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The True Cost of Rationing Health Care

By: Brian Darling (Diary)  |  February 4th, 2011 at 08:00 PM  | 

RESIZE: AAA

For more than six months, breast cancer patients have been stuck in a horrible limbo, being forced to wait and watch the rationing battle over Avastin play out in a debate between government bureaucrats with little concern for their well being at the Food and Drug Administration (FDA). There has been an ongoing battle between victims rights groups, families of cancer victims and the FDA specific to the drug, and other life saving drugs.  The stakes could not be higher when you are talking about a debate over a drug that has proven to extend the life of cancer patients.  Expect this debate to expand to other drugs and services if ObamaCare is allowed to continue to exist.

Conservatives are against big government and the federal goverment spending your tax dollars on health care.  It is wrong for the government to spend so much money on drugs and health care services that cause massive inflation for drugs and care for those paying with after tax dollars.  Just try to fill a prescription without health care insurance and you will feel the sting of health care inflation.  Things would be much better if the federal government just got out of the business of spending your tax dollars on health care services and drugs.

That being said, cancer patients should be left harmless from our dysfunctional health care system.  Yes, these life saving drugs carry a high cost, yet they are extending life.  These cancer patients did not set up our government heavy health care regime and they should not pay the price for a government run health care system experiencing massive inflation.

The FDA is forging forward to de-label the drug Avastin, which means that unless they change their mind in the appeals process, Medicare will soon refuse to pay for the cost of it.  Furthermore, since private health insurance takes their cues from the government most private health insurance plans are likely to stop covering this drug as well.  The drug has proven to work and the FDA is basically saying that costs is a factor in approving the life extending drug.

This is a preview to the world we shall live in under ObamaCare.  If the law is not stricken from the law by the U.S. Supreme Court, expect this fact pattern to repeat over and over again.  If the FDA stands by this move the drug will still be available to those who can afford it, but for those who can’t it’s a different, potentially tragic, story. 

The Brits have the National Health Services program that openly rations care.  The designers of Obamacare worship at the altar of the British health care system.  One of those worshippers, President Obama’s head of Medicare and Medicaid services Donald Berwick has said the following:

The decision is not whether or not we will ration care–the decision is whether we will ration with our eyes open.

Take the case of Christie Turnage.  She is a breast cancer survivor who is fighting a government rationing decision by the FDA.  Expect more Christie Turnages if ObamaCare moves forward, because the government will ration care and drugs.  The fight over full repeal of ObamaCare is a very important issue for those who are worried that the Avastin matter will be repeated on a mass level for every American seeking expensive care and products.

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  • msctex

    This idea first occurred to me when the ugly realities of ObamaCare became apparent, and this seems as good of a time as any to throw it out there.

    There are any number of reasons such a potentially deadly fiasco has been allowed to even near fruition, but high on the list is that those involved in its promulgation fear no consequence. Those who would intentionally cripple the most effective Healthcare system the world has to offer have no reason to believe their actions could come back to haunt them.

    What I propose is providing a reason for fear. If Conservative websites like RedState, Lucianne.com, The Blaze and others could each set aside a bit of bandwidth for the purpose of establishing and maintaining a list of those injured or killed due to the non-functional nature of ObamaCare (or link to a central site — whatever works), it would serve two purposes. First, it would offer incontrovertible proof that this particular Progressive stupidity has a body count. But more importantly, it would provide evidence of the possibility of legal reprisal — something which the half-bright lawyers who concocted this unfolding disaster will instinctively recognize, and from which they will wish to distance themselves.

    It would not be easy, and would require a bit of work to insure accuracy. But I can think of nothing else which would be a simpler, more effective way to cause the rats to flee an already sinking ship.

    • gekster

      If Obamacare was fully implemented when Rep. Gabrielle Giffords was shot,
      she would not get treated because of the low averages of recovery for such injuries, and the “costs” of treatment.
      Maybe because she is a Rep. she might, but you and I, not so much.

