Posted on 07/13/2008 11:59:05 AM PDT by neverdem
It took only an instant for 58-year-old Gailanne Reeh to go from the picture of health to death's door. By chance, her doctor noticed a lump under her arm during a routine exam. It turned out to be advanced breast cancer...
--snip--
What does it mean to say an expensive drug works? Is slowing the growth of tumors enough if life is not significantly prolonged or improved? How much evidence must there be before billions of dollars are spent on a drug? Who decides? When, if ever, should cost come into the equation?
--snip--
Mr. Lemieux, who was a sales manager at a car dealership, says he cannot bear to look at his medical bills. They include bills for hospitalizations and surgery and co-payments for standard chemotherapy, as well as Avastin.
To try to make ends meet, he and his wife just sold their house and are moving into their son's basement. Even so, he says, he expects he will have to file for bankruptcy.
''You figure you've got insurance,'' Mr. Lemieux said. ''I paid 30 years and never got sick. I should have just paid the money to myself.''...
(Excerpt) Read more at query.nytimes.com ...
"Avastin is increasingly used to treat macular degeneration for as little as $17 a dose." Context is everything.
While long, this is a great story for the healthcare debate, IMHO
Only in a world with limited resources should it come into the equation.
Good thing for the NYT we have unlimited resources.
Classic result of a 3rd-party payer system. If patients were paying themselves, they’d weigh cost against benefits. If “somebody else” is paying, who cares?
Of course in the long run, “somebody else” turns out to be all the rest of us. Well, those productive members of society who have health insurance and pay taxes, anyway.
TANSTAAFL
There are works out there by economists that show what can be accomplished by a give sum of money.
Each $100,000 spent to help a rich American live an additional four months is an expenditure of resources not spent on something else.
That $100,000 could in many cases save dozens or hundreds of lives.
Only fantasists believe that cost shouldn’t be an issue.
It’s always an issue, because when X is spent on Y, it can’t be spent on Z.
Yup.
So was I.
People are not supposed to live forever. We just think we are.
Exactly right.
The ultimate capabilities of medical science will always expand faster than society’s ability to pay for that level of service for all.
For instance, we could provide a 1975 level of medical care to all quite inexpensively.
What we will never be able to do is provide state of the art care to everybody. Such care will be rationed one way or another.
In Canada and UK it will be rationed by waiting times and lines. In the US by lack of insurance or money. Results similar for most.
What will never change is that the elite of any society will always get its best care. They don’t wait in line.
Thanks for posting that.
I was thinking of a reply on that order, but not as politely stated.
And under the socialist system, the care never gets any better and the prices never drop.
My husband says he has the solution to the medical "crisis" in this country and it is not universal health care run by the gov't. He says each person should be permitted to access ONLY that medical care that was in use on the day of his birth.
That would be a solution, but I doubt that most people would agree to it.
Hence the problem with socialized medicine. Does anyone here want bureaucrats deciding what is "cost effective per year of life extended" when it comes to your health?
Of course, the third-party payor model os broken as well, because it separates responsibility from decision-making. What we need is an increase in consumer driven healthcare, where the patient pays all fees up to a catastrophic level, and then insurance handles the rest.
In that scenario, suppose I were a pharma company working on an Alzheimers cure. Why would I sink R&D investment into a drug that would have no market for another 60+ years, since that's when children born today would begin to require this drug?
It would most definitely be a solution, but as you say I don’t think it would be very popular.
As with so many things, the issue here is one of inability to comprehend simple mathematics.
There were really people who thought each of tens of millions of ex-smokers could receive a multi-million dollar legal settlement from Big Tobacco.
Today there are people who think we can spend a million dollars on health care for each person who is dying.
Not gonna happen, and the reason can be determined with basic multiplication.
There are more palatable solutions out there. The easiest would be for the insurance companies to build and package many more insurance policies than they currently support. Some would have a low level of critical care at a very reasonable price. Other plans would be very expensive but provide an expensive level of care. The user selects and has to live with that choice. This means cost and money will be used to ration healthcare, as it is right now. Any one who postulates a system not based on cost will have to have a printing press supporting his choice, and the printing press—even if it is the US Government—will eventually run out of money.
For macular degeneration it is used “off label” and it’s compounded, meaning a standard cancer dose is divided into tiny doses at a fraction of the cost.
Lucky for folks with macular degeneration as the alternative is $2000/dose. Great if you have good insurance. Not so great if you have only Medicare as your copay will be $400/month for treatment. Impossible if you have no insurance.
Economics at play here. Demand greater than supply so some type of rationing needed.
Since the government is footing the bill (at least for Medicare and Medicaid), let them do the rationing. Instead they squeeze the doctors and hospitals making them do the rationing, and dealing with the backlash - from patients and trial lawyers.
The problem with your approach in this instance, although generally good, is that use of this drug is by definition catastrophic in cost. So the issue doesn’t change for use of this drug.
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