This is what will happen if we permit government cost/benefit boards to decide on what treatments–and patients–are worth spending money on–and which aren’t. The Province of Ontario, Canada, has limited life extending treatment for terminal colon cancer patients to save $9 million. From the story:
Opponents of the public option maintain that Canadian-style health care would entail rationing, caps on care, bureaucratic interference in medical decision-making and even “death panels” deciding when the ill become too expensive to save. Most Canadians believe this is a gross exaggeration of reality. But then how to characterize Ontario’s decision to cut off funding for colorectal cancer patients taking a life-prolonging drug, in order to save $9-million a year?
Andre Marin, the province’s plain-speaking ombudsman, said the decision “verges on cruelty.” Marin said the “arbitrary” limit on the number of cycles of the drug Avastin that Ontario will fund forces patients to pay out of their own pockets or abandon treatment. Avastin does not cure cancer, but prolongs life when taken in conjunction with chemotherapy treatment, adding, on average, nine months of survival. “For patients whose cancer has already metastasized, it stops their tumours from growing and prolongs their lives, at least for a while. It is, without exaggeration, their lifeline,” Mr. Marin said.
Ontario Health Minister David Caplan rejected the suggestion that the cap on treatment was a financial decision alone, arguing it was based on clinical evidence. But it’s easy to reach the conclusion that the province decided nine extra months of life for a dying patient wasn’t worth the money. Which is pretty much the kind of decision a “death panel” would be confronted with.
This is precisely the “evidence based” kind of decision making, linked with quality of life judgmentalism, that Obamacare would impose to cut costs. And, it is precisely what Oregon did to Barbara Wagner and Randy Stroup under its rationed Medicaid system–with the exception that a compassionate bureaucrat offered to pay for their assisted suicides.
Death panel? You be the judge.
October 7th, 2009 | 9:05 am
Evidence based. How terrible, to only pay for the stuff that works. I’m sure your insurance company will let you use whatever experimental treatment you want, no matter how expensive?
October 7th, 2009 | 9:25 am
This is quite separate from the death panel issue. Canadian Medicare doesn’t cover all health care and definitely not all pharmaceuticals. It was never meant to. There is still room for private insurance (e.g. http://www.sunlife.ca ) for cases that are not covered, and many companies provide extra insurance as a benefit. But since coverage is so extensive, most people stick with what the government provides and deal with the out of pocket for the exceptions. What the ombudsman is saying, is simply that more things need to be covered than are currently on compassionate grounds, no more, no less.
October 7th, 2009 | 10:00 am
Martin: Ontario IS limiting medical care that works, e.g. extends life while not saving it. That is the insidious nature of rationing, it isn’t only what, but who.
October 7th, 2009 | 1:47 pm
Of course it limits care. With no limits to reasonable, evidence-based medicine, no government and no insurance company could afford to provide care. Two million dollars for an experimental surgery that might prolong your life by 6 weeks? $30,000 for a month of avastin that has a one in 5 chance of prolonging your life by two months? The reality is, every government and every insurance company draws lines.
October 7th, 2009 | 3:23 pm
martin: Beautiful! You make my point about the danger of Obamacare. This chemo ISN”T EXPERIMENTAL. It IS EVIDENCE BASED, e.g., it serves the the laudable medical benefit of extending life. So, the panel has decided that these patients will have to just die earlier than otherwise because that benefit–to them–isn’t worth the $.
Death panel? What death panel?
October 7th, 2009 | 3:49 pm
More false comparisons between proposed American reforms (which you sneeringly call “Obamacare”) and the Canadian health care system. Total rubbish! Doesn’t being an “ethicist” imply telling the truth occasionally?
October 7th, 2009 | 8:47 pm
Wesley, you have written several times about how the implementation of a law is as important, and sometimes more important, than the law itself. This case is a good example of several problems with government-run health care.
