Pricing Medicine Out of the Poor’s Reach

Health Care

New Or56586291leans If any readers of the Sunday New York Times Sunday Review section could get by the devastating critique of the Obama “narrative” and therefore Administration and leadership by Drew Westen or the even more shattering, full color satirical cartoon on how to “survive” the continuing recession, they might have stumbled onto the article about how we are essentially killing people who have cancer (and other maladies) by allowing there to be shortages of proven, lifesaving drugs because the government has done the right thing and not allowed predatory pricing by drug manufacturers of generic drugs.

Ezekiel Emanuel, a doctor, former White House advisor, and about to be UPenn professor was attention getting in his own way noting:

“Of the 34 generic cancer drugs on the market, as of this month, 14 were in short supply. They include drugs that are the mainstay of treatment regimens used to cure leukemia, lymphoma and testicular cancer. As Dr. Michael Link, the president of the American Society of Clinical Oncology, recently told me, ‘If you are a pediatric oncologist, you know how to cure 70 to 80 percent of patients. But without these drugs you are out of business.’”

Get this:  people are dying because they can’t get cheaper druges!

Emanuel argues that ending the doctor/drug scam of “buy and bill,” where docs passed on all costs without concern or conscience to Medicare forcing Congressional reform through the Medicare Prescription Drug, Improvement and Modernization Act under George W. Bush in 2003 led to this problem.  When effective drugs went generic accompanied by price falls of up to 90%, manufacturers were forced to go with the “average selling price” plus 6% for handling, so greed being what it is, moved on to greener more lucrative pastures leaving people dying behind them.  You just know that when there is a scarcity and Medicare is involved that it is the poor who are inevitably experiencing the brunt of this shortage, though Emanuel does not make that point.

The point he does make though is somewhat disturbing though:

“You don’t have to be a cynical capitalist to see that the long-term solution is to make the production of generic cancer drugs more profitable. Most of Europe, where brand-name drugs are cheaper than in the United States, while generics are slightly more expensive, has no shortage of these cancer drugs.”

Well, uh, actually you do have to be a “cynical capitalist,” I’m afraid and certainly not a medical ethicist, as Emanuel is now pretending to be.  His recommendation:  let them charge the average selling price plus a 30% profit margin.  I think this is precisely what “cynical capitalists” would advance:  a guaranteed cost plus contract by the government!

But, no, he gets even more cynical than this.  Emanuel proposes an even more “radical” solution:  “take Medicare out of the generic cancer drug business entirely.”  His plan is that Medicare would stop paying for generics and they would then be covered by a “private pharmacy plan.”  Who exactly can afford supplemental drug plans?  Categorically not the poor!  This guy is going to teach medical ethics?  Preposterous!!

Here’s a more radical solution.  Let the government create a cheap and forgivable loan program to allow potential drug manufacturers willing to live on average selling price plus 6% to supply the market.  That’s a real jobs program, and there are few communities who wouldn’t love to have the relatively environmentally safe and sound drug manufacturing work.

Or if you want to be more radical, let the government itself start manufacturing generics to save lives of the poor and any of the folks Emanuel cares about.  Ironically, it would even save money by reducing the cost of cancer care reimbursed by Medicare, thereby creating a win-win solution.

But, now I’m sounding like a cynical capitalist, I suppose.