NICE–the rationing board for the UK’s NHS–is the model that Obamacare’s major supporters want for us, and the potential to create such centralized control was passed under Obamacare. For example, Former Senator Tom Daschle, described by the NYT as the most influential outside adviser on Obamacare, loves NICE. NICE gives Donald Berwick, now temporarily the head of Medicare, the vapors. HHS Secretary Kathleen Sebelius, has supported Berwick’s views, lending her heft for health care rationing under Obamacare. With so many powerful Obamacaricrats swooning over NICE, it is worth our time to keep a close eye on on the rationing board’s many harmful actions.
In our latest chapter, NICE has spent 500,000 pounds to remodel its offices, while denying NHS coverage for a bowel cancer drug that extends life about 8 months. From the story:
Controversial rationing body NICE has spent £500,000 on a plush office refurbishment – despite turning down life-extending cancer drugs for being too expensive. A week after causing a furore by rejecting the bowel cancer drug Avastin, it has emerged that the quango plans to expand still further by taking on more than 160 new staff. The news, which comes as the public sector is facing massive cutbacks, will fuel criticisms of ‘ empire building’ by the National Institute for Health and Clinical Excellence. The amount spent on refurbishment including an extended boardroom and the installation of plasma TVs – could pay for a month’s Avastin for 240 people
This isn’t based on efficacy–which is being questioned by the FDA regarding the drug’s use for breast cancer–but pure cost/benefit and quality of life judgmentalism. (Can you imagine if an HMO did this? The lawsuits would never end!) If Obamacare’s cost-benefit boards ever gain the kind of power NICE wields, the same thing will happen here. And the hubris of feathering its own nest? Par for the course for those who feel self entitled–like California’s white elephant, the CIRM.
Be afraid. Be very afraid.
September 1st, 2010 | 8:56 pm
Spending that kind of money on new offices in an economic downturn and in the midst of healthcare cutbacks is truly awful.
Denying payment for a super expensive chemo drug (50 – 100K) that extends life for only a few months – not awful IMO. That money is much better spent on providing basic care for many.
Wesley J. Smith Reply:
September 1st, 2010 at 8:59 pm
Unless you have the cancer OR mom. And that becomes the problem with rationing, doesn’t it? Judging whether somebody else’s life is worth the price of supporting.
September 1st, 2010 | 9:10 pm
[...] This post was mentioned on Twitter by Vince Humphreys and Stand In The Gap, Wesley J. Smith. Wesley J. Smith said: UK’s NICE Rationers: Plush Office Remodel–YES!–Pay for Life-Extending Cancer Drug–NO! » Secondhand Smoke | http://t.co/Xt8YRsT [...]
September 1st, 2010 | 11:24 pm
Wesley,
There is just something wrong IMO with wanting that kind of expensive tx for a few months more of life. Where does it stop? 500K, 1 million, more? Shall we bankrupt our healthcare system with these kinds of excesses and make it impossible to even take care of the people who would really benefit from healthcare? I equate the desire to have this kind of tx with an unflattering vanity – “I am worth any expense”. Yes, we are infinitely valuable as children of God but life on this earth is only an eyeblink of time in our eternal existence. Is staying here on earth a few more months really that important in the whole scheme of things to warrant taking limited resources away from others who will be here long after we are gone?
This drug is not a potential cure, it’s a life extender only. At some point a person needs to deal with a terminal diagnosis and get on with the spiritual and emotional work of preparing for death (while still praying for a miracle). I think that when this treatment is all that stands between a person and imminent death, a few months earlier or later, it does not justify this expenditure of health care resources. Of course one is always free to spend their own money since you can’t take it with you. Personally if I had that kind of money I would put it to a much better use like giving it to a food bank!
I can say with certainty that if I was the one with the cancer I would still not want this drug.
September 2nd, 2010 | 12:32 am
@OR Mom
From the article, 500,000GBP would pay for 240 months of Avastin, that’s ~2083 GBP per month for treatment. For an average of 8 months of life extension, that’s 16,664 GBP, or right about $25,700 US dollars, for the full regimen.
