Socialized Health Care At Work—Denying Patients Medicine

Ronald Bailey | April 13, 2006

Britain's National Health Service offers the modern anti-breast cancer drug Herceptin to patients only in "exceptional cases" because it is too expensive to offer to all women who might benefit. By contrast, Herceptin has been approved for use in the U.S. since 1998 for women whose breast cancers overexpress the HER2 receptor (between 20-25 percent of cases). It is very effective in preventing the recurrence of cancer in such patients.

In an illuminating story about just how government-funded health insurance works, the Times (London) reports:

PATIENTS will be denied access to drugs at the forefront of medical research after a landmark judgment on the breast cancer treatment Herceptin. The Court of Appeal ruled yesterday that it was illegal for health trusts to discriminate against patients by funding expensive unlicensed drugs case by case. The ruling means that trusts will now either have to agree to pay for a new drug for any patient whose doctor recommends it--with serious implications for NHS budgets-- or refuse the treatment for the entire population it serves.

Whole thing here.

Comments

|4.13.06 @ 10:26AM|#

Though I am no fan of socialized medicine, I wonder if a woman in the US with coverage by your average HMO is covered for this drug as well.

|4.13.06 @ 10:28AM|#

Disingenous post.

The women are not being denied the drug - just state coverage for it. They can pay for it out of their own pocket. It would be just like being provided a baseline coverage while you have to tackle the costs for above-baseline coverage. It's not like the state is saying, if you take that drug, we're gonna put you in jail.

What was your point again?

|4.13.06 @ 10:34AM|#

Point being.. If it all comes down to "Whoever has money has access to care" - than what exactly is the point of nationalizing care again?

MP|4.13.06 @ 10:35AM|#

Ron,

Whether funded by insurance or the state, the line has to be drawn somewhere in regards to the limits of the expenses that can be incurred for treatment. I don't see a problem with what the NHS is doing.

I'll repeat what metalgrid said:

What was your point again?

|4.13.06 @ 10:41AM|#

MP, metalgrid,

I'm not an expert, but it seems that the NHS says either YOU pay 100% or THEY pay 100%, there doesn't seem to be any baseline where they cover up to a point regardless of the medication and then the patient covers the rest.

|4.13.06 @ 10:46AM|#

All: Limits may be set by private insurers (including HMOs)--and patients should get what they pay for--nothing more and certainly nothing less. And yes, you're right that the British woman in question could have bought private health insurance (unlike in Canada where that option was not available until a court ruling in Quebec a year or so ago).

But I suspect that most people in the U.S. who favor nationalized health care believe that modern medicines will be available to them under such a system. The point of the post is to warn people that this is a fantasy. But at least under nationalized health care, we will all get the same equally crappy medical care and medical innovation will slow to a crawl. Simply fabulous.

|4.13.06 @ 10:47AM|#

I expect his point was that socialized medicine cannot afford to provide cutting edge medical care.

|4.13.06 @ 10:52AM|#

Russ,
My take on it was that it was inappropriate to fund the drug for some women and not for others according to the Court of Appeals decision.

Which falls well in line with regularly practiced health insurance. A particular insurance plan covers drugs for everyone in that plan, not just for certain people on that health plan.

Then attempting to twist the story to argue that it's socialized medicine that does this is stupid because private insurance companies do this all the time - it's called drugs outside your coverage that you have to pay for out of pocket or through separate insurance.

|4.13.06 @ 10:58AM|#

The point of the post is to warn people that this is a fantasy. But at least under nationalized health care, we will all get the same equally crappy medical care and medical innovation will slow to a crawl. Simply fabulous.

Comment by: Ron Bailey at April 13, 2006 10:46 AM


Considering the fact that our luddite politicians are driving medical innovation into the hands of South Korea and Singapore and other South/East Asian countries anyway, perhaps we can just import what they discover.

|4.13.06 @ 11:08AM|#

But at least under nationalized health care, we will all get the same equally crappy medical care and medical innovation will slow to a crawl. Simply fabulous.


Considering the fact that the medical establishment currently uses government to screw us over, I no longer have any compunctions about using government to screw them right back by regulating rates and wages for doctors per procedure much like Canada does.

