JAMA just released an editorial about the impact of greed on the US healthcare system. I want to be very clear about the fact that I am devoted to the free market. If history and human psychology teach us anything, it is the value of a free market economy. With the exception of small religious communities, people only ever work for themselves and their families.

We run into problems when the checks and balances of the free market system are removed from the marketplace and that is particularly true with the healthcare marketplace. When it is possible to put ANY price on a drug or device, completely separate from its clinical effectiveness, and get paid any amount of money, completely separate from quality of care or outcome, then the only factor left to determine practice is greed. What appears to run the Cellular Tissue Products / skin substitute marketplace is greed — greed on the part of the manufacturers, and greed on the part of the clinicians.

The problem with the CTP skin submarket is that the free market is not allowed to work. If Medicare advantage plans would let me use the cheapest product that works in my hands, I could save a lot of money and help a lot of patients. If the amount of money that a manufacturer could charge for a product had to be related to its cost-effectiveness — prices would plummet. Let’s face it, if there was a skin substitute that healed a wound in one application, clinicians (at least in private practice) would not use it, because that would limit how much revenue they could make. The current system means that the LEAST EFFECTIVE products are the most popular because they require the most number of applications. The current system also ensures that the MOST EXPENSIVE products will be used regardless of their effectiveness. How did we end up in this mess?

I have to agree with the final sentence of this article: Healthcare should not be an engine for excessive private gain.

We will all pay the price.

–Caroline Fife