Tuesday, August 25, 2009

Prescription Drugs Reply


Not to rain on your parade, but *our* program - clearly still in development - does not HAVE a "Medicare Prescription Drug, Improvement and Modernization Act". (It doesn't have Medicare, Medicaid, and any other politically 'sacred cows', for that matter.)

Thus, applying our valuable time arguing about which party did what-when-where, how much it cost, and who voted for or against such-and-such is a Waste Of Time (other than for making sure we don't repeat the same implementation mistakes in our New Approach). Yes, you and I could point out this or that ideological point ad infinitum - but that doesn't get us anywhere, does it? And isn't that EXACTLY what both of us accuse the current self-appointed ruler of Both Parties of doing? They pontificate about endless and frequently meaningless details and attempts to satisfy their respective power-bases and they are *not* devoting very much statesmen-like effort to ADDRESSING THE PROBLEM! And even when they *do* try, they fail to consider the Unintended Consequences adequately.

As much as I would enjoy the diatribes that would result from each of us chasing those oh-so-tempting ideological rabbits, I am struggling to set such things aside. Instead, I'd like to focus on reaching a genuine, truly-non-partisan compromise - one that has less to do with ideology and more to do with providing the actual products & services for people that are truly in need.

That said, I appreciate your acknowledgment of the HUGE costs associated with the R&D efforts to bring these new wonder drugs to market. Many pundits and 'reform advocates' fail to recognize how things work in the Real World at all. The free-enterprise system has been directly responsible in ways too many to count for making that happen. Those companies and individuals took the risk and I - for one, apparently - have no problem with them charging all the market will bear. For every successful drug there are dozens of failures and those R&D costs must be recovered somehow or there is no reason for businesses to work on finding new ones.

That's not to say that I - yes, your humble resident conservative - do not have issues with the drug companies. I do. For example: I don't like private companies getting government funding and other subsidies to do R&D when the government doesn't get an ROI on it's investment (tax breaks are a different beast). Conversely, I don't like government putting unnecessary, bureaucratic road-blocks to R&D and then ignoring the increased cost those regulations cause. I think drug patent protections are too long in some cases, not long enough in others (the problem here is one-size-fits-none: a new headache remedy is not on the same level as a new cancer drug). I don't like government *not* doing honest negotiations with the end-user in mind (e.g., patient *and* taxpayer) for products and services. I don't like the lack of protection on legitimate patents in the international arena. And so on, and so on...

But these are problems in how it's been done in the past. Are they real issues? Yes, of course. Do we have all the answers? No, we don't (at least; not yet). Yes, the devil is in the details, and we'll get to them.

To avoid future confusion on my comment, re-consider the phrasing of your original point:

9. Provide universal access to low cost, generic medicines.

My Point: I am concerned with that "universal access" phrase. Historically, it almost always gets translated to "confiscate". THAT is the issue I'm raising. There must be adequate protections for developers of goods and services as well as the consumer. Drugs do not start as a "generic", nor should they. But once the patent period has expired - which should be tied to some reasonable recovery of all R&D expenses - THEN a drug can become a 'generic' and the future cost savings are from being tied to the actual production cost of the drug itself.

Commercial Freedom demands that there *must* be a reasonable prospect for profit - which is NOT a 'dirty word' - in the research and creation phases for new drugs and treatments (in all phases, actually). It is the prospect of personal profit based on one's efforts that is the powerful mechanism which drives commerce and many forms of human behavior. This is a good thing, since I, for one, am not interested in being stuck with what we have now (or retreating back to the point of using leeches).

I called "universal access" a sound bite because it's main purpose is to 'sound good' to the Great Unwashed (thus generating popular support), while having no clearly defined meaning for how it gets accomplished, and which all too easily gets translated into, "I want it and *my* government will *force* you to GIVE it to me." Sorry, that philosophy is Wrong.

Let's re-establish Unavoidable Rule #1 - Everything has a cost: TANSTAAFL.

So, let us agree to set aside the ideological arguments you raised about MMA - I agree with many of your points - because such a beast doesn't exist in our plan and we know better than to try it again. As such, my original comments and concerns on #9 and #10 are reasonably valid - simply pointing out topics we must consider when we get to the implementation phase. Among the things we must address at that time will include defining the appropriate mechanisms to encourage and reward Positive Behaviors such as Responsible Planning, Assuming Personal Responsibility even-when-consequences-are-life-threatening, etc., while simultaneously discouraging the negative actions and minimizing Unintended Consequences. (The key word in that sentence is appropriate.) Now, THAT is where the Real Challenge comes into play.

BTW - If there is a True Need to "reform Health care" in this country, then by all means, let's *really* start over from Ground Zero... That means we haven't *saved* anything yet, because we're still trying to define the budget for what we WILL spend. Once that is done, *THEN* we get to prioritize HOW we will spend those funds and on WHAT products and services will be provided... This task cannot be easy, or they would not need people of our caliber to do it...

*sigh* - We have a LONG way to go.

- Steve

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