Selling It

In opposition to the push for greater and more equal access to health care—which means more affordable health care—lobbyists and conservative commentators have constructed the fantasy that patients are the ones responsible for the high cost of medicine in the U.S. If we became “better consumers” of our health care, they insist, making the same kind of informed economic decisions we make in other aspects of our lives, then price competition will drive down prices. As one health care “think tanker,” Merrill Matthews, recently put it in Forbes “liberals … are convinced that people are too stupid to make good decisions.” By his logic, a single-payer health plan is the height of nanny-state condescension, while free market capitalism is an arena where consumers can exercise free choice to make informed decisions about their health care. 

I always bristle when I hear such arguments because they are, necessarily and inevitably, devoid of any concrete examples. What, in our health care system in the U.S., would it mean for consumers to “shop” for the best prices? When my neurologist calls me up and says he wants to order a genetic test to check for a potentially fatal condition, or to arrange a consultation with a colleague who specializes in dysautonomia, do I ask him: “How much is this going to set me back?” Do I shop around for other specialists in my city who work on dysautonomia and compare credentials and costs? 

Of course, there are no other doctors specializing on my condition in my city. But if there were, they would almost certainly not be part of my health plan. In fact, there are some very good specialists up in Cleveland, but my health plan won’t cover me visiting them. There are a ton of neurologists over at a neighboring hospital, where they migrated from Ohio State after a dispute over something or another. But I can’t see them either, as my insurance company will never pay for it. And paying for such services myself without insurance would certainly not be a wise economic decision by anyone’s measure. 

The notion of freedom of choice for consumers in our health care system is of course laughable, even for folks like myself who are fortunate enough to be well insured. Take, for example, a piece in last weekend’s Times by a doctor who also himself happens to be a patient suffering from a debilitating chronic disease. Unlike many patients with ulcerative colitis, Dr. Carroll found a treatment that actually worked for him, and an affordable one. Like all patients, however, and despite being himself a part of the medical system, Dr. Carroll experiences himself as “trapped in the system”—forced to constantly go through a complicated and treacherous obstacle course of tests, permissions and prescriptions to get the refills that allow him to function. He cannot choose the pharmacy. He cannot choose the lab where his blood is sent for analysis. He cannot choose the drug company that manufactures the drug. The very notion of “choice” is completely absent from the process at every stage. 

Still, Dr. Carroll’s story is ultimately a happy one, despite the considerable tension brought on my the system itself—which for most chronic conditions like ulcerative colitis is an exacerbating factor. He has a medicine that works and one whose potentially dangerous side effects he has not experienced. He will continue to get his medicine refilled, even if only after extensive headaches and delays.

But what of the AIDS or cancer patient struggling with toxoplasmosis? They woke up yesterday to the news that a disgraced former hedge fund manager had set up a drug company, purchased a drug crucial to battling the parasitic disease that predominantly impacts the immune-compromised, and then raised the price to $750 a tablet. This is not a new drug, mind you, and the company is not recouping costs related to R&D. This is a 60-year old drug that just a short time ago sold for $13.50 a tablet. This is a case of greed and opportunism, plain and simple. This is what happens when health care is governed by the caprices of the “free market”—patients who formerly had an effective and affordable treatment for toxoplasmosis will have to now subject themselves to potentially less effective and efficient treatments. People will die; and people will get rich. Only one side of this equation has a “choice.”