Spikol Asks, I Attempt To Reply

Liz Spikol was far too kind to me the other day, thinking aloud that I might have something intelligent to say about a move afoot in Congress to create a process--ah, there's a Democratic word--whereby Big Pharma would have to negotiate lower costs for its products with the MediCare system. Since the proposal is still in the hammering-out stage, there aren't many specifics for me to nitpick (for another day!). But it does strike me that given the complexities of how MediCare now does business, it will be difficult for Congress to create a mechanism with enough leverage to carve out the kind of discounts enjoyed by the VA system (about 25 percent off list wholesale prices).

What I will say is that I don't trust the politics of such affairs. Everyone knows we need a global solution to the cost of prescription drugs in this country, especially given that these same drugs are often vastly cheaper 100 miles north of me in British Columbia. We need massive reform of how health care is paid for in this country because our present system of private payers and all these odd government programs has created a kluge of a marketplace that is deeply inefficient, fails to provide its products and services in an equitable manner, blocks access to all sorts of people, and is generally a cluster-fuck. This has, of course, worked much to Big Pharma's advantage--divide and conquer, baby--and has made it the most profitable industry in America. Big Pharma will fight like tigers anything Congress proposes and get things their way in some fashion. I have watched enough state-level formulary deals go down over the years to know that pattern. The Pharma companies are very, very smart business people.

BTW, if anyone thinks these folks will let too much cost-cutting and profit-squeezing hit the psych meds realm, then they need to keep in mind that anti-depressants and antipsychotics are the second and fourth-largest classes of patented medications by revenue in this country. Perhaps fighting like tigers was put it too gently.

But, like I said, we do need a larger, grander solution to the messy healthcare market in this country. I could care less whether that comes from a governmental or free market approach. I just know that it needs to happen.

In the meantime, I think that perhaps one approach would be to force Big Pharma to offer the same prices to MediCare that it negotiates with the VA. That would be pretty damn simple to put into law.

How's that Liz?