mandag den 4. januar 2010

Posner og Becker om priskontrol af medicin-priser ved sundhedsreform i USA

Et emne i debatten om sundhedsreform i USA er om regeringen skal udnytte sin monopson magt til at reducere udgifterne ved indkøb af medicin. Regeringen er direkte eller indirekte gennem de store offentlige programmer (Medicare, Medicaid og sundhedsforsikringer for offentligt ansatte) den største indkøber af medicin.

Professor Richard Posner og professor Gary Becker havde en dialog om dette på deres blog mellem jul og nytår. Posner er for og Becker er imod.

Først Posner:

"Slowing the development of new drugs would be politically attractive because the reduction of government-financed drug costs would be experienced immediately but the cost in slower development of new drugs (because they would be less profitable) would be deferred, and indeed would be invisible because no one would know how much faster the development of new drugs would have been had it not been for the government’s exercise of its monopsony power. In addition, the cost savings to the government from reducing the price of drugs could be used to reduce the deficit that the health-care reform program soon to be adopted by Congress will create.

Complicating analysis is the fact that expenditures on medical care are not well aligned with social benefits. Because beneficiaries of government health-care subsidies do not pay the full cost of health care, including the full cost of drugs, health care is overproduced from the standpoint of economic efficiency".
Dernæst Becker:

"Posner recognizes that especially persons under government Medicare and Medicaid are encouraged to buy an excessive amount of drugs relative to their medical needs because their co-payment rates are only a fraction of the total cost to the government. Posner also believes that advertising and other promotion of drugs induce consumers to buy more drugs than they really “need”. Perhaps that is true, although I am doubtful. Stil, both these considerations suggest that the government should force consumers to pay more for drugs under Medicaid and Medicare. Higher consumer prices could induce consumers to eliminate any “excessive” use of drugs. Whether the government could politically get lower prices from pharmaceuticals and yet force many consumers to pay more is surely questionable".

"Another reason why too little may be spent on developing new drugs is that companies with blockbuster patented drugs collect only a fraction of the total benefits to patients, despite the high prices they charge. This is partly because similar drugs are often developed prior to the expiration of the patents of the original drugs".

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