Who Is More Important For Your Health - Your Doctor or the Drugmaker?

I don't know that anyone would argue with the fact that we are in a financial crisis in the United States, both governmental and for many of us personal. There is record unemployment, record rates of home foreclosures, and ridiculous budget deficits on both the state and federal levels. Many of us are struggling to stay alive financially, keep our businesses from folding, hoping that we won't be one of the unlucky people who is laid off when our employer has to cut corners. The people that still have jobs that offer health care insurance feel lucky, and the people who don't have health insurance secretly say a prayer to stay healthy every night, lest they follow the fastest route to bankruptcy in this country - overwhelming medical bills.

Things aren't so bad though if you are a pharmaceutical company. For example, AstraZeneca, the makers of such medications as Prilosec, Zestril, Rhinocort, Seroquel, and this year a lot of H1N1 vaccine, had a 9% increase in revenue in the US in 2009. In terms of profit, AstraZeneca posted a profit for 2009 of over $9 billion. That's "core operating profit" minus the" adjustments to core operating profit". In 2008, the CEO of AstraZeneca received a salary of $4.7 million, and the next two top earners at AZ were well above the $1 million mark. Now, that's not as ridiculously high as the salaries of certain bank CEOs in the news recently, but it's a nice chunk of change. Obviously life is very good if you are a drug company executive. (And although I have singled out AstraZeneca, it's just because I didn't want to have to make myself ill by listing all of the profits of the major pharmaceutical companies in the world).

In comparison, life is not as good if you are a doctor. Yes, I readily admit that as doctors, we have really good job security overall - there is always a need for physicians, even if it might mean you have to move. We also tend to have great health insurance offered as a benefit to us, which is very fortunate. And for the most part we make great salaries (some of us greater than others, of course). But doctor's salaries haven't even kept up with inflation in the past decade. And we don't belong to companies that post record profits - pretty much all the money we bring in goes to paying the salaries of all the people in the clinical, medical records, and administration departments, the health and malpractice insurances of everyone, the rent, etc.

So when I hear that yet again, the government's plan to save money for Medicare is to cut physician's reimbursement, most recently a proposed 20%, I am forced to ask why cut the amount paid to the doctors rather than the amount paid to the pharmaceutical companies? Perhaps it has something to do with the fact that the 2003 Congress (which had a Republican majority) passed a bill that prohibited Medicare from getting the best deals on pharmaceuticals that it could. Yes, unlike the Veteran's Administration and Medicaid, who both smartly negotiate with the drug companies to get the best possible price for the medications that they have to pay for out of their limited budgets, Medicare instead is NOT ALLOWED to get better prices from the drugs companies, even though it is buying those drugs in bulk quantities that make the jumbo toilet paper packs from Costco look like child's play.

I'm sorry, but I don't know anyone who walks into a car dealership and says "No, no, I don't want to try to get a better price on that car. I am happy to pay the price that you have listed right there on the sticker". If you did that, you would be considered a fool. But the car dealership would be very happy that you were willing to be a sucker. And that is exactly the relationship the big pharmaceutical companies have with Medicare. Medicare, thanks to the Republican Congress of 2003, is a multimillion dollar sucker. P.T. Barnum would be proud.

Given that no one likes to be made the fool, I have to ask why the government keeps a law that so obviously goes against logic. Well, I can give you 266.8 million reasons. In 2009, the pharmaceutical and health products industry spent $266.8 million dollars lobbying the federal government to make sure that their interests were "represented" by the lawmakers they influenced . And just in case you are curious, AstraZeneca spent just under $6 million in 2009 for lobbying and even has a lobbyist who specifically lobbies on their behalf for "Medicare Part D Non-Interference", secret code for not changing the great deal the drug companies have with Medicare.

It seems to me that there is a very obvious way to reduce the budget of Medicare without hurting the salaries of individual doctors, and with perhaps the bonus of saving money for Medicare recipients who pay in full or in part for their medications. Admittedly, the pharmaceutical companies will not be happy with any decrease in their profits. But I have to ask myself, who do I think is ultimately more important, and more worthy of compensation? Is it the doctor, the person I see face-to-face perhaps for decades of my life; my partner in my health; the person who was awake with me in the middle of the night to deliver my baby, or to admit me to the hospital when I had a heart attack; the man or woman I see yearly at an office visit to make sure that I am, indeed, staying healthy? Or is it the nameless (but wealthy and therefore powerful) drug company, that makes a medication that might easily be substituted by another equally if not more effective medication that costs less money?

And yes, I acknowledge fully that there are medications out there that are made by a drug company that do not have an equal made by anyone else, and that can sometimes save someone's life. But we should not forget that without a doctor, those drugs would never get used. After all, it is the doctor that must prescribe them. The pharmaceutical companies would have no profits from prescription drug manufacturing if not for us. When I put it like that, I think the drug companies would be happy to take a small cut in profits in order to save doctors from having to endure more pay cuts.

Like I said, P.T. Barnum would be proud.