Demand for health services will always be infinite while resources will always be finite. Recognise this by ring-fencing funds so we all see where the money goes and see the limitations of what we are prepared to give to it. Make payment mandatory but voluntary! to ease the pain.
We have arrangements for compulsory purchase of land in the public interest. Extend some of this principle to the production of drugs. (in the following allow the substitution of the word drug with procedure, instrument or whatever the health need being addressed is, normally a drug but what about re-usable syringes, rehydration kits etc) Health is not just another form of commerce; like defence it should have a different status. There are very obvious circumstances where the good of the people is not served by present strictly commercial structures in health matters.
When a drug is licensed for use by the "national health service", whatever that service's form may be, the crucial thing being public funding, publish details of what the drug is, what it is for, what side-effects have been detected, its development cost and its true raw production cost.
Add the drug to the list of drugs which the public can decide, in continuous polling, is to be available for use at public cost.
Allow the producing company to make profit unhindered on that drug (figures compulsorily ring-fenced) for five years. At the end of five years the people are given the right (which will remain exercisable indefinitely) to compulsorily purchase rights to produce the drug independently of the commercial company. The drug is then to be produced at public expense, in government factories(?), and sold at raw production cost price. The government will be free to use the drug for the public health service or to sell or give the drug to any other country or organisation it sees fit.
A court will decide, within one week of the public call for compulsory purchase, on whether the public good should overrule the commercial patent. If the public are to buy the drug then the sale will go through one year after the decision is published. A parallel, publicly funded, court will oppose the motion if it is in the public's interest to do so. Consider the indiscriminate use of anti-biotics and drugs of last resort such as methycillin.
The public call for compulsory purchase will arise through continuous polling from the day the drug is licensed for use so that its status on the fifth anniversary is taken as the expression of the public will. The cost to the public purse of the purchase will be decided and published ninety days before the fifth anniversary, or the proposed date of purchase in the event that the call is not made for some longer time (perhaps after a new use for the drug has been found since the arising of a new disease such as AIDS). This price would not be the 'lost profit potential' of the drug company as the company would already have made its profit. The patent will remain unchanged for all other countries and the company will be able to carry on as normal elsewhere.
Where a drug is primarily or exclusively for use for some purpose not applicable in 'this' country then the tax-payer will be aware, painfully perhaps, of its duty to bear a cost for the health of People not just our people. When an issue arouses sufficient passion in sufficient countries using our new principles of government it will be inevitable that all production of that drug (or instrument eg syringes etc) would be taken under the public wing somewhere in the world, and the public good of all of us would overrule the commercial good of a company. This process will also mitigate the negative effects on employment of taking away profit and product from commercial enterprises. We, and that is all of us, still rely on commercial companies being successful enough to create products in the first place. By these means, our moral will and rights will be exercised in preference to material concerns, when we collectively decide this is appropriate. In cases where a need is identified but is not commercially viable enough for a company to pay for all the research etc then the public purse can be made available to subsidise production.
A drug producing company will be completely aware of what is likely to happen because the success of a drug and details of cost etc will be open information from the start. It will therefore be able to plan accordingly. The contract with the people would say bluntly, these are the rules, get out of drugs if you do not wish to abide by them.
Safety standards for drugs are now harming many people they are supposed to protect. All drugs should be made available for discretionary use before the completion of testing so that patients with nothing to lose can benefit and so that people can decide for themselves on their willingness to take risks. To protect the producing companies and the public purse such discretionary use must be public and under a public immunity type legal arrangement. This arrangement is to be standard and pre-defined to prevent any party misusing the process or delaying action to the detriment of a potential beneficiary of the drug's use. Use of drugs or procedures this way must be public to protect all sides from dispute. This is one of the prices to be paid for the benefit of being able to short cut the years of testing delays before drugs are licensed for general use.
As publicly funded health care is inevitably rationed a continuous polling list is maintained of drugs and procedures and practices that are to be priorities. This will allow for 'self-inflicted' harm to be treated or not treated according to the public will rather than according to the diktat of a bureaucrat or an insurance company with commercial gain as its moral base.
Private health care is to be completely available and unregulated. If you wish to pay, pay.
Provision of future health services, of whatever kind, must be funded, so the people must be told in advance how much things are likely to cost so that they can judge if they wish to pay for them. This helps to make sure the people are in charge of their own money rather than vested interests such as greasy-pole climbers, widget producers or property developers. The public are also well aware of the behaviour of costs when 'government' is in charge and while the bureaucrats just ignore 500% cost overruns because they are not their money, the public won't be so soft, in the head.
DRUG WAR etc. Who's winning the drugs war? Vicious circle, stale argument, change the question. If the question is hard, change it, is this a 'local peak'? View drugs, booze, twocing, domestic violence etc as all symptoms, not diseases, of a failure in the spirit department. Then tackle all by tackling the big picture, the system, not the symptom of heroin.
Suggestions for judgements to be made about the cost-effectiveness of health services :
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