Thwart Hillarycare 2006

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Over the weeks leading up to the State of the Union there has been unrelenting negative press about the Medicare drug benefit. The persistent whine of hysteria (to quote Joan Didion) goes something like this: People are too confused, too scared, too ignorant to make the right choice among a "bewildering" array of plans. And if you think making Medicare choices on your own is scary, just try using health-savings accounts.

In other words, there is agreement among mostly liberal policymakers, journalists and advocacy types that people are too stupid to make complex health-care decisions. (Except abortion.) Call this the "Too Stupid To Choose" (TSTC) coalition. And while it seems they are all about making sure life is easier for seniors when they enroll, the coalition has a much bolder goal.

Indeed, the TSTC gang understands what conservatives still seem clueless about: The private drug plans are a staging area for enrolling millions of Baby Boomers in integrated health programs that are largely free of government regulation and price controls. The TSTC coalition is now trying to frighten people back into the comfy confines of government-run medicine to prevent the creation of a real health-care market.

Consider the newest proposal from the AARP (drafted by Democrats) to scrap private health plans and set up a National Drug Formulary much like the one operated by the Veterans Affairs health system. The goal is not just to control drug prices but also to get private plans out of the drug-benefit business in order to make life simpler for seniors.

As with every government-run drug plan, the National Formulary would limit the choices of medicines. Proponents like Sen. Hillary Clinton purr that using "evidence-based" research on what works, the formulary could choose only the best and most cost-effective drugs and scrap the rest.

Actually, under the existing Department of Veterans Affairs' formulary, every new drug approved by the Food and Drug Administration is put on hold for at least a year. If and when the VA actually adds the drug, a patient's access can be restricted. Breakthrough drugs for cancer such as Gleevec are withheld in favor of medicines that are less effective or have more side effects.

Columbia University economist Frank Lichtenberg found that most of the VA formulary's drugs are more than 8 years old. Just 19 percent of prescription drugs approved since 2000 and 38 percent of prescription drugs approved between 1990-2000 are on the VA formulary.

What effect did the choice of drugs for seniors in the VA have on health compared to those available in the private sector? Mr. Lichtenberg estimates that "the use of older drugs in the VA system may have reduced life expectancy by 2.04 months." Meanwhile, veterans' life expectancy increased significantly before the formulary was introduced.

The Lichtenberg study shows that government more often than not chooses to set up barriers to new medicines or technologies that improve overall health. For example, though the government calls obesity a public-health crisis, neither Medicare nor the VA has obesity-management programs in place. It would take an act of Congress or a change in regulation, again at least 18 months, to set them up and authorize direct payment for such innovative care. Drug companies would have to lobby Congress to get their medicines added to drug formularies.

By comparison, health plans such as CIGNA, Destiny Health and Humana have created obesity and cardiovascular-disease management programs in response to consumer demand. The plans are working with biotech and pharmaceutical firms to develop treatment strategies that combine medicine, exercise and nutrition customized to reduce weight.

At Duke University's Prospective Health Care program, emerging information on how genetic variations affect weight gain will be used to further individualize care and use of new obesity medications. Rather than wait months or years for new medicines, patients will have immediate access to cutting-edge treatments. Why would any company or consumer put up with the hassle of getting government go-ahead when they can immediately seek out solutions in the private sector? Medicare reform and HSAs make such experimentation broadly available and make government increasingly irrelevant.

Which is really what the battle over Medicare and HSAs is about. TSTCers truly believe that they are entitled to make health-care policy. However, without government control, they can't. Lionel Trilling wrote in "The Liberal Imagination" that "some paradox of our [liberal] nature leads us, when once we have made our fellow men the objects of our enlightened interest, to go on to make them the objects of our pity, then of our wisdom, ultimately of our coercion." The Too Stupid To Choosecoalitionhas segued into that troubling territory. They must be beaten back if medical progress is to flourish in the years ahead.

Robert Goldberg is director of the Manhattan Institute's Center for Medical Progress.