Beware the Camel’s Nose

There’s and old expression, “don’t let the camel’s nose into the tent,” It is in reference to an old tale about an Arab master who let his camel stick his nose under his tent flap to get warm and pretty soon found that the camel had slowly moved completely into the tent and pushed him out. The moral is, don’t let something start that is wrong, no matter how small or innocuous, because it will soon grow large, much to your detriment. I heard this term used in Washington when I began working in public policy in 1996. It was a way for a partisan party or administration to start the process of passing an untenable change to public policy by passing a small seemingly harmless bill and then slowly building on this approach until it only takes a small step to pass the final ultimate legislative goal. I argued 12 years ago that letting an unelected, judicially exempt government panel decide how to ration healthcare in Medicare was dangerous. It was letting the camel’s nose into the tent that would ultimately result in government-controlled healthcare. I think we are seeing this tactic used again.

Lately, our government has begun sticking its nose into our healthcare in ways that scare me. There has been legislation proposed and, in some cases, signed into law, that inserts the government into our healthcare in unprecedented ways. Here are three examples of what I’m talking about.

The recently passed Inflation Reduction Act (IRA) contains some very dangerous precedents. It allows the government’s health agency, Centers for Medicare & Medicaid Services (CMS), to set the price of selected prescription drugs. This is certainly a step toward government control of our healthcare. The law gives CMS no flexibility on which drugs to select, because there is a very stringent method that leaves no agency discretion on which drugs are selected, while expressly denying any judicial review of their actions . . . does this sound familiar? The legislation grants CMS a huge budget increase to add government workers to support the new oversight. This certainly doesn’t sound like a reduction in government control. The nose has found its way into the tent.

There has been a lot of talk about the new Alzheimer’s drug Aduhelm. It was approved by the FDA for broad use and then the Department of Health and Human Services (HHS) restricted the use to only those participating in a trial, which greatly reduced access to the drug. This seemingly innocuous move to save money was a precedent setting move by a government agency, overriding the approval of the FDA, the world’s gold standard in ensuring the safety and efficacy of prescription drugs, to arbitrarily ration your and my access to this approved drug. The Biden administration had the audacity to claim credit for the expected reduction in next year’s Part B premium price, a reduction that was paid for by their denying our access to an FDA approved Alzheimer’s drug. This government rationing was on just one drug but is clearly the first move into the tent.

My last example is a waiver request Oregon submitted to HHS. This request would allow Oregon to deny Medicaid patients access to selected drugs that were approved under the FDA’s accelerated-approval program. By law, states must allow access to all FDA approved drugs, but this precedent setting waiver would change that requirement. In their request Oregon stated that “it will only exclude accelerated-approval drugs with limited or inadequate evidence of clinical efficacy, as determined by state review.” So, the state of Oregon, with all its legions of medical experts, would “wisely” determine if Oregon citizens would have access to an FDA approved drug. This means that, if this waiver was in affect two years ago, Oregon could have denied access to the COVID-19 vaccines, since they were approved under the accelerated approval program. It seems that this waiver request represented not just a nose into the tent but half the body. I’m a champion of states’ rights, but this seems to be a clear over stepping of powers and would be a dangerous precedent. I expect this part of the waiver to be withdrawn, since I would hope that HHS would not approve of this exclusion, but the mere fact that it was included in the waiver request in the first place scares me.

These examples should be red flags to all of us. Is this the camel we want sharing our tent? Do we want more government involvement in our healthcare? While the Oregon accelerated-approval part of the waiver will likely be withdrawn, it will lessen the shock the next time something like this is proposed. Soon, this approach won’t shock us, and we won’t think it’s so bad when they propose that they limit access to a small portion of accelerated-approved drugs, maybe like in the IRA, where it is 10 drugs for the first year and then adding 15 more and then . . .

It is impossible not to see that the government, both at the state and federal level, is moving toward more involvement and more control of our healthcare. We need more competition in all facets of our healthcare not more government oversight and regulations. I’ll continue to stay up-to-date and strive to inform you on the things that impact your healthcare. I hope you realize that you can have an impact if you take the time to stay informed and active as an advocate. Together we can make a difference.

Best, Thair