Showing posts with label Socialized Medicine. Show all posts
Showing posts with label Socialized Medicine. Show all posts

Saturday, December 3, 2011

Current Decline in the Availability of Pharmaceuticals


In the criticism directed at ObamaCare and socialized medicine in general, there were many consequences seen that would be detrimental to the health of men and women. One consequence that wasn’t predicted (as I recall) is occurring now. From what I have seen in various reports recently (listed below), when socialized medicine collides with high levels of government debt, which it must eventually, the results are decidedly unhealthy.

In Greece and Spain, and also in Italy, even in the United States, we are seeing disruptions in the supply of pharmaceuticals. The disruptions are being caused by two related government actions. Especially in Greece and Spain, the governments are not paying their bills. Surprisingly, the companies making the drugs are beginning to refuse to send additional supplies. I say surprisingly because I would bet that there has been some attempt to get the companies to ship regardless of the status of payment for past shipments.

The other cause of shortages, which is already happening in the U.S. and is probably happening in Europe, is that certain drugs aren’t being produced because the prevailing price, i.e., the price that the government is willing to pay, is too low to justify making the drugs. In the U.S., we are seeing pharmaceutical companies selectively choose to not make certain generic drugs because there is little or no profit in the price at which they can sell the drugs. These companies have limited production facilities and they choose to use them to produce the most profitable product. Duh!

There is another factor that is spreading the problem wider. In Europe, many countries have laws that require the government to pay the lowest price being paid by any European government. So, say Greece unilaterally decides, as it has, that to “save” money they will lower the price of some or all drugs. It doesn’t really matter what price they choose, the price is way below what the drug companies would charge if free to do so, so whatever price the Greek government chooses will be a disincentive. Then other countries’ low price law kicks in. If the drug is going to be available to patients, the drug company has to ship at the new, lower price. The moral and health consequences are very obvious. The drug companies no longer have any say in the revenue for which they are working. That is unadulterated authoritarianism. It isn’t that different from how doctors are treated by Medicare in the US.

As far as I know or have seen, there is no law saying that the drug companies have to ship, have to continue to make the medication. Slavery has not progressed to that point. If not today, then soon, the drug companies will not be able to continue shipping product on which they constantly loose money. Supplies will become smaller. Shortages rampant, not just in Europe, but worldwide. Companies may go bankrupt. Drug formula may be lost.

Some of the European drug companies are now saying that their ability to do research and create new drugs is being threatened. I expect that they are being a little timid in making known their concerns. I expect that the drug companies are not in a strong political position. Someone is probably keeping a close eye on drug company research numbers. Too bad the mainstream press isn’t interested in actually reporting news like that.

Since the widespread government debt and fiscal deficit problems is going to be a major problem for some time, one should expect the problems in Europe to get worse. The governments will have more difficulty in paying for medical care. The problem will be spreading beyond drugs and supplies to include doctors, support staff, and hospitals. I wonder if someone is paying the electric bills? A private company would be constrained from cutting off power to a hospital. A government electricity monopoly may not be so constrained.

No doubt the problem of non-payment extends to other sectors of the economy as well. Someone said that Spain in particular had determined that keeping cash and not paying bills made the government look much closer to solvency.

What bill is or is not paid is a function of the decisions by bureaucrats. These people have not learned the lesson that 70 years of Soviet economics taught: there is no substitute for a market. What drug or service is available or not will depend upon accidents, pull, and ignorance. Actual health issues and medical need will not be ignored so much as it will be unknown and unimportant. I mean the mere fact that there could be medical need will be unknown. It is government money and it will be paid to the concerns the bureaucrats choose. The fact that there is a reality is overlooked in the regulations. Good luck to us all.

Keep your eyes open. This news, that has come to us in a trickle, leaking into the mainstream in little droplets. So far the press has not be recognized the debt issue as impacting people’s health. Even if they do, there isn’t anything that can be done about it, however. Many of the European governments do not have the money to pay those bills, even if they wanted to do so. How much longer will their citizens have drugs? How long until we are in the same situation? How much will the loss of several European markets affect drug availability in the U.S.? Who knows?

