Non-medical switching of prescriptions may be appropriate.

The Des Moines Register recently published an essay by retired pharmacist and former state senator, Tom Greene, in which he supported proposed legislation that would prohibit insurance companies from switching patients to lower cost drugs or increasing co-pays if the patient is stable on a currently prescribed medication.  (“Protect health and end non-medical switching” 2/14/2022) (Link below.)

So, if the newest highest-cost drug works for a patient, this bill would make it illegal to try to change that patient to a less costly drug.  If that’s true, then maybe the law should also require that the lowest-cost drug in the same therapeutic class be tried first. 

If people had to pay their own way for prescription drugs, many would try lower-cost drugs even if a higher-cost drug was working effectively for them.  It seems fair to allow insurance companies to try to save money.  It also seems fair to require higher co-pays if a higher-cost drug is chosen.  If the proposed bill is passed into law, it will certainly help to push prescription drug insurance premiums higher and higher.

Link to essay in The Des Moines Register: https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2022/02/14/end-non-medical-switching-and-protect-iowans-health/6726589001/

“Bending the curve” may only lengthen the time we are suffering.

I don’t doubt the good intentions of our government leaders, including elected officials and public health regulators, as they tighten restrictions on our freedom of movement..  We are “bending the curve” and easing the pressure on our health care system.  But unless an effective anti-virus drug is found and administered to everyone very quickly, bending the curve will only delay the time before most of us will become infected, and will lengthen the time that we all suffer emotionally and economically.

Why is our response to this situation so dramatically different than our response to the flu or automobile accidents?  Both the flu and auto accidents kill tens of thousands of Americans each year and are preventable.  We could dramatically reduce those deaths if we used the same extreme measures that we are using against COVID-19.  But what is the point of living if we have to stay away from our family and friends?  For a few weeks, fine.  For several months or more, not acceptable.  Life has risks.  We need to balance the costs and the benefits of our efforts.  Soon, we need to once again let people decide for themselves how much risk they are willing to take.

Iowa needs to eliminate licensing laws and regulations that protect existing practitioners rather than their customers.

I agree with Valerie Stallbaumer in her letter to the editor in The Des Moines Register, (See link below), that the purpose of professional licensing requirements by government is to help protect the public from harm.   I disagree with her that it also is to guarantee quality. Safety issues are usually objective: we know pretty well what kind of things can hurt people.  Licensing should assure us that the licensed person knows and follows safe procedures.  But for many licensed professions, quality is subjective. If acupuncture is not effective for some people, what is the harm as long as they don’t get an infection?  The only reason I can think of why government would require a four-year program for acupuncturists is that acupuncturists and their schools lobbied for licensing to protect themselves against competition and to appear more professional.  Acupuncturists, physical therapists, tattoo artists, and ear piecers probably can learn proper safety procedures related to “needling” in just a few days.  We do need a complete review of licensing requirements and regulations in Iowa to eliminate those that prevent competition rather than protect people.

Link:  https://www.desmoinesregister.com/story/opinion/readers/2020/02/25/letters-favoring-iowa-lightning-bug-legislation/4819986002/

Price gouging can be a good thing.

Sometimes, price gouging can be a good thing.  If there is a sudden surge in demand for something, say face masks or hand sanitizer, is it better to keep prices low and encourage hoarding that can result in complete outages, or is it better to let prices go up as the market demand allows to discourage hoarding and encourage rapid increases in production?  Why would businesses pay for overtime, or expedited shipping, or other higher costs to quickly increase supplies if they are not allowed to increase prices?  There are certainly extreme situations where price gouging would be considered by most people to be immoral.  (For example, it would clearly be immoral to charge $1,000 for a glass of water to a person dying of thirst when you have plenty of it.)  But there are many other situations where allowing prices to go up significantly and quickly helps to make vital products available for important purposes to more people more quickly.  Private efforts to keep prices low and to prevent hoarding in an emergency are to be commended, but be careful before you call for laws or regulations to prevent price gouging.

