![\"Zeke](\"https:\/\/i0.wp.com\/www.dougsbriefcase.com\/blog\/wp-content\/uploads\/2015\/11\/credit-maryland-public-radio.jpg\")
<\/a>Zeke Emanuel is tired of pay\u00ading for your med\u00adi\u00adcine. [Cred\u00adit: Mary\u00adland Pub\u00adlic Radio]<\/p><\/div>Zeke Emanuel is tired of pay\u00ading for your expen\u00adsive medicine.\n
Dr. Emanuel, who served in a senior posi\u00adtion at the Office of Man\u00adage\u00adment and Bud\u00adget where he con\u00adtributed to the recur\u00adring night\u00admare known as Oba\u00admacare, recent\u00adly com\u00adplained in the New York Times [\u201cI Am Pay\u00ading For Your Expen\u00adsive Med\u00adi\u00adcine<\/a>\u201d] that his insur\u00adance rates are high because the med\u00adi\u00adcines you\u2019re tak\u00ading cost too much.<\/p>\n \u201c<\/span>We all need to care about not only our own health care bills but also those of our neigh\u00adbors,\u201d he writes. And by car\u00ading about your neigh\u00adbors\u2019 bills, he means find\u00ading a way to avoid them.<\/p>\n What evi\u00addent\u00adly pro\u00advoked Dr. Emanuel to fret about your med\u00adical bills was some\u00adthing called a PCSK9<\/span> inhibitor, a recent\u00adly approved class of bio\u00adlog\u00adics that, accord\u00ading to a pre\u00adlim\u00adi\u00adnary study, reduces the risk of heart attack and stroke by half<\/a>.<\/p>\n If you are prone to car\u00addio\u00advas\u00adcu\u00adlar dis\u00adease, you might think this is good news. Dr. Emanuel does not. He cites press accounts indi\u00adcat\u00ading that the med\u00adi\u00adcine will cost more than $14,000 per patient per year, though no insur\u00ader or gov\u00adern\u00adment agency<\/a> will pay that price because they nego\u00adti\u00adate discounts.<\/p>\n So why is Dr. Emanuel wor\u00adried? He cites a recent New Eng\u00adland Jour\u00adnal of Med\u00adi\u00adcine arti\u00adcle, which esti\u00admates that the drug might raise every\u00adone\u2019s insur\u00adance pre\u00admi\u00adums by $124 per year<\/a>. Despite uncer\u00adtain\u00adty around that esti\u00admate, the new drug will be cost\u00adly and Dr. Emanuel clear\u00adly doesn\u2019t think the ben\u00ade\u00adfit it could pro\u00adduce for mil\u00adlions of peo\u00adple is worth $124 to him.<\/p>\n His solu\u00adtion goes beyond price con\u00adtrols. They are, he writes, \u201ca good start and nec\u00ades\u00adsary\u201d but they \u201cwill not solve the sys\u00adtemic prob\u00adlem of super-high drug costs.\u201d Instead of con\u00adtrol\u00adling prices, Dr. Emanuel wants to con\u00adtrol access.<\/p>\n He sings in what he calls \u201ca grow\u00ading cho\u00adrus\u201d that wants to require insur\u00adance com\u00adpa\u00adnies and gov\u00adern\u00adment pro\u00adgrams to \u201cpay for val\u00adue.\u201d Val\u00adue-based pur\u00adchas\u00ading is not a cut\u00adting-edge idea. It\u2019s what you do every time you go to the super\u00admar\u00adket and decide whether to pay $13 for an organ\u00adic roast\u00aded chick\u00aden or $5 for the non-organ\u00adic alter\u00adna\u00adtive. \u201cIn the rest of the econ\u00ado\u00admy,\u201d he writes, \u201cwe let indi\u00advid\u00adu\u00adals deter\u00admine val\u00adue. They decide whether a new gad\u00adget is worth the expense.\u201d<\/p>\n But that won\u2019t do in health care, Emanuel informs us. Let\u00adting doc\u00adtors and patients make med\u00adical deci\u00adsions is a dan\u00adger\u00adous thing. \u201cIt is not just patients\u2019 per\u00adspec\u00adtives we need to take into account. Patients get the ben\u00ade\u00adfit, but all of us are pay\u00ading the bill.