4 ms·

This is hardly surprising, and it's unfair to try to turn it into a problem with "entitlement programs". There are many examples of this kind of thing -- and p

by timr 13y ago

This is hardly surprising, and it's unfair to try to turn it into a problem with "entitlement programs". There are many examples of this kind of thing -- and private insurers aren't pushing back on the costs, either. Take the anti-viral drugs acyclovir and valacyclovir. They're both anti-virals used to treat diseases caused by the herpes simplex virus (e.g. shingles, chicken pox, cold sores, herpes, etc.), and are both commonly prescribed to patients of all ages. The only difference between them is that valacyclovir is a pro-drug -- it metabolizes to acyclovir -- and has slightly higher bioavailability, which means that patients can take three doses a day, instead of five. Otherwise, they're equivalently effective medications. Granted, three doses a day is easier on patients than five doses a day, but that convenience comes at a cost: valacyclovir costs about five times as much as acyclovir. Your doctor won't tell you this -- she'll just prescribe the valacyclovir, in nearly all cases -- and your private insurance company won't do anything to encourage you to take one drug over the other. About the only way you'd know is if you tried to buy the drug without insurance, and your pharmacist told you that you could use this other, cheaper medication to save a lot of money. Not only are "entitlement programs" not the problem here, they could actually be the solution: a single-payer health system would have an economic incentive to push back on providers, and encourage them to use more cost-effective drugs. Our current, private insurance system is almost totally blind to cost effectiveness, because nobody in the chain has any incentive to care. The final costs of the system get passed back to employers in the form of annual rate increases, when it's too late to do anything about them.

hga 13y ago
Errrm, it's my understanding that "compliance", i.e. people actually taking their prescribed medicines per schedule, is a terrific problem in the real world. The payoff in patient health can be substantial; in one area I'm familiar with, anti-depressants, there's a strong bias towards those that are normally taken once a day (one of the many advantages of Prozac, the first SSRI). So I can see lots of physicians routinely prescribing the valacyclovir ... although for someone like me, to whom the whole idea of compliance was a new, almost unthinkable thing when I first learned about it, they'd like go with the acyclovir (especially after I looked up the drugs in question, read up on their pharmacokinetics, etc.; obviously I'm a special case, e.g. nowadays I tell my doctors what to prescribe me for allergies and sinus infections, having learned what works and what's cheap). Hmmm, come to think of it, when I got an "early" (age early 40s) case of herpes zoster (shingles, and, yeah, it's no fun at all, get the vaccine when you can) in 2003 I was prescribed acyclovir, by a doctor who knew both my financial situation (not great then) and compliance patterns.
- timr 13y ago
  Yeah, I don't mean to diminish the importance of compliance -- it's a big problem, especially for things like antibiotics and anti-viral meds. And certainly, three times a day is a lot easier than five times a day. But as you imply, you might rationally make a different choice if you (the patient) know the facts. My point is that nobody has any skin in the game in the current system -- from the perspective of the decision makers, the costs are almost totally externalized. Aside: I also learned about this when I came down with shingles. That was a bummer (not the least of which because I was on COBRA at the time, and the insurance company refused to pay the med costs without going through a complicated reimbursement scheme!)

by timr 13y ago

hga 13y ago

Errrm, it's my understanding that "compliance", i.e. people actually taking their prescribed medicines per schedule, is a terrific problem in the real world. The payoff in patient health can be substantial; in one area I'm familiar with, anti-depressants, there's a strong bias towards those that are normally taken once a day (one of the many advantages of Prozac, the first SSRI). So I can see lots of physicians routinely prescribing the valacyclovir ... although for someone like me, to whom the whole idea of compliance was a new, almost unthinkable thing when I first learned about it, they'd like go with the acyclovir (especially after I looked up the drugs in question, read up on their pharmacokinetics, etc.; obviously I'm a special case, e.g. nowadays I tell my doctors what to prescribe me for allergies and sinus infections, having learned what works and what's cheap). Hmmm, come to think of it, when I got an "early" (age early 40s) case of herpes zoster (shingles, and, yeah, it's no fun at all, get the vaccine when you can) in 2003 I was prescribed acyclovir, by a doctor who knew both my financial situation (not great then) and compliance patterns.

timr 13y ago
Yeah, I don't mean to diminish the importance of compliance -- it's a big problem, especially for things like antibiotics and anti-viral meds. And certainly, three times a day is a lot easier than five times a day. But as you imply, you might rationally make a different choice if you (the patient) know the facts. My point is that nobody has any skin in the game in the current system -- from the perspective of the decision makers, the costs are almost totally externalized. Aside: I also learned about this when I came down with shingles. That was a bummer (not the least of which because I was on COBRA at the time, and the insurance company refused to pay the med costs without going through a complicated reimbursement scheme!)