We are faced with a serious problem, one requiring the full faith and credit of the free market. We need to unleash resources and creativity. That’s what markets do best, right?

The problem is drug-resistant bacteria and diseases that cannot be cured with existing strains of antibiotics. Yet market incentives are perverse. The marketplace is just as often our enemy as our friend.

This is from an article by Jerome Groopman in the New Yorker, Superbugs, August 11/18 issue:

In the past, large pharmaceutical companies were the primary sources of antibiotic research. But many of these companies have abandoned the field. “Eli Lilly and Company developed the first cephalosporins,” Moellering told me, referring to familiar drugs like Keflex. “They developed a huge number of important anti-microbial agents. They had incredible chemistry and incredible research facilities, and, unfortunately, they have completely pulled out of it now. After Squibb merged with Bristol-Myers, they closed their antibacterial program,” he said, as did Abbott, which developed key agents in the past treatment of gram-negative bacteria. A recent assessment of progress in the field, from U.C.L.A., concluded, “FDA approval of new antibacterial agents decreased by 56 per cent over the past 20 years (1998-2002 vs. 1983-1987),” noting that, in the researchers’ projection of future development only six of the five hundred and six drugs currently being developed were new antibacterial agents. Drug companies are looking for blockbuster therapies that must be taken daily for decades, drugs like Lipitor, for high cholesterol, or Zyprexa, for psychiatric disorders, used by millions of people and generating many billions of dollars each year. Antibiotics are used to treat infections, and are therefore prescribed only for days or weeks. (The exception is the use of antibiotics in livestock, which is both a profit-driver and a potential cause of antibiotic resistance.)

If there is a solution to this problem, it will come from the college campuses and the National Institute of Health – government sources. The market is not helping – in fact – is structurally unable to help. This phenomenon is known as “market failure” – the public is disserved by the profit motive. In such situations, government has to intervene to provide for the greater good.

It’s interesting – I realized as I wrote those words that in the past in my exchanges with Dave Budge (a libertarian conservative Republican who at any given time denies affiliation to any of those three schools), he claimed not to grasp the concepts of “market failure” and “greater good”. Ayn Rand herself did not believe in individuals sacrificing to a greater good – that is, she did not think there was any point in people serving anything but their own self-interest. Perhaps libertarianism, a sideshow that has much greater currency in leadership circles than among the general population, is a failed philosophy.

Superbugs are a common problem affecting all of us. Those institutions that profit from the public’s need for drugs have an obligation to step in and help us solve the problem. But they’re not – they’re busy doing the self-interest thing. Rand would be proud.

In an exchange I had with Steve at Rabid Sanity regarding health care, he referred me to two articles that take issue with the current low ranking by World Health Organization of the United States’ health care system against other industrialized countries. We’re 37th. The two articles dispute the rankings, saying they are biased in favor or state-run systems. Our system is not “perfect” one admits, but is probably the best in the world.

The first article is How surveys twist rankings on health care, by Glen Whitman. The problem is, he says, the objectives of the study.

The most obvious bias is that 62.5 percent of their weighting concerns not quality of service but equality. In other words, the rankings are less concerned with the ability of a health system to make sick people better than with the political consideration of achieving equal access and state-controlled funding.

This, he says, is a flaw in the study. The United States is very good at making sick people better – not all sick people, but that’s not the point. A health care system should be measured by its abilities, and not its delivery capacity. That 47 million of us are without insurance? Not an issue. Bias.

The rankings include measures for “health level” and “responsiveness.” “Health level” is their way of saying life expectancy, while “responsiveness” refers to a survey based on “respect for persons” and elements such as speed of service, convenience and choice — yet even in these cases half the overall weighting is determined by considerations of equality. Thus, a country with a poor level of “responsiveness” throughout the population will score higher than a country with a good level in some parts and an excellent level in others.

It’s in the eye of the beholder, I guess. Whitman is a professor of economics, and is not concerned about equality. And he is right: If you only measure the people we actually take care of in this country, we’re the toast of the town.

The second article, Ranking the U.S. Health-Care System, by Jim Peron (for whom it gives no credentials), says pretty much the same thing, but from a doctrinal standpoint. Peron starts off by using the word “socialist” as a pejorative, so it’s not hard to see where he’s going. Referring to a study by the Commonwealth Fund that also ranked the U.S. very low, he says

The Commonwealth Fund marked down the United States partly because “All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefits packages with no cost-sharing by the patients.” Again the American system loses points because it doesn’t provide socialized medicine. And the Times neglected to note that “no cost-sharing” means the people have paid through taxes whether they receive the care or not.

This is a curiosity. The concept of insurance is based on shared risk, no different than coverage of people’s health care through taxation, also a shared-risk system. But Peron presumes that private insurance is a superior model because it is not based on taxation. That’s nothing more than personal bias.

This is priceless:

This issue is not unknown to the Commonwealth Fund. In 1999 it
published The Elderly’s Experiences with Health Care in Five Nations, which found significant delays for “serious surgery.” Only 4 percent of the American seniors reported long waits for serious surgery. The rate was 11 percent in Canada and 13 percent in Britain. For non-serious surgery the differences were more obvious: 7 percent in the United States, 40 percent in Canada, and 51 percent in Britain.

He’s talking about seniors. He doesn’t seem to realize it, but he’s comparing our Medicare, or government-sponsored system that is supported by taxes, with other countries. I’m happy that Medicare is doing well in that regard. It’s a well-run system.

In other areas, Peron simply offers up weak, made-up-on-the-spot excuses.

The United States also lost credit because fewer Americans report having a regular doctor for five years or more. But Americans are more mobile than many other people.CNN reports that Americans move every five years on average.

He does that in other areas as well, as in emergent care wait periods, lack of centralized medical records, and the number of patient complaints. (“But different cultures have different attitudes toward complaining.”)

It’s all illuminating, but not of the relative merits of health care systems. In terms of equality and delivery of care, the U.S. lags far behind other countries. But these articles, and Steve’s post to begin with, shine a light not on study biases, but rather on right wing biases. Yes, we don’t offer care to everyone. We don’t intend to! Yes, our care for the wealthy and well-insured is excellent. Those are the people the system is meant to serve.

The system works as it is intended to work, delivering excellent care to insiders, and poor or no care to outsiders. When we debate conservatives like Steve on this issue, that is the subtext, and the issue we need to highlight. Conservatives are far too caught up in rewarding the financially well-off. In health care, that’s a poor objective. Even if they attain it, they have failed us.

For that reason, they need to step aside and let us “socialists” fix our health care system. It’s long overdue. We have real answers while they offer nothing other than a curtsy to Ayn Rand.