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Cherrypicking health care anecdotes
Yikes. I know there is much more to the policy question than this story, but it is worth keeping in mind:
One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.
By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor. “He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview...
Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.
Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.
And that is The New York Times. Is Atlas Shrugging?
Addendum: More discussion here.
Posted by Tyler Cowen on February 20, 2008 at 05:00 PM in Medicine | Permalink
Comments
This kind of thing is stupid. But it doesn't undermine the case for an intelligent plan for universal medical coverage. I favor Hillary Clinton's, provided the subsidy for those mandated to buy insurance is adequate. Obama's plan is more modest, but still much better than nothing. And nothing is what we'll get if John McCain is elected.
Posted by: Stan at Feb 20, 2008 5:06:20 PM
"Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones."
Another stark reminder that these people don't want equality of opportunity, but equality of outcome, but not even outcomes, equality of...I'm not even sure...medical effort?
Isn't disease the quintessential discriminator? Wouldn't "fairness" be to attack the disease with zeal? How much sense does it make to say you can't spend extra on someone when by fact you are paying extra on them from the get-go because most people don't get breast cancer?
Lucky for her, and not the government's intention, she'll likely be saved from pouring a great deal of money down the med-hole.
Posted by: Andrew at Feb 20, 2008 5:11:18 PM
There are some extremists out there who agree with this kind of policy- we should all get the same healthcare. I think it crazy and those people scare me, but I don't think that's what we're talking about here in the United States.
Posted by: mpowell at Feb 20, 2008 5:12:55 PM
"...provided the subsidy for those mandated to buy insurance is adequate"
A subsidy coming out of my pocket to force people to get crappy insurance? I kind of prefer the way it is, they use the emergency room and as a paying customer I already help pay for it.
But, they should really come up with a different name for it. Emergency rooms should be for emergencies. Maybe they could call it the indigent room. Or the indignant room.
Posted by: Andrew at Feb 20, 2008 5:15:12 PM
The reason cited here was equity, but they often have an economic reason. Allowing people to purchase medicine privately might drive the costs up for government in one of several potential scenarios.
If you want it "free", be prepared for lines and rationing. Then get your checkbook ready, for paying Uncle Sam.
Posted by: liberty at Feb 20, 2008 5:16:30 PM
"And nothing is what we'll get if John McCain is elected."
Oh, that it were November, and I could vote for John McCain now. Bless you, Stan. You've given me faith in John McCain.
I'm sorry. No offense. I just have a hard time jumping on the "we all need free medical care now" bandwagon. How did this suddenly (and I mean very suddenly) become the biggest and most important issue on everyone's agenda? Why do we suddenly have an inalienable right to treatment that wasn't available 100 years ago?
I wish that proponents of massive wealth distribution would simply call it that, rather than bandying around the issue of "health care" per se. If this were anything other than a wealth redistribution issue, its advocates wouldn't be so adamant that participation in it be mandatory. What's next? Universal Lexus Coverage, to insure that we all have equal and fair access to luxury cars?
Posted by: d.cous. at Feb 20, 2008 5:29:16 PM
This is old news.
Posted by: KipEsquire at Feb 20, 2008 5:36:57 PM
What's next? Universal Lexus Coverage, to insure that we all have equal and fair access to luxury cars?
pretty sure it's not but keep me posted because you know I care
Posted by: perianwyr at Feb 20, 2008 5:50:49 PM
Tyler, I don't think you quite understand how the NYT's core audience will interperate this story - they will not see this as a consequence of the failure of government planning, but rather the failure of not ENOUGH government planning. Namely, the failure to nationalize the drug companies and the failure to nationalize health care.
Atlas is not shrugging. The problems of failed statism can only be solved by MORE statism.
Posted by: Other at Feb 20, 2008 5:55:40 PM
Actually, I think capitalist health care is putting an unfair strain on the socialist brand. As the previous poster mentioned, if the drug companies were nationalized you wouldnt have to worry about all of these sexy, expensive, cancer therapies because their development would slow to a trickle. Scary thought, but if you nationalize health care in the U.S who is gonna foot the bill for the world's medical innovations? Is it reasonable for an entire planet of 6 billion people to put so much pressure on the city of Zurich?
Posted by: john pertz at Feb 20, 2008 6:18:04 PM
That shocks me. I would like some sort of universal plan, but if one cannot rise above that, what's the point of building wealth?
(But surely a plane ticket to India was cheaper than $120K in the first place.)
