Health Care Reform: A Professional’s Perspective

I am a pharmacist, and I am writing to weigh in on the health care debate. I am reminded daily of how our health care system is broken. There is no lack of personal anecdotes regarding health care in America, so I will not repeat any. However, people generally seem to agree that our system needs fixing. Those who say we already have the best health care system in the world usually forget to add “if you can afford it.” To me that implies a broken system. Fixing it will take years, but we need to start now, and we need a government funded public option to help do it.

The free market has failed us in health care, and a public option would spur much needed competition in our system. In 2006, Merck’s cholesterol drug Zocor went generic. Merck essentially bribed United Health, the nation’s largest insurer, to charge the lowest copay for the brand name drug, while charging the highest possible copay for the generic alternative. The best part of this story is that Merck cut a deal with a generics company, and Merck actually manufactured the generic version and used the generics company to distribute it. I defy you to find a better example of market failure.

Much in this debate has been said about patient choice and rationing of care. I will interject here to say that the phrase “rationing of care” is pretty ugly and emotionally charged. Perhaps a better term for some situations is “cost-control.” At any rate, the notion that patients should be able to choose their caregivers and their form of treatment is certainly an ideal for which we should strive. As it is now, only those fortunate enough to be able to pay for their care 100% out of pocket are the ones with true freedom of choice. Those saying that a government funded public option would lead to rationing of care are ignorant at best, and dishonest at worst. If you rely on an insurance company – or the government – to pay for your care, you are already subject to rationing and/or cost-control measures, and any appearance of free choice is an illusion.

I see examples of this every day at work. If your doctor writes you a prescription that your insurer deems too expensive and refuses to pay, your health care has been rationed. This happens several times a day. Often times the insurer will recommend an alternative medication, and just as often the alternative is something that should be suitable for the patient, and is less expensive, but is not what the doctor ordered. This is what I would call cost-control. It is different from rationing, in that care is not absolutely denied, and it is something from which a public option would not be immune. However, the practice of rationing or cutting costs in order to profit is exclusive to private insurers.

We must accept that cost-control will occur, but how would a government funded plan do so equitably? For prescription drugs, Arkansas Medicaid contracts with EBRx, a company that runs two committees comprised of Arkansas doctors and pharmacists. These committees analyze safety and efficacy data from clinical trials to determine which medications will be on Medicaid’s Preferred Drug List (PDL). The committees’ meetings are open to the public and comments from the public are welcomed. Through the process the panels evaluate which drugs are most effective and reserve them on the PDL. If all drugs under consideration are found to be equally effective to treat a particular disease, then the least expensive ones are placed on the PDL. It’s natural not to want bureaucrats and politicians deciding who and what is covered. That is why a strong government funded public option should have a system like Arkansas Medicaid’s in which costs are kept as low as possible while still having health care professionals call the shots.

I have some other thoughts on how to help control costs for a public option. First of all, the government must be allowed to negotiate drug prices with pharmaceutical companies. Second, many of the chronic diseases we all currently pay for (diabetes, hypertension, hyperlipidemia) could be prevented through education on proper nutrition and healthy lifestyles. One of President Obama’s principles for health care reform includes nutrition counseling. This is great, and I find it hard to argue with the idea that preventing illness in the first place will save everybody money on emergency room visits and treatments later.

My hope is that my voice will help the case for a strong government funded public option. There are many opportunities to save money with a public option, but from my perspective that is not the real issue. Even though good disease prevention measures and increased competition among insurers could do that, for me reform is really all about making sure every citizen has access to quality health care.

Mike Clark, Pharm.D.