Althouse: "Avastin prolongs life but drug is too expensive for NHS patients."

August 24, 2010

"Avastin prolongs life but drug is too expensive for NHS patients."

We've talked about the limitations on Avastin in the United States. It's much worse in the UK.

88 comments:

traditionalguy said...: The NHS is the Death Panel. C'est la mort. Do they have a set goal to reduce the life expectancy? The head of the planning must be nicknamed Dr Death.; 8/24/10, 10:11 AM
Geoff Matthews said...: If someone else pays for it, then price is an object.
As much as I dislike the Democrat agenda, overall, I have to agree with them on the medicare cuts. We cannot continue to spend freely on healthcare for the elderly. It is not sustainable.

Of course, we cannot continue to spend like we are now, but they show little motivation to change course on this, which is where I do break ranks with them.; 8/24/10, 10:15 AM
Martin said...: Is there a law that says that prevents the private purchase and sale of Avastin?

No. Except most people can't afford it. So you want the government (i.e. me via taxes) to buy it for them?

Now tell me who's a socialist again.; 8/24/10, 10:16 AM
Michael said...: The British "Life Panel" says too bad if you need this drug. No life for you.

Martin: They have universal health care in England. You can go privately if you wish and pay up. Which I would do, of course, if I needed the drug. The poor people of whom socialists are so approving would be the losers.; 8/24/10, 10:20 AM
Irene said...: Here's a broader view of how the British situation applies to many diseases. (The link is buried in a comment in an older thread):

Just as significant is NHS rationing of lifesaving drug--for example, the bowel cancer drug Avastin and Nexavar, the only treatment offering any chance of survival for patients with advanced liver cancer--are routinely used in other European countries.

These drugs typically offer three to six months of extra life, but some patients can survive for years. Although the drug-approving body NICE agrees they work, it says the health system cannot afford them.

The British system is "rationing [ ] lifesaving drugs" because "the health system cannot afford them."; 8/24/10, 10:26 AM
traditionalguy said...: Hey you cheap libertarians, do you admit that a life time of Medicare Taxes have also been paid thru employers as to many vested coverees? So repay them their money, or grant them the insurance they purchased. Then they can buy a few years life or party for a brief time. It is not all about welfare cheats.; 8/24/10, 10:28 AM
Scott said...: If we did a few essential things -- (1) elimination of anticompetitive discount barriers, (2) allowing interstate marketing of health insurance, (3) tort reform, (4) coverage of preexisting conditions after a 90 day exclusion period, (5) insurance vouchers for the indigent, and (6) universal access to pretax healthcare savings accounts, we would have a simple, efficent health care economy that would be cheaper than a big ugly inefficent federal buraucracy.; 8/24/10, 10:38 AM
Alex said...: Death Panels, Sarah Palin was right!; 8/24/10, 10:43 AM
AF said...: So the position here is that the government should pay for unlimited medical treatment without regard to cost.

What is the position on taxes?; 8/24/10, 10:50 AM
MadisonMan said...: This is an interesting discussion for me, because my sister emailed yesterday telling me that her husband, who has lost one organ to cancer, is now on cisplatin, and I just assumed it was because the cancer had returned, but she said No, it was a preventative dose of chemo. I am relieved for her, and for him.

Why did I think the cancer had returned? Because they live in Europe and I just assumed, based on the anecdotes I read here, that anticipatory treatment just isn't done!

I am relieved to be wrong. (They're not in the UK, however).; 8/24/10, 10:53 AM
Anonymous said...: As it is increasingly obvious that almost no one seriously believes in cost containment, repealing Medicare Part D becomes more attractive with each passing day.; 8/24/10, 10:56 AM
traditionalguy said...: The position here is that surplus people should be treated with the same medical care as Government employees. If we cut one, then cut the other. If not, then the Tea Party will come back with some Extremist Nonsense about wiping out the current Congress members of both parties.; 8/24/10, 10:58 AM
Dark Eden said...: The medicine is available but a bureaucrat somewhere has decided You Can't Have It.

That sure sounds like a death panel to me doesn't it?; 8/24/10, 11:00 AM
Thorley Winston said...: Hey you cheap libertarians, do you admit that a life time of Medicare Taxes have also been paid thru employers as to many vested coverees?

No, paying taxes to support a government program doesn’t give one a vested or legally enforceable “right” to receive any benefits from that program. There’s case law from the Supreme Court that no one has a “right” to Social Security benefits just because they paid FICA and the same principle applies to Medicare.

