Thursday, March 27, 2008

Too Many Loraxes (or Why I am Deeply Dubious about Everyone's Health Care Plan)

M. LeBlanc posts an observation on how many more medications are available without a prescription in France than in the US at Bitch Ph.D.'s blog, and the resulting comments thread is, I think, a good illustration of why health care debates in this country tend to be so unproductive.

The discussion starts off wondering if Big Pharma's money isn't responsible for the various roadblocks that exist to getting access to basic medications like antibiotics and birth control pills. A bit into the comments, somebody suggests that doctors are responsible, as they obviously make money being gatekeepers for prescription drugs. Then, somebody shows up to explain the pharmacists' interests, and somebody else defends doctors and blames trial lawyers.

The problem is that all of these groups - doctors, lawyers, drug companies, pharmacists, regulators, even insurance companies - all claim to be speaking on behalf of the interests of consumers, but nowhere in the process do you get much in the way of actual consumers speaking on behalf of consumers.

It's not that I think any of these groups are ill-intentioned, necessarily (though I am extrordinarily dubious about insurance companies). I suspect that even at big pharma, the majority of employees are proud of and motivated by making drugs that help sick people become healthier. It's just that they all have a strong tendency to see the consumers' i nterest most clearly where it intersects with their own.

Now, obviously, experts are experts for a reason, and I don't think all of health care policy should be put up for popular referendum. But it seems to me that something like how to organize access to commonly used medications would be a good issue to put to the general public, because there's obviously a lot of workable middle ground between some sort of completely unregulated libertarian utopia, and our current regime where doctors are the only gatekeepers for most all the good stuff.

But instead, we find ourselves playing the "guess which interest group is responsible for this silly state of affairs" with regard to our medical system, and the thing is, nobody's health care plan involves a strategy to decrease interest group influence. Instead, they all involve making sure everyone gets enough of the pie to keep them from torpedoing the plan, making sure that the squabbling will continue unabated and consumers' interests will continue to get drowned out in the shuffle.

But this article in last Sunday's New York Times Magazine about a website that encourages people to share their detailed experiences treating their serious, chronic diseases offers an interesting model for one way that people can educate themselves about their health problems, and take a more participatory approach towards their treatment. And also, perhaps eventually a way to involve more consumer voices in the debate on health care policy?


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