Having gone to the pharmacy regularly, it would seem almost unimaginable that the drugs we rely on could cease to be there when we need them. Those of us who do depend upon them daily, for example, the millions who keep their blood pressure low or those who survive diabetes with medication, could see those meds disappear in the next few years.

Sources:

Greek crisis takes heavy toll on health
http://www.reuters.com/article/healthNews/idUSTRE7982UN20111009

Spain health service chokes in crisis
http://www.reuters.com/article/healthNews/idUSTRE79A1S120111011

Drug shortage in US
http://www.reuters.com/article/healthNews/idUSTRE79D4GI20111014

BO to take executive action on drug shortages
http://www.reuters.com/article/healthNews/idUSTRE79U23D20111031

More pain for Euro drug makers (includes information about lowest price laws and the threat to research)
http://www.reuters.com/article/healthNews/idUSTRE7A93C220111110

UK pharmacists sound alarm about shortages
http://www.reuters.com/article/healthNews/idUSTRE7A901F20111110

HIV gains ground in Greek crisis
http://www.reuters.com/article/scienceNews/idUSTRE7AA37P20111111

US employer health insurance offerings reach new recent low
http://www.reuters.com/article/healthNews/idUSTRE7AA4AI20111111

R&D proposed in Europe over superbugs
http://www.reuters.com/article/healthNews/idUSTRE7AG0VA20111117

Cancer cost becoming unsustainable
http://www.reuters.com/article/healthNews/idUSTRE78P26B20110926

Saturday, July 9, 2011

The Continuing Story in Greece, Europe, and the World

I’m not giving you a blow-by-blow account of events in and around Greece. I am trying to give you some perspective on the situation, which seems hard to find. I am beginning by offering you some stuff that I have found here and there that adds to the picture. They show that the possibility of Greece growing out of its current difficulties is impossible, because real growth is impossible. Read this article from the BBC to get an idea of how the government and business get along. It makes many of our state governments look brilliant by comparison (but not Obama). I found another article about a village that had attracted major industrial investment, but is now dying and businesses that can are moving out of the country (sorry, I proceeded to lose the address of the article). There is also plenty of evidence that money is fleeing from the country. Bank deposits are declining relatively quickly. None of that is good for the survival of Greece without major disruption.

For you one note medical issue people, read this note form a recent weekly email that I receive from John Mauldin (6-24-11):

“But there are very sad things going on. It is not just banks that are losers here. Pharmaceutical companies are starting to refuse to deliver to Greek hospitals, as they are up to two years behind on their payments. It turns out that Greece owes some €6 billion to private businesses like hospitals and simply cannot pay. Those costs are rising, and much of it is to hospitals for medical care supported by the government. They are issuing bonds (shades of California) for the debt in some cases, which sell for a discount of 50%, if they can be sold. And we thought finding €12 billion was a hard thing.  This is not just a Greek problem, it is a concern in many countries that are having financial difficulties.”

The Greeks are being asked to make some very tough decisions. These decisions would be difficult for brilliant, well-trained, market oriented professionals to make, but what the Greeks are depending upon are politicians who claim to be socialists. Their entire operating mode is making promises, throwing around government money (they have no idea where the money comes from), and taking graft (It would be sort of interesting, in a pathological sort of way, to do a study on the number of “socialists” who have become rich and expect luxury since they became politicians, like the Frenchman arrested on rape charges in NYC, Straus-Khan). If the world press was able to look beyond the superficial, and report more on actual events besides government pronouncements and “protestor” activities, we would see that the Greek economy is barely functioning. To me, the problems in Greece bring into question much of the current plan. For example, the Greeks are required to raise E50B by selling off nationalized businesses. But these companies are most likely very badly managed and their assets may have been looted, many of their employees are protesting the entire program in the streets, and the prospect of profitability in the Greek economy is bleak. Who would bid on these companies? Would the Greek government get more than 10 cents on the dollar?

