Stephen Foley: Big Pharma dodges most of the bullets

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The Independent Online

US Outlook: Barack Obama's gruelling battle to overhaul the healthcare system of the US sprayed gunshot in every direction, but something remarkable is visible as the smoke clears on the political killing fields: the drug industry dodged most all of the bullets. Shareholders in the likes of GlaxoSmithKline and AstraZeneca can breathe easy – for now.

If there is one presidential goal that didn't really get met by the legislation, it is the goal of cost containment. Americans spend more money per head on healthcare than any other nation, without managing to have the healthiest or even the happiest people, and the difference is the profit margin of the private-sector companies.

They divide and rule. Government-controlled schemes can negotiate great deals from suppliers – Germany won a 10 per cent price cut from Big Pharma just yesterday – but the US system is fragmented among private insurers and along state lines. Any hope of fundamental change died with the so-called "public option", which would have set up a government-run alternative to the private sector.

But cost-cutting pressure on Big Pharma died because the Congressional Budget Office refused to include guesses on likely savings in its rulings on whether reform will be "deficit neutral". The bill signed by President Obama on Tuesday, and the companion bill approved by Congress late on Thursday, mainly imposes taxes to subsidise expanded access to health insurance.

So it's a case of different slices – but same size cake. It's why healthcare stocks have kept on rising.

In contrast to medical device manufacturers – the likes of the UK artificial hip maker Smith & Nephew, who will have to pay a modest new sales tax with little in the way of likely extra sales to compensate – the drug industry struck a pretty good bargain. It will contribute some $80bn to help fund drug benefits for seniors and other schemes, but it also has most to gain from selling to the 32 million Americans coming into the system for the first time. In the finer print, there are other goodies, too. Notably, the provision to give 12 years of data protection to biotech firms.

It has been an emotionally exhausting year of fighting, for anyone invested in one side or the other of this debate. Obama supporters have been swung from optimism, to despair, to elation; Republicans from anger, to rage, to blood-boiling fury.

For investors, the system is too complex for there to be any real confidence in the likely effects of these bills over the long run. But there is one thing that everyone can agree upon, and that is that the work of cost-containment has barely begun. Just for starters, Congress is building a case to allow the importation of cheaper drugs from Canada. Big Pharma has won a frenzied battle, but the war continues.

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