“When I headed the Georgia Department of Human Resources, over health and welfare, one of Bibb County’s primary health care issues was lack of access for the working poor due to financial constraints. Unfortunately, this situation has not sufficiently improved in the decades since then.” — Dr. Doug Skelton
There are 159 counties in Georgia. Surprisingly, about 90 percent of them have a healthier population than Macon-Bibb County (per a database maintained by the Robert Wood Johnson Foundation in collaboration with the University of Wisconsin). According to them, an astounding 22 percent of Macon-Bibb residents are in poor health versus 12 percent in the best performing counties in the nation. (Note: Georgia Department. of Public Health has an online data base providing the exact causes of Macon-Bibb mortality and morbidity, the GDPH Oasis data system.)
There are many reasons underlying this upsetting health status situation. The healthiest counties are also Georgia’s most affluent (Forsyth is No. 1). In large part, wealthier individuals lead a healthier lifestyle (less smoking, lower obesity, etc.). However, access to care is also a key factor. In Macon-Bibb, 15 percent of residents are uninsured versus only 6 percent in top performing counties around the nation and 11 percent in Forsyth County.
Both nationally and here in Georgia, it has been shown that the uninsured and under-insured refrain from receiving needed care. In this column, rather than to once again reiterate the obvious need for Georgia to bury partisanship and proceed take federal money to expand Medicaid as most states have already done, we address one factor not normally discussed — excessively high drug pricing.
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Pharmaceutical firms located in the U.S. are extremely profitable. In and of itself, there is nothing wrong with profitability. We are a capitalist society.
However, health care is a much different industry than most. Competition is constrained by outside means via the government. How?
The FDA regulates when a drug may be rolled out and marketed. There are patents given which restrict generic competitors from entering the market for 20 years. Strangely, Medicare is prohibited by federal law from negotiating drug pricing. It is in these areas that positive change can be achieved in order to lower drug pricing.
There are two aspects to making improvements: technical and political. Technically, the solution is clear: (A) provide FDA with qualified staff to review generic applications much more rapidly; (B) change any FDA regulations which are overly burdensome and impede progress, while still insuring the public’s safety; (C) lessen uncompetitive patent protections for brand name manufacturers; and (D) mandate that Medicare negotiate drug pricing and it be given “most favored nations” status (i.e. Medicare gets the lowest pricing of all customers).
Politically, the remedy is not so easily achieved. Members of both parties receive campaign financing from the drug industry, sometimes in the six figures. Lobbyist money inevitably influences how lawmakers feel about the industry as well as how they vote. Currently, there are not enough brave senators and representatives who are willing to tackle the industry fueling their campaigns.
But, the pricing issue must be addressed. America has much higher drug pricing than any other developed nation. This places an undue burden on the people who can afford it the least, our working poor. This fact is especially true in places like Bibb County with high poverty rates.
Health care is different than most industries, which are heavily influenced by private sector competition, driving down consumer prices. Government finances much of our health care via Medicare, Medicaid, VA and so on. It is up to our Congress members to make sure that these dollars are spent wisely, unfettered by protectionist policies favoring the industry at the expense of the health of the people.
Jack Bernard is the former director of health planning for Georgia and a retired senior vice president with a health care corporation. Dr. Doug Skelton is the former dean of the Mercer medical school and current chancellor and dean of the Trinity School of Medicine in St. Vincent.