How I survived my summer vacation

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I took most of July off from work this summer while going through acute heart failure and by far the worst medical crisis of my life. The complexity of healthcare is occupying my mind like never before.

I cannot adequately express my gratitude and admiration for the doctors, nurses, therapists and various other professionals in hospitals and clinics and the companies that develop and manufacture medical devices and pharmaceuticals, whose combined skills have saved my life and set me on a path brought to better health. Millions of other patients with heart disease need the same thing every year, as noted in a separate comment by Haider J. Warraich.

Despite all the enormous costs, inequalities and Byzantine complications of health care in America, I was reminded in the most vivid way that there may not be a better place in the world to be when you get really sick.

Meanwhile, now that I have recovered in an arena of at least as many faults and far fewer virtues – the feverish world of modern American politics – I find my patience with its mendacity and recklessness has diminished as much as my heart’s ejection fraction was a few weeks ago.

It pains me to see Washington’s medicine men, as always, hard at work brewing questionable potions to cure what ails American medicine. You may wonder what fills these shamans with such boundless confidence in their noses.

Is it the recent miracles that politicians have achieved with their economic regulations, especially in terms of inflation? Or perhaps the way their way of sleeping has brought Americans together, as so often promised, in a new birth of democratic harmony? Or the elaborate remedies our ruling elites have devised for the crime problem?

During my medical treatment, real healers repeatedly spoke clearly to me about the risks of what they were planning to do, and checked my CPR wishes several times if something went wrong.

Why do our political quacks never mention the risks of their panacea?

Case in point: Imposing price controls on prescription drugs in the much-celebrated “Inflation Reduction Act of 2022,” which Washington Democrats say will cool the planet, as well as runaway prices.

As I wrote a few years ago about an earlier, even more drastic version of this price-fixing plan — long a favorite among progressives — you won’t often hear what is being presented as “price controls” by the proponents of this legislation. Proponents call it “negotiating” and imply that it’s just about using the Medicare program’s large patient base as leverage to negotiate more reasonable pharmaceutical costs with drug companies.

But what is actually being proposed is “negotiation” only in the same sense as Putin’s “negotiation” in Ukraine. While the current proposal is being narrowed in scope (subject to expansion), it still involves the government setting a “maximum fair price” for selected drugs. And if a company refused to accept the price from the government, its earnings from the drug in question would be subject to confiscation penalties.

It’s not a “take it or leave it” offer. It’s “take it or else”.

Everyone wants to crack down on drug traffickers, I think, as long as the drugs they sell are legal and life-saving. But I was dishonest when I suggested above that no one in government is warning about the risks of this war on prescription drugs. The respected Congressional Budget Office (CBO) has been warning Congress for decades about the complexities and potential consequences of its “negotiation schemes.”

Just last month, the CBO reiterated its belief that one of the likely results of limiting drug companies’ payouts for developing new drugs could be “advance innovation” and that fewer new drugs reach the Americans who need them.

To be sure, CBO does not foresee a major reduction in “the” number of drugs that would be introduced to the US market.” Their estimate (“subject to uncertainty”) is 15 fewer new drugs in 30 years, of the approximately 1,300 drugs likely to be approved during that period.

But crucially, they add, “CBO did not predict what kinds of drugs would be affected or analyze the effects of innovation foregone on public health.”

If the CBO doesn’t know “what kind” of drugs could be lost through this policy, or what the effect will be on public health, it’s a surefire piece of cake that politicians don’t know. For decades, I’ve asked progressive Minnesota candidates and officials what exactly they meant by the “negotiation” on the drug price they usually conducted and what risks they saw in it—and I never got a straight answer.

But let’s think about this carefully. If you were a director of a pharmaceutical company that allocates shareholder dollars, and you’re faced with a government determined to deny your company the full benefit of major new “blockbuster” drugs – the kind that fetch the highest prices – what kind of research projects could then make you disregard?

Perhaps the most expensive, riskiest? Those looking for real, long-term breakthroughs (perhaps a cancer, Alzheimer’s, or Parkinson’s therapy, or something like the life-saving heart medication discussed in the accompanying piece)?

So-called “copycat” drugs and incremental improvements in existing therapies could be better investments in a price-controlled world.

All that said, risking “out of control innovation” in exchange for drug price cuts could in fact be good public policy. All health care costs, including drug costs, are unsustainable and life is full of risks and trade-offs. One day we will have to decide when enough is enough in healthcare. We cannot simply continue to demand better and better care for more and more people and be shocked if the result is higher costs.

But facing such stubborn facts gets harder when you’re the one in need of a medical miracle. The lack of frank discussion about the risks of these choices and why they are worth or not is dangerous to the health of everyone.

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