Healthcare

What happened to the right to choose your healthcare?

From atop the lecterns at the Democratic presidential debates and the White House, a common trope is dismantling and rejiggering how healthcare is delivered in America.

For the left, the emphasis is on expanding who can access government-backed health insurance programs while cutting off the role of the private sector. On the right, President Trump is looking to import drugs and pharmaceutical price controls from abroad.

Missing in both of these visions is the essential component that governs every other sector of the economy: the freedom to choose.

Much like housing, transportation, and education, it’s clear that the entire healthcare sector needs disruption.

We need out-of-the-box thinking, innovation, and on-demand delivery that will bring costs down for ordinary people. It’s this formula that has empowered millions to rise out of poverty, make a decent living for their families, and expand consumer choice to makes their lives better.

But both the Democrats and Trump are leading Americans astray on what really matters when it comes to healthcare.

Sens. Bernie Sanders, Elizabeth Warren, Cory Booker, and Kamala Harris have serious proposals to totally ban the private healthcare market in favor of a “Medicare For All” system. That means every American would be thrown into the government insurance program reserved for our seniors.

All administration, billing, reimbursement claims, and hospital contracts for over 350 million people would be handled by the federal government. For a country as unique, diverse, and large as the United States, this just couldn’t be carried out effectively. The CBO’s analysis of a single-payer system admits that new taxes and an entirely new administrative bureaucracy would take years to implement.

Such plans would make it illegal for Americans to choose the type of healthcare coverage that fit them best, depriving them of fundamental choices.

This makes two grandiose and flawed assumptions. One, that a top-down government reorganization of insurance and health services would be the best method to deliver healthcare, and two, that the individual consumer cannot be trusted to make decisions about their care. That is wrong.

People choose different healthcare plans depending on their employment situation, their age, or their lifestyle.

Many younger working people, such as myself, don’t have comprehensive insurance because it doesn’t make economic sense. We’d rather pay out of pocket for small expenses and use high-deductible disaster insurance when necessary. The young and healthy tend to shy away from the large insurance plans for these very reasons.

For the 8.8 percent of Americans without health insurance, would they benefit from a mass reorganization of the system that would offer the care reserved for our seniors if the cost comes in the form of higher taxes and less consumer choice?

The same applies to Trump’s well-intended but flawed plans on importing drugs from single-payer systems around the world.

The reason pharmaceutical drugs are more expensive has more to do with subsidies than cost. Most drugs are born from innovative American firms but are subsidized greatly or negotiated for lower rates by governments who import them. Firms can afford this because it’s offset by American prices, meaning the rest of the world is freeriding on American innovation and intellectual property.

They achieve this by reducing access and choice. It’s no secret that the lion’s share of pharmaceutical drugs are available in the U.S. while they’re unavailable in the countries that refuse to pay for them. So yes, the prices of drugs may be cheaper in Canada or Norway, but the supply and choices are lacking. Do we want fewer choices of drugs for lower costs or more choices and prices at market rate?

What matters most when it comes to our personal health is the freedom to choose. Whether that it’s our doctor, insurance program, or drugs we buy, Americans want to be able to pick what works best from them. Grandiose plans that seek to completely reorganize how many taxes we pay and how we receive care would severely restrict that.

That may be a well-intended path, but one that millions of Americans are right to reject.  

Yaël Ossowski is deputy director of the Consumer Choice Center

Published in the Chicago Tribune: https://www.chicagotribune.com/lifestyles/health/sns-tns-bc-healthcare2-commentary-20190815-story.html

Published in Globe Gazette: https://globegazette.com/opinion/columnists/commentary-what-happened-to-the-right-to-choose-your-health/article_b941a988-7864-51e5-98e2-5e987626ce16.html?utm_source=dlvr.it&utm_medium=twitter

Published in Duluth News Tribune: https://www.duluthnewstribune.com/opinion/columns/4636779-National-View-Column-Americans-deserve-the-right-to-choose-their-health-care

Liberals want to build their campaign around pharmacare, but ignore where drugs would end up

Fred Roeder is a health economist and the managing director of the Consumer Choice Center. David Clement is the North American-affairs manager for the Consumer Choice Center.

