[bduerst]

Incumbents have a monopoly because of safety regulatory controls inherent to the market, not "indirection".

Companies that have the capital to invest into 15 years of clinical trials are going to dominate the market.

Rather the lowering safety regulations for pharmaceuticals, a better solution would be to offer funding, grants, loans or to use capital redistribution mechanisms for helping new market entrants in drug research. This lowers the monopolistic barrier to entry while still retaining the necessary level of quality.

[snagglegaggle]

You can recognize that at some point safety regulations would cause more harm in their implementation than they would be in their intended effect, right? If so, who is to say that is not already currently the case?

See https://www.forbes.com/sites/timworstall/2017/06/04/milton-f... and the video in it. It lays out how "single payer care" is only a natural conclusion if you start with a hugely distorted market.

[bduerst]

My point is not that safety needs to be increased to the maximum. It's assumed the current level of safety takes into consideration existing market signals and the economic trade-off of diminishing returns.

My point is that trading safety simply to solve the barrier to entry problem has a dangerous cost/benefit trade-off, especially when it is not the only way to solve the problem.

[snagglegaggle]

>It's assumed the current level of safety takes into consideration existing market signals and the economic trade-off of diminishing returns.

Considering the current pharma market and everyone's assumption it's distorted I think this needs a pretty airtight defense. Everyone is aware of the tradeoff, but countries like India, where drugs are easier to bring to market and more drugs are available OTC, has great healthcare outcomes for its poorest citizens.

[bduerst]

Market availability isn't the same as OTC distribution though.

The expensive clinical regulations that creates barriers to entry for the market and leads to monopolistic incumbents is not the same to being able to buy the good with or without an prescription.

The latter is tied more to remuneration from insurance companies - i.e. private insurance companies that are incentivized to not pay for prescriptions are more willing to only pay when care providers specifically order it.

[snagglegaggle]

Yes, yes, I know. But so many drugs requiring a prescription in the US is a market distortion similar to the high cost of bringing drugs to market. It reduces the availability of life saving medicines to people while attempting to minimize other dangers that are likely overstated. Frankly it seems like something doctors lobbied for to ensure a steady stream of office visits.

[bduerst]

Doubtful. Doctors are incentivized to not have to write prescriptions, because it legally shifts the liability (and malpractice claims) to them.

[sokoloff]

> India has great healthcare outcomes for its poorest citizens.

Does it? Why does the life expectancy at birth (68-69) trail the US (76-81) by so much then? That's an average across the country; presumably the poor in India have even lower than that average.

[snagglegaggle]

The country is massive and much of it is in poverty, this is looking at improvements relative to other similarly disadvantaged areas.

[perl4ever]

At no point would all additional safety regulations, on the margin, uniformly make things worse. So I don't think the binary question of whether this "is not already current the case" makes sense.