- Written by Ken Alpern
02 Dec 2011
ALPERN AT LARGE - The concept of Sustainability is a relatively newly-promoted paradigm that should have been promoted decades ago. From an environmental perspective, it references the impacts of humanity on our local and global ecosystems; from an economic perspective, it references practices that just cannot last if budgets and economic prosperity are ever to be achieved.
Never more than now are the painful but mandatory decisions needed to achieve true Sustainability.
For example, the budget that employers and our political leaders assign to medical care is destroying our ability for both our private and public sectors to balance their budgets without asking continually more from businesses, employees and taxpayers—arguably this is a greater threat to our economy than our growing budgets for safety/security, education and defense.
So when Lipitor (which many physicians and their patients believe is the most potent and popular anti-cholesterol medicine in existence) goes generic, the opportunities for both its brand-name and generic manufacturers to pass on enormous discounts to patients and health plans alike abound. (Link)
Unfortunately, the opportunities for malfeasance on the parts of pharmaceutical and other healthcare firms also abound, attracting a timely and appropriate bipartisan alert. (Link)
Similarly, when the makers of the blockbuster arthritis/psoriasis injectable drug Enbrel (which has cost over $2 billion to manufacture but has and is costing our healthcare system billions a year to benefit patients with a host of serious autoimmune diseases) come out with a new patent that might prevent generic-like competition from “biosimilar” drugs for another 17 years, our economic and health care needs as a nation are directly threatened. (Link)
When up to 5% of Americans (and their health plans) with crippling arthritis and psoriasis require medications like Enbrel (or its competitors Humira, Remicade, Simponi, Stelara and other injectable biologic medications) must either pay $15-25,000 annually, the Hobson’s choice between escalating healthcare costs or denying modern/first-rate health care becomes glaring. Physicians, health plans and taxpayer advocacy groups will have to demand a more sustainable amount of $5-10,000/year.
Whether financially-associated healthcare regulation is performed by the public sector (usually favored by liberal/Democratic Americans) or the private sector (usually favored by conservative/Republican Americans), it is the economic survival of businesses and Medicare/Medicaid (funded by private and tax dollars, respectively) that is at play.
Whether the recent Healthcare Reform Bill “overreached” or not, the issue of unsustainable rising healthcare costs is destroying our economic future and quality of life.
Furthermore, health needs and Americans’ ability to work and thrive are also at play—so “capitalism” versus “gaming the system” must be confronted. It is ridiculous how expensive, unscientific and politically-motivated that FDA-forced regulation is for new and even decades-old existing drugs, and it’s equally ridiculous how American drug prices are normally three times that of Europe or Canada … yet the access of Americans to safe and pure medicines must be protected at all costs.
It was the private healthcare sector and capitalism that ultimately forced Claritin, Zyrtec and Allegra to be sold over-the-counter and save patients and health plans untold amounts of money, and similar efforts must be directed at both prescription and over-the-counter medicines.
Most importantly, science and outcome-based scientific and economic data must ultimately be the guiding force for healthcare-related decisions, despite our inherent human nature to pursue self-interest at the expense of others. And Americans need to know that the information they’re hearing is based on the scientific method and the latest medical and economic data.
Demonizing health plans, doctors, pharmaceutical companies, the FDA or any other group will not get the job done, because they all play a role in both the problems and solutions to our healthcare budget problems. There are few if any “shining white knights of truth” in our healthcare industry, because even trusted pharmacists and pharmacy techs have been tainted in certain pharmacy chains to promote half-truths or even falsehoods for their own personal financial gains.
(And those pharmacy chains, as well as everyday practicing healthcare providers, know damn well who they are!)
It is of note that both Republican and Democratic city, county and state leaders have taken measures to reduce healthcare costs, and that despite problems inherent to managed care organizations the increasing management of healthcare and its budgeting is a trend that is not going away. Patients who “want it all and paid for by someone else” will have to confront this limit-setting management or make darn sure they bring their checkbooks next time they see their healthcare provider.
The threat of a dramatic drop in Medicare reimbursement to health plans and individual providers can be legitimately blamed on numerous entities, but included on the “blame list” are doctors and other healthcare providers who do not sufficiently recognize that cost is a legitimate medical issue in choosing the right therapy for a patient, and who do not confront whether their personal practices are cost-effective and/or best benefit their patients.
Conservative healthcare need not be second-rate healthcare because aggressive intervention is not always needed for every patient. Similarly, the questions of access, physician flexibility and who can best benefit patients during both business and after-hours still remain insufficiently answered.
Yet the physicians, healthcare providers, health plans, pharmacies, pharmaceutical companies and other health-related oversight entities that truly make the effort to reach out to individuals who truly need more healthcare intervention (both medical and economic) have, do and always will ensure that the American healthcare system is the greatest on our planet.
(Ken Alpern is a former Boardmember of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Vice Chair of its MVCC Transportation/Infrastructure Committee. He is also a Clinical Instructor at the University of California, Irvine Department of Dermatology and is Chair of the Department of Dermatology at Talbert Medical Group in Los Angeles and Orange Counties. The views expressed in this article are solely those of Dr. Alpern.) –cw
Tags: economy, healthcare, healthcare economy, Lipitor, Enbrel, FDA, Federal Drug Administration, Healthcare Reform Bill, Claritin, Zyrtec, Allegra, Medicare, Medicaid
Vol 9 Issue 96
Pub: Dec 2, 2011