      • sccrenny

        is more true than the first part. Along with the body count idea above the most effective method of fighting Obamacare is to point out that, as with despots and dictators everywhere the political elite will not be affected along with the rest of us.

    • YnotNOW

      are not only the ones who are DENIED care, but even more are the ones who cannot be counted because the drugs they needed were never DISCOVERED. When drug companies become regulated by the government, essentially similar to a utility with managed profit margin, then they will only churn out existing drugs at lowest production cost. The drug companies are already slashing their research budgets into new medications and new trials to bring drugs to market. If you can’t make a profit, and potentially cannot even get approval for your patients to purchase, why would you throw money away?

  • pac_NY

    on such a serious issue as health care, but msctex has a point; the Left was rabidly obsessed over body counts when Bush was in office as it related to the Iraq war. Do you think it would mean anything to the sickos on the Left now to know there are deadly consequences to their tyrannical agenda of life and death control over humans via a health care system that of necessity will cut costs where treatments should least be rationed?

    I have worked in the health field all my adult life, and I know physicians want to be able to offer their patients the best possible treatment modalities and pharmaceuticals available and as is practical given their patient’s overall medical conditions.

    So I wonder too, why we do not see massive, unrelenting protests against the evil Obamacare from the medical community of physicians across the nation who realize they are the ones who will be facing patients and families when a life-saving or life-extending treatment or drug is denied the patient – simply because they are not deemed worthy of the cost?

    I do not believe American citizens will sit idly by and watch loved ones perish – not for lack of available medicines and treatment – but by law.

  • Menlo

    Is the drug still not available for purchase? The government won’t pay for it, and the private insurers choose to do whatever government does. In this case, the individual can still choose to buy it. This could happen with or without Obamacare.

    Unless it is an argument as to why big health insurance corporations differ little from big government, I don’t get it.

    • The_Gadfly

      First, the purported purpose of the FDA is to determine whether or not a drug is “safe and effective.” As originally intended “effective” had no cost component. The FDA merely made a technical determination as to whether or not there was a statistically significant probability that the drug increased the likelihood you would recover more quickly if given the drug. The “safe” component was also a technical determination based on statistics. By including cost as a component of their determination, they are operating outside their congressional mandate.

      Secondly, the much maligned pharmaceutical companies spend a great deal of money testing to the “safe and effective” parameter in the expectation that having invested a billion or so dollars on proving the drug, that they will be able to recoup that money in sales afterward. Changing the rules after the fact is patently unfair and drives up the costs of other pharmaceuticals.

      Lastly, is the most insidious effect. Once a drug is labeled “safe and effective” by the FDA, there is a certain level of protection afforded to doctors who prescribe the drug and the pharmacists who supply it. Yes, the slip and fall lawyers can still try to go after them for gross negligence, but it is easier to prove you are working within expected parameters if the drug is listed. Without that listing, the drug isn’t just going to become more costly, it is likely to disappear completely from the legal market.

      • skorrent1

        The original function of the FDA was to determine only if a drug was “safe”, in keeping with the charge to “first do no harm”. Fairly cheap and relatively easy to do. The charge to determine “effectiveness” was added later and is the cause of much of the expense and delay in getting new drugs. The option of letting the market determine effectiveness was abandoned in favor of growing government power and control.

      • Menlo

        It’s possible I missed it, but I have not seen any document, transcript, or evidence beyond speculation that the FDA considered cost. If the FDA cited cost as a reason, please show me.

        In terms of investment, I believe the drug was initially meant for another condition. From what I gather (and I could be mistaken), Avastin had other primary uses, and this one was only discovered later. I would think that many drugs with high investment costs are eventually denied FDA approval. Many that were approved and marketed have actually been taken off the market, leaving some with no treatment options. Those would make better examples.

