Everyone likes a bargain, but when your health is on the line, cheaper isn't necessarily better.
Earlier this month, an example was provided when the results of an eight-year study of nearly 5 million cardiac patients in Great Britain's Health Improvement Network database were released. The study found a 36 percent increase in "major cardiovascular events," like heart attacks and strokes, among patients who had been switched from one cholesterol-lowering drug, atorvastatin — better known as Lipitor — to another, simvastatin.
Both pills are considered effective statins, but they are different medicines. So why were the patients who had been taking one drug switched over to another?
If you guessed it was because their doctors thought simvastatin was the better option, you'd have to ask why the doctors didn't prescribe it in the first place. Instead, the patients were switched to save the government some money.
Under Britain's nationalized health care system, cost considerations are as influential as medical judgment, and patients are powerless to resist. Things are different in America. When investigative reporters in Boston recently learned that a private insurer was paying doctors to pull the same switch, they rightly featured it on the news as a threat to patient care.
The money-saving incentive arises from the expiration of the patent on branded simvastatin, called Zocor, so that cheaper generic copies have become available in both the United States and Britain. Consequently, as a cost-cutting measure, authorities in Britain's National Health Service (NHS) suddenly had a strong incentive to push generic simvastatin over Lipitor — overriding doctors' decisions that Lipitor was the more effective drug for those patients who had been using it.
This eight-year scholarly study, reported last month at the European Society of Cardiology Congress and pending publication in the British Journal of Cardiology , a peer-reviewed publication, adds to a broad and growing body of evidence that advises doctors' decision-making on the right use of the right medicine on the right patient at the right time.
Unfortunately, in a "closed system" such as Britain's NHS, government agents have the power to inhibit those decisions. When the government foots the bill, cost-conscious budget analysts may not always consider patient well-being the top priority.
In other words, we should all be concerned about the prospect of government-controlled medicine, especially if we have no alternative but to accept whatever decision the bureaucracy hands down.
And this isn't just a problem for Brits.
All the Democratic presidential candidates have made government-controlled, national health care a centerpiece of their campaigns. And as in all national health systems elsewhere in the world, their plans would grant bureaucrats in Washington as much say over how you're treated as your doctor.
Further, the House of Representatives recently passed a measure creating a brand-new federal health bureaucracy — the Center for Comparative Effectiveness — that would make decisions much like Britain's health service. Designed to conduct government-run studies on the economic impact of the choices doctors make, the House has earmarked $300 million in start-up funds for this new bureaucracy.
If a mandatory national health care system comes into being sometime in 2009 or thereafter, one can be sure that the Center for Comparative Effectiveness will house the budget analysts who determine what medicines and treatments are worth the money.
As the Brits have discovered, when bureaucrats managing health care delivery second-guess doctors — or strong-arm them into changing prescriptions to save a buck — the end result is rarely a bargain for the patients involved.
Today, when a U.S. health insurer pays doctors to switch patients from Lipitor to simvastatin, it's a scandal on the evening news. In a few years, if Congress creates a Center for Comparative Effectiveness, it might be mandatory.
|
