Rationing Health Care - it's a lie!

[ddt]

For the fun of it, I also looked at what happened to lapatinib in the Netherlands. The site of the CVZ, the Dutch counterpart of NICE, gives their report here, dated 26 January 2009. Most of it is Double Dutch to me, but the gist is that no advantage has been shown of using a combination of lapatinib and capecitabine to using only capecitabine. And it's six times as expensive. And there was only one study indeed. So they advised the Minister not to put it on the list of drugs that are reimbursed.

And this page on the same site says that GSK retracted their application on 23 June.

 

[BeAChooser]

Quote:
Or do you think the outrage would only manifest if it was a public institution doing the same thing?

I think it would manifest to a greater degree, yes.

Except people will have less ability to do anything about it. If private insurers do it, it's a free market and the customer can walk to a provider that will cover it. But if the provider is the government, they may not listen at all (just look at your past experience with government where complaints are concerned) and if they end up being the sole provider (like Obama wants), you will then have no recourse. In fact, the bill states in Section 123 Page 30 that a government Health Benefits Advisory Committee will recommend what treatments and benefits are available and that once accepted and adopted by the Secretary of Health and Human Services, there is no appeal.

 

[Rolfe]

In fact, experience shows the opposite to be the case.

Rolfe.

 

[BeAChooser]

Try this link. http://nhs.medguides.medicines.org.uk/nhs/medicine.aspx?name=Tyverb&use=Breast cancers&preparation=1

"Your health, your choices" it says at the top of that web page.

You are being deceptive again, Rolfe. What you linked from the NHS regarding Tyverb is just a description of the drug. It doesn't say whether the NHS will actually prescribe it to patients. And this does indeed suggest NHS won't.

http://www.nelm.nhs.uk/en/NeLM-Area...-cancer-in-its-Final-Appraisal-Determination/

NICE does not support use of lapatinib (Tyverb®) for breast cancer in its Final Appraisal Determination

If NHS is currently using it, it's only doing so because GSK has agreed to pay for it's use:

http://www.gsk.com/media/pressreleases/2009/2009_pressrelease_10031.htm

NICE today issued its final appraisal determinationadvising against NHS funding for Tyverb® (lapatinib), a treatment for an aggressive form of advanced breast cancer (ErbB2-positive). ... snip ... GlaxoSmithKline (GSK) will consider appealing the decision. Simon Jose, General Manager, GSK UK commented; “We disagree with the NICE decision and believe Tyverb is a valuable and important treatment for eligible women. In recognition of the cost effectiveness challenges with drugs that treat patients with a short life expectancy, we offered the Tyverb Patient Access Programme to help ensure it was made available on the NHS. ... snip ... GSK proposed the patient access programme in the UK when NICE indicated early on in its review that it did not consider lapatinib to be cost effective in treating this patient population. In an effort to achieve a positive outcome for patients and greater value to the NHS, GSK bears the cost of lapatinib, for all eligible patients under the scheme, for up to the first 12 weeks of treatment. The NHS would commence payment only for the patients who continue to receive clinical benefit beyond 12 weeks. GSK will continue to honour the patient access programme for NHS trusts in the UK.

Now how many patients beyond the 12 weeks is NHS actually paying for?

 

[Ziggurat]

In fact, experience shows the opposite to be the case.

My point is rather different than BAC's point. Precisely because our government is responsive to public demands, I do not think it will be able to cut drug costs significantly, because voters will demand high availability.

 

[GreyICE]

My point is rather different than BAC's point. Precisely because our government is responsive to public demands, I do not think it will be able to cut drug costs significantly, because voters will demand high availability.

Okay, so on this thread there's been the idea that drug costs are mostly due to R&D, so focusing on manufacturing ignores the R&D costs.

And now you're running out the argument that the limiting factor is the manufacturing costs, so if you reduce drug prices, they manufacture less drugs, and R&D costs aren't that big of a deal.

There's four options here: Paragraph 1 is wrong, paragraph 2 is wrong, paragraph 1&2 are both wrong because they're statements made by babbling libertarians, or Health Care is SATAN AND YOU'RE HELPING SATAN!

Can I tick your name off for option 4?

 

[Skeptic Ginger]

But it's not the mere existence of tax breaks that couple it to work, it's the fact that the tax code specifically favors health care purchased through work. And there's no good reason for that. ....

