Recycling bad ideas
The other day, I saw a young man in baggy jeans — that ridiculously enormous cut from the late 90s/early 2000s that seemed to fit every waist size from 28 inches to 4.5 ft., and gave every person the illusion of being their own “after” picture in one of those bad billboard weight loss ads. It was just another reminder that either, for a lack of creativity or extremely bad taste, every bad idea that ever existed eventually will be recycled.
Kind of like we are seeing right now in Washington with health reform: Politics aside, with the exception of a few bright spots, the highly anticipated proposed replacement to the Affordable Care Act, the American Health Care Act, if fully enacted, would represent a step backward in thinking around how to improve health care in this country.
That’s not to suggest that the ACA was perfect. Far from it; the legislation did a lot to expand access, and it got people focused on such important things as the quality of care and realigning incentives around outcomes versus fees-for-service, but it also failed to really lower overall costs.
You could say that allowing insurers to compete across state lines probably would have created more competition in the exchanges, and theoretically helped lower costs. You also could say that the individual coverage mandate under the ACA needed to be reexamined, but it’s hard to argue against making sure every American has basic health insurance. The reality is that Americans have been paying through the nose for years to cover the costs of the uninsured that go without routine, basic care only to wind up later in the emergency room, or on the operating table.
While it may be still too early to tell, according to community pharmacy advocates, it appears that the AHCA would offer mostly a mixed bag to the industry, with maybe a handful of positives. According to an online poll of DSN readers, 41% expect the AHCA to have the most positive impact on OTC sales; 35% expect retail clinics to be the big winners; and just 24% believe pharmacy will benefit most.
On the pharmacy side, it’s hard to imagine that any reduction in the number of covered lives could lead to an increase in script utilization, and the AHCA’s cap on per-patient Medicaid spending also could negatively impact that area of the business.
On the flip side, the AHCA could speed up the pace of new drug development by repealing billions of dollars in pharmaceutical manufacturer taxes, which could enable a broader focus on innovation.
Meanwhile, the prospects for self-care could improve under the AHCA, which would restore eligibility for OTC purchases under Healthcare Savings Accounts and Flexible Spending Accounts.
Separately, but on a somewhat related note, it appears that some members of Congress are noodling with the idea of allowing drug reimportation as part of the discussion around retooling Prescription Drug User Fees — further evidence that all bad ideas are cyclical. Just like those horrible baggy jeans.