Fifteen senators and more than 100 House members recently introduced legislation that would launch a federal takeover of the US health-insurance system and install “Medicare for All.”
“We live in a country where millions of people ration lifesaving medication or skip necessary trips to the doctor because of cost,” said Rep. Pramila Jayapal (D-Wash.), the lead sponsor in the House and a longtime advocate of single-payer health care.
“I’m so proud to fight for this legislation to finally ensure that all people can get the care they need and the care they deserve.”
People are understandably upset when an insurance company forces them to jump through hoops or pay thousands of dollars to gain access to a drug they need — or denies coverage outright.
Progressives capitalize on this outrage by promising a benevolent government will do better — and guarantee access to the therapies they need.
But that’s simply not true.
Government-run health-care systems the world over make far fewer drugs available to their denizens than does the comparatively free US market.
And in the United States, patients have recourse when a private insurer hands down a coverage decision they don’t like.
Under a government-run health-care system, there is no process to appeal.
When a company launches a new drug in the United States, it tries to set a price that will foster enough sales to recoup the millions or billions of dollars it spent bringing the drug to market, as well as a profit margin to reward its investors and fund future research and development efforts.
Private insurers negotiate fiercely with drug companies over those prices — and may be able to extract concessions based on the sales volume they can deliver or whether they’ll nudge their beneficiaries toward the drug over competing drugs.
This system isn’t perfect. But it generally ensures that American patients have access to just about every drug approved by regulators at some price.
In other countries, there is no negotiation.
To keep a lid on public health-care spending, government agencies — like Canada’s Patented Medicine Prices Review Board and the United Kingdom’s National Institute for Health and Care Excellence — tell pharmaceutical companies what they’re willing to pay.
If drug companies balk, then the countries’ health-care systems refuse to make their products available to patients.
This discrepancy in tactics explains why Americans had access to 89% of new drugs approved between 2011 and 2018, while Germans had access to 62% and French patients 48%.
Of the 98 cancer medicines released between 2011 and 2019, 96% were available in the United States.
Just 70% were available in the United Kingdom and 68% in Canada.
Sen. Bernie Sanders likes to ask what good a life-saving drug is if people can’t afford it.
Here’s a better question: What good are “free” drugs in government-run health-care systems if the drug a patient needs isn’t available?
In the United States, if an insurer won’t cover a particular treatment, patients can fight.
They can appeal an insurer’s decision, lobby a complaint with state regulators or enlist the help of their elected officials. They can apply for free or reduced-cost medication through patient-assistance programs that drug companies offer.
Patients trapped in government-run health-care systems can try to fight, too. But cost-conscious governments are unlikely to heed their pleas.
They tend to be far more interested in equity than quality.
Consider the case of a 43-year-old Vancouver man with a rare form of cancer.
His doctor prescribed a drug called entrectinib. But in August 2022, the British Columbia provincial government refused to cover the drug — with no explanation.
Officials later said they were awaiting a decision by the Canadian Agency for Drugs and Technology and Health, which recommends whether and how provincial and federal drug plans and cancer agencies should pay for drugs.
In the meantime, the man and his family were left to fundraise and pay the drug’s $10,200 a month price on their own. So much for socialized medicine.
The drug has been approved in the United States since August 2019.
Americans have access to more innovative treatments than patients anywhere else in the world.
We may have to pay slightly more for them. But at least we have that option.
Our peers in other countries routinely do not.
Sally C. Pipes is president, CEO and the Thomas W. Smith fellow in health-care policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All.”
Twitter: @sallypipes