I would just add that the current beneficiaries of both Medicare and Social Security paid far less in payroll taxes then the current taxpayers are who are supporting both programs. Moreover they had decades to push for the repeal of both programs in favor of some private options and didn’t do so. Why that somehow gives them some sort of moral claim (since they clearly don’t have a legal one) on the earnings of younger workers who didn’t have the opportunity to fix our entitlement problem that the current generation of beneficiaries did is beyond me.; 8/24/10, 11:01 AM
Thorley Winston said...: As it is increasingly obvious that almost no one seriously believes in cost containment, repealing Medicare Part D becomes more attractive with each passing day.

I didn’t support Medicare Part D when it was created but my understanding is unless we’re going to repeal Medicare outright, having a prescription drug benefit is cheaper in that generally the drugs cost less than other treatments already covered by Medicare such as surgery. If that’s not the case, then by all means repeal it.; 8/24/10, 11:01 AM
Anonymous said...: The medicine is available but a bureaucrat somewhere has decided You Can't Have It.

That sure sounds like a death panel to me doesn't it?

Private insurance companies have historically made, and continue to make, similar decisions all the time. Are their corporate bureaucrats death panel members as well?; 8/24/10, 11:03 AM
TMink said...: What Scott said. That and make us pay cash for treatment and get reimbursed later. The only medical fields where costs have gone down and results up is in cosmetic and eye correction. Both are cash pay in most circumstances, and docs run deals to bring in customers.

Capitalism. What a concept!

Trey; 8/24/10, 11:04 AM
TMink said...: Randy, I can change insurance companies fairly easily. There is NO mechanism to change beuracrats.

Trey; 8/24/10, 11:04 AM
Big Mike said...: The Democrats are the party of the poor and the filthy rich limousine liberals.

The poor get the satisfaction of knowing that the middle class get no better treatment than they do. The rich can afford to buy Avastin on their own.; 8/24/10, 11:06 AM
MadisonMan said...: Private insurance companies have historically made, and continue to make, similar decisions all the time. Are their corporate bureaucrats death panel members as well?

The difference, as I understand it, is that you have recourse through the Courts if your Insurance Co is treating you with reckless disregard. You'll find it a bit harder to sue the Government that makes all the rules re: Lawsuits.; 8/24/10, 11:07 AM
Anonymous said...: The difference, as I understand it, is that you have recourse through the Courts if your Insurance Co is treating you with reckless disregard.

It is rarely a question of "reckless disregard." It is usually simply not covered by the contract. In cases involving drugs such as this one, the appeal process usually takes enough time to render any decision moot.; 8/24/10, 11:14 AM
traditionalguy said...: Thorley...Government here works because we are a covenant keeping people. If paying into the Medicare tax for years is revealed to be stolen money by Cons in Congress, then the covenant is broken. That will lead to cash transactions off the books to avoid taxes paid for nothing. The many immigrants here do well in that system. So do we outlaw cash and voting rights over age 65? If not, then keeping the covenant is advisable. And how about getting all those rifles and ammunition out of the hands of the 65+ citizens? It may become easier to starve the population and then introduce new designer diseases to finish off the surplus people. A Death Panelist's work is never finished.; 8/24/10, 11:18 AM
Anonymous said...: Randy, I can change insurance companies fairly easily. There is NO mechanism to change beuracrats.

Trey: If you are fortunate enough to be healthy enough to change companies easily, more power to you! The vast majority of people are not that lucky. They (or their dependents) either have pre-existing conditions limiting their ability to change companies, or are not in charge of making the decisions about which insurance carrier(s) are available at their place of work. I'm not arguing private insurance is evil - far from it. I am saying it is ridiculous to argue that once the government provides coverage it can't say "No."

FWIW, most people I know have never read their group or individual contract, and are only dimly aware that there is almost always a formulary restricting covered medications. YMMV.; 8/24/10, 11:25 AM
Rich said...: MadisonMan said:

“The difference, as I understand it, is that you have recourse through the Courts if your Insurance Co is treating you with reckless disregard.”

Not so much.; 8/24/10, 11:32 AM
Anonymous said...: This comment has been removed by the author.; 8/24/10, 11:43 AM
Unknown said...: The Lefties may not like it, but "death panels" is fast becoming a euphemism for ZeroCare.; 8/24/10, 11:51 AM
Andrea said...: Randy: just because the insurance system sucks doesn't mean letting the government take over is better. Stop diverting the argument, which is: the precious "free" government health care plan isn't much of one.