Posted by: odograph at Feb 20, 2008 6:52:20 PM
1n5an3!!! This is truly the wackiest thing I have heard in years. Genentech should start marketing direct to consumers in the UK.
Posted by: Paul N at Feb 20, 2008 8:10:57 PM
"if you nationalize health care in the U.S who is gonna foot the bill for the world's medical innovations?"
Scientists, perhaps? You know, those same folks who have been playing with quantum particles, staring at far off galaxies, and deconstructing bacteria out of sincere interest and intellectual curiosity (certainly academic salaries are not a pittance, either). I'll bet you can come up with at least a few scientific breakthroughs that didn't take place because of a profit motivation. Guess who the #1 country in cardiological research is right now? France. Weird, huh.
The notion that our instinct to discover will disappear if an absurd profit cannot be made is, well, absurd. Perhaps research will focus instead on real problems, rather than trying to invent a new disorder every month to market the new drug to. That theory is at least as reasonable as the notion that medical innovation will dry.
Posted by: Andrew at Feb 20, 2008 8:13:15 PM
Why do you think that Buffalo and Cleveland have such good cardiac/oncology hospitals? Canadians who are waitlisted for critical treatment choose to run across the border, on their own dime, because the Canadian healthcare system does not allow paying to "jump the line."
Posted by: DougM at Feb 20, 2008 8:49:41 PM
seems exactly how it should work: you get free basic care, and if want extra, switch to private care.
You don't get to waste the time of the basic plan doctors by using them as experts on your custom treatment: feel free to use the basic plan and then pay a private doc to enhance the basic plan, tho
Posted by: at Feb 20, 2008 9:20:05 PM
Andrew,
I imagine profit motive accounts for most scientific research. Scientists do it because they get paid, universities pay them to get patents, or for prestige in order to get more tuition-paying students.
In addition, medical research is unlike astronomy in that it involves enormously expensive human trials, which likely would not get done without the prospect of a profit. If your argument is simply that government can take over any private research and do it as well or better, I have read several articles decrying the woeful results of government-funded research. Generally speaking, I think it is accepted that the government is not as efficient as a private profit-seeking enterprise, due in large part to the lack of incentives.
As far as "absurd" profits, if you believe that, why don't you start a drug company? Why do you believe that the drug industry is the only one where competition does not work and supernormal profits are possible?
Since you say that "perhaps research will focus on real problems... that theory is at least as reasonable as the notion that medical innovation will dry up" I assume that you have some profound evidence in mind to support that. There is quite a lot of evidence to support the latter "notion" but I have seen little research other than anecdotal to support the first. Does your confidence have a basis in knowledge? Care to share?
Posted by: Cliff at Feb 20, 2008 9:30:58 PM
I guess I spent too much of my life in universities, because this kind of egalitarianism doesn't surprise me at all. I know lots of people who insist that no public school should be allowed to spend more per pupil than any other, and I was once on the losing side of a faculty vote that prohibited students from taking exams on a computer because maybe the poorest students wouldn't be able to afford computers.
Posted by: Alan Gunn at Feb 20, 2008 10:07:43 PM
What are the chance that the medication would help?
Posted by: Floccina at Feb 20, 2008 10:08:33 PM
What are the chance that the medication would help?
Posted by: Floccina at Feb 20, 2008 10:08:35 PM
If you go to an emergency room they'll treat you and then they'll bill you. If you don't pay the bill, they'll work hard to collect it. Emergency room care isn't free. As for why there's "suddenly" a demand for universal medical coverage, it's not sudden. Harry Truman proposed it, it was popular with the public, but the AMA bought enough Congressmen to defeat it. It's been that way ever since.
And finally, I'm amused to see the standard nonsense about how Canadians (or Brits, or Germans, etc.) really hate their health care systems and are longing for what we have here. Canada, Great Britain, Germany, etc. are democratic countries with a voting rate better than ours. If their health care systems were unpopular, one of their political parties would propose that it be scrapped in favor an American style system. Does anybody really believe that's going to happen?
Posted by: Stan at Feb 20, 2008 10:26:23 PM
Doesn't seem like that much of a problem since she can go abroad, not that I expect it will do much good.
Posted by: Lord at Feb 20, 2008 10:26:51 PM
Cliff: "I assume that you have some profound evidence in mind to support that."
Well, I did point out that France is leading in cardiological research, but you seem to have brushed right over that part.
