Portal de Periódicos da CAPES

International restructuring, health and the advanced industrial state

2004; Taylor & Francis; Volume: 9; Issue: 4 Linguagem: Inglês

10.1080/1356346042000311146

1469-9923

Rodney Loeppky,

Global Public Health Policies and Epidemiology

Click to increase image sizeClick to decrease image size Notes See, for instance, Moises Naim, ‘The Global Battle for Public Health’, Foreign Policy, Vol. 128 (2002), pp. 24–36; Tea Collins, ‘Globalization, Global Health and Access to Healthcare’, International Journal of Health Planning Management, Vol. 18, No. 2 (2003), pp. 97–104; David Fidler, ‘A Globalized Theory of Public Health Law’, The Journal of Law, Medicine and Ethics, Vol. 30, No. 2 (2002), pp.150–61; Paul Farmer, ‘SARS and Inequality’, The Nation, Vol. 276, No. 20 (2003), pp. 3–6; Kelley Lee, ‘The Impact of Globalization on Public Health: Implications for the UK Faculty of Public Health Medicine’, Journal of Public Health Medicine, Vol. 22, No. 3 (2000), pp. 253–62; Kelley Lee & Richard Dodgson, ‘Globalization and Cholera: Implications for Global Governance’, Global Governance, Vol. 6, No. 2 (2000), pp. 213–36; and Ilona Kickbusch, ‘The Development of International Health Policies—Accountability Intact?’, Social Science & Medicine, Vol. 51, No. 4 (2000), pp. 979–89. Ellen Meiksins Wood, Empire of Capital (Verso, 2003), pp. 134–6. Emphasis in original. One of the more blatant examples of this is probably Robert Reich, The Work of Nations: Preparing Ourselves for the 21st Century (Alfred A. Knopf, 1991). Jan Aart Scholte, ‘Global Capitalism and the State’, International Affairs, Vol. 73, No. 3 (1997), pp. 428–9. Ibid., p. 444. See also David Held & Anthony McGrew, ‘The End of the Old Order? Globalization and the Prospects for World Order’, Review of International Studies, Vol. 24, No. 5 (1998), p. 235. Linda Weiss, ‘Globalization and National Governance: Antinomy or Interdependence?’, Review of International Studies, Vol. 25, No. 5 (1999), p. 73. Heide Gerstenberger, ‘Class conflict, competition and state functions’, in: John Holloway & Sol Picciotto (eds), State and Capital: A Marxist Debate (Edward Arnold, 1978), p. 154. Ellen Meiksins Wood, The Pristine Culture of Capitalism: A Historical Essay on Old Regimes and Modern States (Verso, 1991). On the corporate roots of the TRIPs agreement, see John Braithwaite & Peter Drahos, Global Business Regulation (Cambridge University Press, 2000), p. 165, note 122; Information Feudalism: Who Owns the Knowledge Economy? (New Press, 2002); and Jacque J. Gorlin, ‘The business community and the Uruguay Round’, in: Charles E. Walker & Mark A. Bloomfield (eds), Intellectual Property Rights and Capital Formation in the Next Decade (University Press of America, 1988), p. 172. Jennifer Van Brunt, ‘Grand Ambitions’, Signals Online Magazine (Recombinant Capital), 24 February 2001, available at http://www.signalsmag.com Bernard M. Hoekman, ‘New Issues in the Uruguay Round and Beyond’, The Economic Journal, Vol. 103, No. 421 (1993), pp. 1531–2. Kevin Watkins, ‘The Price Is Still Not Right’, Health Matters, No. 44 (2001), available at http://www.healthmatters.org.uk/stories/watkins.html; Susan Sell, ‘Intellectual Property Protection and Antitrust in the Development World: Crisis, Coercion, and Choice’, International Organization, Vol. 49, No. 2 (1995), pp. 315–49; Susan Sell, ‘Intellectual property rights after TRIPs’, unpublished paper presented to the International Studies Association Annual Meeting, Chicago IL, February 2001; and Philippe Cullet, ‘Patents and Medicines: The Relationship between TRIPS and the Human Right to Health’, International Affairs, Vol. 79, No. 1 (2003), pp. 139–60. Meri Koivusalo, ‘World