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Now that the mid-term elections are over, it’s time to consider what the results may mean for health care in this country. Pharmacists will want to keep a careful eye on Washington, DC, in the coming weeks and months. For many incoming first-term Representatives and Senators, revisiting the Patient Protection and Affordable Care Act (PPACA) is high on the list of legislative priorities.
Regular readers of this column know how I feel about the PPACA, the largest expansion of the power and influence of the US government since the creation of Medicare. Some readers who support the PPACA may have misconstrued my opposition to the provisions of this law and assumed that by focusing on the “big picture” of reform I was forgetting the real-world concerns of pharmacists and patients.
One pharmacist responded to my October column passionately, asking if I knew what it was like to “turn a patient away for lack of the ability to pay,” which he described as “a painful reality in the community pharmacy setting.” The reader argued fervently for reform, and we’ll run his letter to the editor in the December issue.
The pharmacist made me think about the very specific nature of the prescription transaction for a patient who is unable to pay for their prescription. I did not and would not downplay the pain and frustration that pharmacists on the front lines of patient care must deal with on a regular basis. But being opposed to this particular version of health care reform does not mean that I’m opposed to reform overall. Let me be clear: my opposition to health care reform as currently constituted is informed first and foremost by my concern for its effects on health care professionals (including pharmacists) and patients.
I have been opposed to the dramatic expansion of the role of the federal government in health care and the creation of a vast new entitlement program that still neglects the central problem—that consumers don’t have the proper incentive to make choices, and therefore don’t make rational health care decisions based on cost, access, and quality. Markets continually self-adjust in small but meaningful ways that lead to goods or services being available at the price that consumers are willing to pay for it. By their nature, large central programs such as Medicare are not nimble and will lead to unintended consequences. The PPACA as currently structured will continue to prevent consumers from determining the benefit coverage they want given their own resources and health needs.
Health savings accounts work because they allow consumers to determine the value they place on their health benefits. True reform would provide a safety net for patients who are unable to afford needed medications and treatment, while simplifying how health care is funded by putting the consumer front and center in the decision-making process. It would also remove the disincentives for providing the most efficient and effective care.
Many of you are entrepreneurs and business owners yourselves, and if you believe in entrepreneurship and individual freedom, then the fundamental overreach of the PPACA should concern you. Despite several seemingly pharmacist-friendly portions of the PPACA—including its support of pharmacist-delivered medication therapy management services and integrated care demonstrations that call for a greater role for pharmacists— the last thing that pharmacists and other health care professionals need is greater government interference in their business affairs and still more bureaucratic meddling in the patient–provider relationship.
By addressing health care reform with a sledgehammer, Congress and the Obama administration have missed an opportunity to take an incremental approach that would be more effective in the long-term. Now, with a new Congress in place, we have a chance to revisit this issue and refocus on market-driven solutions. I hope we take advantage of this second chance to make it right.
Thank you for reading.