What to do until single-payer plan?

This week Bloomberg News reported that the consultancy DRX found drug prices have continued rising at an annual rate of more than 10 percent, even after the leading Republican candidate and both Democrats in the primaries blast pharma for such greed.

Although political and media attention has focused on Valeant and lesser companies such as Martin Shkreli's Turing, DRX collected data showing that "Pfizer raised prices for 24 drugs by 12 percent or more in the past two months." During the same time GlaxoSmithKline increased prices on 22 products by 15 percent.

Pharma companies and their lobby offer the boilerplate response that published prices represent just a starting point and insurers and health plans negotiate discounts. The DRX spokesman acknowledged as much, but he noted that even if the pharma companies don't receive the entire amount of the price increase, they get a good chunk of it.

Last week's post here made the point that reducing the increasingly unaffordable cost of drugs cannot be accomplished without a comprehensive reform of the health care system that adopts a single-payer or Medicare-for-all plan.

The obstacles to achieving single-payer health care are numerous and extraordinarily high, principally because the giant corporations that control the major health care sectors – manufacturers, providers and payers – make so much money from the currently rigged market.

This week the filmmaker-political commentator (and Kutztown U. graduate) Bob Cesca posted on Salon the cold reality that none of Bernie Sanders' major policies (single-payer, free tuition, breaking up the biggest banks) stand a ghost of a chance in Congress until the following changes occur: (1) an end to state gerrymandering; (2) an end to the Senate filibuster and the 60-vote requirement and; (3) a major overhaul of campaign financing.

Sad to say, Cesca is probably correct. The problem is that any effort to change those processes will be as arduous and take as long as enacting the substantive policies themselves.

This suggests a couple of points. First, no one should hope to see single-payer adopted within one or two election cycles. The most optimistic time frame is 10 years and it seems likely that it will require twice as long. Such a protracted period makes it necessary that full-time, professional political operatives lead the campaign for single-payer, rather than a shifting assortment of groups that rise to attention on transient waves of emotion.

Any effort to advance single-payer through what the 1960s referred to as "consciousness raising," whether the Sanders campaign or some other feel-good movement, is both redundant and ineffective.

An idealistic effort to educate the public is redundant because dissatisfaction with the current system is already high. Surveys by the Kaiser Family Health Foundation, Harris Interactive and others have shown that a majority of the public strongly resents the increasing deductibles and co-pays that are standard parts of current coverage.

A campaign aimed at fostering public concern will also prove ineffective because popular emotion and anxiety consistently amount to nothing in the face of entrenched economic interests. That is true across an enormous range of policy issues. A 2014 study published by two political scientists demonstrated that point precisely.

The authors analyzed 1,799 policy issues in detail to determine the relative influence of economic elites, business groups, mass-based interest groups, and average citizens. They found that, "The preferences of the average American appear to have only a minuscule, near-zero, statistically nonsignificant impact upon public policy."

Instead of public preference, lawmakers respond to wealthy interests with the largest political lobbies and the fattest contributions to bankroll campaigns.

The study covered the years 1981 to 2002, meaning it predated Citizens United, super-PACs and dark money. If the authors concluded, prior to those game changers, that average Americans have a "near-zero" impact on public policy, their conclusion today would be even more dismal.

So the greed of entrenched, big money interests means it will be a long, difficult road to create a single-payer system in this country. Until that time arrives it is worth asking what executive actions a president and/or any agencies under his leadership can take to relieve the current situation of excessive drug costs.

In that connection it would be useful to explore, for example, what's actually involved in implementing the recent request by 50 Congressmen for the NIH to declare "march-in" (that is, effectively suspending the patents) on overpriced drugs. Does the fact that tens of millions of Americans must choose between medication, food and rent qualify as a matter of national security, thereby justifying the NIH in making unaffordable medications available as low-cost generics?

This country was turned upside down by 9/11 and the loss of 3,000 lives. A multi-billion dollar Homeland Security industry was created, privacy and other civil liberties were shredded, and Muslim-Americans were vilified. Yet a study by Harvard Medical School found 45,000 people in this country die each year because of unaffordable medical costs, while Families USA put the figure at 26,000.

Also, as the Veterans Administration is able to negotiate drug prices with the pharma companies, something prohibited to Medicare, the question emerges about whether it is possible for the VA to intentionally buy a surplus supply of drugs and then sell the extras to commercial distributors at the reduced prices?

The legal, political and financial feasibilities of such moves require clarification, but the fact remains that there are a number of ploys a chief executive with cajones (i.e., one unlike the current incumbent) can use to cram down drug prices until that distant day when single-payer becomes a reality.

Such audacious schemes are frequently used in business where an executive who adopts them is considered "bold," "innovative" and "outside the box." Daring approaches of that kind are considered anathema in government, but perhaps the times call for a different model.

Harry Truman once said that a minority of people possesses the resources to make sure their interests are represented in Washington, but representing the interests of the others is the responsibility of the president. Does Barack Obama possess the fortitude, ingenuity and conviction to assume that responsibility by supporting the interests of American consumers over those of the health care profiteers?

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