Health care in miniature
January 31, 2011 1 Comment
Meagan McArdle writes on a topic near to my heart, that is, the current policy with regard to pseudoephedrine in the US.
I should declare my bias in this matter: I have persistent, unpleasant allergies which stem from a congenital problems in my sinus cavities – specifically, the passages are too narrow, and since I’ve lived in Washington their natural state is to be about as porous as a brick. An allergy profile run by one of the top allergists in the country found that at 24 hours (the diagnostic point) I wasn’t allergic to anything, but at 48 hours, I’m allergic to everything. Therefore, my nightly cocktail is 1200 mg of guaifenesin, 120 mg of pseudoephedrine, and 50 mg of diphenhydramine. This approach is what I’ve come to after learning that most antihistamines work on a relatively small percentage of the population (that is, Zyrtec works for some, Claritin for others, and Allegra for a third venn-diagram overlapping group) – and none of them actually work on me for more than three days at a time. Happily, it’s kept me functional and able to sleep for the last few years. Unhappily, I used to be able to get guaifenesin + pseudoephedrine by prescription in a 90 day generic supply for $8, but then it went OTC in the form of Mucinex-D and now a 24-day supply costs > $25. Making bad news worse, under the new health care regulations which took effect this year, these costs are no longer eligible for reimbursement by an FSA.
So pseudoephedrine is a well-understood, well-tested, cheap, old medicine which is known to actually work. Wouldn’t this be precisely the kind of thing we should wholeheartedly embrace if we were truly concerned about the cost of health care in the US? The fly in the ointment here is that it can be turned into methamphetamine in a relatively dangerous but simple process by home-brew chemistry dropouts.
The lesson I learn from this highly specific case study is that controlling health care costs is not a priority when compared to other societal priorities – preventing losers from killing themselves by making or taking dangerous chemicals trumps our desire for rational cost containment. So if our expressions of Puritanism (that is, saving people from themselves) can trump an obvious cost containment measure, a fortiori other expressions of technocratic societal engineering will do so as well.
This is precisely why I am not a fan of the unconstitutional “affordable care act” – the sheer immensity and complexity of that work means that the quality and value of the health care will necessarily decline in the face of the well-intentioned meddling of thousands of people who want to save me from myself.
C.S. Lewis said it well:
Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.