Health Care Again

Charles Peters at The Washington Monthly identifies four ways health care reform can lead to less expensive, but better, health care:

• Give the government the power to negotiate prices with the drug companies. This could save Medicare a ton of money—the Veterans Administration cut its drug bill in half when given the right to negotiate. The House bill makes this reform, but the Los Angeles Times reported that the White House has made a deal with the drug companies’ chief lobbyist, Billy Tauzin, not to support the reform. According to the New York Times, the White House at first confirmed the deal, but then denied it—sort of. The potential savings of having the government bargain for drug prices are so great that Obama should leave no doubt. He should repudiate the deal. Better to betray Billy Tauzin than to betray the American people.

• Abolish or radically reduce drug advertising. Remember, it was outlawed until relatively recently—and for good reason. Not only does it often obscure dangerous side effects, it encourages people to bug doctors to prescribe drugs either that they don’t need or that are the most expensive of the possible therapies. Representative Jerrold Nadler has offered a bill to take away the tax exemption that is now given to drug advertising. And the FDA is proposing regulations that would require drug ads to disclose side effects in an obvious way instead of rapidly reciting them sotto voce over sunny pictures of people happily enjoying the benefits of the drug.

• Encourage doctors to work in Mayo- and Cleveland-type clinics that have doctors working together, and that pay salaries instead of fees for service. Massachusetts, the only state with experience offering near-universal health care, is now being urged by a high-level commission to abolish fee for service, which encourages physicians to recommend services that pay the highest fee, rather than those that are the most needed by the patient.

• Don’t allow physicians to administer expensive tests in their own offices when that encourages them to order more tests than they ordinarily would. To understand why, consider this anecdote reported by the Washington Post’s Shankar Vedantam: "In August 2005, doctors at Urological Associates, a medical practice on the Iowa-Illinois border, ordered nine CT scans for patients covered by Wellmark Blue Cross and Blue Shield insurance. In September that year, they ordered eight. But then the numbers rose steeply. The urologists ordered 35 scans in October, 41 in November and 55 in December. Within seven months they were ordering scans at a rate that had climbed more than 700 percent. The increase came in the months after the urologists bought their own CT scanner."

The practice of medicine is a different animal than it was in the old days.