Health Care Reform and Its Impact on Health System Pharmacy

Mr. McAllister is a health-systems consultant based in Chapel Hill, North Carolina.

Regardless of your political leaningsor preferences, we nowknow that President-electBarack Obama made some substantialcampaign promises regarding healthcare reform. Being from a "swing state,"I was really tired of the incessant televisionads and telephone calls, but nowthat we have chosen a new leader, it istime for all of us to get behind the newadministration in bipartisan supportand do whateverwe can to help ourcountry overcomethe many challengesthat faceus all. I think thatmost of us agreethat the economyis our top nationalpriority, but the strategies and actionsimplemented to improve our financialsystems will in turn impact health carereform.

I was encouraged to read about theUS Government Accountability Office(GAO) launching a new Web site intendedto "serve as a resource to assist withthe transition to a new Congress andadministration." The Web site (www.gao.gov/transition_2009) is certainlyworth a visit, but I was disappointedin the listing of urgent policy concernsthat the GAO considers "critical andtime sensitive and require prioritizedfederal action." Of the 13 urgent policyconcerns, only caring for service membersand preparing for public healthemergencies were directly related tohealth care. The Web site does containmany other categories that areextremely relevant to health care, witha plethora of information available foryour review. As daunting as my cursorysurfing session on the Web site was forme, I cannot imagine how a new presidentand administration will get theirarms around all the information.

Reform will be slow because theeconomy and our global conflicts willbe much higher priorities, but undoubtedlysome incremental changes willtake place. In addition, changes madein tax code, employment, and evenglobal conflict issues will indirectlyimpact health care. During his campaign,Obama suggested that hisadministration will focus on establishinga national health insurance program,requiring more employers to providehealth insurance, and expandingMedicaid and children's health insuranceprograms. Making even a portionof these changes in the near termseems unlikely, whereas the financialimplications of such changes wouldprobably worsen the economy, unlesssubstantial cost-saving initiatives aremade concomitantly. I suspect insteadthat the new administration will makesmall incremental changes in pursuitof its goals. It is widely recognized thathealth care spending at our currentrate is unsustainable, and the statisticsbear that out, so dramatic changes areunlikely.

I anticipate that the FDA will beput under a microscope, and changeswill be made. Given the numerousquality- and integrity-related issuesthat have arisen regarding importeddrugs, chemicals used to manufacturedrugs, and several recalls of drugswith dangerous side effects, the FDAwill be under pressure to improve.Hopefully, improvements can be madewith additional scientific resourcesand new public/private partnershipsto contribute to achieving the missionof the FDA.

Drug manufacturerswill be pressuredto reducedrugprices, especiallyforgovernment-sponsoredprogramssuch as MedicarePart D. The genericdrug industry mayenjoy efforts to promote competitionand perhaps even incentives to expandthe availability of generic "biotechnology"drugs. Drug importation will likelynot be relaxed to stimulate competitionin light of quality disasters like contaminatedheparin that struck the US marketduring the past year.

I do not pretend to be a soothsayer,but it is undeniable that a change inadministration, especially after promisesof dramatic government changethat were made and now are expectedby the public, will produce someresults. It is up to you and the professionof pharmacy to be agents ofchange rather than continue to reactto recommendations from others.What do you think?