Grassroot Perspective – March 6, 2003-Treatment Denied: State Formularies and Cost Controls Restrict Access to Prescription Drugs; Smoke ’em if You Got ’em; In Like Flynt; They’re young – But Still Adults

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”Shoots (News, Views and Quotes)”


– Treatment Denied: State Formularies and Cost Controls Restrict Access to Prescription Drugs

Author: Linda Gorman
Source: Washington Policy Center, 2/03

Prescription drug formularies are a cost containment tool used by health-care payers that usually restrict the number and type of drugs covered, often favoring older and generic drugs. Many states have implemented restrictive formularies in an attempt to control Medicaid costs. But Linda Gorman of Colorado’s Independence Institute says that this may actually increase health care costs in the long run. “Because the Medicaid population is sicker than the general population, political attempts to arbitrarily cap prescription drug spending run the risk of sending other health care costs out of control.” A 1999 review of restrictive formularies by the National Pharmaceutical Council found that, “In general, formularies increase costs because overruling physician prescribing decisions increases the utilization of other forms of health care.” Additionally, physicians in Florida, which has a formulary, reported, “Medicaid patients were not getting the brand name medication that they needed, and that denials had resulted in negative clinical outcomes.”
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The revelation that drug formularies limit patient choice of needed drugs, decrease health outcomes, and lead to higher health care costs in the long run is not a new one. Dr. Susan Horn, senior scientist for the Institute for Clinical Outcomes Research in Utah, conducted a study of 13,000 patients from six HMOs, titled the Managed Care Outcomes Project. This study found that more restrictive drug formularies were correlated with an increase in patients’ use of more expensive medical services, treatment in emergency rooms and hospitals, and visits to doctors’ offices. Horn also recently co-authored a Heritage Foundation paper that found restrictive drug formularies have a greater negative impact on senior citizens than younger cohorts, a warning to those who would design a Medicare drug benefit.

Above article is quoted from The Galen Institute 2/21/03

– Smoke ’em if You Got ’em

It had to happen. The great tax-free-tobacco window appears to be closing. States and localities have too much riding on their tobacco taxes to sit back and let Net sales escape the net. And consumers have way too much incentive, considering the draconian levels tobacco taxes have reached in some jurisdictions, to seek out tax-free sources.

Now some tobacco-selling Web sites are beginning to comply with the Jenkins Act, passed in 1949, which requires tobacco sellers to report their sales. Sooner or later, some state is going take a tobacco hawker to court for its failure to comply with the act, so a few have gotten ahead of the curve.

The states would then hit up the consumers for back taxes on smokes.,1367,57657,00.html

– In Like Flynt

Never one to leave out a demographic, Hustler publisher Larry Flynt is apparently poised to go after the anti-war “war is obscene” crowd. A Hustler staffer will go with U.S. ground troops to Iraq. Flynt may have another infamous scratch-and-sniff issue in mind.

Nor is his the only, uh, specialty outlet heading to the Middle East. MTV, Nickelodeon, and BET, among others, will be turned loose to produce stories relevant to their particular cohorts.

This means that it might be possible to get radically different information about the conflict, depending on which primary source you choose. With so many potential “on the scene” reporters, the American public has a chance to be well-informed about the war. But with so many sources it will be particularly tricky to poll the public about any one aspect of the ongoing conflict. You might be asking about apples while they’ve read and watched oranges.

Above articles are quoted from Reason Express 2/25/03

”Roots (Food for Thought)”

– They’re young – But Still Adults

By Brian Doherty

Associate editor, Reason magazine

Assemblyman Paul Koretz, D-West Hollywood, has reintroduced a publicity-driven, needless bill to raise the smoking age in California to 21. If the bill passes, it would give California the highest smoking age in the nation. Currently in California and in 46 other states anyone 18 or over – that is, any adult – can legally buy and use tobacco (the smoking age is 19 in Alabama, Alaska and Utah).

Over the past decade, the “war on tobacco” has increased in ferocity and casualties. We’ve seen increased taxes, advertising bans and huge jury awards against tobacco companies. Koretz defends his bill with standard rhetoric from this “war.” He argues that tobacco use eventually kills 400,000 Americans each year and that nearly 90 percent of smokers start their habit before age 21. On the surface, the gist of those arguments is true enough. But from that truth anti-smokers leap to many completely untrue suppositions. It is not true, for example, that you cannot stop smoking once you start. It isn’t true that people taking up smoking are unaware of the potential risks. It is not true that smoking on the whole costs “society” money above and beyond the costs borne by the individual smoker.

It is true, though, that smoking can kill you and that most people start smoking when they are young.

But it is the very truth at the heart of the anti-smoking crusade that should make all Americans nervous — if they value their liberty. Koretz says that because “our highest calling is to do things that save lives,” his bill is therefore justified. But this is a very dangerous legal philosophy for a limited government for a free people.

Arguments of the “old enough to die for my country” variety may seem banal. But they express an important truth. The draft age is co-terminous with when we decide you are an adult citizen, with the rights and responsibilities thereof. Many 18-year-olds in the military are facing the possibility of heading to war in Iraq. If they are based in California, they wouldn’t be allowed to buy a pack of cigarettes — but we’ll send them across the globe to hunt down Saddam Hussein?

Most Americans tend to believe that adults should have as much freedom as is compatible with not causing direct, provable harm to other people’s life or property. We have strayed far from this happy American principle of liberty, to be sure. For example, the drinking age is, thanks to the federal government’s threats to withhold highway funds, a uniform 21 across the nation. But such straying ought not be an excuse to give in to every other restriction on liberty that comes down the pike. The fact that smoking is such an unpopular liberty is all the more reason to fight fiercely for it. After all, it is the unpopular liberties that most need a principled defense.

It is of course true that banning cigarette sales to a certain age group and preventing them from smoking are two very different things, but the restriction on freedom is still there nonetheless.
There’s also one interesting wrinkle toward the end of Koretz’s bill, AB 221. Jails will be exempt. “The Director of Corrections may sell or supply tobacco” to any 16-year-old jailbird — with parental permission, of course.

Drug law reformers have often noted the irony that not even in prisons can the government succeed in keeping out illegal drugs. Now prisoners ages 16 to 21 would officially be freer with regard to smoking than those of us outside, living in the outdoor prison that California increasingly resembles.

Koretz’s arguments about the potential dangers of smoking are dangerously beside the point. So, for that matter, are arguments against the bill objecting only to the tax money California would lose in cigarette taxes — though a state in a budget crisis needs to think of such things.

The real point: People over 18 years old are adult Americans. And if being an adult American means anything, it means being free to make decisions about one’s pleasures — and risks. That Koretz doesn’t see this means he doesn’t want to be our legal representative — he wants to be our daddy.

And that’s the last thing adult Americans need, or want, from the government.

Above article is quoted from Reason 2/26/03

”Evergreen (Today’s Quotes)”

“If you are to stand up for your government you must be able to stand up to your government.” — Harold Caccia

“An ambassador is an honest man sent to lie abroad for the good of his country.” — Henry Wotton

”’Edited by Richard O. Rowland, president of Grassroot Institute of Hawaii. He can be reached at (808) 487-4959. For more information, see its Web site at:”’