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Healthcare

For the New Year: Some Fresh Thoughts on How to Tackle High Drug Prices

Some thoughts for 2020 what we need to do in order to tackle high drug prices.

How Can We Improve Healthcare Today?

As 2019 wraps up, there is plenty of ample opportunity to discuss what should be the priorities for Congressional lawmakers in 2020.

What is top of mind for many Americans, of course, is healthcare.

It’s as much about the cost as it is about services and the ability to choose what works best for you and your family.

On the Democratic side, many presidential candidates are endorsing Medicare For All as an answer. We’d be inclined to disagree.

Others have focused just on repealing Obamacare (The Affordable Care Act). A challenge to its constitutionality is once more making its way through the courts.

Here’s a quick breakdown that we believe would empower consumer choice, affordability, and make people better off today.

👉Allow health professionals to practice in every state (reciprocity)

👉Reduce barriers to entry for health professionals, and create more streamlined license recognition for immigrants

👉Promote price of care transparency

👉Keep pharma competitive and protect IP to offer the best treatments

👉Digitize records to upgrade our systems

👉Emphasize the role of catastrophic insurance

👉Allow portability of insurance between employers

👉Allow additional tax benefits for those who save money for health costs (HSAs, etc.) and let them use where necessary

👉Allow insurance companies to offer plans and compete across state lines

We must resist Public Health England’s brave new world

We must resist Public Health England’s brave new world

In a remarkable authoritarian parting shot as she left her post as Chief Medical Officer, Dame Sally Davies published a report entitled Time to Solve Childhood Obesity, which was warmly welcomed by Health Secretary Matt Hancock.

The report’s recommendations would create a positively dystopian world. Public Health England want to outright ban eating on public transport. Inflated VAT rates would make simple food and drinks purchases seem rather more extravagant than before.

There would be no more junk food ads, and buying fast food would become an ordeal and a luxury. But if the government opts to follow the report’s recommendations – which is a real possibility, whoever wins the election – this Brave New World could soon become a reality.

The supposed childhood obesity epidemic has been slowly but surely taking over British public health discourse. It began around 2005, with Jamie Oliver’s televisual lip service, and eventually resulted in George Osborne’s sugar tax eleven years later.

With over one in five English 10 and 11-year-olds suffering from obesity according to the latest available data from the NHS, the government has understandably set alarm bells ringing.

The domineering, restrictive approach being proposed by Public Health England, however, brings to light some deep-seated issues.

The key one has to do with individual freedoms. Radical measures like taxing ‘unhealthy’ foods, banning ads and enforcing plain packaging would fail to tackle childhood obesity, while also harshly affecting adults and their personal choices.

This kind of nannyism is remarkably cross-party, differing only in degree. While Jeremy Corbyn’s support for sin taxes and junk food ad bans comes as no surprise, it is quite baffling to witness Tories persistently meddling with individual choices too.

Considering the party’s ideological roots, you would expect the Conservatives to be more mindful of the dangers this approach poses for the fundamental freedom to choose.

Plain packaging of tobacco products and the ban on plastic straws signalled a drastic shift away from core Conservative values, and it seems that things are only getting worse.

Public support appears dishearteningly high for such approaches. A YouGov poll from a few months ago showed that 55% of the public believe we need additional taxation on unhealthy foods and drinks. Alarmingly, the figure among Conservative voters is 54%.

The poll also found that nearly two thirds of British adults would be in favour of banning junk food TV ads before the 9pm watershed, with only 20% opposed. Almost three quarters support restrictions on food advertising on YouTube and social media.

In this context, ad bans and harsh authoritarian restrictions are seeming less and less draconian. It would appear that infringing on individual choices is politically profitable in Britain today.

It is little wonder, then, that the Conservative party continues to err on the side of greater state interference, despite the ideological mismatch it causes.

Whether we will truly find ourselves waking up one day to be greeted by Public Health England’s brave and healthy new world remains unclear.

