Yesterday, Donald Trump went to New Hampshire, the ‘Granite State’ or, as he calls it, a ‘drug-infested den’. He has launched an initiative against prescription opioid addiction, and would like to execute drug dealers. He has not specified whether he would prefer to do this in the manner of Dirty Harry, or by a legal and perhaps more appropriate method, such as lethal injection.
Some of his audience whooped in approval when he suggested the death penalty for drug dealers. The opioid epidemic is worst among Deplorables, and New Hampshire is a pretty Deplorable state, with plenty of unemployed white gun owners. New Hampshire’s figures for prescription opioid deaths are pretty deplorable too: 39 per 100,000 of population in 2016, which is twice the national average. Its population is small, just over 1.3m, so people are more likely to know an addict or an overdose victim. Since the prescription opioid epidemic took off in 2000, neither Republican nor Democratic administrations have done much. No wonder people were whooping yesterday.
The fuss over Trump’s opinions on New Hampshire and the death penalty obscured his announcement that in 2017 the FDA approved more generic drugs than in any other year. This is not fake news: in January, the fact-checkers corroborated Trump’s claim when he made it in his State of the Union address. It is commendable that Trump wants to do something about opioids, and commendable that under Trump the FDA has lowered drug costs by licensing generics. The two issues are linked, and they go to the heart of the healthcare conundrum.
Big Pharma fuelled the opioid crisis by pushing doctors to push generous doses of their expensive and addictive brand-name drugs. This rigged market, and the addiction that it creates, has driven an illegal secondary market. Just to complete the public’s misery, Obamacare allowed the health insurers to pass as much of the prescription costs as possible back to the public. Taxes were already subsidising drug development through the National Institute for Health. So people were paying more than they needed to for drugs that were more expensive than they should be, and often for conditions that probably didn’t need to be treated with opioids in the first place. And people wonder why Trump won the election.
Here are three eye-catching statistics, none of them to do with Stormy Daniels. In 2016, nearly half of American did not have enough cash to cover a $400 emergency room visit. In January 2018, only 39 per cent of Americans said they had the savings to pay an unexpected expense of $1,000. Last week, a study in the Journal of the American Medical Association (JAMA) reported that the United States has the most expensive healthcare system in the developed world—and some of the worst outcomes.
JAMA found that per capita spending on prescription drugs in countries like Canada, Britain and Switzerland ranged from $466 to $939. In the US, it’s $1,443. In other nations, 1-3 per cent of health spending goes to administrative costs. In the US, it’s 8 per cent.
The difference between the high range of per capita foreign spending on prescription drugs ($939) and the average American’s spending ($1,443) would cover a cash payment for an emergency room visit. The difference between the low range of per capita foreign spending on prescription drugs ($466) and the average American’s spending ($1,443) would cover that unforeseen $1000 expense.
These are the kind of margins that have impoverished half the country. They are also the kind of margins that support a bloated and incompetent government bureaucracy, and its partners in opioid addiction and compulsory health insurance, Big Pharma and the insurance companies.
“It’s going to be beautiful,” Trump purred in New Hampshire yesterday. Probably not, because Congress, soaked in lobbyists’ donations, will block comprehensive reform. But if something isn’t done to make healthcare affordable, and if the percentages of Americans who cannot cover their children’s health costs rises past the halfway mark, then it could get much uglier.