
Drug Shortages are Killing People - jseliger
http://marginalrevolution.com/marginalrevolution/2013/07/drug-shortages-are-killing.html
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Symmetry
Sometimes I wonder if we wouldn't be better with real centrally planned drug
production, even with all the negatives that implies. Then I remember that any
system will inevitably result in mistakes, Congresswill respond to those
mistakes with overbroad rules that restrict the planner, and we'll end up in
an even worse situation.

Well, I don't know. The recent FDA drug quality crackdown has probably saved a
few lives at the cost of hundreds dieing from drug shortages. The problem is
that the former number is much more squarely within the FDA's regulatory
perview thant he later, giving them equal weight. Maybe if we had an
organization equally responsible for both numbers we'd see better outcomes.

ut then again, any beaurocratic boundaries will be unnatural at times, and you
have to divide up departments somehow. I'm not sure any alternative
organization wouldn't result in equally perverse outcomes.

And on the gripping hand, regulators in Europe have somehow managed to avoid
this problem entirely, so we should probably just copy what they're doing. But
I suppose if that was realistic we would have copied the Swiss or Sinaporeans
instead of passing the ACA.

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jjoonathan
> regulators in Europe have somehow managed to avoid this problem entirely

> Maybe if we had an organization equally responsible for both numbers we'd
> see better outcomes.

It's not a "somehow" \-- you answered your own question! Add this to the long
list of reasons why we should switch to single payer.

~~~
Symmetry
Except it's not actually the same bureaucratic entity that does both. The
government may pay for health care but in many countries like France hospitals
are still private businesses.

I think the real difference more different levels of social trust in experts,
parliamentary systems versus presidential systems, etc.

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_delirium
France has a hybrid system, where everyone is covered by the public system,
but you can also choose to purchase care privately if you prefer. But most
hospitals are publicly owned. The breakdown is about 60% public, 25% for-
profit business, 15% nonprofit organization.

Source for the numbers:
[http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth...](http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=hlth_rs_bds2&lang=en)

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kvb
The Washingtonian article is very sad, but I'm not sure I buy Tabarrok's take
on it. He once again harps on GMP regulations, but doesn't Europe have similar
regulations? And the very first page of the Washingtonian article mentions a
case where 9 patients died because a substitute PN was contaminated - to what
extent would reducing oversight lead to even more such incidents? I'm open to
the idea that FDA regulations are an issue but it hardly seems like that's the
most pressing problem, given all of the other issues with our healthcare
system.

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jjoonathan
> doesn't Europe have similar regulations

The crucial difference is that Europe has primarily single-payer systems. They
simply don't need a black market for legitimate drugs: even if you're poor,
you can get them from the doctor.

To be fair, the government won't pay for any drug -- it decides how much it is
willing to pay based on efficacy, and some drugs get priced out (arguably
because they _deserve_ to get priced out).

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kvb
That's certainly an important difference in general, but I don't see how it's
relevant to this article. Here, the issue is not that people are priced out,
it's that important, cheap drugs are underproduced.

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jotm
That's what you get when some companies have a monopoly on selling drugs to
your country's hospitals. There isn't an actual production shortage, it's just
that the hospitals are bottlenecked by having one or just a couple of
providers...

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refurb
This makes no sense at all. The drugs that are having the most severe
shortages are all generics (i.e. no patent, multiple suppliers).

One of the big reasons behind the drug shortages is that generics compete on
price. Often the profit margins are razor thin on generic drugs. If you
encounter a problem with manufacturing, often you'll end up losing money on
the whole endeavor. The result is that manufacturers leave the market and
focus on drugs where they can actually make money.

The brand name drugs have had very few supply issues. When they do, it's
usually a manufacturing issue.

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foobarbazqux
Nationalization of generic drug manufacturing fixes this.

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refurb
How do you deal with patent issues? Do you really want the gov't involved in
challenging patents?

A much simpler fix is simply make generic manufacturing more financially
attractive.

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foobarbazqux
How do you make generic manufacturing more attractive? With subsidies? That's
a kind of soft nationalization, and is all I meant really. I guess that's
different than the government contracting out work to manufacturers, or buying
them outright.