Don’t ban vaping!

It was like a breath of fresh air to read in The Des Moines Register that our Iowa Attorney General, Tom Miller, used logic in concluding that banning vaping by adults in Iowa would be a mistake.  (See link to Register article below.)   It does appear clear that almost all of recently rreported deaths and severe illnesses were the result of vaping black market products that contain THC, not nicotine.

While it may be true that no amount of vaped nicotine has been proven safe, we do know that vaping popular legal nicotine products has been going on for years without the type of health problems that have been reported recently.  We also know that nicotine vape products do not contain the tars and other substances in cigarettes that are known to cause cancer.

It’s reasonable to think that vaping nicotine is less harmful than smoking cigarettes, and that going from smoking cigarettes to vaping can be a good step towards quiting a nicotine habit altogether.  But, prohibition of vaping would only worsen the health problems, just like with opioids, where people who purchase their drugs on the street have no idea of the strength or purity of the products they are buying.

Link to Register article:    https://www.desmoinesregister.com/story/news/health/2019/10/29/banning-vaping-products-life-threatening-iowa-attorney-general-tom-miller-e-cigarettes/4076380002/

How to slow the growth of health care costs.

Thanks to Susan Voss for her thoughtful essay about the complexities of our health care system, and how difficult it is to reduce costs. (See link to Register essay below.)   I don’t claim to have “the answer”, but I do suggest that the following cost saving ideas be given serious consideration.

• Medicare, Medicaid and private insurance should not be required to cover every new drug, product, or procedure that is approved by the FDA. Some are very high cost but provide only marginal improvement over alternatives that cost much less.  Also, at least some covered products and procedures would likely be considered not medically necessary by most people.
• Consider shortening the amount of time that government grants a monopoly for patents.  Patents are not natural property: humans have copied one another since the beginning of time.  Our U.S. Constitution allows patents to be granted to encourage inventiveness, but there is no objective reason why a patent must be granted for 20 years. Why won’t five or ten years work?  Maybe the length of the patent should be based on the cost to develop the patented item and whether or not government funds were used to help develop the item.
• Don’t require limits on out-of-pocket payments such as co-payments, especially for very high cost items.  A person should have “skin-in-the-game” if they expect their insurance to cover very high cost items.  Today, we see the opposite: drug companies offer to help pay people’s out-of-pocket costs so there won’t be so much political pressure on them to lower their prices.
• Allow both pharmacies and individuals to purchase drugs from sellers in other countries that are “deemed” to have sufficient safety procedures in place.  If drug companies are free to charge lower prices in other countries, then pharmacies and individuals should be free to purchase the drugs from those other countries.
• Allow Medicare and Medicaid to negotiate with drug companies on prices they pay for the drugs that are covered by the programs.  Right along with that, Medicare and Medicaid should be allowed to develop formularies (lists of drugs that are preferred over other therapeutically similar drugs), that give beneficiaries a financial incentive to use the preferred drugs and a penalty for using higher cost drugs.

Our health care wants are unlimited.  Our ability to pay is not.  We, as citizens, should not expect private insurance or our government health care programs to cover everything, regardless of cost.  We should expect our government to NOT do things that increase costs, or reduce our choices.

Link to Register essay:  https://www.desmoinesregister.com/story/opinion/columnists/iowa-view/2018/09/19/dont-fooled-when-someone-claims-have-answer-soaring-health-care-costs/1355890002/

 

Free Iowa Car Dealers!

 

It is not surprising that the Iowa Automobile Dealers Association has registered its opposition to Iowa Senate Study Bill 3139 which would allow RV dealers to sell RVs on Sundays.  (See Register link below.)  I’m sure they think if RV sales are allowed Sundays, then car sales might be next.  It would be nice if that were true.  The only reason that it remains a crime to sell RVs or cars on Sundays in Iowa is because of the lobbying power of the dealers.  If RV and car sales were allowed on Sundays in Iowa, it would not require any dealer to be open for business on Sundays.  The decision would be left up to the owner, just like every other business.  I urge Iowans to let there elected representatives know that Iowa should stop making it a crime for RV and auto dealers to be open for business on Sundays.