FWIW, government health care is only useful for generally healthy people (who might be induced to go to the doctor for yearly checkups if they don't have to pay for it), people with sudden unexpected minor injuries or illnesses that only have brief hospital stays and are curable, and people with chronic illnesses who need common, low-cost drugs but not much other expensive care. It's absolutely useless when it comes to people with rare illnesses that need unusual treatments (that are of course more expensive), unexpected catastrophic accidents that leave you with permanent serious conditions (like paralysis, where you will always need some sort of expensive machine or conveyance, not to mention therapy), mental illnesses (just look at the whole mental hospital fiasco of the past forty years), chronic conditions that need expensive rare treatments, and most cancers other than the most minor, curable types. In other words, government health care isn't much good for anything, because funds are and always will be limited.; 8/24/10, 12:18 PM
Martin said...: "because funds are and always will be limited."

I'll buy you and me a policy if you can link to any private insurance plan ANYWHERE that doesn't have a limit on benefits.

I'm not knocking private insurance, but arguing against government provided health care because it's not unlimited is ridiculous.; 8/24/10, 12:25 PM
Opus One Media said...: It is so sad when posts like this appear. No one seems to take the time to read any articles or do any research whatsoever. Not even the fare thee well or reading links.

We talked about Avastin last time. Avastin.com itself - the drugs own site says it has no effect. Medicare is in the process of setting up the payment standards. The UK research indiates that a full course of therapy prolongs life by 6 weeks. On a fairly large segment of the population, it is contraindicated due to prior treatment protocols.

So the headlines make the leap about "too expensive" ...when the real headline is "Expensive Drug has little to no effect on the outcome".

Anyone ever watch The Shipping News? Wicked storm spares village.; 8/24/10, 12:37 PM
Opus One Media said...: MadisonMan said...
Private insurance companies .. make similar decisions all the time. The difference, as I understand it, is that you have recourse through the Courts if your Insurance Co is treating you with reckless disregard."

The average time for a civil action against an insurance company in New York - from service to trial is about 20 months longer than the life expectancy after diagnosis. Just a little heads up before you dispense any more advice.; 8/24/10, 12:41 PM
Known Unknown said...: "I'm not knocking private insurance, but arguing against government provided health care because it's not unlimited is ridiculous."

I'm not knocking ObamaCare, but arguing against private insurance because it's not unlimited is ridiculous.

Hmmm.; 8/24/10, 12:43 PM
Anonymous said...: Andrea: Where did I say it was better?; 8/24/10, 12:43 PM
MadisonMan said...: House, I'm not sure how your little un-sourced factoid invalidates anything I said.

With any insurance, it's in a person's best interest to be very pro-active.; 8/24/10, 12:56 PM
Martin said...: E.M. Davis-where did I make one single argument against private insurance?; 8/24/10, 1:03 PM
Opus One Media said...: MadisonMan said...
"With any insurance, it's in a person's best interest to be very pro-active."

of course it is. what a great system. if you don't threaten and hound the insurance companies constantly they can and will screw you.; 8/24/10, 1:24 PM
Michael said...: HD House: "what a great system. if you don't threaten and hound the insurance companies constantly they can and will screw you."

You can substitute virtually any bureaucracy for "insurance companies" in the above. Vast bureaucracies are constructed on rules, lots of rules, rules for rules. Plus, employees are pretty much in place for life. No rush. No need for urgency. All bureaucracies operate this way. Government being the worst followed by huge companies providing "service" to the consumer; 8/24/10, 1:42 PM
Geoff Matthews said...: factotum,

I'm not making statements on any individual event. I'm simply stating that Medicare as it currently is, is not sustainable. We have limited funds, and when someone else is covering the bill, that someone else is going to decide what is worth paying for and what is not.
Whether it is private or government.; 8/24/10, 1:45 PM
Freeman Hunt said...: Re: private insurance is out to get you

Blue Cross Blue Shield of Oklahoma has been paying enormous sums of money for my father's treatments over the last year and a half. No hounding necessary.

Why? Because if they screw him over, his employer will hear about it and seek out different insurance coverage to keep employees from being screwed over in the future.

