Posted on 05/13/2009 10:56:07 AM PDT by SJackson
One of the more unproductive elements of President Obama's stimulus bill is the $1.1 billion allotted for "comparative effectiveness research" to assess all new health treatments to determine whether they are cost-effective. It sounds great, but in Britain we have had a similar system since 1999, and it has cost lives and kept the country in a kind of medical time warp.
As a practicing oncologist, I am forced to give patients older, cheaper medicines. The real cost of this penny-pinching is premature death for thousands of patients -- and higher overall health costs than if they had been treated properly: Sick people are expensive.
Click for Editorials & Op-Eds It is easy to see the superficial attraction for the United States. Health-care costs are rising as an aging population consumes ever-greater quantities of new medical technologies, particularly for long-term, chronic conditions, such as cancer.
As the government takes increasing control of the health sector with schemes such as Medicare and SCHIP (State Children's Health-care Insurance Program), it is under pressure to control expenditures. Some American health-policy experts have looked favorably at Britain, which uses its National Institute for Clinical Excellence (NICE) to appraise the cost-benefit of new treatments before they can be used in the public system.
If NICE concludes that a new drug gives insufficient bang for the buck, it will not be available through our public National Health Service, which provides care for the majority of Britons.
There is a good reason NICE has attracted interest from U.S. policymakers: It has proved highly effective at keeping expensive new medicines out of the state formulary. Recent research by Sweden's Karolinska Institute shows that Britain uses far fewer innovative cancer drugs than its European neighbors. Compared to France, Britain only uses a tenth of the drugs marketed in the last two years.
Partly as a result of these restrictions on new medicines, British patients die earlier. In Sweden, 60.3 percent of men and 61.7 percent of women survive a cancer diagnosis. In Britain the figure ranges between 40.2 to 48.1 percent for men and 48 to 54.1 percent for women. We are stuck with Soviet-quality care, in spite of the government massively increasing health spending since 2000 to bring the United Kingdom into line with other European countries.
Having a centralized "comparative effectiveness research" agency would also hand politicians inappropriate levels of control over clinical decisions, a fact which should alarm Americans as government takes ever more responsibility for delivering health care -- already 45 cents in every health-care dollar. In Britain, NICE is nominally independent of government, but politicians frequently intervene when they are faced with negative headlines generated by dissenting terminal patients.
For years, NICE tried to block the approval of the breast cancer drug Herceptin. Outraged patient groups, including many terminally ill women, took to the streets to demonstrate. In 2006, the then-health minister suddenly announced the drug would be available to women with early stages of the disease, even though it had not fully gone through the NICE approval process.
A more recent example was the refusal to allow the use of Sutent for kidney cancer. In January, NICE made a U-turn because of pressure on politicians from patients and doctors. Twenty-six professors of cancer medicine signed a protest letter to a national newspaper -- a unique event. And yet this drug has been available in all Western European countries for nearly two years.
In Britain, the reality is that life-and-death decisions are driven by electoral politics rather than clinical need. Diseases with less vocal lobby groups, such as strokes and mental health, get neglected at the expense of those that can shout louder. This is a principle that could soon be exported to America.
Ironically, rationing medicines doesn't help the government's finances in the long run. We are entering a period of rapid scientific progress that will convert previous killers such as heart disease, stroke and cancer into chronic, controllable conditions. In cancer treatment, my specialty, the next generation of medicines could eliminate the need for time-consuming, expensive and unpleasant chemo and radiotherapy. These treatments mean less would have to be spent later on expensive hospitalization and surgery.
The risks of America's move toward British-style drug evaluation are clear: In Britain it has harmed patients. This is one British import Americans should refuse.
My argument with true Libertarians is that without God in the equation, then people become a commodity subject to cost benefit analysis. Old people will always come out o the short end of this stick, unless they are political power brokers, or their friends.
Maybe we can bring back the Coliseum and let the old fogies fight it out for their medicine, be entertaining for the kids and all.
I think it could also be done on a very profitable “mid-level” basis. (disclosure: I know nothing other than the readily apparent about how medical systems work and their profitability)
It can cost $8K+ a month to house an elderly couple in the US, and that ain’t the Ritz, that’s close to the bottom of the barrel. That’s a dumpy suburban facility, nothing special, with only “emergency clinic” facilities available. I am thinking about “packaging” the hospicing of the elder while allowing family members to come around and pay their respects without getting bored to death. I am not sure about the impact of catastrophic insurance + or -, IMO it would make sense on a cash basis. Especially if it could be done in a grade “B” resort that was losing business because it wasn’t in tip-top shape.
That's very true, the arrogance of deciding the worth of a life isn't apparent in non-religious based value systems.
AIDS treatments and Abortions will be swimming in cash.
I’m sure you’re right regarding hospices, and they’d go hand in hand. I was thinking more of the denial and delay of needed care issues. You need a $50,000 to $100,000 (probably less without the US system overhead) life saving or enhancing procedure, but it’s a 4 month delay in the US, or it’s denied based on other health issues, or simply not available. Will an offshore solution develop? I think there’s a good chance it would, particularly if insurance brought the cost of the procedure down to a large deductable, pick your number.
I assert that that is the full intent and reason for implementing a socialist healthcare system -
to control people by granting and denying health care.
Yes they will
Too bad there's not a Ransom to bring it crashing down.
Overseas medical care is what many Americans are already doing..Euros/others have been doing it for years.
I suspect that much more of that will happen in the future.
bttt
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