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Should Insurance Cover Viagra?

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"It looks like when insurance companies were deciding whether to cover Viagra, they probably didn't use a cost-effectiveness analysis [to make the decision]," he says. "It would appear that their decisions have been arbitrary."

In an editorial, Michael R. McGarvey, MD, says Smith and colleagues did their math the right way. But McGarvey, who is chief medical officer for Horizon Blue Cross Blue Shield of New Jersey, says they drew the wrong conclusions about what this means for insurance coverage.

"My personal feeling is that we really need to re-examine the whole issue of what we should be expecting health insurance to do for us," McGarvey tells WebMD. "It should be aimed at providing health services that are of proven value for serious and expensive conditions. We should re-examine the use of health insurance for interventions that 'enhance' our lives."

McGarvey says that Americans expect their health insurance to provide more benefits than ever before. These expectations are partly due to new technologies, he says -- and partly because people fortunate enough to be able to afford health insurance are getting spoiled.

"I think because insurance has become so incredibly complicated, most Americans are reasonably confused about the coverage they have and don't have," he says. "The expectation is that it should cover whatever they want, as often as they want it. Americans tend to have very high expectations and are very unhappy when these expectations are thwarted in any way."

McGarvey points out that there is a limit to what insurers can do. At current rates, one in five Americans will be uninsured by the year 2008. The question the nation must face, he says, is whether less extensive health insurance should be given to more people, or more extensive health insurance should be given to fewer people.

"We are confronting a national embarrassment which is the number of people that are uninsured," McGarvey says. "We know health insurance is an important but increasingly expensive component of our lives. We need to think about it and exercise some judgement in making and adhering to some difficult decisions. As you add more and more and more benefits, insurance will become less and less affordable and people will drop out of the insurance pool. And that is bad for a growing number of people."

Smith agrees that McGarvey is raising important questions. "The points that Dr. McGarvey makes are very good ones -- and we are looking at two sides of the same coin," he says. "I don't think that you can base insurance coverage just on cost-effectiveness. There are other factors. But it should certainly be a factor."

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