Non-medical switching of prescriptions may be appropriate.

The Des Moines Register recently published an essay by retired pharmacist and former state senator, Tom Greene, in which he supported proposed legislation that would prohibit insurance companies from switching patients to lower cost drugs or increasing co-pays if the patient is stable on a currently prescribed medication.  (“Protect health and end non-medical switching” 2/14/2022) (Link below.)

So, if the newest highest-cost drug works for a patient, this bill would make it illegal to try to change that patient to a less costly drug.  If that’s true, then maybe the law should also require that the lowest-cost drug in the same therapeutic class be tried first. 

If people had to pay their own way for prescription drugs, many would try lower-cost drugs even if a higher-cost drug was working effectively for them.  It seems fair to allow insurance companies to try to save money.  It also seems fair to require higher co-pays if a higher-cost drug is chosen.  If the proposed bill is passed into law, it will certainly help to push prescription drug insurance premiums higher and higher.

Link to essay in The Des Moines Register: https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2022/02/14/end-non-medical-switching-and-protect-iowans-health/6726589001/

How to reduce U.S. overdose deaths.

It has been widely reported that more than 100,000 Americans died of drug overdoses during the 12 months ended April 30, 2021, a record high. A large and increasing portion of overdose deaths is attributable to illicitly obtained drugs, especially fentanyl. Many addicts have no choice but to buy their drugs on the black market, so they can’t be assured of the strength or purity of the drug, or what other drugs might have been added to what they think they are buying. As a result, many overdose deaths are accidental.

Imagine if we treated drug addiction using a medical model rather than a criminal model? If addictive drugs could be purchased legally and were regulated as to strength and purity, many overdose deaths would be avoided. Additionally, people who become addicted might be more likely to ask for help to kick the habit if they weren’t afraid of getting arrested and put in jail. Finally, much of the crime and violence associated with the illegal drug trade would go away if our policy of prohibition were ended.

As I’ve written before, if a new pharmacy opens in your neighborhood, the existing pharmacies don’t start a shooting war to protect their turf. And if someone breaks into or otherwise trys to rob a pharmacy, the pharmacy calls the police. It is the prohibition that causes most of the violence.

Under a legal drug regime, it would still be illegal to drive a vehicle while under the influence of intoxicants, and children would be prohibited from buying drugs. But a person who minds their own business would not be a criminal for using drugs in a peaceful manner.

John Deere workers need to be careful to stay competitive.

The striking workers at John Deere just rejected the second contract proposal offered by the company. The workers need to be careful to not put John Deere in the position of being not competitive in world markets.

About 40% of John Deere’s revenues come from outside the U.S.  If the company is not competitive internationally it will see a dramatic decline in revenues, profits… and jobs.  Many people today push us to “buy American”.   That sounds good and patriotic, but if other countries do the same we will all be poorer.

International free trade, just like free trade among the states in the U.S., has two sides:  In the long run, it makes everyone better off, but in the short run disrupts the lives of many.  The best policy is to have a safety net that helps those who lose their jobs transition to new jobs, while allowing free trade to help improve the income and wealth of people around the world.

The world population growth rate is slowing.

In his recent essay in The Des Moines Register, Jonathan Wilson wrote regarding the Earth’s population, “The current rate of population increase is simply not sustainable.” That statement is literally true. The rate of the world’s population increase has been slowing for decades. According to a forecast by the United Nations, which is more pessimistic than other forecasts, the world population is expected to peak at about 11 billion people near the end of this century and then begin to decline.

A clear pattern has been established. As countries around the world have become more affluent, their population growth rates have slowed. As people gain more income and wealth they have better access to birth control and respond to the various costs associated with having more children by having fewer of them. So, maybe the best thing we can do to further slow the rate of population increases is to help people in poorer countries to improve their economic situation. We might best do that by reducing barriers to free trade. Good jobs in poor countries will also result in fewer people wanting to illegally immigrate to other richer countries like the U.S.

Link to Johathan Wilson’s essay in The Des Moines Register: https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2021/10/17/world-food-prize-feeding-birth-control-both-needed/8214529002/

 

Some drug price control by Government/Medicare is probably appropriate.

Jessica Hyland is correct that if our government starts regulating drug prices, then the development of new drugs will slow down. (Below is the link to her essay in the Des Moines Register.) Our current government policies have given us more new drugs at higher prices than we are willing to pay for. So maybe getting new drugs more slowly would be a good trade-off for significantly lower drug prices.

Good health might be the most important thing in our lives, but it is not the only thing. The pandemic proved that many people are willing to risk their health in order to do those other things they consider to be important in their lives.

Today, drugs approved by the FDA are required to be covered by Medicare regardless of the price, and whether or not the drug is any better than cheaper existing drugs!  Government granted patents prohibit competition by generic drug makers for 20 years or more!  There is clearly no free market for prescription drugs.  As a libertarian, I would love to see our government get out of the healthcare business altogether, but we don’t live in that world.  Our government has had its thumb on the scales in favor of drug companies for decades, so it is not unreasonable for it to now start regulating drug prices.

