ABSTRACT
Once a year, the Washington Post publishes a map of the District of Columbia that shows the physical location of all the interest groups (lobbyists) that are located there. A newcomer to the District of Columbia might surely be astonished both at the great number of these interest groups that actually do exist and that are represented there. He or she might even become more astonished if he or she knew the amounts of money these interest groups spend in pursuing their individual economic interests. Such organizations range in character from the American Bituminous Coal Association to the AARP (formerly known as the “American Association of Retired Persons”). To be sure, health care provider interests are also well-represented (to name only a few of the prominent organizations: the American Medical Association, the American Nursing Association, the American Hospital Association, the American Dental Association, the Blue Cross-Blue Shield Association, the Health Insurance Association of America, and the Pharmaceutical Research and Manufacturers of America). There are two important reasons why the headquarters of all of these trade associations are located in Washington, DC: (1) this city is the locus of national political power, and (2) political decisions made here determine how the large sums of federal fiscal appropriations each year will be spent on the allocation of resources into particular economic sectors, and consequently, upon the incomes of all of the participants in these same sectors. Therefore, in analyzing public policy,
it must be remembered that for every proposed change in the pattern of government expenditures, there will also be a consequent change in some peoples’ incomes. And that is why health care reform is so difficult to achieve, because for each amount spent on health care expenditure, there is a health care income. Reform implies changing the pattern of expenditures, which in turn, changes the pattern of health care incomes.1 Such considerations raise two issues, (1) What can theory tell us about how the political process works for public-policy concerns? and (2) how can theory be applied to pharmaceuticals?
