The Other Drug Crisis

As the GOP-dominated Congress looks for ways to cut social programs and consumer protection for most of us in order to fund the trillion dollar deficit that could be the greatest accelerant to income inequality in American history – the Republican tax reform legislation – moves towards becoming law. The stock market wealthiest-in-the-land drool – represented by share prices that are barely related to actual sales and revenue generation – has sent the NYSE and NASDAQ to new heights simply based on that GOP tax giveaway to corporate America.

When the Affordable Care Act (ACA which is also known as Obamacare) was being positioned for Congressional passage in 2010, the Obama administration had to overcome the rather well-funded opposition from the healthcare industry itself. A rather significant source of political contributions that might run dry if industry wishes were not incorporated into the proposed new bill.

The insurance folks – who faced a reduction in acceptable administration costs – won two big concessions: 1. A mandate that would force everyone who can afford it (with subsidies for those who cannot) to have health insurance and 2. That the government would not open up a Medicare-like alternative that would be competitive with the private sector. The pharmaceutical industry did even better. They got a statutory prohibition against the ability of the healthcare exchanges created under the ACA to use their negotiating power to bargain down the price of prescription drugs; pretty much these exchanges had to accept the full retail price without discount. With these concessions, the members of Congress felt that their contributors were sufficiently covered and voted for the bill.

But the Obama administration knew that like every piece of seminal social legislation in U.S. history, the passage of the ACA was the “foot in the door” wedge that was a necessary first step to getting universal healthcare for all Americans. These concessions got the bill passed, but everyone knew that these were flaws that, sooner or later, would have to be fixed. But instead of fixing what everyone, Obama and the Democrats in Congress included, knew were statutory provisions in need of repair – both from where the ACA itself needed clarity and adjustment as well as to address these inherent concession-flaws – the new Republican majority Congress took an all-or-none approach focused entirely on repealing the entire act. They voted over 60 times for repeal, and even when they secured the presidency, could not generate that repeal.

Instead, through a rather open pledge from the President to sabotage the ACA until he made it fail, the GOP began to attack the law, hoping to cripple it bit-by-bit until they could force a “I told you so” collapse, including a reduction in the ACA contained in the tax reform legislation itself. Even as GOP governors pleaded with Congress and the President not to do that, the machine marched against the ACA – something had to pay for the trillion dollar deficit that was about to occur from cutting taxes for the wealthiest segment of American society. And that something was in significant part a direct increase in costs, or a complete loss of medical insurance coverage, for millions of Americans in the middle or lower rungs of the economy. A reverse Robin Hood. Robbing the ordinary man to fund the rich. To put it mildly, there are problems within problems in our healthcare system.

For example, nothing is/was quite as glaring as the exceptionally high prescription drug prices paid by American consumers, the highest in the developed world often by serious multiples over U.S. prices. Experts, convened to analyze the problem, confirmed what most of us already know:

“The U.S. must take urgent steps to rein in the out-of-control cost of prescription drugs, including aggressive government intervention to negotiate lower prices for American patients, a panel of the National Academies of Sciences, Engineering, and Medicine recommended Thursday [11/30] in a sweeping new report on pharmaceutical pricing.

“The report — titled ‘Making Medicines Affordable: A National Imperative’ — includes a strongly worded indictment of the nation’s prescription drug market, which it warns is failing millions of sick patients.

“And the 201-page report takes aim at several of the pharmaceutical industry’s cherished practices, including direct-to-consumer marketing and efforts by drugmakers to block and delay the introduction of lower-priced generic medicines.

‘”Simply stated, the current system is not sustainable,’ concluded the panel’s chairman, Norman Augustine, former chief executive of Lockheed Martin Corp., one of the world’s largest defense companies… ‘Consumer access to effective and affordable medicines is an imperative for public health, social equity and economic development, and … this imperative is not being adequately served by the biopharmaceutical enterprise as it functions today.’…

“[Noting the value of recent new drugs, the report also] noted: ‘There is little value in new drugs that patients cannot afford.’… While the share of Americans reporting they are delaying care because of cost has declined since passage of the 2010 Affordable Care Act, nearly 1 in 5 reported that they did not fill a prescription because of cost in a recent national survey by the Commonwealth Fund.

“Among the steps recommended by the panel to bring down costs are:

·         More aggressive action by federal regulators to curtail drugmakers’ practices of delaying the availability of generic and biosimilar drugs.

·         Use of the federal government’s purchasing power to directly negotiate lower drug prices for patients on government programs such as Medicare.

·         More required public reporting by drugmakers, insurers and others of how medicines are priced.

·         New efforts to determine the “value” of drugs by assessing how well they work relative to how much they cost.

·         Less direct-to-consumer advertising by drugmakers.

·         New limits on how much patients must pay out of pocket for drugs.

“The report comes amid growing public anxiety about drug prices, an issue that has topped Americans’ healthcare concerns in many recent polls.

“President Trump has repeatedly promised action, and this week, Trump’s nominee to take over the Department of Health and Human Services, Alex Azar, told a Senate panel that he would make drug prices a top priority… To date, however, the Trump administration has not taken any meaningful steps to address the affordability crisis.” Los Angeles Times, December 1^st. Can the Republican Congress, hell-bent on passing “tax reform” without much debate or understanding of the obvious consequences, find a way to help “most of us” with necessary cost reforms when their real priority is finding places to cut social benefits to bolster those corporate tax cuts?

I’m Peter Dekom, and this rush to self-destruction is a paean to government by minority by means of gerrymandering and voter limitations.