No, there isn't a good reason but you have too many people from unions to insurers who sell the plans objecting to any changes. Mention the word single payer and people think you are implementing some socialist totalitarian dictatorship.

It's your side making up the lies here rather than introducing legislation getting the employers out of the loop.

 

[Skeptic Ginger]

(I'm on-record somewhere here as believing that the mandatory insurance-based systems such as the Dutch one are even better than the single-payer NHS)

No one seems to be addressing the problem of not making it mandatory to have coverage while at the same time making it mandatory to accept pre-existing conditions. It's obvious that won't work. I'm waiting for one of these politicians to actually even speak to this issue.

 

[Skeptic Ginger]

Going back to the question of whether insured people can rely on getting the care they need, and whether uninsured people will also be looked after acceptably, someone else linked to this article. The quotes below are from the article and the subsequent comments.
...
There's also a funny one about Russell Brand trying to get out of a psychiatric hospital in the USA and nobody would take any notice of him, so he told them he wouldn't be able to pay their bill (yeah, right!) and had no insurance, and he was out the door before you could say "co-pay deductible".

Th internet is crawling with these sorts of stories. Are they all lying or exaggerating for political reasons? Then we only have to look within this forum, everybody from Ducky to epepke and a lot of people in between, reporting that they've been sick and unable to pay for what they needed, and in deep money trouble or going without. I was told about one member, years ago, who needed a lung transplant (for CF) that his HMO denied, and he died while fundraising efforts were getting off the ground.

Has there been one single British resident (or even European resident) who has posted similar difficulties in the forum? I know the baseline numbers may be skewed to the US side, but there are enough non-US folks here that you'd expect to hear about something - that is, if the anti-universal-healthcare propaganda was anywhere close to right. In contrast, it's the experiences of US posters here (starting with epepke, which shocked the socks off me) that reinforces my impression that the "horror stories" coming out of the US healthcare systems are true and are representative.

Does anybody really want to defend the positon that the present system is basically OK and it's just a few people who've unfortunately slipped through the net we're hearing about?

Rolfe.

A few of those supposed stories sound pretty unlikely. The limited number of covered days, for example doesn't jive with the fact kids are not liable for their parent's keep.

Quote:
You have no idea what it’s like to be called into a sterile conference room with a hospital administrator you’ve never met before and be told that your mother’s insurance policy will only pay for 30 days in ICU. You can't imagine what it's like to be advised that you need to “make some decisions,” like whether your mother should be released “HTD” which is hospital parlance for “home to die,” or if you want to pay out of pocket to keep her in the ICU another week. And when you ask how much that would cost you are given a number so impossibly large that you realize there really are no decisions to make. The decision has been made for you.

So while it might bankrupt Mom, the hospital couldn't kick her out without her being stable or without a place to send her, and the hospital couldn't bill the kids.



And this one,

$500,000+ of open-heart surgery later, they tossed her out of the hospital four days later because she couldn't afford to stay. It's obviously impossible for her to pay this bill, so I can only assume they will have to declare bankruptcy.

again is questionable. There have been instances of people being discharged unethically who were unable to walk, for example and needed nursing home care. So I'm not saying it doesn't happen. But it is very unlikely to happen a couple days after some major surgery unless the patient was medically able to be discharged.

 

[Rolfe]

Yeah, I realise that. It's just the sheer number of the stories that make me suspect that there's a fire somewhere under all that smoke....

Rolfe.

 

[Francesca R]

I currently have health insurance through my employer. If I get sick, I know that the insurance company will not revoke my health insurance on a technicality. I know this with absolute certainty. How do I know this, you might ask? Because I didn't have to fill out anything about my medical history when I signed up. Nothing, nada, zip. Revoking my health insurance isn't an option for my insurer. And that's the case for most people who get their insurance through work.

Right but it's the case for everyone who gets their insurance through a universal system even if they are not employed. Getting it through an employer is a halfway house (perhaps more than halfway) to getting it universally. It is more risky though because you have less than 100% security you will keep the employment, whereas you have virtual 100% certainty you will keep citizenship (and you don't even need to be a citizen in many UHC systems). And it can't logically be cheaper through an employer unless the employer is somehow able to select employees of above average health and can demonstrate this to the insurer. Such selectivity is not the business of employers and most probably flouts employment law in the US just as it does through Europe.

