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Treatment costs with Praluent for cholesterol control are extremely high at $14,600 a year.

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A report by pharmacy benefits managing company Express Scripts shows a 13% increase in the price of branded drugs in the U.S. from Sept 2011 to Sept 2012. Generic drug prices declined by 22% in this period. The report also shows that growing spending on specialty drugs for cancer, MS and other diseases is a big reason for the increase in prices of branded drugs. This report is from a random sample of six millon Express Scripts members using prescription drug coverage. Prof. Schondelmeyer of the University of Minnesota, who manages the drug benefits program at the university and conducts a similiar price report for AARP, says the potential benefits for these specialty drugs are not that good to justify the high prices.

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U.S. Senator Ben Sasse suggests an alternative approach of simply repealing the Affordable Care Act called Obamacare and replacing it at a later date. This is endorsed by president Trump. This is the new Republican strategy in July 2017. Forty nine senators voted in favor of this repeal in 2015, when president Obama vetoed this legislation. Two more senators are expected to support repeal according to Ben Sasse.

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The private sector ignores health insurance. And state coverage in China is inadequate. More than two thirds of China's 1.3 billion people have no health insurance at all. If you have insurance you still pay up front in cash, if you do not have the cash up front you cannot get a surgery, treatment of any kind or any drugs, even if the insurance will later reimburse you. The Chinese health care system is dysfunctional and in a crisis because of the way it is structured, and the faulty policy incentives. It caps prices for basic drugs and procedures at below market rates, yet it lets hospitals profit from everything else from advanced drugs to sophisticated diagnostic tests. So hospitals invest heavily in technology and expensive testing. and drug sales account for 45% of revenues. And enforcement is lax. Doctors in Shanghai make monthly incomes of about $400, about what a taxi driver makes, so they supplement their income with bonuses earned by prescribing more expensive tests and drugs. There is no utilization review so the state reimburses for whatever the hospitals charge regardless of whether the test was needed or not. So the system is dysfunctional and lurching towards a crisis. In fact heavily burdening the middle class. The private outlays and burden of total health care spending has increased from 20% to 60% of total health care spending from 1978 to 2003, as the the health care system got the same dose of unfetterred capitalism as the rest of the system. The Government's share of total health care spending has dropped sharply. In addition there are design flaws that push expensive care and build in incentives for expensive care at the expense of good medical care. The government recognizes this problem and sees it as athreat to social stability. It has committed to increase spending on healthcare. ...

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The loss of some 4 million jobs is expected by experts in 2009, and Obama economic advisor Christina Romer has presented information at a meeting that shows the current downturn will be more severe than anything we experienced in the last 50 years. At that meeting on December 16, 2008, Obama met with Romer and other economic and policy advisors for 4 hours. It was decided that the target for jobs should be 3 million jobs created in 2009 and 2010. This still means a lot of the 4 million job loss will still occur in 2009, even if the infrastructure jobs estimated at $136 billion by the nation's governors get off to a fast start as they are supposedly ready to go. Money to states and local governments will reduce job losses and loss of services, and money in the form of lower payroll taxes would probably be saved to reduce debt by the public. Money to the poor to support medicaid and health care services and expanding healthcare coverage for those who lose coverage will be safety net reinforcement and support. So finding places to spend where jobs can be created quickly will be a challenge going forward and some of the $1 trillion stimulus will not go directly to job creation but as support. For the December 16 meeting Romer consulted with Martin Feldstein the senior Republican economist who said that " without action the economy will continue to decline rapidly." For a long time Martin Feldstein has been advocating strong action especially to reduce foreclosures and help stabilize housing prices. As the economy has weakened he has revised upwards what needs to be done, and his estimates are close to the lower end of the $800 billion to 1.3 trillion that is being estimated for 2 years. Lawrence Lindsay and other economists are supporting upto $1 trillion stimulus. ...

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The $350 billon in proposed cuts to Medicare and Medicaid in the 2011 deficit reduction talks will do little to reduce the rapid rise in medical costs. Instead it shifts the costs to seniors, state governments and public hospitals. Gail Wilensky, former head of Medicare under the first President Bush and now a senior fellow at Project Hope, says this should not be confused with real reform to Medicare which reduces the rapid increase in costs. It does little in the way of fundamental changes that would reduce the growth in costs. About $53 billion comes from reductions to senior's ability to buy extra Medicare supplemental insurance or Medigap. Another $14-26 billion would have the government reduce payments to hospitals for unpaid debt. The few items to curtail fraud in the use of CT scans or purchase of power wheelchairs would provide savings of $2-3 billion over 10 years. $4 billion comes from lowering Medicaid payments to hospitals treating a high percentage of low income patients, hospitals such as Cook County Hospital in Chicago, San Francisco General Hospital, and Parkland Hospital in Dallas....

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Lobbying by the American pharmaceutical industry and the Obama administration. Emails showing the negotiations between the administration and the pharmaceutical companies.

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A advisor to U.S. president Obama lists the gains in U.S. healthcare made by March 2014, after the passing of the Affordable Care Act or Obama healthcare law. He cites on access to care the reduction of the percentage of uninsured Americans from 18% in the middle of 2013 to 15.9% in the first quarter of 2014, according to a Gallup poll.

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Serious problem of rapid premium increases for middle class people not eligible for subsidies under the Affordable Care Act. Insurance companies have increased premiums rapidly to pay for the cost of treating people with previous conditions and the uninsured, as well as population with poor health conditions.

