Drug-price controls would hurt, not help, consumers
By: John A. Baden, Ph.D. Robert EthierPosted on April 27, 1993 FREE Insights Topics:
THE president and Hillary Rodham Clinton are selling the outlines of their health-care program to the nation. We have been told to expect many good things from it. Universal access, coverage of pre-existing conditions and expanded basic care would benefit many people. But it is likely that fully implementing a nationalized health-care plan will cost between $50 and $100 billion per year.
Expanding access and coverage conflicts with the desire to trim the nation's health-care bill. But the president feels pressure to "do something" about costs of health care. The pharmaceutical industry is an obvious and tempting target.
The drug industry is vulnerable to attack for several reasons. It has been consistently profitable, with returns as much as double those of the rest of manufacturing. Most prescription drug cost are paid directly by patients, making price increases immediately apparent. And the patent protection provided to new drugs creates an effective temporary monopoly, at least to the extent that a drug's properties are not duplicated by other drugs on the market.
All of this makes drug companies an easy target for government intervention: Some people claim we need price controls to protect the consumer. And what consumer would not like drugs to be cheaper? (Even though prescription drugs account for only a nickel of every health-care dollar, and thus have only a small impact on overall health-care costs.) But more importantly, there are several good arguments as to why price controls would hurt, not help, consumers.
Consumers care about more than just low prices. In the drug market especially, they are served by innovative new products with greater healing properties. That is the trade-off: prices versus innovation. We could have a constrained drug market with low prices and protracted negotiations between companies and the federal government over prices that may be charged for new drugs. But most people would prefer an innovative market with many new, and presumably more helpful, drugs.
It is the profits on new, successful drugs that prompt the intensive research and development to find the next generation of miracle cures and therapies. New drugs are expensive to develop, costing an average of $231 million each in 1987. Of these, only three in 10 break even.
So a successful drug must pay for its own research, as well as the research on the unsuccessful ones on which the company also risked money. In addition to the high emotions of illness, it is this risk and expense that make the drug industry so special. And the high risk explains why the government awards 14-year patents on new drugs. This gives the makers time to recoup their tremendous development expenditures before their research is copied and generic alternatives are offered.
Price controls would take away the monopoly advantages of patent protection and undermine the incentives for research that patents were designed to provide. As an academic report on Medicaid and Medicare drug price controls not-so-succinctly put it, the revenue decline to drug companies resulting from price controls "can be expected to negatively influence the expected returns on new drugs and to decrease the cash flow available to undertake R&D."
Price control enthusiasts will argue that it will be possible to hold down prices, but not so low that it undermines research. But this faith in the ability of regulators to control the market is not supported by our experience with regulation and price controls elsewhere. Medicaid and Medicare efforts to control the price of drugs and services caused cost-shifting to unregulated health-care payers. But industrywide price controls will prevent such shifting, leading to shortages and black markets.
There were similar results during the Nixon-era price controls of 1971-74, as regulations and regulators multiplied while trying in vain to keep pace with the market's ability to circumvent price controls.
As with the rest of the health-care program, we have only been told about the benefits of price controls on drugs. What is hidden are the harder-to-quantify but still real constraints upon innovation and new drug development.
If we do not understand the logic driving the system we are likely to take well-intended actions that have perverse consequences. Unless we are sensitive to the importance of incentives to innovation, we can be sure that some important drugs will not be developed or introduced because of drug-price controls.