Medicare is scheduled to reduce its payments to psychologists and other health care professionals by a whopping cumulative amount of twenty-five percent by the year 2011 if legislative action fails to avert the cuts. That is real money from anyone’s perspective. What makes this news even more startling is that at the same time cuts for providers are being planned, a windfall has been awarded to the pharmaceutical industry in the form of the major Medicare Bill passed in late 2003 and heralded as the most comprehensive reform of the Medicare system since its inception forty years ago. The most significant and costly part of the new Medicare law is the inclusion, for the first time, of drug benefits for seniors. One does not have to drill too deeply into the law to discover that the drug benefit is actually little more than a huge gift to drug companies wrapped in the flimsiest of tissue paper.
You may be asking how this could happen when the U.S. healthcare system as a whole seems to be on the brink of disaster as costs soar every year. I will attempt to answer the question of how this happened, but first let me cite a few data points to underline the proposition that the new law is little more than a payday for the drug companies. First, instead of lowering drug prices for seniors, many reputable sources indicate that the reverse will occur. Seniors may not see cheaper prescription prices when the new Medicare plan is fully implemented in 2006, because it does nothing to control the rising cost of drugs. According to Consumers Union, “most beneficiaries will face higher out-of-pocket costs for prescription drugs after full implementation, despite the benefit.” In addition, drug manufacturers have been raising prices in anticipation of a Medicare discount plan, negating potential savings from discount cards.
Wholesale prices for popular brand-name prescription drugs rose an average 7.1% in 2004, just slightly higher than the 7% price rise in 2003, and more than twice the general inflation rate, a study commissioned by AARP said. The findings come from an examination of prices charged by manufacturers on 195 brand-name prescription drugs widely used by Americans 50 and older. The study’s authors said such increases are routinely passed on to consumers in retail prices.
According to House Government Reform Committee, Minority Staff, the prescription drug benefit is so bad that seniors can pay less over the internet, with price negotiation or from buying drugs from Canada. The prices for drugs commonly used by seniors like Lipitor, Prevacid, Zocor and Aricept are all cheaper from Drugstore.com than with the Medicare prescription drug card.
According to the Minnesota Attorney General’s Office, “[T]he pharmaceutical industry has been the most profitable industry in the United States for each of the past 10 years. In 2001, it was 5-1/2 times more profitable than the average of all other Fortune 500 companies.”
Most astonishing is the fact that the legislation explicitly PROHIBITS Medicare from directly negotiating drug prices with the pharmaceutical industry, an effective cost control solution in place for virtually every other major provider of Medicare services. The provisions will add an additional $139 billion to the cost of the bill over the next eight years in increased drug industry profits, according to the Medicare Rights Center. This provision alone qualifies the legislation as the mother of all sweetheart deals.
The above background information serves to underscore the conclusion that something is rotten in Denmark. How was such a sweetheart deal struck? Much of the answer lies in a predictable five letter word, MONEY.
Even a cursory examination into the way the pharmaceutical industry controls health care policy by buying influence at the highest level of government, and underwriting professional and lay healthcare organizations whose spokespersons parrot the industry’s agenda yields a rich portrait of the power drug companies exert on Capitol Hill.
Of the 1,274 people registered to lobby in Washington for drug makers in 2003, according to the Center for Public Integrity, 476 are former federal officials — including 40 former members of Congress. This is the epitome of “inside baseball.”
The Pharmaceutical industry spent a total of $158 million in 2004 to lobby the federal government and an additional $17 million was disbursed in campaign contributions in 2004 to federal candidates (67% to Republicans). By contrast, the American Medical Association spent a measly $2 million over a two year period ending in 2004, and AAP spent around $200 thousand. Add to these amounts a staggering $7.3 million in support for the 2004 political party conventions (64% to Republicans) and you have the makings of the most powerful lobby on Capitol Hill.