Besides, we still have the option of visiting fabulous tropical islands, staying at a resort while having complex medical procedures performed and still come out ahead in how much we pay. It's a pity we can't outsource our medical care more due to the stranglehold the AMA has on the importation of doctors and the FDA has on importing drugs, but I predict the healthcare industry will use government to put a stop to us seeking treatment in other countries by implementing some trade treaty with them preventing US citizens from going there for treatment.

|4.13.06 @ 11:16AM|#

Ron writes:"By contrast, Herceptin has been approved for use in the U.S. since 1998 "

Just because it's approved for use in the US doesn't mean you'll actually be able to get it. Aston Martins are approved for use in the US too, but that doesn't make them easy to obtain.

I bet you wouldn't have to look very hard to find people in the US seeking Herceptin treatment and getting the runaround from their insurers, resulting in either not getting the medicine, or getting it but then having the insurer balk at covering the charges and thus being bankrupted.

|4.13.06 @ 11:17AM|#

"Considering the fact that our luddite politicians are driving medical innovation into the hands of South Korea and Singapore and other South/East Asian countries anyway, perhaps we can just import what they discover"

Considering that our wonderfully enlightened progressive politicians want to ensure that no one other than a trial lawyer can ever make a dollar developing a new medicine, perhaps we should all just move to South East Asia.

|4.13.06 @ 11:21AM|#

FOOTNOTE FROM PREVIOUS

* can't bring myself to call it capitalism or free enetrprise. The US system isn't even recognizable as insurance if it weren't called by that name by so many.

|4.13.06 @ 11:22AM|#

Considering that our wonderfully enlightened progressive politicians want to ensure that no one other than a trial lawyer can ever make a dollar developing a new medicine, perhaps we should all just move to South East Asia.

Comment by: John at April 13, 2006 11:17 AM


Tell me John, do you often conflate "luddite" with "conservative" that you feel the need to rejoin my post with an attack on "progressives"?

|4.13.06 @ 11:23AM|#

"Considering the fact that the medical establishment currently uses government to screw us over, I no longer have any compunctions about using government to screw them right back by regulating rates and wages for doctors per procedure much like Canada does."

Kinda sums up why most of us libertarian types advocate getting the government out of healthcare at all levels. By the logic of your statement above if government regulations were taken out of the picture then no one would be getting screwed. Somehow I don't think that is what you meant but it is something to think about.

|4.13.06 @ 11:23AM|#

Ron Bailey writes: "But I suspect that most people in the U.S. who favor nationalized health care believe that modern medicines will be available to them under such a system. The point of the post is to warn people that this is a fantasy"

So basically you're using an unusual edge case, a $100,000+ drug, and building an argument off of *that*?

Since we can't all get a drug that costs as much as an Aston Martin, well, let's just forget about the whole thing?

The fact of the matter is, despite the occasional edge case like this, the vast majority of people are adversely affected by lack of access to far cheaper - but also 'modern' - medications and procedures.

You're not showing that there's a lack of access to "modern" medications, you're showing that there's a problem with access to high-demand, small-market, high priced medicine.

|4.13.06 @ 11:26AM|#

What a joke of a post Ron,

you could have written this same post about private health care and your position would have been about the right of the health care companies to deny it and how they have a financial responsibility to keep their costs down.

The point of the post is to warn people that this is a fantasy. But at least under nationalized health care, we will all get the same equally crappy medical care and medical innovation will slow to a crawl. Simply fabulous.

Really?? I call bullshit! The point of this post was the convey your prejudices against socialized medicine by showing coverage for potential life saving medicines being denied to you by the state, while at the same time ignoring that this is going on every day with private health insurance.

Why, in the original post, didn't you express a sentiment that conveyed a message of "socialized medicine will have to make the same financial decisions in what they cover/provide that private health care would" instead of adding this bit:
In an illuminating story about just how government-funded health insurance works, the Times (London) reports:

As if private health plans dont also work this way?

|4.13.06 @ 11:34AM|#

Metalgrid,

Every day is a good day to kick around progressives. It is not like you need an excuse. Indeed you are correct though, not all luddites are conservatives. There are lots of environmental anti GM food nuts and the like who are both plenty progressive and plenty luddite. Unfortuneately, in the medical field most luddites tend to be conservatives. Some for legitimate reasons (the belief that life begins at concception) some very illigetimate reasons (the Leon Class types who think that long lifespans are a bad thing).

|4.13.06 @ 11:40AM|#

All of this misses the point. Even if a socialized plan covered every drug and procedure under the sun it still doesn't take away from the fact that health care isn't a right that you can demand from the government. In other words you can't demand that I pay your doctor and Rx bills. Health care is like anything else, some one has to deliver it and some one has to pay for it. Asking that the force of government be used to make me pay for your health care is simply wrong.

|4.13.06 @ 11:46AM|#

"I bet you wouldn't have to look very hard to find people in the US seeking Herceptin treatment and getting the runaround from their insurers, resulting in either not getting the medicine, or getting it but then having the insurer balk at covering the charges and thus being bankrupted."

