Life after the election

George Bush and John Kerry are each promising to reshape the American healthcare system in ways that would affect the size and dynamics of markets for biotech and pharmaceutical products. Both are focused principally on meeting demands for access to drugs and lower prices, promoting policies with uncertain consequences for pharmaceutical innovation.

President Bush advocates a consumer-driven model that would put greater reliance on market forces to increase the efficiency of healthcare. He relies on the private sector and empowered individual consumers to contain costs, while proposing an incremental expansion of some government programs to enlarge the safety net beneath the poor.

By contrast, Kerry is pitching a dramatic expansion of government's role in the healthcare system, which he says would lead to a halving of the number of uninsured - and by some accounts potentially an increase in the size of pharmaceutical markets. The challenger also promises to cut drug costs by allowing importation from Canada and giving the government authority to negotiate directly with drug companies the prices it pays for drugs covered by Medicare.

The differences between the two candidates' proposals are sharpest on strategies for reducing the number of uninsured Americans, and balancing intense pressures to control drug prices with the risk of diminishing incentives for innovation. They also differ sharply on the ethics of government funding for embryonic stem cell research, a topic that is of more philosophical than immediate commercial importance.

But memories of detailed campaign pledges fade after elections as quickly as a summer tan - few people remember that in 2000 Bush said he supported drug importation. Thus the details of the candidates' proposals are less important than the beliefs that inform them.

Indeed, whoever sits in the White House for the next four years will find attempts to impose sweeping changes in the healthcare system tempered by budget and political constraints. A paper-thin Senate majority unable to act without Democratic consent has stymied Bush on several fronts, and barring a surprise from the electorate, a President Kerry would almost certainly face

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