Stephen Sugarman

(Originally published in the San Francisco Chronicle, March 1, 2009.)

According to the American Medical Association, as many as 150,000 early deaths each year might be saved if Americans were to reduce their salt consumption by 50 percent. Because the sodium in salt raises blood pressure, which in turn increases the risk of heart attacks and strokes, less sodium means better health for many of us.

But merely telling people to eat less salt is unlikely to do the trick. After all, people like salt for its flavor. Moreover, most of the salt we consume is not added in our home kitchens or at the table. Instead, it’s added by food processors to the food we buy in supermarkets and restaurants. We just don’t realize how much salt we’re eating in many products. Although packaged goods today contain standardized information about sodium, it’s easily ignored or misunderstood (cast as it is in terms of portion size and daily recommended amounts).

A more creative way to attack this problem is with performance-based regulation. Continue reading…

Stephen D. Sugarman

To help fund health insurance for children in working-class families, Congress just raised the federal cigarette tax from $.39 a pack to slightly over $1/pack. Both the tax and spending sides of this measure will improve the health of Americans. Future tobacco taxes, however, should be designed to even out the variation that exists from state to state. Ten states impose less than 50 cents-a-pack taxes, while 10 other states tax cigarettes at $2/pack or more.

A good way for the federal government to reduce this difference is to follow the strategy used to fund unemployment insurance. Congress could enact a new $2/pack federal cigarette tax that would be waived to the extent a state’s tax were $2 or more. Surely low-taxing states like Kentucky, Virginia, South Carolina, Missouri, and Mississippi would prefer to increase sharply their own taxes than have their smokers taxed anyway and the money go to Washington.

Not only would the new revenue help those states pay for smoking cessation programs and health care for indigent adult smokers (which might be mandated by the federal government), but reducing the state-to-state tax differential would undermine the moderate but growing problem of interstate tobacco smuggling. Beyond that, an assured nationwide minimum tobacco tax of $3 a pack would bring the U.S. closer to compliance with the Framework Convention on Tobacco Control, the international tobacco treaty already adopted by most nations and which, it is hoped, the Obama Administration will soon convince the U.S. Senate to ratify.

Stephen Sugarman is Roger S. Traynor Professor of Law.

Jacob Hacker

(orginally printed in the Christian Science Monitor, Feb. 3, 2009)

If we heed lessons of the past, we can achieve universal coverage.

The economic stimulus package just passed by the House contains much to jump-start our economy in the next few years. And congressional moves to expand Medicare eligibility and healthcare for children (through SCHIP) are commendable. But these steps still leave largely unaddressed the most fundamental long-term threat to economic security that President Barack Obama vowed to tackle during the campaign: our crumbling framework of medical financing.

Now is the time to fix it. The window of opportunity for comprehensive action is open wider than at any time for decades. But without quick action, it will close, and America’s businesses, workers, and families will continue to suffer at the hands of a healthcare nonsystem that costs far too much, leaves far too many at economic risk, and does far too little to improve our nation’s health. Continue reading…

Michael Pollan

(originally printed in the New York Times Magazine, October 12, 2008)

Dear Mr. President-Elect,

It may surprise you to learn that among the issues that will occupy much of your time in the coming years is one you barely mentioned during the campaign: food. Food policy is not something American presidents have had to give much thought to, at least since the Nixon administration — the last time high food prices presented a serious political peril. Since then, federal policies to promote maximum production of the commodity crops (corn, soybeans, wheat and rice) from which most of our supermarket foods are derived have succeeded impressively in keeping prices low and food more or less off the national political agenda. But with a suddenness that has taken us all by surprise, the era of cheap and abundant food appears to be drawing to a close. What this means is that you, like so many other leaders through history, will find yourself confronting the fact — so easy to overlook these past few years — that the health of a nation’s food system is a critical issue of national security. Food is about to demand your attention.

Complicating matters is the fact that the price and abundance of food are not the only problems we face; if they were, you could simply follow Nixon’s example, appoint a latter-day Earl Butz as your secretary of agriculture and instruct him or her to do whatever it takes to boost production. But there are reasons to think that the old approach won’t work this time around; for one thing, it depends on cheap energy that we can no longer count on. For another, expanding production of industrial agriculture today would require you to sacrifice important values on which you did campaign. Which brings me to the deeper reason you will need not simply to address food prices but to make the reform of the entire food system one of the highest priorities of your administration: unless you do, you will not be able to make significant progress on the health care crisis, energy independence or climate change. Unlike food, these are issues you did campaign on — but as you try to address them you will quickly discover that the way we currently grow, process and eat food in America goes to the heart of all three problems and will have to change if we hope to solve them. Let me explain. Continue reading…

Steven Maurer

Practically all commercial drug development is driven by patents. Unfortunately, this business model assumes a multi-billion dollar market which often doesn’t exist. This is almost always true for developing-world diseases like malaria and dengue fever. Here, patients are so poor that even millions of sufferers don’t add up to a useful market. But inadequate market size is also surprisingly common in rich nations. Probably the most famous example involves orphan diseases that “only” affect a few thousand patients — a category that happens to include most cancers. More generally, rich nation markets repeatedly undervalue goods which (a) have externalities, so that consumers only receive a small part of the product’s overall benefit to society, and (b) are too important to fail, so that consumers calculate that government will eventually supply them gratis. Together, these market imperfections go a long way toward explaining why US companies invest so little in vaccine R&D.

For many diseases, then, patents are not an option. But if patents won’t work, then what? Recent years have seen several high-profile initiatives to fill the gap. The first – and easily the largest – was Congress’s $5.6 billion “Bioshield” program (Public Law 108-276) to promote the private development of drugs and vaccines to fight off a bioweapons attack. Five years on, the program hasn’t delivered a single new product. Bioshield’s defenders like to argue that drug discovery is expensive – about $800 million per drug. By that standard, though, the program’s $5.6 billion budget should funded seven new drugs. The real problem, as critics have repeatedly pointed out, is that Bioshield got the incentives wrong. “Wait for industry to invent a new drug,” Congress told DHS, “and then pay them a reasonable price to make it.” Companies, though, were skeptical. To them the Bioshield law sounded more like an invitation to spend $800 million and then trust the government to set a “fair price.” Not surprisingly, they stayed away in droves. Evidently, just offering money isn’t enough. You also have to get the incentives right too. Continue reading…

Jacob S. Hacker

(originally published in The New Republic, Dec. 31, 2008)

As we move deeper into the recession, most economists are urging President-elect Obama to spend big money right away in order to stimulate and prop up the economy. The sticking point for a lot of people, however, is the long-term budget picture, especially given that Obama is planning to keep most of his predecessor’s tax cuts. How are we going to drop huge sums of money on job creation and fiscal stimulus right now without continuing to suffer through yawning budget deficits years down the road?In fact, we have a magic bullet for short-term spending and long-term saving–health care reform. During the campaign, skeptics complained that a health care overhaul would involve a lot of upfront costs and that the saving would only come later. But that’s exactly what we need right now. Health care involves major spending in the near future, but, more than other initiatives, it will put a brake on federal outlays in the far future. Continue reading…