Maybe. Maybe not. Herceptin is a chemo drug delivered intravenously in clinic, and is pretty pricey. However, knowing insurers, they would not immediately balk at treatment, given that the treatment is necessary and the drug is specifically for that condition, and is highly effective (thus mitigating future costs from less effective treatment having to be administered multiple times for the same effect). Where you get in trouble with insurers is when a doctor starts prescribing expensive stuff that may or may not work - like prescribing this drug for other forms of cancer. The point is that private insurance at least gives me the option for treatment. What NHS has done here is pretty much guarantee a higher death rate from this form of cancer, by denying access to the drug. When it comes down to it, I'd rather be bankrupt than dead.

|4.13.06 @ 11:50AM|#

metalgrid, ChicagoTom,

People bitch about the bad decisions of their insurance companies, and often rightly so. But can you honestly say that the people clamoring for socialized health care are fully aware that the same bad decision-making will take place under a socialized system?

From my short time in health care, the people who bitch the most are under the false impression that having health insurance means never having to open your wallet. And as soon as they get the rude awkening, they immediately bitch about being screwed by their insurance companies and cry for a government takeover.

R C Dean|4.13.06 @ 11:53AM|#

Just checked with one of our oncology clinics. They use Herceptin pretty routinely. No probs with the insurers.

|4.13.06 @ 12:00PM|#

Government run healthcare = All the efficiency of the Post Office + All the compassion of the IRS.

|4.13.06 @ 12:02PM|#

I wonder if the British government will end up with a better price on Herceptin than the US consumer gets. My guess: Hell, yeah!

|4.13.06 @ 12:04PM|#

Hi Ron and others,
if you read here http://www.cancerbackup.org.uk/QAs/TreatmentsQAs/MonoclonalantibodiesQAs/related_faqs/QAs/798
you will see that Herceptin has been licensed in the UK since 1999 in particular for the cases you cite it as being beneficial for. What is in dispute is whether it is given to a different category of women for which the cost per life saved runs to (as far as I know based on hearsay) GBP500k . That is why most of the health trusts don't want to shell out for it.

So I think the title of your post misleads a little. All systems of healthcare deny medicines to those who would benefit, it is just a question of how you choose.

|4.13.06 @ 12:08PM|#

The point is that private insurance at least gives me the option for treatment. What NHS has done here is pretty much guarantee a higher death rate from this form of cancer, by denying access to the drug. When it comes down to it, I'd rather be bankrupt than dead.


AFAIK, it's not denying access to the drug, they are only denying coverage for the drug. People can still bankrupt themselves by purchasing the drug with their own money provided the doctor prescribes it.
This isn't any different from many cases in the US where private insurers will not cover drugs to treat condition X when the FDA has only approved that drug to treat condition Y.
The reasonable solution of course, is to provide a faster approval for life saving drugs and an even faster approval for pre-approved drugs for different conditions.

Ron Hardin|4.13.06 @ 12:12PM|#

It works that way with free market health care, too. Some treatments are too costly, even in the eyes of the patient, who might think it's a waste of resources to in effect have 8 people working full time to keep him alive in bed, even if he has the money.

With socialized health care, the cost is hidden, and the demand is infinite, so as usual you ration by lines and moral posturing and shouting, rather than by good character.

So the effect is to deprive people of a chance to raise good character into public view, and perhaps into their own view.

|4.13.06 @ 12:13PM|#

I'm guessing that the Canadian healthcare system must not cover whatever anti-psychotics that Dave W. so desperately needs.

And as a result, we all must suffer.

|4.13.06 @ 12:37PM|#

Hey Ron,

Americans don't need Herceptin if they can't afford to get the diagnosis in the first place.

jaydee|4.13.06 @ 12:45PM|#

"And yes, you're right that the British woman in question could have bought private health insurance (unlike in Canada where that option was not available until a court ruling in Quebec a year or so ago)."

