Health care’s hard choices

I am a 60-year-old man who owes his good health in no small part to the American health-care system. Since 1980 I have had both Achilles tendons repaired and quintuple bypass surgery and, most recently, my right knee replaced. All these surgeries took place at Enloe Medical Center, and I recovered without complications. Furthermore, I had solid medical insurance, and my out-of-pocket costs were modest.

Yet a recent incident demonstrated why I am convinced that the same medical system that has kept me going is profoundly broken.

My buddy had been suffering from the worst allergies he had ever experienced. Then, one day, he found himself unable to get out of bed. Turns out he had an advanced case of walking pneumonia. He ended up in my favorite hospital, Enloe, where the staff drained two quarts of fluid from his chest and got him back on his feet. So far so good.

The doctor gave my friend’s wife a prescription. She went to Raley’s and handed it to the clerk, who made a funny face. The prescription, for 12 pills of a new antibiotic, cost $437. My friend, who is 74, had made the altogether rational decision not to pay the monthly fee for Medicare Part D, the optional drug-care program. But $437 for 12 pills? Seems crazy, no?

Then the pharmacist came back and told her that, after a call to the doctor, it would be OK to take good old penicillin instead of the new drug. The price? Twelve dollars for 30 pills.

Let’s not blame the doctor who prescribed the name-brand drug—she may have thought my friend had Part D coverage. Maybe she was too busy to think about the cost of the drug.

Let’s pause then to consider the recent Republican proposal made by Rep. Paul Ryan of Wisconsin, who suggested that seniors should simply get a stipend to address their medical needs and then let the “free market” take over. Twelve dollars versus $437? Easy choice.

But can we always afford to ask not just the pharmacist, but also the folks at Enloe—the ones, remember, who prolonged my life—whether they’re making the right call? When do we ask? How do we know?

There must be a better way.