But even should single-payer somewhat ameliorate the economic stranglehold of Big Pharma, it doesn 't do much to alter two other pressing issues: First is the philosophy of drug design, which, in fact, reflects essential problems in how humanity interacts with Nature. Second, is the relative absence of an independently functioning physician class, behaving like the clinical scientists for which---supposedly---their medical education prepares them.
"Like finding a particular snowflake, " goes a radio commercial by one of the major pharmaceutical companies, touting the creativity of its researchers in discovering one new antibiotic after another. For just after they 've discovered one, they remind us, those clever bacteria set right about genetically mutating to develop resistance. What they don 't tell you---don 't dare make you more-cognizant of, particularly if you 're a religious fundamentalist who detests micro-evolutionary theory---is that the antibiotic immediately begins to select for resistant bacteria almost as a side-effect of its very discovery.
"But the war never ends, " as the commercial tells it.
Paradoxically, the problem is that very solution---seeing it as a war, wherein the bacteria 's metabolism must be clubbed to death like a baby seal 's. The whole concept of discovering chemical after chemical to which bacteria develop resistance should tell us that Nature is much more clever at adapting chemistry than the biochemists who toil for their daily bread in the laboratories of Big Pharma; that, in fact, it 's the war ethos that comprises the problem. A much more propitious avenue, for example, might be to place more emphasis on developing drugs that might bolster the efficacy of one 's anti-bacterial immune system responses. But of course, we all know the problem there---much, much less repeat business. Lower profits.
Back to single-payer: The issue seems clear. As long as our health-care system is greed driven, nothing will really change. Preceding or in simultaneity with single-payer must come a philosophical change in the way we view what being healthy means. But that 's an even longer story, of which at least one other plot line involves the role of the family physician, the consumer interface with the health-care system. Having both sampled medical school and gone on for a doctorate in molecular biology, I can tell you that the first 18 24 months of medical training does little to build critical-thinking problem-solvers. Suddenly thereafter (or concomitantly, in better physician-training programs), the student-physician is confronted with "solving" clinical case studies, usually in a group led by a physician teacher-mentor. We see the model on those iconic TV series where young med-student lemmings scurry about through a hospital, poking, prodding, and preparing for professional life as Dr. Kildare. The problem is, that as many of us have experienced, much of that attitude disappears in the real world of practice-as-business, in favor of family-practice MDs who function as minions of Big Pharma.
How many of us really believe that rather than simply absorbing the raps and the wrappings of the endless parade of drug reps, that our family practitioners are burning the midnight oil studying the clinical literature, searching for glitches in the data that might, for example, identify Vioxx as having a high probability of serious side-effects---even assuming that the drug companies would actually publish the correct clinical data. Sorry, John Q. Patient, that 's, for the most part, just not happening. Although they make a better living than most of the rest of us, life for your family practitioner is just too short and just too crowded. The system 's not set up to work that way.
Parenthetically, an even better example than Vioxx is the Ortho Evra patch, where, apparently, the actual clinical data was available: a 60% higher steady-state estrogen level than for the pill. In light of estrogen 's known side-effects, this fact, alone should have triggered a high-percentage of MDs to get mighty suspicious about possible side-effects like heart attack and stroke. In a system where those sorts of suspicions had to mostly await the death of otherwise healthy women in their twenties, something about the basic mode of primary-practitioner functioning is very very wrong.
Which takes us back to the underlying issue --as long as our health-care system is greed driven, nothing will really change. Simply jumping feet-first into single-payer won 't solve all that much, without a radical change in the leverage exerted by Big Pharma on both the psyche of the American consumer and that of his/her physician. Until Americans see health as more than pills and internet-MDs, and until the federal government develops the cojones to heavily regulate Big Pharma, single-payer will be just another bandaid on an already heavily taped-up system.