In a recent study “Medicare Part D and its Effect on the Use of Prescription Drugs, Use of Other Health Care Services and Health of the Elderly” (NBER Working Paper No. 16011), Robert Kaestner and Nasreen Khan estimated the impact of prescription drug insurance through Part D on the use of drugs, other medical services, and individual health. They found that prescription drug use increased 60% with no improvement in health.
The authors find little evidence that the large increase in prescription drug use created by the passage of Part D was associated with any change in outpatient service use, hospitalization, functional health, or general health status for most of those affected. They conclude that “much of the additional use of prescription drugs that results from gaining prescription drug insurance is [of ] relatively low value in terms of health benefits,” although they cannot conclusively rule out small improvements.
This also seems to support the notion that prescription drugs provide little value and that other approaches to health such as diet, exercise, environment, and advanced nutrition are underutilized.
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Part of this is a Medicare problem, but the other part is a patent problem. Both are created by the government to the detriment of business.
The attempt to empirically measure the effects of this plan are a joke when you consider there are hundreds of other factors that effect the metrics that they are measuring in order to determine the effects of Part D. Even if they did have the godlike ability to perform the measurements necessary to show the associations necessary, correlation is not causation. So not only did they fail at their goal of showing no association, but even if they had suceeded, they would have failed to show any causation.
Don’t get me wrong, I’d love for people to realize that this thing (am I speaking of Part D or government as a whole?) is a huge waste of money, but this is hardly the proof we need. Which do we care about more, getting people to believe the things we do, or truth?
Considering the vast majority of prescription medications exist only to mask symptoms of existing problems, it’s probably an accurate assessment. When dealing with the prescription medication market, the cures marketed primarily target conditions that arise due to genetics. The prescription market for bacterial, viral, or other forms of infections make up a tiny portion of the total market. As it stands, we lack the technology to rearrange our genetic structure to eliminate the ill effects that come with them. Prescription medications effectively fall into two categories:
1. Chemical inhibitors
2. Chemical replacers
Both exist because some function of the body is not working properly. The medication only replaces a function that the body has shut down or inhibits a function that the body is not supposed to be doing. The medication doesn’t fix anything, the problem still exists and is still getting worse and is still having the same impact on you as it did prior to taking the medication. Most of it is just a basic cycle of life. The cells that produce the chemicals shut down, they’re pre-programmed to.
Additionally, introducing those external medications builds up a tolerance. Our physiology seems to know if the chemical is being produced in our system or is being taken in elsewhere and adjust to counter this input, even if it’s merely to replace a chemical level we associate with proper. The genes are pre-programmed to tell the system it doesn’t want those chemicals anymore so it builds up tolerances while further shutting down the cells that produce that chemical. Your body is pre-programmed to have that problem, nothing you can do will stop it.
The entire point of this rambling response is that we don’t need to know all the variables because all other variables are effectively vestigial to the debate. Once it’s understood that the prescription drug market is mostly a fancy pain killer, it’s easy to grasp that Medicare Part D wouldn’t have any real impact on the quality or length of life.
J.
Good comment. Anecdotally, I see an increasing number of people (okay, women) who say they’re bipolar and take meds. An acquaintance just got out of alcohol rehab and he said the number one substance putting people in rehab isn’t crack and it isn’t meth. It’s rx meds.
I come across a lot of drug/alcohol rehab patients through my job, and I’d say the #1 substance, and it’s not really close, is alcohol. Of the remainder, the bulk are due to some sort of opiod, be it pills or heroin. Crack, cocaine, meth, etc. make up a smaller proportion than most people would think.
Only because alcohol is the most available and inexpensive form of changing one’s state of mind. An addict is an addict, and if alcohol suddenly stopped existing, they’d find some other substance to latch onto. Whichever was most available would be the one you’d see the most in your rehab patients.
I agree with you, but that’s not the way this study attempted to go about “proving” that Part D was a farce. They attempted to measure things like outpatient service use and hospitalization and pretend like there was some kind of correlation that showed Part D had no effect on these other areas, when there are about a billion independent factors that go into outpatient service use (not the least of which being cost, which is never a constant). Now, I realize that most people buy into the correlation is causation bs, and also buy into the empirical method of proving correlation, since it seems scientific. And perhaps that makes this a small victory, as you’re beating the empiricists on their own terms. But I wouldn’t ever point to this study when trying to convince someone that Part D was a waste of money.
I do not agree that “the vast majority of prescription medications exist only to mask symptoms of existing problems… Once it’s understood that the prescription drug market is mostly a fancy pain killer, it’s easy to grasp that Medicare Part D wouldn’t have any real impact on the quality or length of life.”
Some medical conditions are essentially untreatable. However, palliative treatments for these conditions are popular precisely because they improve quality of life. For example, a pair of glasses will not cure your astigmatism, but it will enable you to read. An example from my own experience is the use of carbidopa/levodopa in the treatment of Parkinson’s disease. Without the drug, the patient is nonfunctional; with the drug, the patient can lead an almost normal life.
I do agree that Kaestner and Khan’s study is likely of little scientific merit. However, I am unwilling to purchase the article, and will therefore take this opportunity to chastise Mr. Thorton for citing an article that nobody can read.
“This also seems to support the notion that prescription drugs provide little value”
Uh, no it doesn’t. It supports the fact that people will get the drugs they truly need even if they don’t have insurance coverage.
The one good thing about Medicare Part D is that, thanks to that law, Medicare will go bankrupt much sooner.
Their sample size was too large. They should have considered the health of the owners, management and employees of the drug companies.
LOL.
A 60% increase since when exactly?
‘Cause if this increase took place in say the last ten years or so I’m actually somewhat relieved.
(Yup, that’s how far I’ve come I guess, feeling some relief if some government f**k-up number is not as high as I expected)
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