If the insurer is the government, where are the competitors to keep service and efficiency in check?; 8/24/10, 1:49 PM
MadisonMan said...: if you don't threaten and hound the insurance companies constantly they can and will screw you.

I'm not sure what your point is. Are you suggesting Insurance Companies should be required to give top-notch service? Do you also want them to turn a profit?

Sometimes (always?), you can't have both.; 8/24/10, 1:53 PM
Rich said...: Freeman Hunt said:

“Blue Cross Blue Shield of Oklahoma has been paying enormous sums of money for my father's treatments over the last year and a half. No hounding necessary.

Why? Because if they screw him over, his employer will hear about it and seek out different insurance coverage to keep employees from being screwed over in the future.”

Boy, I have my doubts about that. Employers provide health insurance as a way to attract employees, as part of their compensation. The employer’s primary concerns are going to be how cheaply it can offer “health insurance,” any health insurance, to its employees, in order to compete for them. Once an employee is hired and enrolled in the employer’s plan then the employer will tend to be entirely indifferent to to any concerns other than premium costs; it will not have much incentive to worry about the quality of the insurance or the good faith of the insurer. The only countervailing concern would be if prospective employees researched the health coverage offered by the employer and made their decisions based on that, which I don’t think will be a very significant factor, especially from the employer’s perspective.

In the area I primarily deal with – group disability insurance governed by ERISA – the employer's incentive is even smaller since the people getting screwed over are, by definition, no longer working and typically are former employees. It will be a rare employer who will concern itself to any significant degree with how former employees are treated.

The appropriate counterbalance to an insurer breaching its contract would be the courts, but as I have discussed elsewhere that isn't available in any effective way.; 8/24/10, 2:03 PM
exhelodrvr1 said...: To Scott's list, add in better access to urgent care clinics, to cut back on ER visits.; 8/24/10, 2:05 PM
Fred4Pres said...: Children of Men is a far better book than movie.; 8/24/10, 2:26 PM
Bruce Hayden said...: The average time for a civil action against an insurance company in New York - from service to trial is about 20 months longer than the life expectancy after diagnosis. Just a little heads up before you dispense any more advice.

While that may be true, as I pointed out last time around, I know several attorneys who make far more than I do by suing insurance companies for denied benefits. They get very substantial punitive damages for this sort of thing. So, sure, if the case goes to court, it may take a bit of time. But the insurance company is potentially liable for many times the cost of the treatment.

I know one woman who was hit by a driver who had the minimum $10k or so insurance. His insurance company should have just cut the $10k check and been done with it. Instead, they hired a PI, who photographed her walking (which she did to strengthen her back), and as a result, denied the claim. In the end, they dropped at least a half a million in medical costs for her, and is paying her a couple of thousand dollars a month for life. All because of a denied claim.

Yes, it took a couple of years, but when they got into serious discovery, and knew the reputation of the attorney on the other side winning such "outrageous conduct" cases, the insurance company settled.

I know people who sell health insurance, and they all will tell you that the reputable insurance companies will go out of their way, when pushed, to not get sued for refusing to cover something that is borderline. Such suits don't help their bottom line, nor their reputation (who is going to sign up with an insurance company that has a reputation for losing this sort of case?); 8/24/10, 2:38 PM
jungatheart said...: F4P
>>>Children of Men is a far better book than movie.<<<

Haven't read it, but I'm a huge fan of her Adam Dalgliesh detective series.; 8/24/10, 2:43 PM
Bruce Hayden said...: of course it is. what a great system. if you don't threaten and hound the insurance companies constantly they can and will screw you.

Of course, government insurance is worse - you typically have no legal recourse when you are denied treatment. And, so, threatening the government has no affect, and hounding them has little.

Liberals, of course, believe that tooth fairies run government health systems and always look out for the best interests of those whose interests they (supposedly) protect. The reality, again, does not bear this optimistic view of bureaucracies out. Rather, government bureaucrats are far less accountable and interested in the plight of others than those who have a direct financial interest in seeing that their customers are well served.; 8/24/10, 2:44 PM
jungatheart said...: MM
>>>Sometimes (always?), you can't have both.<<<

Is it a question of profit margin, I wonder?; 8/24/10, 2:45 PM
Opus One Media said...: Michael said...
"Government being the worst followed by huge companies providing "service" to the consumer"

that is factually incorrect. medicare is vastly more efficient than private insurance. but you knew that and you said it anyway.

wie schade.; 8/24/10, 2:47 PM
Rich said...: Bruce Hayden said:

“I know one woman who was hit by a driver who had the minimum $10k or so insurance. His insurance company should have just cut the $10k check and been done with it. Instead, they hired a PI, who photographed her walking (which she did to strengthen her back), and as a result, denied the claim. In the end, they dropped at least a half a million in medical costs for her, and is paying her a couple of thousand dollars a month for life. All because of a denied claim.”

