legally discriminate against anyone who has had a drug conviction. So, the negative impact on blacks’ ability to get work is again way out of proportion when compared to whites who use drugs. There is no way that the immoral drug wars would have been allowed to continue this long if the tables had been turned and whites were treated so unfairly. If you think that you are not racist, then you must support ending the drug wars – unless, of course, you want to wreck the lives of many many more white people by treating them the same as black people.
Marijuana is now legal for recreational purposes in both Colorado and Washington. It will be regulated like liquor. This is a great step toward liberty and freedom. Marijuana is mostly like alcohol, but its use is unjustly discriminated against by government.
What if police burst into your house and found a six pack of beer – and arrested you – and made you attend rehab classes – and your “criminal record” made it much more difficult for you to get a job? Why is marijuana so different from alcohol? The voters of two states said it is not that different.
It is a proper role of government to create and enforce regulations to reasonably protect the general safety of citizens. Driving while intoxicated, whether by alcohol or marijuana, should be a crime. But if an activity does no harm to others, it is not a proper role of government to prohibit that activity.
The new state laws will likely be tested in the Supreme Court. I hope the Supreme Court finds it is not a proper role for the federal government to regulate the recreational use of marijuana. Alcohol and tobacco are mostly regulated by the States. Marijuana should be no different.