And you thought health care was all about choice

by: Eric B.

Tue Sep 29, 2009 at 00:39:59 AM EDT

Oh boy:

Psychiatric patients on Medicaid would be subject to receiving a cheaper, generic drug unless they have a specific physician orders faxed to the Department of Community Health (DCH), under a DCH conference report that is expected to be reported out Tuesday.

HB 4436, the DCH budget for Fiscal Year (FY) 2010, calls for the repeal of a 2005 law that carves out psychiatric drugs from DCH's normal policy to pay for the "generic" medication to its low-income patients. Doing so would require accompanying legislation, but would save the state $5 million. Senate DCH Appropriations Subcommittee Chair Roger KAHN (R-Saginaw) said the plan allows a patient to stay on whatever medication he or she is taking. It allows a physician to fax in a prescription to DCH with a diagnosis that justifies the name-brand prescription. And it allows the patient to be taken off a generic medication if he or she doesn't like the medicine after only one pill.

Earlier this year, when Gov. Jennifer GRANHOLM suggested this policy change as part of her budget-cutting executive order of 2009, the mental health community took up arms, claiming that psychiatric drugs were not cholesterol-lowering drugs that could be easily duplication.

The idiotic part is that Roger Kahn is a doctor. Or, at least he plays one on television.  I know, I once watched him spend 10 minutes interpreting for the state Senate what the various colors of vomited blood mean -- fully digested, moderately digested, not-so digested.  Yet, he supports this.

The dirty, ugly truth is that under cuts in Medicaid funding, psychiatric patients have already seen their support in terms of government funding cut.  That has, in truth, led to medical decisions made not by patients and doctors, but by government bureaucrats.  Roger Kahn and every other conservative swinging ... elephant trunk ... have a very real, tangible instance where medical decisions are taken from the hands of people and placed into those of gummint peoples ... and instead of railing against the loss of choice, wish to contribute to it.  Not all generics are the same.  Not all Medicaid doctors have the time or the patience to keep close track of what med changes are made through the system, because of course Medicaid reimbursements have been chopped apart so ridiculously so that now those patients are treated as a loss (hence the QAAP tax, which would help those Medicaid docs, but predictably this is opposed by the Republican Party because they above all else are angry over the idea of raising any tax).

My day job has me working in this field.  I've seen changes made to people's meds made for no greater medical or scientific purpose than what Medicaid will pay for.  And, it results not just in medical problems from side effects, but also in behavioral issues.  Again, I cringe at the idea that we're talking about doing this before we're talking about whether we could mitigate the impacts of this by charging people four cents extra for a bottle of beer, instead of just two.