State Run Medicine: Bureaucrat Salaries Trump Patients

Italian Daniele Capezzone writes in the WSJ($):

This situation is especially dire in Italy. The
government has capped spending on pharmaceuticals at 13% of total
health-care expenditures while letting expenses for infrastructure and
staff skyrocket. From 2001 to 2005, general health expenses in Italy
grew by 31% while expenditure on medicines increased a mere 1.7%.
Italian patients might well have been better off if the reverse was the
case, but the state bureaucrats who make these decisions refuse to
acknowledge the benefits of advanced drugs....

Part of the problem is that regional authorities
manage most of Italy's health-care spending. A strike by health-care
personnel has an immediate impact on the region, but the consequences
of cutting the budget for medicines are only felt in the long term and
distributed across the nation. Hence, local authorities continue to
focus on personnel and infrastructure in an age when medical research
has become the most efficient way to improve public health.

Gee, government officials more concerned about raising government salaries than performance?  Couldn't possibly happen in the US, could it?  This is classic government management -- freeze or reduce expenses that actually provide customer service, and raise administrative costs and salaries many times faster than inflation.  This is exactly what has happened in public schools, as infrastructure and teaching aid investments have been deferred in favor of raising salaries and adding untold number of vice-principals and administrators to every school.

But the government is focused on the long-term while greedy old for-profits are short-term focused.  Right?

Unfortunately, most of today's cutting-edge research is conducted
outside Europe, which was once a pioneer in this field. About 78% of
global biotechnology research funds are spent in the U.S., compared to
just 16% in Europe. Americans therefore have better access to modern
drugs. One result is that in the U.S., the annual death rate from
cancer is 196 per 100,000 people, compared to 235 in Britain, 244 in
France, 270 in Italy and 273 in Germany.

Update:  Ronald Bailey points out that drug re importation is just a way to impose drug price controls in the US, effectively applying the most aggressive price-control regime for each drug worldwide to US prices.  Right now, drug companies tolerate price controls set as much as 2/3 under US prices or more because they can still make money at the margin, because the marginal cost of drug production is so much lower than the total cost with R&D, etc. included.  However, they cannot survive at these prices applied to US demand.  Remember, drug companies have profits margins averaging in the 18-20% range.  Perhaps you might argue they should only be making 10%, but that only gives you room for an imposed 10% price cut, not the huge cuts politicians would like.  And you would get that only at tremendous costs in terms of lost freedoms and demolished incentives for new drug development.


  1. dearieme:

    "One result is that in the U.S., the annual death rate from cancer is 196 per 100,000 people, compared to 235 in Britain, 244 in France, 270 in Italy and 273 in Germany." Unless you make an allowance for age distribution, this is a meaningless claim. Even if you do make that allowance, you then have to allow for different habits in attributing Cause of Death. Doctors are pretty good at diagnosing death, but fashion plays quite a role in attributing cause, and that fashion varies from place to place and time to time.

  2. Ian Random:

    Actually, I'm starting to favor drug re-importation, knowing full well that it help prices in the short run and kills research in the long run. I work with a bunch of closet marxists, democrats that didn't know they have slid all the way left. None of my coworkers saw anything the least bit disturbing in Sicko. Castro causes a brief pause, but Bush causes a 10 minute neo-con bitch session. They'll say well $200,000 is enough for a doctor. I'd like to know their reaction if fast food workers got to choose their salary. I want to let them enjoy the full fruits of their ideologies. Let's kill pharma R&D, then a maximum wage for doctors and universal healthcare. But sadly they'll say it's a market failure that can be corrected with more public money.