The Role of Lawyers in Improving Access to Care
Buy Issue for $20 at JHUPMedical practitioners might well think themselves at odds with attorneys: between malpractice threats and the host of regulations a practitioner must comply with, it can seem like the law, and lawyers, mostly hinder the delivery of care. In fact, lawyers and the law play an integral role in facilitating access to care. From arguing for expanded health rights under state and federal laws to prosecuting tobacco companies, lawyers are often on the same side as providers and patients.
Advances in public health, including sewage systems, antibiotics, reduced infant mortality, and the eradication of diseases have contributed to an increased life span for people living in the industrialized world.1 Unfortunately, not everyone, even in highly industrialized countries such as the United States, has access to the best health care. From access to medication to dental health care to issues pertaining to environmental justice, the United States suffers from disparities in health access and outcomes. These medical issues are governed to a large extent by legal and policy regulations.
My interest in health care for the underserved combines my interest in policy, justice and business. Presently, I am a Policy Fellow with the Association of Clinicians (ACU) for the Underserved. The ACU has invited me to share my thoughts about the future of health policy in the United States and the ways the legal community can be an advocate for the underserved.
Attorneys can be an integral part of the transdisciplinary model supported by the ACU, in which clinicians, consumers, and community advocates work together. Lawyers have a role to play in the policy arena to ensure equal access to care and improved outcomes for our community. This can happen in areas as diverse as access to pharmaceuticals and informed consent procedures.
Pharmaceuticals
Currently, national and international law grants pharmaceutical companies exclusive rights to produce drugs. Current United States law also prohibits importation of drugs manufactured overseas, or the reimportation of drugs that have been sent abroad after being manufactured in the U.S. As a practical matter, this means that pharmaceutical companies can set their own prices, without facing competition from overseas [End Page 6] companies. The courts, in 2005, upheld the policy as necessary to protect the safety of pharmaceuticals.2
Nonetheless, legislation has been introduced to allow the reimportation of drugs. One bill limits reimportation to drugs from Canada,3 while the other allows the Department of Health and Human Services to certify that the reimportation would not endanger public health.4 This means that drugs manufactured in the United States could be exported to Canada, then brought back into the United States for sale. Canadian law allows for price controls, so the reimported drugs could be sold at a lower price when they are brought back into the States than they would have sold for originally. Such legislation would allow for a slightly more competitive market, and could bring down the price of prescription medications for Americans. However, a recent report from the Congressional Budget Office has concluded that if there are to be any cost savings for consumers from such loosened regulations, they are likely to be minimal.5,6
Lawyers and lawmakers on a national and local level are moving forward in attempting to reimport drugs. Montgomery County, Maryland, had a short-battle in federal court to challenge the Food and Drug Administration's (FDA's) denial of the county's proposed drug plan. The county had sought an FDA waiver that would have allowed county employees to purchase drugs from Canada. The FDA denied the waiver,7 a decision that was upheld by the dismissal of the county's case.8 Springfield, Massachusetts was the first city in the country to allow reimportation of drugs through its city health plan. During approximately the first year the plan was in existence, the city saved an estimated...
