Health care, it seems, is a never-ending issue in American domestic life. Democrats and Republicans disagree on its importance, on what – if anything – to do about it and about how government should respond, or even if it should.
The argument played out most vocally and unhelpfully in the debate over the Affordable Care Act, aka Obamacare. It may be about to start again as a nonpartisan federal advisory panel calls for Congress to act on the problem of the soaring costs of prescription drugs. With Congress firmly in Republican hands, the subject might not arise on its own, but the Obama administration agrees with the panel’s recommendations and, more to the point of national debate, it could easily become a topic among the 2016 presidential candidates.
The Medicare Payment Advisory Commission wants Congress to force private insurers to rein in the rising costs of prescriptions by cutting some Medicare payments to insurance companies while offering protection to older Americans from higher out-of-pocket expenses.
The idea is to create strong incentives for insurance companies to manage the use of prescription medicines by Medicare beneficiaries and, at least as important, to negotiate larger price discounts with pharmaceutical manufacturers.
It’s a plausible approach to a real problem. Consider the case of Barbara N. DalPonte from a suburb of Salem, Ore. As reported in the New York Times, the 67-year-old takes six drugs, including one for chronic lung problems and another for excess stomach acid. She was in a Humana plan last year, but when she learned that her out-of-pocket costs would reach $7,400 this year, she switched to another plan that limited her costs to a still daunting $3,400.
“The costs are distressing,” she said, “but the drugs are effective, they work for me, and I don’t know what I would do if I did not have coverage for them.”
It’s an unsustainable trend, and the choices are to do something about it, creating the possibility of unintended consequences, or to do nothing and consign millions of Americans to misery or poverty or, in many cases, both.
The choice seems obvious, but even then, it seems doubtful that Congress will act on this. When the Medicare prescription law – called Medicare Part D – was negotiated in 2003 by the administration of President George W. Bush, it prohibited the government from using its bulk purchasing potential to negotiate lower prices with drugmakers.
It was a ruinously bad decision, contrary to any business approach. It drove up public and private costs for no reason but to further enrich the pharmaceutical companies at the expense of taxpayers. And the Congress then was more rational than the one seated today.
While this is the Congress we have, and while it is interested more in opposing anything President Obama favors than in serving the interests of Americans, the issue has been raised and should not be evaded. Indeed, an election year is an appropriate time to raise it, so that Americans know what their legislative candidates think about this crucial matter.
But it doesn’t have to be an us-or-them confrontation. As in most negotiations, it would not be inappropriate for all sides to give more than they want and get less than they’d like. The drug companies make a lot of money, but their products aren’t candy bars. They are, in many cases, lifesaving products whose availability to Americans is a legitimate public issue.
The question will be whether Congress understands that.