来源：《彭博商业周刊》
原文刊登日期：2022年2月11日
As talks continue on what might be salvaged from President Joe Biden’s stalled tax-and-spending plan, one of its smaller pieces is worth singling out — a plan to cut the prices Americans pay for prescription drugs. As it stands, it’s a good first stab, but Mr. Biden should press further. Doing so would serve the public and strengthen the president’s popular support.
随着挽救乔·拜登总统停滞不前的税收和支出计划的谈判继续进行，其中一个较小的部分值得挑出来，那就是降低美国人支付的处方药价格。就目前的情况来看，这是一个不错的第一步，但拜登应该进一步施压。这样做既能服务于公众，也能加强总统的民意支持。
The existing system must strike any outside observer as absurd. U.S. pharmaceutical companies charge their domestic customers vastly more than they demand of buyers in the rest of the world. And Medicare is expressly barred from doing what foreign equivalents take for granted: using its bargaining power to get better prices.
现有的体系肯定会让任何外部观察者感到荒谬。美国制药公司向国内客户收取的费用远远高于向世界其他地区买家收取的费用。而且，Medicare也被明确禁止做外国同行认为理所当然的事情：利用其议价能力来获得更便宜的价格。
In short, producers are granted government-enforced monopolies for new drugs and are generously assisted by research carried out at taxpayers’ expense — yet the U.S. suspends this public-private partnership at the point of sale. This leaves manufacturers free to maximize their profits, with their most powerful customer's hands tied, rendering treatments unaffordable for many of the people who need them.
简而言之，制药商被授予由政府强制执行的新药垄断权，并得到由纳税人出资进行的研究的慷慨帮助——然而，美国在药品销售时暂停了这种公私合作关系。这使得制药商可以自由地最大化利润，却束缚了它们最强大客户的手脚，使得许多需要这些药治疗的人负担不起费用。
To sustain it, the industry invests heavily in Washington, securing the support of Republican and Democratic lawmakers alike. Earlier plans for pricing reform were sharply scaled back in the version of Build Back Better passed by the House in November. The current proposal calls for Medicare to negotiate, in the first instance, the price of just 10 drugs, with the stipulation that new drugs won’t be included. An earlier version had up to 250 in its sights.
为了维持这一局面，制药行业在华盛顿大举投资，以获得共和党和民主党议员的支持。早前的价格改革计划在11月众议院通过的“重建更好”版本中大幅缩减。目前的提案要求Medicare首先就10种药物的价格进行谈判，并规定新药不包括在内。早期版本的目标是250个。
Still, it’s a start. It would save $80 billion over 10 years, according to the Congressional Budget Office. More important, it would establish the principle that Medicare can press down on drug prices without causing the industry to collapse.
不过，这只是一个开始。根据国会预算办公室的数据，这将在10年内节省800亿美元。更重要的是，它将确立一个原则，即Medicare可以在不导致制药行业崩溃的情况下压低药品价格。
Critics say the changes would reduce the companies’ revenue and profits. True: That’s the idea. And they say this would affect future innovation. So it might. The CBO reckons that one fewer drug would come to market in the first decade after the bill’s passage, and nine fewer over the following 20 years. But the goal can’t be to maximize innovation regardless of cost. The challenge is to get the balance right. As things stand — just look at what America is paying — the balance is far too skewed in the companies’ favor.
批评人士说，这些变化将减少药企的收入和利润。没错，是这样的。他们还说，这将影响未来的创新。确实有可能。国会预算办公室估计，在法案通过后的头十年里，上市的药物将减少一种，在接下来的20年里，将减少九种。但目标不能是不计成本地最大化创新。我们面临的挑战是如何保持平衡。就目前的情况来看——只要看看美国支付了多少——平衡太偏向企业了。
Lawmakers have been induced to look away, but Mr. Biden could use this cause to rally voters, regardless of party, to his side. At a minimum, he should campaign for the current proposal.
议员们被诱使把目光转向别处，但拜登可以利用这一理由来团结选民，把不分党派的选民拉到自己一边。至少，他应该为当前的提案进行宣传。
But it would be better to advance the ball. Broaden the list of drugs whose prices can be negotiated — aiming to make drugs not on the list the exception rather than the rule. Adopt value for money as an explicit factor guiding those negotiations. Counter the effect on innovation by using some of the savings to boost research, especially in the institutes and labs that seed the real breakthroughs. Make the case and dare the industry’s pals in Congress to disagree.
但最好是把事情向前推进。拓宽可以谈判价格的药品清单——目的是让不在清单上的药品成为例外，而不是规则。把“物有所值”作为指导谈判的明确因素。为了抵消对创新的影响，可以将部分节省下来的资金用于促进研究，特别是那些孕育了真正突破的研究所和实验室。拿出这个理由，让制药行业在国会的朋友们不敢反对。