Mid-90s Arlen Specter Explains the Healthcare Fight

The Washington Post has an excellent story that illustrates how different incentives within the healthcare system can lead to higher prices and unsafe outcomes. The article is about a group of anemia drugs produced by a company called Amgen, and the basic story is that a successful lobbying effort by Amgen raised the maximum dosages covered under Medicare and allowed doctors to make money off each dose by charging more than the drug was costing them. The result was a huge increase in high-dosage treatments for a drug that ultimately proved to be unsafe at high doses.

I recommend reading the entire article, but the following passage about Arlen Specter caught my eye because I think it does a nice job illustrating a fundamental difference between the healthcare views of liberals and conservatives. (The anecdote is from the 90’s, so the Specter here is a conservative.)

After a sharp rise in spending in the mid-’90s, the bureaucrats instituted a rule: No longer would Medicare cover expenses for the drugs when the patient significantly exceeded the FDA recommended level. Moreover, physicians could no longer apply for exceptions to the limits…

But it was then-Sen. Arlen Specter (D-Pa.) who led the charge against the new policy. During a hearing, he angrily questioned Nancy-Ann Min DeParle, the director of the Health Care Financing Administration, which had implemented the policy. As chairman of the subcommittee overseeing the agency’s budget, Specter could command more than the usual deference.

“There is a fury out there in the medical community as to what you are doing,” Specter, then a Republican, told DeParle.

Specter wanted Medicare to cover enough Epogen for patients to reach a hematocrit of 37.5; that change could have raised by 20 percent the amount of Epogen that doctors could freely prescribe in an average patient, adding a cost of $2,000 or more. Moreover, he indicated that if doctors wanted to go higher, they should be able to do so as long as they submitted a written justification.

Specter wanted to know: Who were the bureaucrats to question how doctors prescribe medicine?

Special interests and elderly constituents aside, I think Specter’s motivations provide a more accurate and more realistic picture of the “rationing vs. letting the uninsured die” caricature that pervades the American healthcare debate. What you can see in Specter’s outrage is that although conservatives are not opposed to somebody being denied a certain treatment because they don’t health have insurance, once a person has coverage conservatives are adamant that nobody but a doctor should be able to deny them treatment. Liberals tend to have the opposite view. They’re not opposed to somebody being denied a certain treatment because a government body determined it’s not cost-effective, but they hate the idea of somebody being denied treatment because they don’t have health insurance.

What’s important to note here is that neither position is inherently wrong or a bad-faith philosophy of providing treatment. I tend to share the liberal view that there’s more social welfare in ensuring universal coverage, but those who prize personal freedom extremely highly could legitimately argue that there’s more social welfare in the conservative view.

I often complain that in education policy debates there’s a lack of clear, honest, and detailed articulation about what the specific philosophical disagreements are really about, and I think the same is true of healthcare policy. Obviously my characterization of the liberal-conservative disagreement is still a generalization that simplifies and caricatures both views, but at least it’s a step in the right direction, and it would be nice to see a Republican and a Democrat have a good-faith debate centered around this articulation of their differences.

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