Ontario has a “Committee to Evaluate Drugs” (CED). This makes recommendations to the Ministry of Health and Long-Term Care concerning what should be funded by the province’s New Drug Funding Program. The CED recommended that bevacizumab (Avastin) not be funded at all through Cancer Care Ontario’s New Drug Funding Program. That recommendation was explicitly based on cost-effectiveness evaluation and perceived quality of life assessment. The CED stated, “The submitted analysis suggests an incremental cost per quality adjusted life year (cost/ QALY) compared to an
irinotecan/flurouracil regimen that is roughly three times that seen for other cancer drugs.” So the first take-home lesson for America here is that quality of life considerations very quickly enter funding decisions.
The executive (ultimately, the health minister) overrode that recommendation. He allowed funding for Avastin in limited circumstances. These are that (1) it be used for first-line therapy of colon cancer, (2) and that it be used for up to 12 cycles (about 6 months). He also allowed 4 more cycles for those patients whose disease is not worsening while they are receiving the drug. Importantly, his ruling would preclude the ongoing use of the drug beyond 16 cycles for patients who are still demonstrating benefit from it.
Three points must be made here. First, oncologists virtually never continue to prescribe Avastin for patients whose disease is worsening while they receive it. Therefore, the arbitrary limit of 16 cycles applies ONLY to those patients who are benefiting from it! The benefit of continuing Avastin for that subpopulation of patients is vastly greater than the usually cited overall benefit of the drug for unselected patients.
Second, the policy does not allow Avastin for second-line therapy in patients who did not receive Avastin with the first-line treatment. Yet, there is strong evidence of benefit in this setting, such that this use is authorized by the U.S. Food and Drug Administration.
Third, we see the role of politics in the health care decision making. The executive simply ignored the advice of his expert panel and made an arbitrary decision. We Americans have every reason to anticipate that the most vocal disease or treatment advocacy groups will similarly be able to sway decisions made under a future government health plan.
Was the health minister’s decision not to simply deny Avastin for colon cancer patients motivated by his desire to buttress his political position in anticipation of the Auditor General’s report of a billion dollar spending scandal? We’ll probably never know. If so, it wasn’t sufficient. The health minister resigned today (October 7).
For those who like to inspect primary documents, you may find the CED report and executive’s response here:
http://www.health.gov.on.ca/english/providers/program/drugs/ced/pdf/avastin.pdf
October 8th, 2009 | 4:00 am
[...] how it works in Ontario, Canada according the the National Post. (H/T Secondhand Smoke via [...]
October 8th, 2009 | 9:13 am
[...] This post was mentioned on Twitter by quality life. quality life said: #qualityoflife : Obamacare: Ontario Rationing Board Limits Life-Extending Colon … http://ow.ly/15TnP6 [...]
October 9th, 2009 | 9:32 am
[...] how it works in Ontario, Canada according the the National Post. (H/T Secondhand Smoke via [...]
October 14th, 2009 | 11:52 pm
Why are we talking about Canada? It is quite obvious that the health care reform that will pass in the US has no basis of comparison with Canada’s system. Sounds like just another scare tactic to me.
But either way, I would take Canada’s health care system over what we have now in a second. I have many friends who live in Canada, and guess what? When they get sick, they get treated, (and without the long waits that those who want to scare you say is there), and the best part is… They don’t have to choose between getting treated or making a mortgage payment.
October 21st, 2009 | 9:02 pm
[...] that may have brought back door euthanasia to the UK. Similarly, we recently discussed a similar refusal of coverage in Ontario, Canada, for life-extending colon cancer [...]
October 24th, 2009 | 3:33 am
[...] that may have brought back door euthanasia to the UK. Similarly, we recently discussed a similar refusal of coverage in Ontario, Canada, for life-extending colon cancer [...]
November 24th, 2009 | 2:04 pm
[...] thinks the extra six weeks of life provided by the chemo shouldn’t be provided–just like Ontario, Canada’s rationing board decided with regard to colon cancer earlier this year. We do not want such centralized planning in this [...]
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