A Side Rant: Budgets, Toenail Fungus and Viagra

Everybody's budgets are being hit nowadays by the rise in the cost of health care. In today's New York Times Paul Krugman writes the first of a three part series on the rising cost of health care, The Medical Money Pit. (Yes, you'll have to make up a password and login to read the article, but it is well worth it.)

He compares the amount per person spent on healthcare in the US to the same moneys spent in other countries:

In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending.

Amazing, isn't it? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else.

What do we get for all that money? Not much.

Most Americans probably don't know that we have substantially lower life-expectancy and higher infant-mortality figures than other advanced countries. It would be wrong to jump to the conclusion that this poor performance is entirely the result of a defective health care system; social factors, notably America's high poverty rate, surely play a role. Still, it seems puzzling that we spend so much, with so little return.

Klugman goes on to cite doctor's salaries, more use of high-tech services, and inefficiencies in record keeping as reasons why medical services cost more in the US.

Everytime I think about the rising cost of health care in the US, all I can think about is erectile disfunction and toenail fungus.

In fact, I think about erectile disfuction and toenail fungus almost constantly, at least while watching TV, because I get reminded of them every commercial break. Of course there are other prescription drugs advertised on television, but I have no idea what most of the others are for.

It turns out almost everyone over the age of 40 has toenail fungus. I remember studying adults' feet when I was a kid and marvelling over the different shapes that toenails could grow into. It wasn't an affliction back then; ladies just painted their toenails every summer no matter what shape they were, then put on their sunglasses and got on with life. Kids are still studying adults' toenails; two summers ago a six year old looked at my feet, told me I had toenail fungus, and then told me I needed to ask my doctor about Lamisil.

Even at a Canadian online pharmacy a prescription for Lamisil costs $248.70, not counting the doctor's visit, or the optional blood test to screen for liver problems. Yet, if I decided that I wanted to brave possible liver damage, unexplained changes to the retina, and the usual assortment of side effects, I could get my Blue Cross to pay for it tomorrow. An expensive cure for an invented problem.
A need created to sell a drug.

The erectile disfunction ads are in the same category, but with a sick turn. Sure it was cute at first to watch advertising agencies struggle to talk about sex without mentioning sex. In the beginning my husband told me that Viagra must be a drug for guys that didn't know how to dance since every ad ended with a couple dancing. Then there was the guy who got to throw the football through the tire, then Bob Dole on the beach, then the race car. There was an odd sidetrack to the couple who sat holding hands in separate bathtubs poised at the edge of a cliff. Finally we moved on to the guy that grows horns on his head and the woman who is filmed from the shoulders up while she wriggles like a puppy and talks about how her man didn't really need help with sex, it's just better with Levitra. (This one ends with the warning about the 4 hour erection.)

None of the people in these ads are of childbearing age. Given that advertisers routinely use models that are 10 or 15 years younger than the target audience, it is clear that these products are being pitched to aging baby boomers for purely recreational sex. A quick Google search tells us the cost for 10 tabs is $96. Why am I paying, through increased insurance premiums, for other people's recreational drugs? What's next -- prescription beer?

The promise when we decided to allow prescription drug advertising was that a better informed public would be a healthier public. I think we might be healthier if we were to forego drug advertisement once more and resolve to spend our medical dollars targeting real medical problems.