Friday, December 14, 2007

Huckabee, Schmuckabee, Fred's Dead: Is Mitt a Twit?

Like Fred Thompson before him, Mike Huckabee is about to squander thenewswalk.com bump that comes with the honor of being the subject of our news ticker in the right column.

Huck has leapt to near the top of the polls, but you just don't accuse your opponent of believing that Satan is Jesus' brother. Even if it were true, which it apparently ain't, that's just bad form.

Neither do I, a putative Christian, want a president who advertises himself as a "Christian Leader." I'm also putatively a Catholic, and I don't want any "Catholic Leaders" as my president either. I prefer my sectarianism in this republic mellow and understated, invisible even, just like the Founders did. "Christian Leader" means Pat Robertson, and the Republican Party didn't like that noise the first time around after he finished second in the 1988 Iowa Caucuses.

The general electorate liked it even less. Huck, you're out. I like Christians. I'm married to one. But too much is way too much.

National Review, which founded modern conservatism, and which historically has been more Catholic and Jewish than Protestant, has endorsed Mitt Romney, who is none of the above, Mormonism being its own thing.

Harkening back to Abraham Lincoln, who said he'd fight to preserve the Union even if it meant not freeing a single slave, National Review endorses Romney to preserve the unity of the conservative movement, even if it means not electing a Republican to the presidency in '08.

[Well, they didn't admit the last part, but that's what's going on here.]

So, OK. I can dig that. Mitt Romney gets thenewswalk.com ticker now. Me, I think Mitt's a plastic man and genuinely weird, like Gore and Kerry before him, who deserved to lose. Weird like he put his family dog on the roof of his car for 10 hours on a trip, and then insisted the doggie liked it, even though the car was covered in doggie poo.

I mean, that's weird, I don't care how cleancut His Mittness looks.

I don't want a weird president. If Romney's the GOP nominee, I can't guarantee he gets my conservative vote, just because I happen to be a conservative. But Brother Mitt, you have our news ticker now, with all the perks and responsibilities it entails.

Prove to us that you ain't weird, please? I wanna believe.

Wednesday, December 12, 2007

A Word About "Authorized" Generics

Patents are valuable, often enough, and economic value attracts the sort of attention that honey elicits from bugs. And so whole industries evolve around legal challenges to patents, and the more valuable a given patent, the stronger the incentive to use the courts to redistribute wealth. Moreover, litigation is expensive, and the risk of losing a pharmaceutical patent to a challenger---to a generic drug producer in this context---analytically is equivalent to a shortening of the patent period expectationally. The process, therefore, reduces the expected returns to investment in the research and development of new medicines, and reduces as well the development of me-too drugs, that is, competition in the pharamceutical market.

And that is why the geniuses in Congress who want to limit the ability of innovative pharmaceutical producers to settle such lawsuits with payments to the challengers are utterly myopic in their view that such limits would increase (generic) competition and thus lower prices. In the very short run, maybe. But the increased challenges to patents would have the longer-run effect of reducing the flow of new medicines, and thus competitive pressures from them with respect to older, more-established drugs. That this is so obvious is the central reason that many in Congress cannot understand it.

[cross-posted from www.medicalprogresstoday.com/blog/]

Tuesday, December 11, 2007

The View From the Top...

... is always top-down, particularly in that city of the exalted, Washington D.C. So what is it this time? "A Food and Drug Administration medical reviewer said it wasn't clear if consumers could safely and effectively use a proposed Merck & Co. cholesterol-lowering drug without a prescription." (Wall Street Journal, December 11)

And that just about sums it all up, doesn't it? Forget consultations between doctors and their patients. Forget the heterogeneous characteristics and needs of millions of individual patients. Forget the huge informational advantage engendered by ongoing experience, modern mass communication, and individual trial and error. Forget the reality that some very substantial proportion of prescriptions are for off-label uses. Sorry: The Beltway knows best, children---because it says so---and "safety and effectiveness" is one-size-fits-all.

It is not only inside the Beltway that this sort of arrogance is to be found, but it is the Beltway in which it is rewarded so consistently and in which it simply is more than a way of life. It is a mindset.

