NCPA - National Center for Policy Analysis


June 17, 2008

The medical system is broken, and everyone has to share the blame.  But the person suffering the most (literally) is the patient, says Dr. Robert Kramer, a pediatrician and health care consultant.

Nowadays, everything functions at the whim of the insurance industry -- increased and cumbersome approvals and compliance requirements, decreased reimbursements to physicians, increased costs to employers, and decreased service and benefits for patients.  And the insurance company is the only one guaranteed a definable profit.  This is a bad economic model -- one winner, three losers.

Insurance companies are now increasing pressure on doctors to convince them to switch patients away from medications that are the most effective for them to cheaper options, says Dr. Kramer.

For example:

  • The powerful drug Cymbalta for depression, which is about $80, is often switched to the much cheaper and much less effective Wellbutrin (around $10).
  • The cholesterol drug Lipitor is often switched to Simvastatin, a drug that is much less expensive but not nearly as effective at reducing cholesterol quickly.

For physicians, this is not only invasive, pervasive and frustrating, but it can be dangerous.  For the sake of everybody's health, we must allow decisions regarding medications to be made by the physician -- and only the physician, says Dr. Kramer.  Insurance companies are not licensed to practice medicine.

Source: Dr. Robert Kramer, "Your Insurance Company is Not Your Physician," Dallas Morning News, June 16, 2008.


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