THE TREATMENT MARCH 24, 2009
Earlier today the Pharmaceutical Reserach and Manufacturers of America held a conference call for bloggers. PhRMA President Billy Tauzin led the call and used his introductory statements to position PhRMA as a champion of reform--an organization that understands American health care needs to be better and more widely available. He noted, among other things, that PhRMA has been an active participants in discussions on health reform taking place all over Washington, like the ones profiled in this recent Politico article by Carrie Budoff Brown.
That much seems to be true. Sources in the greater reform community--a group that spans the Obama Administration, Capitol Hill, and various liberal interest groups--say that PhRMA and its allies have been surprisingly open-minded during group dialogues. That could indicate PhRMA is geuinely interested in helping to create a more efficient, more humane health care system. Or that could indicate that PhRMA thinks it's politically savvy to sound as constructive as possible, at least right now.
Either way, PhRMA still has its own, very specific notions of what reform should look like. Giving everybody insurance? Sure, that's great. Applying more scrutiny to effective treatments--a move most experts would argue is essential for bringing the cost of health care under control? Um, not so much.
And so, once Tauzin was done saying all the right things, he got down to business.
Tauzin warned that reform must not deter innovation. He also said that reform should not interfere with the "wonderful, uniquely American experience in which doctors and patients make their decisions about health care." Tauzin later expanded on this point in response to a question--posed, I think, by National Journal's Marilyn Werber Serafini--about whether PhRMA considered any particular ideas "hot spots" or "deal breakers." The answer, Tauzin said, was yes:
Anything that takes us to a place ...where government is making decisions instead of doctors and patients is a hot spot for us.
This posture is hardly surprising. PhRMA has traditionally fought efforts to give the federal government more authority over the way health care is delivered, whether it's defining insurance benefits, creating public insurance programs into which people can enroll, or using government bargaining power to drive down prices. Most recently, during the stimulus battle, it opposed efforts to create an institute that would study the effectiveness of new medical treatments.
But however familiar, the arguments still have power. So it's worth going over why they are wrong.
Let's start with the point about innovation. Yes, the U.S. is a world leader when it comes to developing new treatments, just as Tauzin says. But public investment in health research, via the National Institutes of Health, is what generates most major scientific breakthroughs in medicine.
And while the drug industry plays a key role in transforming those breakthroughs into usable, marketable medications, scrtunizing those inventions to make sure they add actual value--and, if so, when it's appropriate to use them--should not hamper innovation. If anything, such scrutiny should improve innovation. (For a more nuanced and thorough treatment of this issue, read this article from last year.)
As for Tauzin's suggestion that reform would disrupt the sanctity of the "uniquely American" doctor-patient relationship, you have to wonder whether he's spent much time talking to American physicians lately.
All insurers, public and private, have rules for what they will cover and what they won't. But when private insurers make these decisions, they do so in secret, using their own criteria. Those criteria may reflect a desire to give beneficiaries the best care. Or they may reflect a desire to give beneficiaires the cheapest care, which isn't always the same thing. There's really no way to know.
What's more, private insurers frequently make phyicians and patients obtain prior approval for anything beyond routine care. Obtaining that approval can be cumbersome and frustrating, as any doctor or nurse who's blown part of the day arguing with a poorly run HMO can attest.
Meanwhile, physicians in many countries abroad--specifically, the ones with models most similar to what we'd create in the U.S.--tend to have the opposite experience. I learned this first-hand last year, while I spent several weeks in France and the Netherlands, courtesy of a fact-finding trip financed by the Commonwealth Fund. When I asked doctors about the level of bureacratic interference with their medical practices, they looked at me as if I was from Mars. They practiced medicine freely, they told me. If they thought a patient needed a treatment, the patient got that treatment. No questions asked.
Of course, physician and patient autonomy isn't always such a great thing. French doctors are able to prescribe medication virtually at will. Not coincindentally, the evidence suggests the French probably get too many prescriptions.
That's why a well-designed health care system would actually provide some guidelines about appropriate care--guidelines that reflect the best clinical data and still allow practitioners leeway to go around them in special cases. You tend to see such arrangements in places like Group Health of Puget Sound, the Mayo Clinic, or the Veterans Administration, which deliver top-quality medical care at relatively low cost.
You won't hear that from lobbyists like Tauzin, who actually singled out the VA as a system to avoid. Whether that's because Tauzin really believes those systems are substandard--or because Tauzin believes such systems would cut into drug industry profits--is a matter readers will have to decide for themselves.
Update: Over at the Huffington Post, Sam Stein has more on Tauzin and PhRMA position, with a particular focus on Tauzin's comments about a public insurance plan. It's worth a read.