After garnering little discussion and even less governmental concern over the past several years, America's opiate problem — a problem that, based on the numbers, deserves the label epidemic — is finally reaching public consciousness.
"The majority of drug overdose deaths (more than six out of ten) involve an opioid," according to the Centers for Disease Control and Prevention. "And since 1999, the rate of overdose deaths involving opioids (including prescription opioid pain relievers and heroin) nearly quadrupled."
Last week, CNN held a town hall at which victims of the opioid epidemic and their families spoke of their hardships and asked medical professionals, who were positioned across from the moderator, Anderson Cooper, what can be done to mitigate the problem.
But town hall meetings, while important for raising awareness, will do little in the face of an intransigent Congress dominated by ideologues who have shown themselves to be deeply committed to blocking even the most basic of procedures. As Norman Ornstein observes in The Atlantic, Congress has been dragging its feet on the opioid crisis just as it has with other devastating public health issues, from Zika to Flint.
These crises are, in the words of Ornstein, a conservative, "crying out for a sharp and focused response from the federal government."
"The opioid crisis has resulted in widespread debilitating addiction and many deaths from heroin and painkillers," Ornstein adds. "Congress’s response last month? Go on recess without dealing with them."
On the surface, though, it seems that Congress is finally waking up and taking steps toward a potential solution. As a New York Times editorial pointed out on Monday, "The House last week passed 18 bills related to opioids, and the Senate approved a comprehensive bill in March."
But this is far from enough.
The editorial adds: "The question now is whether Congress will appropriate enough money to address the scale of the problem. Democrats are seeking $600 million, and President Obama has asked for $1.1 billion. Republican leaders have not said how much they would be willing to spend, but insist that the total be offset by reductions in other programs or increases in revenue."
Phrased differently, and more bluntly, the question is: Will a Congress dominated by deficit hawks and bankrolled by corporate America be willing to put forward money that assists the public, and not just their beloved special interests?
"The country is facing a health emergency," the Times editorial continues, "and it would be tragic if a self-imposed budget rule got in the way of a robust federal response."
This "self-imposed budget rule" is more sinister than the Times implies: It is not merely a reluctance to allocate money to important causes, like the treatment of drug addiction. It is also a deep commitment to providing corporate America with unhindered access to the public trough.
While Congress hesitates and waffles, the pharmaceutical industry, whose powerful painkillers are often the source of the deep addictions ravaging communities and destroying families, continues to be lavished with federal subsidies — direct and indirect — and preferential treatment. Yet this taxpayer money is hardly mentioned by those outraged by the prospect of putting forward funds to deal with a public health catastrophe.
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America's political elites are, in short, perfectly happy to allocate taxpayer funds to pad the profits of large pharmaceutical corporations — corporations that comprise one of Washington's most prominent and influential lobbies — but they are unwilling to pay for the effects these companies' products are having on the population.
But less understood is the fact that, as Mariana Mazzucato observed in the Los Angeles Times late last year, taxpayers also happen to fund the development of these same drugs.
"Big Pharma, while of course contributing to innovation, has increasingly decommitted itself from the high-risk side of research and development, often letting small biotech companies and the NIH do most of the hard work," Mazzucato notes. In other words, the costly side of business has been pushed onto the lap of the public while the profits remain private.
An instructive case is that of the cancer drug Taxol, which was developed using taxpayer money and then handed over to the pharmaceutical giant Bristol-Myers Squibb, which sold $9 billion worth of the drug worldwide. Medicare then proceeded to pay "nearly $700 million over a five-year period, to buy a drug the government helped develop," according to a report by the General Accounting Office.
"But if Big Pharma is not committed to research, what is it doing?" Mazzucato asks. "First, it is well known that Big Pharma spends more on marketing than on R&D. Less well known is how much it also spends on making its shareholders rich. Pharmaceutical companies, which have become increasingly 'financialized,' distribute profits to shareholders through dividends and share buybacks designed to boost stock prices and executive pay."
Mazzucato concludes that it is, essentially, a "long con," a "parasitic" relationship between the public and private sectors in which pharmaceutical companies, taking advantage of their influence in Washington, reap the benefits of public funding without having to pay their fair share. In other words, the public is subsidizing the rich.
And it is not just the pharmaceutical industry that is granted such privileges, but corporate America broadly.
Banks that bring down the economy are rescued and insured by the government, and no one is held accountable. Oil companies, including those that, on multiple occasions, have been guilty of systematically violating environmental regulations, are the recipients of huge tax breaks and federal subsidies, year after year. Military contractors with a history of over-billing the government continue to be lavished with grants and no-bid contracts.
While the blatant disregard for public health that members of Congress have shown in their feeble attempts to address the opioid epidemic is striking, it is not unpredictable. Elite sectors of the population hold a virtual monopoly on policy decisions: If economic and political elites are opposed to a proposal — like, say, spending $1 billion in an attempt to tackle a public health crisis — its likelihood of passing is close to zero. "The preferences of the average American," write the political scientists Martin Gilens and Benjamin Page, "appear to have only a miniscule, near-zero, statistically non-significant impact upon public policy."
Why should our expectations differ in the context of the opioid epidemic?
And America's politicians seem more than happy to enable this dependency at the expense of the public. We should be outraged. But we should not be surprised.