CliffsNotes on ACA

We are now a matter of days or even minutes away from hearing the Supreme Court verdict on the constitutionality of the Affordable Care Act (ACA).  The Court could declare it constitutional, declare the individual mandate unconstitutional or even tear apart larger parts of the act.  The polls show that the majority of the public would like to see at least parts of the law overturned, but there is no consensus on which way to turn next.  For a glimpse at what is happening right now, this CNN piece gives a good behind the scenes look.

In case you have just entered the world from Mars, it is time to catch up with what is happening with our healthcare system.  Thankfully, the New York Times provides an incredible overview of the issues in their debate section.  Click on the “read the discussion” button on the lower left and enjoy.  Please don’t just read your friends but go through it in its entirety, as there is so much to learn from those who do not share your opinions.

I really think this piece could be viewed as the CliffsNotes for the reform discussion.  Everyone knows the yellow booklets that you could breeze through the night before a report was due to overcome the fact that you didn’t read the book.  Obviously, by doing this, you lost all the richness that came from enjoying the book and letting the plot unfold, but it avoided disaster.  I know it seems weird but there were some people who read both the assigned book in school and then read the CliffNotes for added depth.  That is how I would prefer to talk about the NYT debate.

The first things to note are what everyone from the most liberal to the most conservative agrees on.  The group all clearly have no idea how the Supreme Court is going to rule.  Justice Ginsberg kidded about broccoli and schisms in the court over the weekend but this gave no indication on how this is going to turn out.  Everyone in the debate thinks there could be improvement in the law, but these could range from having a public option to national healthcare to having less government involvement.  Perhaps the main point of agreement is that the system definitely needs change of some kind as the current system seems to be unsustainable.

For those of us in pharmaceutical marketing, it is important for us to really laser focus on what this all means for our industry.  Start a list of all the significant things that have changed with the ACA and then try to determine the impact the ruling would have on these key areas.  It would seem that the ACO, or accountable care concept, is here to stay for both government and commercial payers.  The heavy emphasis on prevention will remain.  The major concern for the industry would be the grand agreement between the administration and the industry that could be voided in some way should the law be struck down.  Cost containment will continue to be the huge battle cry for all sides and that’s not always good for branded pharmaceuticals, unless this is appropriately balanced with a discussion of outcomes.  It seems there will remain the desire to have more people brought into the system rather than having the uninsured dangling as the uncertainty costs the system a lot.  There are many more items that I am sure you will add to your list.

Besides the obvious anxiety of uncertainty, the part that concerns me most is really about how little our industry is being discussed in all of this debate.  It seems that everyone assumes that drug costs will be controlled mostly through generic utilization and with the patent cliff the overall cost to the system will remain under control.  Where is the potential upside for us?  If proper use of branded pharmaceuticals really is a net benefit to the system why isn’t greater use of drugs a strategic imperative?  Why did PhRMA cut a deal and then walk away?  Shouldn’t we be fighting for longer patent life and greater access that would allow for lower costs and more research?  Why didn’t the NYT piece include one of the leaders from our industry?

We really need to get our heads out of the sand and start standing up “in the public square” for what we believe.  The old way of just laying low is not working.  We are being attacked on every side and perhaps now is the time for us to stand up rather than just provide financial backing.  It is never too late to enter the debate, as long as you have a good grasp of the CliffsNotes.

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