Don't Throw Me In That Briar Patch!

by hilzoy

Well, this is interesting:

"The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage. (...)

The industry's position differs from that of Mr. Obama in one significant respect. Insurers want the government to require everyone to have and maintain insurance. By contrast, Mr. Obama would, at least initially, apply the requirement only to children."

Several things about this are very significant. First, the insurance industry helped to block Clinton's health care plan. If they are entering the negotiations about what sort of national health care we will end up with, they are a lot less likely to play a completely obstructionist role. And that's very good news.

Second, requiring all Americans to have health insurance is very good policy, at least if it's coupled with some kind of subsidy for people who wouldn't be able to afford insurance otherwise. Obama did not propose to require it, which I very much hoped was because he suspected it would be political poison, not because he was opposed to it in principle. (I don't mean that he was being disingenuous: politicians fail to propose policies that they think would actually be good all the time, and as long as they do not plan to propose those policies, there's nothing disingenuous about it.) This aspect of his policy didn't bother me that much: in practice, if you're going to ban discrimination on the basis of preexisting conditions, you need to have some sort of penalty to discourage people from signing up for health insurance only after they get sick, and the difference between having such a penalty and having a mandate (which presumably also includes a penalty) seems to come down to whether or not you tell people that they must sign up. Moreover, I thought he was probably right on the politics.

That said, having someone else insist on mandates makes me want to adopt a mock-horrified look and say: oh please don't throw me in that briar patch!

There are, of course, a whole lot of details to be worked out, the kinds of details in which devils are found. For instance:

"The new policy statements are silent on two important issues: how to enforce an individual mandate and how to regulate insurance prices, or premiums.

While insurers would be required to sell insurance to any applicant, nothing would guarantee that consumers could afford it. Rate regulation promises to be a highly contentious issue, since it pits the financial interests of insurers against those of consumers.

At present, insurance premiums are generally regulated by the states and often vary according to a person's age, sex, medical history and place of residence within a state. In the individual market in most states, a person with a history of serious or chronic illness can be charged much more than a healthy person of the same age and sex."

Still, this is really good news.

Comments

[Vance Maverick]

politicians fail to propose policies that they think would actually be good all the time, and as long as they do not plan to propose those policies, there's nothing disingenuous about it

Don't you mean that it's OK as long as they do plan to propose them? That is, it would be bad for BHO or whoever to think, "X would be a really good idea", and then never to speak of X. On the other hand, to think that, but not to mention it until the time is ripe, is maybe not the plainest dealing, but I think a venial sin by political standards.

[xanax]

Totally OT and IANAL but... any cause for concern that SCOTUS apparently plans to conference on the topic of Brocco's citizenship/elegibility to be president Dec. 5th?

[DCM]

No, I think Hilzoy meant exactly what she said, Vance. Namely that it would be wrong for a politician to campaign on the platform of implementing policy A, and then to implement mutually contradictory policy B, the real intent all along, with neither an attempt at A nor a good reason based on changing circumstances.

We have a democratic republic, not a straight democracy, so it's not like a candidate has to spell out every little thing they might do in office during the campaign and put it up to a vote. But I think if you have any belief in a democratic system at all, it seems important that a candidate actually say what they really do intend to enact. If you still don't see the problem, try flipping the parties around so it's a Republican feigning a moderate, politically acceptable plan and then implementing something more extreme in contradiction of the policy he ran on.

As to the 'sin' of not proposing a good idea: there are *all sorts* of policies I think would be great if enacted, but would never be passed and would provoke backlash as such political losers that I don't want to see them raised as Democratic party plans. Among those would be eliminating *any* state recognition of marriage, offering only civil unions, and letting people & religions decide what they considered a marriage; legalizing Marijuana and eliminating fines or jail for possession of small amounts of other drugs, replacing them with mandatory rehab; and raising taxes across the board (well, in better economic conditions) if that's whats needed to pay for the government services we desire.

But the practical, political effects of proposing any of those (and pretty much everyone can toss on their own additions; that's far from a complete list of mine either) would be totally counterproductive, so I'm really quite happy they aren't part of the Democratic Party platform or Obama's agenda.