For those who purchase plans individually, I do not know where to find those statistics, but I do know that you can protect yourself from being dropped on a technicality by filling out the application forms accurately, and buying a plan which allows automatic policy renewal.

I would not be surprised if "insurance against being dropped/rejected" arose somewhere if it has not already. Of course this will be prey to the same selection bias as non-universal insurance is in the first place, but probably more exaggerated. COBRA is simply HC-inspired insurance against losing your job. This is an additional cost of insuring your health unnecessary in a universal system. (And another one only available to some of the population)

Partial systems like employer-funded insurance can generally only mitigate against adverse selection by capping your cover and excluding items. Universal systems get around it by having a pool so encompassing that there is precious little selection going on (other than Sicko's ill French guy travelling home from the US before annnouncing his illness). Because universal systems correct this important market failure they are able to cap the participant's maximum co-pay, which is the reverse of capping the cover and massively more conducive to social welfare.

(This is not intended to contradict my statement that they do still ration. Both systems do)

 

[Ziggurat]

No, there isn't a good reason but you have too many people from unions to insurers who sell the plans objecting to any changes.

I know that they would object to any reduction in the tax breaks for employee-provided healthcare purchases, but why would they object to an extension of those tax breaks to non-employee health plans? It's no skin off their backs.

It's your side making up the lies here rather than introducing legislation getting the employers out of the loop.

First off, it's not "my side". This isn't a football game. It's me, with my opinions. And secondly, actually, republicans are in fact trying to do exactly what I'm talking about:

http://republicans.waysandmeans.hou..._Solutions_Group_Outline_Health_Care_Plan.pdf

"To lower the costs of health care, the Republican plan:
•
Brings greater fairness to the tax code by extending tax savings to those who currently do not have employer-provided insurance but purchase health insurance on their own. This provision would provide an “above the line” deduction that is equal to the cost of an individual’s or family’s insurance premiums."

 

[Ziggurat]

Okay, so on this thread there's been the idea that drug costs are mostly due to R&D, so focusing on manufacturing ignores the R&D costs.

And now you're running out the argument that the limiting factor is the manufacturing costs

No. I'm not sure what got you confused, but nothing I've said has anything to do with manufacturing costs.

 

[kellyb]

My point is rather different than BAC's point. Precisely because our government is responsive to public demands, I do not think it will be able to cut drug costs significantly, because voters will demand high availability.

Just negotiating the prices down will reduce costs quite significantly.

 

[kellyb]

Right here, on this forum, from people complaining about evil insurance companies.



I think it would manifest to a greater degree, yes.

I think the outrage degree and direction will vary by political philosophy. People on the right prefer covert and private profit-driven rationing, while those on the left would prefer and open and transparent public process such as NICE.

So, ok. Conservatives are going to throw a fit. They're in the minority, though.

 

[BeAChooser]

So, ok. Conservatives are going to throw a fit. They're in the minority, though.

http://www.gallup.com/poll/120857/Conservatives-Single-Largest-Ideological-Group.aspx?version=print

Thus far in 2009, 40% of Americans interviewed in national Gallup Poll surveys describe their political views as conservative, 35% as moderate, and 21% as liberal. This represents a slight increase for conservatism in the U.S. since 2008, returning it to a level last seen in 2004.

http://www.lifenews.com/nat5197.html

Despite the results of the 2008 presidential election, Americans, by a 2-to-1 margin, say their political views in recent years have become more conservative rather than more liberal.

Some 39 percent of Americans say they are more conservative, 18 percent say they are more liberal, and 42 percent say their views have not changed.

 

[kellyb]

40% is not a "majority".

 

[makaya325]

I was just talking to some guy in Starbucks over politics:

He said this: Where should health care funding go to more: A dieing man who needs a liver transparent, or a man who wants a sex change?

I know, its OT, but i just wanted your opinion.

 

[Ducky]

I was just talking to some guy in Starbucks over politics:

He said this: Where should health care funding go to more: A dieing man who needs a liver transparent, or a man who wants a sex change?

I know, its OT, but i just wanted your opinion.

False dichotomy. You're assuming health care funding is going to pay for one procedure at the detriment of the other.

This type of loaded question seems to me to do little more than trolling for inflammatory responses.

 

[makaya325]

False dichotomy. You're assuming health care funding is going to pay for one procedure at the detriment of the other.

Correct