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November 27, 2006

Kondracke Vs. The Facts

I'm not exactly going to stun anyone by suggesting that Mort Kondracke doesn't know what he's talking about, but this is rather offensive:

The reason that V.A. prices are lower is, it's basically a socialized medical system. You go to a V.A. doctor, you go to a V.A. hospital, you go to a V.A. pharmacy and the V.A. pharmacies only have 25 percent of the drugs that seniors actually use all the time. So, you know, it doesn't work.

There is an implicit contract between pundits and their audiences. The audiences, whose attention pays our salaries, are working off the assumed information that the networks and publications elevate only those who take the time to accurately comprehend the issues they're speaking about. And we, as our part of the deal, are supposed to take ten minutes and figure out what we're talking about.

The VA, just like the Medicare presciription drug plans, uses a formulary of drugs on which they negotiate discounts. That formulary contains drugs for every condition, but mostly eschews the copycats and useless medications that clutter up the market. Your pharmacy, remarkably enough, does the same thing. Now, VA users still have coverage for drugs off the formulary, they just don't get the bargained discounts on them. And here's the kicker: The VA has the best outcomes, for the lowest cost.

Those two points are not unrelated. As part of "knowing what I'm talking about," I called Phil Longman, who's done the best work on the system. As he explained, the VA is almost fetishistically rigorous about testing new drugs for efficacy and safety before adding them to the formulary. Vioxx, for instance, was never added to the list, because the VA thought it neither effective nor safe. They were right, and their patients were protected. That didn't -- and doesn't -- mean VA doctors can't approve off-formulary drugs. They just have to explain why doing so is necessary. In that way, the VA incentivizes the proven, well-priced drugs on their formulary rather than the ones in the news, but doesn't eliminate new and necessary treatments.

And how's that worked out? Well, in 2003, The New England Journal of Medicine found the "socialized" VA better on all 11 metrics of care than fee-for-service Medicare. The Annal of Internal Medicine found they surpass the commercial managed-care systems on all seven metrics of care for diabates patients. The National Committee for Quality Assurance, the gold-standard, found the VA the best health system in the country, beating out such star performers as John Hopkins and the Mayo Clinic. And an astounding 81% of Vets approve of their care, higher than Medicare, Medicaid, or the private sector.

But Kondracke doesn't know any of that. Or if he does, he's not telling. And in doing, he's breaking trust with and misinforming his audience. What conservatives literally cannot get around -- and so must ignore -- is that the single best health system in the country today is the socialized one. But inconvenient as it is for their ideology, what's all the more inconvenient is that the pundits Americans entrust to know about and inform them of these things are failing to do so.

Also at Tapped

November 27, 2006 in Health Care, Insurance | Permalink

Comments

Better prices based on guarantee of patients is the current basis for every private health insurance company. If United Health, Blue Cross, stc can all demand and get price cuts (and kick-backs) from pharmacuetical companies based solely on numbers of guaranteed patients who will be forced to use their products, why can't all of US? Big pharma really doesn't have a choice here, play ball or pack up and sell in another country, they'll play ball, Ecuadorians can't afford Lipitor.

Posted by: bones | Nov 27, 2006 6:29:39 PM

Ezra's effort to actually learn something about something is paying off for his readers. Thank you, Ezra, for all the work you've done to master health care policy. And thank you for telling me something that I didn't know before I read this post.

Posted by: JR | Nov 27, 2006 10:18:50 PM

Thanks for the great piece. Where did this word "formulary" come from -- it's one of the ugliest words I've ever seen/heard (of course I see it all the time in my own insurance information, but I finally had to ask someone)

Posted by: David | Nov 27, 2006 11:42:17 PM

"Formulary" is an old word that originally meant a compendium of formulas. It's an "Englishing" of the Latin formularium. (You can see the same process in bestiary, a catalogue of animals, from bestiarium, and apiary, a place for bees, from apiarium). Pharmacists used to make up their own drugs, so a pharmacist's book of formulas was his formulary - his recipe book. (Alchemists had formularies, too.) It came to mean any list of pharmaceuticals, and now it means a list of drugs that are approved for use or that a hospital will keep in stock.

Posted by: JR | Nov 28, 2006 12:33:34 AM

Thanks, JR. Interesting evolution: from a list of things that can be made to a list of things that will be covered. Do you know when this word choice was first made, or how long the word has had this modern meaning?

Posted by: David | Nov 28, 2006 7:07:49 AM

This is one of the most enlightening and informative articles on health care I've read in 20 years of following the subject. Thank you.

Posted by: greenvtster | Nov 28, 2006 12:18:05 PM

So, the part that Mort's wrong about is that it doesn't work... yes? I only split hairs because I think one of the things we need to have happen in discussing health care is the sense of group responsibility - the VA is socialized medicine, and the point is it works... but say "socialized" in many places and you'll get shivers... especially when people are surprised at words like "formulary" which I thought everyone knew, and probably everyone doesn't, unless they've had reason to deal with the insurance company or HMO on it...

Posted by: weboy | Nov 28, 2006 12:30:31 PM

I don't. But there's been something called the National Formulary since 1888. http://www.medterms.com/script/main/art.asp?articlekey=25605

One of the smaller coincidences in life: last night, after I wrote the above post, I came across the word "antiphonary." It turns out that this means a kind of mediaeval Christian prayer book - one that contains "antiphones," or responsive readings.

Posted by: JR | Nov 28, 2006 1:55:59 PM

It should probably also be noted that the VA was not such a well-run organization prior to the Clinton Administration's concerted effort to upgrade it. That's the second part of the Truth That Must Be Suppressed, that the horrible hippie liberal Clinton (I know, he was neither of those things), did his very best for veterans, while the "Support Our Troops" crowd does everything in their power to screw them over at every opportunity.

Hmm, does that make Mort Kondracke the George Orwell of Bizarro World?

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