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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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The Oxford vaccine is showing promising results and is expected to be authorized for use by December 2020. The vaccine being developed in partnership with Astra Zeneca PLC for marketing and Serum Institute of India for mass manufacturing is shown to be proven 90% effective in preventing infections in clinical trials. The partners say there were no serous safety events and the vaccine has proven 62% to 90% effective with an average of 70%.  This vaccine is significant because it is being developed with this partnership not seeking profits from this venture, providing it at cost and keeping the price to about $4 a dose compared to competitors Moderna and Pfizer whose vaccine is expected to be at $24 a dose. The Oxford vaccine also uses existing technology for vaccines and manufacturing is being done in India with the world's top manufacturer of vaccines. By using existing technology unlike the Pfizer and Moderna technology Oxford has taken an approach that could prove to be unique by minimizing side effects for vaccines that are being developed with such speed. By not requiring refrigeration at very low temperatures the vaccine makes itself ready for immediate and widespread uses all over the world. By use in its home country India with its large population Oxford vaccine can gain even wider acceptance because of India's long experience in pharmaceutical technology and manufacturing. Of particular interest is the study of 23,000 participants showing that the 90% effective dosage is one that only requires half a dose for the first shot. This say scientists is because the vaccine first dose prepares the body for a more powerful second dose and creates the maximum effect. This means the vaccine can be used for more doses than 2 full doses. It can be stored in a fridge making it easy to use in many countries. The full study will have 60,000 participants spread across U.S. Britain, Brazil South Africa and India. ...

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While communities with high unemployment and depressed areas like Rocky Mount in N. Carolina, with 14% unemployment -and many customers skipping prescriptions because they can't afford them- are the worst off, the national picture shows many similiarities. Even with Medicare drug benefit, lowcost generics, and Walmart type low cost drugs, many Americans cannot afford prescription medications for life threatening illnesses. Nationally a third of respondents say they are not complying with prescriptions as they cannot afford them, compared to a fourth three years ago.

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John Cochrane, professor at the Booth School of Business, University of Chicago points to the simple truths about U.S. healthcare- out of control pricing because of the pathologies created by previous laws and regulations. He points out that costs are high in healthcare because regulations keep them high. Supply of new doctors is controlled because Congress and the AMA made it that way with a cap on residency programs and AMA opposing the expansion of medical schools. In a system of open competition new hospitals and health care businesses would challenge old ones which is not happening in a regulated market with regulations working to limit competition for the firms already in the business and with the influence to limit competition. Insurance costs for major expenses in an open and deregulated competitive market without the regulations would be so much lower than todays costs that its likely we would not even need a mandate such as the one the Obama healthcare law imposes.

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Elizabeth Rosenthal looks at Obamacare's contribution to cost containment in 2013-2014. Rosenthal says its is a kind of delicate maneuvring at the edges, because serious work needs to be done. The fee-for-service and many of the drivers for increases in medical costs, the old system of pricing, are still in place. In 20 years at the current rate and after Obamacare health care will still take 25% of the U.S. budget if nothing is done. Healthcare costs are about half that of the U.S. in some of the advanced European countries. She calls Obamacare a trickle down theory of cost containment becaue it leaves most of the drivers for cost increase in place and works at the margins. Princeton economist Uwe Reinhardt calls it an ugly patch on a somewhat ugly system. Rosenthal cites the armies of consultants anticipating every move to reduce prices, and working on "strategic billing'' to increase revenues for hospitals and doctors. For those who say the prices are now up more slowly than in the past, Michael Chernew of the Harvard Medical School, has this to say- its like a diet, reminding us that that we haven't even lost weight, just gaining weight slower than before. ...

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A health care practitioner says the real problem is the high cost of medical care in the U.S. when compared to other countries. She points out that the Obama bill in 2008 did not take effective steps to bring down the cost of health care before enacting legislation to cover the uninsured, leading to higher premiums for the middle class. The link between healthcare and profits is seen as the main problem. 

