Prescription drug regulation and the art of the possible: Reconciling private interest and public good in American health care policy

In the United States, health care access has long been a fixture on the agenda. As this issue has persisted and evolved over time, prescription drug pricing has become a central front in the policy debate, as pharmaceuticals have become an increasingly significant component in the practice of medicine and in people's conception of medicine. Many policymakers and other figures from across the ideological spectrum agree that the lack of affordable access to health care and prescription drugs is a problem, yet there is considerable disagreement over the range of acceptable solutions. A common view is that government must do more to help improve access to health care and prescription drugs for the millions of people who cannot afford them. But this view is contested. Many people believe that government's current level of participation is not only sufficient, but perhaps even excessive and counterproductive. Others acknowledge that government's function in the health care market is important but that it must be recalibrated in order to better serve the public good. This divide raises some important questions about regulation and principles of distributive justice, as well as ideological questions about the scope and role of government itself. Why does affordable access to health care and prescription drugs continue to be a problem? Why are there competing claims about government's role in addressing this problem? How might these ideological and political obstacles be overcome in order to arrive at a viable policy solution? To answer these questions, this dissertation analyzes the political development of the prescription drug regulatory state and adjudicates competing principles of justice in health care in order to inform the political discourse and help achieve a policy outcome that will redress the problem by relying on Alexis de Tocqueville s concept of "self-interest rightly understood," which appears to describe how similar conflicts and stalemates were overcome in the creation and expansion of the prescription drug regulatory state.