Screaming About Health Care

0 Comments | Insight on the News, Feb 16, 2004

Byline: Jennifer G. Hickey, INSIGHT

It would be easy to ascribe the shift in the political fortunes of former governor Howard Dean to "the scream." It might have been the case that Dean's fanatic demonstration of his command of U.S. geography, punctuated by his exemplary mimicking of the mating call of an oversexed hermit thrush state bird of Vermont frightened Democratic voters and confirmed concerns about his temperament. But any such presumption would have been based upon a mere snapshot rather than the whole picture.

In fact tracking polls conducted by John Zogby showed that, by mid-January, Massachusetts Sen. John Kerry had moved into the lead in Iowa. A survey taken Jan. 12-14 found Kerry with a 22 percent to 21 percent lead over Dean, a gap that widened to three points (25 percent to 22 percent) in the final Jan. 16-18 tracking poll. Whether Dean's assertion that the world was no safer with Saddam Hussein out of power, his short-tempered response to a voter at a town hall or the dismissive remarks he previously made about the Iowa caucuses (and his subsequent explanation) contributed more to his decline must for the moment remain matters of speculation.

What the post-Iowa frenzy exemplified was not how the media gangs up on a candidate. Rather it reflected a tendency to report the individual threads of a story rather than a more complex tapestry. Boiling into a two-minute sound bite the hours of testimony by former weapons inspector David Kay, for instance, may service the needs of a deadline or the whims of politicians, but it does not serve the long-term interests of the nation. That sort of distillation was made easier, however, by George W. Bush's refusal to mount an affirmative defense of administration foreign policy until the State of the Union, not necessarily the forum best suited for such arguments, and his expression of confidence in the state of the intelligence community.

But in the age of immediacy, where information scrolls across the bottom of cable-news channels and more people click their news from Internet briefs than dirty their hands with comprehensive newspaper articles, ephemeral sound bites trump thoughtful analysis. This is true particularly when it comes to health care, the issue du jour.

"As president, I will overturn the Bush rules that prevent Medicare and our state government from negotiating for lower drug costs," declamed Kerry in a Jan. 21 address entitled "Ending the Era of Special Interests." Seizing on the perception among partisan Democrats that the Bush administration is driven by corporate forces, Kerry asserted that the only reason for opposing drug reimportation is "because the drug industry would lose billions in excessive profits."

On Jan. 27 the Food and Drug Administration (FDA) issued a second report echoing some of its earlier warnings about reimportation. The report detailed findings from a joint effort with U.S. Customs and Border Protection (CBP) to crack down on entry from abroad of unapproved drugs. According to the FDA, the campaign found 1,728 such unapproved drugs, including "FDA-approved drugs, recalled drugs, drugs requiring special storage conditions, drugs requiring close physician monitoring and drugs containing addictive controlled substances."

Of the packages examined, 80 percent were imported from Canada, while almost 16 percent came from Mexico, and the remaining 4 percent were exported from several Asian nations, the Netherlands and the United Kingdom.

FDA Commissioner Mark McClellan raised his concern that many of the imported prescription drugs, including medications requiring a physician's prescription, were labeled improperly and others had been subject to recall. Those dangers are in competition with the allure of cheaper drugs, while Democratic rhetoric on provisions in the Medicare bill are in competition with reality.

A Jan. 23 letter to Senate Majority Leader Bill Frist (R-Tenn.) from the Congressional Budget Office (CBO) indicates that permitting the government to negotiate drug prices would not have as much impact on prices as some Democrats contend. At issue is the "noninterference" provision of the new Medicare law, which prohibits the secretary of Health and Human Services from interfering with negotiations between drug manufacturers and drug-plan sponsors.

After examination of the issue, CBO Director Douglas Holtz-Eakin wrote that rescinding the ban would have a "negligible effect" on federal spending. The CBO estimates that because "they will be at financial risk, private plans will have strong incentives to negotiate price discounts," a point Holtz-Eakin reiterated in response to Democratic inquiries at a Senate hearing Jan. 28 on rising health-care costs.

In testimony before the Senate Health, Education, Labor and Pensions Committee, Holtz-Eakin also addressed the "incomplete and potentially misleading picture of the uninsured population" created by frequent recitation of the statistic that about 40 million Americans lack health-care coverage. He noted that this figure encapsulates both individuals who lack coverage on any particular day or week, as well as the 21 million to 31 million who are uninsured all year.