[Warren Terra]

One of the things I liked about Obama's plan (and I think other Dems' plans may have shared it) was the idea of offering a Government plan in competition with the private insurers - if done right, this could force the private insurers, in essence, to justify their existence on an ongoing basis, and provide a possible mechanism for drift in the direction of single-payer. If done wrong, of course, it could be like the fiasco we've seen with partial privatization of Medicare, in which the companies cherrypicked the cheapest people to cover and got paid a rate based on the care provided to the average person covered by the whole system. Still, one assumes that the insurance companies don't want to face Government competition (even with their cherrypicked clientele, private Medicare providers haven't done well, albeit in part because insurers make a fair bit of their money by investing their premiums in the market, and in addition the per-patient rates offered to them will likely be discounted in recognition of the way they gamed the system, suggesting that gaming the system may not be a viable long-term plan for private insurers to survive competition with the Government). One reason for this initiative might therefore be to seek a mandate that people purchase private insurance, lest they might instead be able to purchase Public insurance. I can see how acquiescing to some regulation would be worth avoiding that government competition to the companies. That is, of course, assuming they are in any meaningful way sincere - and it's important to recall that in 1993 the insurance companies first negotiated an acceptable plan with Clinton, one that they thought would work for them - and then worked to be sure it never came close to becoming law.

[Gary Farber]

"...the topic of Brocco's citizenship/elegibility to be president Dec. 5th?"

Who is "Brocco"?

[xanax]

I tried first to post the same question over at Amygdala, Gary, but I don't have the proper account/clearance.

Re: Brocco -- During the primaries, my 5-year old son kept hearing news reporters discussing the election and what was (obviously) Barack Obama he kept hearing as Brocco Bama. One day he asked me, "Dad are we for Hillary or are we for Brocco?" I laughed and said, "We're for Brocco, son." And in our house he's (affectionately, and with all due respect and admiration) been Brocco ever since. We'll probably always call him that.

Now, about this court challenge: Anything to the fact that this apparently wasn't just dismissed out of hand?

[Vance Maverick]

Point taken, DCM. The evaluation turns on the relationship between the policies campaigned on and the policies pursued. To take a random example, if a politician were to campaign on a health care plan without a mandate, but then in a changed political environment, were to support a plan with a mandate, that might not be a crime.

[Warren Terra]

I have no real idea whether it means anything, Xanax, but if I'm reading your link rightly (and I offer no guarantees) Souter triex to toss it and Clarence Thomas insisted it get a hearing. It would not startle me one bit if Thomas, who is a good friend of Rush Limbaugh and who most recently reintoduced himself to the public as a man seething with barely restrained fury during his book tour (including a preview of Palin's "real America" sentiments in a C-SPAN interview that made very clear Thomas's dedication to the culture war and the politics of resentment), read The Corner religiously and uncritically and was quite open to the less hinged theories propounded there and in even less reputable regions of the wingosphere.

[xanax]

Thanks, Warren. The link provided is probably not the best, but it does at least seem authentically linked to SCOTUS (as opposed to being mere blog-chatter... which there's now quite a bit of on this topic).

My reading is similar to yours, that this is something Thomas is spearheading for his own reasons (your speculation sounds about right). It just makes me wonder: doesn't there have to be a shred of substance for SCOTUS to take this up in the first place? And if there is some substance, is it cause for concern? If there's none, doesn't CT emerge with significant egg on his face?

I'm really wondering about the substance part of the question.

[farmgirl]

hilzoy, I guess I'm not clear on why you think this is such a great idea.

Mandates for universal health insurance do NOT necessarily translate to universal access to affordable health care. I'd like to see that line drawn a lot more clearly before I celebrate the insurers' desire for mandates.

[d'd'd'dave]

farmgirl
//universal access to affordable health care//
How do you mandate affordability? And while you're at it why not just mandate housing affordability, and education, and food, and vacations, and telecommunications, and whatever else people may dream up as a necessity?

Just make a law: life must be affordable. That will fix it.

You have a right to affordability. If one person on the planet can afford it then everyone must be able to afford it.

[Eric Martin]

How do you mandate affordability?

Funny, other countries seem to manage it. Are you saying that those countries are more capable than the United States at crafting health care solutions?

