The “Other” Election Debate about Single-Payer Health Care

Stop me if you’ve heard this one before: There’s a national election going on, and single-payer health care is one of the prime points of contention. It’s not what you think.

Voters in Great Britain head to the polls on Dec. 12 in the country’s third general election in just more than four years. The ongoing Brexit debate, about whether or how Britain will leave the European Union, necessitated the early election. With his Brexit agreement with the European Union bogged down in Parliament, Conservative Prime Minister Boris Johnson felt the need to go to the country, to obtain a mandate to push the deal through.

But health care has also taken a prime place in the campaign. The Labour Party, led by Jeremy Corbyn, have raised the specter of the Conservatives “putting the National Health Service up for sale” to reach a post-Brexit trade agreement with the United States.

The issue of the NHS’s status in a U.S.-U.K. trade agreement came up during President Trump’s state visit to Britain in June. In a press conference with then-Prime Minister Theresa May, Trump originally said “everything with a trade deal is on the table,” only to walk those comments back one day later. With the president due back in London on Tuesday for a NATO summit, and Labour trailing in the polls only a week before election day, Corbyn will doubtless make the issue a focal point of Trump’s visit.

Drug Pricing Issues

Last week, a series of government documents leaked that summarized preliminary trade discussions between American and British negotiators. Corbyn waved around heavily edited versions of the documents at his first debate with Johnson earlier this month. Government officials had redacted large swathes of the documents, to preserve the sensitive nature of the trade talks, but those discussions escaped into public view via the unauthorized leak.

The leaked documents confirm that drug pricing remains a prime point of contention regarding a U.S.-U.K. trade deal. One document, summarizing a series of meetings held in July, includes a lengthy section entitled “Intellectual Property: Patents and Pharmaceuticals.”

Britain’s Channel Four reported in October that two linked issues drive the talks. First, American negotiators prefer the United States’s longer period of data exclusivity as part of any Anglo-American trade agreement. This policy would seek to preserve incentives for innovation, allowing manufacturers to maintain their exclusive intellectual property for longer periods of time.

Britain Wants to Keep Rationing Health Care

Second, the American side “want[s] to remove the UK’s ability to block American drugs not deemed ‘value for money.’” The BBC notes that Britain’s National Health Service relies on the National Institute for Health and Care Excellence (NICE) “on what offers the best benefits for patients balanced against value for money:”

The NICE regime, introduced 20 years ago, is seen as a great success in helping the NHS strike realistic pricing deals. A recent deal for the cystic fibrosis drug Orkambi was hailed by health leaders in England as a big win for the system, with the American manufacturer Vertex, having initially refused to bring down its price, eventually signing up.

However, the BBC neglected to mention that, as part of its “negotiations” with the manufacturer Vertex, NICE denied thousands of British patients access to Orkambi for more than three years, because the drug exceeded cost limits set by the government body.

It seems somewhat ironic that in October, a spokesman for Britain’s Department for International Trade told Channel Four that the British government “could not agree to any proposals on medicines pricing” that would “reduce clinician and patient choice.” For the past three years, patients had no choice for accessing Orkambi—bureaucrats called the drug too expensive, therefore British cystic fibrosis patients could not receive it.

End Foreign Freeloading

Britain’s drug pricing policies cost American and British patients alike. British patients pay when they cannot get access to treatments the government deems too expensive, and their health suffers as a result. And American patients pay when Britain, like other European nations, free rides on American innovation—allowing U.S. consumers to pay far more for pharmaceuticals, absorbing a disproportionate share of drugs’ research and development costs.

U.S. House Speaker Pelosi and others have suggested importing socialist-style price controls to the United States to “solve” the free-rider problem—a variation of the “If you can’t beat them, join them” approach. But a better solution would involve American negotiators taking up the issue of foreign freeloading with other governments as part of trade talks—the exact policy pursued as part of the U.S.-U.K. discussions.

Trump’s visit to London so close to Britain’s election has prompted speculation about its political ramifications. Johnson has warned Trump not to endorse his re-election bid, fearing it may only encourage Britons to vote for his Labour opponents instead.

But on policy, the United States absolutely should work to stop foreign free-riding over pharmaceutical prices. Moreover, we would do the British people no small favor if, in the process of ending that free-riding, we could stop that country’s health care system from denying patients access to life-saving treatments that a government board deems too costly.

This post was originally published at The Federalist.