Thursday, December 24, 2009

Not a Dime of My Tax Dollars for That Brand Name Drug!

Dr. Scott Gottlieb has rallied the "America has the best health care in the world" crowd with his pro-doctor, pro-medical industry op-ed in today's WSJ.

Let me just say up front that it's hard to find something good in this health care bill already without making up poorly-framed arguments that those poor doctors and suffering medical corporations are going to have to, you know, adjust their practices. Had the industry better regulated itself over the past few decades, we wouldn't be where we are now. In a predicament where health care coverage is tapping the country's economy and still not reaching the majority of citizens effectively.

Of course the Wall Street Journal has a particular clientele, one that belongs to a class of society pampered by employer-paid stellar health care coverage. To claim that our system is currently working is to ignore the 45,000 deaths a year from inadequate health care access, or the 50 million Americans who have no health care at the moment. But this demographic never saw health care as a right, only as a commodity. If those poor bastards in a Texas had studies harder, pulled themselves up by their boot straps, they'd have decent jobs and decent health care coverage. In other words, not having health care is shameful and indicative of laziness. So goes the privileged reasoning.

Gottlieb makes the following claims in his piece:

While the AMA supports health care reform (and it's a dogged piece of legislation that has little to do with reform and all to do with appeasing the medical industry), various surgeon and specialty associations oppose it. That's because they will be hard pressed to pursue their specialties with the same abandon if they hope to accept Medicare payments. The legislation reigns in specialists - a group that has ballooned over the past few decades simply because the AMA has encouraged licensing of such specialists and because that's where the money is.

He protests the new powers given to Medicare and Medicaid to select cheaper services for patients, refusing to pay for name-brand drugs and treatments when generic will do. Of course the medical industry is up in arms over this. The overhead on name-brand services is what has made the industry such a rich and powerful loggerhead in medicine. Basic economics shows that Medicare and Medicaid can't afford - and shouldn't pay for - such overpriced services when cheaper ones are available.

Gottlieb argues that those who want to sue Medicare for not covering less expensive services will be discouraged from suing for them. To this I say: If you want a specialty services, pay for it. As women are being forced to do with the "specialty" service of abortion. For women the law of no coverage is simply religious discrimination but once mention that making economic decisions regarding other coverage is unfair and you get a gaggle of "free-market" conservatives claiming that Medicare has too much power. Let the patient pay for their extraordinary care if they think it will better help them. This isn't rationing. This is practicality in buying as far as I am concerned.

Gottlieb also criticizes what he calls incentives for independent specialists to merge or consolidate with other practitioners in order to keep costs down in delivery. This too is a practical concern. Independent specialists cost more, their overhead is not shared with other practitioners and therefor must come from somewhere. Until now that has been from Medicare and Medicaid or high-end insurance companies willing to pay more when the employer or patient pays more. If we want to cover all citizens and apply government regulation to government plans to reign in costs, we have to address the excesses. But if I were an independent specialist, I would be squealing too. My fat run is coming to an end.

Most of the cost-saving programs Gottlieb is criticizing are really demonstration programs, trials by Medicare to see what works. Instead of addressing the excessive costs of health care today, he is focusing on the wrong audience, the doctors, privileging their position - as all associations are of course apt to do - above that of the patient. But that's because Gottlieb is opposed to treating medicine as a right, affordable and accessible. Instead he wishes it to remain a commodity that has led to overspending.

He writes:

Regulation of medicine has always been a local endeavor, and it's mostly the province of medical journals and professional medical societies to set clinical standards. This is for good reason. Medical practice evolves more quickly than even the underlying technologies that doctors use. This is especially true in surgery, where advances flow from experimentation by good doctors to try different surgical approaches.

Sorry, but industry self-regulation is not regulation. As the medical industry has proven over the past decades, the great percentage of killers in the US have gone unaddressed by the big money innovators. Equipment and drug manufacturers have both pressured the public into pursuing boutique illnesses while heart disease and cancers have proven to go unchecked. That advancing innovation comes from small-time, independent surgeons is a fallacy. Innovation now, as Gottlieb calls it, is large corporations finding niches that will make them quick money.

The rallying cry worked for abortion has been "Not my tax dollars!"; how about using it to curtail excessive drug company profits and "innovations" in medicine that only address boutique treatments? When we start seeing advancements that change lives for those suffering the primary killers, preventative medicine that reduces costs and increase quality of life, and more affordable prices for all Americans, we can then discuss the excessive ways of the medical industry as innovative.

Gottlieb, a fellow at the notoriously conservative Free Enterprise Institute is approaching medicine from the medical industry's position. We've unsuccessfully tried that for decades. It's time we approach medicine from the standpoint of the patient.

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