[d'd'd'dave]

d'd'd'dave: I'm sick. I can't afford care. Hand me your wallet Eric.
eric: I believe in the principal of affordability. Like they have in other countries. But ... er ... not my wallet ... i'm not rich ... er ... that guy over there should pay ... er... no, we'll call it the collective. The collective will pay ... by which I mean not me but that guy over there .... jeeze. You're a troll d'd'd'dave. Why can't you just accept the premise?

[d'd'd'dave]

d'd'd'dave: What is the premise?
eric: The premises is that I believe in you being helped but that the help should come to you in a way that doesn't take anything from me therefore I always want to take it from the pocket of the 'other' just like they do in those other countries.

[mckinneytexas]

So, should obese smokers who can't hold a job and revel in a sedentary lifestyle get the same insurance at the same price as people who proactively pursue good health and hold a steady job?

It is one thing to mandate against pre-existing, no-fault health conditions, but another thing entirely to force insurers or taxpayers to underwrite poor lifestyle choices.

[Sebastian]

"Funny, other countries seem to manage it. Are you saying that those countries are more capable than the United States at crafting health care solutions?"

This is entirely unhelpful. Yes other countries do different things. Lets talk about it.

Some of them limit care.

Nearly all of them don't continue care at end of life as long as we do.

All of them free ride off pharmacueticals.

Most of them pay doctors much less.

Some of these things we can learn from, some we can't.

[Eric Martin]

Some of these things we can learn from, some we can't.

I'd be fine with an honest inquiry into that.

Also re: the Pharma free ride: The majority of big Pharma's budgets are dedicated to marketing. Not to mention the enormous sums spent on lobbying. This is, at least in part, wasteful and unnecessary.

There is a way to bring down pharma prices (negotiating prices) without impacting R & D - especially if we offset the benefits of such marketing.

The premises is that I believe in you being helped but that the help should come to you in a way that doesn't take anything from me therefore I always want to take it from the pocket of the 'other' just like they do in those other countries.

The benefit of insurance is spreading the risk. I'm fine if that means my taxes go up. I'm blessed enough to be in a position in which Obama's tax increases will soon pinch my bottom line (depending on my X-Mas bonus). Sooner than, say, Joe the Plumber.

But I don't mind. America will be stronger for it, our businesses more competitive - not to mention, or citizens healthier!

But as Seb said, I'd want this to be done on a solid empirical basis.

Lucky for us, the rest of the world have provided several models from which to pick and choose, separate the wheat from the chaff.

Doubly lucky for us, Obama seems the type to appoint people that care about such things as empiricism.

[Sebastian]

"The majority of big Pharma's budgets are dedicated to marketing. Not to mention the enormous sums spent on lobbying. This is, at least in part, wasteful and unnecessary."

We've had this conversation before. The majority of big Pharma's budgets that you are getting your numbers from are for the typical 10-K item Marketing *and* Administrative which includes almost all non-capital overhead (mail, secretaries, finance departments, legal departments, i.e. everything you need to run a company). Furthermore, so long as marketing is positive sum, it usually isn't wasteful in the sense you are using it--it DOES NOT lead to higher prices. Marketing typically doesn't lead to higher prices in a product oriented business because you evaluate it on a per unit basis of sales increases. I don't put in $1 of marketing unless I am likely to produce at least $1.01 in sales.

"Not to mention the enormous sums spent on lobbying. This is, at least in part, wasteful and unnecessary."

This is pretty much a necessary component when your entire livelyhood is completely under the thumb of the government. It is part of what economists call deadweight loss, but you can't get rid of it from the company perspective unless you want to have no company. Also I've never seen any indication that it is less a factor in Europe. And my barely informed impression is that companies engage in plenty of lobbying and less formal but equally pernicious stints in bed with each other.

So as far as differences between European systems and US ones, I'm very skeptical that you have identified an important one.

[Turbulence]

Furthermore, so long as marketing is positive sum, it usually isn't wasteful in the sense you are using it--it DOES NOT lead to higher prices.

To the extent that marketing induces demand where there would be none and thus leads to overtreatment which brings with it a whole host of complications, marketing does lead to higher costs in the system. After all, the point of marketing is to get as many people as possible taking your drug whether they need it or not.

