A Message from Executive Director Ann Woloson

As lawmakers contemplate health care reform “savings” at the federal level, it makes sense to start with the obvious.

First, the federal government, not the private sector, should negotiate prescription drug prices for the newly insured and the elderly under Medicare Part D. Currently, the private sector reaps billions in revenues negotiating prices and steering plans (and beneficiaries) toward certain drugs under Part D. Meanwhile, the government obtains lower prices for veterans and Medicaid patients and could achieve huge savings as the nation’s largest drug purchaser for our elderly. Savings could be funneled back into Medicare to slow its growth and used to help expand coverage to the estimated 46 million uninsured Americans.

Second, reform measures must place more emphasis on evidence-based medicine to improve health care quality in the US. Too often it’s assumed health care providers and consumers receive the best information available regarding treatment options, that is, the science showing what works best, is safest, and is most effective. While most of us want to believe information used by our health care providers is just that, the unfortunate and costly truth in many cases is that it’s not.

It’s no secret the US pays more than any other country for health care, yet our health outcomes remain marginal. Preventive care is important, as are tests to diagnose illness early and prescription drugs to help us get better when we are sick. It’s clear, however, we pay too much for care we don’t need and may be unnecessary or even harmful. Prescription drugs, for example, approved by the FDA, are assumed by most of us as safe. We want access to the medicine
we need to treat what ails us. We also want to know what actually works best and is safest. Unfortunately, many new drugs are heavily marketed, often for uses not approved, or for uses approved, but not
sufficiently tested.

One example is Vioxx, the supposed miracle pain killer, which was linked to an estimated 139,000 heart attacks or strokes—40% of which were fatal. Other examples include certain drugs used to treat anemia in dialysis or cancer patients, which are prescribed in much higher doses on average in the US, even though such doses increase the possibility of blood clots and death. Still other examples include atypical antipsychotic drugs approved for use in adults that are being prescribed to kids, while reports of questionable effectiveness,
deaths, and dangerous side effects mount.

Hats off to Congress for including and keeping comparative analysis funding in the economic stimulus bill—it’s critical to improving the quality of health care in the US. Health can improve and money saved can be used to improve access. Simple, yes; but special interests are already fighting information on safety and effectiveness, claiming it’s cramming government controls down our throats. Of course, knowing what’s best for us isn’t the same as having a mandate to do it. Health care marketers would rather we depend on their inept advertising than actual science when deciding medical treatments.

Reform efforts need to make sure the best science regarding treatment options ends up in the hands of providers and patients. Academic detailing programs, also known as prescriber education, have proven effective in countering the pharmaceutical industry’s sales strategies, improving health care quality, and reducing costs. Trained clinicians provide prescribers with unbiased information regarding certain therapeutic areas and drug classes.
Doctors want to provide quality care, but they are busy. Many find it difficult to keep up-to-date on all of the latest treatments available. Comparative analysis and prescriber education are useful tools in helping health care practioners provide the best care possible. It’s information we want our doctors to use when we need care.

Finally, proposals to create a public option shouldn’t get lost in all the reform talk in Washington. The importance of the competition such a plan would create in today’s market can’t be overemphasized. Pharma’s proposal to close the “donut hole” (for some) under Medicare Part D to “create” $80 billion in savings in 10 years does nothing to slow growth or ease government spending under the program. Yes, the “donut hole” should be closed, but using it as a bargaining chip to thwart badly needed reform is shameful. Providing a public option will help give the industry the impetus it needs to reduce costs and rethink the way it does business. It will also provide purchasers of coverage with another choice; something many have looked for when exploring current options.

By starting with the obvious, reform will take shape and public opinion will remain optimistic that something meaningful will result.