Life, and health, after W.

By Richard Parker

AUSTIN, Texas — It’s over. Oh, sure, you still see a few of those trademark black bumper stickers boldly and simply proclaiming "W." But there are a lot fewer of them; the ones that remain are starting to crack and fade. The era of George W. Bush is over.

The historians will figure out his legacy. But Texas, where the W. era started, is a good place to examine what to do next. Yes, Texas rode the excesses of the era but now we’re paying for it, too: the Texas National Guard is headed to Iraq, again, the oil boom has turned to bust, and the country’s economic pain is being felt here.

Yet there is no worse example of the problems to tackle than health care. America’s second-largest state ranks dead last and holds up a mirror to the country that practically pleads: Fix health care. The era of managed care, keeping costs down and profits up for the insurance companies, has turned the doctor-patient relationship on its head.

And there is no more ironic example of the topsy-turvy, upside-down mess than, of all things, the increasingly widespread practice of mandating the use of generic drugs. Ten years ago, when Bush sat in the governor’s chair, Texas made it hard for doctors to prescribe less expensive generics. But at the end of his tenure in Austin, the pendulum started to swing — ultimately in the exact opposite direction.


Now, it’s hard for doctors to insist on a brand name drug for their patients as the relentless profit motive of insurance companies has met with the easy pliancy of politicians. As a result of the legislature’s work, doctors have to write on the prescription pad "brand medically necessary" to prevent pharmacists from automatically substituting generic drugs and spend hours on the phone with the insurer. Generics have their place, but they also inflate insurers’ profits — regardless of how they perform.

"Ninety percent of the time a generic is just fine. But it’s not fine if you’re in that 10 percent where the drug is going to fail. Those people get sicker before they get better," says Dr. Josie Williams, an internist at Texas A&M University and president of the Texas Medical Association. "It is unequivocal: It is a definite intrusion in the physician-patient relationship."

In 2007, Blue Cross and Blue Shield of Texas mailed to physicians "switch letters" recommending that they prescribe cheaper generics that would lead to more modest improvements for people suffering from moderately high-cholesterol, adding that many patients could be "adequately treated." From Maine to Hawaii, these have gone out to physicians, pharmacies and patients alike from insurers.

And that percentage of patients for whom generics don’t work? Well, they seem to just get sicker, as Williams put it, before they get better:

• In New York, in 2007, an independent evaluator of drugs and nutritional products, found that at least one generic version of the anti-depressant Wellbutrin did not perform as well as the brand name drug.

• In Ohio this year, the Toledo Blade newspaper surveyed 900 physicians. Ninety-five percent said insurers interfered with their prescription of drugs to patients. 99 percent said that insurers interfered in the doctor-patient relationship overall.

The next president would be well-served to look at how changes to Medicare during the W. era all failed, and how health care got worse — not just for Texans but for all of us.

Richard Parker is a publishing executive and writes about Texas for the McClatchy-Tribune news service.

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