george

Maybe one of the reasons drugs/medicines are so expensive, at least here in the US, is precisely that they are not as expensive in other countries; but instead, are price-controlled through various mandates as part of a country's national health care system. Drug research is time consuming and very expensive. Companies have to recoup costs to have enough left over for R&D for ever-new drugs. The US does not have mandates and price controls; hence, the higher prices in the US. Thus, we help subsidize cheaper medicine for those other countries.

Who asked the US to subsidize the world?
This is an interesting rationalization, and should be because Pharma lobbyists spend a lot of time and money propigating it, but the difference in the cost of drugs did not develop for these reasons. They developed because the US pharmeceutcial industry lobby controls the politcal agenda in a way they cannot in other countries.
The idea that RD from pharma is responsible for most of the major advances is false too. Most comes from original lab science in Universities. What Pharma describes as research is often developing minor changes to a drug in order to regain patent protection and exclude generics. Adding a buffering agent, or changing formulation strengths to develop "childrens" versions.) They also enlarge the numbers, because it gives them significant tax advantage... (Staff that have nothing to do with real research have their salaries labelled RD)
Should the US allow medicare to honestly leverage prices down, Pharma will adjust to the new reality of the market. Just as they have in every other country. There's a lot of expense in the way Pharma markets that they would eliminate. And trhey might have to live with smaller, but emminently predictable - profit margins.

Most drugs are post-patent and so can be made by 'generics', but what pharmaceuticals do is to try and 'renew' patents by coming up with new variations of, or new applications for, existing drugs. During the paten period, pharma does indeed try to maximise profit, and also to build a brand name (so that it will have decent sales in the post-patent period despite cheaper generics being available).

Besides, we Brits are always being told by conservatives and free market advocates that price controls and 'socialism' are inefficient, and that a market would reduce costs. Clearly that does not happen with the freer US drugs market.

Frankly, I think the main reason that drugs in the US are costing so much is that the market will bear the price. The complex system of organisations between patient and supplier (insurers, employers, HMOs and hospitals) don't seem to be working well to apply downward pressure. The hospital or doctor simply charges the cost on. The insurer pays it and passes it on in premiums. The employer / patient has little choice but to choose between various insurers, all increasing the costs, or going uninsured. The government may have some input with price control, but seems reluctant to do it.

Also, because for most people healthcare is not a 'nice to have', but a necessity (at the point of need, anyway), people will pay the cost more readily than if they were 'planning'. You don't plan to go sick or have an accident.

dan

Frankly, I think the main reason that drugs in the US are costing so much is that the market will bear the price. The complex system of organisations between patient and supplier (insurers, employers, HMOs and hospitals) don't seem to be working well to apply downward pressure. The hospital or doctor simply charges the cost on. The insurer pays it and passes it on in premiums. The employer / patient has little choice but to choose between various insurers, all increasing the costs, or going uninsured. The government may have some input with price control, but seems reluctant to do it.

Yes but; That reluctance comes from the necessity of dealing with the Pharma lobbyists, and the politicians need for the enormous political donations that come from the corporate stakeholders in the "complex system of organizations".
The system is gamed to maximize profits, and isn't a functioning free market. Fundamnetally because, as you note, consumers of medicine generally don't behave like they do when consuming any other product or service. Life or death having an overwhelming influence.

Who asked the US to subsidize the rest of the world, you quipped? I think that's what used to be called Foreign Aid, and much of the world depended upon it for many years to varying degrees. We've been moving away from that posture, thank goodness, though not fast enough.

However, in this particular case, it is not a point of choice so much as happenstance. I believe that most Pharma companies are international these days, like the oil companies, so it isn't strictly an "American" thing. As for these companies depending on academic generosity and research, the reality is that most university medical research is funded by private companies, such as pharmaceuticals. Academic departments become, de facto employees, in a way.

And yes, market demands, leverage, and multi-level deals have a lot to do with prices, which supports my contention: Price controls versus market supply and demand. Where do you think the big companies are going to find most of their revenue? Not in Germany, England, or Japan.

As for companies diddling their patents, so what? Every business tries to get the most mileage out of their patents. Nevertheless, new drugs are always being developed and they take a long time and cost a lot of money, no matter how you look at it. Generics only become available, popular and cheap after the original research and medicine is developed and marketed. That doesn't get done for free. Even Teaching Associates and Research Assistants have to get paid.
As for congress and their relationship to Big Pharma, I'm certain that the US could institute price controls, similar to what other countries are doing. But price controls rarely work and often backfire in some way or another. On the other hand, I agree the system is gamed. Unfortunately, there is no clear answer to what should be done. The so-called "Obamacare" package does not seem to have anything in it, but the Repubs have nothing to solve it, either.

But we are getting off-topic. Or I am. The original proposition was " is it moral for our society, given its relative wealth, to allow uncovered people to die at higher rates because they cannot afford to pay for care?"

By "society", I presume "Government" is really meant, since "society" speaks more of private enterprise: people and organizations. I don't think that is what advocacy groups are looking at. I think the question should be: "To what extent - if any - should government assist or manage the health care of its citizens?" Keep in mind that government-assisted health care is a recent phenomenon in world history. My counter-argument might be: Why do people assume that government must be the answer? Why don't we look to private contributions, and why aren't we all making those contributions any more? Or have we become so dependent upon the government taking care of us in other ways? Instead of assuming the government has or has insufficient morality with regard to allowing people to die, how about asking why you or I did not do anything to help prevent that? Wealthy is not a property of the government, but a property of its citizens. Government only has money that it obtains from citizens through taxes and fees.

George - to answer your questions at the end, it's because it tends to work better, even where the solution is not universal government provision but (as in Switzerland) mandatory insurance with private suppliers and assistance for the poorest.

