OpEd Contributor
Government health care? First, do no harm
By: Daniel J. Popeo
Examiner Contributor
April 16, 2009
From the Hurricane Katrina response, to ongoing dysfunction in providing adequate medical care to veterans, to keeping out illegal aliens, the federal government has done little to inspire public confidence.
Our healthy distrust toward government is reflected in recent polls—barely 30% of American adults favor nationalized health care. And yet, many in government are promising Americans swift and sweeping changes to our health care system through increasing doses of federal control.
Before rushing down a policy making path that will profoundly affect our lives and freedoms, America’s leaders should consider the timeless Hippocratic Oath: first, do no harm. This is especially critical considering that current government policies have caused much unnecessary suffering and are to blame for many of the problems with American health care.
The nation’s massive health regulatory structure already exercises excessive control over private care decisions and undermines access to the latest medical innovations.
The Food & Drug Administration’s (FDA) self-described mission, for instance, is to protect and promote the public’s health. But Congress never intended this regulatory and enforcement agency to practice medicine. Yet, isn’t that what the agency does when it denies terminally ill patients access to promising experimental drugs?
Consider the plight of those who suffer from Amyotrophic Lateral Sclerosis – ALS, sometimes called Lou Gehrig’s disease. Bereft of treatment options, some victims of this fatal neurodegenerative disease sought access to Iplex, an FDA-approved growth disorder drug which doctors in Europe have been administering to ALS sufferers with promising results. Despite agreement from Iplex’s producer to provide the drug on a compassionate use basis, FDA denied the ALS patients’ request.
Earlier this year, with Washington Legal Foundation’s assistance, a small number of ALS patients appealed FDA’s decision and won access to the treatment. Unfortunately, FDA is forcing others with the disease to enter a lottery for a clinical trial of the drug; it is unlikely that many will live long enough to get it.
Federal Medicare bureaucrats at the Center for Medicare and Medicaid Services (CMS) routinely ration medical care through reimbursement and coverage decisions. CMS and its cost-cutting policies relegate America’s sick to ineffective or lesser treatments and ignore the benefits of modern, personalized medicine.
The agency, for instance, denies full coverage for BiDil, a unique and highly effective medication which FDA approved specifically for heart failure in African-Americans. Such patients instead must take two medicines whose combined use hasn’t been proven effective.
Last year, CMS slashed reimbursement rates for breakthrough non-Hodgkins lymphoma drugs to below hospitals’ own costs, limiting access to what is often a treatment of last resort for these cancer patients. CMS reimbursement and coverage decisions have an impact far beyond the Medicare program and its beneficiaries, as private insurers regularly follow the federal agency’s lead.
Other CMS policies allow health insurers, when they are officially administering the Medicare drug benefit, to substitute their medical judgment for that of a patient’s own physician. Doctors treating sufferers of fibromyalgia, for instance, are forced to experiment unsuccessfully with up to four medications which FDA has not approved for this painful disorder before insurers will pay for a patient’s use of a drug specifically approved for fibromyalgia.
Physicians and patients’ groups, joined by a bi-partisan coalition of state attorneys general, urged CMS to eliminate this dangerous policy, but the federal agency rejected these demands and formally restated it in a guidance document to insurers last month.
Despite bitter complaints from patients and doctors about bureaucratic intrusions into our private medical decisions, government remains convinced it is the cure. Some U.S. reformers admire Canada and England’s approach to care, and are working to create a board of economists and health policy experts to study the cost effectiveness of the latest treatments.
Such government-run “comparative effectiveness” programs bottle up new drugs and devices in econometric studies, and then make medical decisions based not on what’s best for sick patients, but on meeting national budgetary goals.
These politically-driven health judgments have chased medical innovation out of many countries with nationalized care, and stifled their citizens’ ability to make choices about their own health. Are we headed down the same road?
We must confront the reality that big government solutions can be hazardous to America’s health. Bureaucrats have held back the modernization of medical care. America can’t afford more government-run experimentation. For those who think the health care system is too big to fail, they must realize it’s also too big to bail out.
Examiner contributor Daniel J. Popeo is chairman and general counsel of the Washington Legal Foundation.
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