The Mesnick Index

One of my friends is a pharmacist and recently posted this on facebook:

“For my entire 40+ year career, patients have complained about the high cost of their prescriptions by asking “what’s in these pills — gold?” Well, my wife is a jeweler, and tracks the gold market, so I’ve been inspired to create “the Mesnick Index”: the daily price of a “prescription” of thirty 10 mg “pills” of gold. Turns out gold is pretty cheap when compared to many popular drugs. Today’s Mesnick Index is about $16.”

His “Mesnick Index” compares gold (spendable capital) to medicine (ability to preserve and enhance life). I like having that comparison because it forces us to compare those two goals.

I remember a decade ago, a doctor giving us a prescription for a medication for my husband (ten pills), but at the pharmacy we were told that we had to have our insurance pre-approve it. As it was Friday evening (of course), with no way to get back to the doctor to find out how important this was- they always present their recommendations as something absolutely necessary to keep the cancer patient from dying. Turns out there was a reason to make sure it was covered. The pills were $700 each. I suppose that was because the research that went into them probably was about seven million dollars, and they figured they’d only ever be able to use them on a thousand or so people so they needed to charge that much to get their investment back. Besides, if the insurance company would cover it- why not try it?

That’s the thing, when your life is on the line, you’ll pay whatever it takes, if you have it, and by having healthy people paying thousands of dollars a year into insurance when they don’t need it (immediately), the theory is that the few who do can have the expense of the treatments they need covered even when it’s expensive. It used to be that people saved for emergencies, and when the money ran out, they just lived- or died- with that. If insurance didn’t cover it, there is no way we’d have tried that medicine.

Many years ago when I was having babies, and went in for my first pre-natal visit, I asked the doctor how much the tests would cost. He told me that it was important for doctors to not worry about that; all they should concern themselves was what was best for the patient. Eventually he told me that it would probably be about $200 for the pregnancy, and I agreed to the tests. When the bill came in it was more than twice that. I pointed out to the financial officer that there is no way that one can give “informed consent” without knowing how much a service is going to cost. Given those costs, I’d have to skip pre-natal care because we just didn’t have the money. He denied that, and said that the best they could do was to set up a payment schedule, but on my next visit, the prices of the most common tests were posted in the waiting room in English and Spanish. I think my logic was sound, and apparently, so did the hospital.

We certainly don’t expect medical people to work for free- they have the same needs for housing, and food and other bills we have. If we can’t afford to pay, we do without. That happens whether it’s food, or clothing, or repairs, or anything else, why should health care be different?

When we look at the Gross National output, it seems like there should be plenty to cover everything. After all, not everyone needs a $7K prescription, so if we balance everything out we should be able to handle it. But does it really? Logic says that if we ALL pay in, there will be a total about taken in, and therefore, we cannot pay out more than that amount. Once there is that finite number, then we have to decide how it will be spent, because let’s face it, there are a lot of people who could be getting their anti-biotics, heart medication, insulin etc. for the same money that pays for that one cancer treatment. Once you factor in that the cancer treatment may only add a couple months to the life of that patient, it seems a poor trade-off for helping a lot of other people who need less expensive treatments. You can NEVER ignore what the cost is.

In the real world cost is always a factor. Some people choose to spend their money on memories; others choose to save for the future. These choices reflect different attitudes about life, and I feel that people should be allowed to make those choices.  Where we spend our resources is a matter of priorities, and how a society prioritizes its goals defines the culture.

Another of my friends said “The Bill of Rights grants all citizens the following Rights, regardless of disability. My Unalienable Rights: The Right To Life. I deserve to live the best life medical science can provide.” I feel that this must be poorly phrased. Or perhaps not. It’s not about what we deserve or think we deserve. It’s what’s possible, and what’s right. The Unalienable Right is to life, not to medical care, and certainly not the best that science can provide- in any sphere.  The Bill of Rights is not so much a list of what the government owes us, but what it may not take away from us. The government does not, for example, have the right to destroy the means of livelihood of those who live off the land by granting permits to others to destroy the natural environment. It doesn’t have the right to decide to kill people because there are too many. It doesn’t have the right to force people to do things that will lead to their deaths (like live in disease-creating conditions). But this doesn’t mean that it has to feed us, house us, or clean up after us. It just has to not slap us down while we feed, house or clean up after ourselves.

How much is medication worth to you? How much is your ability to get money for your work and be able to invest it in other things? One thing many people forget is that your health is an investment. When you are healthy, you can do so much more than when you are weak or ill. Think back to the last time you had the flu, or how much time it took you to catch up on all the things you normally do after you had it! This is why a group- whether the size of a family, or a country, often feels that supporting the health of its members is a great investment.

So the next time you think about a medication or a treatment, or a nutritional supplement or exercise program is going to cost you, don’t just apply the Mesnick Index. Think about how much you stand to lose if you don’t invest in better health. So often it’s the hidden costs, the costs we don’t track that show what we stand to lose, not just in time, but in our ability to live the lives we want to live.



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