Wednesday, June 25, 2008

Reform by Obfuscation

The government apparently wants to do something to control drug reimbursement costs, but exactly what it is proposing isn't clear. It seems that the cost of some drugs won't be reimbursed. Which drugs? Some say it's long-term medications for cancer and diabetes patients. Others say it's only "auxiliary drugs" used in the treatment of such diseases. Roselyne Bachelot, the minister of health, says that no decision has been taken but that she wants to maintain full coverage for chronic disease patients. But some of that coverage may be provided by private insurance rather than the state. Will private insurance costs go up as a result? Eric Woerth says no, but he also says he hasn't yet discussed the issue with private insurers. The unions are up in arms, concerned--understandably--about the rupture of "solidarity" with chronic patients, which would be a major change in the philosophy of French medical insurance.

So what is going on? Apparently an internal report on the reform leaked out before the government was ready, triggering an uproar and leaving the two ministers to cover the internal confusion with a temporary story. But the broad thrust of the proposal is clear enough: the government will stop covering some drugs, the costs will be transferred to private insurers, those without private insurance will continue to receive government coverage, and the private insurers--we are assured--will simply swallow the bitter pill. This is as incredible as it is nonsensical. It is reform by obfuscation, and even if the government somehow strong-arms insurers into accepting this plan for some period of time, obviously it will eventually result in increased premiums.