The entire program is based upon premises that have not been substantiated. There is very little connection with reality in the entire effort. Part of the reason is that none of the countries, including the supposed healthy countries like Germany, could comfortably face the same reality oriented scrutiny that Greece should be facing. I am sure, as a semi-reality oriented premise, i.e., the German reputation, that German nationalized companies and German government management is better than that in Greece. But I’ll also bet that it does not rise to the standard of German private enterprise, let alone American private enterprise. So the problems that the Greeks face very likely exist to some significant degree in every European country and at some point down the road, they will each face default and depression.

If Greece defaults, do not be surprised if other countries don’t follow suit. Iceland is expected to walk away from its debt at any time. As for Ireland, from all I have seen, it is a country plunging down the economic hole. Portugal is pretending that it is functioning and will not need another bailout, but it isn’t growing. Spain is seeing massive internal dissent aimed at its austerity programs. But, back to Greece.

So, in the last week the Greek parliament voted to further reduce spending and sell off government “businesses”. This is just the briefest of stop-gap measures (the popular phrase is that they are just “kicking the can down the road”) and it is not considered to be sufficient. More cutting and so on will be needed next year.

Some commentators wonder if the actual events will occur. All that has actually been passed are general bills. The legislation that will provide the details will be offered later, including the specifics of the asset sales. It is noted that the current government originally built its power base on the employees of the government and these government companies, promising them heaven on earth, regardless of the cost, productivity, or sanity of their programs or “businesses”. To sell off these enterprises would be a complete reversal, and it is wondered if these politicians can do it. Politicians of this stripe are great at making promises, but recognize the difference between policies that will get them reelected or appointed and those that no one will pay any attention to. Since these politicians are hardly connected to reality, they could easily declare that they will not act against the “interest of the Greek people”, and say to hell with the bankers, and not sell the assets. It would be a disaster and fairly soon those “businesses” would have to close down, since no money would be available to subsidize them, but the politicians would probably be reelected.

But, even if all of that goes fine, the Greeks will still need over E100B next year. I don’t know how they figured that, but if they are depending upon the Greek economy to assist in the government’s efforts to remain solvent, they will be very disappointed. I expect that the Greek economy will decline faster than they expect. Relatively speaking, it is an advanced economy, probably one of the top 20 or 25 in the world. It is more advanced than the US was in 1930. It is more corrupt and probably more productive, but in terms of interconnectedness and of business practices, it is more advanced. When even a relative small, advanced economy begins to fail, things will unravel rapidly. The politicians in charge will be like military leaders, who are said to always be ready to fight the last war. The politicians (and the economists) do not really know what is going to happen. They are basing their reasoning upon assumptions that most likely have little to do with present day economies. (Since the last depression occurred 80 years ago, we have little actual experience for rational economists to base their expectations. No one knows what will happen. But the irrational people in charge now won’t even realize things aren’t going right for some time.) So the needs of Greece next year will most likely be larger than presently expected. Larger than the current leaders in Germany and France are telling their people they are committed to cover. Politics in those countries will be rather interesting to watch.

But then, even before that point we have the French and German leaders coming up with another wrinkle, witch will cause great stress. They are saying that the “private sector” needs to participate in saving Greece. Now, considering that the “private sector” has already put itself out on a limb and bought a lot of Greek debt, it would seem the private sector has already engaged in significant participation. Why anyone in their right mind would do such a thing is beyond me. Then, much of that debt was purchased before the rating agencies really took the Greek government’s ineptitude into account and began lowering the credit rating of Greek debt, meaning that interest rates for Greek debt have gone up, a lot. Interest rates on the open market are now in the upper teens, say 16% or 18%. Say you bought Greek bonds at 8% and it is now 16%. You have lost half of your capital on the secondary market. Your only chance of getting your capital back is to keep the bond until maturity. It will probably still be a loss (due to the declining value of the currency), but perhaps not as much (figuring this out calls for some very complicated math). But now the French and Germans are telling the private sector that they will have to roll over their bonds, that is let the Greek government keep the money, with a new maturity date (I haven’t seen any indication of what duration.), but with interest rates probably lower than market. This is a clear loss for the bond-holder, and in any rational world, would be called a default, as the credit rating agencies have clearly stated.