That’s about half of even your conservative-side estimate of $50k.
And you casually say “a few months” as in, a toss-away, meaningless time frame. But the average increase in life is 8 months. From the NIH and NSF data, the average age for bowel cancer patients is 65 years of age. Eight months is a 1.0% increase in total length of life. I don’t think that’s a trivial amount.
Think of all the things you’ll do in the next eight months. Then try to convince yourself that it meant nothing.
Or suppose a 10-year-old boy
September 2nd, 2010 | 12:35 am
In other words, you based your opinion on a half-second mental calculation that reached up to $100,000 (I’ll be charitable, even though you just say “100k” and the article is using British Pounds, which would be over $150,000 USD) which is FOUR TIMES the actual cost.
Welcome to reality, where health care rationing isn’t an inevitability.
September 2nd, 2010 | 12:38 am
Sorry to spam, but the mention of a 10-year-old in my first post was meant to be removed after I checked the average age of patients who could be reasonably expected to need this drug.
September 2nd, 2010 | 7:40 am
Well, Wesley, if that’s the way you like to operate a business — with no regard to cost/benefit realities — remind me not to invest in anything you operate. First you complained that “Obamacare” would be too expensive; now you criticize similar programs because they DON’T waste money on treatments that have significant cost but no significant benefit. How do you explain this apparent logical inconsistency? Should health care be operated as a business (the way it’s currently being done)? Or what? The statement “imagine if this were done by an HMO” is totally irrelevant nonsense. Insurance companies have been engaging in cost/benefit decision-making for decades with nary a peep from “ethicists” such as yourself. About time for a little truthfulness, isn’t it — like admitting that your objections to “Obamacare” are political because you’re a shill for the GOP? Give it a try. Confession, they say, is good for the soul.
Wesley J. Smith Reply:
September 2nd, 2010 at 9:26 am
History Writer: If Kaiser or Blue Cross denied 9 months of life to a colon cancer patient due to bottom line considerations, you would rightly erupt. But a government do it? No problem! Kind of explains why I have changed my mind about statist solutions to these issues.
Oh, and the “ethicists” who shill for HMOs tend to be mainstream bioethicists, who push utilitarianism. Finally, I am no shill. Obamacare is just a flat out disaster.
September 2nd, 2010 | 8:10 am
“That money is much better spent on providing basic care for many.”
Most people can afford “basic” care. It’s the more expensive things that the government should help out with if we’re going to have government involvement in healthcare at all. The only people who should be entitled to government subsidies for basic care or truly destitute people who can’t get it any other way. Middle class people and above are NOT in my opinion, entitled to government-funded basic care.
September 2nd, 2010 | 9:55 am
Chris,
I didn’t make a quick calculation for my comment. I Googled the cost of avastin tx and read numerous articles. You however, seem to be willing to get all your info from one article.
Wesley,
HMO’s have been using evidence-based guidelines to direct (ration) care for years in this country and we are better off for it when unnecessary tests are avoided and less costly tried and true tx are substituted for the latest and greatest that may or may not be any better.
safepres,
Many people cannot afford basic care, especially because our current system of insurance is tied to employment. The people who are least able to afford care, the unemployed, are the ones without insurance. How backwards is that? A person doesn’t lose a job one day and get on Medicaid the next. Many are harmed in the gap.
Wesley J. Smith Reply:
September 2nd, 2010 at 11:18 am
OR mom: I have blogged on Avastin many times and the statist rationing, such as in Canada. HMOs cannot deny efficacious treatment based on cost benefit. They can require things like generics when available. But NO WAY Blue Cross could do what NICE has done, since the FDA has approved the drug for use in metastatic colon cancer. Nor should the be able to.
