Rick Santorum: “We’re Going To Ration Care”
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As the US grapples with an ailing economy, the notion of cost effectiveness of medicines has entered the Republican primary race. Although some people were concerned about rationing when the Obama administration introduced health care reform, Republican presidential contender Rick Santorum this week expressed support for the idea during what was billed as a major address on health care.
The ABC News clip does not show you everything he said, but his remarks were made during a brief, but heated exchange with the mother of a young boy, who asked Santorum what he would do to lower the cost of medicines. He responded that drugmakers are entitled to charge whatever the market will bear and certain meds may not be available to everyone if they are not cost effective.
“People have no problem going out and buying an iPad for $900. But paying $200 for a drug they have a problem with – that keeps you alive. Why? Because you’ve been conditioned in thinking health care is something you should get and not have to pay for. Drug companies, health care companies need to have a profitability, because if they don’t, then how are we going to regulate costs? We’re going to ration care,” Santorum said in response to the boy’s question, according to NBC News (read here) . “And you may be someone who gets that care, but this little boy, because of his condition, or because of his life expectancy may not. Why? Because it’s not cost effective.”
That prompted a sharp retort from the mother of the boy, who ABC News reports is taking Abilify, a Bristol-Myers Squibb medication for schizophrenia and bipolar disorder. She responded that she could go bankrupt paying for the drug, although she did not specify whether she has health care coverage or how much she pays for the medication. Santorum, who has a three-year-old daughter with a rare genetic disorder, replied that drugmakers need to make a profit in order to fund research and development, and innovative medications would not become available without such incentives.
“You have that drug, and maybe you’re alive today because people have a profit motive to make that drug,” he told her, according to ABC News. “There are many people sick today who, 10 years from now, are going to be alive because of some drug invented in the next 10 years. If we say: ‘You drug companies are greedy and bad, you can’t make a return on your money,’ then we will freeze innovation.”
“I hear these and sympathize with these very passionate cases,” he continued. “Look, I want your son and everybody to have the opportunity to stay alive on much-needed drugs. But the bottom line is, we have companies with the incentive to make those drugs. And if they don’t have the incentive to make those drugs, your son won’t be alive and lots of other people in this country won’t be alive. We either believe in markets or we don’t.”
A form of rationing occurs elsewhere, of course. In the UK, for instance, the National Institute for Health and Clinical Excellence, or NICE, uses a measure of cost effectiveness called Quality Adjusted Life Year, or QALY, to determine whether the government will pay for medications. NICE is regularly criticized by patient advocacy groups, although a columnist for The Independent argues the UK National Health Service would go bankrupt without such measures (see here).
Recently, some drugmakers have begun experimenting with money-back guarantees – improved outcomes or a refund – in hopes of enticing governments to provide coverage. Three months ago, Roche began offering hospitals and insurers in Germany a money-back guarantee for its Avastin cancer med, for instance (read this). In 2007, a Johnson & Johnson unit offered NICE a refund for the cost of its Velcade treatment for bone cancer multiple myeloma if results were unsatisfactory.
Santorum, however, did not suggest creating such an entity. Rather, he argued the marketplace – not the government – should determine availability. This would preclude drugmakers from having to haggle with an agency that has the authority to decline coverage. For the record, the pharmaceutical industry was the 15th-largest contributor – among industries – to his presidential campaign to date, according to the Center for Responsive Politics. Pharma contributed approximately $17,000 of a total of nearly $2.2 million that he collected through December 31, 2011 (see here).