        I can’t much speak to the issue of legal protection, other than to say I would not want a doctor who thwarted action for fear of potential lawsuits more than the real risks leading to such suits. It’s quite possible that doctors would agree with the FDA in the first place. I don’t know.

        Unless the FDA cited cost as a reason in its decision, then the whole argument lacks credibility. If in fact they did, then I think their words doing so should be quoted and highlighted.

        I don’t like to defend the FDA. Their practice of allowing food and drugs to be made in China with less scrutiny shows that they have grave disregard for both the safety and effectiveness of drugs and for the American public. They obviously don’t have their priorities straight and I believe have become increasingly incompetent.

        • Flagstaff

          will still be on-label to be prescribed for its original medical conditions.

        • edintexas

          The failure of the FDA to cite any harmful effects, even for the off-label use, and the proven effectiveness for the off-label use, is the proof that the only remaining reason is cost to the government programs (Medicare and the Federal/State Medicaid).

          But since you have already stated (in another post) that you would be in favor of a Socialist government if it guaranteed whatever you define as basic human rights, we are wasting our bandwidth on you.

  • taxpayer1234

    Even for the approved uses, the NHS is denying Avastin to patients. And if the patients buy it themselves, the NHS will boot them out of the system completely! Here are three stories that illustrate just how much the NHS cares about expensive cancer patients:

    http://www.dailymail.co.uk/news/article-1230349/Bowel-cancer-victims-UK-denied-life-prolonging-drug-thats-free-Europe.html

    http://www.echo-news.co.uk/news/2313704.0/?act=complaint&cid=1614249

    http://www.dailymail.co.uk/news/article-502664/NHS-tells-cancer-patient-care-stop-buys-extra-drugs.html

    And this is what will happen here if Obamacare gets implemented.

  • Carol Tarasewicz

    Let’s save these sites and send to our next congressman or woman that voted for Obamacare. I don’t wish it but eventually one of them might end up needing this drug or another banned drug.

  • Flagstaff

    This story illustrates one thing. When the approval for use of a drug is dependent on a private insurance company, there will be competition between companies. One or more will likely have a policy that will cover this type of drug situation. When it’s the government you are dealing with, once the decision is made, there is no other place to turn to. You’re out of luck, unless you can convince your representative to try to get the agency to change its rules.

    When you deal with an insurance company, you at least have a chance of getting a favorable decision or an exemption if they’ve turned you down. If the government is your opponent, the answer is, “Sorry. It’s the law.”

    Another example is the situation in Arizona. The state can’t pay for organ transplants–no money, so treatment is rationed. Liberals are outraged that the state will “let these people die.” Yet they see no irony in having voted to eventually turn all of our health insurance over to the federal government, a government that has shown time and again that it will serve the preferred constituents and ignore or penalize the rest.

    Liberals are incensed at the state, saying the decision amounts to a “death panel” (because the governor and legislature is Republican), but they deny that such a thing could ever happen with the federal government.

    • mwmom

      This is what mystifies me when people want to give the government control of things like healthcare. A private company can’t force you to do something. You can take your business elsewhere and/or the market can respond accordingly. Once the government is in control, if they say no you have no recourse. People are all too happy to relegate tough decisions to someone else to make until they are not happy with the decision. By then it’s too late.

      • Flagstaff

        spread the word.

      • edintexas

        We all know it takes Congress (or government) to really screw things up (even worse than computers). Though we shouldn’t let the tort bar off the hook for their contributions (including the contributions to Congresscritters).

        I’m old enough to remember going to a doctor’s home at dinner time with a cut needing sutures. The doctor interrupted his dinner to see to my care in the office (at the back of the house). I was clearly underage, but the issue of parental permission never came up. He stitched me up (only a couple needed) and told me to come back to have the stitches removed. He never asked for payment up front, or even my name. When he removed the sutures, he charged me all of $2.00. Obviously this was also when doctors still made house calls. Seems like ancient history now. All this was before Medicare (or Johnson even being VP) and tort lawyers filing malpractice actions at the drop of a hat.

