The Good the Bad and the Ugly

While the blog title is a good one for a great spaghetti western it’s not so good when it applies to pending legislation that will have a long-range effect on our lives. I’m talking about the Inflation Reduction Act that survived Saturday night and early Sunday’s gauntlet of voting on amendments to the bill, affectionally known as the vote-a-rama, and was passed by a partisan 50 to 51 vote with the Vice President breaking the tie. It will now go to the House where they will most assuredly pass it, probably on Friday. So, how did we get to this point on this ominous piece of legislation?

Since the massive Build Back Better bill failed to gain traction, the Democrats have worked feverishly to try to find a narrow bill that they could pass before the midterm elections. This meant they needed to broker a deal with two moderate Democrats, Senators Joe Manchin III (W.Va.) and Kyrsten Sinema (Ariz.), who were the ones that held up the passage of the larger bill. When Senator Manchin abruptly changed his stand opposing legislation that would impact inflation and raise taxes, and Senator Sinema got her changes to the bill, the door was open for a pared-down bill that they named the Inflation Reduction Act, an obvious nod to Senator Manchin. The only way to pass this bill was through a process called reconciliation. I discussed this process and my disdain for using legislative maneuvers like it to pass such important legislation in a recent blog. Suffice it to say that this bill, if it passes, and it probably will, will be a purely partisan law. In essence, a bill that affects 100% of us will only have the support of 50% of those who represent us. It took the vote of the Vice President to break the tie. This bill certainly contains some good, some bad and some ugly parts.

The good –I think that capping the out-of-pocket costs for prescription drugs at $2,000 a year is definitely good for seniors. I’ve been advocating for this change for more than a decade. It gives older Americans some sense of security knowing they won’t be bankrupted by drug costs, and it gives younger people a definite ceiling on out-of-pocket costs as they plan their retirement.

The bad – This bill allows the government to fix the price of some of the highest priced drugs. I’ve talked ad nauseum about the problems of allowing the government to insert itself into our healthcare when it’s not needed. Drug prices have not risen faster than inflation for years and they have risen slower than the other parts of healthcare. There are parts of our prescription drug system that need to be changed. Having the government set the prices for important drugs is not the answer. Many have talked about the negative effect this change will have on innovation and the discovery of new life improving and lifesaving drugs. It is difficult for many of us to understand how this will dampen the willingness of investors to risk their money on new research. Maybe this example will help.

The movie industry and prescription drug business have a lot in common. For starters, the drug industry calls a very successful drug a blockbuster, the term was taken from the same moniker enjoyed by a very financially successful movie. Thousands of movies are made each year with very few of them breaking even or making a profit. Small independent movie makers have an idea and develop a script and work to find money to make the movie. Likewise, there are many small biotech firms that have a scientific idea about a new drug and work to find the money to continue their research. Both of these businesses rely on investors who are willing to wait years, some over a decade, for a return on their investment, with the understanding that about 9 out of 10 will be failures. They are still willing to invest because of the chance for the financial windfall of a blockbuster, whether it be a movie or a drug. If the government gets the power to limit the price of the expensive blockbuster drugs, it will be like the government limiting the number of movie tickets that can be sold for a successful movie. In both of these scenarios the number of new movies and the number of new drugs will both be limited because the reduced reward will not be worth the risk. Investors will take their money elsewhere. This same scenario plays out for big movie producers and big drug manufacturers – they won’t be willing to purchase these smaller companies if the big payoff is not available.

There is one other consequence of this price fixing legislation. In the late 1980s and 1990s many prominent scientists left companies in other countries, especially Europe, and came to America where the environment for pharmaceutical innovation was much better. If that environment worsens, that migration is sure to reverse itself and we will lose those great scientists. Having new discoveries in our country proved to be very valuable during the pandemic. I would hate to lose that advantage to other countries.

The ugly – I’ve already talked about the ugliness of the process used to pass this bill here and in an earlier blog. The reason this bill was forced through had everything to do with politics and the upcoming midterm elections and very little to do with the long-term health and the wellbeing of older Americans. I wish it didn’t have to be this way.

I’m sure there will be more to say as this law is passed by the House at the end of the week and as it is implemented. We will continue the fight to lessen the impact of this bill and we will continue the fight for better healthcare for you and me.

Best, Thair