\u201d<\/p>\n Deci\u00adsions about clin\u00adi\u00adcal val\u00adue should not be made in the clin\u00adic, Emanuel argues. \u201cBecause we all pay, all Amer\u00adi\u00adcans have to have a voice in deter\u00admin\u00ading value.\u201d<\/p>\n By \u201call Amer\u00adi\u00adcans\u201d he means gov\u00adern\u00adment, guid\u00aded by peo\u00adple of his aca\u00add\u00ade\u00adm\u00adic pedigree.<\/p>\n Dr. Emanuel offers a for\u00admu\u00adla, bor\u00adrowed from the U.K.\u2019s Nation\u00adal Health Ser\u00advice (NHS<\/span>), for \u201cdeter\u00admin\u00ading val\u00adue\u201d and thus for decid\u00ading whether your med\u00adi\u00adcine, surgery or treat\u00adment is worth the price. The NHS<\/span> cal\u00adcu\u00adlates \u201cQual\u00adi\u00adty-Adjust\u00aded Life Years\u201d [QALY<\/span><\/a>], a met\u00adric that takes into account both the quan\u00adti\u00adty and qual\u00adi\u00adty of life gen\u00ader\u00adat\u00aded by med\u00adi\u00adcines and oth\u00ader treatments.<\/p>\n \u201c<\/span>In Eng\u00adland, they have a flex\u00adi\u00adble tar\u00adget,\u201d he writes, \u201cwhere\u00adin above $45,000 per QALY<\/span> require an increas\u00ading\u00adly strong case for cov\u00ader\u00adage.\u201d The PCSK9<\/span> inhibitor, as you may have guessed, miss\u00ades the tar\u00adget. Indeed, Emanuel esti\u00admates that the bio\u00adlog\u00adics would cost \u201cas much as $300,000 for every qual\u00adi\u00adty-adjust\u00aded life-year they add.\u201d<\/p>\n Eth\u00adi\u00adcal con\u00adcerns aside (should gov\u00adern\u00adment deter\u00admine how much an addi\u00adtion\u00adal \u201cqual\u00adi\u00adty-adjust\u00aded life-year\u201d is worth?), gov\u00adern\u00adment poli\u00adcies have so dis\u00adtort\u00aded med\u00adical prices as to ren\u00adder sus\u00adpect the sorts of cal\u00adcu\u00adla\u00adtions Emanuel favors. Before con\u00adsid\u00ader\u00ading whether to import England\u2019s algo\u00adrithm for deter\u00admin\u00ading val\u00adue, pol\u00adi\u00adcy\u00admak\u00aders would do well to reflect on the wreck\u00adage that pre\u00advi\u00adous gov\u00adern\u00adment for\u00adays into the health care mar\u00adket\u00adplace have wrought.<\/p>\n The gov\u00adern\u00adment, for exam\u00adple, impos\u00ades price con\u00adtrols in the VA<\/span> sys\u00adtem<\/a>. It also oper\u00adates a Med\u00adic\u00adaid \u201crebate\u201d pro\u00adgram<\/a>,<\/span> which requires drug mak\u00aders to mark down the price of med\u00adi\u00adcines in that bur\u00adgeon\u00ading pro\u00adgram. It man\u00addates that drug com\u00adpa\u00adnies make sim\u00adi\u00adlar price con\u00adces\u00adsions<\/a> to a grow\u00ading list of clin\u00adics and hos\u00adpi\u00adtals. Man\u00adu\u00adfac\u00adtur\u00aders also must slash prices by 50 per\u00adcent<\/a> for Medicare ben\u00ade\u00adfi\u00adcia\u00adries who have fall\u00aden into the drug benefit\u2019s \u201cdonut hole.\u201d<\/p>\n When the gov\u00adern\u00adment requires man\u00adu\u00adfac\u00adtur\u00aders to pro\u00advide steep dis\u00adcounts to such a broad swath of the mar\u00adket, every\u00adone else is pre\u00addictably charged high\u00ader prices.<\/p>\n Then there are the lim\u00adi\u00adta\u00adtions gov\u00adern\u00adment enforces on the intel\u00adlec\u00adtu\u00adal prop\u00ader\u00adty rights of phar\u00adma\u00adceu\u00adti\u00adcal com\u00adpa\u00adnies. Dis\u00adney still holds exclu\u00adsive rights<\/a> to Mick\u00adey Mouse (intro\u00adduced in 1928), but knock-off ver\u00adsions<\/a> of the drug Abil\u00adi\u00adfy (first approved<\/a> to treat schiz\u00ado\u00adphre\u00adnia in 2002), hit the shelves this year. That means man\u00adu\u00adfac\u00adtur\u00aders have to recoup all of the devel\u00adop\u00adment costs of a prod\u00aduct (and sus\u00adtain ongo\u00ading research and devel\u00adop\u00adment efforts) in a very short peri\u00adod of time, putting fur\u00adther upward pres\u00adsure on prices.