12 August 2009 
Here’s the President again at the Portsmouth, NH town hall on health care reform:
(In response to a gentleman’s question about Medicaid forcing him to take a generic equivalent for Lipitor):
THE PRESIDENT: Now, I want to be absolutely clear here: There are going to be instances where if there is really strong scientific evidence that the generic and the brand name work just as well, and the brand name costs twice as much, that the taxpayer should try to get the best deal possible, as long as if it turns out that the generic doesn’t work as well, you’re able to get the brand name.
The proxy for the taxpayer is the government bureaucrat running the program. At least for this Medicaid patient, he President is in effect saying that, “if there is really strong scientific evidence” of medical equivalence, then a government official, on behalf of the taxpayer, should make the decision for you “to get the best deal possible.”
It’s hard to square this with his earlier statement that “This is not about putting the government in charge of your health insurance.”
Continuing with this same case, the President said:
THE PRESIDENT: So the basic principle that we want to set up here is that — if you’re in private insurance, first of all, your private insurance can do whatever you want. If you’re under a government program, then it makes sense for us to make sure that we’re getting the best deal possible and not just giving drug makers or insurers more money than they should be getting. But ultimately, you’ve got to be able to get the best care based on what the doctor says.
And it sounds like that is eventually what happened. It may be that it wasn’t as efficient — it wasn’t as smooth as it should have been, but that result is actually a good one.
The questioner said “And I had to go through two different trials of other kinds of drugs before it was deemed that I was able to go back on the Lipitor through the New Hampshire Medicaid system.” The President responded, “It may be that it wasn’t as efficient … it wasn’t as smooth as it should have been, but the result is a good one.”
This man had to wait in a line. Earlier the President said about reform, “You will not be waiting in any lines,” and yet in this case, “The result is a good one.”
Continue to the next post in this series…
Other posts in this series:
You've made some excellent catches here Keith. I wonder when the President is going to put two and two together and realize the more he talks, the less people support this reform.
On this one the President picks the easy case. What if the name brand works 25% better than the generic? Then who makes the decision? Who decides the reduced efficacy, and the risks that go with it, are justified by the lower cost? It's no fair pickin' the easy ones
On this one the President picks the easy case. What if the name brand works 25% better than the generic? Then who makes the decision? Who decides the reduced efficacy, and the risks that go with it, are justified by the lower cost? It's no fair pickin' the easy ones
Keith,
Perhaps I missed it in one of your posts, but no one seems to want to challenge allowing illegal immigrants free government health care. Obviously, this would cause whatever waiting lines created to be even longer, taxation greater, etc. Catastrophic and emergency assistance aside, I don't feel many Americans want to foot the bill for the rest their medical care. I understand it's a politically charged issue, but it needs to be aired out too. You've read alot of the proposed bills – I have not. Perhaps it's something I shouldn't be concerned with?
My question back to you Keith, is how should the President phrase this? There are a lot of generic drugs that are identical to the name brand. (And there would be a lot more if Pharma wasn't so entrenched). There are also some drugs that have the same active ingredient but use a different delivery method, e.g. generics use cheaper things like sulfa to deliver the active drug. Some people may have different reactions to these other non-active ingredients. In that case obviously the generic doesn't work as well as the name brand. I wouldn't call this "waiting in line". These things are frequently done by doctors and patients, i.e. "let's try this one and see if it works since it's a bit cheaper. If it doesn't work then we can try something else". This is a very good move for cost savings. The President hits on that by saying "the taxpayer should try to get the best deal possible". Should this not be the case?
Good question, Kevin Mc. In the easy case of a chemically identical generic drug, there would seem to be no harm to switching from the more expensive brand name pill. In other cases, there may be medical differences in how any given person reacts to a similar-but-not-identical generic drug. These differences then provoke two questions:
1. Who should make the decision about whether the cost savings of switching to the generic drug is worth the medical difference for a given patient?
2. Does your answer to (1) change if the taxpayer is paying for it?
In Portsmouth the President answered "the government," but only for the trivially easy question of an identical reaction from the patient to the two pills. The much harder question is who decides when the pills have different effects.