Health care - administrative incompetence

[Architect]

What I don't get is why the transplant and one year of follow-up would run $450,000. Again, I don't know enough to say if that's expensive or cheap for what needs to be done, but I know it's a buttload of money. The parents were told they could pay for it if they could come up with a $75,000 down payment.

Source

Oh FFS, that's just terrible.


ETA: And I'm not being sarcastic. I think it's terrible that any parent would be faced with that kind of thing.

And XJX: That doesn't happen in our country.

 

[Delscottio]

Don't go pulling a xjx388 on us (unless that's what you're intentionally doing).

Apparently the girl had recurrent leukemia and had just a few weeks before received a bone marrow transplant. They said patients like her have a 65% 6-month survival rate. I believe they were declining on the basis of not being worth it rather than experimental. It sucks that we have to make those kinds of decisions, and I personally don't know enough to make that call.

What I don't get is why the transplant and one year of follow-up would run $450,000. Again, I don't know enough to say if that's expensive or cheap for what needs to be done, but I know it's a buttload of money. The parents were told they could pay for it if they could come up with a $75,000 down payment.

Source

Thinking about would she even made the transplant list.

How does the transplant system work over there?

 

[Agatha]

The guidelines for renal transplants can be found on this page and approximately the same guidelines are used for other cadaveric transplants.

Basically, if a patient has a clinical need for a transplant, and will benefit from it, then they get put on the list.

The list is a national thing, so if an available organ comes up, it goes to the person nearest the top of the list for whom it is suitable, no matter where in the UK they are. People on the transplant list are always waiting and hoping for that phone call, and although a lot of people do agree to be organ donors, the demand tends to outstrip supply.

 

[Emet]

The guidelines for renal transplants can be found on this page and approximately the same guidelines are used for other cadaveric transplants.

Basically, if a patient has a clinical need for a transplant, and will benefit from it, then they get put on the list.

The list is a national thing, so if an available organ comes up, it goes to the person nearest the top of the list for whom it is suitable, no matter where in the UK they are. People on the transplant list are always waiting and hoping for that phone call, and although a lot of people do agree to be organ donors, the demand tends to outstrip supply.

But in the US, if you don't have insurance or cash up front, well, you're likely to be turned down:

Many transplant centers will not accept people without insurance.

http://www.thehastingscenter.org/Publications/BriefingBook/Detail.aspx?id=2198

 

[Delscottio]

Imay not have been clear. over there = US

 

[Tatyana]

It sounds horrible but I am a bit puzzled. Would she have recovered from the vegative state and if she got passed the 6 month stage how long would she be looking at? I presume the answer to the former is yes and the latter years? If so disgusting.

Don't go pulling a xjx388 on us (unless that's what you're intentionally doing).

Apparently the girl had recurrent leukemia and had just a few weeks before received a bone marrow transplant. They said patients like her have a 65% 6-month survival rate. I believe they were declining on the basis of not being worth it rather than experimental. It sucks that we have to make those kinds of decisions, and I personally don't know enough to make that call.

What I don't get is why the transplant and one year of follow-up would run $450,000. Again, I don't know enough to say if that's expensive or cheap for what needs to be done, but I know it's a buttload of money. The parents were told they could pay for it if they could come up with a $75,000 down payment.

Source

As long as Nikki Blunden is mentioned as evidence as to how care is 'rationed' in the UK, Natalie Sarkisyan is my evidence that care is also rationed by insurance companies.

I think they are equivalent.

 

[xjx388]

I was thinking about xjx388's weird attitude that not giving Nicky Blunden the experimental drug that wasn't passed as safe and effective was major-league evil, but he's prepared to overlook all the far worse outrages that happen in America.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199374.htmIt is safe, effective and in use regularly here in the US. All insurers cover it.

He repeatedly asserted that if we think healthcare is a right, then we're evil if we don't spend every penny possible on everybody's healthcare, no matter how pointless or how untested the drug. I think it's back to this strange right-wing concept of "rights" that we've debated before. Rights not being whatever your society has legislated that you have a right to, but something innate.

In the case of lapatinib, it is not pointless or untested. Unless, of course, you are the NHS and you want to save as much money as possible -then yeah "pointless and untested!"

Remember the arguments we had with Jerome, who was using much the same language, including the stuff about "you don't have a right to take the fruits of my labour". He asserted, vociferously, that rights were innate and unalienable, but when pressed about what they were could only say "life, liberty, pursuit". Trying to explain that none of these things is either innate or unalienable, even by using the example of slaves, was an uphill struggle.

So a child born in the Democratic Republic of the Congo has no inalienable rights of their own? They can be used as soldiers because that's what their society has deemed OK? I think even you would agree that there are certain rights we are born with and that it's wrong for society to take away.