Trade Organisation and Trade‐Creep in Health and Social Policies’, Occasional Paper, Globalism and Social Policy Programme, Helsinki, 1999, p. 28. General Accounting Office (GAO), Medicare: Financial Outlook Poses Challenges for Sustaining Program and Adding Drug Coverage, GAO‐02–643T, Government Printing Office, Washington DC, 2002. Figures regularly circulated amount to well over US$800 million per successful drug. See Henry Grabowski, ‘Patents, Innovation and Access to New Pharmaceuticals’, Journal of International Economic Law, Vol. 5, No. 4 (2002), pp. 849–60. These figures have been extensively questioned. See Arnold S. Relman & Marcia Angell, ‘America’s Other Drug Industry Distorts Medicine and Politics', The New Republic, Vol. 16, No. 4587 (2002), pp. 27–42; James Love, ‘How much does it cost to develop a new drug?’, unpublished paper presented at MSF Working Group, Geneva, 2 April 2000, available at http://www.cptech.org/ip/health/econ/howmuch.html; and Merrill Goozner, ‘The Price Isn’t Right', The American Prospect, Vol. 11, No. 20 (2000), pp. 25–8. On the Orphan Drug Act, see Janice Marchiafava Hogan, ‘Revamping the Orphan Drug Act: Potential Impact on the World Pharmaceutical Market’, Law and Policy in International Business, Vol. 26, No. 2 (1995), pp. 523–61. In this sense, the negotiated deal prior to the Cancun Summit of 2003, related to ‘Paragraph 6’ of the 2001 Doha Agreement, has very wide ramifications. While the debate has focused on the export of generic drugs under compulsory licence to countries without a domestic manufacturing capacity (particularly in the case of a ‘health crisis’), the aim of US negotiators was almost certainly to secure assurances from middle‐income states—such as east European states, Korea and Brazil—that they would not use the agreement to undermine the enforceability of TRIPs. In an equally significant manner, a large number of advanced industrial countries have proactively ‘opted out’ of the agreement, reinforcing its exceptional status. With its many problematic stipulations concerning generics exports, the central lesson of the latest agreement at Doha seems to be that TRIPs remains solidly the rule across markets where more considerable value accumulation is likely. See Clive Cookson & Geoff Dyer, ‘A drugs deal for the world’s poorest: now the fight over patents and cheap medicine is in middle‐income countries', Financial Times, 2 September 2003, p. 19. Stevan M. Papa, ‘International Trade and Emerging Genetic Regulatory Regimes’, Law and Policy in International Business, Vol. 29, No. 3 (1998), p. 23. Coalition of Service Industries (CSI), ‘Response to Federal Register Notice of March 28, 2000 [FR Doc.00–7516]’, p.65. Ibid., p.66. PhRMA, ‘Germany’, Submission for the National Trade Estimate Report on Foreign Trade Barriers (NTE): 2002, 17 December 2001, p. 102. Similar concerns arise in relation to France. See PhRMA, ‘France’, Submission for the National Trade Estimate Report on Foreign Trade Barriers (NTE): 2002, 17 December 2001, p. 99. PhRMA, ‘Germany’, p. 102. VFA, ‘Mit einer gezielten Wende in der Forschungspolitik kann Deutschland wieder den Sprung in die Spitzengruppe schaffen’, Pressemitteilung, 27 November 2001; and ‘Wettbewerbsfähigkeit Deutschlands als Standort für Arzneimittelforschung undentwicklung’, Boston Consulting Group, 27 November 2001. See VFA, ‘Ausgrenzung von Arzneimittelinnovationen hat zu massiven Qualitätsmängeln im deutschen Gesundheitssystem’, Pressemitteilung, 3 June 2002. VFA, ‘Positionen’ and ‘Reformkonzept’, available at http://www.vfa.de Gary G. Yerkey & Daniel Pruzin, ‘United States Proposes Broad Opening of Services Sector in WTO Trade Negotiations’, BNA International