Re: [A-List] Well, Anne W Gives An Interesting Lecture

["Annewilliamson" <Annewilliamson@xxxxxxx>]

On January 14, 2003, Hari Kumar wrote:

Anne:

> I have no idea why you feel it necessary to lecture me as if I have the
> brains of a retarded 18 month child. However, presumably you do have
> some legitimate cause to argue in said manner. Perhaps your X-Ray vision
> detected my diapers.
> 1) AW: "In economics, "incentives matter." .
> REPLY: A most interesting and novel thesis I am sure.


I am puzzled by the venom in your response to my
post on subsidized prescriptions since I was trying
to flag the issue of incentives, and was not delivering
a "lecture."  So as to whether or not "incentives matter"
is groundbreaking economics - which it isn't and I am
well aware of that - it had not yet been raised in the
discussion of this issue.

> (i) In Canada the generic drug manufacturers provided drugs to the state
> at a fraction of the cost by the multinationals; & as part of the NAFTA
> agreement were shut down. Those drug companies were not being provided
> then, by any "incentive to medicate" - other than raw profit - by the
> state since the state had NO drug incentive programme at that time.
> Regarding the "population as guinea pig" - you are - in part - feeding
> on the mythology of the anti-medicine movement. But - yes only proven
> efficacious Randomised trials level-proven-medications should be
> presribed in the main.  [Hint - there are some]. As for "good-hearted" -
> whoever said that public policy intents were naive "good-heartedness?"
> [Please read my mild comments below to refresh your memory]. The
> earliest health reforms in the British industrial revolution were
> explicitly driven by a fear of revolution - as Chadwick eloquently
> explained. After that it was Joseph Chamberlain - that wily gentleman of
> the ruling classes who pointed out that it was necessary to make some
> social reforms:
> "What ransom will property pay for the security which it enjoys? What
> insurance will wealth find it to its advantage to provide?"
> (J.Chamberlain in J.L.Garvin 1932).

As to your point that generic drug manufacturers in Canada were
shut down due to NAFTA, well, you certainly won't find any
support of NAFTA from me.  If this is true, and I have no reason
to doubt your word, then it's just one more example of why NAFTA
is a bad treaty.  But, nonetheless, there is an "incentive to medicate"
in a drug industry relying upon "raw profits" alone, just as there is
an incentive for resteranteurs to feed people.  But the "incentive to
medicate" isn't a bad thing on the part of drug suppliers since medication
is their business.  So long as it is a beneficial product, then hey!  Pop
that
pill.  If it's not beneficial, if it makes you sick, then probably you will
stop
taking that pill, and the drug companies' "raw profits" will decline until
they produce something that is beneficial.

But when you see the state drugging schoolchildren - mostly boys - with a
cocaine
based substance (ritalin) and the number of children being dosed doubles
over a five-year period, then I think the danger of state involvement in and
subsubsidies to the pharmaceutical industry can be seen as sinister.  This
is the situation in the US, I do not know if Canadian schoolchildren are
subject to similar coercion.   Additionally, I am unaware of any large
Canadian
drug manufacturers that produce new products with patents they wish to
protect, "generic" producers by definition being copy cat producers.
We have several such companies in the US, and they support
mighty lobbying groups that seek state-provided favors regarding
subsidies and patents - and this, I suspect, is largely the reason why,
as you wrote, "Comparisons of Canadian vs USA citizens shows markedly higher
drug over-useage in the USA."

The "good-heartedness" I was referencing was that of the public, not
of "public policy intents" whose participants manipulate the public's
desire to do the right thing for their own purposes.  I specifically
cited Jeff Sachs because he is a master of this type of p.r., personally
producing truckloads of it himself while leaving mostly devastation in
his wake.

As far as public insurance and retirement schemes go, I prefer the raw
honesty ("far easier to handle"/"will put up with much more") of Bismarck
to that of Chamberalin:

"Whoever has a pension for his old age is far more content and
far easier to handle than one who has no such prospect.  Look at
the difference between a private servant and a servant in the chancellery
or at court; the latter will put up with much more, because he has a
pension to look forward to,"

It is indeed a long time since I have heard a panegyric to the
> hallowed "doctor-patient relationship" - from a non-physician. I think
> you are not entirely wrong - but are somewhat naive about it, since,
> state regulation in fact enabled the hallowed patient-dr relationship
> you appear to like so much - at least in vast parts of Western Europe
> and in Canada - by making an effing doctor available.

Regarding the supply of doctors, I am at a loss as to your assertion
that the state makes doctors available.  Doctors want patients,
people get sick, there is no need for the state to supply them when a
contracted
arrangement based on mutual need exists.  True, you do need the coercive
powers of the state to round up all those schoolchildren for their
daily dose of ritalin, but I maintain this is a negative.  And, I believe,
the concept of medical privacy arose within the medical community
itself - and from ancient times, not from modern state regulation.

2) Many elderly poor in the USA - are either poor 'cos of drug bills;
> or
> are too poor to pay for drugs.

The elderly are poor because for the entire course of their lives, the
government taxed them when they earned their money, taxed them when
they saved their money, taxed them when they invested their money, taxed
them when they spent their money, taxed their "benefits" when they received
them, and when they die, they'll tax what's left, if anything.  Talk about
thorough!  Of course they are poor, 50% of their income has been
given over to the non-producing state.

Unlike most working peoples in the USA - one can only assume that
> you can afford the type of "catastrophic" insurance that you casually
> discuss. That is fortunate for you.

Catastrophic insurance is quite cheap, and far more affordable than the
medical insurance foisted on the public with all its restrictions, controls,
codicils, and trap doors.  One does not have to be "fortunate" in order to
afford it.

Your final, mocking comment of "But why don't we just take a leaf
out of Jonathan Swift's book, & just change the age-scale on his
prescription? eh?" only demonstrates that you didn't read what I
wrote which is that state-subsidized medicine is dangerous for
this very reason. As far as the implication that I am some unfeeling
monster happy to see old people suffer and be hustled off to eternity
goes, I want no one to die unnecessarily or to be denied needed care,
but I do have different, sincerely held ideas about how that can best
be accomplished.

Anne