Bruce, that’s auto insurance and the med pay/liability part of the other driver’s policy. It isn’t health insurance and certainly not group health insurance governed by ERISA. I know you and I have discussed this in the past. Do you dispute that group health plans, thanks to ERISA, have no (or at best insufficient) incentive not to cheat people?

“As of now we have a situation where the law tells insurers they face no meaningful consequences if they deny care improperly or even commit outright fraud. As one federal judge has commented, ‘if an HMO wrongly denies a participant's claim even in bad faith, the greatest cost it could face is being compelled to cover the procedure, the very cost it would have faced had it acted in good faith. Any rational HMO will recognize that if it acts in good faith, it will pay for far more procedures than if it acts otherwise, and punitive damages, which might otherwise guard against such profiteering, are no obstacle at all.’”; 8/24/10, 2:55 PM
Phil 314 said...: Avastin costs almost £21,000 (=$32,400) per patient and an estimated 6,500 people per year could be eligible for the drug.
..it can typically offer patients an extra six weeks of life when added to the chemotherapy drugs capecitabine and oxaliplatin.

so who (or what combination of parties) should pay for this medication. And at what level of cost or cost per year of life gained can one of those parties opt out of paying, 1 million per year of life saved?; 10 million?; 1 billion?

Saying "I don't know but that third party SHOULD pay" is not an option.

I do note by the discussion that once again Liberal distrust private companies and conservatives distrust the government.
The equation presented above IS NOT a political question.

And re: wast, fraud and abuse. You can eliminate ALL administrative costs in America (public and private ) and you will have reduced the per capita expenditures for health care by about 7%.

Yes you can talk about make the system more "efficient". That's anoble goal BUT it won't come free; there are no magic wands.; 8/24/10, 3:28 PM
AC245 said...: I do note by the discussion that once again Liberal distrust private companies and conservatives distrust the government.
The equation presented above IS NOT a political question.

c3, once again you (and others) miss the fact that with private companies providing goods and services, you can choose to continue doing business with one company, you can choose to do business with another company, and you can even choose to do business with no company at all.

When a law forces you to pay the government for a service (e.g. Medicare, Obamacare), you do not have a choice to stop doing business with them and therefore cannot choose to take the money you were paying to the government and instead pay it to a private company or keep the money for yourself if those options would better suit your situation.

If the government's service is so spectacular (or at least superior to the private services available), then let them offer it in competition on the marketplace without coercing people to participate. People who want to pay the government to take care of them can choose to spend their money in the government plan, and people who do not want to pay the government for health insurance can choose not to do so.

(Also, your shtick of pretending to be above any partisan discussion and "helpfully" pointing out that there are no easy answer is obnoxious and tiresome.); 8/24/10, 4:33 PM
Opus One Media said...: The idiocy of the right wing is over the fringe.

If people stop just stiffing hospitals and doctors because they treat you as a mercy and you pay something - whatever it is - but something into the system we are better off.

God save us from the entry level stupidity of the right wing.; 8/24/10, 4:38 PM
Ritmo Re-Animated said...: If the government's service is so spectacular (or at least superior to the private services available), then let them offer it in competition on the marketplace without coercing people to participate.

The left tried that approach and the right shot it down out-of-hand. Gee... I wonder why.; 8/24/10, 6:10 PM
Ritmo Re-Animated said...: And re: wast, fraud and abuse. You can eliminate ALL administrative costs in America (public and private ) and you will have reduced the per capita expenditures for health care by about 7%.

Twenty bucks says that the 7% saved through further efficiencies wouldn't touch the amount spent by private insurers on marketing, executive compensation and administrative overhead.; 8/24/10, 6:13 PM
Anonymous said...: Geoff, based on what little I know of medicare, I would say that it needs a serious overhaul. It appears that the recipients have almost no financial responsibility for their care.