Trade Reporter, 4 July 2002, available at http://www.bna.com WTO, General Agreement on Trade in Services, Preamble, available at http://www.wto.org/english/docs_e/legal_e/26‐gats.pdf Scott Sinclair & Jim Grieshaber‐Otto, Facing the Facts: A Guide to the GATS Debate (Canadian Centre for Policy Alternatives, 2002), p. 43. WTO, General Agreement on Trade in Services, Article 1.3 (b). Ibid., Article 1.3 (c). Ibid., Article XIX, paragraph 4. Allyson Pollack & David Price, ‘Rewriting the Regulations: How the World Trade Organisation Could Accelerate Privatization in Health‐care Systems’, The Lancet, Vol. 356 (2000), p. 1997. Quoted in ibid., p. 1999; and WTO, Working Party on Domestic Regulation, Report on the Meeting Held on 11 May 2001 (S/WPDR/M/11), 7 June 2001, p. 2. WTO, General Agreement on Trade in Services, Articles VI.4 and VI.4 (b). Pollack & Price, ‘Rewriting the Regulations’, p. 1998. Yuji Iwasawa, ‘WTO Dispute Settlement as Judicial Supervision’, Journal of International Economic Law, Vol. 5, No. 2 (2002), pp. 287–305. Ernst & Young, Millennium in Motion: Global Trends Shaping the Health Science Industry, June 2001, p. 22. Wood, The Pristine Culture of Capitalism. Luigi Orsenigo, The Emergence of Biotechnology: Institutions and Markets in Industrial Innovation (Pinter, 1989), pp. 111–12. Koyin Chang, The Organization of the R&D Intensive Firm: An Application to the Biotechnology Industry, unpublished Ph.D. dissertation, University of Kentucky, Lexington, 1998. Martin Kenney, The University‐Industrial Complex (Yale University Press, 1986), p. 200. US Congress, Commercialization of Academic Biomedical Research, Hearing before the Subcommittee on Investigations and Oversight and the Subcommittee on Science, Research and Technology of the House Committee on Science and Technology, US Government Printing Office, Washington DC, 1981, p. 1. Sheldon Krimsky, Genetic Alchemy: The Social History of the Recombinant DNA Controversy (MIT University Press, 1982); and Biotechnics and Society: The Rise of Industrial Genetics (Praeger, 1991). See, for instance, US Congress, Office of Technology Assessment, Federal Technology Transfer and the Human Genome Project, US Government Printing Office, Washington DC, 1995; and US Congress, Office of Technology Assessment, Pharmaceutical R&D: Costs, Risks and Rewards, US Government Printing Press, Washington DC, 1993. Rodney Loeppky, Encoding Capital: The Political Economy of the Human Genome Project (Routledge, forthcoming). David Dickson, ‘German Biotech Firms Flee Regulatory Climate’, Science, Vol. 244, No. 4910 (1989), pp. 1251–2; and Lyn Tattum, ‘Viewpoint: Sustainable Development in Germany’, Chemical Week, Vol. 151, No. 3 (1992), pp. 2–3. Clearly, by using this terminology, I do not mean to imply that these firms can be easily summarised under one ‘nationality’. Obviously, firms of such proportion exhibit ownership structures beyond the confines of one state. Aventis (a merger between Hoechst and Rhone‐Poulenc) epitomises such arrangements. However, it is still, particularly in the case of Germany, possible to speak of firms with a central national affinity, and there is no doubt that states do exhibit biases towards multinationals that have ‘roots’ in their own political jurisdiction. Moreover, even considering cases in which the state in question does not match the firm's geographical origins, the goal remains for the state to ensure, to the greatest possible extent, that the benefits of production and accumulation accrue within its own political jurisdiction. Thus, while ‘national’ firms may enjoy favourable status, the attractiveness of national production spaces in relation to infrastructural support, regulation and