[Eric Martin]

The majority of big Pharma's budgets that you are getting your numbers from are for the typical 10-K item Marketing *and* Administrative which includes almost all non-capital overhead (mail, secretaries, finance departments, legal departments, i.e. everything you need to run a company).

Actually, some years back, I was an attorney for a large white-shoe law firm that was representing one of the biggest Pharma companies in the world. I was part of the team on a major litigation.

I got a look at the numbers under the hood, and they weren't pretty.

Without betraying attorney-client privilege, let's just say that the amount spent wooing doctors, politicians, med schools, professional associations and other institutions was enormous. Those aren't even included in typical "marketing" costs - but they were just that.

Also quite sizable: the amount spent lobbying domestic and foreign politicians, as well as various media outlets (real and astroturffed).

So perhaps your point on lobbying is correct.

But I do know that foreign jurisdictions do, actually, limit the ways that Pharma companies can market their products, which leads to less money being spent on marketing in those jurisdictions.

[Slartibartfast]

To the extent that marketing induces demand where there would be none and thus leads to overtreatment which brings with it a whole host of complications, marketing does lead to higher costs in the system.

What extent is that, exactly? Or, lacking that, approximately? Is there a more pleasing alternative that's clearly a cost-saver?

[Eric Martin]

So as far as differences between European systems and US ones, I'm very skeptical that you have identified an important one.

To some up, I think money could be saved on limiting marketing, and prices lowered through negotiation leverage - as in Europe.

But still, the biggest difference is the amount of money wasted by private insurance companies.

These companies, themselves, spend large amounts of money on marketing, lobbying, developing means testing and other analysis, and denying claims put in by sick customers.

Government provided health insurance would be able to greatly reduce or eliminate those costs - which in turn makes the provision of health insurance more affordable.

[Sebastian]

I'm fine with limits on marketing for all sorts of reasons in theory. But as to Eric's specific concern--marketing *as compared to research*, he doesn't make sense.

The records are easily available in 10-Ks online at the SEC and you can see that the ratio of marketing and administrative to research was about the same in the years before the changes in the marketing laws. I looked at Pfizer for example for 10 years before the laws changed in the 1:45 on March 29, 2006 to this post (direct comment linking no longer seems to work in the new multi-page commenting format). BTW that post held up pretty well, as the argument that pharmacueticals are unfairly profitable looks ridiculous in the 2 years since--even before the recent market crash.

[Sebastian]

"But still, the biggest difference is the amount of money wasted by private insurance companies."

That may be true, but insurance companies have a rather large incentive to save costs that you seem to think isn't working for them.

My impression is that end-of-life care (last week and last month) is by far the largest component, and that in other countries it is dealt with differently.

Does anyone have access to a serious look at that?

[Nell]

Warren Terra is onto the heart of the matter: One reason for this [insurance industry] initiative might therefore be to seek a mandate that people purchase private insurance, lest they might instead be able to purchase Public insurance.

There absolutely must be a public pool that people can join. If health care "reform" goes forward without that, then we're further from real universal health care than we were to begin with. The issue is whether we'll be in this together, or up against the insurance giants on our own.

[Eric Martin]

That may be true, but insurance companies have a rather large incentive to save costs that you seem to think isn't working for them.

Well, say they spend $500K in claims denying actions and save $1 million in health care expenditures as a result.

The costs make sense for them.

But in the larger picture, they still spent $500K more than the govt. would have spent (and those costs are pused to consumers). And by denying those claims, they forced their putative clients to pay $1 million in health care costs.

That's not ideal.

(keep in mind, some of the claims denial comes down to slight omissions on applications, that are only cited when claims are made, not when fees are paid in the preceding months/years)

Also: Say they spend $500K on marketing, and drum up $1 million in business as a result.

The costs make sense for them.

But in the larger picture, they still spent $500K more than the govt. would have spent, and those costs are passed to consumers.

[Sebastian]

"But in the larger picture, they still spent $500K more than the govt. would have spent (and those costs are pused to consumers). And by denying those claims, they forced their putative clients to pay $1 million in health care costs."

You're presuming that the government wouldn't have denied the claim. That seems like a non-obvious assumption.

You're further presuming that if the government denied the claim, it would cost nothing. Seeing the rather fruitful state of government litigation in other areas (environmental for instance), that seems like a non-obvious assumption too.

