MANAGED CARE December 2000. ©2000 MediMedia USA
In health care, as in our whole society, many interest groups battle for position. These groups — patients, doctors, hospitals, health plans, long-term care facilities, drug and device manufacturers, and all the others — mostly seem to have reasonable arguments when they seek business and try to influence legislation and regulation in Washington and the states.
With the prescription drug reimportation act, which may eventually prove to be comparatively small potatoes on the vast health care buffet, we saw respected players promote their positions and, as Managing Editor Mike Dalzell notes in his story , we should look for post-legislation developments in the rulemaking phase. There could even be an attempt to use state legislation or regulation to limit the effectiveness of the federal act.
It's part of the American way: Keep fighting for advantage. As I write this, a soon-to-be-textbook example of this is underway in Florida, as this incredible presidential election grinds on.
I feel sorry for the elderly who depend on Social Security and Medicare, and the many uninsured younger people. Per-capita costs for drugs have gone up dramatically, and many people don't have drug coverage. In the midst of prosperity, we've changed the rules for these folks. What's right is the great success of the pharmaceutical industry in bringing to market drugs that truly prolong life and reduce the need for surgeries and hospitalizations. What's wrong is that we've been quietly cost-shifting: relying on drugs to improve health and control other costs in the system, without addressing the underlying insurance structure that places a growing burden of drug costs on those with the least resources.
Drug reimportation is a curious and limp attempt to deal with the greater issue. It's not clear that reimportation will actually have much effect when it happens, but it is definitely a politically safe response to rising drug costs. It's an important matter of public policy, not just a market issue.