Actually, Canadians have always been able to purchase private health insurance, but only for services not covered by the public system. That's what was against the law. The vast majority of Canadians have some form of private health insurance to cover things like prescription drugs, dental and vision care, physiotherapy, and private hospital rooms. It is against the law for any private insurance to cover services that are also covered by the socialized health system (hip replacement surgery in the Quebec case).

Also, the Quebec decision did not open the door to overlap between private and public coverage carte blanche. It merely asserted that Canadians should be allowed to seek private insurance, or pay out of pocket, if the public system fails to treat them in a reasonable amount of time. This has made the situation even more ridiculous as now the focus of the federal government is on developing "national standards for acceptable wait times", not improving the health care system. Basically a bunch of politicians in Ottawa are going to decide what the acceptable amount of time is that Joe in Regina should wait for his operation.

jaydee|4.13.06 @ 12:46PM|#

"And yes, you're right that the British woman in question could have bought private health insurance (unlike in Canada where that option was not available until a court ruling in Quebec a year or so ago)."

Actually, Canadians have always been able to purchase private health insurance, but only for services not covered by the public system. That's what was against the law. The vast majority of Canadians have some form of private health insurance to cover things like prescription drugs, dental and vision care, physiotherapy, and private hospital rooms. It is against the law for any private insurance to cover services that are also covered by the socialized health system (hip replacement surgery in the Quebec case).

Also, the Quebec decision did not open the door to overlap between private and public coverage carte blanche. It merely asserted that Canadians should be allowed to seek private insurance, or pay out of pocket, if the public system fails to treat them in a reasonable amount of time. This has made the situation even more ridiculous as now the focus of the federal government is on developing "national standards for acceptable wait times", not improving the health care system. Basically a bunch of politicians in Ottawa are going to decide what the acceptable amount of time is that Joe in Regina should wait for his operation.

|4.13.06 @ 12:51PM|#

jaydee: Thanks very much for the clarification.

jaydee|4.13.06 @ 12:52PM|#

"And yes, you're right that the British woman in question could have bought private health insurance (unlike in Canada where that option was not available until a court ruling in Quebec a year or so ago)."

Actually, Canadians have always been able to purchase private health insurance, but only for services not covered by the public system. That's what was against the law. The vast majority of Canadians have some form of private health insurance to cover things like prescription drugs, dental and vision care, physiotherapy, and private hospital rooms. It is against the law for any private insurance to cover services that are also covered by the socialized health system (hip replacement surgery in the Quebec case).

Also, the Quebec decision did not open the door to overlap between private and public coverage carte blanche. It merely asserted that Canadians should be allowed to seek private insurance, or pay out of pocket, if the public system fails to treat them in a reasonable amount of time. This has made the situation even more ridiculous as now the focus of the federal government is on developing "national standards for acceptable wait times", not improving the health care system. Basically a bunch of politicians in Ottawa are going to decide what the acceptable amount of time is that Joe in Regina should wait for his operation.

|4.13.06 @ 12:56PM|#

C'mon Ron. Think these things through a little.

So, using 2003 numbers cuz that is all I could get at quickly, the UK covers everybody in the country for $2231/person. The US spends $5635/person. If under the British system they chose to more than double the funding of the system, do you think it may be possible to cover the cost of Herceptin to coverage equivalent to US levels?

This kind of apples to oranges question is disingenuous or foolish, and you would not trust someone who tried to pull it on you in another context.

Using tricks over legit arguments may bolster the converted, but you are digging a hole when trying to convince others.

It may even be the case that more than doubling the British funding would not cover these types of drugs -- I do not have the time to look into it, but I can say that I am more inclined now not to believe these sorts of explanations.


numbers from http://ocde.p4.siteinternet.com/publications/doifiles/012005061T002.xls

|4.13.06 @ 1:02PM|#

Perry -

"Point being.. If it all comes down to "Whoever has money has access to care" - than what exactly is the point of nationalizing care again?"

I suspect the point would be (theoretically) that the money you save on basic care with nationalized health care could then be used to buy the more expensive drugs that aren't covered.


Tim -
"Asking that the force of government be used to make me pay for your health care is simply wrong."