September 2nd, 2010 | 12:26 pm
Wesley,
I understand you and I have a different view of what constitutes efficacious tx and neither one of us is going to change the other’s mind. I see nothing wrong with considering cost/benefit of medical care. We have to deal with the realities of economics. I think my position is just as moral and ethical as yours given the economic realities we have to deal with. Would I like to scrap the whole medical payment system and start over? Absolutely, but
Wesley J. Smith Reply:
September 2nd, 2010 at 12:34 pm
It seems to me OR mom, that if we are going to ration, we should ration out those who need care LEAST before we do it to those who need care MOST. Rationing will end up political. Those with clout, will not be rationed. Those without clout, will. It is that unjust.
September 2nd, 2010 | 1:17 pm
Well Wesley, we can spend ourselves into total bankruptcy over your approach to “efficacious” healthcare or we can deal with reality and make the best of the economics we are faced with. Dollars are not the best measure of what constitutes quality healthcare anyway. One only needs to look at what so often happens to an elderly person who spends the last days/weeks of their life in an ICU getting the best futile tx money can buy.
IMO what is really broken is our spiritual health. It is our lack of preparation to leave this life and enter the next that causes us to cling to life at any cost. When our spiritual focus is where it belongs, one is not so afraid to die. Our resources would be better spent on helping people with a terminal illness deal with that fear and come to peace with death than on supporting a desperate attempt to stave off the inevitable for a few more weeks/months.
September 2nd, 2010 | 1:19 pm
OR Mom: “I equate the desire to have this kind of tx with an unflattering vanity – ‘I am worth any expense’.”
I’d call it “vanity” if we were talking about a nose job. This is about dying or not dying — yeah, maybe adding “just” eight months or a year, but that’s really what a cure is, too: adding time to one’s life.
When a 93-year-old person passes away, people usually say, “Well, the person did have a nice, long life, after all…” Which is true. But life is the one thing we should be greedy about.
“I can say with certainty that if I was the one with the cancer I would still not want this drug.”
That’s fine; we’ll remember if it’s ever your turn in this situation. Some would make a different choice, though…
September 2nd, 2010 | 1:33 pm
“we should ration out those who need care LEAST before we do it to those who need care MOST. ”
EVERYONE should have their basic healthcare needs met before we fund extraordinary care. The cost of one organ transplant or the like that benefits only one person can fund a lot of basic care that is not currently available to all regardless of ability to pay. It is basically those who can afford it the least that are being rationed under our current system.
September 2nd, 2010 | 3:09 pm
Wesley:”Unless you have the cancer OR mom. And that becomes the problem with rationing, doesn’t it? Judging whether somebody else’s life is worth the price of supporting.”
That remark reminds me of Sir Paul McCartney & his first wife Linda the devote PETAfiles. They vilified all animal research until Linda was diagnosed with agressive breast cancer. He & she became a couple of raving hypocrites in visiting every available chemo or medical advanced procedure ever orchestrated in a biolab with regards to cancer.
September 2nd, 2010 | 5:21 pm
I’m new here and curious. Do you (Wesley and those who agree with his position on this) think that payment for any efficacious necessary care, regardless of cost, is a requirement of all HC insurers? Or does that only apply to tx to extend life?
Let me give you an example from my own experience that illustrates an abuse of this kind of policy that happens multiple times, day in and day out. A diabetic friend of mine developed a sore on his little toe that went to the bone and he developed osteomyelitis. His doc said he could amputate it or treat it medically to try and save the toe but the chances were slim. He opted for saving the toe. After a couple of hospitalizations and 6 weeks of outpatient IV therapy through an IV line in his chest and tx for totally foreseeable complications from the antibiotics and close to 100K in charges plus at least 2 months off work on disability pay – the tx failed. His toe was amputated to the tune of another 40K in charges plus another 3 months off work on disability. All for a little toe and he said he would do it again (presumably 9 more times!).
All of his tx qualified not only as efficacious but curative as well until it failed. Was it reasonable or moral? I say NOT. Was he justified to expect his insurance company to pay for this? Or is there something a bit off about a person who will risk their life and health to save a little toe that had a very poor prognosis? Should someone have said “No” and offered him some mental health counseling to deal with his attachment J to his toe? Should someone say “No” to him in the future if it happens again, which is likely? Even though it’s not a terminal diagnosis I’m afraid that under the HC policy Wesley supports there can be no justification to place any limits on this kind of tx either.