  • skorrent1

    The question is whether it should be rationed by government fiat or by the market. Like every supply-demand situation, it is impossible for every citizen in the world to be treated by the best doctor/surgeon in the world, with the best equipment in the world, and the best medicines in the world. If it were determined that a patient’s life could be “extended” by existing in zero gravity, would it be “worth it” to establish a hospice in orbit just for him?

    Much as we dislike thinking in those terms, every medical decision has both a price and an opportunity cost. Those paying the price get to make the decision. To the greatist extent possible, the patient should be involved in both the decision and the price.

    • http://teapartisan.wordpress.com Socrates

      The market does not ration. Accepting the leftist practice of redefinition doesn’t help the debate.

      Rationing assumes a fixed supply. The market, by definition, responds to a limited supply by searching for more.

      • Bill S

        The only reason for the supply to be fixed is that the government would constrain it. And that will be done by OCare, unless eliminated.

      • streiff

        all markets ration. That’s what pricing does.

        skorrent1 is right. Health care is de facto rationed because there is a near infinite demand and a very finite supply. You have a choice whether it is rationed by price, the way it is now, or it is rationed by committee decision as it is in Canada and Europe.

        • http://www.hakubi.us/ Neil Stevens

          Markets allocate resources. Rationing is the placing of a hard cap on what resources may be given to one person, regardless of his ability to pay.

          • streiff

            of rationing that only covers one part. By definition, rationing can be accomplished by markets or government action. You’re describing something like sugar/auto tire rationing in WW II. That’s one aspect but it certainly isn’t exhaustive.

            All rationing is is the allocation of resources when demand exceeds supply. It isn’t a bogeyman. We experience it every day.

          • acat

            is at work here.

            It’s possible, in fact encouraged, in an environment where resources are allocated by a free-ish market. A clever person can build a better mousetrap, iron lung, casting material, lathroscopic hardware, what have you.

            Where the resources are rationed by government fiat, there’s significantly less profit opportunity for the clever, and so … we get people coming from fiat-rationed countries to the U.S. market-rationed system… and we want to change it?!?!

            Mew

          • http://www.hakubi.us/ Neil Stevens

            That’s certainly how I’ve seen it used throughout the Obamacare debate.

          • YnotNOW

            even though the term technically does not apply. Because the market allocating resources implies that people must be responsible for their own decisions, and must bear the cost (and other fallout) of their decisions.

            Liberals want the Government to make the decisions, bear the cost, etc. for their wards of the state.

            But the way to let the market work efficiently in allocation of resources in healthcare is the same as throughout the economy – get government out of the way and let supply and demand meet freely in the marketplace.

          • catt

            Thanks for spelling out a clear distinction between _allocating resources_ versus _rationing_. I’ve often made the same mistake as the person you were replying to here in not having that distinction clear in my mind.

            But then how is Avastin an example of rationing as the OP says? The article and video about Christie Turnage are about FDA approval so they can get the expensive treatment via insurance. Avastin would still be available for breast cancer patients who had the ability to pay for it. By definition that’s not rationing. Right? What am I missing?

            I’m not defending the FDA’s decision. They don’t have the authority to take the cost of the drug into account.

            On the other hand … if they don’t have the authority to take the cost of the drug into account … and Medicare follows whatever the FDA says and private insurers do the same … then somehow the resource allocation decision has been punted to the FDA. Which means the resource allocation decision is essentially being made by the government already … and being made by an agency that is not supposed to do a cost/benefit analysis. Is this as messed up as it sounds?

          • davesinsanantonio

            probably worse. We are still early in this debacle, and the stories are only bound to get worse!!! The really messed up thing is that it is all going according to plan. The intent is final and absolute control over your life, and especially the ending of it. If you understand the mind of the Left, it is to make you do what you are told as long as you are productive, and then get rid of you when you are not. That is the essence of Statism. The individual is nothing, the state is everything. Individuals are replaceable and should be when they are worn out. Thus the state becomes a big machine, with no soul, and no heaven. The state is god and can destroy at will. And does.

