So elderly patients in the neighborhood who have trouble leaving the house to begin with, but are otherwise able to get to my nearby office, have to arrange transportation to a center (after locating a new doctor there, and waiting months for an inital appointment) to get established, so that they can continue to travel every period (month, week, every 2 weeks) to get their medication.

Of course I could purchase the med at a loss. Federal law prohibits me from passing the difference on to the patient. But it becomes a very significant inventory cost, especially when you consider that there is no margin to make up for any other loss (waste, spoilage, etc).

Increasingly, hematologists in my area are no longer providing procrit in their offices, for this very reason. We used to also provide Aranesp, but can no longer do so. Treatment is delayed, and often skipped because of the hardships imposed on the patients, who can no longer be treated by their local physician. Also, FWIW, medicare will not pay for the medication if a patient administers it themselves at home or via an aid. They only pay if administered in the office.

At present, the situation is MUCH better with commercial insurers. Perhaps they will follow medicare’s lead, as you suggest, and we will all suffer equally.

How, exactly, do they suffer?

But of course, if we nationalize and subject everyone to the same suffering, we will all be better off, right? Well, at least it will be “fair.”

I don’t think you’re following what’s happening - Medicare and the government are driving changes in private plans.

See http://www.managedcaremag.com/archives/0804/0804.cancerdrugs.html

As for trials, you are completely wrong. The low US rate, particularly among minority groups, is a function of insurance status, low physician and patient awareness (the vast majority of patients are treated outside of comprehensive cancer centres) and lack of government mandate - among other factors. See http://iccnetwork.org/cancerfacts/ICC-CFS11.pdf

So, you can make a fairly certain bet, than any commercial plan provides at least what Medicare allows. Though most provide more.

As for the UK having more people in trials, that is likely because having failed first line therapy with the single approvied drug for a condition, the only option is no treatment or enter a trial. Fewer people in the US enter trials because they have other options.

http://www.cancer.gov/clinicaltrials/learning/approval-process-for-cancer-drugs/page5

‘The U.S. Congress passed a law in 1993 requiring Medicare (http://www.medicare.gov/), the federally funded health care program for elderly and disabled people, to cover off-label drugs used in cancer treatment when the use is supported by:

* a citation in at least one of the following authoritative drug reference books.
o The American Society of Health-System Pharmacists’ American Hospital Formulary Service (AHFS). There is a regularly updated online version.
o U.S. Pharmacopeia Drug Information
* two or more peer-reviewed articles published in respected medical journals.

‘Medicare coverage policy is not binding on private health insurance providers, although some insurers have adopted coverage policies consistent with Medicare’s. Many states (see below) have passed laws or issued regulations requiring state-regulated private health insurers to provide coverage similar to Medicare’s for off-label drug use in cancer treatment. However, organizations (usually large companies) funding their own health insurance coverage are exempt from these state laws and regulations, although many comply voluntarily.’

You won’t take my word for it, but you are wrong. Medicare and state and federal agencies that are involved in treatment payment decisions are infinitely MORE restrictive than commercial plans, almost across the board. Medicare Part D is an excellent example. I don’t know where you possibly leaned that Medicare sets the benchmark for such things.

No, I’m aware that off-label use is widespread anywhere in the world. The question is who pays - and it’s definite that in the US not all insurers will authorise all experimental treatments, and for those they do there are increasingly higher co-pays.

And it is federal and state regulation, and Medicare, that tend to set the benchmark for what private insurers will cover.

In fact, if I practiced using medications and devices only as indicated by the FDA, I would have a whole lot of time on my hands, and a ton of sick patients.

We would also take those cancer patients who failed or could not tolerate their first-line treatment, and set them out on ice floes.

And let’s not forget that your system and that of Canada forcibly removes money from the public’s collective purse, ostensibly to pay for “universal” health care. That would be tough to defend if they actually provided necessary care. As it is, they take your money, deny treatment, and punish you if you try to supplement mediocre care with your own money. In a rational world, defense of such a system would qualify you for a psychiatric exam.