Wesley J. Smith Reply:
September 2nd, 2010 at 5:28 pm
Don’t you see the potential for tyranny in your position? Trying to save the toe was a perfectly acceptable decision, and one the HI company should have to pay. The outcome you described was not known. You have said we shouldn’t pay to extend cancer patient’s lives. That we should not be able to choose options that have a better outcome potential if that potential is against the odds. We shouldn’t discriminate against people who are very sick. I totally support education efforts to help people make wiser choices. But coercion? Nope.
September 2nd, 2010 | 6:09 pm
Wow. How much is a little toe worth? I guess any amount the owner says it is. That works fine in a world of private pay or unlimited insurance resources. I for one would be thrilled if that kind of care was disallowed and I would give up my little toe in a heartbeat rather than go thru what my friend did and be such a financial drain on the system. I know he would have too if he had to pay for it himself – priorities have a funny way of changing when the cost comes directly out of one’s own pocket.
I guess you’re really saying the patient’s desired ends justify any medically acceptable means. That too can be (is) extremely tyrannical and coercive and will destroy our health care system. As far as I know the ends justifying the means has never been a valid model for determining the right thing to do.
September 3rd, 2010 | 5:20 am
EVERYONE should have their basic healthcare needs met before we fund extraordinary care. The cost of one organ transplant or the like that benefits only one person can fund a lot of basic care that is not currently available to all regardless of ability to pay.
No, OR Mom, EVERYONE should NOT have their “basic healthcare needs met” before we cover the care of dying patients. Also, some people want us to pay for birth control before we pay for cancer drugs, because birth control is “basic care.” That is ridiculous. Birth control is cheap and people can afford it themselves. And, if they can’t, they are perfectly capable of taking other actions to prevent pregnancy. Not so with a cancer victim. Your self righteousness is disgusting.
September 3rd, 2010 | 5:23 am
“”regardless of ability to pay.”
This would mean that people who are perfectly capable of paying for their own basic care would be entitled to taxpayer funded care. This is wrong. And, as for going on Medicaid because you lost your job, what’s wrong with that if it gets you the “basic care” you insist such people can never afford themselves?
September 3rd, 2010 | 8:43 am
It seems to me, after reading these comments, that it is true that the “right to die” crowd does not see its own tyranny. Obviously the “right to live” are Ok with others who choose not to accept treatment. The “right to die” group, though, believe that everyone should make the same decision they would. “I Wouldn’t Want to Live That Way” really means that “SHE Shouldn’t Be Allowed to Live That Way”.
When my best friend way passing away, her husband was virtually overrun by his inlaws (her parents). I was at the hospital when they called them to say she was about to go into coma, but they did not come. The doctor and nurses could not believe they didn’t come. Still, the husband was pressured by her parents to “pull the plug” within a day or two of her being on life support despite the fact that he was not at all ready. It was obvious that he still had hope for her to come back. Since they weren’t next of kin, the mother’s husband set up a meeting with himself, his wife (mother of patient), the husband of the patient, and some doctors and nurses. Clearly, I was not invited. They basically talked him into pulling the plug. He ended up a single father of two children, one of whom is disabled. The mother and her husband have also moved into the home, since they feel he is unable to care for the children alone. Really, I think he is simply unable to stand up to them. For quite a while, he had a deep regret that he didn’t get to see her that one last time, and now she was gone.
Maybe they thought they were doing the best thing, but when you have five people in a room against one, what do you think is really happening?
September 3rd, 2010 | 10:00 am
Every time the word “secretary” is mentioned in the Obamacare bill it grants new powers to the health secretary. And no one knows for certain how the secretary will decide to use those new powers. If you find yourself feeling unusually brave some day take a minute out of your day and look up how many times “secretary” is mentioned
Wesley J. Smith Reply:
September 3rd, 2010 at 10:20 am
Indeed, Hondo69: In fact, I pointed out that about 100,000 pages of regulations would flow from the 2500 or so pages of legislation. And it is in the regs that the devil will be in the details.
