This article mostly addresses (1) and somewhat (3), but doesn't really give enough attention to (2). If pharmaceutical companies are granted a patent for a drug, then they have the sole capability to set the price, which the purchaser of the drug will be required to pay. The most obvious example is that of Martin Shkreli, who bought a patent for an existing drug and hiked the price.
How do you fight someone like Martin Shkreli who raises the price?
One option: don't buy the drug until the price is lowered. Collateral: anyone who doesn't have access to the drug. Problem: it is "unethical" to not pay for a drug that could save someone's life. (That is, our emotional brains set the value of a life at infinity).
Another option: set price controls for drugs. Problem: pharmaceutical companies will inevitably lobby the government so that the "right" price control will be a very high one.
Yet another option: Remove patents altogether. Problem: This removes the incentive to produce pharmaceutical drugs with a low barrier to entry (which is practically all pharmaceutical drugs).
So, any discussion of healthcare that says we need "universal coverage" needs to balance all of these issues. So far, everyone seems to ignore (2).
I think you will find that there is a much more important issue that defines all the other issues:
1st and last) What does it cover ?
Because today the answer is "everything", and that's where a lot of troubles come from. If we just said "lung cancer because of smoking ? You're on your own", that would save multiple percentage points right there.
More generally, if we said, let's take 3-4 nines of all issues a human body can have, and solve those in a standard way BUT if you have anything else palliative care and/or pain control is all we offer, that would fix most healthcare issues (and put Shkreli out of business).
Of course nobody's going to do that. There'll be a very sick baby every 2-3 months or so on TV with an illness that's essentially incurable, but could have a very painful 10-year life if we just pay 1 million $ for every month of that life. And we all know the message on the television will focus on how she could have a "short, but normal life" and not on the fact that there is no such thing as a painkiller that makes 3 chemo treatments per year anywhere close to a normal life.
This decision determines how much it costs, which makes the question who pays for it easy to answer, as well as who has access to it.
Our answer today is very simple "everything, no matter the cost, and no matter the outcome (and no matter the resulting patient discomfort)". The result is perfectly predictable.
But of course changing that would require you to acknowledge that you do not have a right to health, and society does not owe you a healthy life, especially not in cases where that's impossible. Society will provide a certain level of service, but will only expend limited resources to keep one individual alive. If your problem falls outside of that service, society will provide some help in taking away the pain.
Another option: free market, but create a streamlined process for removing patents in a punitive fashion so bad actors like Shkreli can lose their patent within a very short time for price gouging.
OTOH the drug Shkreli hiked the price at was already out of patent. So you can see the "free market" issues. Nobody cared about bringing competition as the price was too low.
The article is about health care in general, not drugs.
But you're still in a better negotiating position if you're a single buyer talking to a single seller than if you're multiple buyers talking to a single seller.
1. Who has access to it?
2. How much does it cost?
3. Who pays for it?
This article mostly addresses (1) and somewhat (3), but doesn't really give enough attention to (2). If pharmaceutical companies are granted a patent for a drug, then they have the sole capability to set the price, which the purchaser of the drug will be required to pay. The most obvious example is that of Martin Shkreli, who bought a patent for an existing drug and hiked the price.
How do you fight someone like Martin Shkreli who raises the price?
One option: don't buy the drug until the price is lowered. Collateral: anyone who doesn't have access to the drug. Problem: it is "unethical" to not pay for a drug that could save someone's life. (That is, our emotional brains set the value of a life at infinity).
Another option: set price controls for drugs. Problem: pharmaceutical companies will inevitably lobby the government so that the "right" price control will be a very high one.
Yet another option: Remove patents altogether. Problem: This removes the incentive to produce pharmaceutical drugs with a low barrier to entry (which is practically all pharmaceutical drugs).
So, any discussion of healthcare that says we need "universal coverage" needs to balance all of these issues. So far, everyone seems to ignore (2).