Without a doubt, the pharmaceutical companies are together one of the strongest, most well-connected and most effective lobbies in Washington. Going up against them is more often than not a losing battle. But lobbyists aren’t the industry’s only voice. When witnesses lined up last Spring for a Senate hearing on the FDA’s drug-approval process, no representative from the pharmaceutical industry was present. But at least three witnesses on the sixmember panel were from groups that get money from drug makers
Perhaps worse than the industry’s official lobbyists, are the industry’s “friends” who masquerade as patient advocacy groups. A story about the industry in USA Today quotes Nancy Davenport-Ennis, who heads the National Patient Advocate Foundation (NPAF). She was the leadoff witness in the Senate hearing about Vioxx and the other painkillers, warning against any “overemphasis on safety.”
It appears to me to be a bit unseemly when a “patient advocacy” group worries more about delay in availability of new drugs—rather than their safety. While not a slam dunk, I’d say this provides reasonably good data to conclude that the NPAF and groups like it are in bed with the pharmaceutical industry. When confronted about her organization’s funding sources—e.g., Pfizer, Merck and GlaxoSmithKline—Davenport- Ennis told USA Today, “the drug company grants come with no strings attached and amount to ‘a whole bunch less than half’ of the group’s budget. I don’t think there is a patient-advocacy group in America that does not receive some level of funding from a pharmaceutical company.” Therein lies one of the problems.
The pharmaceutical industry has more than demonstrated that it knows politics as well as it knows chemistry. The short list of their recent successes includes: winning coverage for prescription drugs under Medicare in 2003 while blocking the government from negotiating prices downward, so far they have kept out imports of cheaper medicines from Canada and other countries, and they have protected a system that uses company fees to speed the drug-approval process.
In the end, drug makers are fully dependent on the federal decisions made by Congress. The government determines almost every aspect of how a drug gets into a consumer’s hands. Not only that, but the government buys massive quantities of drugs through Medicaid, the Veterans Administration and other programs. Once the new Medicare prescription drug benefit takes effect in 2006, the government will be paying 41% of Americans’ drug bills, up from 24% now. It’s hard to imagine any group doing better than this industry does with the government.
It is eminently reasonable to conclude that the industry wins more in Congress than they should. And it’s not hard to understand what the main ingredient of their winning strategy is. The one really big thing they have going for them, as stated above, is MONEY.
I know that many psychologists are prone to wring their hands and complain about how awful it is that legislation can be infected by the infusion of political money. I don’t disagree with their complaints. I do know, however, that the situation is not going to change anytime soon, regardless of how many campaign finance laws may be introduced. So if we psychologists are realists/pragmatists and can put our idealist aspirations on hold, we must play the advocacy game within the system as it currently exists with its emphasis on money.
Psychology will never have the kind of money to throw around that drug companies do. That goes without saying. The point of this column is to emphasize, once again, that money matters in Washington, perhaps more than it does in many other places. While psychology can never hope to reach the lobbying heights of the drug-industrial complex, we CAN do far better than we have done to this point. The fact that you are reading this column indicates that you are probably doing your part to contribute. I ask that you consider contributing one additional item to the profession, and it doesn’t involve your checkbook. I urge you to educate your uninformed colleagues about the critical need to get involved in political advocacy for psychology. Ask them to become members of AAP, and don’t take “no” for an answer. Ask them to contribute to AAP/PLAN, and don’t take “no” for an answer. The only way our clout will grow in the halls of Congress is by this kind of personal appeal to our non-participating colleagues. It doesn’t take much to make a difference. If every AAP member would recruit just one colleague, it would make a very substantial difference in the way psychology is perceived on Capitol Hill. Recruiting involves educating at least one colleague about the importance of joining AAP and/or contributing to AAP/PLAN, and then “closing the deal” by obtaining their commitment with a follow-up contact to insure that they have fulfilled that commitment to you. On the one hand that is asking a lot of you I know, but on the other hand it is the least we can all do to insure that psychology will have voice in Washington. Please commit to do this today