The debate on the President's signature healthcare reform law will be shaped by important events unfolding on the political stage over the next six months. For interested parties on both sides of the political aisle, there will be ample opportunity to sidestep decisions made on the national stage by putting forth state laws that directly impact care at the bedside.
When we think of healthcare reform nowadays, we tend to frame our thoughts in terms of Democrats and Republicans, and of the President and Congress. And this makes sense, as the 'Affordable Care Act' has been the subject of hotly debated and important country-wide issues facing the future of medical care in America. However, there are issues even more immediate and pressing that will impact the lives of every patient in the United States — and they are playing out in the legislative arena in states such as California right now.
When you crystallize the concerns and uneasiness of most physicians in the U.S. today, the predominant theme is a worry that their patients will find increasing obstacles to treatment which is considered to be 'standard of care.' Doctors learn state-of-the-art healing techniques in medical school and residency, but when bureaucrats replace these with government or profit-dictated alternatives that are inferior in terms of effectiveness, people can really get hurt.
Enter the State of California, whose legislators are currently considering Bill AB 369 for the treatment of pain in patients.
This bill, also called the 'Limit Step Therapy/Fail First in Pain Management Bill', would prevent insurance plans and health systems from supplanting the role of the physician by first running patients through many layers of "other" medicines (ostensibly less expensive, but not what the doctor actually prescribed) before getting the medicine that was ordered in the first place. This bill would "prohibit a healthcare service plan or health insurer from requiring that a patient first try and fail" on more than two pain medications (including over-the-counter meds) before allowing the original drug to be dispensed (and covered under the prescription plan).
AB 369 would authorize that the "duration of any step therapy or 'fail first protocol' be determined only by the prescribing provider."
Also known as the Huffman Bill, and co-authored by Assembly Members Ammiano, Beall, Carter, Chesbro, and Feuer, and Senator Pavley, this bill has profound implications for the role of 'middle managers' in the assessment and treatment of all patient disease conditions. Imagine that a precedent is allowed to be set in the area of pain management, which then is co-opted to suit profit-driven executives in the area of cancer, diabetes, high blood pressure and the like.
Aside from self-serving corporate executives, or even well-intentioned elected officials, the average American has reason to favor initiatives to the cost of medical care in our country — and costly prescription drugs are a reasonable place to start tinkering with the numbers. But a close look at the statistics can reveal a picture with less concern about prescription drugs than the prescriptive reform law itself:
• By 2021, annual prescription drug spending in the United States will indeed double to $483.2 billion.
• Healthcare reform will add an additional $25.9 billion in annual drug spending by 2021.
A more discerned look at these numbers reveals a telling fact: overall medical system spending in America will skyrocket (not the least of which will be the cost of drugs for previously uninsured patients) and should of course be factored in to the new healthcare reform legislation (whether the Patient Protection and Affordable Care Act or some other new replacement legislation). In fact, the new healthcare law itself is so laden with expanded 'government'/bureaucracy, that non-patient care expenses are expected to also skyrocket — with little directly attached patient benefit. This is revealed by the next statistic:
• In the year 2021, prescription drugs will account for 10 percent of all U.S. healthcare spending, BUT this percentage will remain unchanged from today's current level.
In other words, drug spending may be expected to increase another $240 billion in nine years, but expenses in other areas of medical treatment (clinical and non-clinical institutional expansions, new government oversight agencies, etc.) are also projected to essentially double as well. This insight should lead us to the skeptical concern held by many patient advocates that the new reform law may not have been altogether well designed or thought out. The intrinsic danger herein is that quality, access, and the timely application of therapeutic options will be severely hampered by rules which California Bill AB 369 was written to counteract. If we cannot maintain our focus on the most sacred core of any medical system reform — the physician-patient relationship — then we risk endangering the very patients we are purportedly trying to protect.
California's Law AB 369 portends many more political battles to come, and deserves our utmost attention as we navigate the waters of health reform ahead.
Dr. Dorin is a board-certified physician, practicing in Southern California. He is the Founder and President of America's Medical Society, a healthcare policy non-profit entity created to be a source of education for physicians and patients alike.
Confronting the Painful Consequences of Healthcare Reform for Physicians and Patients — How California's Legislators are Taking the LeadWritten by Adam Frederic Dorin, MD, MBA, Founder & President, America's Medical Society | June 26, 2012
This article is written by Adam Frederic Dorin, MD, MBA, Founder & President, America's Medical Society.
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