Should Medicare Pay for Drugs Like Viagra?

by Robert E. Cranston

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	Robert E. Cranston, M.D., M.A., is an Attending Physician, and Head of the Division of Neurology at Carle Clinic and Carle Foundation Hospital in Urbana, Illinois; a Clinical Associate Professor at The University of Illinois at Urbana-Champaign; and a Fellow of The Center for Bioethics and Human Dignity.
	Post Date: February 11, 2005

“If wishes were horses, then beggars would ride,” says an old aphorism. If we had all the money we wanted, we could purchase all manner of discretionary products and services. If I had my way, I would be smarter, richer, better looking, and perhaps 10 years younger.

On February 1, Laurie Kellman, writing for the Associated Press, reported Medicare’s decision to cover “sexual performance drugs such as Viagra” in their new prescription drug program.¹ With the rare exception of potential utility for treatment of enlarged hearts, Viagra, Levitra, and Cialis all are used primarily to treat sexual dysfunction.

While I would certainly not wish erectile dysfunction on anyone, I have to ask myself, “Should we as taxpayers really be responsible for subsidizing what amounts to elective, primarily recreational activity?”

One might argue that sexuality is a much larger issue than recreation, and that difficulty with sexual performance may impair relationships, social functioning, and general joy of life. I agree. And if money were no issue and we had no other compelling needs, then I would gladly allocate funds to this perceived need. That, however, is precisely the issue. We do not have unlimited funds, and we have other compelling needs—including the need to keep Medicare and Medicaid from bankrupting the country.

We do not pay for everyone’s desired plastic surgery. I might like a smaller nose, or perhaps more hair, for example. We do not pay for unlimited infertility evaluations. We do not pay for month long vacations for overworked, anxious medical professionals. (Now there’s an idea.)

In fact, we do not pay enough for many, more appropriate things, which would benefit all of us—better palliative care, better residential psychiatric care, better and more widely disseminated abstinence-based sex education for teens. These are but a few of the areas on which we easily could spend many times the current budgetary allotment. What about covering the basic medical needs of the millions of working poor who currently receive no health coverage whatsoever? We have a moral obligation to help provide a basic level healthcare to all, and we are not meeting that need as a nation.

We have no obligation, nor do we have any business subsidizing life-style choices in the name of healthcare. We should take a hard look at current federal medical programs and medication benefits before we approve billions of dollars in spending for questionable benefits. We do not need caviar for the currently eligible Medicare and Medicaid recipients; we need meat and potatoes for all. Let us meet the needs of the many before we satisfy the wants of the few.CBHD

¹ Laurie Kellman, "Medicare to Cover Sex Performance Drugs," Associated Press, February 01, 2005, http://apnews.myway.com/article/20050202/D88047N80.html (accessed February 10, 2005).