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The failure of the 117th Congress to pass key parts of president Biden's agenda for hard hit families and workers in America is now taking place. The 50-50 standoff in the US Senate and failure of two Democrat senators Sinema of Arizona, Manchin of West Virgina to support Biden's Families and Workers Plan leaves key parts of the safety net being left out. This leaves out the education, and paid leave part of the agenda and provisions for utilities to accelerate shift away from coal out of the bill. It fails to implement a new national agenda for upward mobility, child care and paid leave to help stressed out mothers and families. The failure to include even a modest community college 2 years of support at a time when men's college enrollment is dropping to disastrous levels for America's economic competitiveness is a failure of the 117th Congress to grasp the needs of families and workers in America today. Only a new Congress in 2022 can take up the needed action for families and workers in education, health care, child care and help for families. The passage of the infrastructure bill and the current version of the social spending bill can only be seen as a first step in the right direction, after three decades of different administrations neglecting infrastructure, education, healthcare, childcare, elderly care, upward mobility, and climate change. On the plus side as the first step to restore dignity and health of families and workers in America it includes- $150 billion for rental assistance, home buying help, public housing repairs, and building 1 million affordable housing units. $150 billion for federal programs for home health care and community care for older Americans and people with disabilities $165 billion to reduce premiums for people under Affordable Health Care Act, cover additional 4 million through Medicaid, adding hearing coverage but not dental or vision to Medicare. $200 billion for child care tax credit to parents. $400 billion to reduce health care costs and give universal pre-kindergarden for 3-4 year old children. $40 billion for worker training $555 billion for fighting climate change including through tax incentives for sources of energy that are low emission and low carbon. It will be paid for by additional taxes on incomes of very high income earners in annual $1 million plus range, and by having a corporate minimum tax of 15% for large corporations, including on profits overseas, that previously did not pay this tax. A wealth tax on unrealized capital gains of billionaires or other wealth of the richest Americans is left for a future Congress to consider for financing the key parts of climate change provisions, education and health care that were left out. The education and healthcare provisions need to be expanded to restore America's historic mission of upward mobility for all. A provision for Medicare to comprehensively negotiate prices with pharmaceutical companies that would be taken for granted in any advanced country as in Europe, is also left for a future Congress that understands and responds to the dire needs of families and workers in America for affordable healthcare medicine neglected by administration after administration for the last three decades.   ...

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An indepth look at Mexico, its assets, its huge potential and what is holding Mexico back. It ranks much higher than Brazil in many respects- higher investment as a fraction of its GDP, technical education, an easier place to do business, less regulation, better management talent, more industrialized. In 2010 Mexico had $400 billion of business with the U.S. With rising Chinese wages Mexico is an attractive place for foreign investment, with a hardworking and educated workforce. Mexico suffered badly during the 2008 recession in the U.S. It is trying to reduce its dependence on exports to the U.S in key areas such as the automotive industry. Exports to the U.S. by the automotive industry are now 65% of the total, and the auto industry association in Mexico is working to bring this figure to 50% by exporting to Latin America and Europe. Economic growth was 5.4% in 2010, and expected to be 4-5% in 2011. Drug violence may have reduced the growth by one percentage point according to some estimates. The think tank, Mexican Institute for Competitiveness, estimates that economic growth would be 2.5% percentage points higher if labor market and competition laws are changed, and the oil industry is opened up to foreign investment as happened in Brazil. A study by OECD and the Federal Competition Commission (CFC) of Mexico has shown that 31% of Mexican household spending goes to products operating in high price monopolistic or oligopolistic markets. The bottom ten percent spend even higher proportion of incomes, around 38%, for products supplied in such markets. This includes pharmaceuticals, airline travel, banking, and electricity. Taking on these cartels is a difficult task. The CFC is beginning to take the first steps in this direction, in what will be a long road to fair prices for Mexican consumers. Banking was opened to Wal-Mart. The collapse of Mexicana was an opportunity to auction landing slots to other airlines. An auction system has been developed by CFC for drugs. A new competition law sets penalties for collusion in pricing, with upto 10 years in jail. And Carlos Slim's telephone monopoly was fined $1 billion for its telecom monopoly practices. In 2009 the Calderon government shut down Luz y Fuerza, a state electricity company costing the governmment $3 billion in subsidies for an highly inefficient operation. ...