This seems to be a common misconception among Americans. They argure whether acccess to healthcare is or isn't a right, as if this is a question with some sort of moral absolute answer, like "is murder wrong?". The actual situation, which is that (like all other rights) it's a right if you live in a society which has legislated to make it a right, and not if you don't, seems hard for them to grasp.

Why is murder wrong, Rolfe? Could it be because we are all born with the right to life? And if society legislates that children can be used as soldiers, then that's OK? Or is it violating their inborn human rights?

They seem particularly scared to answer "yes" to the question, because they then conclude that if access to healthcare is a right, then there is absolutely no limit on anything citizens might then have to be provided with.

No, no. You have it twisted. You guys have already decided it's a right. Yet your system lets people die everyday because their treatment isn't "cost-effective." And who determines cost-effectiveness? Why, your government of course! You know, the ones who hold the purse strings? In this way, your government is no different than a US insurer except for the fact that your poorer citizens have no choice to find an alternative.

I remember one poster, a while ago, saying that of course it would be impossible to make healthcare a right, because then everybody would demand to see only the best surgeon, even if he was thousands of miles away, and the state would have to pay for people to be flown thousands of miles to see the consultant of their choice. Because it was their right! Trying to explain that this wasn't so, and that it was perfectly easy to structure a universal healthcare system to provide only what was reasonable or deliverable, was a struggle. Because limiting access in any way would then be violating someone's "rights".

It's completely batcrap insane.

What's completely insane is continuing to insist that the NHS provides for everyone's needs. The evidence is mounting that this is not so, especially for people in poorer regions. Now you are qualifying your statement with "only what is reasonable and deliverable." Interesting change from your rosy-cheeked description earlier.

That seems to be the basis of xjx388's criticism of the NHS though. No matter how comprehensive the coverage, there's always a boundry somewhere, and if you've decided people have a right to healthcare, you have violated their rights!! The USA, of course, doesn't confer any right to healthcare on anyone, so it's perfectly peachy if even basic care is denied. No rights have been violated.

No one said the US system was perfect the way it is. It needs major changes to make it accessible to everyone.

That's why I tried to explain the actual situation. In Britain, we have decided to set up a universal healthcare system, with defined benefits which are pretty comprehensive, and give every legal resident the right to access that system when they need it. You can try to make the case that coverage should be even more comprehensive than it is, but so long as people are given the care that is covered by the NHS, nobody's rights have been violated.

And that system works for you. But to say that the NHS should be our model for healthcare is wrong. I'd rather look at what countries like Switzerland and yes -Singapore are doing. They've found ways to

• Provide care to all citizens
• Make people personally responsible for their healthcare -thus lowering costs
• Keep medical decision making in the hands of doctors and patients
• Keep physician pay at acceptable levels.

And it doesn't involve a single government payer solution.
Those are the four things I think we need for America. Everything else is just emotional hand-wringing.

The question the Americans should be asking isn't "is access to healthcare a right" in some fundamental philosophical sense, but "should US citizens be given the right to access affordable healthcare?" Put that way, it is a question that can be debated sensibly. It can then be debated further as to what level of healthcare US society wishes to grant people as a right, because obviously it is up to that society to decide just how far it wants to go.

Should citizens of the world's only superpower and self-described greatest country on the planet have the right to access to affordable healthcare? I'd say it's a no-brainer.

On this we agree 100%

How comprehensive should that access be? Given that everywhere else can afford transplants and chemotherapy and quadruple bypasses for their citizens, I'd say they'd have a hard time setting the bar lower.

Is it possible, with present resources? Obviously yes, since the current healthcare system is gobbling up twice the amount of money that most universal healthcare systems consume.

Would it be economically advantageous to do it? Again, obviously yes, since pissing away about 8% of GDP on a healthcare system that isn't delivering anything extra for the money is beginning to cause the USA appreciable economic harm.

Is it possible within the socioeconomic structure of the USA? Given the political lobbying power of those who have been made immensely rich by trousering most of that excess 8% of GDP, I'd say the USA is ed.

Sorry, chaps.

Rolfe.

Again, no one is disputing the fact that the current American system mostly sucks. What I say is that NHS-style UHC would be an economic disaster here in the US based on numerous reasons which I've presented here. There has to be a better way to do it and that's what we should be fighting for.

 

[Ducky]

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199374.htmIt is safe, effective and in use regularly here in the US. All insurers cover it.

In the case of lapatinib, it is not pointless or untested. Unless, of course, you are the NHS and you want to save as much money as possible -then yeah "pointless and untested!"