"Also: Say they spend $500K on marketing, and drum up $1 million in business as a result.

The costs make sense for them.

But in the larger picture, they still spent $500K more than the govt. would have spent, and those costs are passed to consumers."

Passed on seems like a weird word to use there. You mean paid for by the people who bought them, right?

[Eric Martin]

You're presuming that the government wouldn't have denied the claim. That seems like a non-obvious assumption.

This was a generalization. But in truth, the government insurance program wouldn't turn people away for prior existing ailments, seek to disqualify people for fine-print technicalities or because of a missed payment or some other clerical oversight.

Insurance companies pay people top dollar to investigate and deny just such claims.

So in many instances, there is no assumption at all: the government would not deny those claims.

When you look at the overall numbers, that makes a big difference.

You're further presuming that if the government denied the claim, it would cost nothing. Seeing the rather fruitful state of government litigation in other areas (environmental for instance), that seems like a non-obvious assumption too.

True, but then insurance companies face the same litigation costs, so I don't see that as auguring in favor of comparative insurance company thrift.

Passed on seems like a weird word to use there. You mean paid for by the people who bought them, right?

I mean paid for by people that pay the premiums - which go to pay the overhead of the insurance company in question, including marketing expenditures.

The more insurance companies spend on marketing, the more they have to charge their clients to cover those costs.

[Sebastian]

I'm not sure what insurance company you're using, but in mine, for the types of drugs that people are typically marketed to, the buyer will end up paying most of the costs himself because it won't be on formulary.

And you seemed to have skipped past your original assumption that marketing and research costs were intimately related. Is that intentional or do you have some comment on the evidence I presented (see especially historical 10-Ks from before the marketing rule changes which seem to show that the ratio of M&A to research is about the same before and after the rule changes)?

"True, but then insurance companies face the same litigation costs, so I don't see that as auguring in favor of comparative insurance company thrift."

This is an interesting rhetorical move:

1) You claim that a *move* to the government will save money.

2) I point out that it isn't at all obvious that it will in the areas you're seem to be relying on.

3) You say that insurance companies have to face the same costs.

4) Therefore it is not an argument for insurance thrift you say?

Ok. But that doesn't help 1) much. Which is what we were talking about.

[d'd'd'dave]

turbulence
//After all, the point of marketing is to get as many people as possible taking your drug //

It is about informing the public about alternatives.

Progressive voice: "I'm for all the people! All people should be equal! But they are stupid. Informing them is uselessly expensive. And they are not smart enough to spend their own money. So, gather in all the money and I, the expert, will spend it on their behalf. And don't let companies advertise and tell the people what they might be missing. It would only agitate them needlessly. Trust me. When have you ever been let down by experts in charge of the collective interest?...Huh?...I mean except for those times."

[Eric Martin]

I think you're being a bit unfair to my argument here:

First, I didn't say that a move to the government would save money necessarily. I said that it would cut out wasted money that private insurers spend that don't go toward health care costs. I am arguing that the government would be able to deliver health insurance more efficiently when measured on a cost per insured basis.

RE: Litigation Costs - If the litigation costs would be the same for private and public insureres, then the government would not save money on litigation costs. True.

But that doesn't change the fact that it would save money in other areas - for the original example, not having the same overhead in terms of claim denial.

Let's say that private insurers spend $100 million on claim denial and $100 million on claim denial litigation.

And the government spends $10 million on claim denail and the same $100 million on claim denail litigation.

The government is still spending $90 million less on the entire claim denail regime.

But even then, there is good reason to believe that the government would actually spend less on litigation since it would not be involved in the same level of claim denial activities. The government would not deny claims based on arguments that there existed a prior ailment, or based on contractual and technicality grounds. Each of those denails can provide causes of action in lawsuits.

Since the government would be denying fewer claims, it is likely that it would face fewer lawsuits arguing about the validity of such claims.

Getting back to my original argument, though, it is important to note that the government system may end up costing more money overall, but that is because it will cover more people, more comprehensively. It won't be denying as many claims after all.

The current system leaves out tens of millions of Americans altogether, and tens of millions more are underinsured.

The argument really comes down to the fact that it will cost less on a per capita basis, and that covering everybody has a value in itself (as well as the relief such coverage would provide businesses currently tasked with providing such coverage to employees and retirees).