September 3rd, 2010 | 6:57 pm
Safepres thinks:
My idea of basic healthcare excludes care of the dying!
NOT! But “care” doesn’t have to be extraordinary and expensive to be excellent, anymore than a coat has to be a mink-coat to keep one perfectly warm. A callous analogy to be sure but it makes the point about need vs want. Public insurance pools should pay for needs, private pay and private insurance policies should pay for wants. Do the rich get more wants? You bet, but they always have and always will.
I’m disgustingly self-righteous – Did I hit a nerve?
People with money shouldn’t receive tax-payer funded basic care
Tell that to those with money who still get the Medicare they paid into. Why shouldn’t all taxpayers get the benefit of any HC taxes they pay?
I’m against Medicaid
NOT! I said it is not an immediate solution for the unemployed/uninsured. Public funding of basic healthcare wouldn’t leave the gaps we have now for the un- and under-employed to fall through.
Michele thinks:
I’m part of the “right to die” crowd.
This could not be farther from the truth. But then I’m not surprised at the misunderstanding when I read the rest of your comment in which you think your friend should have been kept alive longer because the husband wasn’t ready to let her go yet and still hoped she’d come back. I do know that no hospital “pulls the plug” unless a patient is brain dead and beyond all earthly hope, so perhaps he wasn’t thinking too clearly, understandably, and needed the help of clearer heads. Keeping her alive until her husband can cope (hours? days? weeks?) is a pretty good example of tyranny, all cost factors aside. It would reduce her to a utilitarian object – exactly what the “right to die” crowd does.
September 3rd, 2010 | 9:28 pm
OR-you need to read our comments again and also reconsider your own responses. Frankly, I don’t give a rat’s butt whether you are part of the right to die crowd-you are worse, because you believe in forcing someone to die earlier than they want to. Moreover, your fur coat analogy is profoundly callous-like I said, I think it shows extreme self righteousness on your part to say that someone who wants to live for another eight months is being selfish. Thirdly, for all your complaints about there being a “gap” for the uninsured and out of work, you want to create another gap for the seriously ill. Lastly, it disgusts me to hear you pontificate about spirituality while shoving your own brand of death-pushing bureaucracy down other people’s throats. And, since you’ve said that you’re religious, I’m going to speak as another religious person and say that IMO, you should go and have a serious talk with God about your attitude toward the terminally ill.
September 4th, 2010 | 2:53 am
safepres, methinks thou doth protest too much. You’re one of the fearful people I talked about aren’t you? You can’t possibly conceive of rejecting any tx and happily and peacefully preparing for death can you? I suppose you think that all the people in poorer countries without access to all our latest tx must necessarily suffer tragically deprived deaths don’t you?
How can you wish for every possible tx for yourself without regard to cost, knowing there are people in your own country suffering from a lack of the most basic care or medicine? Tell me how your superior moral position of unlimited care on demand is going to include them? You demand your rights without any plan to fix the coming collapse of the system. Maybe you don’t care what’s left for anyone else as long as you get all you want of the finite $ before you go. I think you are the one who is self-righteous.
September 4th, 2010 | 7:12 am
Michele: Your story sounds like that of Terri Schiavo with the roles reversed. Yet in Terri ‘s case Michael Schiavo has been criticized for NOT giving in to her parents. He had the right to make the decision, being next of kin; and he exercised it. I suspect that your evaluation of the husbands’ behavior in these cases is based more on what they ultimately decided, not on why.
September 4th, 2010 | 11:36 am
HistoryWriter, just for the record Terri Schiavo’s situation was nothing like what Michele described either morally or physiologically. Removing a respirator from someone whose brain is dead is NOT the same as withdrawing food and water and starving someone who is still capable of living without life support equipment.
Perhaps you realize that and were merely pointing out who made the decision – but I couldn’t tell.
