What I want is something like the Japanese system, which would cost less. An initial step in this direction (that would save big bucks) is to allow Medicare to negotiate with pharmaceutical companies for lower prices like Walmart does with its suppliers. Everybody else in the world does that except America. And everywhere else people pay less for the exact same drugs as Americans do. Conservatives passed a law that forces Medicare to pay whatever price the drug companies want. Repeal that provision and taxpayers pay less.
Or we could go full-Japan and have Medicare. Medicaid, the VA and the big private insurers collectively bargain with medical care providers and drug companies for lower prices across the board. The Japanese consume far more medical services than do Americans but they pay much less, because the
price their insurance companies get charged is less because of such bargaining pools.
In Japan, insurance is all private, but the fees the companies collect and the costs they pay are fixed by these collective negotiations. It's like a regulated utility. The competition is fierce because the business has a fixed margin, the more customers you can get to sign on with you rather than your identically-priced competitor the more money you make. So its all about operating efficiency, customer service, and extras (like coverage for certain cosmetic procedures not covered under the national program).
International pharmaceutical companies all do business with Japan (we do at Pfizer). They are the biggest buyer of drugs in the world. They won't allow our drugs in their formulary unless we charge a lot less that whan we charge Americans, so we do--its still good business. But since
Medicare is required by law to pay us whatever we want, selling to Americans is truly great business. And with half of the American market price-locked in, we can bargain hard with private insurers and gouge them too. No other healthcare provider investment can remotely offer the return that political contributions can
Before you trot out that stale argument about recouping the costs of R&D, know that R&D isn't the big expense. Hell we've shut down almost all of the R&D. Kalamazoo (Upjohn) and North Chicago (Searle) got axed in 2004. A few years later they axed An Arbor (Parke-Davis). They shut down BM R&D and the Pfizer R&D in England. Now even legacy Pfizer in Conn is coming under the knife. I don't know who's left. I think all the other companies are dumping R&D too. Discovering new drugs is hard--too hard for out multimillion dollar a year executives to handle. Better to let someone else do it and buy the stuff they come up with. A big chunk of our costs nowadays is merger costs and writedowns for paying way too much for stuff we acquired. All the guys on the corporate office know how to do is financial deals. Its the same all over. If Congress had the balls to do what I suggest it would force us to cut all that administrative bloat or go out of business. Maybe that would force them to spin us off.
You know if you pay executives huge salaries for years and years, you will eventually get incompetence. It's the same principle that operates in spoiling children. The executives come to think they deserve their super-high compensation. A middling CEO today makes much more than a top man 40 years ago. That mediocrity is eventually going to think he is better than Alfred Sloan, and the result is bankruptcy, or the 2008 collapse caused by morally-challenged pygmies who think they are better than the greats of the past simply because they are paid more. And the nation goes to shit as a result.