The devil, of course, is always in the details. And that is certainly true for drug pricing. I do not believe that the present
system of pricing is sustainable indefinitely—domestically or internationally. The bigger the pharmaceutical share of healthcare
spending, and the more visible those costs are (for example, through larger co-pays, higher deductibles, or coinsurance),
the greater the political pressures will be to squeeze prices down. It will surely be a bumpy ride.
The Leadership Question
It's hard to pass major reforms. The more specific the proposals, the more opposition rises. Major reform legislation usually
has passed when the nation has been led by a strong and popular president who commanded majorities in both House and Senate
(the way Social Security passed under Franklin Roosevelt and Medicare/Medicaid under Lyndon Johnson). Even then, it probably
took exceptional times (the Great Depression, the death of President Kennedy) to make reform possible. What might those exceptional
times be in the future? The uninsured population reaching 60 million? The collapse of employer-provided insurance? A major
recession?
When a president proposes major reform, he or she will need to be ready to deal with the criticism that opponents of the Clinton
plan used successfully to undermine public support—that it would be too expensive, involve much higher taxes, damage the economy,
create unemployment, require bigger government, necessitate rationing, and reduce quality and choice. This new president will
also need to avoid the political mistakes made by the Clintons. The president must lead the charge, but Congressional leaders
must be given substantial ownership of the proposal and be responsible for writing the bill.
One thing is certain, reform won't happen without the strong leadership of a skillful, persuasive president with job ratings
high enough to get the Congressional support he or she will need.
When might this happen? Arguably, the easiest time to pass major reforms is after a landslide election for both the president
and his or her party. Election years, presidential or midterm, are tougher, and lame-duck years even worse. Furthermore, most
presidential parties lose seats in Congress in midterm elections. This suggests that major reforms are most likely to occur
(depending, naturally, on the election results and who is president) in 2009, 2013, 2017, or 2021.
Of course, no single reform bill will solve all our problems. Even after implementing major reform, we will clamor for changes,
and the debate will continue.
Humphrey Taylor is chairman of the Harris Poll, Harris Interactive. He can be reached at htaylor@harrisinteractive.com
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