« How honeytrappers work | Main | How high is the U.S. poverty rate? »
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
