Oncologist and bioethicist Dr. Zeke Emanuel discusses the ongoing debate over the Affordable Care Act, his ideas on regulating drug prices and the reforms that he believes could transform the way health care is delivered.
On the regulation of drug prices in the US: “On a per capita basis in the United States we spend $1443 roughly, per person, for drugs. You go to the next highest country that is Switzerland, it is $939.... And it is not because we get more prescriptions in the United States per capita. On average our prices are 56% higher than European and others. They are just way high. The simple way to understand this is we give drug companies monopoly rights. We give them monopoly rights through patents and FDA marketing exclusivity. And then we basically say, set the prices. Well what is a monopolist going to do when they are given rights to set the prices? They are just going to raise the prices until you get to the tipping point of profits. And every other country says, yes we are going to give you a monopoly but we are also going to regulate the drug prices. They do it in many different ways. And by the way, not all of them do it through the government. Some of them do it through private organizations.… We are going to get to the right solution. We are going to have to regulate drug prices…. I think it is going to happen early in 2021 and I think it will be a good thing for the country.”
On his thoughts on the overutilization of medical care: “About a decade ago, the National Academy of Medicine estimated that unnecessary care is at least $150 billion. That was in 2009 dollars. [It’s] well higher than that today. But it's also the case that once you do a test…[there’s a] one in 20 chance that something comes up positive just random because that's our cutoff for most of these things. Well, even if you don’t have anything wrong, it might turn out to be positive. Then we chase it. We do a biopsy. We do an additional MRI. And things happen. As I like to say, there's no medical procedure that doesn’t have some adverse consequence. Even the simple things like drawing blood has adverse consequences and you do it on enough people; a lot of people [could] have adverse consequences.”