Medicaid

The Trump Administration Should Stand for Cancer Patients' Freedom to Choose

Restricting a cancer treatment to only hospitals will harm patients.

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On May 17, the federal government may decide that it can dictate to cancer patients where they are allowed to receive life-saving treatment, and where they are not. That type of control is seriously dangerous; restricting access to treatmentin this manner gives the government far too much sway over people's lives for no clear benefit.

On February 15 the Center for Medicare & Medicaid Services (CMS) released a good proposal intended to help victims suffering from certain types of cancer, specifically those relating to the blood, like leukemia, by expanding access to CAR-T cell therapy. CAR-T is widely considered to be a medical breakthrough; the treatment is at least partially—if not wholly—successful in 80 percent of cases. But despite the treatment's fabulous success rate, some cancer sufferers may be unable to take advantage of it due to one restrictive mandate within its National Coverage Determination (NCD).

The NCD outlines the cases in which treatments are covered and those in which they are not. In the case of CAR-T, within CMS' otherwise commendable policy proposal, the agency will permit CAR-T treatment only when it is administered in hospitals. This stipulation is counterproductive red tape and can restrict people's access to this life-saving cancer treatment. It is yet another example of the unintended, destructive consequences of government-controlled health care.

At first glance that restriction might seem entirely reasonable. After all, aren't sick people treated in hospitals? Yes, but when it comes to treating cancer, hospitals are by no means the only viable option for care.

Over the course of the last decade, there has been a surge in outpatient facilities that treat cancer patients as well. These facilities have become especially important for those who live in rural areas and do not have an inpatient facility within reach. Demonstrating the value of the free market in health care, the growing marketplace for treatment locations provides patients with greater opportunity to choose the facilities that are right for them. Leave it to the federal government to inadvertently strip that freedom away.

To the credit of America's governing officials, many members of Congress have recognized the CAR-T hospital treatment requirement for what it is: a disaster which could undo the utility of the rest of the proposal. On May 1, a group of legislators from across the country came together to express those concerns to Seema Verma, the administrator for CMS. In a rare demonstration of political unity, Democrats and Republicans wrote to Verma and outlined the problems the CAR-T hospital mandate would cause. Namely, hospitals alone won't cut it.

A staggering 106 rural hospitals have closed since 2010. The problem may soon get even worse, with nearly 700 at risk of shutting down. While CMS deserves praise for crafting an otherwise commendable proposal, limiting CAR-T treatment to hospitals can have serious real-life consequences, harming cancer patients by limiting affordability and access to care.

For many cancer sufferers, travel is not a viable option. Over half of patients eligible for the CAR-T treatment don't live close enough to hospitals where the therapy is administered. Even for those that do, other factors can be equally prohibitive.

Due to the substantial risk of dangerous side-effects, patients receiving CAR-T are required to remain within a half-hour away from a treatment facility. This poses a severe problem for some individuals of limited income, who can't afford the financial burden of relocating for treatment. About one in two patients eligible for CAR-T live at least an hour away from a qualifying treatment facility. To receive treatment, they would have to secure temporary housing within the prescribed 30-minute radius. For many, that's just not an option. That is precisely why individuals must have the autonomy to choose the treatment centers that work best for them, absent the useless, counterproductive edicts from government bureaucrats.

It was undoubtedly not CMS's goal to restrict access to life-saving cancer treatment, but that is what will occur should they not remove this one anti-competitive mandate in the NDC from their otherwise sound proposal. For some, limiting CAR-T treatment to hospitals would mean a far greater financial burden on their shoulders. For others, it means they won't be able to receive treatment at all.

Ultimately, the government has no business telling cancer victims where they can and cannot go to receive life-saving treatment. The NDC must be amended to extend greater access to treatment and allow the free market to thrive once again. Otherwise, cancer patients will suffer the consequences.

Dr. Ron Paul, a former U.S. congressman from Texas, is chairman of Campaign for Liberty.

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  1. They are practicing for the upcoming rationing.

  2. This is unintended consequences at work.

    The complications of CAR-T are very real, and very serious – tumor lysis syndrome, severe swelling of the brain, and other potentially fatal events. However, if they are detected and addressed in a timely manner then some of those lives can be saved. If people are not close enough for such treatment then it is a mathematical certainty that more people treated with CAR-T will die from the treatment

    When too many people die directly from a treatment this tends to make the treatment less favored and might even remove it from the table of available options.

    That’s what the FDA is seeking to prevent. It is a form of risk mitigation. Ron Paul is right that the government should not be telling people how they can and cannot treat their own illness, but the reality is they already do, and in many more ways than just this.

    It would be nice if we could just inform patients, and let them choose their own level of risk, and then somehow treat their outcome data differently, but in practice it does not work that way, and I’m not sure how we get to there without harming other people ( those that could benefit from CAR-T but can no longer get it because it has been decided (by oncologists, by the FDA, by insurance companies) that the rate of negative outcomes was just too high to warrant further use of the modality.

    Evidence based medicine is not foolproof.

    1. I should also add that, in libertopia, it would fall to the oncologists to set professional standards for such situations. But no doubt there would be rogue practitioners who choose to bend the rules – providing greater freedom of choice to their patients but also thereby making the treatment look more risky than it otherwise might if performed under more suitable circumstances.

      How would Dr. Paul feel if that professional organization then sought to sanction, or at least publicly denounce those rogue practitioners?

      The fact is the FDA often plays the ‘bad guy’ so that individual practitioners do not have to, and many practitioners understand and tacitly appreciate it. No matter how much they may publicly groan about their hands being tied.

      1. “How would Dr. Paul feel if that professional organization then sought to sanction, or at least publicly denounce those rogue practitioners?”
        He would feel fine about it.

        1. I’m not so sure. If the organization was merely policing it’s own ranks, perhaps. But to the extent that policing was also interfering with a cancer patients ability to choose their own course of treatment?…

  3. >>>the agency will permit CAR-T treatment only when it is administered in hospitals

    seems stupid and mean.

  4. At first glance that restriction might seem entirely reasonable. After all, aren’t sick people treated in hospitals?

    God knows the last place I want to be if I am sick is in a hospital. Seeing my mother’s last year and half turned me off of that.

  5. Freedom to choose?
    But that would take away the government’s control over all us little people!
    What a sick and twisted idea that is.

  6. On May 17, the federal government may decide that it can dictate to cancer patients where they are allowed to receive life-saving treatment, and where they are not.

    Well get ready for it because if Medicare for All comes into being this proposal will be law!
    Now I believe that if a person is suffering from a terminal illness the patient should be allowed to direct his/her own medical treatment with the guidance of medical personnel. In most cases health insurance and/or medicare if they are on medicare would pay for the treatment.

  7. So glad to see an article by Ron Paul. I’m a HUGE Ron fan. Reason needs more stuff like this.

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