Sally Field Stole My Health Insurance

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Tell your sickly mother to watch her back. Thanks to President Obama's health care proposals, bureaucrats will soon be rifling through her medicine cabinet to confiscate the cancer medication keeping her alive. At least this is what Rush Limbaugh [2], Fox News [3], and the Washington Times [4] want you to believe, pointing to measures like the $1.1 billion in the stimulus bill for research on which medical treatments work best. This, they say, is the first step toward health care "rationing."

Fox and friends don't scare me, though, because I know this research is the best way to fight back against a much bigger threat to my health care. I'm talking, of course, about Sally Field.

Every time I see Sally Field on TV hawking the osteoporosis drug Boniva, I have this nightmare: It's August of last year, right when my student health insurance is about to run out. I am self-employed and phoning insurance companies to find an individual policy I can afford. In my dream, Sally Field answers every number I call, and she tells me that my premiums will be $1,000 per month, almost as much as my rent.

Scary, right? The truly terrifying thing is that only a small part of this is fantasy—Sally Field was not the one telling me I wouldn't be able to afford insurance, but I really was facing premiums in the neighborhood of $12,000 per year. (Because I'm under a doctor's care for asthma and a cranky stomach, I was lucky to be able to buy health insurance at all.) Sally Field gets a cameo when I relive this horror show because pharmaceutical boondoggles like Boniva really are part of the reason it is so hard for Americans like me to afford health insurance.

Boniva's manufacturer, Roche, spent nearly $100 million last year on the ad campaign featuring Sally Field, making it the 18^th most heavily advertised drug in 2008, according to Nielsen Media Research. As a result, Boniva is one of the nation's most frequently prescribed brand-name drugs, even though it cannot claim to be more effective than a generic medication that retails for less than half the price. Doctors prescribe Boniva, Dr. Timothy Cutler of the University of California-San Francisco pharmacy school told me, not because it works better but "because the pharmaceutical industry does such a good job of detailing the doctors on their product." Without comparative-effectiveness research of the kind funded by the stimulus bill, there's no independent source of information to counteract the more than $5 billion the drug industry spends advertising its products each year.

Why does this make my health care more expensive? Health insurance works because it pools costs: When you're healthy, the premiums you pay subsidize care for sick folks, and these people return the favor when their health is restored and you're the one needing care. If new drugs or other technology come into use for a certain illness, everyone's premiums go up a little. I'm happy to pay more when these new technologies cure previously fatal diseases or improve patients' quality of life just as I'm grateful to the others in my insurance pool who have helped make my care affordable. But spending on expensive treatments that add no value raises everybody's costs and prices millions out of health insurance altogether. Rising costs have already contributed to a doubling in insurance premiums since 2000 [5], and 9 million more Americans have joined the ranks of the uninsured during this time [6], bringing the total to an estimated 48 million [7].

Believe me, I want osteoporosis patients to have the best treatment available—my mother has the condition. But when she told me she was thinking about asking her doctor about Boniva, I called her pharmacy. They charge $133 for a month's dose of Boniva and $49 for a month's worth of generic medication alendronate sodium. The only advantage Boniva offers is that she could take only one pill each month instead of four.

There are undoubtedly patients for whom taking a pill four times a month is a real burden—say, those with dementia or other difficulties keeping track of their medication. And there are others who may have a bad reaction to the generic or who do not respond to it. But for every patient who legitimately needs an alternative like Boniva, there are many like my mother who are simply swayed by advertising. As it happens, my mother teaches health policy at a major university—if Sally Field comes even close to fooling her, I can only imagine the influence the actress has on less-expert patients.

The stimulus bill's $1.1 billion for comparative-effectiveness research funds the efforts of three government agencies to gather data on treatment options. This is the beginning of building a resource that doctors and patients can consult to determine which treatments are the most effective, most efficient, and safest. Treatment decisions should be based on independent research, not the advice of drug reps and Sally Field.

Two models show that such voluntary programs produce substantial cost savings and improve patient outcomes. One is Consumer Reports' Best Buy Drugs [8], which reviews comparable drugs so patients can educate themselves. In one study [9], Best Buy Drugs estimated that a public-education campaign could save $2.76 billion on heart medication alone. "People want to talk to doctors about the effectiveness of their drugs, and they want to talk to pharmacists about the cost," says Best Buy Drugs Director Gail Shearer. Patients, she says, understand that drug reps have undue influence on their doctors. "They know who those nicely dressed people in their doctors' offices are."

Best Buy Drugs relies on data from the Drug Effectiveness Review Project [10], which advises 14 states on drug coverage for Medicaid, the government program that provides coverage to some low-income families. Their research has not only saved these states more than $1 billion by encouraging doctors to prescribe the most cost-effective drugs, but their research caught signs that Vioxx was unsafe two years before the drug was pulled from the market and may have saved thousands of patients from an increased risk of heart attack.

I'm happy to report that Sally Field did not keep me from getting health insurance. After days of panic last August, I learned I was lucky to live in one of the only states that have programs to help modest-income people buy health insurance. It still wasn't cheap—$260 each month—and I could still afford the payments only with help from my parents. Today my mother is still helping me pay my premiums, and she's doing a small part to lower everyone's costs by steering clear of Boniva.

Getting coverage for the 48 million uninsured Americans will undoubtedly require additional resources, but we make it easier for Americans to access care by spending existing health care dollars more wisely. I know Sally Field likes her Boniva, but I'm sure she'd be willing to take three more doses each month if it helped people like me afford basic health insurance.

This isn't "rationing"—it's common sense.