Internal documents from within the Liberal Party recently showed that Ontario Liberal MPs want 2019’s election campaign to be built on a national pharmacare plan.

Specifically, the proposed plan would seek to centralize and consolidate the 46 drug-procurement programs that exist in Canada. The goal would be to give Canada as a whole more bargaining power in the drug-procurement process, which would potentially lower the prices Canadians pay for their medicine. Although pharmacare could lower drug prices in the short run, it could also run the risk of exacerbating Canada’s existing drug shortage, and significantly limit patient access in the long run.

If a national pharmacare plan were to work, as advertised, it would help Canadian patients by lowering the price they pay for medicine. Unfortunately, the Liberals are largely ignoring the issue of where much of these low-priced drugs would end up, which is the United States. It is one thing to lower drug prices for Canadians, but that benefit isn’t realized if Canadian patients never actually have access to those cheaper drugs.

Pharmacare would be an attempt to further control the price of drugs. The problem is that Canada already has price-control mechanisms for prescription drugs at the federal and provincial level. Those price controls lead to much lower drug prices compared with the prices paid south of the border. That said, because Canadian drugs are cheaper than in the United States, several U.S. states have begun looking at importing pharmaceutical products from Canada in an attempt to undercut U.S. prices. For example, the Republican Governor of Florida has recently pushed for federal approval for drug importation from Canada, and U.S. President Donald Trump has already signalled his support of this measure.

And while importation from Canada to the United States could mean lower drug prices for patients in Florida, Canadian patients could suffer as a result of worsening access. U.S. Health Secretary Alex Azar has publicly stated that Canada doesn’t have the appropriate supply to meet patient demand, and that large pharmaceutical companies are unlikely to increase their supply for the Canadian market. Worsening drug shortages are the most likely outcome for Canadians if the federal government adds in more price controls while having large-scale drug exports to the United States. We know that this is the probable outcome because Canada already suffers from a lack of supply, and another measure to intervene on pricing will simply increase the incentive for American states to import from Canada.

Supply is one problem for Canadian patients, but it isn’t the only issue they face, and it isn’t the only issue that could get worse as a result of pharmacare. In addition to poor supply, Canada is significantly lagging in terms of access to potentially life-saving and innovative medicines. Countries such as Germany, Japan and the United States all introduce, and reimburse for, innovative drugs quicker than in Canada. Here, it takes more than 450 days for a new drug to be reimbursable, while that number is only 180 days in the United States. It can be expected that a pharmacare plan would make this innovation problem worse. It is unlikely that the manufacturers of these drugs will want to roll out innovative medicines in Canada, under various forms of price control, if those drugs can then be resold into other markets, undercutting prices abroad.

For cost, it is important to remember that Canadians have lower drug prices than Americans. At the same time, it is important to be aware that because of price controls, Canada is not a significant market for drug manufacturers, especially when compared with the United States, which accounts for more than 50 per cent of the industry’s global profits. If Canada goes too bullish against drug prices, while at the same time allowing American states to import prescription drugs from Canada, we might run the risk of drug companies leaving entirely, or massively delaying the introduction of new drugs in Canada.

Companies leaving the domestic market entirely might sound like a far-fetched concept, but it is something the Canadian marketplace has seen in other industries. Take Google and the recent issue of political advertising in Canada. Ottawa significantly changed its election advertising regulations, and rather than comply, Google decided that it would leave the political advertising market altogether. Thus, we have a large multinational entity cutting itself out of the political advertising market because conditions aren’t ideal, and because Canada’s market is minuscule in comparison to others.

Everyone wants more competitive and better pricing for patients. Unfortunately, the elephant in the room is where these price-controlled drugs end up, and how industry will respond. Our concern, as a consumer group, is that the pharmacare plan, without addressing export, could exacerbate the already serious issue of drug availability in Canada.

If a provider of vital pharmaceuticals were to pull out of the Canadian market as a result of price fixing and undercutting, it would be Canadian patients who pay the ultimate price. Drug access – especially to new innovative treatments – lags in Canada, and without the foresight to correct some of these blind spots, access could either get significantly worse, or be eliminated altogether under a national pharmacare plan. That scenario should concern all Canadians.

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