Tuesday, December 29, 2009

One Story of a Market Oriented Approach to Health Care

I know that I’ve been quiet here, what with the holidays and all. That doesn’t mean, though, that I haven’t been paying attention. In the midst of all the holiday stuff there have been continued to be some good reporting on health care in the United States. While most of that has centered on the Senate’s bill, and now prospects for reconciliation of the House and Senate Bills in conference, there have still been some valuable stories on the provision of health care.

Like this one from NPR’s All Things Considered. Titled "How A Bone Disease Grew To Fit The Prescription," it’s worth your time (you can read or listen here). It describes how a drug company virtually created a market for a new drug. It’s not that there wasn’t a market at the beginning, but it was small and not very profitable. This is the story of how the drug company moved to create a market, with results we see in television ads virtually every day.

In the process, a number of things happened that are typical of how health care works in a "market approach." The company supported research – but primarily research that supported the need for drugs like the one they were marketing. It worked with doctors, but especially to induce them to prescribe radiology studies that weren’t necessarily all that valuable (and perhaps not worth the incremental radiological risk). It lobbied Congress, so that eventually Medicare and other insurers would pay for all of this. Note that in all of this the company did nothing illegal. As to whether it was unethical – well, that’s another question.

I have said before that part of the problem of our health "system" is a view that health care is a retail item, rather than a public service. That’s where a "market approach" to health care continues to take us, until we make some other provision. This story provides a good object lesson why simply "trusting the market" would likely continue to expand our costs and our exposure to care we just might not need. So, take a few minutes for the story.

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