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.

Iowa needs to eliminate licensing laws and regulations that protect existing practitioners rather than their customers.

I agree with Valerie Stallbaumer in her letter to the editor in The Des Moines Register, (See link below), that the purpose of professional licensing requirements by government is to help protect the public from harm.   I disagree with her that it also is to guarantee quality. Safety issues are usually objective: we know pretty well what kind of things can hurt people.  Licensing should assure us that the licensed person knows and follows safe procedures.  But for many licensed professions, quality is subjective. If acupuncture is not effective for some people, what is the harm as long as they don’t get an infection?  The only reason I can think of why government would require a four-year program for acupuncturists is that acupuncturists and their schools lobbied for licensing to protect themselves against competition and to appear more professional.  Acupuncturists, physical therapists, tattoo artists, and ear piecers probably can learn proper safety procedures related to “needling” in just a few days.  We do need a complete review of licensing requirements and regulations in Iowa to eliminate those that prevent competition rather than protect people.

Price gouging can be a good thing.

Sometimes, price gouging can be a good thing.  If there is a sudden surge in demand for something, say face masks or hand sanitizer, is it better to keep prices low and encourage hoarding that can result in complete outages, or is it better to let prices go up as the market demand allows to discourage hoarding and encourage rapid increases in production?  Why would businesses pay for overtime, or expedited shipping, or other higher costs to quickly increase supplies if they are not allowed to increase prices?  There are certainly extreme situations where price gouging would be considered by most people to be immoral.  (For example, it would clearly be immoral to charge $1,000 for a glass of water to a person dying of thirst when you have plenty of it.)  But there are many other situations where allowing prices to go up significantly and quickly helps to make vital products available for important purposes to more people more quickly.  Private efforts to keep prices low and to prevent hoarding in an emergency are to be commended, but be careful before you call for laws or regulations to prevent price gouging.

Right-to-work laws need a change.

Laws and regulations should not require a person to join a union in order to work for a unionized employer, including the government.  But for privately owned businesses, the owners should be able to work exclusively with a union, and require employees to join the union, if that is what the owners want.  Most if not all right-to-work laws do not give owners that right.  Those laws should be changed.

Drug Prohibition causes the associated violence

Under our current regime of drug prohibition in the U.S., it is true that American drug users support the violent drug cartels in Mexico.  If we ended the drug wars, and instead legalized and regulated peaceful drug use, and treated addiction under a medical model, the violence associated with the illicit drug trade would mostly go away.  When CVS opens a drug store across the street from Walgreens, they don’t get into a gun battle.  When a drug store is robbed, they call the police instead of sending out a gang to get revenge. It is the government policy of prohibition that causes the violence associated with the illicit drug trade.  Our drug wars will be endless until prohibition is ended.

Link to related Wall Street Journal opinion:  https://www.wsj.com/articles/the-cartelization-of-mexico-11572999461

Don’t ban vaping!

It was like a breath of fresh air to read in The Des Moines Register that our Iowa Attorney General, Tom Miller, used logic in concluding that banning vaping by adults in Iowa would be a mistake.  (See link to Register article below.)   It does appear clear that almost all of recently rreported deaths and severe illnesses were the result of vaping black market products that contain THC, not nicotine.
While it may be true that no amount of vaped nicotine has been proven safe, we do know that vaping popular legal nicotine products has been going on for years without the type of health problems that have been reported recently.  We also know that nicotine vape products do not contain the tars and other substances in cigarettes that are known to cause cancer.
It’s reasonable to think that vaping nicotine is less harmful than smoking cigarettes, and that going from smoking cigarettes to vaping can be a good step towards quiting a nicotine habit altogether.  But, prohibition of vaping would only worsen the health problems, just like with opioids, where people who purchase their drugs on the street have no idea of the strength or purity of the products they are buying.

Time to start reducing use of government force in transportation fuels.

The forced use of biofuels, euphemistically called the Renewable Fuel standard (RFS), was established in 2005.  Then as now, the RFS requires refiners and importers of transportation fuels to add minimum amounts of ethanol or bio diesel to their fuel, or be subject to fines.  The requirement has grown from 4 billion gallons in 2006 to 15 billion gallons for traditional ethanol for 2019.  Existing legislation requires a completely unrealistic total of 36 billion gallons by 2022, including at least 16 billion gallons from cellulosic biofuels.
The current “rebellion” by Iowa biofuel leaders against the waivers of the FRS requirement that are being granted to small refiners is understandable.  (The waivers allow small refiners to be exempt from adding bio-fuels to their gasoline or diesel.)  All businesses that are dependent on government protection will fight back if they feel their favored status is being threatened.  Biofuels producers and their suppliers (corn farmers), will lobby hard and loud to stop any reduction of the RFS.
Will the subsidies and use of force ever end?  After 13 years of increasing subsidies, we now need to pass laws to start reducing, and over time end, the forced use of ethanol.

Living has risks. Government should not prohibit things that are not proven safe.

The Des Moines Register recently published a report about Madison County Boar of Supervisors considering a requirement that wind turbines be setback 1.5 miles from the nearest home.  Ben Johnson, a cardiologist who lives in Madison County was quoted as saying, “Industrial wind turbines have never been proven to be safe, nor free of adverse health effects,”

It is difficult, if not impossible, to prove that anything is safe or free of adverse health effects.   For example, driving or riding in a car at any speed has never been proven to be safe. No amount of second-hand barbeque smoke has been proven safe.  Eating chocolate has never been proven free of adverse health effects. We live in a risky world. It would be impossible to live our lives if we were prohibited from doing anything that was not proven safe or free from adverse health effects.

We should not have policies that prohibit things until they are proven safe or free of adverse health effects. Unless something is proven to be unreasonably dangerous, it should be allowed.

Bootleggers and Baptists – strange bedfellows.

During the time of alcohol prohibition, bootleggers and baptists were both opposed to repeal of the Eighteenth Amendment.  It’s an example of how, “politics makes strange bedfellows.”  Even though the two groups seemed to have completely opposite views about drinking alcohol, they both opposed the repeal of prohibition: The baptists for moral reasons, the bootleggers for financial reasons.
I read the report in The Des Moines Register about how scared the Iowa medical marijuana dispensaries are about losing money once the legalization of recreational marijuana in Illinois begins next January 1st.  (see link below)  It makes me wonder if Iowa might face a similar situation in the future. The governor and many other politicians oppose efforts to legalize the recreational use of marijuana for moral reasons.  I wonder if Iowa’s legal medical marijuana producers and sellers will oppose efforts to legalize recreational marijuana for financial reasons?