Posted by
ShiningCity on Monday, April 14, 2008 6:02:34 PM
One of the common justifications for national health care is "access to medications." As an example of this need, liberals point to the uninsured and social security-dependents who reportedly cannot afford needed pharmaceuticals. Liberals offer as a solution: the government must step-in and apply cost-containment strategies "so everybody's fundamental needs are met." Actually, liberals accuse the pharmaceutical industry of all kinds of atrocities with this typical bottom-line: "the CEOs make too much money." Pharmaceutical companies nearly tie "Big Oil" in terms of who is the most "heinous" and "greedy." I'm quite surprised at the hostility toward these companies by even some avowed conservatives.
My disclaimer: I own no stock in any pharmaceutical company. (I should have gotten in on the phosphodiesterase inhibitor craze [i.e. sildenifil, brand name Viagra]. Alas, I'm not one to invest outside of safe mutual funds.) I know only one person who works for a pharmaceutical company, and we never talk drugs. I am no longer involved in direct patient care, so I receive no visits from Drug Reps. And when I was in practice, I never gave them more than 2 minutes of time. I didn't display their freebie merchandise; I was never on a speakers' bureau for any drug; I didn't attend their after-dinner functions. I can say honestly that I've never prescribed a drug based on any marketing tactics from a company. I did attend an event at the Fairmont hotel in Whistler, British Columbia when I was in my ID fellowship, sponsored by Roche. It was the most opulent thing I've ever seen. When I returned home, I was especially guarded about prescribing Roche's Rocephin (ceftriaxone) out of fear that I was "biased." Eventually I just gave in, because ceftriaxone is a damn great antibiotic, and Rocephin was the brand on my hospital formulary. I'm most proud of the fact that I do not use or distribute (or even have in my office) any drug company pens. They run out of ink too fast, and most are cheaply made. I purchase my own pens and am very partial to Zebra fine tips. On to the meat of the essay. . .
Pharmaceutical companies are a very important part of today's health care system, and, in addition to drugs, many of the research products we enjoy have been funded with pharmaceutical dollars. Ask anybody suffering from seasonal allergies how important their Zyrtec is to them, or the Rheumatoid patient taking Etanercept--what a difference it makes in their quality of life. Do these companies make a profit? You bet they do. Last I checked, though, that was part of the "capitalism" deal. In many instances, these companies have manufactured drugs for rare illnesses when doing so was hardly profitable (AIDS drugs come to mind. The government has a reimbursement max on these drugs, and you can bet it doesn't come close to what the pharmaceutical company invested in development. Of course, most of the AIDS patients are on the government reimbursement system; they don't have their own insurance or pay cash. On the whole, these companies make off these drugs what our government pays them.)
These companies are also great models of what a free-market can do to accomodate the needs of the less fortunate. I'm guessing many TH readers don't know about Patient Assistance Programs. Often, drug companies have programs that provide free medications to patients who meet income eligibility criteria and who are motivated enough to fill out some forms. In my center, we had a case worker whose job was to keep these forms updated for patients, such that free medication was provided to a very high percentage of the indigent. These programs are completely private and are not subsidized in any form by the U.S. government. Companies don't have to offer them, yet many do. They are so common that clearinghouse websites exist, like
RxAssist, to help patients with access to the programs.
To see if the average internal medicine patient would be able to get the most commonly-prescribed drugs, I did a search of RxAssist. Assuming Mr. Average Patient has diabetes, hypertension and some arthritis, he might be prescribed: rosiglitazone (Avandia), atenolol (Tenormin), hydrochlorothiazide, and plain-Jane ibuprofen (which can be purchased over-the-counter).
GlaxoSmithKline offers 3 formulations of rosiglitazone:
2 different companies have access programs for atenolol formulations:
2 companies also offer several thiazide diuretic formulations. (I might also add, this drug is very inexpensive, costing about $15.00/month for generic if you pay out-of-pocket.)
And even though ibuprofen can be purchased over-the-counter, some companies still provide this free to eligible patients:
The average liberal is thinking, "yeah, BUT, I'll bet you have to be 'really poor' to get on these assistance programs. I mean, what about the 'blue collar' guy? See, that's why we need national health care--for the blue collar guy." Let's say Mr. Blue Collar, who is generally healthy, has inhalent allergies--not a serious condition but a sure-enough pain-in-the hiney if you can't get your work done because your nose runs all day. Cetirizine (Zyrtec) is a commonly prescribed non-sedating antihistamine that costs about $75/month out-of-pocket. There is a patient assistance program for Zyrtec also. And here's an example of the eligibility criteria:
These are widely-accessed programs that benefit lots of people. And the pharmaceutical companies don't have to provide these services. We don't need national health care to distribute drugs to those in-need. We need to let the markets provide.