The Government's Creeping Control Over What Drugs Doctors Can Prescribe For You
I get terribly motion-sick -- from my own driving, even, if I go more than short distances and if there's traffic.
I love when people suggest that I take Dramamine. They mean well, but that's like asking somebody to stop a speeding car by throwing pebbles at it.
Even Scopolamine -- the patch -- isn't entirely effective in me.
Well, a friend in Paris had suffered temporarily from vertigo and was prescribed Serc (betahistine) for it. She told me about this, but I found that it is no longer sold in the USA; it was deemed to not be effective in some clinical trial.
I read that and didn't get it because of that, and then my motion sickness really started affecting me. (Thomas Stoffregen, a researcher who's been very kind to me, has, with his colleagues, published research on sexual dimorphism in motion sickness -- how it seems to affect women more than men, possibly having to do with estrogen, and possibly with differences in "postural sway.")
Anyway, I ended up getting this drug over eBay from overseas. Yes, I know -- eekers. However, back when I was in advertising, I produced commercials, and I had to order "color-corrected product": Reproduced packaging made to look good on TV. It was extremely expensive. It's cheaper now to make packaging, but I decided that, for $19 or, most recently $15, it probably wasn't worth it, and the stuff was probably real. (Nobody snorts anti-motion-sickness drugs.)
Well, the stuff is pretty miraculous. It doesn't make you drowsy and only gives me a slight rumbly feeling in my stomach from taking it. The very slightest, that is. And at the end of January, I drove two hours in hellish LA traffic (that would, sans Serc, have taken me out in about 20 minutes). In fact, I went all the way over windy Beverly Glen to Sherman Oaks. I was queasy when I got there, but for a two-hour hell-ride over hills...well, that was pretty amazing.
Anyway, this post relates to drug availability. Yeah, that's kind of funny, considering I had to get mine over eBay; I don't get it from the doctor. But I am desperate to have it. Because it is the only thing that can help me have a sort of normal life vis a vis how we in this society get around in motor vehicles, not by particle-beaming.
Scott Gottlieb writes at Forbes that the government is using an "elaborate scheme that Medicare unveiled this week to give federal regulators the power to restrict use of prescription drugs."
President Obama used vast authorities he garnered under ObamaCare to change how doctors are paid to prescribe injectable drugs like chemotherapy to Medicare patients. This "Part I" of the plan aims at a small and fixed percentage that doctors are paid off the total price of the drugs they prescribe. That money is meant to cover the cost of infusing injectable drugs in a doctors' office. The aim of the new policy is to eliminate any financial incentive doctors might have to select costlier drugs.But the biggest effect of the change will be to saddle more doctors with losses when they infuse drugs in their offices, forcing this medical care into hospitals where it's easier to finance, and also easier to federally regulate. This will be especially true for oncologists, who have already been merging their once-independent practices into hospitals as a result of declining reimbursement. The new plan will hasten this shift.
Yet it's "Part II" of the new regulation, which kicks in as early as January 2017, that's getting far less attention but is even more profound. Under this second part of the plan, Medicare gains the authority to stipulate when they believe that drugs are similar enough that they can be used in place of one another. The agency would then say that within a group of different medicines that the Medicare staff judges to be clinically "similar," the agency would only pay for the cheapest therapeutic option.
This plan is the culmination of ObamaCare's aspiration to exert more control over the practice of medicine. Under the scheme, Medicare would have the ability to stipulate when the agency believes that drugs are clinically interchangeable, even though in most of these cases, the Food and Drug Administration will never have made a similar judgment.
In other words, your health care decisions will be removed -- even more than they already are by other regulations -- from your doctor and handed to the government.
Here's some fun:
The Medicare agency is widely recognized as lacking clinical expertise to draw credible clinical distinctions between drugs. Here the new regulation reveals the ultimate intention of these schemes. The idea is to selectively outsource some of the politically hot policy work of making the clinical judgments to third parties, and then peg federal payment to these conclusions....The collective goal is to get more control of how doctors prescribe injectable drugs like cancer medicines. In this way, Medicare can get more leverage not only over the how these drugs are priced, but also how doctors use them.
...The Obama team is trying to control costs more directly; by regulating the clinical choices doctors make to sometimes use costlier medicines.
These constructs have long been liberal dogma when it comes to our relatively free market for drug development. Turning over the determination of "comparative value" to third parties, and then tying federal reimbursement to these subjective conclusions, represents a circuitous way to exert government control over how drugs are priced and prescribed. Only with far fewer fingerprints affixed.
"In other words, your health care decisions will be removed -- even more than they already are by other regulations -- from your doctor and handed to the government."
Noted in 2009...
