I have a relative works on the clinical side of Pharma.
David Cearley

Bunch of stuff here to be clarified, I think.

First, I think there is plenty to done in the way of reforming FDA processes and I think a lot of that will happen through tech / biotech innovation. There are any number of health issues that could probably be better addressed at the level of individualized or trait-based genomics/proteomics v. population studies designed to ensure safety for everybody rather than high-efficacy for a relevant group. The way we do drug development now can be far too slow and far too wasteful. But patents are an entirely different matter and they are a bad (or at least, a poorly targeted) way to incentive an end-to-end process that entails everything from basic research to development to clinical trials to commercialization. (The rent-seeking inefficiencies in the patent system are too long to detail here, but they apply to drug patenting as much as to anything else).

I understand your point about doctor salaries. Some doctors are on government payrolls such as NHS in Britain, but most are simply paid by reimbursement entities at pre-negotiated rates ($x for checkup, $y for a colonoscopy, etc.). In fact, payment at pre-negotiated rates is what happens virtually everywhere, including the vast majority of the US system. The thing that varies is who gets to negotiate and what their negotiating power is. In the US we let doctors and hospitals form local monopolies or oligopolies and then make insurers compete with each other to provide a bundle of services that are then re-sold as “Health Insurance” to employers and individuals. As a consequence, insurers have no real market power to control costs, so they simply pass them on to the ultimate buyers, plus a small markup for profit and a charge reflecting the downside actuarial risk of greater than expected utilization. In this scheme, providers have no incentives other than to raise prices (because they have the bargaining leverage) and to increase utilization (because patients tend to do what their providers tell them to do, and because if they have “good” coverage that they have already paid for it, why bother to shop around?) So again, this is the system that has got us health care that is twice as expensive as most other countries for outcomes that are slightly worse than average.

Doctors who work for pre-negotiated rates are not “enslaved” by anyone. If they don’t like the way their businesses work (and these are businesses) they are entirely free to do whatever they want. In fact, there are plenty of doctors out there who content providing healthcare in clinical and academic settings, who happily work as salaried employees at HMOs, who do medical research, who found medical startups…. We’ve seen slavery and we still have it in parts of the world, and this is not what it looks like. So I resent the comparison, even if you only meant to deploy it a rhetorical flourish.

As for “corruption prone powerful bureaucrats”, they can be found everywhere — government agencies, insurance companies, pharmaceutical companies — and should be resisted everywhere. Same point about people being held accountable, which happens as rarely in industry as in government (there is lots of social science research on this point that I encourage you to consult).

As for “public lies…” etc. That’s just standard Fox News gibberish that is both untrue and sheds no light on any of the public policies at stake, so I’m gonna pass on that.

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