Poor prescriptions

THERE’S NO QUESTION THAT Californians of modest income need help with the high price of prescription drugs. Two initiatives on the Nov. 8 ballot, Propositions 78 and 79, promise to give it to them. Neither one would have much of an effect, and the politics behind these measures are so cowardly that voters could be forgiven for rejecting them both out of pique.

Such irritation is understandable, but there are more coolheaded reasons to vote against these propositions. We recommend a “no” vote on both. The governor and Legislature should work on a better cure for the state’s healthcare crisis.

The Legislature in recent years has considered all manner of plans to make drugs cheaper for people without insurance. Some of these plans were prompted by pharmaceutical companies trying to forestall tougher regulation. Some were proposed by consumer advocates or union lobbyists looking for ways to bargain with or bypass “big pharma.” Such plans regularly died at the hands of special interests (on both sides) or the governor and his veto pen.

The dueling propositions just move this dysfunctional stalemate from the Capitol to the voting booth. Proposition 78, written by the pharmaceutical industry, would enable uninsured residents with low or modest incomes to buy prescription drugs at a discount from any manufacturer that chooses to participate in the program. Proposition 79, backed by labor and consumer groups, would offer a larger discount to more people and would penalize drug manufacturers that refuse to participate. It aims for a 60% to 65% discount, while backers of Proposition 78 say their measure could cut prices 40%.

Had it come from the Legislature, Proposition 78 might have been a good starting point for taming drug prices. In the hands of the pharmaceutical companies, which have spent $80 million on this campaign, it becomes an end result. Its chief flaw is that it is voluntary. Proposition 78’s discounts depend on the goodwill of drug manufacturers. For oversight, it would rely on state officials serving at the pleasure of the governor. It does nothing to insulate the problem it aims to solve from political influence, supposedly one of the purposes of the initiative process.

Proposition 79, meanwhile, enforces its provisions by allowing state officials to remove a drug from the “approved” list of Medi-Cal, the state’s health program for the poor, if its maker refuses to discount it. But this provision is unlikely to be implemented, at least beyond what the state already does. That has been the experience of Maine with a similar plan. Proposition 79 would also cover families up to 400% of the poverty level (compared to 300% for 78), and it includes people with partial drug insurance.

Unfortunately, Proposition 79 overreaches in granting private attorneys the right to sue companies charging “unconscionable” prices without having to produce a client who has been harmed. Californians last year rejected such “private attorney general” suits when they passed Proposition 64, and 79 would chisel away at that reform.

California’s healthcare crisis is all too real. Unfortunately, neither of these propositions addresses it in a practical way.