Given a deserved black eye because of the goings on during the residential real estate boom, the credit rating agencies are trying to act like real credit raters. That is not what politicians want, actually. Welfare state politicians generally do not like letting people know the truth about things. Just in the last couple days, the leaders of Europe, especially that crazy lady in Germany, have attacked the credit rating agencies. It is an ad hominem argument, accusing the agencies of having a bias against Europe. Yes, if you don’t get your way, if someone calls your spade a spade, accuse him if bias. The best defense is a good offence. Offend every one you can.

Well, I can now get to one of my biggest reasons for writing this post. Greece is really small potatoes. I mean, Greece has a small economy, although if it does (which is to say that when it) defaults, the repercussions will be significant, because a lot of banks have significant amounts of Greek debt. But there are also two other small countries in the EU who might take the same opportunity to default on their loans, i.e., Ireland and Portugal. I’m not sure how seriously to take this, but Ireland is in dire straights and Portugal is not improving either. Then anyone who looks sees that Spain and Italy are both in situations not that much different than Greece. The “contagion” effect could go far, especially if these countries have major financial issues when Greece fails. I mean banks failing and soaring private bankruptcies will be dangerous in every country.

Then, hidden and ignored, is the plight of France and Germany (which is to actually say all of the European developed welfare states) that cannot sustain their own spending and borrowing as their populations age and shrink (and go Muslim). The problems in France and Germany are greater than that of the US in the long run, i.e., next few years.

That means that to the extent that France, Germany, and the other apparently healthier countries weaken themselves bailing out Greece, Ireland, Portugal, Spain, and Italy, they bring on their own problems that much sooner.

More broadly, the world is awash with debt. Every major economy that you can name that appears strong has got major debt, and rapidly growing debt. Japan, for example, with the reconstruction it now has to address, was beginning to feel overextended before the earthquake and tsunami. The Japanese economy is under great strain, yet the regional governments, businesses, and the population are all making new insistent demands on the national government to spend more money. The brics, Brazil, Russia, India, and China, that are growing fast depend upon the developed countries for markets, are themselves heavily controlled by their governments, are awash with government spending and debt (domestic and international), and at least three of the four (I don’t know enough about Brazil to say) are rife with corruption. In no way can we say that they are healthy economies, no matter how rapidly they are actually growing.

In spite of the international financial meltdown in 2008, there is little real difference in the way the international economy is functioning, except there is a lot more government debt worldwide and much more government interference. Consistently, they have all blamed the financial problems on the banks and, in fact, made the banks weaker.

The results from this will not be good. I am not predicting the end of the world nor utter catrosphie, I just don’t know enough to do so. But nothing good can come out of the current mix of debt, government controls, ignorance, and purposeful pursuit of policies that have never worked. It can not help but be worse than 2008.

We can avoid the meltdown here, but only by getting hold of things and making real change, to freedom, to capitalism. We will still suffer because there is no avoiding the problems of the rest of the world. But we can survive in fairly good order, if we do it.

Thursday, October 28, 2010

The Attraction of Free Medical Care: Egalitarianism

I have seen several different facebook entries, blog posts, and articles about how bad medicine under state control is. I am sure that an actual effort to put together a history of medical care in Canada, for example, would provide more horror stories and causes for fear than we could imagine. Socialized medicine, medicine under the rule of force, is bad medicine.

What is even more disturbing is that the citizens who live under government controlled medicine know very well what is happening to them. They are the ones who have to suffer the mistreatment, poor service, lower standards, and rationing that state controlled medicine inevitably leads to. Why haven’t we heard from these victims? Why are they silent?

