Wednesday, January 15, 2003

WASHINGTON, Jan. 14 (UPI) — Though the so-called experts may quibble, any person faced with a life-threatening illness knows the United States has the best healthcare anywhere.

People complain about the expense but, as is true with steaks and plumbers and just about any good or service you can name (save lawyers), you get what you pay for. America spends a higher percentage of its gross domestic product on healthcare than just about any other country. People come from around the world to America seeking surgeries and treatments unavailable in their homeland because of cost or age or waiting lists.

Nevertheless, some Democrats continue to push healthcare reforms that may kill the patient. President Harry Truman tried after World War II. Bill and Hillary Clinton made a stab at it early in their presidency.

Both paid an enormous political price after the voters figured out the “free” healthcare being dangled before them could only come about if quality was compromised and choice were eliminated.

This has not stopped them from moving forward. On Tuesday, former Vermont Gov. Howard Dean, a physician and candidate for the 2004 Democrat presidential nomination, said his party should fight the $674 billion Bush tax cut by arguing for higher levels of spending on schools, roads and healthcare.

According to him, the Democrats are wasting time on the wrong issues, citing the so-called patients’ bill of rights as one example.

“No matter which bill passes,” Dean said, “not one more American is going to have health insurance.” Like many of his colleagues, Dean is confusing the lack of insurance with a lack of healthcare.

Many countries have tried to reform healthcare. Several, like Canada, have gone to a single-payer system. West Virginia Gov. Bob Wise, a Democrat, is one politician who repeatedly suggests their model is the right one for America to follow.

Wise believes Americans are “being taken advantage of” because they have to pay more than Canadians for what he says are the same drugs. This is a specious charge.

Patricia Danzon, an economist at the University of Pennsylvania, found it is possible to show that prescription drug prices are 218 percent higher in the United States than in Canada and, at the same time, 171 percent higher in Canada than in the United States — depending on which variables are considered in the analysis.

The principle difference, say some healthcare scholars, is that the Canadian system provides a hidden subsidy for pharmaceutical drugs that only makes them seem cheaper.

In Canada, the state pays for about 50 percent of these costs — but they can also arbitrarily drop drugs from the approved list, increase deductibles and co-payments and impose other price controls that leave healthcare consumers with little or no recourse except to go to the United States.

The state is also, as a general rule, unwilling to pay for innovative treatments, miracle drugs or so-called orphan drugs, designed to treat illnesses that are not prevalent enough to create an enduring and profitable market for drug manufacturers.

In short, the government acts like a worse version of the most parsimonious and difficult HMO or insurance company.

According to the Organization for Economic Cooperation and Development, Canada is ahead of only Mexico, Poland and Turkey in available medical technology. OCED also says it ranks 21st out of 29 member nations in the availability of computerized tomography, or CT scan, machines and 19th in magnetic resonance imaging, or MRI, machines.

Yet this is the system that Wise and certain other governors and members of Congress think would be the best way to bring down the high costs of America healthcare. In what The New York Times has called “the strongest challenge yet in the battle between the states and the manufacturers and distributors of prescription drugs,” several states announced Tuesday they are pooling their efforts to reduce their costs for prescription drugs for state workers and Medicaid patients.

According to the Times, “The states intend to hold down spending on medicines … by creating an organization designed to be immune to drug makers’ promotions of many of their more expensive products” — which sounds suspiciously like a plan to take from doctors and patients the ability to choose which drugs will be used in treatment.

Business for Affordable Medicine is a special interest group made up of big businesses, pharmacies, unions and generic drug manufacturers. It is working with a handful of Democratic governors including Wise to push for federal and state-based legislation to force consumers to switch from brand name to generic prescription drugs.

Many of the constituent groups that make up the BAM coalition stand to make billions if their efforts are successful — while the health of millions of Americans might be compromised.

Hippocrates said that the obligation of a healthcare provider is, first, to do no harm. It would be good for all Americans, indeed for the sick and the dying all around the world, if the politicians who are busy trying to reform healthcare understood themselves to have the same obligation. Otherwise, we may be in a situation where the reform was a success but the system died.


(The Peter Principles is a regular column on politics, culture and the media by Peter Roff, UPI political analyst and 20-year veteran of the Washington scene.)

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