To Lower US Drug Prices, Raise Them Abroad?

♠ Posted by Emmanuel in , at 5/12/2018 02:48:00 PM
Trump's new health plan: Make Foreigners Sicker Than Americans.
With the exception of diehard Trump fans who would applaud anything he does [like bragging about grabbing women's private parts], his recently-released plan to reduce drug prices was met with mostly negative reviews by those who actually understand what it consists of [1, 2]. To non-Trump fans, this is as disappointing as it is predictable. Like American leaders before him, to be fair, Trump's plan doesn't involve making Big Pharma squirm. It neither drains the s wamp nor provides evidence that Trump alone can fix spiraling health care costs. Indeed, the relatively bulletproof nature of the drug giants is evident, as politicians have been unwilling to offend their interests (and bottom lines) once more.

How much do American politicians take the interests of Big Pharma to heart? When Trump helpfully suggests (rather unforcefully) that they make token price concessions, he still has their best interests at heart by suggesting that they sock it to foreigners instead by raising prices for them. This, of course raises several pointed questions, followed by a New York Times excerpt:
  • Aren't there ethical concerns for pricing drugs significantly higher outside the world's richest country--especially developing countries?
  • If foreign countries have successfully negotiated bulk discounts while buying for their national healthcare systems, then why should they be made to follow the abysmal US model wherein such bargaining is not practiced?
  • Why should the US set policy setting the prices charged by American pharmaceutical firms abroad? Isn't the US a believer in a "market-based" economy?
[The Trump administration] has an idea that may not be so popular abroad: Bring down costs at home by forcing higher prices in foreign countries that use their national health systems to make drugs more affordable...

“We’re going to be ending global freeloading,” Mr. Trump declared at a meeting with drug company executives in his first month in office. Foreign price controls, he said, reduce the resources that American drug companies have to finance research and develop new cures. The White House Council of Economic Advisers fleshed out the idea three months ago in a report that deplored the “underpricing of drugs in foreign countries.”
The council said that profit margins on brand-name drugs in the United States were four times as high as those in the more regulated markets of major European countries and Japan. The United States, it said, needs to “address the root of the problem: foreign, developed nations, that can afford to pay for novel drugs, free-ride by setting drug prices at unfairly low levels, leaving American patients to pay for the innovation that foreign patients enjoy.”
Moreover, there are no guarantees that increased profits abroad would translate into savings at home:
“There is absolutely no reason to believe that trade policies designed to raise prescription drug prices overseas will result in equivalent or any decreases in prices in the United States,” six House Democrats, led by Representatives Jan Schakowsky of Illinois and Rosa DeLauro of Connecticut, said in a recent letter to Mr. Trump.

People who work in the industry said it was unlikely that consumers would go to the pharmacy counter and see a meaningful reduction in drug prices before the end of the year.
Just because your "health care system" [sic for the United States] is supremely dysfunctional in no small part because of political inaction to confront price gouging, it doesn't mean that matters would be "improved" if you strong-armed other countries into making their systems as pathetic as America's.

The Hippocratic oath states that, first, medical professionals should do no harm. By the Trump administration's reckoning, a lot of harm should be done elsewhere to compensate for the ineptitude of American government officials unable to get their act together and extract meaningful concessions from drug firms who've been exceedingly successful at lobbying against rational drug pricing Stateside. 

BTW, I still recommend Marcia Angell's book on my virtual bookshelf on how Big Pharma actually doesn't put in most of theresearch for drugs but rather takes advantage of publicly-funded institutions. They only make profits afterwards by commercializing others' work.

5/15 UPDATE: See the New York Times for more on the decrepit state of the US health care system.