There is much to complain about with the US health care system. But there is no question it is the driving force in the world behind the continual advancement of medical knowledge and skill. But that innovative energy could well be dissipated by the cost/control/ rationing boards that Obamacare would impose on both private and public insurance policies alike.
I thought about this when reading a story in today’s paper about how two breast cancer drugs extend the life of terminally ill patients for five or six months. From the story:
Some women with very advanced breast cancer may have a new treatment option. A combination of two drugs that more precisely target tumors significantly extended the lives of women who had stopped responding to other medicines, doctors reported Friday. It was the first big test of combining Herceptin and Tykerb. In a study of 300 patients, women receiving both drugs lived nearly five months longer than those given Tykerb alone. Doctors hope for an even bigger benefit in women with less advanced disease and were elated at this much improvement for very sick women who were facing certain death.
The headlines calls this test “good news,” and it is. But this is the very kind of medical advance that would be stifled by rationing–both in the delivery at the clinic and in the development.
Why is that? Today, once a treatment is approved by the FDA, insurance companies can’t refuse it. Imagine, the outcry if, for example, Aetna or Humana refused to extend the life of colon cancer patients by paying for a chemotherapy that gives another 9 months of life. There would be hell to pay! The lawyers would pour out of the woodwork. The government regulators would bring them to heel! That’s because the burden of proof would be on the insurance company to demonstrate why it won’t provide the treatment–and woe betide the PR spokesman who invoked quality of life!
Yet, should the government refuse coverage based on quality of life, the denigrating judgment would be likely to hold because the entire burden of proof would shifted. And the system would be clearly be predicated on quality of life. Most bioethicists, the very people who would be appointed to and advise the cost/benefit/best practices boards, reject the equality/sanctity of life ethic and embrace viewing medical delivery through a distorting quality of life prism. In the UK, for example, the rationing board NICE uses a “quality adjusted life year” (QALY) measuring stick, in which a treatment providing life for five years could be worth only one QALY year.
Once rationing were imposed, rather than being on the side of the patient, regulators would be on the side of the bureaucrats, and the lawyers would have far less chance of prevailing. That is because in a rationed system medicine becomes societal rather than individually oriented. And indeed, as just one example, when Ontario, Canada restricted a colon cancer treatment that extends life for nine months, there was some public disquiet, but no redress for those patients told their lives weren’t worth the money to pay for it. Ditto, the Barbara Wagner case in Oregon, in which a Medicaid bureaucrat refused life-extending chemotherapy, but offered assisted suicide. (Wagner eventually got the treatment free from the drug company.)
Should such a system be imposed on the USA, it would not only victimize the very sick, it would also sap most of the energy out of innovation. It often takes billions to bring a drug to market. If some of treatments derived therefom might not be covered even if they work, they won’t be developed. Thus Obamacare would eventually both stifle the delivery of efficacious medicine and its innovation. That would not only be disastrous for us, but for the world that looks to the USA for these kind of advances.
December 12th, 2009 | 1:24 pm
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December 12th, 2009 | 1:42 pm
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December 12th, 2009 | 2:51 pm
Five extra months of life for a terminally ill breast cancer patient may seem like a waste of time and money until one looks deeper at the ramifications. While going through treatment for stage 4 breast cancer recurrence, ( considered terminal), I watched some of my friends thrive while others died. I’m alive to give my opinion from first hand experience from the trenches of treatment.(www.survivingcancerland.com)
Unless Obama gets his way, scientific progress in the field of medicine will continue growing with leaps and bounds. What used to take 10 years to discover now takes 1/4 the amount of time.
The question is not, “Should we be extending terminally ill patient’s lives of six or eight months,” it is, “What are we learning from this information? How can it be applied to non-terminal patients, and possibly other related illnesses. And how many people declaired terminal went on to live a full and prosperous life?” The term terminal is relative. The terminially ill may be viewed as the ‘guinea pigs’ of the treatment indestry, so let’s honor them by applying the informaion gained from their sacrifices to the betterment of mankind.
If Obama gets his way, we won’t be able to afford this information and our progress on the medical front will come to a screeching halt.
Right now, there are excellent study groups through out the country available to patients who cannot afford health care. Doctors work hard to get needy patients into these groups. Both the groups and patients are growing in numbers because of the symbiotic need that exists between science for reliable data and people for experimental drugs when drugs on the market have failed. These groups exist because they have proved their worth. In most cases a few patients expected to die soon live longer as a result of the experminital treatments. That information is then compiled, computed, and adjusted for the next group of terminal patients. Again more patients survive longer and more comfortably than expected. And on, and on until a cure is found! These groups are a choice. Patients can chose not to be in one.
However, if Obama gets his way, there will be no need for these groups because the infomation will be unnecessary. Government will make all decisions concerning life and death. There will be no choices. The only thing available to severely ill patients will be death and that will affect the lives of everyone.
Wesley J. Smith Reply:
December 12th, 2009 at 4:52 pm
Kathleen: Thanks for this. The question of whether we should extend, is yes. The second question is a very good one. Notice the story said that the researchers hope this new approach could help earlier stage breast cancer patients.
Once innovation slows, the predictable answer will be to set up yet another bureaucracy to decide what research should be done. It would be a boon for bureaucratic scientists and bioethicists, and a bane for the rest of us.
December 12th, 2009 | 2:54 pm
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December 12th, 2009 | 10:25 pm
[...] upholding an important side of the argument. In a post today he does not disappoint in arguing against the rationing implications of Obamacare: Once rationing were imposed, rather than being on the side of the patient, regulators would be on [...]
December 12th, 2009 | 10:34 pm
Wesley, I’d love your response to this post when you get a moment:
http://nohiddenmagenta.wordpress.com/2009/12/12/the-individual-the-community-and-obamacare/
December 13th, 2009 | 10:45 am
Please write your elected representives in Washington and tell them this needs to be stopped. This is not about us, but just for politics and so Obama can say he did something. I am a Senior that happens to own a Insurance Agency working with Seniors for the past twenty three years. We need to stop this and now. If they do pass this it will not be Health Care Reform but Health Care Disaster for Seniors or maybe everyone
December 15th, 2009 | 9:18 am
I’m a practicing physician and I favor medical rationing. Before you judge me as a callous doctor, see http://bit.ly/5XxRWK
December 15th, 2009 | 1:03 pm
Dr Kirsch,
As a Rheumatoid Arthritis patient on Remecaid – which is very expensive about $3000.00 every 8 weeks, so much so that the pharmaceutical company give rebates for the drug – when will I be culled from the herd?
I am disabled, still on my husband’s insurance, not Medicaid, thus I meet the criteria for “useless eater” though my family are still grateful that I am around.
I ask you: Who gets to tell me that my treatment is too expensive? That if I want to live, I should just take Prednisone? Which is very cheap but has extreme costs with long-term usage (been there done that!) and is zippo for keeping one’s “quality of life”.
As to rationing, how about just a prudent use of resources – choices made by my physician for me – the patient? HMO’s have wrought chaos on the system, as has Medicaid which skews the true prices of medical tests. If medical care were priced accurately then I could make even better decisions regarding my own care. And I speak as someone who has never gone through an Emergency Room, without it being an actual emergency!
The government is force. The problem is with “who” makes the decisions, not that we don’t see issues with our current system.
And Wesley, I think testing will become mandated – ala the “Aid’s Gel” and patients will have diddly to say about it if they want to see a doctor. So much for personal liberty…
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