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KONDRACKE VS. THE FACTS. I'm not exactly going to stun anyone by suggesting that Mort Kondracke doesn't know what he's talking about, but this is rather offensive:
The reason that V.A. prices are lower is, it's basically a socialized medical system. You go to a V.A. doctor, you go to a V.A. hospital, you go to a V.A. pharmacy and the V.A. pharmacies only have 25 percent of the drugs that seniors actually use all the time. So, you know, it doesn't work.There is an implicit contract between pundits and their audiences. The audiences, whose attention pays our salaries, are working off the assumed information that the networks and publications elevate only those who take the time to accurately comprehend the issues they're speaking about. And we, as our part of the deal, are supposed to take ten minutes and figure out what we're talking about.The VA, just like the Medicare presciription drug plans, uses a formulary of drugs on which they negotiate discounts. That formulary contains drugs for every condition, but mostly eschews the copycats and useless medications that clutter up the market. Your pharmacy, remarkably enough, does the same thing. Now, VA users still have coverage for drugs off the formulary, they just don't get the bargained discounts on them. And here's the kicker: The VA has the best outcomes, for the lowest cost.Those two points are not unrelated. As part of "knowing what I'm talking about," I called Phil Longman, who's done the best work on the system. As he explained, the VA is almost fetishistically rigorous about testing new drugs for efficacy and safety before adding them to the formulary. Vioxx, for instance, was never added to the list, because the VA thought it neither effective nor safe. They were right, and their patients were protected. That didn't -- and doesn't -- mean VA doctors can't approve off-formulary drugs. They just have to explain why doing so is necessary. In that way, the VA incentivizes the proven, well-priced drugs on their formulary rather than the ones in the news, but doesn't eliminate new and necessary treatments.
