This article originally appeared in The Boston Globe on January 15, 2020.
If you care about waiting times, the likelihood of a safe pregnancy, or how long you might live, the difference between the US health care system and that of other countries is not whether one pays into a private insurance company or a single-payer government program, but whether their government is focused on controlling costs or padding their donors’ pockets.
In Germany, health insurance is compulsory, and if you lived there, you’d enjoy some of the lowest wait times among developed countries and receive health outcomes in the top 10 in the world. You’d also pay about half as much for health care than in the United States because, after prescription drug prices rose by an annual rate of 4 percent, Germany’s parliament used its national buying power to negotiate consumer discounts.
In sharp contrast to how German legislators behave, despite drug prices in the United States rising 139 percent between 2000 and 2016, Congress continues to forbid the Department of Health and Human Services from negotiating prescription drug prices on behalf of Medicare and Medicaid. These entities are the largest buyers of pharmaceuticals in the world, with massive purchasing power. While DHH is required to shop for the cheapest ballpoint pen, when it comes to chemotherapy medication, it is obligated to pay whatever price drug manufacturers want to charge. Furthermore, because many private and state insurance programs reimburse at a formula based on Medicare and Medicaid pricing, this anti-competitive policy causes a cascade of inflated prices throughout the system.
Japan has the highest life expectancy in the world and consistently ranks in the top 10 countries for health care quality. But unlike Germany, it has over 3,500 private insurance providers, and health insurance is effectively voluntary since there is no penalty for being uninsured. But while Japan and Germany differ in how health care is financed, they share an equal commitment to keeping costs down for consumers. Every two years, the Japanese government negotiates prices on behalf of their citizens, which explains why the same hospital services cost 29 percent less in Japan than in the United States.
Congress further protects the pharmaceutical industry from competition by making it illegal to purchase identical prescription medications outside the country. In my 2018 campaign for Wyoming’s US Senate, I won’t easily forget the mother and father from Worland who explained to me that each year they used all their vacation days to travel to Mexico in order to buy a year’s worth of drugs for their son’s cancer therapy. In fact, an estimated 19 million Americans risk prosecution each year in order to buy their drugs illegally, for the simple reason that if they don’t, they can’t afford to take their medicine. Congress’s immoral behavior creates a public health emergency because, despite millions of Americans crossing the border to buy medicine, a staggering 29 percent of us are still unable to afford to take our drugs as prescribed. As a nation, we are getting sicker and risking further health problems because, unlike the governments of other developed nations, Congress chooses the profits of their donors over the health of their citizens.
Last year Senators Charles E. Grassley and Ron Wyden introduced modest legislation to cap Medicare drug prices at the rate of inflation — a rather small ask given the other protections Congress provides the industry. But Senate majority leader Mitch McConnell, with the support of my own senator, John Barrasso of Wyoming, who is one of only two physicians in the Senate, refused to allow a vote on the bill. They recognize that a family struggling to buy medication for their daughter to control her epilepsy can hardly afford to also buy a senator. The same politicians who had no reservations about shielding drug companies from foreign competition, and who continue to forbid the DHH from using their buying power to negotiate pricing, declared Grassley’s bill “anti-competitive.”
These shameful market protections that provide billions of dollars in excess profits make it no wonder the health care industry donated close to $500 million to Congress in the last election cycle. It turns out that, in the United States, while it’s expensive to buy insulin it’s rather cheap to buy a Senator.
In terms of quality and outcomes, our health care system ranks number 37, (right above Slovenia) and dead last in the world in terms of cost. Life expectancy here is going down, not up. But the difference is not whether we pay into a private program or a public program. While partisans debate single-payer versus private-pay, the issue is that we have a corrupt political system. Until we address a political system designed to put donors over families, we’ll never solve our health care crisis.