I might also point out that according to industry data, roughly 2/3 of pharma research goes into copycatting patented drugs. Is that efficient? Might our society look a little different if antibiotics, insulin or the polio vaccine were developed by Pfizer?
I have full faith and confidence in profit as a motive. You seem to doubt there is any other. I suppose we could have a silly contest, and see who can list more medical breakthroughs vis-à-vis government v. corporate research. If one takes it on faith that the profit motive trumps all, and government is a four letter word, however, then there is little point in discussing the matter.
Posted by: Andrew at Feb 20, 2008 10:45:25 PM
Holy crap! I knew the Canadians pulled stuff like this, but I thought that the Brits were different. Isn't the idea of the NHS that it provides a minimum standard of care, and wealthier Brits buy supplemental insurance that provides a higher standard of care? Or does supplemental insurance in Britain just pay for private rooms and regular pillow-fluffings? Can an upper-income Brit please clarify?
Posted by: David Wright at Feb 20, 2008 11:46:48 PM
>> This kind of thing is stupid. But it doesn't undermine the case for an intelligent plan for universal medical coverage.
In the U.S. it would be clearly unconstitutional, rendering the discussion moot. I am also against it on moral and economic grounds.
Posted by: Chris Meisenzahl at Feb 21, 2008 12:31:43 AM
Floccina raises an excellent point. These anecdotal arguments (a al Michael Moore) glaze over the most important question - did the drug have a reasonable chance of improving her quality of life? It's very possible that the cost simply was not worth it. Another way of asking this question is, "if she were American, would her insurance company have paid for the avastin, or rejected her claim because her doctors couldn't prove medical benefit?"
Posted by: John at Feb 21, 2008 12:38:03 AM
Andrew,
As a biology Ph.D. researcher who knows plenty about the realities of medical research, you don't know what you're talking about. In fact, most of you have no idea. Admit it. "Copycat drugs" You don't understand. Scientific motivation? Paying scientists' salaries? Do you know the difference between the NIH and the NSF? Seriously, stick to whatever it is that you know better.
Posted by: Joey at Feb 21, 2008 12:50:01 AM
I am not defending the policy which is most likely wrongheaded, but my understanding of the general logic is this:
If you go private (which you always can) you go private - in for a penny in for a pound.
If you go public, then likewise you are public on the whole deal.
This avoids the taking up of a private option itself creating a burden on the NHS, which the NHS wouldn't have facilitated. It is normally applied to post operative care, that is you can't have surgery privately, and then expect the NHS to cover follow-up checks on your surgery, complications arising from it etc.
Why private surgery deserves to be treated differently from, for example, accidents caused by driving very fast and very expensive is not obvious.
Posted by: tadhgin at Feb 21, 2008 3:56:26 AM
This woman gets screwed on Avastin; an American woman without insurance goes broke from the cost. The calculation is, would you rather be dead than poor? The odds of either happening are small in both systems, but that's the choice.
Currently, most government spending is on the poor and elderly, while the costs are passed to the middle and upper income earners. If we switch to universal care, isn't it more likely that the elderly and poor will experience a decline in medical care with no offsetting benefit, while the taxpayers experience a net drop in cost (higher taxes offset by even higher wages) in return for a lower level of care?
Posted by: 8 at Feb 21, 2008 7:18:36 AM
Are the British still allowed to buy their own bandages, or must they visit the NHS for that?
If it helps clarify, in the US avastin is only in "late-stage" trials for metastatic breast cancer according to Wikipedia, but really that has no bearing on availability in the UK.
But really the lady could be stuck in a catch-22. The avastin has only been shown to work on breast cancer in concert with standard chemo. She's already selling her house, will that raise enough to cover both avastin and chemo, or just the avastin, which may not work without the chemo? It may stop new tumors from growing (it inhibits blood vessel growth), but it won't kill the ones already there I think. But she never got private insurance that might have covered this or allowed out of pocket expense, because she had the NHS. And it's not like she's taking advantage of the system while having hundreds of thousands of pounds stashed away that she can pull out when she needs the good stuff. She's going to the extreme step of selling her home to save her life.
It's pathetic that the woman's going to die for someone else's principles, principles that largely seem based on class warfare. In this instance the UK's safety net has become a suicide pact.
Posted by: Jethro at Feb 21, 2008 7:38:24 AM
Joey: As an engineering/computer science researcher, I didn't really see a problem with Andrew's argument. Care to enlighten us with some of the details?
