Patients are demanding doctors' orders for over-the-counter products because of a provision in the health-care overhaul that slipped past nearly everyone's radar. It says people who want a tax break to buy such items with what's known as flexible-spending accounts need to get a prescription first.
The result is that Americans are visiting their doctors before making a trip to the drugstore, hoping their physician will help them out by writing the prescription. The new requirements create not only an added burden for doctors, but also new complications for retailers and pharmacies.
"It drives up the cost of health care as opposed to reducing it," says Dr. Chung, who rejected much of a 10-item request from a mother of four that included pain relievers and children's cold medicine. ...
To the handful of congressional aides who came up with the idea to limit tax breaks on over-the-counter drugs, it was supposed to be a minor tweak to raise revenue and to discourage wasteful spending on health products.
Some 33 million Americans are in families that have flexible-spending accounts, which are funded through payroll deductions and allow consumers to pay for health expenses with tax-free dollars.
The change also applies to health savings accounts designed for consumers in insurance plans with high deductibles. If fewer people use these accounts to buy drugs, the government gets more tax revenue. Retail sales of over-the-counter medicines amounted to about $17 billion in 2010, not counting sales at Wal-Mart Stores Inc., according to Nielsen Co.
What the law's writers didn't anticipate was the determination of some people to squeeze every last drop of tax savings from their accounts.
- This is the sort of thing that happens when you have a massive bill, which nobody has a chance to read and evaluate front to back before it is passed. Instead, you get small groups working on little pieces and if they miss something you get screwed. This is precisely why major legislation needs to be posted on the internet several days before the vote.
- I've always believed that health care reform requires consumers to make choices about how they spend their money. The flexible-spending accounts have the potential to do just that. But the rules of the game ought to be designed to encourage people to make decisions that lower health care costs, not to impose new ones.
- It's sort of appalling that this huge change came because one Senate staffer told an anecdote about how he would buy Prilosec instead of a prescription alternative.
Meanwhile, other provisions are also wreaking unintended havoc:
Health-policy experts predicted that new insurance pools for high-risk patients would attract so many expensive enrollees that funding would be quickly exhausted. In fact, enrollment is running at just 6% of expectations, partly because of high premiums.
A provision preventing insurers from denying coverage to children with pre-existing health conditions prompted insurers in dozens of states to stop selling child-only policies altogether.
And a piece of the law designed to centralize patient care by encouraging health-care providers to collaborate is running into antitrust concerns from regulators.
It's clear that Obamacare was seriously botched. We need to repeal the damned thing and start over with a more modest, incremental, and carefully vetted alternative.