by: OP-ED: Donald Barlett and James Steele
from: New York Times, October 24, 2004
For years the people in Washington have offered one plan after another
that they said would provide health care for all Americans and rein in
costs. Each plan has failed. Today more people than ever have
inadequate coverage or no insurance at all. And still costs continue to
spin out of control.
Notably absent from the rhetoric has been any mention of the
existing system's inherent flaw - the inability of market-based,
for-profit medicine to deliver on the political promises.
Two decades ago, when Washington embraced the for-profit model to
curb escalating charges, health care spending represented 10.5 percent
of gross domestic product. Now it is approaching 16 percent. We spend
more per capita on health care than any other developed country. Yet on
the important yardsticks, like life expectancy measured in healthy
years, we don't even rank among the top 20 nations. In fact, according
to the World Health Organization, we come in an embarrassing 29th,
sandwiched between Slovenia and Portugal.
The explanation for this abysmal record is one that politicians decline
to discuss. The market functions wonderfully when we want to sell more
cereals, cosmetics, cars, computers or any other consumer product.
Unfortunately, it doesn't work in health care, where the goal should
hardly be selling more heart bypass operations. Instead, the goal
should be to prevent disease and illness. But the money is in the
treatment - not prevention - so the market and good health care are at
odds. Just how much at odds is seen in the current shortage of flu
vaccine, as men and women in their 80's and 90's line up for hours at a
time, hoping to get the shot they have been told they need, but may not
receive because not nearly enough has been manufactured.
The reason for the shortage is this: Preventing a flu epidemic that
could kill thousands is not nearly as profitable as making pills for
something like erectile dysfunction, a decidedly non-fatal condition.
Viagra, for example, brings in more than $1 billion a year for its
maker, Pfizer. The profits to be made from selling flu vaccine are
measly in comparison. If selling flu vaccine were as lucrative as
marketing Viagra, sports broadcasts and the nightly news would be
flooded with commercials warning that "winter is almost here; ask your
doctor about flu vaccine" - and it would be available to anyone who
wanted it. Instead, while many of those at risk of the flu go without
the vaccine, primetime programs are sponsored by the makers of Viagra
("Get back to mischief"), Cialis ("Will you be ready?") and Levitra
("Stay in the game").
To understand what has gone wrong in health care, one need only
look at the booming market for prescription drugs. Once upon a time,
drugs were a needs-based product. You received a prescription when you
were truly ill. Now many drugs are demand-driven, just like Froot Loops
and Lucky Charms. Instead of using the cartoon characters that sell
cereals, the drug companies employ celebrities.
One of the earliest was Lauren Hutton, the supermodel whose
enthusiastic endorsement of Wyeth's hormone replacement therapy helped
propel prescriptions for all such drugs from 58 million in 1995 to 90
million in 1999. Ms. Hutton made the rounds of the talk shows, telling
her "personal" story. She said her doctor warned her that if she didn't
take estrogen, "I was up for colon cancer, eye loss, osteoporosis,
shrinkage, lots of things."
More recently, Merck recruited Dorothy Hamill, the Olympic gold
medalist, to pitch Vioxx. "This is my favorite time to skate," Ms.
Hamill said in a commercial. "I guess it's from all those years of 5
a.m. practices. But it's also the time when the pain and stiffness of
osteoarthritis can be at their worst."
As has been the case with so many other drugs, estrogen therapy and
Vioxx proved to be a triumph of marketing over science. Not only did
the hormone replacement drugs fail to provide the promised protection,
studies found they increased the risk for developing cancer and heart
disease. Vioxx was withdrawn last month after evidence from clinical
trials showed that it increased the risk of heart attacks and strokes.
Since 1997, when the Food and Drug Administration loosened restrictions
on television commercials for prescription drugs, the marketing
departments of pharmaceutical companies have exercised ever-greater
influence on which drugs will be brought to market. That's why we have
three drugs to treat erectile dysfunction, a condition that once was
called "impotence." The name change was essential for the products to
be sold by the likes of Bob Dole or Mike Ditka, the former Chicago
Bears coach.
Aggressive marketing and pricing have made pharmaceutical companies
America's most profitable industry. On the whole, Americans pay higher
prices for prescription drugs than anyone else in the world because the
United States is the only industrialized nation that does not exert
influence over prices.
What's needed to control the costs and to provide basic health and
hospitalization coverage for all Americans is an independent agency
that would set national health care policy, collect medical fees, pay
claims, reimburse doctors fairly and restrain runaway drug prices - a
single-payer system that would eliminate the costly, inefficient
bureaucracy generated by thousands of different plans. It's not such a
radical idea; a single-payer system already exists for Medicare.
Such an agency would need to be free of politics and could be
modeled on the Federal Reserve System, whose members are appointed to
terms that do not coincide with the terms of either the president or
the Senate. It could be financed through two taxes, a gross-receipts
business tax and a flat tax, similar to Medicare, but on all individual
income.
Under a single-payer system, never again would you be asked, when
calling to make a medical appointment, "What type of insurance do you
have?" Never again would doctors need bloated office staffs to track
what is and is not covered under thousands of insurance plans. Never
again would you have to worry about being bankrupted by a medical
emergency. Never again would American business be saddled with the
responsibility for providing health insurance.
A unified, single-payer system could do more than pay the bills. It
could gather information to more accurately identify the surgical
procedures and drugs that work, and those that don't. It could funnel
research money to where it will do the most good rather than to those
areas with the largest and most vocal constituency, thereby treating
the victims of various diseases and conditions more equitably.
It could make possible a centralized computer network to reduce the
100,000 deaths each year from adverse drug reactions - a number of
fatalities five times greater than those caused by street drugs like
cocaine and heroin. Similarly, a nationwide network could track medical
errors across the country to increase accountability and to identify
hospitals or surgeons who make repeated mistakes. And it could
guarantee supplies of needed medications. In short, over time such a
system could transform the practice of medicine and give all Americans
the first-class health care they deserve - without breaking the bank.
Donald L. Barlett and James B. Steele are editors at large at Time
and the authors, most recently, of "Critical Condition: How Health Care
in America Became Big Business-And Bad Medicine."
Orginal Web page: http://www.nytimes.com/2004/10/24/opinion/24barlettsteele.html?th
