05/01/2007
Dear Editor:
In "Heal Thyself", Maggie Mahar is absolutely correct when she says that patients cannot be left to make their own decisions regarding the value of certain medical procedures and choice of medications. The high cost and the ineffectiveness of healthcare is the result of too much input by too many special-interest groups and their lobbyists. As you can see below, it really is a case of too many cooks spoiling the broth.
Pharmaceutical companies
spent more than $4.5 billion on direct-to-consumer advertising in 2005. They
spend billions to promote drugs to the medical professions, and most of their
sales reps do not have a medical background. They are schooled in their
companies’ products and parrot the benefits, but often soft peddle adverse
effects.Physicians are provided with enticements, pharmaceutical firms own drug studies, and patients pressure doctors to write prescriptions for drugs they see advertised. One big problem is the fact that physicians don’t know the costs of these drugs—and if they did, they couldn’t remember all the dollar figures for the number of drugs out there.
The government put its foot in its mouth with Medicare Plan D for prescriptions. It did not allow bidding for low-price drugs and permitted more than 500 profit-making insurance companies to write the policies for all the different coverages. They had different formularies that were based on the efforts of pharmacy benefit managers to get drug contracts (large hospitals use a formulary that saves them millions). Total confusion by seniors and financially challenged consumers ensued.
The public is also to blame for the high cost of healthcare. They want a pill or a cream to take care of all their ills. Their co-pays of $5 to $20-plus are like the use of casino chips—and they use more medications than they really need.
Sam Schiffman, past president, New Jersey Society of Healthcare Pharmacists, Wayside, N.J.
Dear Editor:
Maggie Mahar’s "Heal Thyself" article misses the mark in addressing the causes of and solutions to healthcare costs. Mahar concludes that consumers’ inability or unwillingness to make sound healthcare choices is exacerbating cost pressures, and therefore they should rely on others to do so for them.
Mahar cites a June 2006 study in the New England Journal of Medicine of patients with capped medical plans being no more compliant in taking their medicines than those with uncapped plans. Hence, placing some financial onus on patients does not change behavior. The problem with this kind of thinking is that it examines behavior after patients get sick—but ignores the benefits to those who expend the effort to stay healthy.
Imagine how much more expensive auto insurance would be if oil
changes and routine maintenance were covered by the premiums we pay. We expense
these tasks out-of-pocket to prevent catastrophic expenses and injuries. Yet
with healthcare, we have developed an entitlement mentality that absolves us of
personal responsibility to do routine maintenance, such as eating smart and
exercising regularly.
Sadly, despite all we now know about the benefits of healthy
living, Americans are still overweight, lazy and uneducated when it comes to
healthcare. Worse yet, the inevitable health problems that result from poor
lifestyle choices do not manifest themselves for years.
The quickest way to get people’s attention and improve their
behavior is still to hit them in the wallet. Basic economics teaches us that
when the price of a desired and essential commodity is reduced to nearly zero,
demand is unlimited. Couple that with a system with no competitive
price-rationing mechanism and a hyper-regulatory government and you have a
recipe for disaster. Health insurance should protect those with bad luck or bad
genes—not those with bad habits. To get back to that basic premise, we must
first expunge a generation of bad thinking.
To repeat an old adage: If you think healthcare is expensive
now, just wait until it’s free.
James Martin, Troy, Mich.
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