Can biotechs survive if the US goes to single-payer?

Of course they will.

The more interesting question is whether they should. Or at least, whether it would be a loss to society if many did not.

The assumption implied in this question is that high profits from US sales are needed to finance R&D to bring innovative, life-saving medicines to the rest of the world. But are biotechs indeed creating products that save and improve lives? Well, yes, but perhaps not nearly as much as you’ve been lead to believe. Many biotechs, perhaps most, could go out of business and no one would care.

Oncology is a major focus of biotech innovation – markets are large, clinical need is high, and stellar profits can be made. It’s fair to say that a gold rush mentality rules biotechs, all of whom hope to find the oncology mother lode:

From The costly war on cancer

But more ≠ better. The median survival benefit of the new, innovative cancer drugs is 2.7 months, and is not trending upward:

From Cancer Drug Benefits Overhyped

The same cannot be said of costs, which are rising so fast that a log scale is needed to track them

From Price & Value of Cancer Drug

One of the arguments against universal health care in the US is that it will lead to cost controls. Medicare and Medicaid are currently required by law to pay for all FDA-approved drugs and are forbidden to negotiate prices.

In contrast, the UK health system is not only universal but socialized – the government runs the hospitals and employs healthcare professionals. It has the National Institute of Health Care Excellence (NICE), which evaluates the cost-effectiveness of treatments and recommends whether they should be paid for by the government. Google “cancer drugs rejected by NICE” and you will find no shortage of stories about costly cancer drugs that are available in the US but not the UK. How’s that working out for them, as compared to the US?

Data from Health status – Life expectancy at 65 – OECD Data

Not so bad, apparently. Cancer is an old peoples disease, and the second-leading killer in both countries. If access to biotech cancer drugs was a problem, surely it would affect life expectancy for 65-year olds. Instead we see UK men catch then exceed the US in this metric (same story for women).

The FDA sets a low bar for clearance of oncology drugs – they merely need to have a plausible chance at providing a benefit. The agency tends to err on the side of approval. That’s a political and a value judgement, and it is defensible.

But it becomes toxic when coupled to Medicare’s inability to negotiate costs. Liberal approval added to no cost control amounts to a legally-mandated transfer of funds from taxpayers – a requirement to pay good money and receive no benefit. Robbery is one term for this arrangement, although I believe economists prefer “rent-seeking”.

Deprived of the ability to seek rents from US taxpayers, many biotechs would indeed go out of business. The ones that create real value would continue to succeed. I see no problem with that outcome.

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