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A critical part of the Affordable Care Act is the setup of marketplaces or exchanges to let people without insurance buy individual health plans. Some states setup their own exchanges, and some states let the federal government step in and run them. To help the lower middle class and poor the Act provides health subsidies to buy insurance in the exchanges, and 85% of customers in the exchanges qualify for this benefit. The U.S. Supreme Court voted 6-3 in 2015, compared to a tight vote in 2012 on the Affordable Care Act, to maintain the health subsidies. Justice Roberts wrote the majority opinion, saying "Congress passed the Affordable Care Act to improve health insurance markets, not destroy them." Justice Scalia dissented calling it "interpretive jiggery-pokery." Justices Clarence Thomas and Samuel Alito Jr. dissented. Voting in favor were Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, Elena Kagan, Justice Kennedy dissented in the 2000 case. The challengers petition to the courts was based on a reading of phrases in the Affordable Act which had not occurred to the writers of the law. The reading suggests only people enrolled in state setup exchanges are eligible for subsidies. If the Supreme Court ruled in favor of the plaintiffs the 6.4 million Americans who are enrolled in the federal exchanges would lose the subsidies provided under the law and lose health insurance. And the economic foundations of the Affordable Act would be undermined with insurance companies required to provide insurance to all regardless of pre-existing conditions and subsidies removed, leaving the companies with sicker pool of customers resulting in destabilizing the exchanges and higher premiums. The court ruled in favor of an interpretation that is compatible with the whole law and the intentions of the statute to help the middle class and the poor buy health insurance. The chaos in the insurance markets that would result in going with the plaintiffs because of a careless writing of a phrase, was uppermost in the majority's mind. Chief Justice Roberts emphasized this, saying- "The statutory scheme compels us to reject petitioners' interpretation, because it would destabilize the individual insurance market in any state with a federal exchange and likely create the very 'death spirals' that Congress designed the act to avoid." This case originated with 4 plaintiffs from Virginia who challenged the IRS regulation that said subsidies were allowed regardless of whether the exchanges were run by the state or the federal government, arguing that this was at odds with the particular phrase in the law that was ambiguous about federal exchanges eligibility for health subsidies. Judge Roger Gregory of the Fourth Circuit Court of Appeals in Richmond, Virgina, ruled that the phrase was indeed ambiguous, but the IRS was owed deference in its opinion. Chief Justice Roberts made it clear that this was not a case for the IRS, saying "it is instead our task to determine the correct reading." ...

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A study by AARP of 514 brand name and generic drugs between 2005 and 2009, shows that generic drug prices went down an average of 31% during this period, and brand name drug prices went up by 41%. One of the authors of the report says that it is important to look at individual drug prices and not studies showing total spending on drugs, because this is a significant cost for people paying out-of-pocket, It drives up insurance premiums, and pushes retirees into coverage gaps in Medicare Part D drug program. Analysts indicate pharmaceutical companies are increasing prices on drugs before patent expiration to get as much profit before the patents expire.

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India's National Pharmaceutical Pricing Authority placed pricing controls on frequently used antibiotics including Ciprofloxacin, diabetic drugs including Metformin, and heart medications. It also said it would audit manufacturers to ensure that normal production continues. The pricing authority acts under a 1955 law that requires pricing to be affordable for essential drugs needed by the vast majority of poor people in the country. Some mass consumption drugs are now imported where it is unprofitable to make them in India. In the case of other drugs the volume increases from lower prices increases access to medicines, and the volume makes up for the price cuts. An example cited by the pricing authority is essental antibiotic (especially for children), Augmentin, where the prices dropped by 40% but the volume increases as it became more affordable have more than made up for the price reductions, with overall sales higher than before the price cuts.

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Political activism and grassroots efforts- other than street protests - are increasing in eurozone countries facing high unemployment and austerity cuts. The focus is on cleaning up the political system rife with cronyism, corruption and wasteful spending. Brat and Bjork describe one such effort in the town of Torrelodones, Spain, 18 miles from Madrid. Criminal investigations in many Spanish cities have increased public awareness and participation in local government. European Social Survey based in London, reports political activity of this kind in Spain jumped from 27% in 2008 to 39% in 2010. There is an increasing sense that the political elites of the two main parties, the Partido Popular and the Socialists have failed to bring clean government and transparency to Spain. As a result progressives are joining conservatives in an effort to clean up years of wasteful spending, cronyism and corruption in government. The Union for Progress and Democracy, representing an alliance of such groups would win 13% of the vote in a national election, and the ruling conservative Partido Popular would lose half of its support and get only 22.5%, according to independent Spanish polling firm Metroscopia. The new push for transparency is one of the welcome changes at a time of austerity cuts and 27% unemployment in Spain. Many of the perks of public officials such as chaeuffer driven cars and police escorts, contracts for favored few at higher prices, are out in many cities, and accounts made public for scrutiny and change. Transparency International's transparency index shows 33 out of 110 of Spain's biggest cities scoring top grades on the 2012 index, jumping from only one. Following the example of the regional government in Navarra, the central government is drafting the first open-records law. Castilla-La Mancha, the area around Toledo, run by a clean government advocate Maria Dolores de Cospedal from the Partido Popular has taken aggressive steps to clean up the local government and wasteful spending- see the link to Castilla La Mancha. Her long term approach is to clean up government spending and accounts with the idea of preserving spending where it is most needed, in education, healthcare and vital services hit by cuts, an approach being taken in other Spanish cities. ...