Back in July, Boris Johnson vowed to review sin taxes and put an end once and for all to the “continuing creeping of the nanny state”, but since then, solid commitments or steps in that direction have not been forthcoming.

Perhaps, the nanny state seems appealing to many at the moment because we have not yet experienced fully-fledged nannyism in action.

If the current trend continues, we may find out by 2024 whether following Public Health England’s programme of taxes, ad bans and plain packaging will be enough to fight childhood obesity, or if yet more restrictions on choice will be on their way.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at 
consumerchoicecenter.org

Counterpoint: What about freedom to choose your care?

From atop the lecterns at the Democratic presidential debates and the White House, a common trope is dismantling and rejiggering how health care is delivered in America.

For those on the left, the emphasis is on expanding who can access government-backed health insurance programs while cutting off the role of the private sector. And on the right, President Donald Trump is looking to import drugs and pharmaceutical price controls from abroad.

Missing in both of these visions is the essential component that governs every other sector of the economy: the freedom to choose.

Much like housing, transportation and education, it’s clear that the entire health care sector needs disruption. We need some out-of-the-box thinking, innovation and on-demand delivery that will bring costs down for ordinary people.

It’s this formula that has empowered millions to rise out of poverty, make a decent living for their families, and expand consumer choice to makes their lives better.

But both the Democrats and Trump are leading Americans astray on what really matters when it comes to health care.

Sens. Bernie Sanders, Elizabeth Warren, Cory Booker and Kamala Harris have serious proposals to totally ban the private health care market in favor of a “Medicare for All” system. That means every American would be thrown into the government insurance program reserved for our seniors.

All administration, billing, reimbursement claims and hospital contracts for more than 350 million people would be handled by the federal government. For a country as unique, diverse and large as the United States, this just couldn’t be carried out effectively.

Such plans would make it illegal for Americans to choose the type of health care coverage that fit them best, depriving them of fundamental choices.

Many younger working people don’t have comprehensive insurance because it doesn’t make economic sense. They would rather pay out of pocket for small expenses and use high-deductible disaster insurance when necessary.

For the 8.8 percent of Americans without health insurance, would they benefit from a mass reorganization of the system that would offer the care reserved for our seniors if the cost comes in the form of higher taxes and less consumer choice?

The same applies to Trump’s well-intended but flawed plans on importing drugs from single-payer systems around the world.

The reason pharmaceutical drugs are more expensive has more to do with subsidies than cost. Most drugs are born from innovative American firms but are subsidized greatly or negotiated for lower rates by governments who import them.

Firms can afford this because it’s offset by American prices, meaning the rest of the world is free-riding on American innovation and intellectual property.

They achieve this by reducing access and choice. It’s no secret that the lion’s share of pharmaceutical drugs are available in the United States while they’re unavailable in the countries that refuse to pay for them. So yes, the prices of drugs may be cheaper in Canada or Norway, but the supply and choices are lacking.

Do we want fewer choices of drugs for lower costs or more choices and prices at market rate?

What matters most when it comes to our personal health is the freedom to choose. Whether it is our doctor, insurance program or drugs we buy, Americans want to be able to pick what works best from them.

Grandiose plans that seek to completely reorganize how many taxes we pay and how we receive care would severely restrict that.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at 
consumerchoicecenter.org

Zölle schaden Ihrer Gesundheit

In New York tritt vom 17. bis zum 30. September zum 74. Mal die Weltgemeinschaft zusammen, um dringende Fragen zu diskutieren. Die Vollversammlung der Vereinten Nationen befasst sich nicht nur mit der Frage, wie die Waldbrände im Amazonas zu löschen wären, oder wie die Nachhaltigkeitsziele erreicht werden können. Die Delegierten fragen sich auch, wie in ärmeren Staaten die Gesundheitsversorgung verbessert werden kann. Dazu haben sie die Bekämpfung nichtübertragbarer Krankheiten und den umfassenden Zugang zu Gesundheitsleistungen auf die Tagesordnung gesetzt. In Schwellen- und Entwicklungsländern warten Patienten bis zu zehn Jahre auf ein neues Medikament und zahlen häufig auch noch das Dreifache des eigentlichen Importpreises.

