When the State Can Overrule Your Doctor, Will Your Health Be Run Like the Post Office?

Post Office?
Proposed Medicaid cost control plan would make bureaucrats prescribe the treatment for the poor.

WASHINGTON – Legislators in special session in Olympia, WA, are grappling with ways to slow the growth in spending on the state\’s Medicaid program for the poor and disabled. A compromise proposal is said to be in the works that would mandate so-called "therapeutic substitution" that would control prescription drug costs.

Therapeutic substitution is a euphemism for the creation of a state-approved list of prescription drugs for treating illnesses. But approval or disapproval is dependent not on drug safety or effectiveness in treating each disease, it is based on cost alone – cheaper drugs are approved, more expensive ones are forbidden. Drugs of very different chemical composition could be substituted for doctor-prescribed drugs, without notification, by bureaucratic fiat.

"The Washington House\’s proposal is government meddling at its worst," said taxpayer advocate Grover Norquist, president of Americans for Tax Reform. "The doctor-patient relationship is vital to quality care. It is the doctor\’s responsibility to know his patient, and to prescribe the appropriate treatment for that specific individual. When a government bureaucrat can deny a prescription to a Medicaid recipient and give him or her a totally different drug instead, because some chart tells him it is ok, we are putting people\’s lives at risk!"

Medicaid is the federal-state joint program to give medical care to the poor and disabled. Washington State is proposing to combine this drug substitution with tax increases on the drug companies in the form of "kickbacks" called supplemental rebates – drug companies must pay the state to have their products be part of the state\’s Medicaid program. Together, therapeutic substitution and supplemental rebates deny the best, most effective drugs to patients, lower the returns on drug companies\’ investments (thus discouraging the development of new, innovative drugs), and end up costing taxpayers more when the "bargain" treatments don\’t work.

"Therapeutic substitution and supplemental rebates are destructive policies that endanger people\’s health today and lead to higher costs tomorrow," Norquist continued. "Reformers should look to market-based solutions rather than price controls and government takeovers of medical decisions."