A big pill for healthcare to swallow

By Laura MacCleery and Zachary Proulx | December 22, 2008

PRESIDENT-ELECT Obama has promised a system of universal healthcare, but enacting one will be far more difficult than it should be. Even with change coming to America, drug companies and other high-spending special interests will keep buying their way onto Capitol Hill if other things don't change first.

The drug companies have mastered the art of purchasing favorable results. In the same election cycle that brought record presidential fund-raising from grassroots donors, the pharmaceutical industry contributed over $22 million to members of Congress. It hedged contributions evenly between the Republican and Democratic parties for the first time in nearly 20 years. Pfizer, a longtime donor to the GOP, is now doling out 51 percent of its campaign contributions to Democratic candidates.

Massachusetts's Department of Public Health has recently proposed regulations to address the influence of drug companies by limiting their payments and gifts to doctors. As critics note, however, the proposal would exempt disclosure of payments to doctors for research and related activities - a stipulation the drug industry lobbied for - which could leave open windows for more foul play.

An investigation launched last year by Republican Senator Charles Grassley of Iowa found government-funded physicians at universities like Harvard and Emory have frequently failed to disclose consulting receipts, stock holdings, and other conflicts-of-interest with drug makers as they research and discuss products. Grassley's investigators found that the former director of the National Institute of Mental Health, Dr. Frederick Goodwin, had failed to disclose at least $1.3 million in income from marketing lectures for drug companies while advocating for their products on his NPR program "The Infinite Mind."

Medical journals have been similarly affected. A British Medical Journal article from 2003 reviewed 30 studies published in journals and found that a "[s]ystematic bias favors products which are made by the company funding the research," and the pharmaceutical company Wyeth was just exposed for paying ghostwriters to publish journal articles.

Whatever shape Massachusetts's regulations take, national healthcare reform has still a bigger pill to swallow, for drug makers also invest, systemically and opportunistically, in politicians. Healthcare PACs do too - they increased donations to Democrats in the latest election cycle by more than 50 percent compared with 2006, according to Congressional Quarterly.

So long as lawmakers need contributions to get reelected, the drug lobby and other special interests will give them, and expect a return on their investment. The only way out of this endless cycle is to dismantle the access-for-favors system and take a different approach to campaign finance.

Public financing of elections would provide a solution, by supplanting private campaign donations with public money and giving lawmakers a shot at legislating beyond the shadow of their donors.

In Maine, for example, state legislators attribute the success of a 2003 healthcare reform effort to public financing. In Arizona, Governor Janet Napolitano, who received public funding for her 2002 and 2006 gubernatorial campaigns, credits public financing with allowing her to offer prescription drug discounts to seniors and the disabled on her first day in office - a program expanded to all Arizonans in 2006.

Just as doctors are courted by drug makers, we have to stop pretending that public officials are immune to the enticements of financial incentives. Our politicians may come to Washington to make change, but they cannot in the current system. Public funding of elections would stop the game of "let's pretend" and allow members of Congress to be both interested in their own political survival and public-spirited.

Kudos to Massachusetts for pursuing what it says will be the strictest law in the country on gifts to doctors and disclosure requirements. Perhaps now it's time we take a page from the pharmaceutical companies' playbook and give elected officials financial incentives that will let them truly serve the public. A public funding system for members of Congress may be the best shot at making real the changes we've been promised.

Laura MacCleery is deputy director of the Democracy Program at the Brennan Center for Justice at NYU School of Law. Zachary Proulx is a research associate at the Brennan Center.

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