Link to Register essay by Jessica Hyland: https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2021/05/25/hr-3-prescription-drugs-stifle-health-care-innovation/5240432001/

The battle among the crony capitalists!

I read the report in The Des Moines Register about the questioning of Tom Vilsack by Joni Ernst during the Senate hearings on Vilsack’s nomination for Secretary of Agriculture.  (Vilsack nomination moves to full Senate” 2/3/2021)  President Biden has ordered the development of a plan to convert all federal, state, local and tribal vehicles, including Post Office vehicles, to “clean and zero-emission vehicles.”  Ernst asked Vilsack if he will direct the USDA to buy Tesla trucks that run on electricity or Ford vehicles that run on 85% ethanol.  Vilsack, like a good politician, said it’s not ” an either-or circumstance.”  It will be interesting to see how Vilsack balances the interests of farmers and biofuels producers with the interests of the zero-emissions vehicle and power producers.  One thing is for sure: lobbyists will be in high demand.

Money grab by States in anti-trust suit against Google.

As reported in The Des Moines Register, Iowa has joined 37 other states in an anti-trust suit against Google for discriminating against other search engines. (See link below.)

The purpose of anti-trust action against any company should be the protection of consumers, not the protection of competing businesses.  If consumers are not harmed, which is the case here, then anti-trust action should not be taken.  I have a strong feeling that the State governments joined this lawsuit in order to share in the billions of dollars of penalties or settlement – a money grab from a deep pocket.

Why should Google be forced to list links to other search engines in the results of their Google searches?  Why shouldn’t Google be allowed to pay smart phone makers to make Google the default search engine – which helps to reduce the cost of cell phones?  Where is the harm to consumers?  In fact, Googles actions arguably help consumers.

Link to Register report: https://www.desmoinesregister.com/story/news/crime-and-courts/2020/12/17/google-antitrust-lawsuit-iowa-joins-case-with-38-states-over-internet-search-and-advertising/3939064001/

Trump is wrong on his nationalist, anti-international trade policy

Below is the link to an excellent article by Eric Boehm from Reason magazine’s August/September issue.  It gives specific evidence that shows how international trade makes us safer in a world-wide pandemic rather than the opposite.  There is a knee-jerk reaction when we have shortages to assume that we would be better off if we did not depend on other countries for our various needed products.  This essay shows that the facts indicate otherwise.

link to Reason essay by Eric Boehm:  https://reason.com/2020/07/11/trumps-trade-war-made-the-pandemic-worse-and-nationalism-will-slow-the-recovery/

Our ability to pay for prescription drugs is not unlimited!

I agree with John Stanford’s essay in the Wall Street Journal today that controlling drug prices would slow biomedical innovation and and research.  (WSJ 7/2/2020 – see link below.)  When you spend less money on anything you will get less of it.  But that’s okay.  Today, we get more drug research and innovation than we want to pay for.
Most drugs approved by the FDA are required by law to be covered and  paid for by Medicare and Medicaid regardless of price! Many are required by law to be covered and paid for by private insurance companies regardless of the price!  This is true even when the drug provides little or no improvement over other existing approved drugs!  Under such a situation we, of course, get maximum research and development.
If we did the same for space exploration, we would probably already have colonies on Mars.  If we did the same for climate change, we would probably already have that problem solved.  The point is that development of new prescription drugs is not our only priority, and our ability to pay is not unlimited.
We don’t have anything close to free market capitalism in the prescription drug market in the U.S.  Government is already very involved, mostly providing subsidies, protection from competition, and other benefits to drug manufacturers.  It is not unreasonable to set a drug price ceiling that is 20% higher than what is being paid by Australia, Canada, France, Germany and Japan.  We can always make special exceptions for something like a vaccine against the Covid-19 virus.
Link to John Stanford essay in WSJ:

https://www.wsj.com/articles/price-controls-would-throttle-biomedical-innovation-11593625880?mod=searchresults&page=1&pos=1

“Bending the curve” may only lengthen the time we are suffering.

I don’t doubt the good intentions of our government leaders, including elected officials and public health regulators, as they tighten restrictions on our freedom of movement..  We are “bending the curve” and easing the pressure on our health care system.  But unless an effective anti-virus drug is found and administered to everyone very quickly, bending the curve will only delay the time before most of us will become infected, and will lengthen the time that we all suffer emotionally and economically.
Why is our response to this situation so dramatically different than our response to the flu or automobile accidents?  Both the flu and auto accidents kill tens of thousands of Americans each year and are preventable.  We could dramatically reduce those deaths if we used the same extreme measures that we are using against COVID-19.  But what is the point of living if we have to stay away from our family and friends?  For a few weeks, fine.  For several months or more, not acceptable.  Life has risks.  We need to balance the costs and the benefits of our efforts.  Soon, we need to once again let people decide for themselves how much risk they are willing to take.