The Democratization of Health Care: Prescription Drugs as Infrastructure

Politicians can always get an “attaboy or attagirl” from their constituents by announcing their commitment to dramatically cutting the cost of prescription drugs. It sounds great, akin to a chicken in every pot. Drug pricing is a perennial source of conversation and confusion, and passions are inflamed whenever an egregious example of drug profiteering is exposed. Passions do not change the fact that prescription drugs are essential components of the larger enterprise to build sustainable communities.

The ideas behind sustainable development and communities are rooted in efforts to align economic growth with new forms of energy that do not destroy the environmental equilibrium that supports life on earth. Managing sustainable communities, however, means a lot more than using renewable energy to drive economies. Sustainable communities are characterized by a public understanding that investments in health care, including medical innovation, are similar to investments in roads, technology, affordable housing, or clean energy.

The ability to distribute medical therapies readily across diverse populations informs community well-being. We cannot have sustainable communities without vibrant health-care research, finance, and delivery systems. And health care means more than healing; it is an economic engine in its own right, employing today more people than manufacturing. Public policies that fail to recognize this duality can create both negative medical and economic consequences. For example, ill-considered policies that result in the closure of rural hospitals reduce employment as well as the ability to provide care in the community they serve.

We have reached the point in our society’s evolution where we must move beyond accepting every roll of the dice as determinative of health outcomes (see: Democratization of Health Care: The Quest for Sustainability). We aspire to regulate and manage health outcomes in our communities, but establishing the infrastructure to manage population health will require coordination and accountability that goes far beyond the capacity of existing medical systems. Embedded in the current discussion around drug pricing is the potential to shift public policy toward a new understanding of how to manage community well-being. If we do not improve prediction and control of health outcomes, our investments in transportation, housing, energy, and clean water, air, and food have limited value.

Medicine is on the front line of the struggle against the effects of disease, disabilities, and aging, whose progression not only narrows the context of community well-being but also complicates efforts to achieve controlled sustainability. We must understand our investments in innovative therapies as building infrastructure essential to sustainability. Investments made today will free us and future generations from suffering and shorten life expectancy.

Community sustainability would be jeopardized by policies that direct government to set drug prices by using its weight in the market as a monopolistic buyer. In other sectors of our economy, it has long been recognized that government price controls retards innovation, create scarcities, and diminishes quality--that has been our historic critic of command economies. We can expect the same effect if government began to dictate the price of medicines.

The 21st century is about sustainability, and we must not be sidetracked by solutions that seek to address present discomforts by sacrificing our future. In our markets—and that includes the health-care market—government should protect and encourage competition as the main engine to regulate prices.

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