    • http://www.hakubi.us/ Neil Stevens

      No, you don’t get to redefine what rationing means, so you’re wrong.

      Get educated, son.

      • Warrior

        The term “rationing” implies that someone will ration a resource, just as “resource allocation” implies that someone will allocate resources. Strictly speaking, neither is true of a market economy, unless one wishes to posit that Adma Smith’s “invisible hand” rations or allocates. (Of course, the healthcare market is highly skewed by the gubimnt’s involvement and that’s the real problem, although not the gravamen of the current discussion.)

        The real problem is that we have bought into the left’s co-opting of top down, statist TERMINOLOGY which always predisposes the idea that resources, I mean products and services (see, now I’m doing it) are given, handed out or awarded by a beneficent state. Consider the lamestream media’s constant carping about how wealth is “distrubuted.” Now, this is a term they borrowed from academia (statistics) which in truth is a description of how scores are arrayed on a graph, e.g. a bell curve, a bi-modal distribution, etc.

        But we know that wealth is CREATED, not DISTRIBUTED. The gubmint distributes welfare checks, it does not (or should not) distribute wealth. Indeed, that is the problem. The revenues the gubmint takes in should be used for Constitutionally mandated functions PERIOD. If they have enough money to distribute it to hungry lobbyists, be they states, corporations, foreign gubmints, or individuals, they have TOO MUCH of OUR MONEY.

        So, let’s be careful not to buy into their statist terminology. Let’s speak of money earned, wealth created, tax money for legitimate functions only, gubmints fro carrying out gubmint functions, NOT spreading, distributing or allocating OUR wealth.

  • rubicon01

    Few new drugs are introduced & they work perfectly right up front. Few new drugs are introduced & their costs are minimal right up front.
    That said, Avastin Is an expensive drug. All new drugs are. Avastin has apparently had terrific effects for some but for others almost no reaction. Again, this is typical for almost all new drugs,
    The FDA issue was & is, cost. When it comes to drugs, the costs are what Americans have always subsidized. Other nations get to make deals, we Americans get to pay the bill. That said, we also get access to all those new drugs & that means we get to survive earlier than others in most cases.
    The problem is, if Avastin can be eliminated from the list of available drugs, so too can ANY other drug. All the FDA need do is say, its too expensive. That can be said for thousands of drugs!
    Limitations by the FDA, mean bureaucrats get to decide what to even make available. Not that it will or might work, but that “in their opinion its too expensive, so it will not be available.”
    If “I” and my family, along with my Doctor & insurance company come to that conclusion, then “we” made an informed decision. Under ObamaCare, we do not get to make that decision. We are told what the decision is!
    Every new drug takes time to work its way through the system & many are re-formulated in the first months & years to make them more effective. Avastin was in the process. Over time, its effectiveness would have been increased & its costs would have been lowered as its use was expanded.
    Once they limit drugs, what happens next? How about limiting specific surgeries or other treatments? When does it stop?
    Are we really going to insure 30 million more & that is why the rest of us must undergo this intrusion into our lives, or will we still have millions uninsured & we still lose out to paying for the massive federal bureaucracy that will be limiting our access to medical treatments, because we have to pay for the bureaucracy?
    I suspect the real costs of ObamaCare, are the bureaucratic costs that will only grow & grow beyond even the costs of new drugs. I suspect we also have a new way for the costs to run America to be reduced.
    I call it, eldercide! After all, babies are being aborted by the hundreds of thousands. With ObamaCare, hundreds of thousands of the elderly, whose numbers are increasing everyday with the boomer population coming of age, can be just as effectively “aborted” by just limiting what medical care, or even “if” medical care will be available!!!
    Sick thought, isn’t it???