National Nurses United

them to effectively close their discount program when too few manufacturers voluntarily lower their prices," wrote a coalition of senior, consumer, and good government groups in the voter information pamphlet. "Make no mistake, this provision was in- cluded by the drug companies so they can end the program at any time and protect their profit margins." The same thing happened to a 2001 program called the Gold- en Bear State Pharmacy Assistance Program, where 500 drug manufacturers were invited to give voluntary discounts to Cali- fornia's seniors, but only 14 companies participated. According to the Kaiser Family Foundation website, the program stopped operating at the end of 2002. Perhaps what's most important about Prop. 78 isn't what it doesn't do, but what it does do. The way it's written, the measure effectively blocks the creation of more aggressive drug discount programs in the future. According to the initiative language, all amendments to the law require a two-thirds majority of the State Legislature—a near-insurmountable task requiring Republican support—and must further and be consistent with the law as it already exists. What if California decided in the not-so-distant fu- ture that the voluntary program wasn't working and should be made mandatory? Under this language, that couldn't happen be- cause it would conflict with the voluntary nature of the law. It's a Catch-22 situation for which drug companies are more than happy to pay upwards of $100 million. The Pharmaceuti- cal Research and Manufacturers of America (the industry's heavyweight lobbying and trade group that famously employs more drug lobbyists to influence Capitol Hill than there are con- gresspeople) has kicked in almost all of this amount. They in turn get these funds in astronomically-large chunks directly from the drug companies: $4.5 million each from Abbott Laborato- ries, Amgen, Astrazeneca, Bristol-Meyers Squibb, Eli Lilly, No- vartis, and Wyeth, and almost $10 million each from Glaxosmithkline, Pfizer, Johnson & Johnson, and Merck—and that's just as of August 20. Part of that huge war chest is to pass Prop. 78, while part of it is to defeat Prop. 79, a rival drug discount initiative sponsored by some well-meaning consumer groups that's also on the bal- lot. Prop. 79 would also discount drugs, but for people at or below 400 percent of the poverty level, and bar companies that refuse to negotiate discounts from selling drugs through the state's Medi- Cal program. It would also expand the right to sue drug makers for "profiteering" from drug sales. If both measures pass, the one with the most votes will win. While Prop. 79 is well intentioned, proponents of more ag- gressive prescription drug and healthcare reform do not believe it goes far enough, and is a piecemeal approach to a problem that requires a comprehensive and systemic proposal. For all these reasons, CNA is advising no votes on both 78 and 79. Lucia Hwang is editor of California Nurse. ican public from taking a closer look at why we tolerate such high drug prices while our Canadian neighbors to the north enjoy typically much lower prices negotiated through their national healthcare system. The program would also temporarily placate the public and defuse the growing threat by state lawmakers around the country that they'll pass legislation mandating lower prices. Eventually, opponents of Prop. 78 say, the companies will let the program wither away as they pull out of the program, or as the public pulls out after realizing they are not seeing much savings on their drug bills. "The drug lobby buried a provision in Prop. 78 that allows Feature Story THE BIG GLITCH IS THAT THERE'S NO RULE THAT PHARMACEUTICAL COMPANIES MUST PARTICIPATE, NO REQUIREMENT THAT DISCOUNTS ACTUALLY BE OFFERED, AND THERE ARE NO CONSEQUENCES FOR FAILING TO DO EITHER OF THESE. The Nov. 8 special election is conservatively project- ed to cost more than $250 million, after the price of conducting the election, the cost of television ads, radio ads, print ads, mailers, campaign consultants, phone banking, and a host of other campaign activities (by both sides) is totaled. How could this money have been better spent? Here's a look at what $250 million could have paid for: ✔ 4,813,246 prescriptions in California at an average price of $51.94 ✔ 98.7 percent—almost all—of the state of Alabama's mental health expenditures ✔ the construction of 1,250 new homes at $200,000 a house ✔ 11,363 aortocoronary bypass surgeries, at $22,000 per surgery ✔ 3,735 California RNs at the state's average salary of about $67,000 ✔ 182,347 hospital days for the nation's patients, at average daily cost of $1,371 ✔ 250,000,000 bottles of drinking water for Hurricane Katrina survivors at $1 a bottle ✔ the full, remaining cost of shoring up New Orleans' levee system prior to Hurricane Katrina, according to reports in the Times-Picayune What Else Could We Have Bought for $250 Million? 8 O C T O B E R 2 0 0 5 C A L I F O R N I A N U R S E

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