In beiden Feldern ist der Rückstand auf die 35 reichsten Länder enorm. Patienten in ärmeren Ländern müssen häufig ihre Behandlungskosten selbst zahlen. Die Entwicklungshilfe, deren Milliarden seit Jahrzehnten auch in die Gesundheitsversorgung fließen, hat an diesem grundlegenden Missstand kaum etwas geändert. Die Förderprogramme scheitern an Korruption, Misswirtschaft und fehlender Infrastruktur.

Mit einigen einfachen und wirksamen Instrumenten kann die Weltgemeinschaft die Gesundheitsversorgung weltweit deutlich verbessern. Wenn Regierungen weltweit Einfuhrzölle und andere protektionistische Maßnahmen gegen lebensrettende Medikamente reduzieren, machen sie diese für die Ärmsten der Welt deutlich erschwinglicher.

Dort wo Krankenversicherungen nur unzureichend ausgebaut sind – wenn sie überhaupt existieren – müssen Patienten und ihre Familien die Kosten einer Krankheit allein bestreiten. Der Fiskus zockt sie dabei auch noch ab, indem er oft hohe Einfuhrzölle und Verbrauchssteuern auf innovative ausländische Medikamente erhebt. Indien beispielsweise erhebt einen zehnprozentigen Einfuhrzoll auf importierte Medikamente. Damit nicht genug. Der indische Staat hält noch einmal die Hand auf und verlangt von seinen Bürgern bis zu 18 Prozent zusätzliche Mehrwertsteuer auf ihre Arznei. Im benachbarten Nepal zahlen Patienten sogar fast 15 Prozent Einfuhrzoll auf Medikamente. Die Zölle und Sondersteuern sorgen dafür, dass den Ärmsten der Welt unnötig der bezahlbare Zugang zu lebensrettenden Gesundheitsleistungen versperrt ist. Wer ein Medikament nicht mehr bezahlen kann, weil es durch den Staat massiv verteuert wurde, muss an anderer Stelle verzichten – oder die Behandlung ganz bleiben lassen. Die gierige Bürokratie stellt Patienten vor eine teuflische Wahl: Ruin oder – potenziell tödliche – Krankheit.

In Indien 4.000 Bestimmungen zur Einfuhr von Medikamenten!

Der Ökonom Matthias Bauer hat errechnet, dass chinesische Patienten 5,5 Milliarden Euro sparen würden, wenn die Zollschranken gegen importierte Medikamente fielen. In Indien und Brasilien würde Freihandel die Medikamentenpreise nahezu halbieren.

Zusätzliche Steuern und Auflagen verursachen in Brasilien, Kenia und weiteren Staaten eine Verdoppelung – mitunter gar eine Verdreifachung! – des Endkundenpreises gegenüber dem eigentlichen Einfuhrpreis. Diese Steuern treffen die Armen der Welt am härtesten. Ihre Abschaffung macht eine würdige und angemessene Gesundheitsversorgung für hunderte Millionen Menschen deutlich erschwinglicher.

Doch nicht nur Zölle und Steuern verteuern die Medizin im Bestimmungsland. Langwierige Einfuhrprozesse, Etikettiervorschriften und missverständliche Bestimmungen erhöhen den Endpreis. Derlei Vorschriften nützen sicherlich den Zollbehörden, um ihre Budgets zu rechtfertigen. Diese bürokratischen Hürden schaden letztendlich den Patienten und treiben die Preise wichtiger Medikamente. 

Indien allein kennt beinahe 4.000 Vorschriften und Lizenzbestimmungen zur Einfuhr und dem Vertrieb von Medikamenten! Jeder Importeur muss sich diesen Regelungen beugen und die dadurch entstandenen Kosten auf den Preis für Endkunden aufschlagen. In Russland und der Türkei halten Regierungen die Patienten an, heimisch produzierte Medikamente zu kaufen und erschweren den Zugang zu ausländischen Produkten. So wird das Patientenwohl politisch-wirtschaftlichen Interessen untergeordnet. 

