- The Washington Times - Wednesday, June 17, 2009

ANALYSIS/OPINION:

COMMENTARY:

The Senate Health Education Labor and Pensions (HELP) Committee today is marking up the American Health Choices bill, Massachusetts Democratic Sen. Edward M. Kennedy’s version of the Obama health care plan. Many in the mainstream media repeat the meme that this bill will finally ensure universal quality health care for all Americans, but it more likely will lower the quality of coverage for many Americans, especially those reliant on advanced medicines.

Besides creating a federally run insurance network to compete with existing private-sector insurance, Mr. Kennedy’s bill would require the federal government to subsidize insurance premiums for families of four with incomes up to $100,000. It would create a national mandate for every American to obtain health insurance, with penalties on as many as 5 million Americans who don’t have coverage (although the bill does include an “exceptional financial hardship” exemption for a few). Not leaving employers out of the picture, the bill would place a similar mandate on all medium and large businesses, forcing them to provide coverage, and it would expand Medicaid to cover people with incomes up to 150 percent of the poverty level ($16,245 for an individual and $33,075 for a family of four).

Perhaps the most significant change is the additional cost controls Mr. Kennedy’s bill would place on the existing insurance sector, including eliminating nearly all options for insurers to deny or price different applicants according to their health needs. Taken together, these changes would lead to radically different treatment tomorrow for patients who already have coverage. For those individuals, the changes could be deadly.

One particular area of concern is the potential changes in patient access to lifesaving statins - a class of drugs that lowers cholesterol levels for those at risk of heart disease - that would come as a result of this bill.

Heart disease is the No. 1 killer in the United States, and any changes to our health care system should improve this situation, not exacerbate it. Proposed changes in Mr. Kennedy’s bill would likely limit or reduce access to lifesaving statins for patients who currently have coverage, which is likely to lead to more deaths, not fewer. Why?

The cost sharing and nondiscrimination mandate that would herd high-risk and already ill patients into the pre-existing insurance pool provided in Mr. Kennedy’s bill would force insurers to reduce coverage and spend less per patient. Insurers would be forced to go even further in restricting the choices of doctors and patients than they do at present.

Like many pharmaceuticals, cholesterol-lowering statin medications have many variations, and each has different benefits and uses. Different patients with different risk factors require different medications. Those attributes - gender, race, family history, age - and other medical risk factors have always been the primary decision-drivers for prescribing statins.

However, because Mr. Kennedy’s bill requires rationing to achieve its goals, the cost of statin medications, not patient needs, would drive health care decisions. Getting patients to meet or exceed their cholesterol goals should be the priority, not assuming that the cheapest statin medication is the best.

Just as night follows day, the insurance sector will respond to these federal mandates by requiring that the lowest-priced statin be used regardless of applicability, and this will have deadly consequences. There simply is no good reason for this kind of cost-containment experimentation, particularly for the high-risk populations that rely on statins. In the long run, it won’t be more cost-effective, and it will cost lives.

The costs for brand-name medications and insurance formularies change constantly, and today most patients have access to the most effective heart-disease medications without realizing it. Before rushing headlong into a system of government-controlled health care layered on top of an already overregulated industry, patients should determine what the impact on their own health care needs would occur with these proposed changes. If this bill goes forward, the consequences could be deadly.

Horace Cooper is a legal commentator and an adjunct fellow with the Institute for Liberty.

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