Pharmaceutical politics
The Senate ties itself in knots over cheaper drugs from Canada
Given the odorously partisan nature of the national political climate, it is something of a stunner to find an issue that can live up to any claim of bipartisan support. But after a long-running battle, a surprising consensus has emerged in Congress around a controversial effort to allow individuals and businesses to import prescription drugs from Canada and other countries where they are generally cheaper than in the United States.
What other issue can bring liberals like Ted Kennedy and Hillary Clinton together with conservatives like Trent Lott and contrarians like John McCain? "The reason this is so popular in Congress is that it is so popular in the country," says Barry Piatt, a top aide to Democratic Sen. Byron Dorgan, who is spearheading the effort to legalize drug importation. A recent survey of Medicare recipients showed 79 percent of them supported changing the rules to allow Americans to buy cheaper drugs in other countries, chiefly Canada.
The problem, of course, is that powerful countervailing forces--the Bush White House, the influential pharmaceutical lobby, and its allies on Capitol Hill--are steadfast in their opposition to any change. So the bottom line is this: As Congress seeks an exit from Washington in the weeks before the election, drug importation looks like a loser. And its dim prospects provide powerful testament to the complicated political alliances that often carry the day in the nation's capital.
There's no doubt that the cost of drugs is an important issue for consumers. Many of these drugs are manufactured in the United States but sold more cheaply abroad, where they are subject to government price controls. A congressional study found that a 90-day supply of the cholesterol-lowering drug Lipitor costs about $320 in the United States, compared with about $180 in Canada. "On average brand-name drug prices charged by manufacturers, wholesalers, and retailers were higher in the United States by about 70 percent," the study concluded.
Sabotage? "It's an outrage what's going on," says Dorgan. "The American consumer is charged the highest price for prescription drugs in the world." A drug importation measure passed the House in July 2003, over the objections of GOP leaders there. Now senators on both sides of the aisle are accusing Senate Majority Leader Bill Frist of sabotaging the effort--and doing the White House's bidding--by refusing to schedule a vote on a similar bill in the Senate. In mid-September, a half-dozen senators--including Republicans McCain, Olympia Snowe, and Lincoln Chafee--sent Frist a letter pleading with him to schedule such a vote.
The Bush administration says that importation would allow unsafe drugs into the country. "It would expose Americans to greater potential risk of harm from unsafe or ineffective drugs, would be extremely costly to implement, and would overwhelm the FDA's [Food and Drug Administration's] already heavily burdened regulatory system," the administration said in a statement last year, opposing the successful House measure. Bush administration officials say the president is also concerned that importation could alter the free market in part by channeling more drug sales through countries with price controls. As for the level of public support for importation, a White House official says the president "doesn't make policy based on polls."
For his part, Frist, the Senate's only physician, says safety is his chief concern. "Senator Frist feels very strongly that until you can do this safely, it is not something you can bring to the floor," says Frist spokeswoman Amy Call. In response to the charge that Frist is carrying water for the White House and the drug lobby, Call says, "I think that really underestimates Senator Frist and his abilities."
Backers of importation say a carefully crafted bill could guarantee the safety of the drugs. What's really going on, they say, is big-money politics. "I'm afraid it might be that simple," says Senate Minority Leader Tom Daschle. "The big drug companies have convinced some of our Republican friends that they don't want this bill to come up, and so the Republican leadership won't let it come up."
Even some Republicans, like Iowa Sen. Charles Grassley, chairman of the Senate Finance Committee, joined in the criticism of Frist. "It is my presumption that he is doing everything he can to keep the bill from being [brought] up for a vote," says Grassley, who has a reimportation proposal of his own. "If it was up, it would pass 75 to 25."
Big money. Over the past five years, pharmaceutical and other healthcare companies have contributed more than $67.5 million to political campaigns, about 60 percent to Republican candidates and causes. Frist has been one beneficiary. Since 1999, pharmaceutical or health product companies' employees or political action committees are No. 4 on his list of industry supporters, having ponied up at least $123,000, according to the nonpartisan Center for Responsive Politics.
"The question you always have to ask in politics is 'Who do you stand with?' " says Senator Dorgan of North Dakota. "The White House and the Senate leadership answer it this way: We are on the pharmaceutical industry's side. We are not on the side of the American consumer."
Supporters of the bill are now searching for ways to get the measure passed in the Senate before Congress breaks for the year, but they are facing long odds and a tight schedule. Democrats also concede that this election battle is not being fought on terrain they would choose. "The war in Iraq is so overwhelming that nothing else is getting through," says former Democratic Rep. Barbara Kennelly, who now heads the National Committee to Preserve Social Security and Medicare. "If it wasn't for the war, this would be the issue." But with more and more Americans wanting cheaper drugs from Canada, this issue looks to have some staying power.
This story appears in the October 11, 2004 print edition of U.S. News & World Report.