And you seemed to have skipped past your original assumption that marketing and research costs were intimately related. Is that intentional or do you have some comment on the evidence I presented (see especially historical 10-Ks from before the marketing rule changes which seem to show that the ratio of M&A to research is about the same before and after the rule changes)?

I'll have to take a closer look at the numbers and what you are purporting they say. It's hard to give this subject the attention it deserves while at work.

[Eric Martin]

It is about informing the public about alternatives.

Not really. For that, primary care physicians are much more qualified and can do a much better job.

Are you really suggesting that people should get medical advice from television ads and billboards?

The Pharma companies can and should let physicians know about the alternatives, and then the physicians can and should inform their patients.

Further, are you really suggesting that the ubiquity of viagra and cialis adds is the product of the altruistic impulses of drug companies seeking to keep the public informed about the alternatives?

[d'd'd'dave]

//Are you really suggesting that people should get medical advice from television ads and billboards?//

Yes. From every source possible. It's part of 'informed consent'.

//are you really suggesting that the ubiquity of viagra and cialis adds is the product of the altruistic impulses of drug companies seeking to keep the public informed about the alternatives?//

No. But what does it matter what they spend advertising viagra unless you are planning on the government paying for it's use. And if it is good enough for the government to pay for then it must bee good enough to advertise. You can't argue it both ways.

[Eric Martin]

Yes. From every source possible. It's part of 'informed consent'.

But the commercials do little to actually inform.

But what does it matter what they spend advertising viagra unless you are planning on the government paying for it's use. And if it is good enough for the government to pay for then it must bee good enough to advertise. You can't argue it both ways

That isn't both ways.

Is it really contradictory to argue that a drug should be covered by a government plan, but that we should regulate its marketing to the public at large as part of a larger curb on drug marketing?

I don't see the contradiction or the inconsistency.

[Hob]

Hilzoy: Ezra Klein attempted to pry some more details out of an industry flack, and asked about those pesky "details" you mentioned, such as affordability. The answer was 9 parts meaningless bullshit (oh yes, affordability is a concern, it sure is something we ought to think about, etc.) but also included a pretty blunt statement about their position on community rating, or a public insurance option, or any other mechanism that could actually enforce affordability: oh no no no no, no way, the government shouldn't try anything like that or some scary things will surely happen.

Judging by that interview, what their proposal amounts to is: "Create a mandate so that millions of Americans will be required to buy insurance from us. We promise we will sell it to them." They're not offering or supporting anything beyond that; in fact, they're opposing anything beyond that. Not really so encouraging.

[d'd'd'dave]

Viagra has what is essentially a non-medical purpose. You're not going to die if you're flacid. And it is okay with you if government pays for viagra prescriptions. You just don't want too much of it which advertising might promote.

To me, the inconsistency is that you've been talking earnestly about cost efficiency yet you want to furnish what amounts to entertainment for free ... but just don't advertise it. Viagra is not healthcare.

You: "Oh but it is already a covered charge"
Me: "Yes. Now it is covered. And you'd rather get rid of advertising than Viagra coverage."

[jim filyaw]

excuse my niavete, but as long as we're going into the "requiring" business, why not just simplify the whole mess and "require" everyone to have good health. that's no more ambitious than "requiring" everyone to have health insurance. just how the hell are those members of the great unwashed supposed to come up with the wherewithal to meet this requirement? and i damned sure don't trust the insurance industry to offer any input into this issue that could be remotely considered as honest. we didn't need it for social security, we didn't need it for medicare, and its usefulness in providing the means to obtain necessary medical care for working americans has long passed.

[Gary Farber]

"What extent is that, exactly? Or, lacking that, approximately?"

How about "to the extent tv commercials directed at consumers are run morning, day, and night, on tv," given that consumers aren't, as a rule, competent to judge whether they need a drug or not?

For an approximation. Certainly more than one doctor has suggested to me that they think tv advertising of drugs is a terrible idea.

[Eric Martin]

What Gary said.

And it is okay with you if government pays for viagra prescriptions.

Well, I didn't actually say that. I was going along for the sake of argument.

To me, the inconsistency is that you've been talking earnestly about cost efficiency yet you want to furnish what amounts to entertainment for free ... but just don't advertise it

Again, I am not a proponent of government funded Viagra.

