Richard O. Dolinar, MD

A bill currently before the Massachusetts Senate, S.1048, would require pharmaceutical companies to release information about the cost of the development and production of their medications “to promote transparency and cost control of pharmaceutical drug prices.” However, an economic fallacy underlies this and similar legislation in other states. The fallacy is that price is a function of cost, that if we can determine how much it costs to make a drug, then we could judge the appropriateness of its price.

How can it be that the same exact prescription drug can have such markedly different prices?

The distinguished economist Thomas Sowell once said, “It is amazing that people who think we cannot afford to pay for doctors, hospitals and medication, somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer it.”

Proper nomenclature is crucially important when framing a debate — debates can be won or lost before they even start. And so it is in medicine today with “biologic” and “biosimilar” drugs. Biosimilars are about to enter the marketplace.

One day in the fifth grade, I was challenged with the following problem: Draw a diagram showing how to connect the utility lines from the water, gas and electric companies to three houses without allowing the lines to cross one another. Simple enough, I thought. But in the next few days, no matter how hard I tried, no matter whether I used straight lines or curved ones, or moved one house here or another utility company there, I could not do it. I could almost do it. But, invariably, there was at least one house that couldn’t be connected to at least one utility. Often, I was so tantalizingly close I could almost taste victory, but didn’t.

You can feel it in the air. It’s that time of the year again, isn’t it? I don’t mean the coming of the holidays — Thanksgiving, Christmas, New Year’s. No, it’s that time of the year when we face the “sword of Damocles” in the form of the Medicare sustainable growth rate.

Washington is a company town. The “company” passes laws and makes rules and regulations for the nation.

A central concern for any physician is reimbursement: “How do I get reimbursed fairly for the value of my services?”

No matter which, with his Supreme Court decision, Chief Justice John G. Roberts Jr. has given us an unprecedented opportunity to vote in November on an entitlement program called the Affordable Care Act. A vote for President Barack Obama is a vote in favor. A vote for Gov. Mitt Romney is a vote against. The importance and magnitude of this choice cannot be overstated.

Once upon a time, not so long ago, I used to be a doctor.