Indeed it is new. And for most of our history (and still in poor countries that cannot afford it), people die needlessley because of lack of access to healthcare.

Personally I see 'society' as everything, not just government, or the rest. Government, however, is the representative of society in a democracy. We could as the same questions about policing or fire services - they tend to be more effective when organised by an involved 'state', and more accountable in a democratic state.

I woud not shift the burden from society to government--our society is constituted of all of us Americans, every single one. Morality is much easier in small groups. Human beings and our hominid ancestors lived small bands for millions of years. It is only since agriculture was developed 10,000 years ago that we were able to live in large groups. In a small tribal band the leader would not get 50% of what was procured from a hunt or even the best hunter would not get such largesse. Maybe they would get the best cuts of meat but they would not get everything. In order for the tribe to survive people had to cooperate and share when they had excess. Somehow in our culture of greed and gluttony, a lot of people find it wrong for those with extreme amounts of excess wealth to give back in the form of taxes to those less fortunate. There is not the sense that we are in the same society and we owe obligations to each other.

One of those obligations is health care. Do I really want to spend the time myself making sure others have access to health care? No. I just want send my tax dollars to the government and let it take care of it. I don't see how private charitable groups would do the best job of making sure everyone has health care--for one thing they may be oriented towards funding treatment for certain diseases, they may be religiously oriened making it difficult to provide certain kinds of treatment to people, etc. And most importantly people will not give enough to charity to make sure everyone has access to health care.

As a people, given our level of wealth, everyone should have access to health care. It is immoral to let people prematurely die so that a certain percentage of the population can have unprecedented levels of wealth, wealth that they cannot even spend if they tried. I don't see that the morality is different in a tribe where the best hunter says I deserve all of the meat because I shot the animal (even though a bunch of other hunters contributed or even if they did not he has excess meat he cannot use now but others can and he will benefit from a system where meat is somewhat shared) than in our society where a billionaire pays 15% in taxes and those at the bottom cannot get health care as a result. Of course socialized medicine appears to be the most efficient delivery system, but if it were not and we had to pay more money we still have to cover those less fortunate.

George, it wasn’t a quip when I asked “who asked the US to subsidize the rest of the world when it comes to drug costs. It was very serious. And your answer was unserious. The price of drugs in the SU, is a US problem. Period. When people bring up the non-sequitar of “Yeah but if we don’t pay these high prices, no research will happen… “ Thus “Who asked you,” becomes relevant. In no other situation would you find conservatives defending companies discriminating against Americans in pricing. Why accept such an unproven argument as a defence for the exploitation of American citizens by international corporations?
george

However, in this particular case, it is not a point of choice so much as happenstance

.
No. Its a choice. Politicians, and citizens refuse to accept the evidence that other systems of running health care are more efficient and cost effective. They have deliberately chosen the current path. Especially politicians who are dependent on corporate money in order to run their never ending election campaigns.
george

And yes, market demands, leverage, and multi-level deals have a lot to do with prices, which supports my contention: Price controls versus market supply and demand. Where do you think the big companies are going to find most of their revenue? Not in Germany, England, or Japan.

,
one of the things central purchasing of drugs in countries does do is it eliminates many of the costs associated with sales and marketing of drugs in the US. So, profits aren’t diminished all that drastically… BY the way, restrictions on “advertising” similarily reduce marketing costs, although they do also seem to limit the growth of use of certain drugs that are heavily advertised in the US. The broad point I’m making is that there are pay offs both ways… And the drug companies havn't stopped doing business in any of the countries you've named have they?
george

As for congress and their relationship to Big Pharma, I'm certain that the US could institute price controls, similar to what other countries are doing. But price controls rarely work and often backfire in some way or another

.
Please demonstrate how this has turned out in the area of health care delivery. Health care in the US is 17% of GDP and health care inflation has been outrageous. Health care delivery in most of the west diverged from the model currently in use in the US 60 years ago. You should have ample evidence to show how the use of centralized buying and negotations has failed…. Well, actually you won’t because its been largely successful. Hence the lower cost and greater effectiveness.
george

On the other hand, I agree the system is gamed. Unfortunately, there is no clear answer to what should be done. The so-called "Obamacare" package does not seem to have anything in it, but the Repubs have nothing to solve it, either

.
Obama care is no great shakes. But initial evidence shows that as people are renewing health insurance under the new law, premiums are not rising much. And some are not only getting decreases but some have gotten refunds… So, in terms of health care cost it does, at least initially , seem to be delivering efficiencies.At least in insurance costs...

Good news: The middle class will be taxed under Obamacare!

Nearly 6 million Americans — most of them in the middle class — will face a tax penalty for not carrying medical coverage once President Barack Obama's health care overhaul law is fully in place, congressional budget analysts said Wednesday.
The new estimate amounts to an inconvenient fact for the administration, a reminder of what critics see as broken promises.
The numbers from the nonpartisan Congressional Budget Office are significantly higher than a previous projection by the same office in 2010, shortly after the law passed.
The earlier estimate found 4 million people would be affected in 2016, when the penalty is fully in effect. The difference — 2 million people— represents a 50 percent increase.
That's still only a sliver of the population, given that more than 150 million people currently are covered by employer plans. Nonetheless, in his first campaign for the White House, Obama pledged not to raise taxes on individuals making less than $200,000 a year and couples making less than $250,000.
And the budget office analysis found that nearly 80 percent of those who'll face the penalty would be making up to or less than five times the federal poverty level. Currently that would work out to $55,850 or less for an individual and $115,250 or less for a family of four.
Average penalty: about $1,200 in 2016.