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Pill Bill Chock-Full of Defects
Nicholas Johnson
Muscatine Journal, Opinion
November 29, 2003
p. 4A

NOTE: You'll also want to see Nicholas Johnson's "Another Iowan for Kucinich" page,

Even backers of the new prescription drug bill acknowledge it contains a “doughnut hole.” That’s the gap in a senior’s coverage between costs of $2250 and $5100 a year.

Backers’ rhetoric reminds me of the coffee shop doggerel, “As you ramble on through life, brother/Whatever be your goal/Keep your eye upon the doughnut/And not upon the hole.”

The pharmaceutical industry, and the elected officials whose campaigns they finance, want us to believe the illusion we’re actually getting something. We’re not.

Drug companies will get the customary 1000-to-one return on their campaign contributions. Billions will flow from taxpayers, not to seniors, but through their hands, and pharmacists, straight to a drug company’s bottom line. (There are also billions for doctors, hospitals and HMOs.) Moreover, since it’s all phony, borrowed money, we’ve just put it on our grandchildren’s credit cards.

The doughnut hole is the least of the pill bill’s defects, but let’s start there.

The premium and deductible total $670 a year.  The 25 percent co-pay to $2250 will be $500. And the gap to $5100 is $2850. The total? “Beneficiaries” end up paying $4020 of their first $5100 in annual drug costs.

By postponing the effective date until 2006, backers can take the credit in the 2004 election and save the apologies for later.

Worse, they’ve capitulated to the drug companies’ demands there be no price controls, government negotiated reductions, or imports. Firms can charge whatever they want.

Their exclusive patents already give them monopolies protected from price competition. Combined with neither price controls nor negotiations, what happens? As rapidly as health care costs are rising, drug prices are rising faster – usually two-to-three times the rate of inflation.

The odds are great that patients’ out-of-pocket costs will be far greater [ital] after [end ital] these “benefits” kick in than they are today.

The fundamental flaw in our health care system in general, and prescriptions in particular, is their delivery through profit-maximizing businesses.

There’s little need for government operation of designer jean, gourmet food or luxury yacht industries. We can safely leave distribution of their goods to the power of advertising and consumers’ choices for discretionary spending.

But the provision of adequate health care, including drugs, is a human right. It’s a moral issue, whether in a third world country suffering an AIDS epidemic or here. The UN’s Universal Declaration of Human Rights so views it, as do industrialized nations with single-payer systems and drug prices a fraction of ours.

Congressman Dennis Kucinich, and 62 percent of Americans, think that’s what we should have. The other leading candidates, and special interests that profit from human misery and misfortune, think not.

Drug companies advertise their most profitable drugs on TV. Yet it would be as illegal for viewers to purchase them as to purchase heroin. The law wisely prohibits patients from making these decisions. It leaves them to physicians and pharmacists – and even they sometimes over-prescribe.

Companies cite the costs of “research” to justify exorbitant prices. But much of that research has been paid for by taxpayers. And the rest is more likely to have tweaked a product enough to extend a patent monopoly than to have created a genuine breakthrough.

To these unnecessary advertising and research expenses add the multi-million-dollar executive compensation, stock options, retirement packages, and other excessive administrative overhead. Do you begin to see why the drug industry has to be one of the most generous campaign contributors of any industry to keep this scam going?

Some of the solutions are obvious. Others are more complex. But clearly our new pill bill is neither.

One-time presidential candidate Walter Mondale once borrowed a line from a fast food TV commercial to criticize an opponent: “Where’s the beef?” My question is: Where’s the doughnut? I tried to keep my eye on it, but all I can see in this Congressional prescription drug bill is one big hole in my pocket and another in what never was a doughnut.


Nicholas Johnson, a former co-director of the University of Iowa Institute for Health, Behavior and Environmental Policy, teaches at the University's College of Law and maintains