Unless you can show that this will have a net benefit for society as a whole. eg, if gov't takes the burden of health insurance off of employers, they won't relocate to Canada (unless someone has come up with a way to make health care affordable for individuals so that neither gov't nor businesses have to pick up any slack. I'm in over my head here.)

jaydee|4.13.06 @ 1:04PM|#

I apologize for my multiple postings! I kept receiving http errors and then a message telling me to wait a while before posting. I reloaded the page to see if my previous submissions had gotten through and didn't see them, but perhaps they were queued or cached. Sorry! :-)

Back to the original post, I believe the overall point is a valid one. Canada is similar in that the government and various health bodies routinely harp about how important it is to get certain tests, yet there are massive waiting lists for them.

Even more interesting is the fact that organizations such as the Workers Compensation Board and the military operate outside the regulations and are allowed to use private clinics and facilities to perform publicly covered procedures. Thus if you get injured at work the WCB will have you treated immediately in a private facility but if you get injured at home you'll have to wait years in the public system.

|4.13.06 @ 1:07PM|#

metalgrid,
There are other alternatives you may want to look into, although I presume that faster approval would help. Consider this paper by Dean Baker

I doubt many will read it, but it takes a real economic look at how to fund drug production.

|4.13.06 @ 1:19PM|#

Considering the fact that the medical establishment currently uses government to screw us over, I no longer have any compunctions about using government to screw them right back by regulating rates and wages for doctors per procedure much like Canada does.

Overworked, underpaid doctors = bad medicine. Like the doctor who told my mother-in-law "Don't worry about the lump in your breast, it is probably nothing... no need for further testing", it creates an incentive to get as many patients through as quickly as possible, spending the least amount of time with each patient as possible. My doctors in the U.S. used to know my name, talk to me about my family and medical history, explain everything to me in excrutiating detail. I have never seem my doctor in canada for longer than 2 minutes (literally... 2 minutes...).

Whether funded by insurance or the state, the line has to be drawn somewhere in regards to the limits of the expenses that can be incurred for treatment. I don't see a problem with what the NHS is doing.

Except that the idea of a national health care service is that there is no line drawn. The idea is that everyone gets the health care they need, regardless of cost. If the government isn't giving lifesaving treatment to people, and only rich people can afford the treatment, then what is the point of having the government micromanage health care?

Now, know that government services will cut you off at a lot lower threshhold. For example, my unemployed single mother cousin, who had no health insurance whatsoever, and no money, chose to get Cancer treatment in the U.S., instead of getting it in Canada, because the treatment that she needed was too expensive to be available to the general public. In reality, the government health insurance can deny people healthcare quite easily, because people have blind nationalistic faith in government healthcare, where as people will scream bloody murder when some free-market institution wouldn't give them the health care they need.

There is no factual basis in the belief that government can provide better health care, more equitable health care, cheaper health care, or health care to those who would otherwise not get health care. The faith in government to provide healthcare is a religious faith, like the faith in telligent design. If you admit you are a government worshiper, then maybe I can respect your beliefs, in the same way I can respect a Christian who things that God is the solution to all problems. But don't pretend that in any way, shape, or form, there is any rational reason to have government involved in providing health care.

|4.13.06 @ 1:24PM|#

theCoach: You could do some thinking too. Basically you seem to be lumping together choices made by consumers with choices made by governments. This is very similar to the way bioethicist Dan Callhan who also favors government-funded health care argues.

For example, he argues that "developed countries will not be able to devote a steadily growing proportion of their gross national product (GNP) to health care...a limit will be set, politically and economically." This limit, he says, has almost been reached by many countries; there is "a growing public unwillingness to pay steadily higher prices or taxes for health care, or to devote an ever larger portion of national resources to the improvement of health care."

Thus, Callahan conflates the willingness to pay higher taxes for other people's health care with the willingness to pay more for one's own. I think you're doing much the same thing and you're wrong for the same reasons.

|4.13.06 @ 1:40PM|#

It merely asserted that Canadians should be allowed to seek private insurance, or pay out of pocket, if the public system fails to treat them in a reasonable amount of time. This has made the situation even more ridiculous as now the focus of the federal government is on developing "national standards for acceptable wait times", not improving the health care system. Basically a bunch of politicians in Ottawa are going to decide what the acceptable amount of time is that Joe in Regina should wait for his operation.

I don't see this as ridiculous at all. Insurance companies decide the same thing in about the same way in the US, except: (1) you can't follow their debates in the newspaper; and (2) no access to stats on what the wait times actually are.

Being in Canada 2 years now, it is clear to me that the customers see wait times as the biggest problem with socialized medicine. So Quebec takes an incrementalist approach and allows competition, but only with respect to the area that is perceived as a problem. If the Quebec decision is upheld, then they can observe how this controlled margin of competition works and then try to expand it or scale it back.