There are mundane answers to those questions, for example, the fear that speaking out would result in being treated even worse by vindictive administrators and “doctors” who have bought into the “free” system. Fellow citizens also may inflict punishment on “complainers”, who, after all, are threatening a service that everyone has a right to receive, in the local accepted prejudice.

But there is something deeper I think. This isn’t just the ideal of altruism, because socialized medicine isn’t solely, or predominately, based upon the sacrifice for the sake of others or even the state. This is worse. It is egalitarianism. This is the enforced requirement that everyone be treated equal, and lower quality, equally bad medical care is acceptable. To not accept it would require questioning the premise. A person cannot argue that they should have good medical care, because that would be demanding something that cannot be offered to everyone within a socialized country. To demand good medical care is to demand that you be treated as an individual.

In “The Age of Envy”, Ayn Rand offered this example of egalitarianism, “Suppose a doctor is called to help a man with a broken leg and, instead of setting it, proceeds to break the legs of ten other men, explaining that this would make the patient feel better; when all these men become crippled for life, the doctor advocates the passage of a law compelling everyone to walk on crutches – in order to make the cripples feel better and equalize the “unfairness” of nature.” (The New Left, p. 170)

In practice, if that term has any meaning, the medical practice in a socialized country will not go around breaking legs. That would be even too obvious for most people. What it does do, however, is almost the same. Instead it makes treatment egalitarian by limitation (not to be confused with rationing). That means that the treatment a person can receive has to fall within a certain range of acceptability, of equality. This restriction to a range is justified by citing the funding limits. But is actually the reverse. It is the principle of egalitarianism that mandates the “equality” of treatments. Even if funding was unlimited, treating individuals differently would violate the fundamental tenant of egalitarianism.

Thus the result is not that the doctor has to go around breaking legs. He only has to say that available resources and funding limits restricts the treatment options available to different cases, regardless of the severity of their illness. Thus someone with a leg that is severely damaged would suffer amputation or permanent disability, rather than receive treatment that is significantly beyond what a broken leg would normally receive. Then, as funding levels do decline, doctor availability and capability decline, as standards of the population decline, the level of treatment will continue to decline over time, with no noticeable reaction from the populace.

The egalitarian application to health care also means that any medical treatment that is considered optional, such as hip replacements, would be eliminated, as has been the case in Canada for decades. It is not egalitarian to offer options.

Just this week there was a long article on the current status of Canadian health system on Yahoo. In the article there is a significant glorification of the size of the operation, ranking it internationally as a business. There is criticism of some spending shortcomings, as you find in the criticism of many government operations in this country. They are only concerned with waste and fraud, ignoring the inherent incompetence of government bureaucrats attempting to deal with such a complex subject as medical care. The article attacks the elements of the Canadian “system” that still contains some element of individual choice (the doctor’s choice of business organization and medical decisions). It goes on to discuss future funding issues. Nowhere does it discuss the actual level of care a Canadian resident receives. This subject is irrelevant!

You find the disconnect between the promise of government run health care and the quality of the care in every discussion of government run health programs. You find this disconnect in the arguments for government health care in the U.S. The proponents of health care provided by force do not actually care about the quality of care. They do not care about the consequences for the individual recipients of government run health care. Neither, apparently, do the proposed recipients, who seem only to care that they are receiving “free” health care. They only care about the implementation of force by the government. The supporters of freedom fail to point this out. It needs to be emphasized.

To my knowledge there has not been a study of the level of health care in any of the Western nations that have socialized medicine. It is quite puzzling. This study needs to be done. A study of the Canadian experience would be most helpful, since it is the most recent and most like our experience would be. (If anyone knows of a study, please tell us.)

As these arguments go on, and egalitarianism becomes more entrenched, at least implicitly, it will be harder to dig out. We must not forget the ideal of egalitarianism in our arguments and protests. It is a special application of altruism and needs its own special attention. Otherwise we shall see continued adverse consequences from both the liberal left and the religious fundamentalists. Both will push egalitarianism.

This is the way mankind pulls back from civilization, from industrialization, from the digital world, from large populations, from survival. What is killing us is egalitarianism.