116 3rd St SE
Cedar Rapids, Iowa 52401
Dr. Mariannette Miller-Meeks, who is my representative in Congress, uses Republican talking points to justify an utterly untenable position against allowing Medicare to negotiate prices with pharmaceutical companies. I am also a physician (retired) and I have to call out Miller-Meeks for hurting Iowans and people across the country for strictly political purposes.
If we live in a capitalist economy, then we have to respect the dynamic between those who buy and those who sell. Unfortunately, pharmaceutical companies have rigged that dynamic in their favor by getting Congress to pass legislation that prevents Medicare from negotiating drug prices. How could any elected representative do that to their constituents in good conscience?
Let's see what Miller-Meeks said.
She said that "prescription drug cost controls would interfere with the doctor-patient relationship." The Democratic proposal before Congress would not impose controls. Rather, it would allow negotiation for what Medicare pays for drugs, which is a very different dynamic.
And how would that interfere with the doctor-patient relationship? It certainly would not, as she said, "undermine … how they [physicians] prescribe best treatments for their patients," which introduces the question of access and opens a "Pandora's box" of issues around access to health care.
Let's look at a couple issues regarding access to health care under the current system and see whether allowing Medicare to negotiate drug prices would improve or worsen those issues.
Medicare has a formulary. That formulary does not include all medications. What drugs are included in the formulary is limited in part by the price Medicare has to pay. Medicare also limits the use of certain drugs in an attempt to control the cost of care, generally using less expensive drugs as first line care and higher priced drugs when first line drugs aren't sufficient. Many insurance companies use similar policies to control what they pay out for drugs and, therefore, also limit access to drugs. The notion that doctors give you the best treatment they know simply isn't true. They give you the best treatment they are allowed to give you.
Miller-Meeks also said: “We’ve had governors make decisions over what drugs doctors can prescribe their patients under the penalty of doctors losing their license. We’ve seen government bureaucracy interfere with the doctor-patient relationship, whether it’s prescribing treatments, what they can get through hospitalization.” She said this in the context of prescribing for treatment of COVID-19, but if it applies there, it applies everywhere. Government agencies and laws passed by our elected representatives have often restricted the use of medically indicated treatments, particularly in the areas of reproductive care (remember the battles over access to the "morning-after" pill?) and gender-assignment care. Miller-Meeks, like most Republicans, is perfectly willing to let governments interfere in health care when it suits her/them.
Returning to the specific issue of doctors prescribing drugs that have not been demonstrated in scientific studies to be efficacious for treating COVID-19 (hydroxychloroquine and ivermectin), doctors are required to work under a standard-of-care determined by state medical boards. Doctors can be disciplined for prescribing outside that standard. Also, the FDA determines what drugs can be used for what diseases. It is not bureaucratic interference for the FDA to make such rules. We need those rules to protect public safety. It is only Republican denial of the nature of the COVID pandemic that prompts Miller-Meeks to reject controls under which she has practiced medicine and surgery.
Finally, about Miller-Meeks's fear of a "slippery slope," we can only hope that our elected representatives work in the future to expand Medicare's ability to negotiate prices. Given the enormous investment that the pharmaceutical industry makes in lobbying our representatives, we cannot expect that our representatives will remember who elected them any time soon. We need to support allowing Medicare to negotiate drug prices and we need to replace representatives who oppose this common sense measure with people who truly represent the well-being of the people.
David Sands is a retired physician from Fairfield.