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Abbott Labs acquisition of Piramal Healthcare for $3.7 billion gives it 7% of the Indian market. Acccording to IMS Health emerging markets drug sales for 17 countries went up from $42 billion in 2000 to 126 billion in 2009. Anlysts expect 70% of global growth to come from these areas in next 5 years.

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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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On April 20, 1996 the story of the merger of Ciba Geigy with Sandoz was the first story in notes made that day for Lyrarc from the WSJ Europe. This was during a trip to Europe. Ciba Geigy and Sandoz had become part of the home medical kits in Asia and Latin America by the 1960's, and their story had to be told to millions of people in these countries bringing Basel, Switzerland, to the world. Sandoz was founded in Basel in 1886 as a chemical company in Basel, Switzerland, and entered pharmaceuticals business in 1900. Ciba Geigy was formed in the 1850's as a chemical company for dyeing silk fabrics and entered the pharmaceuticals business in 1930's. The two companies were merged in December 1996 to form Novartis. Today Sandoz is the generics manufacturing part of Novartis. As prices of generics have declined Novartis CEO Narasimhan is planning to sell or spinoff Sandoz. With this move Novartis will focus solely on innovative drugs, says this report in WSJ. CEO's have also shifted fin the 25 years since the merger of Ciba Geigy and Sandoz from one with family connections to one with a professional background from India.   ...

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Indian finance minister Sitharaman announces a new stimulus package "Atman Nirbhar Bharat." This includes an effort to incentivize creation of employment opportunities for people making less than Rs. 15,000 a month ($215 a month), called "Atman Nirbhar Rozghar Yojana, for a period of 2 years. Sitharaman cited stock market rebound and foreign reserves reaching $560 billion to show that along with the government efforts and planned infrastructure the economy would make a robust recovery. Because of India's large informal economy help to street vendors and other small retail is critical in the Indian economy. The finance minister cited the "One Nation, One Ration Card" which allows street vendors and other retail merchants to access foodgrains from FPS of choice in 28 states and union territories in India. This is part of the effort to build demand and upward mobility in the economy. The names given for these efforts or yojanas are unique- PM SVANidhi stands for PM's Street Vendors Atmannirbhar Nidhi. Atmannirbhar is the overall plan for self reliance in the economy and the prime minister Modi has pushed for buying Made in India, to promote jobs and technology + capital accumulation in Indian manufacturing. India took a blow from the coronavirus with close to 9 million infected by the virus and lockdown in March. By September 20 the daily cases reached 100,000, and by November 10 the daily cases have dropped to 44,000. Social distancing and mask wearing are widely accepted in India. India has other advantages in the large pharmaceutical industry and access to drugs at government regulated and low prices as part of the planned effort after independence in 1947. Other aspects of Indian life are cultural preference for vegetables and fruits in the diet, and spices, herbs in cooking, yoga practice, which are anti-inflammatory and promote healthy living.  With the largest population in the world the region in the Indian ocean comprising the countries of India, Bangladesh, Pakistan, Burma and Indonesia, former parts of the British and Dutch empires, is a region where the coronavirus posed a great threat to human life. An early carefully orchestrated lockdown by prime minister Modi  helped with the message in March that India faced a singular choice - between going back 21 years in development or controlling the coronavirus in 21 crucial days. The setting up of the direct transfer of money to bank accounts  of farmers, urban street vendors and lower income people in rural areas by giving everyone a bank account under a government plan early in the first term of the current administration enabled it to send aid directly when coronavirus hit the country. Other schemes included cooking gas for women in rural areas who depended on firewood for cooking. These schemes and sanitation infrastructure setup under the Clean India campaign, helped India build an element of resilience when coronavirus hit.  The government plan to remove interstate barriers to commerce and integrate tax system collection at the federal level, bringing parts of the informal economy into the formal economy, have increased revenues that now finance an infrastructure plan that hopes to match the one in China over the next decade.   ...