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The Best Medicine Often Costs More By: David Gratzer
The New York Post | Tuesday, August 04, 2009


AT his July 22 press conference, President Obama explained that under his health-care plan, doctors would be "free to provide Americans with the best care -- just not the most expensive care."

This suggests the president has been captured by a myth that is simply too clever-by-half -- the idea that American health care is a giant con, with greedy doctors and companies drowning us in expensive, pointless treatments.

As a physician, I can confirm that there often are cheap, simple treatments for various illnesses. Sometimes there is, to pick up on the president's point, a red pill that is just as good as the blue pill, but half the cost.

But human biology is complex. Not surprisingly, the most expensive diagnostic, drug or device can often also be the best.

Science hasn't gone backward; there's a reason you don't see cost-conscious drivers buying Model Ts.

Take some examples from the pharmaceutical world: a kidney cancer drug, which is both expensive and proven to extend life; a costly medication that prevents the onset of disease-related blindness; a new and life-saving breast-cancer drug; an expensive Alzheimer's drug shown to slow the deterioration of the patient's mind.

All four examples are real drugs: Sutent, Lucentis, Tyverb and Aricept. And the British single-payer health-care system has refused to cover all four medications even when prescribed by their doctors.

The denials came on the recommendation of Britain's National Institute for Health and Clinical Excellence, or NICE. This government-mandated panel rations care based on financial and scientific considerations.

And now, a committee modeled on NICE -- called the Independent Medicare Advisory Committee -- is a key part of the ObamaCare plan.

In a blow to the "best versus expensive" myth, NICE has frequently been forced to reverse its "evidence-based" thinking. The decisions on Sutent, Lucentis, Tyverb and Aricept were all reversed (or reopened for review) despite initial "evidence-based" decisions to reject them.

NICE changed its mind not because the independent panel was conned by greedy corporations, but because it faced public outrage and, in some cases, even lawsuits from doctors' and patients' groups, all of who knew what the "best care" was even if NICE found excuses not to pay for it.

There's waste in American health care, no question. And the president deserves credit for attacking it. But his stated goals are to control cost inflation, broaden coverage and increase competition -- all of which are achievable without the draconian big-government solutions he's proposed.

Obama holds up the Mayo Clinic and the Cleveland Clinic as examples of innovation -- but neither was created by a government committee or by federal legislation. Rather, both institutions were founded and expanded because of community-based innovation and excellence. The Mayo Clinic, incidentally, joined several other top health-care institutions in a letter warning that the congressional bills would force them to close.

If he wants more Mayo Clinics, then why is Obama designing his health-care plan to centralize decisions about everything -- insurance, technology review and even care itself -- in Washington?

The president complains of perverse incentives under Medicare to offer more treatment instead of better treatment. So why is Washington focused on creating a giant new version of Medicare before it has addressed these challenges in an existing program?

Obama insists that what's needed is more insurance competition. So why is Congress focused on the complex mechanics of creating a public insurance company with his full support, when the chief barrier to national insurance competition is a set of federal and state regulations that prevents competition among existing private insurers?

There's irony here. Even as he wrongly suggests that the problem is doctors who prescribe expensive care instead of the best care, "Dr." Obama is prescribing the most expensive health-care reforms -- not the best reforms.




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