Und selbst wenn Patienten sich die Medikamente leisten könnten, sind diese häufig nicht verfügbar. Neue Arzneimittel erreichen diese Länder oft erst nach Jahren. Die lokalen Behörden verzögern die Anmeldung von Patenten und weiteren Rechten durch langwierige Prozesse. In Thailand dauert es 14 Jahre, ein Patent zu erteilen – 14 Jahre, in denen Patienten auf die Therapie warten, leiden und schlimmstenfalls sterben. Mit dem erteilten Patent ist das Warten aber längst nicht vorbei, denn dann geht es an die Verkaufsfreigabe.

Sieben Jahre bis zur Medikamenten-Freigabe

Es dauert lange bevor die einzelnen Länder Medikamente zum Verkauf freigeben: in China drei, in vielen afrikanischen Staaten zwischen vier und sieben Jahren. Die Aufsichtsbehörden in Entwicklungsländern wären gut beraten, sich auf die fundierten Zulassungsentscheidungen der amerikanischen FDA oder der europäischen Zulassungsbehörde EMA zu verlassen und auf einen erneuten Zulassungsprozess zu verzichten. Das käme den Patienten zugute, die nicht mehr jahrelang auf diese oft lebensrettenden Medikamente warten müssten.

Eines sollte den Delegationen bei der UN-Vollversammlung klar sein: Zölle und Vorschriften können sie einseitig und schnell abschaffen und verschlanken. Das ist in der Regel ein einseitiger Schritt des jeweiligen Landes, der besonders Entwicklungsländer bei den gesundheitsspezifischen Nachhaltigkeitszielen deutlich voranbringt. Schnellere Zulassungsverfahren und erleichterte Einfuhrbestimmungen senken den Leidens- und Preisdruck auf Patienten weiter.

Selten hat ein trockenes Thema wie Bürokratieabbau so weitreichende Folgen für große Teile der Weltbevölkerung. Zölle schaden Ihrer Gesundheit, es ist höchste Zeit für den kalten Entzug.


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Should I Stop Vaping?

Over the past few weeks we’ve seen a surge of headlines that say vaping may be more harmful than we might have initially thought. Seven deaths have been linked to the use of e-cigarettes. In response, some states have banned vaping products. However, naysayers — including experts — argue that a knee-jerk reaction by health agencies is premature, overlooks the harm reduction that vaping achieves, and could cause a potential public health disaster

If smoking is the de facto predecessor of vaping, then e-cigarettes should be examined within the context of nicotine delivery systems as a whole. Smoking is the leading cause of preventable death in the United States. Should the risk associated with vaping be a deterrent when the alternative is smoking cigarettes?

Some in the recovery community say that it shouldn’t. Many former cigarette smokers have replaced their “analog” smokes with e-cigarettes, using vaping as a means of harm reduction that swaps out cancer-causing tobacco with a safer means of nicotine delivery. Recovery purists and some clinicians, however, argue that smokers are trading one addiction for another and express concerns that, lower risk or not, most vapers are still ingesting large amounts of highly addictive nicotine. They also point to this recent rash of deaths as evidence against vaping.

Before we address the question of harm reduction, though, do the alarming headlines have any merit in science? And given that e-cigarettes have been around for 15 years, why are we only seeing deaths now?

RECENT MEDIA COVERAGE OF VAPING

The American Medical Association (AMA) recently labeled vaping “an urgent public health epidemic,” and physicians have urged the Food and Drug Administration (FDA) to act. The AMA claims that research has shown that the use of e-cigarettes and vaping products is unsafe and causes addiction, however the statement does not provide the supporting research. The AMA also says they “applaud steps to remove flavored e-cigarette products from the market.”