Another potential advantage of the incrementalist approach taken by the Quebec court is that it may allow a healthcare market to develop without the impediment of "insurance." Ya know, like a normal person can just walk into a clinic and pay for services without paying 10X what the services cost to provide. Or the "insurance" might develop in such a way so that its cost is based on actuarial data, instead of the political logrolling fantasyland that is US healthcare actuarial analysis.

None of that market development stuff is going to happen if Canada decided to simply phase out socialized medicine. If Canada did that, then it would just get the US system, as-is. Yuk!

|4.13.06 @ 1:52PM|#

None of that market development stuff is going to happen if Canada decided to simply phase out socialized medicine. If Canada did that, then it would just get the US system, as-is. Yuk!

I am an American living in Canada, and I am looking to get catesprophic health insurance in the U.S... I will take the U.S. system any day. I will go to the Canadian doctor to get wax cleaned out of my ear, or to get stitches if I cut myself. But if I need cancer treatment, or an organ transplant, no way in hell I am gonna die here in Canada when I can get real treatment in the U.S.!

s.m. koppelman|4.13.06 @ 1:55PM|#

Just the other day I got a brochure from one of the higher-quality US health insurers, touting plans for self-employed individuals like me. After getting through the usual list of medical conditions that would render someone ineligible to apply for this insurance on rational market-oriented cost grounds, one of the major selling points was its generous $5 million in lifetime coverage.

So there you are, a healthy woman with this coverage. And you're diagnosed with breast cancer. How many tens or hundreds of thousands in billings is that insurer going to incur from the doctor visits, the tests, more tests, the surgery to remove the tumors, the surgery to get the stuff they missed, the hospitalization, the chemo and other post-surgical therapies, and -- lucky patient! -- maybe even cosmetic surgery to give you a new breast so you can wear comfortable clothes again?

And now, the Herceptin. One year of Herceptin treatment alone at the current price of $40,000 is about 1% of lifetime total benefits a patient with this and any of the countless similar policies could receive. And if our insured person was unlucky enough to be enrolled in a policy with percentage copays on presccription drugs to get the premium under $300/mo., she'll be paying a great deal of that $40,000/yr. out of pocket. At a mere 25% copay on brand-name drugs, that's $10,000 a year out of pocket, just for that one drug.

I'm guessing, Mr. Bailey, that you exercised your freedom of choice to choose an insurance policy (or an employer that provided one) that's better than this. I'd venture to guess, as a writer and not a multimillionaire, you got a plan with fixed- or zero-copay prescriptions, for one thing, and that if someone covered under your policy had a comparably catastropic illness with comparable treatment costs, you wouldn't be facing tens of thousands of dollars in drug copays. I'm also going to go out on a limb and guess that you make sure you have a policy with low, capped copays on things like hospitalization so that if you're in this siuation, you're unlikely to be impoverished by it.

So my question is this: for someone with the adult median income around $30,000/year in the US, what percentage of after-tax income would they have to pay for a policy like yours?

How about someone earning 20% below the median? For those who can't afford low-copay comprehensive health insurance, what is it about them that makes them deserving of much less catastropic medical care than the women being denied Herceptin by the NHS?

|4.13.06 @ 1:58PM|#

Ron,

Even granting you your extremely shaky premise (are we still talking about the politically possible government mandated insurance plan, or the Ron Bailey-everybody-gets nano drugs and a pny plan?) you are still comparing a healthcare system where one plan spends $2231/person to one that spends $5635.

If you adopt the previous one, and keep the low coverage, then consumers are free to buy on average $2400 more in supplemental coverage if they choose to [cheesy emphasis mine].

In your post, the money simply disappears. Frankly, your argument is just baffling.

you seem to be lumping together choices made by consumers with choices made by governments.

When I am comparing the two, yes, I try to compare them. But where are you going with this? -- the only statement you really make is:

Thus, Callahan conflates the willingness to pay higher taxes for other people's health care with the willingness to pay more for one's own.

With regard to what I wrote, what does this mean? Are you sying that it is unfair to comapre the costs, but it is fair to compare the results on a single anecdotal drug? In what possible way is the cost of the program not relevent? Can you provide me some scale of gov't $ to private $ that I can use to do a comparison?

The only thing I can think of, is that you are using that old strawman that the government will disallow you to buy supplemental insurance. Is that what you mean?

