The problem with price fixing NHS drugs

Markets have a funny way of getting around behind the rational planner and biting him in the buttocks. And so it is with price controls on NHS drugs. Sure, it sounds great that we use the power and majesty of the law to keep taxpayers’ money out of the hands of those rapacious Big Pharma companies. But the problem is that this is leading to there being no drugs for people to take:

Patients are being harmed and put at risk because of national shortages of some prescription drugs, doctors have warned.

Medicines currently subject to shortages include Tamoxifen for breast cancer, Naproxen for arthritis and Amiloride, used to treat heart failure and high blood pressure.

A poll of GPs has revealed that more than nine in 10 family doctors have been forced to write prescriptions for “second choice” medicines because the drug they wished to provide was out of stock.

In recent years, scores of medicines, including those for breast cancer, arthritis and schizophrenia have run low because drugs intended for British use are being diverted abroad for profit, while others have been subject to production problems.

The survey of more than 600 family doctors by GP magazine found that one in three said their patients had suffered harm as a result, or faced a longer recovery.

The background to this is that there is an absolute freedom of trade across the EU. This is what the Single Market means. And we also have the NHS insisting that it will only pay certain prices for certain drugs. Fine, volume discounts aren’t a problem and, if we’re to be honest about it, nor is the use of countervailing economic power as a near monopsonist argues with the monopolies that pharma companies have over their still in patent drugs. But we do get to the standard problem with price fixing. Set the price too low and you’ll get a shortage of whatever it is you’ve set the price of. Too high and you get a glut, fix prices at what the market price would be anyway and what’s the point?

Here what’s happening is that the freedom of trade is bringing that iron law of one price into play. Different EU countries fix (or don’t even try to fix) drug prices at different levels. So there are arbitrage opportunities to buy pharmaceuticals in one country, at that country’s controlled price, and move them to another EU country where the price is higher. It is this that is causing the shortages here in the UK.

Of course, people are trying to deal with this:

Because of the shortages, the Department of Health has introduced a system of rationing, which is supposed to mean the right number of drugs are held in stock. However, the system often means particular parts of the country run low on stocks, because they are not allowed to have more than their quota of medicines.

Facepalm. If the problem is initially caused by having fixed prices too low then the solution is to raise prices, isn’t it? Remove the arbitrage opportunity and there won’t be any arbitrage.

Climate change is three times worse than we thought, apparently

A new paper tells us that climate change is actually three times worse than we thought. For there may be tipping points, catastrophic changes, that cannot be worked back from and this shows that the carbon price should actually be three times higher than it is:

Climate policy aims to internalise the social cost of carbon by means of a carbon tax or a system of tradable permits such as the Emissions Trading System set up in the EU. But how do we determine the social cost of carbon? Do we take everything into account that should be taken into account? Most integrated assessment models (Nordhaus 2008, Stern 2007) calculate the net present value of estimated marginal damages to economic production from emitting one extra ton of carbon caused by burning fossil fuel.

However, global warming has many non-marginal effects on both the economy and on the carbon cycle. Climate catastrophes can occur that lead to sudden flooding, hurricanes, desertification, water shortages, etc. Many of such changes may be irreversible. Other catastrophes such as reversal of the Gulf Stream or sudden release of greenhouse gases from the permafrost lead to a sudden and long-lasting change in the system dynamics of the carbon cycle. Such changes in the system dynamics of the economy and/or the carbon cycle are called regime shifts. When such a shift takes place, this is called a tipping point. Scientists predict that at some point, structural changes will occur with effects that are very difficult or even impossible to reverse. The usual marginal cost-benefit analysis of existing integrated assessment models then puts us on the wrong track. The problem is much more serious than we think.

This argument seems, superficially, to have some legs. However, it doesn’t really hold up for their conclusion is:

If the potential tipping point is ignored, our calibration yields, in steady state, a social cost of carbon of $15 per ton of CO2, which is about the same as in well-known integrated assessment models. If the potential tipping point is not ignored, the social cost of carbon increases to $55 or $71 per ton of CO2, depending on whether we take a constant or an increasing marginal hazard rate as a function of the stock of atmospheric carbon. These are big potatoes, we would say. The precautionary returns are 0.6% per year and 0.5% per year, respectively. The need for precaution indeed decreases when emissions are reduced more with a higher tax on carbon.

Splitting the social cost of carbon into the three components provides additional insights. For example, the $71 per ton of CO2 is split into $6 for the marginal damages, $52 for the risk-averting component, and $14 for the raising-the-stakes component. The risk-averting component is by far the largest, and it is clear that ignoring potential tipping points is putting us on the wrong track when discussing climate policy to curb greenhouse gas emissions.

The problem here is that public policy is not based upon a carbon cost of $15. Rather, it’s based on the Stern Review result of $80. Which means that we’re already doing enough to cover the new findings of this paper.

In fact, we’re actually doing too much. The fuel duty escalator has led to us taxing petrol as if the correct carbon price is $160 a tonne CO2-e. The truth is we’re doing too much to avert or mitigate climate change even if (or perhaps especially if) we take all of the scientific consensus about the subject entirely seriously.

Criminalizing consumption: Alcohol tags are a step too far

At 2:30pm, I’ll be going on Sky News to argue against the implementation of alcohol tags the Mayor of London has announced will be piloted in four major London boroughs: Croydon, Lambeth, Southwark and Sutton. For 12 months, courts will be able to instruct “alcohol abstinence and monitoring requirements” on 150 offenders for a determined period of time. Any consumption of alcohol could lead to stricter punishment, including imprisonment.

