If you’re battling cancer and your health insurance provider won’t pay for a new drug that may or may not improve your condition, should you be allowed to buy it on your own if you have the means to do so? I think most Americans would answer with a vehement yes. We value our individual freedoms, and our capitalistic marketplace that allows us to buy pretty much whatever we can afford (and lots that we can’t thanks to credit cards and financing).
In the UK, there is currently a heated debate about whether patients in the National Health Service should be allowed to privately purchase treatments that are denied by the NHS. The NHS provides health care for everyone in the UK – there is no uninsured population falling through the cracks. And everyone has access to the same health care – unlike our system with hundreds of different health insurance plans available and tremendous differences in coverage from one plan to the next. But the NHS is not a money tree, and faces the same budget issues that any universal health care program does. In order to reduce costs, they have opted to not cover certain high-priced medications and treatments. They have chosen to offer health care to the entire population rather than provide high-cost treatment to a select few. In theory, it’s a good plan. Do what’s best for the majority. But what if you’re one of those people with a life-threatening illness and you’re being told that not only will your health insurance not pay for a possible treatment (that happens all the time with private health insurance too), but that you’re not allowed to mortgage your house and use the money to pay for the treatment on your own? Seems a bit Draconian.
The NHS stand is that if they allow wealthy people to purchase their own medications outside the NHS, there is no motivation for the pharmaceutical companies and health care industry as a whole to keep costs in check. They would rather see the costs kept to a reasonable level so that the treatments can be made available to everyone through the public health service. At the Colorado Health Insurance Insider, we’ve written about the financial devastation faced by families when a high-priced medication is not covered by their health insurance carrier. But it seems that it would be even worse to not have the option to at least try to purchase the treatment on your own. These are people’s lives we’re talking about – most of us would be willing to spend everything we have to save our own life or that of a loved one. After all, money and assets aren’t worth much if you’re dead.
I can see the virtue in the position that the NHS is taking. By standing up to the pharmaceutical companies and not allowing patients to pay sky-high prices for treatments that have been denied by the health care system, they are hoping to bring down the cost of the drugs so that they can afford to provide them to all patients. But the health care industry is a global market. Pharmaceutical companies are not limited to providing treatments only in the UK. The huge “free-market” private health care system in the US provides plenty of grease for the wheels of the capitalistic model of health care. As long as pharmaceutical companies can continue to operate on a strongly for-profit model in the US, restrictions on sales in other countries will have little impact. I would love to see the NHS succeed in their attempts to push for lower prices on high-end medical treatments, but it seems that they will need some powerful allies in their fight. And I would hate to be the person with the rare illness who gets told that my health insurance won’t cover my treatment and I also can’t pay for it on my own.
