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Uwe E. Reinhardt, Peter S. Hussey, and Gerard F. Anderson U.S. Health Care Spending In An International Context Health Affairs, May/June 2004; 23(3): 10-25. [Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

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Electronic letters published:

Major Factor Limiting Change In U.S. Health Care

Edward C. Lipman   ( 5 May 2004 )

Prescription Use in the U.S.

Donald Schott   ( 1 June 2004 )

Major Factor Limiting Change In U.S. Health Care 5 May 2004
Edward C. Lipman, Managing Director ECLCo Send letter to journal: Re: Major Factor Limiting Change In U.S. Health Care eclipman{at}peoplepc.com Edward C. Lipman	I firmly believe that the single major factor preventing debate and changes in the supply and delivery of health care evenly and more efficiently in the United States is the fact that lawmakers are exempt from participating in the system available to the majority of the rest of the population. First, both the federal-level legislative and administrative branches of government, along with most states, have health care coverage outside the system available to most other Americans. Second, the system is far too complicated and therefore significantly more costly than systems offered in other developed countries. An example is the new drug programs being offered over the next few years in the Medicare system. None of the legislative participants will be included or subjected to the mess they have created. The cost estimates have already be increased significantly over the original estimates, and I don't think anyone believes that there will be true savings to the participants. Every time someone in the administration answers the question concerning savings to the pariticpants, they compare the cost differences to the highest prices within the old system, not to costs/prices available outside the system. Plus I have yet to see anyone who has explained the options which will be available in an easy manner that shows what the true savings will be. Before we can make meaningful changes to the health care system, we must make it beneficial to the legislative bodies (conversely, they must participate in the penalty, along with the rest of us, for their lack of real change and cost savings) to seek better systems applied across the entire population.
Prescription Use in the U.S. 1 June 2004
Donald Schott, Consultant Send letter to journal: Re: Prescription Use in the U.S. Donschott{at}sbcgobal.net Donald Schott	The prices and patterns of medical care use in the U.S. are driven by commercial interests as Uwe Reinhardt and colleagues describe. The pharmacy segment is particularly troubling with its growing influence on U.S. and foreign policy. Although foundations and nonprofit corporations affect health care policy in some segments of U.S. health care, pharmaceutical interests are exclusively commercially driven. Their influence on the FDA to adopt the latest round of stents with limited testing and their influence on the Commerce Department to further their pricing outside of the U.S. show their influence over federal policy. A more disturbing influence on pricing is the Justice Department's recent settlements with "pharmacy managers" steering patients to higher-priced alternatives where the manager can increase profits.[1] However, there was no admission of guilt in the settlement with MEDCO. Finally, the number of patients with prescriptions is growing dramatically (aside from the pricing) with elderly with at least one prescription averaging over 23 in the last year studied.[2] Overuse of antibiotics, dangerous drug interactions, and lack of compliance with prescribed doses are well documented. However, these are not on the agendas of the drug manufacturers’ lobbying efforts. 1. OREGON DOJ TO RECEIVE $800,000 IN MULTI-STATE SETTLEMENT AGAINST MEDCO HEALTH SOLUTIONS http://www.doj.state.or.us/releases/rel042604.htm 2. Statistical Brief #21: Trends in Outpatient Prescription Drug Utilization and Expenditures: 1997-2000. February 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/papers/st21/stat21.htm