available market opportunities constitute the guiding principle for state and corporate actors alike. Rodney Loeppky, ‘History, Technology and the Capitalist State: The Comparative Political Economy of Biotechnology and Genomics’, Review of International Political Economy, forthcoming. On associational governance, see Wolfgang Streeck, ‘German capitalism: does it exist? can it survive?’, in: Colin Crouch & Wolfgang Streeck (eds), Political Economy of Modern Capitalism: Mapping Convergence and Diversity (Sage, 1997), pp. 33–54. Philip Manow has also made the critical point that much of the associational (and corporatist) structure of industrial bargaining and social governance was highly conditioned by the shape of Bismarck's social insurance schemes. See Philip Manow, Social Insurance and the German Political Economy, Max‐Planck‐Institute für Gesellschaftsforschung, Working Paper 97/2, Cologne, 1997. See, for instance, Steven Casper, ‘High technology governance and institutional adaptiveness: do technology policies usefully promote commercial innovation within the German biotechnology industry?’, mimeo, Wissenschaftszentrum Berlin für Sozialforschung, Berlin, 1999. Ray Moynihan, Iona Heath & David Henry, ‘Selling Sickness: The Pharmaceutical Industry and Disease Mongering’, British Medical Journal, Vol. 324, No. 7342 (2002), pp. 886–91; Andrew Herxheimer, ‘Relationships between the Pharmaceutical Industry and Patients’ Organizations', British Medical Journal, Vol. 326, No. 7400 (2003), pp. 1208–10; J. Bancroft, ‘The Medicalization of Female Sexual Dysfunction: The Need for Caution’, Archives of Sexual Behaviour, Vol. 31, No. 3 (2002), pp. 451–5; and Ray Moynihan, ‘The Making of a Disease: Female Sexual Dysfunction, British Medical Journal, Vol. 326, No. 7379 (2003), pp. 45–7. Jacob Hacker, The Divided Welfare State: The Battle over Public and Private Social Benefits in the United States (Cambridge University Press, 2002). Joan Sokolovsky, ‘The Making of National Health Insurance in Britain and Canada: Institutional Analysis and Its Limits’, Journal of Historical Sociology, Vol. 11, No. 2 (1998), pp. 247–80. Hacker, The Divided Welfare State, pp. 201–3. The latter involved the Employee Retirement and Income Security Act or ERISA, passed in 1974. See Hacker, The Divided Welfare State, pp. 256–61. Robert Pear, ‘Health spending rises to 15% of economy, a record level’, New York Times, 9 January 2004, p. A16. Uwe E. Reinhardt, ‘The Predictable Managed Care Kvetch on the Rocky Road from Adolescence to Adulthood’, Journal of Health Politics, Policy and Law, Vol. 24, No. 5 (1999), p. 904. Peter Swenson & Scott Greer, ‘Foul Weather Friends: Big Business and Health Care Reform in the 1990s in Historical Perspective’, Journal of Health Politics, Policy and Law, Vol. 27, No. 4 (2002), pp. 605–38. Susan Giaimo & Philip Manow, ‘Adapting the Welfare State: The Case of Health Care Reform in Britain, Germany and the United States’, Comparative Political Studies, Vol. 32, No. 8 (1999), p. 989. Robert Pear, ‘Spending on health care increased sharply in 2001’, New York Times, 8 January 2003, p. A12. Robin Toner & Robert Pear, ‘Bush proposes major changes in Medicare and Medicaid’, New York Times, 24 February 2003, p. A1; Robert Pear, ‘Bill on Medicare drug benefit is stalled by House‐Senate Republican antagonism’, New York Times, 27 August 2003, p. A15; ‘Congress strikes a tentative deal on drug benefits’, New York Times, 23 October 2003, p. A1; and Gardiner Harris, ‘Drugmakers move closer to big victory’, New York Times, 25 November 2003, p. A20. This process was hardly without contentious debate. See also US Congress, Strengthening and Improving Medicare, Hearing before the Subcommittee