September 4th, 2010 | 12:32 pm
“You’re one of the fearful people I talked about aren’t you? You can’t possibly conceive of rejecting any tx and happily and peacefully preparing for death can you? I suppose you think that all the people in poorer countries without access to all our latest tx must necessarily suffer tragically deprived deaths don’t you?”
LOL, you don’t even know me, and making such judgments about someone you don’t even know just shows what a self-righteous hypocrite you are. I would rather have the most pro abortion atheist looking after my care than a hypocritical “pro lifer Christian” like you. YOUR plan is bad because it substitutes one deprived group of people with another. Who says that ANYONE needs to be deprived? That’s why we have Medicaid and Medicare and why many clinics provide basic care free of charge. As to people in other countries, do you KNOW how much money and medical supplies the US GIVES to them every single freaking year? We are ALREADY addressing the needs of such people. For that matter, did you know that my father, who is a dentist who doesn’t take Medicaid anymore, sees his former Medicaid patients for FREE?? Bet you didn’t know that, did you? That is hardly allowing such people to go without treatment, my friend. And, again, what “basic” care are we talking about for those in this country? If the basic care costs $40, the patient can take care of them themselves.Thus, they are NOT being deprived. If they can’t, then they are destitute and can go on Medicaid which DOES have a system to provide basic services to the needy.Furthermore, did you NOT NOTICE that instead of paying for cancer drugs, NICE REFURNISHED IT’S OFFICES?? THAT is what happens to money that is not spent on drugs for dying patients-it gets used to refurnish the offices of those who did the rationing, not used to help the needy. Wake up. And, I stand by my statement that your attitude toward those who are dying is un-Christian.
September 4th, 2010 | 3:05 pm
safepres, I guess your dad the dentist makes rationing choices to protect his bottom line too doesn’t he? None are so blind…
September 4th, 2010 | 3:26 pm
No, my father doesn’t “ration” anyone out of care. There are many other skilled dentists to whom they can go if they are on Medicaid, and as I said, he didn’t ration or drop any of his current medicaid patients when he stopped participating in the program. He still sees them and gives them whatever care they need, FREE. If you had your way, the government would decide who could get what care and there wouldn’t be anywhere else for people dependent on that system to go. I’m not against expanding care, even if the government has a hand in it, but helping one group of people at the expense of another is wrong.
September 5th, 2010 | 12:07 am
This drug was not available/on the market when my longtime spouse was diagnosed with terminal colon cancer. My husband was not a candidate for experimental protocols. The prognosis was 4-6 months.
My husband lived, however, for nearly FOUR MORE YEARS by treating with alternative care methods. I never told him how much all of the treatments cost. Twelve years later, my credit card balance is manageable, as opposed to topping $50,000 when my husband died.
I paid back every dime myself, by working two jobs. And I would do it again in a heartbeat, to have those four last years with him.
Now, OR mom, lecture me on how that fifty grand might have been better used in the service or care of others. My husband’s life was invaluable to me – and to him, and his children. There was no way he was going to leave this earth without putting up a fight – with me fighting right along beside him.
It doesn’t always take courage to die, OR mom. But it does take extraordinary courage to live, even when all the odds are against one. Refusing available care to a terminally ill patient leaves that person without hope and deprives them of the courage to LIVE.
September 5th, 2010 | 8:24 pm
Fionnagh-you go, girl. Absolutely. I think it takes courage to both live and die, but the time of one’s death shouldn’t be hastened by the unavailability of medication.
September 6th, 2010 | 12:35 am
Want a preview of “obamacare”? Try Tricare. You can’t get much needed medication or bloodwork done because a four day weekend is coming up, the MTF is closed and the prescription you needed took 3 hours to fill and you need to get to work on time. Oh and your husband calls you from the FOB in Afghanistan and says “What’s that Tricare number? How dare they treat you like that?!?” Like he really needs to worry about that kinda stuff right then anyway. Really. ( I only told him what happened cause I didn’t want him to think something was seriously wrong.)
Links
Blogs
Find Us
Contact