Copyright 2000 P.G. Publishing Co.
Pittsburgh
Post-Gazette
January 17, 2000, Monday, SOONER EDITION
SECTION: EDITORIAL, Pg. A-15
LENGTH: 837 words
HEADLINE:
THE WRONG MEDICINE;
GORE DOES CONSUMERS NO FAVORS WITH HIS CRUDE
PRESCRIPTION
BYLINE: GEORGE F. WILL
DATELINE: WASHINGTON
BODY:
One reason - perhaps a sufficient reason; certainly a matter of life
and death - for hoping Bill Bradley defeats Al Gore is an accusation Gore makes
about Bradley. Gore says that when he, Sen. Gore, "was fighting for the
consumers," Sen. Bradley aided the pharmaceutical industry, for example by
favoring extensions for some pharmaceutical companies'
patents.
Gore deplores this because
patents, which give innovating companies a period without
competition from generic versions of drugs they develop,
provide temporary protection from downward pressure on drug
prices. But it is demagogic, myopic and false for Gore to say that consumers'
interests are served by whatever reduces consumers' drug
expenditures. Besides, limiting drug expenditures would
increase the nation's overall medical expenses.
The surest way to
restrain the growth of spending on drugs is to restrain the
growth of medicine's pharmacological options. A certain way of doing that is by
squeezing drug companies' profits, which must fund the huge
costs of research. A certain way to squeeze profits is with price controls, for
which Gore is paving the way with his crude consumerism.
There he goes
again. Gore supported Hillary Clinton's health care plan to limit increases in
medical expenditures by shrinking and dumbing down medicine. She favored cutting
the number of doctors: fewer doctors - "cost centers," she thought of them -
would mean fewer doctor bills. And she favored cutting the number of
specialists: With their sophisticated diagnostic and therapeutic techniques,
specialists are expensive.
Medicare is heading for insolvency, and for
enlargement, as political pressure grows for prescription drug
coverage. About 13 million American seniors - one in three - have no such
coverage. These are low-income people - but not the poorest, who have Medicaid.
Total drug expenditures by the elderly (not
drug prices) are increasing 15 percent a year.
However,
an even faster rate of increase might mean a slower growth of health care
spending overall. This is because drugs increasingly can
prevent or improve treatment of diseases, sometimes obviating the need for
surgery or hospitalization. And the velocity of drug
development is about to accelerate dramatically.
Probably not until
around 1910 did the average visit to a doctor do more good than harm. Since the
middle of the 20th century, pharmacology antibiotics, the polio vaccine, etc. -
has made Americans think of themselves as the first beneficiaries of truly
modern medicine. Actually, we are at the end of the era of pre-modern medicine.
As drugs developed by the intensely competitive
pharmaceutical industry become more capable, prices may decline, as has been the
case in the computer industry. Even so, aggregate drug
expenditures may rise. Indeed, we should hope they do.
This is so
because biology and genetics - especially the fast-unfolding Human Genome
Project - are going to revolutionize drug development.
Understanding the biological and genetic mechanisms of, say, Alzheimer's (which
costs upward of $ 90 billion a year for doctors, drugs and
care) or breast cancer will lead to drug treatments that may be
expensive but also cheaper than today's limited responses to those afflictions.
It is a fatal conceit for government to think it can know how much
Americans will be willing to spend on drugs after 10 more years
of exponential growth in pharmacological prowess. Willing? They will be eager:
Wait until baby boomers meet arthritis. And infectious diseases can mutate in
response to drugs, so the creative dynamic cannot end.
Many Western nations' pharmaceutical policies are akin to their defense
policies - they are hitching a ride on American enterprise. Nevertheless, when
pharmaceutical costs are measured in terms of "purchasing power parity" in
various countries, Americans spend less per capita on pharmaceuticals than do
the French or Germans and just slightly more than Canadians.
When
government responds, as surely it will and arguably should, to the desire for
Medicare coverage of prescription drugs, it will be the
dominant purchaser of drugs. It will want to use its
monopsonistic power (the power of a single dominant buyer) to pressure
pharmaceutical companies into price controls. Gore already seems ready to
sacrifice long-term health benefits for the short-term political benefit of
government drug pricing.
Bradley's mild senatorial
support for the pharmaceutical industry may have been mere parochialism: The
industry is New Jersey's largest employer. He opposed ethanol subsidies until he
fell in love with Iowa, whereupon he said he had opposed ethanol because it was
unimportant to New Jersey.
Still, Bradley seems less likely than Gore to
injure the industry that is poised for exponential increases in its ability to
reduce pain, extend and enhance life, and reduce the rate of growth of health
care expenditures.
George F. Will is a syndicated columnist for The
Washington Post.
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