‘No Pain, No Gain’ Meets the Hippocratic Oath

It is no surprise that the American health care system has severe problems. Add this one to the list: third- (or fourth-?) party agencies hired by insurance providers in an effort to economize costs of pharmaceuticals, even to the point of contravening doctor’s recommendations. The Columbia Tribune has the story.

Obviously, people are suffering as a result of this, and surely to some it is a repugnant practice. I hope I won’t sound like I am heedlessly advocating such things if I propose that it is a good thing that insurance companies are taking an innovative approach to cost cutting. Medical costs in the United States have run amok. It is important to remember that every dollar we save by using generic medicines for one patient is a dollar that can be spent helping someone else. Insurance has the tendency to divorce individuals from budget decisions that would require spending within their means. It is easy to make the emotional argument that no one should have to give up any amount of health care — but costs should be considered. I hate to miss an opportunity to plug one of my favorite studies of all time.

On balance, restricting access to needed medicines, and contravening doctors’ explicit instructions, is probably not the best way to manage costs. Pharmaceutical benefit management companies would probably do better to develop relationships with doctors as well as patients, perhaps helping to remind doctors that they should consider generic alternatives but not forcing patients to contravene prescribed treatment. The economics of medical care seem to be particularly vexing, given the high emotional context involved (although some things are still cut and dried, like this).

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