- The Washington Times - Saturday, November 14, 2009

ANALYSIS/OPINION:

A few weeks ago I walked into the pharmacy of one of those “we sell everything and cheaper” places to fill a 14-pill prescription for a cancer patient. The smaller amount of a chemotherapy drug was needed to round out a course of treatment linked to a radiation regime for a brain tumor.

The patient explained that the pharmacy had not had the full number of pills on a previous visit so these had to be ordered.

I realized that insurance would cover most of the cost, but out of curiosity I asked the pharmacist what the price would be without the insurance. She looked at me and smiled and said in a very low voice, “$4,100.”

“Excuse me. Did I hear $4,100 for 14 pills - almost $300 for one?” I said, my voice becoming shriller with each word.

“Yes,” she replied at an even lower decibel, glancing nervously over at the line of customers waiting to be served.

For more than a few minutes, I was utterly incoherent, sputtering expletives helplessly in amazement until the patient took me by the arm and led me out of the store and said smilingly, “They don’t leave much alternative do they? Either one can afford them or one can’t, and the latter ends badly. Even if one has the money or insurance, it can go that way, but at least chances are better.”

As the conflict over health care rages on in advance of full-out warfare in both houses of Congress in the next few weeks, it is clear the one ingredient for successful reform - cost containment - could doom any legislation to failure. The fact is that the enormous outlays involved in just the average dispensing of day-to-day medicine in this country may ultimately be the economic rock on which this democracy founders - the one problem no one seems able to solve despite decades-long promises by politicians on the right and the left to do so.

What is desperately needed, of course, is a detente of some sort among medical care providers, patients, politicians and a host of others associated with the industry that would substantially bring some sanity into costs that have been spiraling at rates far higher than the cost of living for years and years. But that seems not only unlikely; it may well be impossible.

At this stage of the debate, it is safe to predict that the complexity of the entire subject has not only bumfoozled most of the Republic’s citizens but is beyond the true understanding of even the few who claim they have enough answers to revolutionize 16 percent of the economy. If they did, they wouldn’t need a bill that is expected to be at least 1,200 pages long to do so. As someone pointed out recently, the Constitution of the United States is only a few pages long.

Would a public option bring down the prices or actually raise them? How can we afford to pass anything that adds 40 million more people to the insurance rolls? How can we eliminate defensive medicine, pay for advanced technology and research new chemical cures? Why should hospitals be allowed to use accounting methods that assign outrageous prices to bedpans and plastic water pitchers? The questions abound, and before each can be answered one must deal with an impacted constituency.

Until then, the same old pat explanations are given ad nauseam. When I related the story of the 14 pills to a congressman the other morning at a press breakfast, he was stunned for only a second and then began the standard defense about how much it took the pharmaceutical companies to research and produce such special medicine. He said nothing about how many billions in profits these companies have made over the years or the fact that very few new medicines are being produced or that stockholder demands that the research costs be recaptured quickly are a problem.

Some of my colleagues stopped me after the meeting to ask what kind of pills they were and who was the person who needed them? My daughter, I replied, for a brain tumor.

“Wow!” one of them said.

“Yeah, wow!” I replied.

Dan K. Thomasson is the former editor of the Scripps Howard News Service.

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