It’s Easier To Go After The Cold Sufferers Than The Meth Makers

It's Easier To Go After The Cold Sufferers Than The Meth Makers
The Atlantic's Megan McArdle goes after the asshattery in behind notions that it's okay that you'll suffer from cold symptoms -- as long as somebody's prevented from getting Sudafed to make meth. One suggestion is that states do as South Carolina has and make Sudafed prescription only:

Let's return to those 15 million cold sufferers. Assume that on average, they want one box a year. That's going to require a visit to the doctor. At an average copay of $20, their costs alone would be $300 million a year, but of course, the health care system is also paying a substantial amount for the doctor's visit. The average reimbursement from private insurance is $130; for Medicare, it's about $60. Medicaid pays less, but that's why people on Medicaid have such a hard time finding a doctor. So average those two together, and add the copays, and you've got at least $1.5 billion in direct costs to obtain a simple decongestant. But that doesn't include the hassle and possibly lost wages for the doctor's visits. Nor the possible secondary effects of putting more demands on an already none-too-plentiful supply of primary care physicians.

Of course, those wouldn't be the real costs, because lots of people wouldn't be able to take the time for a doctor's visit. So they'd just be more miserable while their colds last. What's the cost of that--in suffering, in lost productivity?

Perhaps it would be simpler to just raise the price of a box of Sudafed to $100. Surely that would make meth labs unprofitable--and save us the annoyance of a doctor's visit.

They can still buy cold medicine, protest the advocates for a prescription-only policy. But as far as I can tell, there's really no evidence that the current substitute, phenylephrine, does a damn thing to ease congestion; apparently, a lot of it gets chewed up in your liver pretty quickly, and because the FDA only allows a low dose to start with, the resulting pills don't seem to be any better than placebo. For people who are prone to sinus or ear infections, that's no joke; one of the main ways you prevent them is by taking a decongestant as soon as you feel the first ticklings of a cold--not four days later, when your GP can finally see you.

Obviously, the suffering of someone caught in a meth lab is much, much higher--but how many of these people are there? Should we deny millions of people a useful treatment in order to prevent a handful of fatalities? Before you answer that, ask yourself whether you'd be willing to stop driving on the grounds that statistically, you're reducing the chances that someone will die. Or to endorse a policy that involved punching 15,000 people in the head, hard, in order to prevent one death.

Perhaps it's unfair of me, but it seems to me that there's a lot of tunnel vision in these proposals. People who present prescription programs as simple and obvious seem fixated on the horror of the stories they are confronted with . . . to the exclusion of the very large costs that they're proposing to impose on the rest of us. All they're interested in is "how do we put an end to meth labs?", a question to which one can reasonably argue the answer is "better control of pseudoephedrine"**.

But no policy question is ever as simple as "How can we stop X", unless "X" is an imminent Nazi invasion. We also have to ask "at what cost?" and "by what right?"

The "prevention" here is via TSA-style logic: Search every granny and 6-year-old little girl who comes through the airport and you might one day find a terrorist. The intelligent airport security proposition: Keep your latex-gloved paws out of granny's diaper and hire highly trained, actually intelligent intelligence officers to use targeted intelligence on people who show probable cause to be considered suspects.

Same goes for meth. Follow the meth back to the hole...don't make everybody with a stuffy nose take a day out to go to the doctor -- or go to work sick and leak nose germs all over the damn place. Ick.