Posted by: billb at Feb 21, 2008 8:32:45 AM
You know, those same folks who have been playing with quantum particles, staring at far off galaxies, and deconstructing bacteria out of sincere interest and intellectual curiosity (certainly academic salaries are not a pittance, either).
You don't have to spend half a billion dollars to prove to NASA that your newly-discovered galaxy won't hurt anybody.
Posted by: Josh at Feb 21, 2008 8:59:30 AM
[On December 5, 2007, the FDA voted 5-4 that Avastin's risks outweighed its benefits for women with advanced breast cancer.]
http://en.wikipedia.org/wiki/Bevacizumab
Posted by: ideogenetic at Feb 21, 2008 9:02:12 AM
I wonder how Terry Schiavo fits into the rightwing world view on health care.
In the UK, you're not allowed certain health care.
In the US, it's forced upon you by wingnut lawmakers.
Posted by: meter at Feb 21, 2008 9:09:10 AM
For every such case in Britain, we can probably find thousands here in the US where cancer patients have no health care coverage and simply die without treatment.
Folks like Tyler are up in arms when rationing is overt and a patient with money is told no. They could care less when the rationing is hidden by the sacred workings of the market, ie. the patient doesn't have money. Or when it is a private insurance company that denies paying for a treatment.
Posted by: Mike Huben at Feb 21, 2008 9:26:26 AM
I made the first Andrew comment, and none other til this one.
I should amend my first comment. Although most chemotherapy is wasted money, who would not buy that lottery ticket, even if it cost all your resources?
But, Avastin may be effective, is a new approach to attacking tumors, and I think has shown some success, even though it is "experimental" (What treatment with a 4% success rate is not properly considered "experimental?"). Everything is experimental in medicine. You try stuff and it works or it doesn't. That's called an experiment. Legislators want to treat it like a Six Sigma project.
So, the government is likely paying for inneffective treatments, while not allowing this patient to pursue one with a higher probability of effectiveness.
Posted by: TheLibertarianAndrew at Feb 21, 2008 9:45:04 AM
The British system has always been a dual system of both public and private health care. The public health system provides a base of good care but individuals have always been free to purchase private care on top or instead of public and the private health care system in the UK has always been fairly large. The public system provide a base of good care at a very low share of GDP and a low cost to taxpayers. If you wanted more then the base care system you are always free to buy it. But it has always been a trade off -- and they spend about half of what we do on health care. This looks like some case where someone has got caught in the intersection of the two systems. It is a single observation, and in any complex system one can almost always find some single observation of the system not working. It is not necessarily an indication of systematics problems.
Posted by: spencer at Feb 21, 2008 10:08:18 AM
I particularly liked this:
Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,” the health secretary, Alan Johnson, told Parliament.“That way lies the end of the founding principles of the N.H.S.,” Mr. Johnson said.
Iow, the health of the NHS is more important than the health of the people it's supposedly treating.
Then the tragedy turns to farce at the end of the article:
But in a final irony, Hirst was told early this month that her cancer had spread and her condition had deteriorated so much that she could have the Avastin after all - paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense.
Posted by: Patrick R. Sullivan at Feb 21, 2008 10:12:55 AM
Libertarian Andrew, sorry for appropriating your name. My intent was not to mislead, I just didn't notice there was another Andrew here.
PRS- "Iow, the health of the NHS is more important than the health of the people it's supposedly treating."
Socialized medicine lends itself to this sort of observation. If there is a failure like the one in this article, the responsibility for the failure is clear.
The U.S. system makes assigning blame more difficult. Is it the insurance companies, the individual, the AMA, ect...? The diffusion of blame makes it easier to defend. Which is why we look at systems in terms of outcomes instead of anecdotes.
Posted by: Andrew at Feb 21, 2008 11:13:35 AM
"And finally, I'm amused to see the standard nonsense about how Canadians (or Brits, or Germans, etc.) really hate their health care systems and are longing for what we have here. Canada, Great Britain, Germany, etc. are democratic countries with a voting rate better than ours. If their health care systems were unpopular, one of their political parties would propose that it be scrapped in favor an American style system. Does anybody really believe that's going to happen?"
American-style? Doubtful. But you must not pay attention to the news if you don't think that the quality of health care provided isn't an issue in either Canada or the UK. A quick google news search turned up numerous articles on Canadian health care, such as this:
http://www.theglobeandmail.com/servlet/story/RTGAM.20080219.wquebechealth0219/BNStory/National/?page=rss&id=RTGAM.20080219.wquebechealth0219
Tony Blair, meanwhile, made an election issue out of making reforms to the NHS.
