Rationing Health Care, A Must

I was talking to a friend of mine who works in the pharmaceutical industry last week. He was on a trip trying to market the use of a drug for multiple sclerosis. He was circulating amongst neurologists in my area trying to encourage these doctors to use his drug. Out of curiosity, I asked him how much the medicine costs and he responded $48,000 per year. I told him that I thought that was a ridiculous price and he responded by asking if I knew how much it costs to investigate new drugs and bring them to market.

So here is the problem. We are discovering drugs and new medical devices that can extend the duration and quality of people's lives. That is wonderful but the problem is we cannot afford it. The advances in the medical and pharmaceutical industries have outpaced our ability to pay for it. There is no way government can afford to pay 48K for one drug per year to extend peoples lives with MS. Insurance companies would have to charge such high premiums if this drug was included in their benefits that it would be unaffordable. That is a sad statement but indicates ultimately the requirement at some level to ration care. At some level there must be a limit to an individuals medical consumption and the population of this country needs to understand that and establish the limits.

In Europe the governments decide which medications and technologies are allowed in the country. Part of their determinations are guided by a cost/benefit analysis. Can we afford to pay for this procedure or this medication? Is it worth the benefit received by the individual and society as a whole? In fact, I asked my pharmaceutical friend if the MS drug is being used in Europe and he said it was rejected. Likely due to cost as its efficacy has been proven. We in the US need to have this conversation and set limits. As technology continues to advance we will surely bankrupt ourselves using more and more expensive modalities.

People should be able to choose an insurance policy that would cover these extremely costly medications and they would be required to pay the fair premiums. People should also be allowed to buy a bare bones or catastrophic policy in which case they would not be covered for expensive drugs and would either not get it or have to pay out of pocket. In both cases, with private insurance the individual sets the limits by purchasing the appropriate policy/benefits. The problem is if you are on government insurance. What are the limits that should be set? Who should set it? Very difficult questions that we have to confront, but we absolutely must and soon.