<\/p>\n Emanuel doesn\u2019t just over\u00adlook the dis\u00adtort\u00ading effect gov\u00adern\u00adment actions have had on drug prices. He also fails to see how gov\u00adern\u00adment has deformed health insur\u00adance mar\u00adkets. Fed\u00ader\u00adal pro\u00adgrams have long divorced pre\u00admi\u00adums from risk. Oba\u00admacare has extend\u00aded that prac\u00adtice into the indi\u00advid\u00adual and small group mar\u00adkets, cre\u00adat\u00ading a pro\u00adgram in which peo\u00adple who wait until they are sick to buy insur\u00adance pay the same rates as those who main\u00adtained con\u00adtin\u00adu\u00adous cov\u00ader\u00adage when they were healthy.<\/p>\n It has thus made insur\u00adance a good deal for peo\u00adple who have pre-exist\u00ading med\u00adical con\u00addi\u00adtions and a bad deal for peo\u00adple who don\u2019t. That is a major rea\u00adson why the vast major\u00adi\u00adty of unin\u00adsured peo\u00adple<\/a> in rea\u00adson\u00adably good health who don\u2019t qual\u00adi\u00adfy for gov\u00adern\u00adment pre\u00admi\u00adum and cost-shar\u00ading sub\u00adsi\u00addies have so far cho\u00adsen to remain unin\u00adsured. It also helps explain how insur\u00adance com\u00adpa\u00adnies have man\u00adaged to lose mon\u00adey under the pro\u00adgram, even after pock\u00adet\u00ading bil\u00adlions in cor\u00adpo\u00adrate wel\u00adfare pay\u00adments<\/a>.<\/p>\n The accre\u00adtion of gov\u00adern\u00adment intru\u00adsions into the health care mar\u00adket\u00adplace has dis\u00adtort\u00aded med\u00adical prices beyond recog\u00adni\u00adtion. Good inten\u00adtions have moti\u00advat\u00aded every inter\u00adven\u00adtion, each of which has engen\u00addered a new round of prob\u00adlems that, in turn, have inspired fur\u00adther well-mean\u00ading inter\u00adven\u00adtions. The result is a cost\u00adly and inef\u00adfi\u00adcient sys\u00adtem where prices are unhinged from value.<\/p>\n Gov\u00adern\u00adment is bad at pay\u00ading for val\u00adue. For con\u00adsumers, it is a core com\u00adpe\u00adten\u00adcy. Instead of smol\u00adder\u00ading over oth\u00ader people\u2019s med\u00adical bills, Emanuel would do well to devote his con\u00adsid\u00ader\u00adable intel\u00adlect to scrap\u00ading away reg\u00adu\u00adla\u00adto\u00adry bar\u00adna\u00adcles that pre\u00advent price dis\u00adcov\u00adery. Instead of more gov\u00adern\u00adment, we need a health care sys\u00adtem that func\u00adtions like the rest of the econ\u00ado\u00admy where, as Emanuel put it, \u201cindi\u00advid\u00adu\u00adals deter\u00admine value.\u201d<\/p>\n In a sys\u00adtem like that, he wouldn\u2019t have to wor\u00adry so much about oth\u00ader people\u2019s med\u00adical bills.<\/p>\n A sim\u00adi\u00adlar ver\u00adsion of this post also appeared on the Galen Insti\u00adtute web\u00adsite<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Zeke Emanuel is tired of pay\u00ading for your expen\u00adsive med\u00adi\u00adcine. Dr. Emanuel, who served in a senior posi\u00adtion at the Office of Man\u00adage\u00adment and Bud\u00adget where he con\u00adtributed to the recur\u00adring night\u00admare known as Oba\u00admacare, recent\u00adly com\u00adplained in the New \u2026 Con\u00adtin\u00adue read\u00ading