A couple of weeks ago I noted the ironic fact that Edward Kennedy is receiving cancer treatment in the U.S. health care system that he has so often maligned. Robert Goldberg points out another important detail of this story in the New York Post:
With his wealth and power, Kennedy would get good treatment anywhere. But the same care is available to every American.
This is, of course, true. I can, as a mere working stiff, get the same fast, high-quality care that Senator Kennedy is receiving. That would not, however, be true in a country with government-run health care. Goldberg provides an example:
Consider Jennifer Bell of Norwich, England. In 2006, the 22-year-old complained of headaches for months - but Britain’s National Health Service made her wait a year to see a neurologist.
When she finally got to see the neurologist, he ordered an MRI:
Then she had to wait more than three months before should could get what the NHS decided was only a “relatively urgent” MRI scan. Three days before the MRI appointment, she died.
For the benefit of those who believe that the single-payer model (as used in Canada) is superior to socialized systems like the NHS, Goldberg provides the following:
Things are no different in Canada, where the wait for an MRI … has grown to 10 weeks. For Canadians relying on their government health care, the average wait time from diagnosis of cancer to surgery is beyond the guideline set by both the US and European societies for surgical oncology.
Moreover, like its English counterpart, the Canadian system refuses to fund up-to-date cancer drugs:
The same doctors now treating Sen. Kennedy told [Chad Curley] and his wife that the Avastin combination could stop his tumor from growing and add months to his life. But HealthCanada wouldn’t pay to use Avastin to treat his tumor.
U.S. health care is regularly trashed by the “news” media, ”progressive” policy wonks and politicians. And it does indeed need some work. Nonetheless, despite all its faults, it is far better than the real-world alternatives.
Comments 11
David, Avastin for brain tumours is not approved by the FDA, so insurers won’t cover it. It also costs about $500,000 a year…
Posted 06 Jun 2008 at 5:12 am ¶Marc, this is one of your trademark red herrings. Ironically, it supports my point, although you don’t seem to grasp that. The FDA is a sclerotic government bureaucracy much like NICE. In other words, the FDA approval process is one of the few areas where our system emulates yours, which makes it slow and inefficient. So, your FDA example suggests that we should move AWAY from government-run health care not toward it.
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.
Posted 06 Jun 2008 at 8:58 am ¶The error in your argument, Marc, is that FDA approval is a prerequisite for coverage for a treatment.
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.
Posted 07 Jun 2008 at 7:40 am ¶‘FDA approval is a prerequisite for coverage for a treatment.’
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.
Posted 08 Jun 2008 at 5:26 am ¶I was going to write a fairly extensive and elaborate response, but I changed my mind.
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.
Posted 09 Jun 2008 at 6:52 am ¶Well, have a look at this page on the NCI’s site. You may also be interested to know, on a related matter, that the UK’s entry in clinical cancer trials is now 12% of the cancer treatment population, far higher than the US.
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.’
Posted 09 Jun 2008 at 8:23 am ¶So, this just establishes that Medicare sets the Minimum requirement for coverage.
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.
Posted 09 Jun 2008 at 10:08 am ¶‘So, you can make a fairly certain bet, than any commercial plan provides at least what Medicare allows. Though most provide more.’
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
Posted 09 Jun 2008 at 4:51 pm ¶I am all too aware of the change to ASP as my patients suffer as a result, on a daily basis.
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.”
Posted 09 Jun 2008 at 7:19 pm ¶‘as my patients suffer as a result, on a daily basis.’
How, exactly, do they suffer?
Posted 10 Jun 2008 at 6:20 am ¶They can’t get their medications. They have to travel to a center to get their medications, because the local ASP price is significantly lower than the vendors will sell it to me for, because I am unable to purchase sufficient quantity to get the discount.
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.
Posted 10 Jun 2008 at 9:48 am ¶Post a Comment