How I survived my summer vacation

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I took most of July off work this summer while I lived through acute heart failure and by far the most serious medical crisis of my life. The complexities of health care are on my mind as never before.

I can’t adequately express my gratitude and admiration for the doctors, nurses, therapists and sundry other professionals at hospitals and clinics and the firms that develop and manufacture medical devices and pharmaceuticals, whose combined skills saved my life and have placed me on a path toward better health. Millions of other heart disease sufferers require the same each year, as noted in a separate commentary by Haider J. Warraich.

For all the daunting costs, inequities and Byzantine complications of health care in America, I’ve been reminded in the most vivid way imaginable that there may be no better place in the world to be when you get really sick.

Meanwhile, now that I’ve been restored to an arena with at least as many malfunctions and far fewer virtues — the feverish world of modern American politics — I find that my patience with its mendacity and foolhardiness is as diminished as my heart’s ejection fraction was a few weeks back.

It pains me to see the witch doctors of Washington hard at work, as always, brewing up dubious potions to cure what ails American medicine. One wonders what it is that fills these shamans with such boundless confidence in their nostrums.

Is it the recent wonders politicians have achieved with their economic prescriptions, especially concerning inflation? Or maybe the way their bedside manner has brought Americans together, as so often promised, in a new birth of democratic harmony? Or the comprehensive remedies our governing elites have crafted for the crime problem?

Repeatedly during my medical treatment, real healers talked plainly to me about the risks involved in what they planned to do, several times double checking my wishes about resuscitation should something go wrong.

Why don’t our political quacks ever mention the risks of their nostrums?

Case in point: The imposition of prescription drug price controls 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 couple of years ago about an earlier, even more sweeping version of this price fixing drug plan — long a favorite among progressives — you won’t often hear what’s being proposed described as “price controls” by the advocates of this legislation . Advocates call it “negotiation” and imply that it merely involves using the Medicare program’s large patient base as leverage to bargain with drug companies for more reasonable pharmaceutical costs.

But what’s actually being proposed is “negotiation” only in the same sense as Putin’s “negotiation” in Ukraine. Although the current proposal is scaled back in scope (subject to expansion) it still involves the government setting a “maximum fair price” for selected drugs. And if a firm declined to accept the government’s price, its revenue from the drug in question would be subject to confiscatory penalties.

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

Everybody wants to crack down on drug peddlers, I guess, so long as the drugs they peddle are legal and lifesaving. But I was unfair in suggesting 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 about the complexities and possible consequences of its “negotiation” schemes for decades.

Just last month CBO repeated its belief that one of the likely outcomes of restricting drug firms’ payoffs for developing new medicines may be “foregone innovation” and fewer new drugs reaching Americans who need them.

To be sure, CBO doesn’t foresee a large the reduction in “the number of drugs that would be introduced to the US market.” Their estimate (“subject to uncertainty”) is 15 fewer new drugs over 30 years, out of some 1,300 medicines that are likely to be approved in that period.

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

If CBO doesn’t know “what kind” of medicines might be lost through this policy, or what the effect will be on public health, it’s a surefire cinch that the politicians don’t. For decades I’ve been asking Minnesota progressive candidates and officials about what exactly they meant by the drug price “negotiation” they were habitually pushing and what risks they saw in it — and I’ve never received a straight answer.

But let’s think this through. If you were a drug company executive allocating shareholders’ dollars, and you were faced with a government determined to deny your firm the full benefit of major new “blockbuster” drugs — the kind that fetch the highest prices — what sort of research projects might you force?

Perhaps the costliest, riskiest ones? The ones going in search of genuine long-shot breakthroughs (maybe a cancer, Alzheimer’s or Parkinson’s therapy, or something like the lifesaving heart medications discussed in the companion piece)?

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

All this said, running the risks of “foregone innovation” in exchange for drug price reductions might actually be sound public policy. All health care costs, drug costs among them, are unsustainable, and life is full of risks and trade-offs. Someday we will have to decide when enough is enough in health care. We can’t just go on demanding ever better care for ever more people and being shocked when the result is higher cost.

But such hardheaded fact-facing gets tougher when you’re the one who needs a medical marvel. The lack of candid discussion about the risks involved in these choices and why they are or not worth taking is hazardous to everyone’s health.

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