From the way that some
politicians talk, you could come away with the perception that the U.S. health
care industry is an example of the free market running wild. Yet the reality of
American health care is that there are countless ways that state and federal
government policies explicitly ban competition. Over decades, vested health
care interests—bottleneckers—have lobbied legislators to create laws that
protect their place in the market and guarantee them a steady stream of
customers. That adds up over time and many consumers don’t realize that their
choices are restricted.
For many Americans, a visit to the doctor
leads to a trip to a pharmacy to get medication. It’s an extra step that for
one reason or another isn’t always taken, meaning that some patients don’t get
their prescription and end up with more serious medical issues. A review by the
Annals of Internal Medicine found that up to 30% of prescriptions are never
filed. Not taking prescribed medications contributes to 125,000 deaths a year
and costs the American health system nearly $300 billion annually.
To alleviate these problems, 45 states and the
District of Columbia allow doctors to both prescribe and dispense medication
(with exceptions for controlled substances) directly to their patients. “Doctor
dispensing” is common in many states. Patients are routinely sent home with the
exact drugs they need without an extra trip to the pharmacy.
Texas is one of the five states that generally
bans doctor dispensing and in the case of the Lone Star state, it’s not in the
name of health and safety. Doctors in Texas are only allowed to dispense
prescriptions if their practice is located in a “rural” area and more than 15
miles from a pharmacy. In other words, doctors aren’t allowed to compete with
pharmacists.
You would think that a state known for its
wide-open spaces might have many doctors working in places without pharmacies,
but in fact only eight doctors in the state qualify for the exemption and only
three of these are actually registered to dispense. For years, the Texas
Medical Association has asked legislators to get rid of this senseless ban, but
every time reform is considered powerful pharmacy groups step in to defend the
status quo.
The Texas Pharmacy Association claims that the
health and safety of patients is at stake, but that doesn’t square with the
latest research. An in-depth study published in the journal Pharmacotherapy in
2014 concluded that doctor dispensing does not increase adverse drug reactions
and may reduce urgent care and emergency room visits. That’s confirmation that
doctor dispensing increases safety and reduces costs.
It may be easy for pharmacy groups to scare
legislators away from reform, but two Texas doctors are now working with
Institute for Justice to ask a state court to protect their rights under the
Texas constitution. Dr. Michael Garrett of Austin and Dr. Kristin Held of San Antonio
both want to use doctor dispensing to save their patients money and better
manage their health care.
For instance, Dr. Held is an ophthalmologist
who administers outpatient eye surgery in her office. She would like to send
her patients home with the anti-inflammatory eye drops they need to take after
their procedure. Dr. Garrett is a family doctor who would like to dispense
common medications for high cholesterol and seasonal allergies. Patients could
develop serious problems if they didn’t take these medications regularly.
Texas’ ban on doctor dispensing is just one of
the many anti-competitive laws that drive up health care costs. In North Carolina and Iowa, IJ is helping doctors fight certificate
of need laws. CON laws require doctors to get permission from the government
and often their competitors in order to open new medical facilities. Patients
in these states are paying more for common eye surgery or medical scans because
new providers can’t enter the marketplace and compete with big hospitals.
In Indiana and South Carolina, IJ is representing the online
eye test company Visibly. Visibly offers affordable exams to help individuals
determine their prescription for eyeglasses or contact lenses. Their technology
is registered with the FDA, but optometrist groups in these two states have
convinced lawmakers to ban residents’ access to Visibly in the name of health
and safety.
Few lawmakers are medical professionals,
making it easy for interest groups to pass off protectionist legislation as
essential for public safety. But protectionism isn’t a valid government
interest. Courts should strike down laws when they exist only to enrich one
group at the expense of another. There may be no magic bullet for fixing
American health care, but a good start would be rooting out laws that restrict
patients’ options.
https://www.forbes.com/sites/instituteforjustice/2019/07/17/protectionist-health-care-laws-enrich-special-interests-and-its-patients-that-pay/amp/?__twitter_impression=true
No comments:
Post a Comment