People may care as much about the cost of prescription drugs these days as they do about getting a good deal on a car. They're up against the breathtaking drug costs a lot more often.
At least they can talk to the car salesmen. Even if we're not good at numbers, we probably get a better deal when we haggle. With cars, it's accepted as the American way.
So, what if we could bargain a little on the cholesterol meds? And what if the state came onto the showroom floor (as it were) to strengthen our hand? Couldn't hurt.
A bill that that would have allowed states to intervene on behalf of low-income consumers was offered five years ago by then-Sen. Paul D. Wellstone, Democrat of Minnesota. When he was killed in a plane crash, his bill effectively died with him.
Since then, as health costs increase for everyone and as concern rises for the millions with no health insurance, others have picked up the Wellstone banner, and prospects for passage may be improved. Heavy pressure is being exerted by state governments anxious to help low-income workers stay off the budget-busting Medicaid rolls.
Pushed by groups like Health Care For All, Maryland and several other states recently passed laws that would have allowed them to use the bulk buying power available for Medicaid purchases to negotiate prices as much as 40 percent lower than the sticker price. Then-Gov. Robert L. Ehrlich Jr., a Republican, signed the law, but it couldn't be used unless the federal government issued a waiver of regulations preventing the practice. Mr. Ehrlich requested the waiver, but it wasn't granted.
Thousands of Marylanders would have been helped by the bill.
Now, though, a measure similar to the one proposed by Senator Wellstone - requiring no waiver - is pending in the House of Representatives. Maryland's Rep. Chris Van Hollen is the sponsor. His bill would allow Maryland and all the other states to negotiate reduced prescription drug prices for low-income families - those earning less than three times the federal poverty level of $20,650 for a family of four. Patients would get discount cards for use at the drugstore.
The reappearance of this idea in Washington comes with several arresting political ironies. It proposes to allow states to make their own deals with the drug companies, pushing aside a Republican administration's opposition. There was a time when Republicans were major proponents of letting states make their own decisions.
Irony No. 2 involves Florida and its governor, Jeb Bush, the president's brother. Governor Bush was granted a waiver to negotiate lower prices for drugs provided under Medicaid, the state-federal anti-poverty health program. Though they may have been unhappy about the Jeb Bush precedent, the federal government had little choice but to allow every other state to follow Florida.
Mr. Van Hollen expects opposition from the drug manufacturers, whose lobby in Washington is as muscular as any. But he said he's optimistic the bill will be passed.
The atmosphere for passage of the bill may be improved by Michael Moore's movie Sicko, which points out deficiencies in the health care system - particularly in comparison with systems in other countries. The film made a point of suggesting that change is blocked because the drug companies have spread around large amounts of political campaign contributions. Some senators and congressmen may feel beholden to their drugmaking contributors.
"This is an issue that we can bring a majority of members together on," Mr. Van Hollen said. "The power of that drug lobby has been diminished since we got a new Democratic majority in Congress."
It's a worthy effort, to be sure. But the bill is another palliative, a reflection of the failure of government and industry to find a comprehensive way to contain medical costs, provide insurance for all and keep drug bills from rivaling the monthly car payment.
C. Fraser Smith is senior news analyst for WYPR-FM. His column appears Sundays in The Sun. His e-mail is firstname.lastname@example.org.