Healthcare Hullabaloo: Socialized Medicine

…the devil's best trick is to persuade you that he doesn't exist!"
"Le Joueur généreux," pub. February 7, 1864

Socialized Medicine. No two words strike greater fear in the hearts of Americans than socialized medicine. Once we are forced to endure socialized medicine, all hope will be lost. In the great health care debate, the phtase ‘socialized medicine’ is the nuclear warhead – dropped when desperate times call for a game-ending action. No one wants socialized medicine. Discussion over.

Socialized medicine means many things to the American people, but most importantly, it means the end of choice. Freedom and Liberty are the cornerstones of the foundation that this country was built upon. Losing ones Freedom of choice is the perhaps the greatest affront to our national character,
And that is why we will fight socialized medicine with our dying breath. For Americans, nothing is worse.

All I can say to my fellow, Liberty-Loving Americans is “WAKE UP!” In case you haven’t noticed, socialized medicine (or at least its consequences) is here. It has lived here, warm, fat and healthy, for many years. Remember this the next time that your doctor gives you a prescription.

When it comes to our prescription medicines, we really have no Freedom of Choice – we can only buy the specific brand of medicine that out doctor gives us the permission to buy. Yet, most of us remain oblivious to this fact. Do you have High Blood Pressure? You get a prescription for an ACE inhibitor. You can take benazepril, captopril, enalapril,fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, or trandolapril. For most of these examples, you can take one of several name-brand drugs, or you can take its generic equivalent. There are of-so-many ‘prils to choose from – but not for us Americans. We can only buy the SPECIFIC ‘pril that our doctor gives us permission to buy. Yes, there are different side effects and interactions to these varied ACE inhibitors, but none of these drugs are particularly different or dangerous. Yet, when you go to the pharmacy, you are limited to the SPECIFIC ‘pril that your doctor gave you on the prescription. Your doctor gave you a prescription for quinapril, but lisinopril is on sale? - tough luck – you have to buy quinapril. You have a prescription for Zestril but it costs 5 times as much as generic lisinopril – you can’t buy the generic version without your doctor’s permission, even though it is the same thing. Your doctor most likely decided what ‘pril to prescribe based upon what drug rep last bought his staff lunch or dropped off a case of free samples, or took his family out to a ballgame or fancy restaurant. Or perhaps your doctor was swayed by some shady research report that shows that their brand of ACE inhibitor was marginally better in one way or the other. In any event, the choice of ACE inhibitor is not up to you, the consumer. This effectively eliminates competition between competing drugs at the consumer level. Completion at the consumer level is what drives prices down and keeps quality and innovation up. This is why over-the counter medicines cost a mere fraction of their prescription-only cousins..

This argument is not limited to ACE inhibitors. Similar arguments could be made for many other classes of drugs, from proton-pump inhibitor stomach medicines (Omeprazole, Lansoprazole, Dexlansoprazole, Esomeprazole, Pantoprazole and Rabeprazole) to cholesterol-lowering statins (Atorvastatin, Fluvastatin, Lovastatin, Pravastatin, Rosuvastatin and Simvastatin).

Why do we not have a choice? Well, the primary reason is that by taking the choice out of the hand of the consumer the prices can be driven up to the current stratospheric levels and even beyond. The argument is that the consumer does not have the intelligence, experience or knowledge to make the correct decision. However, I would counter that argument by saying that, thanks to the internet, many patients are more informed and knowledgeable than physicians were just a generation before. Patients who are not knowledgeable would always have the option to defer to their physician- or pharmacist – as to what drug would be the right one for them and their budget.

I don’t think that this could be done for all types of prescription drugs, but it certainly could be done for a large percentage of them. If physicians were only able to prescribe only a certain CLASS of drug (and still RECOMMEND whatever brand they wished), it would return decision making back to the consumer level, and start driving down the cost of many prescriptions. The Freedom of Choice as to what ‘pril, ‘zole or ‘statin to purchase would ultimately be in the hands of the consumer, and out of the hands of our pharmaceutical ‘Big Brothers’. This is right for so many reasons, but mostly because it is the American Way.

Until we see this change in the way that prescription medicines are prescribed, competition on the consumer level will be almost non-existent, and the prices of prescription drugs will continue to skyrocket. And well all know what eventually happens to a skyrocket…