Jewish World Review July 19, 2002 / 10 Menachem-Av, 5762

Drs. Michael A. Glueck & Robert J. Cihak

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Medicare Drug Follies as in "now you see it, now you don't" | Our seniors should have the life-saving medicines they need without going broke or giving up life's other necessities in the process. However, we need to inject or infuse a dose of common sense into the treatment plan.

We won't anesthetize you with a scorecard on the current Congressional "bidding wars" (as Grace-Marie Turner of the Galen Institute calls them) regarding Medicare drug coverage. Suffice it to note that our legislators get re-elected by bringing home the tofu. Suffice it also to note that Medicare is a political animal, and subject therefore to all the vagaries and ills of that sadly unendangered species.

And so it will be if and when the government assumes a virtual monopoly on providing prescription drugs to Medicare patients. Congress apparently believes, as did the HMOs in the beginning, that they can bring down costs by "negotiating" with the drug companies. Yes, there can be short-term savings by squeezing out "inefficiencies." But after the squeeze, what happens? Rising costs force cutbacks in drug development (a notoriously risky and inefficient behavior).

As Mrs. Turner points out, "Between 1975 and 1994, the United States developed 45% of new major drugs, but France produced only 3%, Germany 7% and Britain 14%." The European problem wasn't lack of pharmaceutical smarts; it was lack of funds, and of the possibility of a reasonable return on investment.

So far, the United States has been relatively lucky with Medicare, given that even its original backers - a combination of welfare state zealots and venal pols - knew that the system wasn't sustainable. (We respectfully pass over in silence the role of managed care.) Unfortunately, it took several decades for the predictable problems to meld into the Insanity That Dares Not Speak its Name. In a rational, i.e. a market economy, when people want more of something, they get it, often at reduced cost. In state medicine, the more people want, the less they get, and at increased cost to all.

Congress knows that nearly all legislation ends up in court, where the judges decide what they think they meant. So be it. Congress also knows that bureaucrats will write, usually in secret, detailed "interpretative" regulations. So be it. But Congress also loves its loopholes and set-asides and special constituents and exceptions, so vague verbiage now co-exists with hundreds of pages of micro-management and dishonesty.

Which brings us to another normal-seeming yet foolish pattern - how social engineers turn issues into laws. The tactic has worked since the Progressive Era. First, find some problem, real or imaginary. Next, redefine the problem as a "crisis" - an imminent calamity that only the government can solve. Next, redefine the "solution" as a "right" or an "entitlement." Then pass legislation that can't possibly work, and will indeed create more problems that can then be defined as crises . . .

Federal control of drugs must inevitably lead to rationing.

When something is perceived as "free," especially something as vital to seniors as medical care, demand soars beyond any government's ability to provide. So we all end up with the worst-of-both worlds: fewer new drugs, straitened access to current drugs . . . and yet another crisis requiring yet another governmental solution.

It's also totally unnecessary. Most seniors already have drug insurance. Others, who may not have such insurance because they don't need it, use their own resources. And there's no shortage of workable proposals for getting insurance to those who need it.

For one example, consider the "Prescription Drug Security Card Plan" developed by the Galen Institute and AEI ( This plan would provide a subsidy directly to needy seniors "to purchase needed medicines and also to provide them with insurance protection against the risk of high prescription drug costs."

But perhaps the greatest madness lies in our failure to recognize that the advocates of state medicine positively benefit by their failures, since their goal is to create a situation in which total government take-over comes to seem the only rational course of action left. Perhaps we're not that many years away from that final, graceless surrender. And perhaps it might be well to reacquaint ourselves with a simple concept.

Today, the choice may be between between creating a genuine open market for medical care in which a variety of systems and plans compete -- and a closed government system which first says, "Yes," to all your needs when it really means, "No."

The later won't serve our senior citizens safely.

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Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.


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© 2002