The Centers for Disease Control and Prevention (CDC) issued a statement that together with the FDA, local health departments, and other clinical and public health partners, they are investigating a multi-state outbreak of lung disease associated with e-cigarette products. The FDA echoed the CDC’s concern, calling the outbreak “a frightening public health phenomenon.”

Dr. Dana Meaney-Delman, who is leading the CDC’s investigation, said in a statement, “The recent rise of acute lung illnesses linked to vaping has deepened concerns about the safety of the devices.” 

But why now? People have been vaping for over a decade. The CDC’s Meaney-Delman says, “We’re all wondering if this is new or just newly recognized.”

Here’s what we know: As of this writing (9/21/19), the CDC states that 530 cases of lung illness have been reported from 38 states, and seven deaths have been attributed to vaping. Most affected patients also reported a history of using vaping products that contain THC. 

The CDC does not yet know the specific causes of these illnesses: “The investigation has not identified any specific e-cigarette or vaping products (devices, liquids, refill pods, and/or cartridges) or substance that is linked to all cases.” Regardless, for those who are concerned with these issues, the CDC recommends refraining from using all vaping or e-cigarette products until they know more.

Elsewhere on the website, the CDC still states that e-cigarettes have the potential to benefit adult smokers as a substitute for regular cigarettes.

E-CIGARETTE BANS GOING INTO EFFECT

Because of the media coverage and caution by public health agencies, we are seeing increasing action across the US: New York’s former mayor, Michael R. Bloomberg, has committed $160 million to ban flavored e-cigarettes, Governor Gretchen Whitmer issued an executive order to ban the sale of flavored vaping products in Michigan, San Francisco has banned the sale of e-cigarettes, and President Donald Trump says the FDA will ban flavored e-cigarettes. 

Is this a knee-jerk reaction? It seems that some of the pressure is a result of parents and politicians who are concerned that flavored vaping products are responsible for the surge in teen use. That’s understandable, given the potential for nicotine to harm the developing brain. According to the CDC, one in five high schoolers and one in 20 middle schoolers vape.

For adults, however, there appears to be conflicting statements by researchers, doctors, and health officials. 

In a September 2019 article, Dr. Robert Shmerling at Harvard echoed the CDC’s bottom line: Experts are unsure if vaping is causing these lung problems, and lung disease has not been linked to a specific brand or flavor of e-cigarette. A more likely culprit, they claim, is a chemical contaminant within the inhaled vapors that is causing an allergic reaction or immune system response. 

This belief is supported by a study that came out last year linking the chemical flavors within e-cigarettes to an adverse effect. Dr. Sven-Eric Jordt, PhD, one of the authors of the study, recently told The Guardian that “the liquids vaporised by e-cigarettes are chemically unstable and form new chemicals that irritate the airways and may have other toxic effects.” These new chemicals are not disclosed by the manufacturers to users. 

Dr. Michael Siegel, a professor at Boston University, claims that health officials and physicians are not telling the full story: In every case in which a specific e-liquid has been identified, that e-liquid has been found to contain THC — a fact corroborated by the CDC. He states that the e-liquids in some of these cases were oil-based and typically purchased off the street; therefore, their ingredients are not strictly regulated. It is these oil-based THC liquids that are known to cause acute respiratory illness. 

Similarly, the Washington Post reported that the FDA investigation found the same vitamin E-derived oil in cannabis products that were used by those found to be suffering vaping-related illnesses throughout the country. 

CDC’S GUIDELINES: UNNECESSARILY BROAD

While Siegel acknowledges we aren’t in a position to draw conclusions about THC oils or to say that street products are definitely to blame, he believes the CDC’s recommendations are unnecessarily broad and consequently harmful, since people who vape may think it’s safer to go back to smoking cigarettes. 

“I cannot overemphasize how insane this policy is,” he says. “From a public health perspective, it makes absolutely no sense to ban these fake cigarettes but to allow the real ones to remain on the shelves.”