I can assume that in some vague sense you are pointing in the direction of incentivizing drug research, in which case I will post again the link to Dean Baker's paper

|4.13.06 @ 2:09PM|#

My father had his Lipitor cut off cold after 6 years on, with no annoucement, for about a month by the VA hospital administration just because he hadn't been evaluated on the correct drugs in the correct order.

I don't remember the middle one but you are supposed to go: Zocor -> ?? -> Lipitor and he had already been evaluated on the Zocor by his civilian doctor and it didn't work so he took the Lipitor which VA had provided for six years without a peep.

The doctors there protested but the pharmacy took forever getting a prescription out and only then when he wrote an article and sent it to the correct people which shortly after the VA people are all, sweetly, "Oh, it's being it filled. We'll have it to you soon."

Obviously they got word. I don't think he's done with them yet.

They said they spend something like $560,000 annually on Lipitor and decided it would be best to just cut off all the patients that hadn't been "correctly evaluated" instead of continuing their prescriptions and reevaluating them without a medication interruption which can indeed be quite dangerous, esp. after about two weeks off the drugs.

|4.13.06 @ 3:39PM|#

Overworked, underpaid doctors = bad medicine. Like the doctor who told my mother-in-law "Don't worry about the lump in your breast, it is probably nothing... no need for further testing", it creates an incentive to get as many patients through as quickly as possible, spending the least amount of time with each patient as possible. My doctors in the U.S. used to know my name, talk to me about my family and medical history, explain everything to me in excrutiating detail. I have never seem my doctor in canada for longer than 2 minutes (literally... 2 minutes...).


And as has been noted for quite a while, this is because the AMA in cahoots with the government work at keeping the supply of doctors below the market levels. This in turn leads to overpaid doctors with artificial barriers to self-medication, which is also caused by the AMA and government acting against the interest of the market and the public.
Hence my animosity towards the medical profession. First they create their monopoly on healthcare by using government to prevent a proliferation of a much needed profession, then they interfere with self-treatment by limiting access to drugs without paying for their blessings. Which ends up forcing us to require insurance in order to afford either. No wonder less regulated medical services in many Asian countries are becoming preferable due to greater affordability for equivalent services.

Deregulation is a lost cause, it isn't going to work in the current political climate - so the only hope is to get some revenge out of it by turning their buddy government on them by slapping em with socialized medicine.

uncle sam|4.13.06 @ 3:47PM|#

I think discussion of health care systems show how limited is the thinking of many of the participants. What?!.. our choices are between major government participation in health care or total domination? What kind of shit is that?
Nobody knows what it might have been like in the U.S. today had not the government involved itsself in the economy and health care.
Not everyone can afford quality health care?
What Questins should be asked here?
Instead of: "How can the government solve that problem?", how about providing tax credits to health care providers (and anyone else) for chipping in on the expense of providing that quality care to those in need? (just one possibility)
Save some government administration costs there.

Doesn't anyone realize how much more expensive government makes life for everyone? Jeez, doctors and nurses have to pay income taxes too. How much does that add to medical bills?

Where is the creativity in problem solving?

The possibilities are much greater than is assumed.

|4.13.06 @ 3:47PM|#

My doctors in the U.S. used to know my name, talk to me about my family and medical history, explain everything to me in excrutiating detail. I have never seem my doctor in canada for longer than 2 minutes (literally... 2 minutes...).

Strange, my wife has had pretty much the opposite experience in US and Canada. She is quite happy that the Canadian doctor knows her and talks to her and listens. My experience is quite limited, but: (1) I have found the level of attention to be the same; (2) Canadian facilities look a lot shabbier and are smaller (although clean); and (3) Canadians (and the American students who work for them) are terrible at drawing blood.

|4.13.06 @ 4:08PM|#

How many millions in Canada dont receive any medical treatment at all unless they pay out of their own pocket?. Does NONE sound close enough.

The clamour for unrestricted access to Herceptin in countries with State subsidised drug plans seems to have popped up simultaneously. The drug companies up to their marketing campaigns again!

R C Dean|4.13.06 @ 5:37PM|#

How many millions in Canada dont receive any medical treatment at all unless they pay out of their own pocket?. Does NONE sound close enough.

Like all socialized medicine arrangements, the Canadians ration by forcing delays. There are lots of people in Canada being denied care right now because they can't or won't pay out of their own pocket, because they haven't made their way through the waiting list.