We were among the first to suggest that the pattern of backroom dealing violated Candidate Obama's pledges of greater transparency and openness in government, and an end to the special relationship between industry groups and policy-makers. We noted with regret that the President had invited healthcare industry groups, including PhRMA, the trade association for the pharmaceutical industry, headed by Billy Tauzin, the former-Louisiana Congressman who not only engineered the restriction against price negotiation in Part D before resigning his elected post shortly afterward to accept a $2 million annual salary position as head of PhRMA. To some, including me, it appears that a case might be made that there could be a conflict between representing a Congressional district while leading a legislative effort that was going to reap billions of dollars in benefits for an industry that was soon going to offer you a $2 million salary. This was why we bemoaned the new found alliance of the Obama Administration with PhRMA.
We asked: What is the payback to the industry? It is an honored guest at The White House; it is praised by the President as he speaks to Seniors, praising pharma's largess in reducing their pain with the 'offer' to reduce the cost of medicines for those stuck in The Doughnut Hole; it negotiates with Senator Max Baucus, (D-MT), chair of the influential Senate Finance Committee (and the recipient of large contributions from the healthcare industry); it has the audacity to 'demand' that the White House 'clarify' its 'agreement' that the Administration will 'honor' its agreed-to commitment to not allow price negotiation--and it gets its way, as the White House quickly falls in line, even to the point of having Press Secretary Robert Gibbs flounder as he had to admit he really didn't know the details.
But then, in a complete flip-flop, the next day, a new stance emerges, largely due to opposition from House members such as Rep. Henry Waxman, chair of the influential House Energy and Commerce Committee, which included price negotiation in its markup of HR3200. Waxman put it bluntly--neither he nor the Committee were bound by the negotiations with the Administration or with Senator Baucus.
Apparently others had the same concerns at about the same time we started asking questions about the relationship of this Administration with the pharmaceutical industry. There is an increasing number of stories asking questions about details of the agreement.
This is a fortunate turn of events. During the campaign, Candidate Obama made two pledges regarding prescription medicines: (a) to lower prices for Medicare by removing the restriction on price negotiation and (b) to allow Americans to expand their freedom of choice by legislation that would allow personal importation of safe, affordable medicines from licensed, registered pharmacies in Tier One countries, those that have standards of safety and efficacy that meet or exceed those of the United States.
It is interesting to note that earlier this year--at about the time that the White House was starting its outreach with industry reps, including PhRMA, that seizures by the FDA of vital medicines from Tier One countries picked up. The question must be asked, was this another part of the deal being cut with PhRMA? It is well-known that in addition, the other monster under the bed for PhRMA is importation of medicines at affordable prices. Interestingly, these are the same medicines that the industry ships into this country at prices 60 to 70 percent higher.
After a concerted effort,including appeals directly to the President by publishers of leading websites for seniors, and news releases about the seizures, they declined.
The continued concern about seizures was the reason that we hailed the successful legislative maneuvering of Senator David Vitter (R-LA) for an amendment restricting such seizures, a stance that reaffirmed the banning of such seizures by Congress in 2006. Still, even the Senator has said that he is not confident that the Amendment will stick in conference, perhaps reflecting the feeling that many share that the reach of pharma is such that it can have its way.
And therein lies the moral of the dilemma that the President faces. Will legislation affecting the price and availability of vital medicines be conducted in the bright sunlight of openness and opportunity for total and equal participation by all? Or will we be subjected to the special interests of groups such as PhRMA?
If it should be the latter, we would like to remind our elected policy-makers of the old tale that so amply illustrates the consequences of bad decisions...the fable of the snake and the little girl:
A young girl was trudging along a mountain path, trying to reach her grandmother's house. It was bitter cold, and the wind cut like a knife. When she was within sight of her destination, she heard a rustle at her feet.
Looking down, she saw a snake. Before she could move, the snake spoke to her. He said, "I am about to die. It is too cold for me up here, and I am freezing. There is no food in these mountains, and I am starving. Please put me under your coat and take me with you."
"No," replied the girl. "I know your kind. You are a rattlesnake. If I pick you up, you will bite me, and your bite is poisonous.”
"No, no," said the snake. "If you help me, you will be my best friend. I will treat you differently."
The little girl sat down on a rock for a moment to rest and think things over. She looked at the beautiful markings on the snake and had to admit that it was the most beautiful snake she had ever seen.
Suddenly, she said, "I believe you. I will save you. All living things deserve to be treated with kindness."
The little girl reached over, put the snake gently under her coat and proceeded toward her grandmother's house.
Within a moment, she felt a sharp pain in her side. The snake had bitten her.
"How could you do this to me?" she cried. "You promised that you would not bite me, and I trusted you!"
"You knew what I was when you picked me up," hissed the snake as he slithered away.
The moral of the fable is that things are not always as the seem. PhRMA has not shed its skin. Americans pay the highest prices for prescription medicine in the world. The industry's predatory pricing has contributed to the costs that now are the biggest obstacle to necessary healthcare reform, and the 'savings' of the brokered arrangement carry a heavy price...we can only hope that it will not be a snakebite that creates a climate of an industry group dictating to the Administration and Congress, thereby throwing into question the need for and benefits of healthcare reform.