For the November 2016 election, we get to vote on 17 propositions. It can be hard to make up your mind about so many. One proposition, for better or worse, may affect many people who live with mental illness, through it’s effect on pharmaceutical prices. I’m not going to tell you how to vote; I see good people and organizations coming down on both sides on this one. But I am going to talk a bit about how to figure out how to vote. What would this proposition do, what are the pro and con arguments, and what sources of information can help you?
The first place that we can look to learn about the propositions, of course, is the California ballot pamphlet. Conveniently, for those of us who sometimes misplace things, you can also find the ballot pamphlet online at the California Secretary of State web site. Here is a link to the ballot pamphlet section on Proposition 61.
In the ballot pamphlet, you can find the full text of the proposition, a legislative analyst’s summary (which gives you an idea of the effect of the proposition that those of us who aren’t lawyers would have trouble getting from the text of the law), and ballot arguments that are submitted by proponents and critics of the proposed law. But it’s rather long, and can take a while to read all this information for 17 different propositions. If you don’t want to read through the whole ballot pamphlet (or even the whole pamphlet leaving out the text of the proposed laws), there are simpler summaries. One is actually in the pamphlet (see the first page of that link I gave, and just jump to the longer sections after reading that. Another is supplied by the League of Women Voters. Here is their information on Proposition 61, including official links to support and opposition.
Another way to evaluate propositions is to look at who endorses or opposes them. For this, you can find a handy chart by California Choices. California Choices does a round up of ballot endorsements by a wide range of organizations and papers each election. (California Choices’ page rounding up information about Proposition 61 is here.) Or, if you’re interested in the money trail, you can check out what Ballotpedia has to say about Proposition 61.
OK, I’ve talked a lot about sources, but I haven’t told you what’s in the proposition, or what the pro and con arguments actually are. Here’s a brief description from the ballot pamphlet:
Prohibits state from buying any prescription drug from a drug manufacturer at price over lowest price paid for the drug by United States Department of Veterans Affairs. Exempts managed care programs funded through Medi–Cal. Fiscal Impact: Potential for state savings of an unknown amount depending on (1) how the measure’s implementation challenges are addressed and (2) the responses of drug manufacturers regarding the provision and pricing of their drugs.
The crux of the controversy between pro and con (and there appear to be organizations and people I respect on both sides) comes down to “(2) the responses of drug manufacturers”. Proposition 61 is aimed to ensure that drug manufacturers lower their prices, for certain purchases the state makes, to those supplied to the US Department of Veterans Affairs. The connection to mental illness and mental illness advocacy, here, is the fact that some people on Medi-Cal require psychiatric medications, and Medi-Cal programs that don’t involve managed care are covered by this proposition. And lower prices for the state could also mean lower co-pays for patients. Proponents argue that the proposition will lead to lower prices and an end to price gouging like the EpiPen price hike. But, since the proposition dictates what the state can do, not how drug companies will respond, lower prices aren’t the only possible consequence. Opponents of the measure argue that it could, instead, lead to higher prices for veterans (if drug companies decide to raise prices for the US Department of Veterans Affairs rather than lower prices for the state of California), or, alternatively, that pharmaceutical companies could simply refuse to sell some medications at the lower prices, thus forcing the state to restrict what drugs it covers. The end result, say opponents, could be to increase drug prices and reduce patient access to needed medicines.
Whose argument do you believe? You can follow the links I’ve supplied (or add your own sources), weigh the arguments, see who’s supporting each side, and make up your own mind.