Instead, Siegel suggests, the CDC could offer more specific and useful guidance to the public, specifically: Do not vape THC oils (including butane hash oil), do not use any oil-based vaping e-liquid product, and refrain from buying products off the street or using any e-liquid that doesn’t disclose its ingredients. To reduce risk, people should “stick to products being sold at retail stores, especially closed cartridges where there is no risk of contamination or the presence of unknown drugs.”

Switching from smoking tobacco to e-cigarettes is a proven harm reduction strategy supported by health officials and used by individuals in recovery. 

Lara Frazier, a person in long-term recovery, explained, “I am in abstinence-based recovery and quit smoking cigarettes over four years ago, thanks to e-cigarettes.” Regarding the recent deaths associated with vaping, she says: “There is mass hysteria about vaping, with people not being properly educated on what is actually occurring.”

Frazier is concerned about the consequences of recent official warnings: “Nicotine addiction is like any addiction, and banning flavors will likely not result in less nicotine being smoked. This could cause more harm because the teenagers will have to find black-market cartridges, make their own juice, and/or switch to smoking cigarettes.”

She continues, “I think it’s ridiculous that they are going to ban all flavored juices that aren’t tobacco-based on five (now seven) deaths and illness without properly looking at the data or researching the cause of the illness.”

VAPING AS HARM REDUCTION

There is world-wide support and evidence for vaping as harm reduction. A study conducted by the New England Journal of Medicine found that vaping was nearly twice as effective as conventional nicotine replacement products for smoking cessation.

In the UK, Public Health England also supports vaping as a harm reduction strategy. Even in light of the recent concerns, their position has stayed the same: “Our advice on e-cigarettes remains unchanged — vaping isn’t completely risk-free but is far less harmful than smoking tobacco. There is no situation where it would be better for your health to continue smoking rather than switching completely to vaping,” they said.

Yaël Ossowski, deputy director of the Consumer Choice Center, urged President Trump to consider the facts before reacting hastily and pushing for a ban, arguing that vaping is a less harmful alternative for consuming nicotine. Ossowski cites a 2016 report by the UK’s Royal College of Physicians, which reviewed the science, public policy, regulation, and ethics surrounding vaping and concluded that e-cigarettes should be promoted widely as a substitute for smoking. The report also sought to clear up misinformation about vaping and long-term harm, stating that while there is a possibility of harm from e-cigarettes, it is unlikely to exceed five percent of that associated with tobacco products. 

SMOKING CIGARETTES IS STILL THE LEADING CAUSE OF PREVENTABLE DEATH

According to the Centers for Disease Control and Prevention, more than 16 million Americans are living with a disease caused by smoking. We have abundant evidence that smoking leads to disease and disability, harming nearly every organ in the body. It causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease. It also increases the risk for tuberculosis, eye diseases, and autoimmune conditions. 

Worldwide, the use of tobacco products is responsible for more than seven million deaths each year. In the U.S., 480,000 people die every year from smoking, and 41,000 people die as a result of secondhand smoke. Economically, smoking has a huge impact on the United States: it costs $170 billion a year in direct medical care, and $156 million in lost productivity. 

Smoking remains the leading cause of preventable death. 

At this point, the evidence supports vaping as an effective means of harm reduction, thus outweighing the limited risks. Further, public health officials have yet to complete their investigations into these risks so they can conclusively identify the cause of the deaths attributed to vaping. It seems foolish to enforce blanket bans on e-cigarettes, as that may cause further harm by pushing people toward buying black-market vaping products or resuming smoking cigarettes.

This article was originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at 
consumerchoicecenter.org

What happened to the right to choose your healthcare?

From atop the lecterns at the Democratic presidential debates and the White House, a common trope is dismantling and rejiggering how healthcare is delivered in America.

For the left, the emphasis is on expanding who can access government-backed health insurance programs while cutting off the role of the private sector. On the right, President Trump is looking to import drugs and pharmaceutical price controls from abroad.

Missing in both of these visions is the essential component that governs every other sector of the economy: the freedom to choose.

