Friday, November 04, 2005

bitter pills are better pills

Occam's Razor encompasses the idea that if you have a simpler and more complicated explanation for the same phenomenon, your default should be to favor the simpler one and you should only prefer the more complicated one if there is good reason to do so. Let me articulate a general principle about pills that I call Pharmaccam's Razor: if you can get through life taking less pills or more pills, your default should be to take less pills, and you should only take more if there is good reason to do so. This isn't an anti-pill position; it's just a pro-pill-parsimony position.

I don't know if Pharmaccam's Razor sounds immediately reasonable to you or if it is something you need to be persuaded about. If the latter, too bad for now, as I'm not writing this post to defend the idea. Instead, what I'm thinking about are its implications.

The main one being: if you believe that taking fewer pills is preferable to taking more pills, you are probably better served by a policy where adding a pill to your life hurts a bit. Note that I am NOT AT ALL saying a policy that keeps you from being able to afford pills you need, but a policy that forces at least some contemplation before adding a prescription.

I mean, if I believe in the basic idea of Pharmaccam's Razor, then why should I be happy to have a health insurance policy in which I pay next-to-nothing for a prescription drug? My plan is basically $5 for a generic drug and $10 for a brand-name drug. I'm not going to present an embarrassing expose here of my spending patterns, but suffice it to say that there is ample evidence that $5 does not provide much of an economic disincentive to me.

The thing is, of course, I'm actually paying extra to have the pricing plan that I do. Given that employers never tire of pointing out that their contribution to your health insurance is part of your total compensation--for example, the chair of my department recently sent an e-mail to graduate student employees reminding them, correctly, of this--I am basically paying some amount of money each month so that I only have to pay $5-10/month per prescription, where what I'm arguing here is that my personal health interests would actually be better served if I had to pay $50 for a prescription, even if that meant just entering into some binding agreement where I would pay $5 for a prescription to the pharmacist and gave the other $45 to Dorotha to subsidize her stuffed-monster-making-hobby.

This leads me to wonder why I am paying for prescription drug coverage at all, or at least why I'm not just paying for some plan that protects me from the possibility of a health problem that prompts sufficiently expensive treatment that I wouldn't be able to afford pills I really needed. A problem here, though, is that if I gave up drug coverage, it would mean the extra money I paid for prescriptions would go to pharmaceutical companies, since they sell drugs to my insurer for less than they would sell drugs to me if I was uninsured. Plus I don't even know if I have the option of opting out of prescription drug coverage.

So, I guess this provides an opportunity for you, JFW reader, to make a zillion dollars and improve public health. I presume I don't have to connect the dots. Well, okay, the first dot is you have convince a bunch of people with employer-provided health coverage of the wisdom of Pharmaccam's Razor, and the last one involves people making a binding agreement to give you the difference between what they have to pay to a pharmacy to fill a prescription under their insurance plan and what would be a genuine but not constraining disincentive for filling a prescription.

10 comments:

dorotha said...

i am currently on 5 different medications meant to help control my life consuming anxiety problems. i would really like to go off my meds, but i don't know what that would mean for me. i think being on meds have made some small improvements in my life, but if i still have panic attacks, maybe it just isn't worth the small changes... i don't know.

making monsters helps. i am still working on one for my mom's birthday, which was at the end of last month. it is pretty cute.

jeremy, should i make one for you? i could stuff it full of meds that i no longer use. i've got a bottle of welbutrin and a bottle of celexa that are both pretty full.

Anonymous said...

Jeremy, I think you have officially fallen off your rocker. This post makes no sense to me. Maybe you should go back on those pills.

jeremy said...

If you could be so kind, where in my argument do you think I go off my rocker? Do I ever get back on, or is it compounded insanity all the way to the end.

Anonymous said...

Maybe if you addressed the other half of the prescription equation, that is, the doctor who gave you the prescription(s) because s/he told you that you need it. How are people to judge which prescriptions they really need? I would agree that this country is overmedicated, but where does one draw the line? It's not as if a cardio-vascular patient can judge whether or not their health is in jeopardy if they take 6 heart medications instead of 7. Have you thought about penalizing doctors for over medicating the country? -Anonymous (aka JJ)

jeremy said...

(JJ: Why do you continue to refuse to put a tack in my map?)

I have about a million thoughts about the physician side of the equation, actually, but I don't have the chance to type any of them now. I'll see if I can unravel at least a couple in subsequent posts.

Anonymous said...

You've twisted my arm. I'll tack myself to your map. That sounds weird.

Another thing I thought of....
Just the act of taking a pill everyday that one feels one doesn't need is hassle enough to get one to stop taking a med that they feel is unnecessary. I know there are a lot of drugs that don't fall into this category (like ones that you're not supposed to come off w/o medical supervision), but remembering to take your pill every day is a huge pain in the ass. JJ

Anonymous said...

Yep, pharmaceuticals are big business. Insurers are big business. Physicians? I don't think so — at least not mine, though I did just drop one arrogant specialist and replaced him with a gem of a doc. Still, he wasn't big business.

Correct the situation and make 'zillions'? Sounds like big, big business. See if YOU can make that 'simple' plan — also known as the Law of Parsimony — without the motivation to make money for yourself. YOU can do it, JF.

Anonymous said...

GRANDMA'S A DRUG SMUGGLER: Drug company profiteering has turned bingo-playing grandma into a drug smuggler. Watch an animated cartoon and rap song about grandma and her "bingo posse" at www.TodaysSpecial.org

Rhymes With Scrabble said...

I think you should split the money between Dorotha and me, because I need it for yarn. Stupid Hobby Lobby, putting all their store brand yarn on sale...

hoof_in_mouth@hotmail.com said...

Keep the moderate $25-50 deductible on group pricing, then once a year, provide a cash rebate to those that have kept their costs under a particular level. Voila, an incentive to get the insurer to send YOU a check.