You seem to be under the mistaken impression that if it's approved in the US the rest of the world agrees.

 

[Architect]

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199374.htmIt is safe, effective and in use regularly here in the US. All insurers cover it.

Can we therefore assume that your FDA will automatically approve a drug if the NHS have done so first?

No, I didn't think so.

In the case of lapatinib, it is not pointless or untested. Unless, of course, you are the NHS and you want to save as much money as possible -then yeah "pointless and untested!"

And your source for this? Link, please?

So a child born in the Democratic Republic of the Congo has no inalienable rights of their own? They can be used as soldiers because that's what their society has deemed OK? I think even you would agree that there are certain rights we are born with and that it's wrong for society to take away.

I don't know. Why don't you read the Congolese constitution and tell us?

Why is murder wrong, Rolfe? Could it be because we are all born with the right to life? And if society legislates that children can be used as soldiers, then that's OK? Or is it violating their inborn human rights?

I see; you believe we're born with a right to life. You just refuse to provide medical cover to everybody in order to then save that life. What a peculiar view.

Yet your system lets people die everyday because their treatment isn't "cost-effective."

I think you'll find that you've yet to provide any evidence that this is the case.

This may be hard, what with us outliving you and everything.

And who determines cost-effectiveness? Why, your government of course! You know, the ones who hold the purse strings? In this way, your government is no different than a US insurer except for the fact that your poorer citizens have no choice to find an alternative.

Well you've yet to prove that. You know - links, evidence, reports and stuff.

What's completely insane is continuing to insist that the NHS provides for everyone's needs. The evidence is mounting that this is not so, especially for people in poorer regions. Now you are qualifying your statement with "only what is reasonable and deliverable." Interesting change from your rosy-cheeked description earlier.

What "evidence" would this be? So far, you've given us scant information to support your own thesis.

Did I mention that we lived longer than you and had lower infant mortality rates? You know, two key healthcare indicators?

No one said the US system was perfect the way it is. It needs major changes to make it accessible to everyone.

Hmm. And this involves opening it up the private sector who are currently shafting you, one assumes. It would be funny, if it weren't for the fact that you appear to mean it.

 

[Uncayimmy]

As long as Nikki Blunden is mentioned as evidence as to how care is 'rationed' in the UK, Natalie Sarkisyan is my evidence that care is also rationed by insurance companies.

I think they are equivalent.

Fair enough.

 

[kellyb]

Xjx, do you understand that the NHS isn't "a single government payer solution" to the health care needs of the UK citizens?

 

[xjx388]

According to Cigna, a liver transplant is an experimental therapy for liver failure, therefore, they don't need to pay for it.

The initial refusal killed Nataline Sarkisyan.

http://www.msnbc.msn.com/id/22357873/ns/health-health_care/

Nope. Leukemia and it's complications killed Ms. Sarkisyan. Liver transplant is not medically indicated in such a rare occurrence. Sad but true.

In Mrs. Blunden's case, Tyverb/Tykerb is indicated for treatment. In the US it is prescribed for such patients.

 

[Ivor the Engineer]

Well, you are someone who conservatives think should be sacrificed (like, actual human sacrifice-style) to the "invisible hand" (aka, god-like force) of the free market.

Funny how they back peddle and get all "Oh, I'm not really, necessarily saying that, exactly" when faced with an actual human they would, if it were more anonymous, rather see die than see tax money save.

One death is a tragedy. A million deaths is just a statistic.

 

[Gandalfs Beard]

Xjx, do you understand that the NHS isn't "a single government payer solution" to the health care needs of the UK citizens?

The NHS IS a Public Single Payer system, though Private Insurance is also available.

If xjx388 wants to point to alleged inequities in the UK's NHS system, then xjx should acknowledge the Horrorshow that is the US's Privatized Health Insurance system.

I have yet to see any factual evidence of how horrible the UK's NHS is, yet there is plenty of factual evidence of how horrible the US's Private Insurance industry is.

GB

 

[kellyb]

Nope. Leukemia and it's complications killed Ms. Sarkisyan. Liver transplant is not medically indicated in such a rare occurrence. Sad but true.

In Mrs. Blunden's case, Tyverb/Tykerb is indicated for treatment. In the US it is prescribed for such patients.

How is a 65% chance of living another 6 months "not medically indicated"? Her own doctors were pushing for it!

 

[kellyb]

The NHS IS a Public Single Payer system, though Private Insurance is also available.

If xjx388 wants to point to alleged inequities in the UK's NHS system, then xjx should acknowledge the Horrorshow that is the US's Privatized Health Insurance system.



