I’ve been writing for some time upon how repeal of prescription laws will reduce the cost of health care and likely give patients the power to decide for themselves on what medications they wish to use. In this post I’m going to discuss the economic effect upon physician incomes from repeal and return to the pre-1938 status quo in access to medical drugs. And while as a libertarian I oppose all drug laws period, I will limit this to those medical drugs that are neither of the narcotic class or habit forming.
Primary care physicians are those who mainly diagnose and prescribe for their patients. Specialists do this to some degree, but the primary care physician is usually the one who either prescribes or sends the patient to see a specialist for more involved treatment. For chronic conditions the primary care doctor is generally the one you usually see for treatment of things such as high blood pressure, cholesterol, diabetes, arthritis. They are also usually the ones who order lab tests and so forth unless the condition is one where a specialist will be involved in the patient’s care for a condition such as ulcerative colitis.*
- I’ve had this condition for about a decade now. It is increasingly commonplace today as it is a malfunction of the immune system that effects non-smokers.
So what would be the economic effect of repeal of prescription laws for most medicines? One aspect of this would be that the patient, not the doctor makes the decision as to what medicine to take. Most likely the decision would also be guided by the cost of the medication. Brand name drugs are considerably more expensive than generics. And for most people, generics will do just as good a job for them as the more expensive brand names do. The diabetic for example is much more likely to start with generic drugs such as Metformin. Then move on to the lowest cost insulins if this drug is not effective enough. The same thing would hold true for high blood pressure, cholesterol, common arthritis medications. The three most popular generic medications for these are quite cheap. They don’t necessarily “work” on everyone, but they do work effectively upon most people. In general if people start at the lowest effective dosage, they are also relatively “safe” for most. However one should carefully check for side effects which are available on a number of “health care” websites. I can recommend “WebMD” as being quite useful this way. It is alway possible that you might experience adverse results from products that most people won’t have problems with. I speak here from experience. The fact 999 people may be able to use a medication might not apply to you as being the “one in a thousand” who can’t… This means that if you are able to treat yourself, you will still have to be responsible for seeing as to what the effect of a medication is upon you. So even if prescription laws are repealed, you will likely still have to see a doctor upon occasion to “check on things”.
Taking his into consideration, I believe an accurate estimate would be that about half of all visits to primary care physicians will come to an end. As many of these scheduled visits are made after lab tests are made, reducing the number of visits also eliminates the lab tests. We’re looking at a 50% reduction in medical office visits and lab tests by patients who are not suffering from a disease that needs immediate attention. Assume that 1/2 of all visits to physicians are for treatment of chronic conditions. These get cut in half. Visits for the treatment of a disease that needs immediate treatment wouldn’t be effected too much. The income of US primary care doctors is in the $150,000 range. Without prescription laws this would drop to $112,500. However “overhead costs” would still remain about the same. Most likely fewer doctors in training would go into primary care instead of a speciality. On the other hand the number of nurse practitioners, physician assistants might increase. The medical labs that do the testing would likely have less customers than before. So there would be an economic effect there. Fewer tests, fewer visits to physicians. This state of affairs however could be effected by the creation of powerful medical software programs, perhaps using artificial intelligence.
There is however another effect from repeal of prescription laws. Patients are more likely to choose “comfort” over “life span” while doctors generally operate today in the opposite direction. This might result in a slight (less than a few percent) in the length of life spans. As living past 80 seems to increase the likelihood of ending your life in a nursing home, it might not be that bad a “trade off” as people might first think… (it’s a lousy place to die)