My point was, rather, how does the avalanche of Viagra and Cialis adds favor the informed patient goal? So why would regulation of pharma advertising really hinder that goal?

Especially when, as you said, neither has a pressing medical purpose.

[Bernard Yomtov]

Is it really contradictory to argue that a drug should be covered by a government plan, but that we should regulate its marketing to the public at large as part of a larger curb on drug marketing?

Eric,

I think Dave is arguing that some specific drugs ought not be covered by a government plan, or maybe any insurance, at all, so that complaining about ads for them is silly. If you want to cut costs don't cover them at all. Have users pay out of pocket. Then there's no problem about the advertising costs.

[243]

Viagra has what is essentially a non-medical purpose. You're not going to die if you're flacid.

Sez you. ;-) Seriously, there are a whole slew of non life threatening things we expect to be part of medical care, say like reattaching severed limbs when possible. You could certainly live without that arm or whatever, but the quality of life would be better if you got to keep it. Ditto, IMO, with erections. I frankly wouldn't mind to see either my tax money, or my insurance money going to that sort of care, whether I need it or not. Granted there are grey areas. Does someone get plastic surgery when they are disfigured in an accident, when they are born disfigured, or because they are less than happy with their looks? I don't know how to properly draw the line with that, except to say that it should be towards the middle and not at either extreme.

[liberal japonicus]

We've had this conversation before. The majority of big Pharma's budgets...

Sorry to be chiming in late here, but most (all?) of these conversations occurred before Eric was here, so one shouldn't assume previously made arguments will be known. In fact, a big Pharma post might be very appropriate in light of the new emphasis on some sort of universal health care.

[Sebastian]

"Sorry to be chiming in late here, but most (all?) of these conversations occurred before Eric was here, so one shouldn't assume previously made arguments will be known."

No, that one we had with him. :)

Frankly Pharma isn't a big component of health care costs. It is kind of like focusing on earmarks if you want to cut the federal budget. High profile, low impact.

I typically feel the need to defend it because people seem to want drastic changes in pharma policy with what I see as very negative effects for what amounts to very little in helpful savings.

Pharma *feels* like a big expenditure for lots of people because it isn't as covered by insurance as many other things so it tends to hit the pocketbook.

[yoyo]

Erectile dysfunction is a medical problem. But as we've seen countless times, as long as you can still slave away for your employer, then your problems aren't real.

And unless we change the law so insurers must pay claims, then you have universal insurance premiums, not universal health care. It doesn't matter if you can get insurance with a preexisting condition if the insurance company will just decide not to pay things.

[Slartibartfast]

How about "to the extent tv commercials directed at consumers are run morning, day, and night, on tv," given that consumers aren't, as a rule, competent to judge whether they need a drug or not?

Good thing consumers don't, in general, have access to the prescription pad, then. But I see your point, possibly: doctors eager to make a buck or two...uh...somehow, writing scripts for people who don't need them...um...guess there'd have to be some kind of kickback mechanism, wouldn't there?

Not that there isn't. Just that there would have to be one, no?

Or, possibly, the point was that all those advertising dollars are wasted. Again, no idea. When's the last time you bought a Sham-wow?

But then there are the drugs that have made it into the OTC ranks. But some of them are worth having. Claritin, in particular, seems to work pretty well for everyone in my family, on days when they're having problems. Usually it's just my youngest.

Off I go to snort a Cialis/Viagra mix, with a Nyquil chaser. It's Nyquil driving time!

[Gary Farber]

Slart, if you have a point behind all that, you might try stating it clearly.

[hilzoy]

Slarti: the usual idea is that consumers come to see their doctors wanting a particular drug, the doctors write the prescription for that drug because the patients want it (in cases where it's one of several that might be prescribed), and that since drugs that are still on patent are the ones that tend to get advertised, this leads to patients getting on-patent drugs over generics, or more expensive patented drugs over less expensive ones.

However the mechanism works, though, either it exists or the pharma companies are wasting a whole lot of money.

Fwiw, when I've talked to pharma people, I've gotten the sense that they would be happy to have marketing curtailed across the board. It's like the arms race: no one can stop alone, but it makes everyone worse off.