GB

Sure, but the NHS isn't the only option for care in the UK. In addition to insurance, you can also pay out of pocket (direct pay to MDs) in the UK.

 

[xjx388]

Can we therefore assume that your FDA will automatically approve a drug if the NHS have done so first?

No, I didn't think so.

Oh no, quite the opposite. Rimbonabant is a good example of this. It was available just about everywhere except the US. Then the FDA refused to allow it. Can anyone in the class guess what happened next?^WP

And your source for this? Link, please?

Is lapatinib given to people with breast cancer in the UK by the NHS? No. Why not? There's your answer.

I don't know. Why don't you read the Congolese constitution and tell us?

Nice avoidance of the issue. I assume you have no clue about human rights violations in the world around you.

I see; you believe we're born with a right to life. You just refuse to provide medical cover to everybody in order to then save that life. What a peculiar view.

I guess you only believe you have a right to what the government lets you have a right to. Quite the opposite of what we believe here. And a right to life does not necessarily mean that you have a right to measures to save it.

I think you'll find that you've yet to provide any evidence that this is the case.

How easily you forget reports like this one. Or this one. Or this one. Oh, and don't forget this one. That ought to be enough to get you started.

Hmm. And this involves opening it up the private sector who are currently shafting you, one assumes. It would be funny, if it weren't for the fact that you appear to mean it.

No. The private sector is not shafting us. The whole system is set up to incentivize shafting us. That's what needs to change.

 

[Tatyana]

Nope. Leukemia and it's complications killed Ms. Sarkisyan. Liver transplant is not medically indicated in such a rare occurrence. Sad but true.

In Mrs. Blunden's case, Tyverb/Tykerb is indicated for treatment. In the US it is prescribed for such patients.

To extend her life a few months, and it only works in 35% of patients.

Same thing as far as I am concerned.

Ms Sarkisyan's healthcare was rationed.

However, if you don't like this rationing, I am sure I could find more examples.

 

[Tatyana]

Nope. Leukemia and it's complications killed Ms. Sarkisyan. Liver transplant is not medically indicated in such a rare occurrence. Sad but true.

In Mrs. Blunden's case, Tyverb/Tykerb is indicated for treatment. In the US it is prescribed for such patients.

Hmmmmmmmmmmmm, would PROFIT MOTIVES of the insurance companies and the big pharmaceuticals in the US be the reason for promoting drugs that may not be safe?

Just because the toothless dragon, the FDA, plays fast and loose with the regulations and has been sold out to big pharma (and big sCAM) ages ago doesn't mean that every single regulatory body is going to bend over and take it.

There are risks with every single drug, the question is, is it worth it?

Right now, the monoclonal antibody therapies have a lot of promise, but they are just not working out that well.

I know what needs to be done to sort it out, as does just about anyone with a knowledge of immunology.

Let me know if you know what the solution is.

http://pharmagossip.blogspot.com/2008/03/gsk-tykerbtyverb-liver-is-evil-it-must.html

GSK - Tykerb/Tyverb: the liver is evil, it must be punished

GlaxoSmithKline’s breast cancer therapy Tyverb has suffered a setback in Europe after regulators referred the drug back to the Committee for Medicinal Products for Human Use for further consideration, following new data on a potential liver risk.

Another monoclonal antibody therapy bites the dust.

http://us.mobile.reuters.com/article/healthNews/idUSTRE6BF3MI20101216

U.S. and Europe seek limits on Roche's Avastin

Thu, Dec 16 16:13 PM EST
By Lisa Richwine and Ben Hirschler

WASHINGTON/LONDON (Reuters) - Roche's top drug Avastin should no longer be approved for breast cancer, U.S. health officials said on Thursday in an unusual move that could shave $1 billion from annual sales.

European authorities, meanwhile, recommended restricting the drug in breast cancer so it is given only with one type of chemotherapy.

Avastin, the world's best-selling cancer medicine, has been approved for fighting breast and other cancers. But the drug failed to extend survival in four trials of patients with breast cancer.

"Given the number of serious and life-threatening side effects, the FDA does not believe there is a favorable risk-to-benefit ratio," Dr. Richard Pazdur, the U.S. Food and Drug Administration's head of cancer drugs, told reporters.

Side effects include holes in the stomach and intestines, bleeding and blood clots.

Did you notice the amount of money that this drug made each year?

 

[kellyb]

Oh no, quite the opposite. Rimbonabant is a good example of this. It was available just about everywhere except the US. Then the FDA refused to allow it. Can anyone in the class guess what happened next?^WP

.

So, when a European agency doesn't approve a drug, it's evidence of some sort of international covert rationing conspiracy. But when the FDA doesn't approve something, it's evidence based medicine?

Is that your argument?