Radwaste at March 21, 2016 6:50 AM
In other words, your health care decisions will be removed -- even more than they already are by other regulations -- from your doctor and handed to the government.
If only someone had predicted this...oh, wait, I did as did many others. This is just rationing by fiat. We're well on our way to getting our own personal VA Experience.
At least when you get your treatment denied by an HMO or insurer, you can fight them on it. Try fighting a faceless, nameless bureaucrat who's banking on this quarter's cost cutting to put them in line for a fat bonus.
I R A Darth Aggie at March 21, 2016 6:57 AM
Also, when a private entity denies your preferred treatment option, you can still pay out of pocket for it.
No such luck when the government is involved.
I R A Darth Aggie at March 21, 2016 6:58 AM
Very glad you've found some relief, Amy! I had a crippling bout of vertigo in 2012 and I'm writing down the name of this drug if I ever go through this again. I got relief from meclizine but honestly it knocks me out on my butt. Good to hear there's an alternative out there.
I buy drugs from a site overseas regularly. I keep antibiotics (2 kinds) and skin ointments and various things you need expensive appointments to be able to get prescriptions for. The drugs are reasonably priced and I'm avoiding expensive specialist appointments to get something I am very capable of dispensing properly to myself.
Also, I believe the oncologists will find a work-around on the policy of lower cost infusional reimbursement. I've seen several different offices admitting patients for chemo that other offices just administer in infusional chairs under the watchful eye of trained chemo nurses. These cost-cutters will probably join ranks with hospital admitters for simple infusions to justify expenses. Government just gonna cost itself more money in the long-run. Idiots.
gooseegg at March 21, 2016 8:31 AM
Very glad you've found some relief, Amy! I had a crippling bout of vertigo in 2012 and I'm writing down the name of this drug if I ever go through this again. I got relief from meclizine but honestly it knocks me out on my butt. Good to hear there's an alternative out there.
I buy drugs from a site overseas regularly. I keep antibiotics (2 kinds) and skin ointments and various things you need expensive appointments to be able to get prescriptions for. The drugs are reasonably priced and I'm avoiding expensive specialist appointments to get something I am very capable of dispensing properly to myself.
Also, I believe the oncologists will find a work-around on the policy of lower cost infusional reimbursement. I've seen several different offices admitting patients for chemo that other offices just administer in infusional chairs under the watchful eye of trained chemo nurses. These cost-cutters will probably join ranks with hospital admitters for simple infusions to justify expenses. Government just gonna cost itself more money in the long-run. Idiots.
gooseegg at March 21, 2016 8:31 AM
Well I am somewhat sympathetic but the hospitals and pharmaceutical companies have chosen the form of their destructor.
When the cost of everything was driven sky high by the third party payer system, something had to give.
Not saying rationing is a good solution, but is is the only one the socialist ninnys will accept.
The good solution is to have medical services and treatments go largely over the counter, and into the free market where rent seeking behavior which has overwhelmed the cost of treatment, ends.
Isab at March 21, 2016 9:03 AM
Seems to be available in Canada, eh?
Earl Wertheimer at March 21, 2016 9:03 AM
I'm glad you found some relief too. I also get terrible motion sickness so someday I may try the therapy you mentioned. Do you ever get people who have never suffered from motion sickness tell you it's all in your head? I do and when I hear it I just want to puke!
Jennifer K at March 21, 2016 10:19 AM
Our government is mangling medical care and prices much more than is commonly understood. This is the interaction:
() The doctor or Hospital wants say $100 for services. This includes all of the expenses required to meet the reporting requirements and investigations of the government. The unregulated cost would be much less, maybe $50.
() Medicare routinely sets its payment to the hospital at 60% of the list price. This follows the bureaucratic belief that any market price is too high for government. Government must get a discount. Socialists don't want to pay for anything called a profit.
() Doctors and hospitals set rates at $167 to bargain for the $100 they really want. A market price of $167 emerges as the standard.
() Insurance companies negotiate 60% off list, on par with Medicare. They don't want to pay the inflated, artificial list price.
() Patients without insurance or who receive out of network treatment are charged list price, to preserve the agreements with Medicare and the insurers. That charge is 67% more than the in-network charge would be. If hospitals charged less, everyone would complain and want the lower price.
() Hospitals are required to provide emergency services regardles of the ability of the patient to pay. They inflate those charges under the same pressures and by even more, trying to be paid for the services they are delivering for free, by any patient with insurance and those with assets. There is constant negotiation to set rates, give discounts, and somehow collect income to cover expenses.
