Dear Mr. Obama and all of you congress folks: I know you have been arguing about how to fix our system (and it really does need fixing).  I know there is not much you can all agree on.  I know it wasn't all that much fun to face those yelling people at the town hall meetings.  The press hasn't been nice, and the polls aren't good either.  You guys are having a rough go of it.

So I am going to do you a big favor.

What you need right now are some quick wins - some things you can do that will make people happy quickly, and things that can be done without much cost.  This is low-hanging fruit that can be picked without a high ladder; it is fruit that will sweeten things and make swallowing the more bitter pills a little easier.  Here is what you need to do first:

1.  Allow Medicare Patients to Use Drug Discounts

I know some lawyer somewhere is wetting his pants as I write this, but there are some really inane rules that hurt the people (read: VOTERS) who need the most help.  One of the strangest rules is the one that says Medicare patients aren't allowed to use drug discount cards.  Somewhere sometime some attorney felt that if some Medicare patients got a discount, then this implied that Medicare was being overcharged for those who didn't receive this discount.  This is like telling a grocery store that if they put some items on sale, they need to put all items on sale.  It's ludicrous.

Drug companies have drug discount cards that lower the out-of-pocket cost for their drugs substantially.  I can give these cards to people with private insurance or with no insurance at all, but my Medicare population can't use them.  It's against the law.  The drug companies are trying to get us used to writing for their medications - especially for drugs that are not real popular.  It's something called competition, and it tends to drive down prices.  You know, it's that capitalism thing they taught about in college?  These companies want market share, and so they offer discounts to get volume.  It makes my patients with good jobs and good insurance very happy, but not Medicare patients - even when they are in the "donut hole."

It would make a whole lot of people (VOTERS) very happy (likely to VOTE for you) if you made a specific exception for this (made an idiot lawyer wet his pants).  You make the laws.  You can do it.  People would get their medications, pay less, and be healthier.  What's the bad side to doing this?

2.  Allow Medicare Patients to get Free Drugs

The same inane rule that makes it impossible to give discounts also prevents seniors from getting free drugs.  Drug companies have long had patient-assistance programs for people with low income.  We have used this to get free drugs from pharmaceutical manufacturers.  Again, they do this to ingratiate themselves with the doctors and change prescribing habits.  They figure that the amount that they lose on this is offset by the goodwill from both the doctor and the patient.  They also probably have some sort of non-profit that allows them to use these donations as a tax-deduction.

Why can't we get free drugs for Medicare patients?  This would be great PR for pharmaceutical manufacturers and for you.  Perhaps you can give Pharma the ability to have a foundation that will get drugs to seniors who can't afford it.  Face it: both Pharma and elected officials like you need as much good press as you can get.  This helps you both with one fell-swoop.

3.  Fix Generic Medications

Something really strange is going on with generic medications.  It seems rational to think that generics are a big part of healthcare savings for patients.  After all, the pharmaceutical companies insist that the reason drugs are so expensive is the high cost of developing them.  If this is true, generic drugs should always be much cheaper, as they have not gone through the trial/error process of drug development.  But this system is broken in several areas:

  • In the 6 months after a drug goes off patent, one generic manufacturer is given exclusive rights to make the generic.  They have little to no motivation to drop the price, as their only competition is from the expensive branded drug.  The end result is a generic that is often 90% of the cost of the brand.  This is essentially permission to gouge customers.
  • The exclusive generic contract is now often being given to the same company that makes the brand-name drug.  This is essentially defeating the purpose of generics, extending the patent by 6 more months.
  • Insurance companies are making such good deals with manufacturers of brand-name drugs, that they are now often preferred over generics.  What's wrong with this?  Several things: first, the consumer pays a brand-name copay for a drug that is available in generic.  Second, the "deal" made with the pharmaceutical is not through discounted drug prices, but instead a "rebate" that is sent to the insurance company from the pharmaceutical manufacturer if they get a certain percentage of market share.  The drug companies compete based on how good of a "rebate" they can give (a process that in other businesses is called a "kick-back.").  The end-result is a great deal for insurance companies, but no savings passed on to the insured.

All of these problems would have a huge positive effect on the people buying prescriptions (most of them are VOTERS, by the way).  People are hurting financially - especially seniors - and cutting the costs through these measures will not only save them money, it will make it easier for them to get the drugs they need to stay healthy and stay out of the hospital.

I think this is a bipartisan win.  The liberals should like the savings passed on to the most needy, and the conservatives should like the way that these measures encourage a free-market within healthcare.

I am really sorry you guys are having such a bad time of it.  Think about what I have said; it is definitely low-hanging fruit.  You don't have to pass some huge bill to get these changes enacted, you just need to address these specific issues.  The end result would be a bunch of happy people (VOTERS), cheaper care, and higher quality.

Isn't that what we want?

Say hi to the lobbyists for me.

Dr. Rob

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