I was absolutely outraged (yes, the word is overused, but this piece of news really got to me) today. I happened to be in the bathroom when something caught my eye. It was the headline to a report on a copy of the Wall Street Journal that had been put over a box of potatoes we grew and have stored in the coldest part of our temporary home (an old restaurant we are slowly restoring). I had to read the first sentence in the article twice just to make sure I hadn't misread I thought I had read. A German company by the name of Turing Pharmaceuticals had bought the rights to sell a drug used to treat toxoplasmosis called Daraprim from an American company and then raised the price of a single pill from $13.50 to a mind-boggling $750. In the collective wail of protest that had ensued, another company, Express Scripts Holding Company had taken steps to secure the services of a drug compounding company in San Diego - Imprimis Pharmaceuticals - to make an alternative using the same active ingredient, primethamine, that would be more affordable. The result is a pill of equal efficacy that costs - get this - $1!!!!!!
There are two co-supporting reasons that Turing was able to charge $750 for a pill that can be made for less than a dollar - the desire by health insurers to drive premiums as high as the market will support, and the intensity of the will to live, on the part of the afflicted. To really get your head around this, you need to understand that, within the system currently in existence, your primary importance as a patient in some facility, seeking treatment for a disease that can kill you, has less to do with your inherent value as a human being who needs to be saved than it does with the ability of your desire to live to help drive the currents of a giant river of money that moves out of the hands of premium payers (and their loved ones) into the hands of higher-than-average earners throughout the insurance/medical/pharmaceutical complex.
Note carefully, I did not say physicians and nursing staff, who are the front line of care (though some physicians may indeed be driven more by what they can get out of the suffering of others than the tenets of Hippocrates). What I'm talking about are people much further up the food chain - those who, increasingly, determine the conditions under which physicians and nurses obtain employment and how much is to be charged for services and materials applied in the provision of medical care.
If your dislike for the current system is to be anything more useful to society than impotent resentment, it helps to realize that, from the point of view of the Complex, you're really nothing but a faceless shunt. As a faceless shunt, you are forgiven for not being nice in the face of those who have subtly schlepped you into having to accept what you know is the financial equivalent of date rape. You need to be moved enough to throw open the window and yell with all your might that you're mad as hell and not going to take it anymore.
So here's my two cents worth: Every company operating as a corporation falls under the jurisdiction of the society in which it is registered and licensed. From the license-holder's point of view, there are certain inherent advantages to being licensed, which are counterbalanced by certain caveats. On the up side, the license restricts the ability of outside parties to hold employees of the company to account for failures of performance in the conduct of business. The flip side of this protection is that the company must abide by such regulations as society deems it needs to enact for the preservation of the greater good. In simple terms, the issue of a license to a corporation amounts to a contract between society and the officers of the corporation that basically says "Be earnest, be honest, honor the Greater Good of That Which We Are and we will protect you against those who seek to hold you personally accountable for performance that falls short of their desires or expectations."
This contract works best when society is unflaggingly insistent that it be observed and upheld, without exception.
Lest there be any misunderstanding, I definitely DO NOT support the the idea that it is OK for society to apply anything other than the minimum amount of corrective action as is needed to render an outcome sufficient to bring the underlying social contract back into balance. Some support the idea that draconian penalties, that put fear into the hearts of others contemplating similar violations, are the most cost effective way for government to keep corporate misbehavior in check, along the lines of "Spare the rod, spoil the child". In today's world of not-so-tough people, that approach may save some money at the government level, but it also suppresses both legitimate economic activity and business incubation, as principals act to create a wider margin of error for themselves, under the influence of fear. Fear is what holds dictatorships together. We aver rule-by-fear in this country - a republic forged to uphold as much personal liberty as our form of social order could sustain.
So, before I make my suggestion as to how extortionary drug pricing might be brought to heel, just understand, I'm certainly no advocate for high-handed government action, however well-intended. In fact, I myself have suffered grievously as a direct result of heavy-handed, government ordered, corrective action. As a consequence of my erstwhile landlord being required by the city of Seattle to dig up and rebuild the sidewalk next to his building to abate an incursion of hydraulic oil from an ownership of several decades prior - an incursion he had nothing to do with, nor any knowledge of - not just once, but three times, I lost my own business. In the execution of that demand, my landlord expended so much money of his own that he had to sell the building to recover financially. By arrangement with the new owner, my landlord would get the space I was renting and the new owner would take the space he was using. I was out on the street and had neither the money nor the will to relocate. You can imagine how I felt about it when my landlord told me that the ground test had shown that natural decomposition had taken contamination down to the point where only one year more was needed to reduce levels below that where no remediation would be required.
Now that the reader knows where I'm coming from, let me get to the meat of this post - namely, government push-back against drug pricing that holds a knife to the rope a patient is clinging to, for life. If the Wall Street journal can dig up an instance where a pill that can be produced for less than a dollar gets jacked up with a $750 price tag, a single government office in some back room, with a couple of good computers, a reliable phone system and two field-tested ex-reporters, with only one mission to fulfill, can track down a whole lot more.
Every instance of inexplicably high pricing, where the consequence of not receiving the drug involved holds the potential for dire consequences to a patient - death, failure of a vital organ, loss of a sensory system, loss of manual ability, loss of ambulatory ability, loss of speech, mental failure, unabated pain, etc - should be inducted into a methodical process that begins with investigation and, based on the outcome, may proceed forthwith to expropriation of the right to sell to the government alone, as sole agent, at a price related solely to such outlays as have to be made to purchase raw materials, turn them into the packaged finished product, plus a conscionable profit for the addition of value, marketing and distribution to patients in need of the drug, plus whatever costs the government incurs in the exercise of its duty. This condition must pertain until the producer of said drug contracts with the government to sell the drug at no more than x times the benchmark set by the government - the numerator, x, to be set by an independent panel whose sole obligation is to see that the program retains sufficient persuasive force to produce a cessation in unjustifiably high pricing of vital pharmaceuticals, throughout the USA and all its territorial possessions.
The whole process has to be transparent to be effective. There must be a grace period, following the opening of any investigation giving the company the opportunity to adjust its pricing to a level it believes will be consistent with the end result that going through the full process would render. It is far better to nudge people into doing the right thing than to force them to do so. Nudging respects the dignity of those involved; force crushes it.
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