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Less choice, better outcomes?

January 29, 2013 - John Stack
Now here is a conundrum. What is the rallying cry of many opposed to ObamaCare? It is that decisions that should be made between a doctor and patient would now be made by a bureaucrat. (I’ve always thought that claim was BS, but anyway). Now though, King Andrew is proposing such a plan that takes over even more of a doctor’s prescribing capabilities. And this year, he’s doing it to the people who can literally and figuratively afford it the least. His plan is to deny for low-income mental health consumers specific brand-name anti-psychotic drugs their doctors prescribe, in favor of less expensive versions. How much will this technically save in dollars? 9 million dollars. Or, 6/1000th of 1 % of the state budget. (He is also proposing 420 million dollars in new tax breaks for movie productions, so to paraphrase Carl Spangler –“We got that going for us”)

Health insurers claim this will not only be cheaper, but will actually be better for patients care. As my son would say “Really?”. Who does this cover again? Oh yeah – low income mental health consumers who may have schizophrenia, bipolar disorder, personality disorders and deep depression. You know, those that it already tough to get them to see a doctor/psychiatrist/therapist, then to convince them of the best course of action, and then to tell them that what everyone in their therapy team thinks you should have based upon weeks, months , years of observation of the patient, some bureaucrat is going to tell them they can’t have it. But there is an appeal process! Many of these drugs take up to a month to just start being effective. Then you wait a couple months to see if the patient is responding as well as they should, if it decided they are not doing well, they can appeal to someone somewhere. Mind you, again this is these are low income patients with mental health problems. Are they going to be the ones who actually appeal? Will they even know they can? Our doctors/therapists/psychiatrists are way too overworked and underpaid to now spend hours of THEIR resources just to get someone’s meds changed? Then, IF SUCCESSFUL – and they probably won’t get a hearing for weeks or months, then they have to start all over on a new drug.

Cuomo says this will pose no public threat. Again, let quote Liam “Really?” But we have new tax breaks for the film industry that costs 50 times more than this idiotic plan hopes to save. Last year, Cuomo started this with moving prescriptions for 3.5 million Medicaid patients into 20 private managed care companies. These companies all have different rules, and different lists of approved drugs for a specific health problem. It’s rare that so many health care groups have come out against this (mostly unsuccessfully). From The American Cancer Society, The American Lung Association, Long island Breast Cancer Action Coalition, The Lupus Foundation and countless others have said this is possible cost savings on one side but with worse outcomes and higher associated costs. More ER visits from people who have to wait too long, or can’t get the drugs they need. Many doctors and patient advocates have said that for many medications, it can take weeks, months and longer to narrow down what is best for a patient. What is good for one may cause rashes, vomiting or worse in another. Today, many patient advocates have a slew of stories of how this has undermined good patient care, but to no avail.

Last year, the State blew this with contraceptions. The low-income people getting contraception were poised to be forced to take whatever pills the state said they could have, not their own doctor’s decision based upon his knowledge of the patient and her needs and health concerns. This was the plan – IF the new contraception didn’t work – ie THE GIRL GOT PREGNANT ON IT – they could the appeal to the state so they could possibly switch back to what their doctor said was the best choice for them. Sometimes a plan required that 2 drugs failed! 2 unintended pregnancies was their litmus test.

Again, mental health gets the shaft. Know who mental health consumers are? Its me. Its your neighbor. Your parents. Its your kid’s teacher. It’s the policeman, mailman, DOT worker or prison guard. They aren’t standing on a street corner on a box with a megaphone. It is everyday people. People who have had abusive parents growing up. Maybe an orphan. Maybe they’ve gotten depression when they went through a divorce or a close family member died. Maybe they are dealing with the stress of making do with much less in this economy. Maybe its your 70 year old father who has lost the use of a limb. The loss to our economy for not recognizing this problem runs in the hundreds of billions of dollars. But because a person who needs mental health treatment doesn’t have a big scar on their arm or a big bandage, you can’t tell they go to see a therapist or take Lexapro or Prozac.

The “savings” are 9 million dollars. That’s an embarrassment. There is no way this ends good for patients, or New York. Back when Paterson was governor (who I believe was the best we’ve had in a long long time) some legislator told him how they had saved $40,000 on closing some campground or another. Paterson openly laughed, saying they now needed just another 9 billion Nine hundred million nine hundred sixty thousand dollars to fix our 10 billion dollar gap. I understand that all items need to be under review for saving money, but somehow $420 million was found in new movie tax breaks, which is iffy on the actual return, and they are going to cut what those vulnerable around us need.

 
 

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