So this notion that politicians aren't talking about it and voters aren't concerned in the UK and Canada is quite bogus. (I have no idea about Germany)
Posted by: Colin at Feb 21, 2008 12:20:13 PM
I grew up in the UK and lived there until last year when I moved to the US, so I have some experience of universal health care.
The only difference between the UK's NHS and the US's private health systems is who pays the bills. The patient is just the recipient of treatment and services, but those services are dictated by the companies or bodies that pay them. In the US, this is typically an insurance company, whilst in the UK it is the government.
The end result is the same. Try arguing with your insurers that you should get a drug that isn't on their list and you will find the response remarkably similar to that which Ms. Hirst recieved from the NHS.
In essence, the NHS trys to delay treatment (by delaying consultations that would neccessitate them treating someone), so that patients will either: (a) get well of their own accord; or (b) spend their own money to get treatment (thus saving the NHS budget for more management consultancy fees); or (c) die before they are treated (see b. for the resultant benefits)
Personally, I would recommend universal primary care for the US (freeing up lots of ER time & money spent treating stuff that should have been dealt with by a general practitioner). However, individuals should insure themselves against surgery, and exotic drug perscriptions, etc, so as to keep the entire enterprise and expense managable.
Posted by: Digga at Feb 21, 2008 12:50:57 PM
Joey: As an engineering/computer science researcher, I didn't really see a problem with Andrew's argument. Care to enlighten us with some of the details?
OK, let's take "copycat drugs." Lipitor would be defined as one of those. It's also far more effective than the earlier statins. And having multiple statins on the market provides competition and lowers prices for consumers, whether they are individuals or national health services. Arguing that researching "copycat drugs" is inefficient is just plain stupid.
Posted by: Joey at Feb 21, 2008 5:41:38 PM
How about funding? The NIH budget is about $29 billion, the NSF budget is about $6 billion. For one agency, part of its mission is funding science aimed at improving human health. The other focuses on basic science. Our government has made it quite clear that it wants more science done that impacts human health.
Or let's take graduate students. In the sciences, tuition and fees are free. And at least at the elite universities, science grad students have pretty small teaching requirements. This is even more true for biological research. They also get paid a stipend, which is right now in the high $20k area. It's not a lot of money, I know. But if science students had to deal with what English or philosophy students had to deal with, i.e. no money, more teaching, and not free school, the number of grad students would be FAR lower.
Posted by: Joey at Feb 21, 2008 5:56:19 PM
[On December 5, 2007, the FDA voted 5-4 that Avastin's risks outweighed its benefits for women with advanced breast cancer.]
Funny, the Wall Street Journal editorial page had an article about that today.
It seems that, once the patient is diagnosed, Avastin increases t_healthy, the amount of time before the cancer spreads further and healthy becomes significantly worse. However, it decreases t_sick; once it spreads, the patient dies quicker. The FDA regulatory process mostly cares about mortality rates and t_total = t_healthy + t_sick. Avastin most likely increases t_total by a small amount, but current small studies have not shown an effect large enough to be considered significant.
Posted by: John Thacker at Feb 21, 2008 6:45:37 PM
And also note that Tyler is no friend of the FDA's regulatory structure either.
The end result is the same. Try arguing with your insurers that you should get a drug that isn't on their list and you will find the response remarkably similar to that which Ms. Hirst recieved from the NHS.
Except that she was arguing to pay the incredibly high cost with her own money. US insurers wouldn't bat an eye about a patient choosing to pay herself for the portion of treatment that they wouldn't pay for. That's a pretty significant difference.
(Luckily, I don't deal with this at all either. For me at least (and I don't presume to speak for other people), my HSA high-deductible plan works pretty well when it comes to getting the treatment I want. And yes I have used it.)
Posted by: John Thacker at Feb 21, 2008 6:52:40 PM
In response to Colin, I agree that the quality of health care is an issue in Canada and the UK. It's also an issue here, but an unreported one. Millions of people in the US are not getting preventive care because they can't afford it. They go to the doctor when they're sick, and that's it. Economists like Cowen always talk about the economic losses associated with social welfare programs. Do they ever think of the economic losses caused by not having them?
Posted by: Stan at Feb 21, 2008 7:35:43 PM
Stan,
you are siply wrong here.
Preventative care (yearly doctor's visits, cholesterol monitoring, cancer screening at 45+) costs a few hundred dollars per year. If a person really cannot afford that, they are poor enough to qualify for Medicaid, in which case, the government already pays for their healthcare.