() Pity the person who has an uninsured heart attack. The bill will be $300,000. The insurance company of an insured patient will probably pay around $30,000. The hospital charges $300,000 because sometimes it can get it, or at least more than $30,000. The insurance company demands that the list price be collected if possible, because it wants to sell insurance against these "catastrophic" charges.
If you ask about a price, either no one knows or they don't want to tell you and open a negotiation dispute about all of their other charges.
This is a confused, rotten system imposed by stingy, uncaring politicians. Politicians have convinced the public that they are providing free emergency and medical care by decree. The consequences are complex, expensive, and not understood.
In short, the government has imposed a health care tax on all sick people, paid by those with resources or insurance. It is a wonderful tax on the middle class, hidden in a maze of intermediaries and hospital bills impossible to understand. This tax goes direectly from insurers and hospitals to medical subsidies, so the government doesn't have to make it a line item in the budget and anger the people who are paying.
We must get the government out of healthcare to discover what the true costs and rates should be under competition. The government should at most subsidize healthcare for the poor at market rates.
This is not the fault of having health insurance. We have accident and home owners insurance which does not inflate rates. Health insurance is tightly regulated at the state and federal levels. People cannot get lower rates for choosing less costly treatments, so they demand and get the most costly ones. It is not the insurance, but the incentives which are wrong in healthcare.
Andrew_M_Garland at March 21, 2016 11:57 AM
In Economics 001 there's this nifty graph. Demand for something goes up as prices go down. Supply goes up as prices go up. The lines have to cross. At the price at which they cross, demand is the same as supply.
I really shouldn't have had to say that. It's got to appear condescending as hell. Sorry about that. But ignorance of it was built into the phrase I'm responding to.
It's impossible to subsidize anything at market rates. The subsidy moves the market. And because Free Shit is very popular, it very quickly becomes the market.
phunctor at March 21, 2016 12:57 PM
I'm waiting for one of the Mexican cartels to figure out that they can make a hell of a lot of money by selling gray-market pain relievers and other non-available drugs in the U.S. The market for heroin is small. The market for people who need drugs for chronic pain is big, and it gets bigger the more that the DEA intimidates doctors.
Cousin Dave at March 21, 2016 2:02 PM
And you better bet the government will come down on that cartel like a bag of bricks, while leaving its heroin and cocaine dealing competition alone. Can't hurt the monopoly doncha know.
spqr2008 at March 22, 2016 5:37 AM
There's a comment on her Facebook that shows exactly the problem with people:
"You have to actually see these issues (and poor medical judgment) at work to really *get* that medical professionals are not all the genius, God-like people society holds them out to be (especially in a country where preventable medical error is the 5th leading cause of death). They are just people with the same fallibility and motivations as everyone else, except they have the power to accidentally kill you more regularly."
Seriously? And what, does this person think that govt bureaucrats with ZERO medical training, ZERO medical experience, and ZERO relationship/contact with the patient are better than actual doctors at determining the best practice for the patient?
This person has placed all her faith in the infallibility of the govt, which would be fine if she were the one riding that bomb to detonation, unfortunately she votes and has determined that the rest of us are going to join her.
Fenia at March 22, 2016 7:33 AM
I'm an optimist Fenia. I think she wants to make preventable medical errors the leading cause of death in this country.
USA! USA! USA!
Ben at March 22, 2016 8:22 AM
To phunctor at March 21, 2016 12:57 PM,
Yes, you would be condescending if you had a position to do it from. You use an old technique of argument. State something which is almost always true (supply and demand), wave your hands, and state your unexplained and unsupported belief.
Consider charity. This is a subsidy at market rates. Charity has not caused the price of food and housing to rise dramatically.
Rates for medical care have adjusted to disruptive mandates. That was the point of my post. Hospitals are charging more than the costs for an insured individual and are applying the extra cash to support mandated medical charity.
Hidden taxes are distoring the market for medical care, not the subsidy that the government provides. That subsidy is low, as revealed by the low reimbursement given to hospitals and doctors for medicare and medicaid patients. Many doctors will not take those patients because they aren't paid enough. That is not a subsidy driven high market price.
Andrew_M_Garland at March 22, 2016 1:34 PM
Actually I thought phunctor's post was good basic information, especially how little most people know about basic economics these days. So many people engage in magical thinking about imposing non-market costs on a product (taxation and regulatory costs); somehow they believe that they can do things that will make prices go up without any impact on either supply or demand. The issue with the medical industry is that government meddling has so corrupted the pricing process that the market-signaling information that is normally provided by price is overwhelmed by noise. No one has any idea what the price of anything actually means in the medical field, so it's impossible to walk away with a good feeling that you got what you paid for. I think this is a big reason that distrust of the medical industry in general is so high.
Cousin Dave at March 23, 2016 8:45 AM
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