Linda & Michael and everybody else:

Pricing of drugs can be presented in moral terms, i.e. one can advocate
there should be social justice and everybody has a right to the proper and
most efficacious drugs. Unfortunately the real world does work like this.
There will always be shades of gray. Can everybody have a Rolls Royce and a
10,000 square foot house? In looking at the price of drugs one can argue
they are too high for many people. As was pointed out here and in the media
the cost of developing drugs is very high. So, a more realistic question is
to ask where is the money from the sale of drugs going? Are the profits of
the drug companies excessive (especially when compared to those of other
businesses)? If they are then the governments can do something about it (
by creating rules like those in Europe). But if they are not other
mechanisms must be found to pay for them. These mechanisms would be
insurance plans or government actions. There is a hidden uncertainty in
this: What is the proper allocation of resources for medical activities.
The society as a whole needs to decide how much for various activities
needs to be spent. Defence, Infrastructure (roads), medical, etc.

It is unfortunately true that for new drugs the relevant companies have a
monopoly which allows them to charge essentially anything, without bounds.
But why have established drugs for which the development cost has long been
paid off have risen as well, above the rate of inflation?
A simple answer again is to ask: are the drug company profits excessive? I
think if they are we would all be buying Drug Company stocks.

So what is  the answer? The first is to streamline and make more efficient
the development process. The second is to find a way to distribute the
load. This is what insurance companies do now in collaboration with
employers (in a rather ineffective and inefficient way). Unfortunately the
cost of medical activities has risen steeply recently and shows very little
sign of slowing down. In fact Carline (the PWP) recently has gotten kicked
out of an Aetna HMO because their costs have risen too steeply, so oops,
here goes her plan.

Should medical care be free enterprise based or should there be a
government based system. The latter tend to be inefficient and cumbersome
and the former have unaffordable prices. We need somebody to design a
system. Maybe something like a constitutional convention (similar in
concept of the framers of the constitution) is needed.

For those who favor "free enterprise" and who argue that it works in the
US, I would point out that in all such systems there are (government and
Legal) controls, so that in some sense there is no such thing as "free
enterprise" it is always only more or less free. The other observable fact
in the US is that the system as it is practiced now has increased the gap
between rich and poor and the gap is larger than in many other
industrialized countries. So maybe the thing we need to go after is
equalization.

K-F  cg Carline

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