The vast majority of Americans are making a choice to forego the preventative care in favor of spending the money elsewhere. This is a foolish choice, but it is nevertheless a choice. Cases like Ms. Hirst's are shocking to the conscience because she had both the desire and the means to provide for her own (supplemental) treatment and the NHS forbade her from getting that treatment. Any system is limited in the total amount of healthcare it can provide by the high price. (Medicines and doctors are very expensive, even under socialized medicine) A market system will (as you point out) often refuse care when it cannot be paid for, but it never leads to such an absurd result, where care is denied, even though the funds and the willingness to pay are present.
Posted by: heedless at Feb 22, 2008 10:59:00 AM
PS: that's "simply" in the first sentence.
Also, you tell 'em, Joey. (I'm serious here. I've worked in basic bio research myself, in a well funded lab, and money was overwhelmingly important. From speaking with post-docs who were trying to start their own labs, I can tell you it doesn't become less so when you don't have any. Quite the opposite.)
Posted by: heedless at Feb 22, 2008 11:04:28 AM
I know its late, but I have to interject a few thoughts into this overwhelmingly anti-nationalized-healthcare glee fest. I am seeing alot of expertise illustrated here on the effectiveness of avastin in improving the outcome of patients in Mrs. Hirst's situation. You all seem to just assume that the drug would have had a positive effect in her case. What if she had sold her house, purchased the drug, and then still descended to the level of health that she eventually reached before the drug was approved for her by the NHS? The NHS seems to have some kind of data somewhere suggesting that, at least statistically, this would have been the case for people in her situation. It is very possible that they were taking a principled stand on denying coverage to every single whining patient that comes screaming to them about drug X or procedure Y simply because they read about it from a 'so-called' patient network (usually funded by drug companies to promote their own drugs), but lack the knowledge to decide if it is really in their best interest. It is not known whether the NHS made their decision with or without the knowledge of what Mrs. Hirst was planning to do to raise the money to obtain the treatment, e.g. sell her house, and not unreasonable to suppose that they did, given her Doctor's communication with them. If they were in possession of this knowledge, in addition to the statistical facts about the outcome of using avastin in her condition, it might very well be that this merely strengthened their resolve to make Mrs. Hirst really want to buy it by forcing her to take on the complete cost burden. I am not saying the paternalistic bureaucrats involved could not have been better at explaining why the decision was made, I am just saying that there may be more to the story than what the NYT has written. Just because someone wants a drug doesnt mean it is going to help them. And part of the economic story of healthcare expenditure in the US (you know, the fact that it dwarfs expenditure of every single country in the world with no better outcomes) is deciding how best to facilitate people in getting access to the drugs/treatments that they really need, while avoiding those that they dont, and thus employing their (or their insurance companys, or the governments) money more effectively in the economy.
Posted by: Darin London at Feb 22, 2008 1:00:46 PM
Again, the awful nature of this episode has NOTHING to do with the NHS not giving her the drug. That's fine. That's standard rationing. Whether it's the government or an insurance company, cost/benefit decisions are necessary. It doesn't matter that the NHS wouldn't pay for it, nor does it matter how effective the drug is.
The point is that the NHS wouldn't allow her to buy it herself, a power insurance companies don't have. Denying a person the ability to spend their own money based on their own decisions about their own health and claiming to do so in the name of "fairness" is just plain wrong. Truthfully, it may well be a mistake for her to spend so much on an ineffective treatment, but that's her choice and it's literally life or death. It's one thing for the government or an insurance company to say "We won't spend that money on you." It's quite another to say "You can't spend it on yourself."
Posted by: Stretch at Feb 22, 2008 2:31:44 PM
The NHS decidedly did not force her to not buy the drug herself. They simply stated that if she really wanted to buy the drug herself, she would have to pay for all of her healthcare related to the cancer. That is a very big difference than not allowing her to buy the drug. They effectively made a principled stand to state that not only was it a bad decision for her to buy the drug, based on their understanding of its efficacy in her case, it was such a bad decision that she would have to forgo all government aid in order to make that bad decision. She still had a choice, but the choice was certainly more stark than what our market based healthcare system would have forced on her. Sure you can buy as much quacker as you want, sure, just sell your house, sell your car, do whatever you think you need to do. nevermind that it might not do you any good.
Posted by: darin london at Feb 23, 2008 5:16:19 PM
