Republicans wisely want to inject more consumerism into the medical marketplace. Health savings accounts, high-deductible health plans, direct primary care, price transparency are all attempts to encourage patients to act more like consumers. Democrats, by contrast, seemingly want to remove every shred of consumer sovereignty from health care. Not to cast aspersions, but it is true. Obamacare is but one example. Their belief is not merely that someone may lack the discretionary income to pay for a physician visit or a prescription. Rather, they believe it is inadvisable for consumers to forgo a medical service after judging it to be a poor value for the money. Most public health advocates believe having to reach for your wallet after receiving a medical service reduces access to care. Take over-the-counter drugs for example. During the debate about switching Prilosec, Claritin and especially during the debate about switching the hormonal birth control pill, Opill, to OTC, many public health advocates opposed the move. A primary concern (besides patients not needing consumer sovereignty) was that health insurance would no longer cover these drugs once consumers had access to them without a prescription. As I explained in other posts, prices fall by up to 95% when consumers have access to a generic drug over the counter compared to the name brand prescription drug price before losing patent protection. If you really want to lower prescription drug costs, just ban insurance coverage and switch them all to OTC.
The U.S. health care system is based on an insurance model, as are virtually all the world’s health care systems. The theory goes that when something goes wrong with your body health insurance should be there to fix it or manage the condition. It is largely reactive, rather than proactive. Most preventive care is not preventive; it is mostly a screening to catch disease before it becomes worse. Not everyone is onboard with that concept.
The Secretary of Health and Human Services has come under criticism because of his support of alternative medicine. In years past I have heard critics say there is no such thing as alternative medicine. There is only medicine that has a basis in science. Perhaps another way to view alternative medicine is not that it is anti-science. Rather, it is anti-being told what you can have and what is out of your reach based on someone else’s preference. Alternative medicine is just another attempt to exercise consumer sovereignty over one’s health care. It is like a catch 22: alternative medicine that does not work is ridiculed by medial science. Alternative medicine that works becomes subject to U.S. Food and Drug Administration (FDA) authority, where it is banned (or if later approved as a drug) is out of reach for consumers without a doctor’s prescription.
Over the years the FDA has warned consumers on numerous occasions that popular male enhancement products were found to be adulterated with sildenafil, the active ingredient in Viagra. I use the word “warned” loosely. Ingredients that actually work were a feature, not a bug. The products were popular because they worked. When the FDA discovered the traditional Chinese supplement, red rice yeast (used for lowering cholesterol), produced a naturally occurring form of lovastatin (a cholesterol drug), the supplement was banned. Phenibut, a supplement used in Russia and Eastern Europe for anxiety and as a sedative became popular in the U.S. It was banned by the FDA too. The FDA plays a game of wake a mole with peptide makers selling products that would likely never gain approval even if a company had the hundreds of millions necessary to perform formal clinical trials. The reason is because the FDA does not consider aging to be a disease. Thus, approving a product to reduce the signs of aging faces a higher bar for approval than those that directly treat a disease.
That begs the question: should there be a carve-out for alternative medicine, where patients have the right to ingest, inject and inhale products the FDA does not regulate? Why not? Of course, full transparency should require disclosing ingredients, and Federal Trade Commission regulations should apply. What about when artificial intelligence becomes better and consumers want immediate access to treatments without the hassle of seeing a doctor? That is yet another reason to boost the availability of OTC medications.