on Health of the Committee on Energy and Commerce, House of Representatives, US Government Printing Office, Washington DC, 2003. Giaimo & Manow, ‘Adapting the Welfare State’, p. 991. Magnus Ryner, ‘Disciplinary neo‐liberalism and the social market in German restructuring: implications for the EMU’, unpublished paper presented at the International Studies Association Annual Meeting, New Orleans, March 2002. Thomas McGraw, Creating Modern Capitalism: How Entrepreneurs, Companies, and Countries Triumphed in Three Industrial Revolutions (Harvard University Press, 1997). Manow, Social Insurance and the German Political Economy, p. 16. Martin Pfaff & Dietmar Wassener, ‘Germany’, Journal of Health Politics, Policy and Law, Vol. 25, No. 5 (2000), p. 907. On reform, see Giaimo & Manow, ‘Adapting the Welfare State’, p. 982; for updated figures, see Reinhard Busse, ‘Health care systems: towards an agenda for policy learning between Britain and Germany’, mimeo, Anglo‐German Foundation for the Study of Industrial Society, June 2002, p. 24. Giaimo & Manow, ‘Adapting the Welfare State’, pp. 977–83. Ned Stafford, ‘Germany Issues Drug Price Limits as Part of New Law’, Reuters Health, 12 June 2002. Giaimo & Manow, ‘Adapting the Welfare State’, p. 983; emphasis added. The degree to which ‘efficiency’ and ‘quality’ actually correspond to market‐based reality is open to question. The voluntary organisation of health insurance markets in the US has not, in terms of relative social spending, translated into cost efficiency. Indeed, although over 40 million Americans chronically lack healthcare coverage (and over 70 million are without it at any given time), OECD statistics demonstrate that per capita expenditures on healthcare are 69 per cent higher in the US than under Germany’s universal system, 83 per cent higher than Canada, and 97 per cent higher than France. See OECD Health Data, ‘Total expenditure on health—Per capita, $US PPP’, available at http://www.oecd.org/document/16/0,2340,en_2825_495642_2085200_1_1_1_1,00.html. Statistics on life expectancy, infant mortality and acute care place the US in a similar position vis‐à‐vis its OECD counterparts. This is not meant to imply that German health governance is devoid of self‐interest or power. Doctors' associations (Kassenärtzliche Vereinigungen) have, in fact, come under considerable criticism for abusing their monopoly position with respect to ambulatory care, and for the fact that they are not doing enough to fulfill their social duty to reform the system in an equitable manner. See ‘Ministry says doctors are breaking the law: report reveals physicians cash in on reform’, Frankfurter Allgemeine (English Edition), 9 April 2004, available at http://www.faz.com/IN/INtemplates/eFAZ/default.asp Heidi Sylvester, ‘Drugmakers threaten to leave, stay put for now: new pharmaceutical projects at home planned years ago, future investments not in Germany’, Frankfurter Allgemeine (English Edition), 19 September 2003; and Elise Kissling, ‘Pharmaceutical industry threatens exile: drugmakers struggle in regulated German market, make most of their profit abroad’, Frankfurter Allgemeine (English Edition), 14 February 2003, available at http://www.faz.com/IN/INtemplates/eFAZ/default.asp Trudo Lemmens, ‘Selective Justice, Genetic Discrimination, and Insurance: Should We Single Out Genes in Our Laws?’, McGill Law Journal, Vol. 45, No. 2 (2000), p. 407. Additional informationNotes on contributorsRodney Loeppky Rodney Loeppky, Department of International Relations and Politics, University of Sussex, Falmer, Brighton BN1 9SN, UK. Rodney Loeppky, Department of International Relations and Politics, University of Sussex, Falmer, Brighton BN1 9SN, UK.