A patient goes to a doctor with a serious illness and is prescribed a new, expensive drug the doctor thinks will provide relief or a cure. The patient takes the medicine and gets better.
That’s the way health care is supposed to work. Instead, many insurers tell that patient, oh, wait a minute. And the companies dictate that the patient has to take “step therapy,” wherein he or she must try cheaper alternative treatments before the insurer will consider paying for the medicine the doctor prescribed.
This is an outrageous practice and should have been banned long ago. But in the profit-driven American health care system, one in which insurance companies and drug companies have a vise-grip on the rules to protect their bottom lines, the patient’s best interest seems to be a low priority. Insurers say all the time, “We don’t try to practice medicine or interfere between a patient and the doctor.” Really?
Credit state Rep. David Lewis, a Dunn Republican and the House Rules Committee chairman, with trying to do something about it. Lewis, a reliable conservative on most issues, put in a bill to ban step therapy essentially by empowering doctors to order exceptions from insurance company mandates. Lewis, though, withdrew his the bill.
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Any mystery about what happened?
Insurance companies and pro-business groups like the N.C. Chamber lobbied against the bill as too costly for business. Done and done.
“What this bill is trying to do,” Lewis said, “is make sure that a patient gets the medicine they’re prescribed, when they’re prescribed it, without having to jump through multiple hoops.”
Of course. The principle is simple. And right.
Unlike other health care systems in industrialized nations around the world, America’s system is in the control of the profit-driven parts of the health care industry. Doctors put the patient’s welfare ahead of all else. But once the drug companies and the insurance companies get in on the act, look out.
The insurers say: “Oh, we’re just trying to hold down the cost of health care for everyone.”
They’re holding down the costs for insurers. Meanwhile, they’re sometimes making patients endure pain and unnecessary side effects until they get the drug their doctor said would be best for them in the first place.
Efforts need to be made to hold down drug costs – the arbitrary price inflation is a scandal – but those efforts should be directed at the drug companies, not the patients.