Much like housing, transportation, and education, it’s clear that the entire healthcare sector needs disruption.

We need out-of-the-box thinking, innovation, and on-demand delivery that will bring costs down for ordinary people. It’s this formula that has empowered millions to rise out of poverty, make a decent living for their families, and expand consumer choice to makes their lives better.

But both the Democrats and Trump are leading Americans astray on what really matters when it comes to healthcare.

Sens. Bernie Sanders, Elizabeth Warren, Cory Booker, and Kamala Harris have serious proposals to totally ban the private healthcare market in favor of a “Medicare For All” system. That means every American would be thrown into the government insurance program reserved for our seniors.

All administration, billing, reimbursement claims, and hospital contracts for over 350 million people would be handled by the federal government. For a country as unique, diverse, and large as the United States, this just couldn’t be carried out effectively. The CBO’s analysis of a single-payer system admits that new taxes and an entirely new administrative bureaucracy would take years to implement.

Such plans would make it illegal for Americans to choose the type of healthcare coverage that fit them best, depriving them of fundamental choices.

This makes two grandiose and flawed assumptions. One, that a top-down government reorganization of insurance and health services would be the best method to deliver healthcare, and two, that the individual consumer cannot be trusted to make decisions about their care. That is wrong.

People choose different healthcare plans depending on their employment situation, their age, or their lifestyle.

Many younger working people, such as myself, don’t have comprehensive insurance because it doesn’t make economic sense. We’d rather pay out of pocket for small expenses and use high-deductible disaster insurance when necessary. The young and healthy tend to shy away from the large insurance plans for these very reasons.

For the 8.8 percent of Americans without health insurance, would they benefit from a mass reorganization of the system that would offer the care reserved for our seniors if the cost comes in the form of higher taxes and less consumer choice?

The same applies to Trump’s well-intended but flawed plans on importing drugs from single-payer systems around the world.

The reason pharmaceutical drugs are more expensive has more to do with subsidies than cost. Most drugs are born from innovative American firms but are subsidized greatly or negotiated for lower rates by governments who import them. Firms can afford this because it’s offset by American prices, meaning the rest of the world is freeriding on American innovation and intellectual property.

They achieve this by reducing access and choice. It’s no secret that the lion’s share of pharmaceutical drugs are available in the U.S. while they’re unavailable in the countries that refuse to pay for them. So yes, the prices of drugs may be cheaper in Canada or Norway, but the supply and choices are lacking. Do we want fewer choices of drugs for lower costs or more choices and prices at market rate?

What matters most when it comes to our personal health is the freedom to choose. Whether that it’s our doctor, insurance program, or drugs we buy, Americans want to be able to pick what works best from them. Grandiose plans that seek to completely reorganize how many taxes we pay and how we receive care would severely restrict that.

That may be a well-intended path, but one that millions of Americans are right to reject.  

Yaël Ossowski is deputy director of the Consumer Choice Center

Published in the Chicago Tribune: https://www.chicagotribune.com/lifestyles/health/sns-tns-bc-healthcare2-commentary-20190815-story.html

Published in Globe Gazette: https://globegazette.com/opinion/columnists/commentary-what-happened-to-the-right-to-choose-your-health/article_b941a988-7864-51e5-98e2-5e987626ce16.html?utm_source=dlvr.it&utm_medium=twitter

Published in Duluth News Tribune: https://www.duluthnewstribune.com/opinion/columns/4636779-National-View-Column-Americans-deserve-the-right-to-choose-their-health-care

Liberals want to build their campaign around pharmacare, but ignore where drugs would end up

Fred Roeder is a health economist and the managing director of the Consumer Choice Center. David Clement is the North American-affairs manager for the Consumer Choice Center.

Internal documents from within the Liberal Party recently showed that Ontario Liberal MPs want 2019’s election campaign to be built on a national pharmacare plan.