Link ro Register article:  https://www.desmoinesregister.com/story/money/business/2018/02/07/its-illegal-buy-car-rv-sunday-iowa-new-law-might-change/315016002/

Prairie Meadows should open their books, regardless of ruling

On 12/16/2016, The Des Moines Register reported that the Iowa Public Information Board had ruled that Prairie Meadows  Race Track and Casino was not a “government body” according to their rules and, therefore, was not required to follow open records laws, and not required to provide the Register with records pertaining contracts of its top executives.  (See link below.)

The Register can appeal the decision, and has some good arguments why Prairie Meadow should be subject to open records laws.  But even if Prairie Meadows is not required to follow open records laws, they could still release the records voluntarily.  Just because it is legal to do something does not mean it is the right thing to do.  Prairie Meadows would not exist if not for the original support of Polk County taxpayers.  The board claims that Prairie Meadows is a not-for-profit organization, (even though the IRS disagrees).  I don’t understand why any board member would want to be anything other than completely transparent about the operations of Prairie Meadows?  I presume that none of them feel they have anything to hide.

I appeal to the board members of Prairie Meadows to simply do the right thing, and voluntarily open their records to the public, and the Des Moines Register.

 

Link to Register article: http://www.desmoinesregister.com/story/news/local/government/2016/12/15/iowa-board-says-prairie-meadows-records-can-secret/95492840/

Checkoff programs for commodities should be ended.

The Des Moines Register recently reported that all Iowa cattle producers will soon be forced to pay $0.50 per head into a “checkoff program.  The funds will be used for beef promotion, research and other activities.  56% of the cattle producers voted for the “checkoff” program – forcing the other 44% to contribute to the scheme.  In any other setting, it would be called a tax.

There are many checkoff programs for a wide variety of commodities, both nationally and in various states.  They all work the same way.  If a majority of the producers want to tax themselves to promote their commodity, then they get to force all producers to pay into the program.

There is not the kind of activity that should be ruled by a majority.  I understand that if the programs were voluntary, which they originally were, that those who did not pay would get a “free ride” – they would get the benefits without paying for any of the costs.  That is not a sufficient reason to use the force of government.  There are an unlimited number of things that a majority of businesses might like to do, if they could force all competitors to help pay.

Both federal and state governments need to repeal the laws which allow checkoff programs to exist.

Link to Register article: http://www.desmoinesregister.com/story/money/2016/12/08/iowa-beef-checkoff-passes-with-56-percent-approval/95138020/

End racist prohibition.

As The Des Moines Register reported on 10/13/2016, “Black Iowans are seven times more likely to be arrested for drug possession than white Iowans…”  (See link below.)  Drug possession.  A crime without a victim.  Arrests that create a criminal record that seriously negatively affects a person’s ability to get a job.

Even if blacks do possess illegal drugs at a rate seven times more than whites, which I very much doubt, treating possession of any drug as a crime is clearly unfair, if not racist.   Why don’t people get arrested for “possession” if they are caught with a six pack of beer?  Why aren’t people be arrested and charged with “intent to deliver” if they are caught with more than a case of beer?  Why aren’t people charged with a more serious crime if they are caught with high alcohol content distilled spirits, which are surely more dangerous?

We need to end the immoral and impractical drug wars.  The correct and reasonable thing to do is to legalize and regulate the manufacture, sale and use of all drugs, just like alcohol, tobacco, and prescription drugs.  Just like with alcohol, fair regulations would include protecting our children, and prohibiting driving vehicles while intoxicated.  In any case, we need to end prohibition.

Link to Register article: http://www.desmoinesregister.com/story/news/crime-and-courts/2016/10/12/iowa-ranks-2nd-worst-racial-disparities-drug-arrests/91958452/