[cross-posted from www.medicalprogresstoday.com/blog/]

What Is a Mandate?

A good fight is always fun to watch, particularly if it is only political blood that is being spilled, and it is flowing freely in the Democratic free-for-all in the context of health care reform. Senators Clinton, Edwards, and Obama are united in their policy preferences for "reforms" that inexorably will lead to a single-payer system of health care insurance and to all of the perversities attendant upon it. Anyway, one way to reduce the taxpayer cost---not the true economic cost---of such a system is to force those who otherwise would find health insurance not worth its cost to buy it anyway. They would pay more than the benefits they receive, and so would subsidize others.

Such an "individual mandate" for all is part of the Clinton and Edwards proposals, and for children in the Obama plan. So: How would the government enforce this requirement? Edwards is quite clear: He would require proof of insurance with the annual filing of income-tax returns, and in the absence of such documentation the IRS would automatically enroll the scofflaws in a plan. And if the freeloaders refuse to pay the premiums? Wages will be garnished! The IRS becomes ever friendlier!

Hillary, after having blasted Obama for not having a mandate, and thus not "covering" everyone, finally has been forced to admit, sort of, that a mandate is meaningless without enforcement, and that she too might consider garnishment of wages and the like. Obama, more honest than the other two---not an exacting challenge---has not responded with a proposal for expanded coercion, and indeed has not explained even how the mandate for kids is to be enforced.

So let us be very clear: Mandates will be hard to enforce, and so the cost estimates in the respective plans---for this reason and host of others---will come a cropper. Which illustrates an eternal truth: Government planning cannot work, never has worked, and always yields unexpected effects less than salutary. Will our crack journalists covering this issue understand any of this? Not a safe bet. Not at all.

[cross-posted from www.medicalprogresstoday.com/blog/]

Monday, December 10, 2007

Super-Sized Stupidity, Beltway-Style

Well, not exactly the Beltway this time, but instead a member of the D.C. Council, David A. Catania, who without any doubt at all looks in the mirror and sees Senator Catania. After all, they all drink the same water. Anyway, Comrade Catania now proposes to license pharmaceutical sales representatives, in an effort to rein in "disreputable agents who drive up the costs of prescription drugs."

Got that? Restricting the supply of reps through licensing will reduce costs! And how will this bit of alchemy be achieved? Elementary, Watson: No longer will we have pharmaceutical representatives who can "mislead doctors and patients into buying the most expensive drugs on the market, shunning reasonably priced generics or drugs that could be just as effective." After all, sayeth the deep-thinking Catania, "the agents' salaries are dependent on sales, [so that] they sometimes give the wrong impressions about drugs and present themselves as medical professionals."

So there we have it. Doctors who are licensed are fools, but pharmaceutical representatives who are licensed are wise and scrupulous. Oh, by the way, since Comrade Catania seems not to propose a change in the way that "the agents' salaries" are determined, it is not quite clear how licensing would change their incentives. And speaking of which, incentives for deception are far weaker than Catania assumes, given that the reps and the pharmaceutical producers have ongoing relationships with the medical providers, so that deception now carries a real risk of damaged business tomorrow. After all, do the representatives not place some value on their credibility? And, of course, there is the FDA: Is Catania oblivious to the fact that the reps are not allowed to make claims not approved by the FDA? Perhaps Catania is generalizing from the record of dishonesty observed eternally in the world of politics---the D.C. government is not exactly a model of good-government progress---a possibility magnified by the view of reality shaped by a lifetime outside the real world.

More wisdom from Comrade Catania: "If [licensing] is good enough for cosmetologists, it ought to be good enough for the pharamceutical company." Catania, naturally, has this precisely backward: Just as market forces are quite sufficient to lead cosmetologists toward honest behavior, so the same is true for pharamceutical representatives, who have to deal with physicians and others who are not idiots. But Catania must truly believe that they are idiots, just as the political class believes that the rest of us are children rather than citizens. That we have to pay their salaries is a monument to the perversities of that sausage factory known as lawmaking.

[cross-posted from www.medicalprogresstoday.com/blog/]