Specifically, the proposed plan would seek to centralize and consolidate the 46 drug-procurement programs that exist in Canada. The goal would be to give Canada as a whole more bargaining power in the drug-procurement process, which would potentially lower the prices Canadians pay for their medicine. Although pharmacare could lower drug prices in the short run, it could also run the risk of exacerbating Canada’s existing drug shortage, and significantly limit patient access in the long run.

If a national pharmacare plan were to work, as advertised, it would help Canadian patients by lowering the price they pay for medicine. Unfortunately, the Liberals are largely ignoring the issue of where much of these low-priced drugs would end up, which is the United States. It is one thing to lower drug prices for Canadians, but that benefit isn’t realized if Canadian patients never actually have access to those cheaper drugs.

Pharmacare would be an attempt to further control the price of drugs. The problem is that Canada already has price-control mechanisms for prescription drugs at the federal and provincial level. Those price controls lead to much lower drug prices compared with the prices paid south of the border. That said, because Canadian drugs are cheaper than in the United States, several U.S. states have begun looking at importing pharmaceutical products from Canada in an attempt to undercut U.S. prices. For example, the Republican Governor of Florida has recently pushed for federal approval for drug importation from Canada, and U.S. President Donald Trump has already signalled his support of this measure.

And while importation from Canada to the United States could mean lower drug prices for patients in Florida, Canadian patients could suffer as a result of worsening access. U.S. Health Secretary Alex Azar has publicly stated that Canada doesn’t have the appropriate supply to meet patient demand, and that large pharmaceutical companies are unlikely to increase their supply for the Canadian market. Worsening drug shortages are the most likely outcome for Canadians if the federal government adds in more price controls while having large-scale drug exports to the United States. We know that this is the probable outcome because Canada already suffers from a lack of supply, and another measure to intervene on pricing will simply increase the incentive for American states to import from Canada.

Supply is one problem for Canadian patients, but it isn’t the only issue they face, and it isn’t the only issue that could get worse as a result of pharmacare. In addition to poor supply, Canada is significantly lagging in terms of access to potentially life-saving and innovative medicines. Countries such as Germany, Japan and the United States all introduce, and reimburse for, innovative drugs quicker than in Canada. Here, it takes more than 450 days for a new drug to be reimbursable, while that number is only 180 days in the United States. It can be expected that a pharmacare plan would make this innovation problem worse. It is unlikely that the manufacturers of these drugs will want to roll out innovative medicines in Canada, under various forms of price control, if those drugs can then be resold into other markets, undercutting prices abroad.

For cost, it is important to remember that Canadians have lower drug prices than Americans. At the same time, it is important to be aware that because of price controls, Canada is not a significant market for drug manufacturers, especially when compared with the United States, which accounts for more than 50 per cent of the industry’s global profits. If Canada goes too bullish against drug prices, while at the same time allowing American states to import prescription drugs from Canada, we might run the risk of drug companies leaving entirely, or massively delaying the introduction of new drugs in Canada.

Companies leaving the domestic market entirely might sound like a far-fetched concept, but it is something the Canadian marketplace has seen in other industries. Take Google and the recent issue of political advertising in Canada. Ottawa significantly changed its election advertising regulations, and rather than comply, Google decided that it would leave the political advertising market altogether. Thus, we have a large multinational entity cutting itself out of the political advertising market because conditions aren’t ideal, and because Canada’s market is minuscule in comparison to others.

Everyone wants more competitive and better pricing for patients. Unfortunately, the elephant in the room is where these price-controlled drugs end up, and how industry will respond. Our concern, as a consumer group, is that the pharmacare plan, without addressing export, could exacerbate the already serious issue of drug availability in Canada.

If a provider of vital pharmaceuticals were to pull out of the Canadian market as a result of price fixing and undercutting, it would be Canadian patients who pay the ultimate price. Drug access – especially to new innovative treatments – lags in Canada, and without the foresight to correct some of these blind spots, access could either get significantly worse, or be eliminated altogether under a national pharmacare plan. That scenario should concern all Canadians.

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