As custodial sentences go, alcohol tags are highly intrusive; the 24-7 monitoring over one’s consumption undermines their entire sense of autonomy. If such a policy were to be adopted, we must ask when – if ever – this kind of policing should be enforced.

The primary problem with the Mayor’s pilot plan is that is does not distinguish between violent offenders and more minor, drunken offenses. These tags are supposed to be part of an effort to create tougher community sentencing, which one could receive for committing assault, fraud, or playing music too loudly at night; policing one’s lifestyle choices for owning a speaker system seems nothing short of absurd.

There are also more principled problems, including the assumption of a second offense, which arguably undermines the notion of innocent until proven guilty. There is also a question of misplaced priorities; why does the government always jump to scale back the liberties of offenders, rather than addressing the deep, underling problems that lead to the offense in the first place?

Some former offenders have argued that alcohol tags have helped them to overcome their issues with substance abuse that have led them to commit crimes. Such testimonies, however, suggest that alcohol tags could prove useful in a voluntary, op-in system, when the offender has decided to tackle alcohol abuse and can use the tag as part of their support system.

But apart from that voluntary aspect, this new pilot sets a dangerous precedent that the best way to create order in society is for politicians and law makers to monitor and ban consumption and behavior until everyone fits neatly into line. Autonomy is sacred; even those criminals with their iPod docks don’t deserve to lose it.

The solution to climate change killing all the little fishies

News today that climate change is going to kill off all the little fishies off Alaska. The rise in atmospheric CO2 leads to a similar rise in the ocean where it forms carbonic acid and thus reduces the alkalinity of the water making it hard for various species to operate. This ending up with a reduction in fish as the lower parts of the food chain suffer. The part of all of this that we might have difficulty getting our heads around is that there’s a known technique to deal with this problem: it’s just that the UN insists that we don’t use it. Odd that we’re not actually allowed to do something that will mitigate both climate change itself and also alleviate one of the effects of it.

The story about the fishies is here:

Alaska’s fishing industry could soon be threatened by increasing ocean acidity, says an NOAA-led study to be published in the journal Progress in Oceanography. The acidification is due to increasing carbon dioxide release, which is absorbed by the ocean

Molluscs, such as the aforementioned Red King crab may struggle in acidic water, and find it difficult to maintain their shells and skeletons. As well as this, it has previously been shown in studies that Red King crabs die in highly acidic water, and both it and the Tanner crab grow more slowly in acidic water.

Alaska is particularly threatened by ocean acidification for a number of reasons: cold water will absorb more carbon dioxide than warm water, communities in certain parts of Alaska, namely the South-East and the South-West are reliant on fishing, and there are fewer other job opportunities in these areas than other parts of the state.

OK, is there anything we can do to deal with this?

When a chartered fishing boat strewed 100 tonnes of iron sulphate into the ocean off western Canada last July, the goal was to supercharge the marine ecosystem. The iron was meant to fertilize plankton, boost salmon populations and sequester carbon. Whether the ocean responded as hoped is not clear, but the project has touched off an explosion on land, angering scientists, embarrassing a village of indigenous people and enraging opponents of geoengineering.

The iron did fertilise plankton, there was an algal bloom, fish numbers increased and at least some of that carbonic acid was removed from the local waters, all at the same time. There was even some amount of the CO2 being deposited as nascent rock on the ocean floor and thus it being sequestrated for geologic periods of time. All in all it sounds like a most wonderful technology really, doesn’t it?

The project was also on uncertain legal grounds. Ocean fertilization is restricted by a voluntary international moratorium on geo­engineering, as well as a treaty on ocean pollution. Both agreements include exemptions for research, and the treaty calls on national environment agencies to regulate experiments. Officials from Environment Canada say that the agency warned project leaders in May that ocean fertilization would require a permit.

Other than this, probably illegal, experiment the last official one was done 10 years ago. It’s just great that everyone’s working so hard to find even a partial solution to what we’re generally told is the greatest problem of our times, isn’t it?

We’ve spoken to one of those who studied, in detail, that last official experiment and there’s no doubt that it works, would be extremely cheap and is capable of not only increasing fish numbers but also of sequestering some 1 gigatonne a year of CO2 into rock. But the powers that be won’t let anyone actually do it and there are no further officially approved experiments in the pipeline either. It’s almost as if people don’t want solutions to climate change, isn’t it?

Clement Attlee’s Lesson

Biteback Publishing have published a new biography of Clement Atlee.  Authored by Michael Jago, it explores what motivated Atlee and drove him to become one of the most influential of Labour Party leaders.

Atlee had a remarkable record in putting through his programme.  In 6 years he achieved major structural reform of Britain’s economy and society.  He is thus to be admired dispassionately as an effective Prime Minister.  What he also did was to teach us all an important lesson:  Socialism doesn’t work.  While other European nations were renewing themselves after the destruction and exhaustion of a world war, Britain wallowed in nationalization and allowed its industries to stagnate and decay under state ownership and control.  He left a country impoverished, heading down a slope that left it diminished, impoverished and ineffective.  Only in 1979 did Britain begin to shake off his influence, change direction, and once again climb back to prosperity and significance.  Atlee left a legacy that lasted, it is true, but it was a legacy that left his country ruined for decades.

It was an important lesson, though, and one we learned again just 25 years ago when the Communist empire collapsed and left exposed not just the terror that had sustained it, but the squalor it had concealed for so long.  Socialism doesn’t work and never has done because it goes against the grain of human nature and the desire of peoples to make free decisions that can improve their lives and better the lives of others in the process.

We can only hope that people will not only read the new book about Atlee, but that they will also remember the lesson and the years of suffering that it took to learn it.