According to this medicare site,* the deductible is $135 a year with a 20% coinsurance of the medicare rate, which is very low. There is no incentive for someone to be cautious about consuming medical services (i.e., my drunk father in law who calls an ambulance every time he falls out of bed) because it costs them almost nothing.

Perhaps medicare (or at least the benefits) should be means tested so those who have the cash for a couple of gallons of booze a week, cable, a gardener, and a maid should pay a little more for their care than the farmer's widow in her little house living on nothing but her social security check and what she cans from her garden every summer.

https://questions.medicare.gov/app/answers/detail/a_id/2100/~/medicare-premiums-and-coinsurance-rates-for-2009; 8/24/10, 6:48 PM
Freeman Hunt said...: Rich, you don't think it matters to an employer if the employees think the health coverage is bad? Companies don't care whether or not they can retain employees? Companies have no care for their employees?

The company I worked for would most certainly have cared if the health insurer was denying employee claims. HR would have been incredibly angry about it and switched coverage.; 8/24/10, 7:31 PM
bagoh20 said...: This matter is not quite that simple. As noted late in the article, it can save a person's life, and not for weeks, but years or decades. It depends on the patient's condition. The statistical average effectiveness is deceptive. I agree it is a waste to use it to extend life a few weeks, but there is a point where it is worth it. For some patients it would be immoral to not provide it, while for others it would be reasonable - not that anybody wants to be reasonable.

My life was saved in a similar way. My liver tumor was 5.1cm the limit for a transplant is 5cm. I was given chemo that had zero chance of curing me, but it shrunk the tumor just enough to get me a new liver.

That was 4 years ago on Sunday. I have no cancer today, feel great and do a lot of good for those around me.

If the low effectiveness of the chemo drug I got prevented me from getting it, I'd be dead right now. So I'm a little biased.; 8/24/10, 7:59 PM
bagoh20 said...: My insurance would pay for Avastin with absolutely no balking. Of course that's American private enterprise insurance that I've paid for by staying insured for decades no matter what it took. I may even have had to pass up a new TV now and then and work some extra hours. It's a disaster I tell ya.; 8/24/10, 8:05 PM
Rich said...: Freeman Hunt said:

“Rich, you don't think it matters to an employer if the employees think the health coverage is bad? Companies don't care whether or not they can retain employees? Companies have no care for their employees?”

(1) No I do not think it matters to employers what employees think of their health coverage. I am not even sure it should. Employers are in business to turn a profit (and if they are a publicly-held company they have a fiduciary duty to maximize shareholder value) and if they can offer “health insurance” sufficient to compete in the employment marketplace and pay lower premiums in so doing it should not be incumbent on them to pay higher premiums for better coverage. Indeed were the law as it should be by buying insurance they would satisfy their obligations to their employees, because they would then be providing an insurance policy, enforceable in court if necessary. As it is they pay premiums and provide an empty promise that some insurer will pay claims if it feels like it.

(2) Companies do care whether or not they can retain employees -- to the extent consistent with turning a profit.

(3) I do think, in general, companies have no care for their employees, and again I don’t think they necessarily should. If the law allowed the courts to do their job as against insurers the employer’s level of “care” wouldn’t matter, as the employer would not be in the position of having to go to bat for an employee it cares about – the courts would enforce the policies the employer has in good faith paid for.

You know I review an awful lot of claim files, and the number of times there’s an indication the employer said “you son of a bitch, pay my employee’s claim” is profoundly dwarfed by the number of times I see “if you pay this claim it won’t make our premiums go up, will it?”

BTW this is not just some anti-employer or anti-business bias at work (well, I am anti- the insurance business I suppose). We see the same dynamic in plans sponsored by unions ostensibly for the good of their members. In fact those guys are worse if you ask me because they don’t have a legitimate profit motive to explain their indifference to anything other than lower costs.

If your company was more concerned about employees’ well-being, and would have switched to a different insurer to get better coverage and service, then it was, IMO, an outlier.; 8/24/10, 8:20 PM
bagoh20 said...: "I do think, in general, companies have no care for their employees, and again I don’t think they necessarily should."

Would you care if you were their employer?

I'm the decision maker at my company, and I can tell you that it's probably one of the most important concerns I have. If one of my people gets sick and can't get help, we would get on the phone and bitch and threaten with the loss of our business. It has never happened in over 2 decades.

The only problem is employees who decline to get coverage that is mostly paid by the company. They will not sacrifice the cost of a single cell phone plan.

Company management is made up of people who generally also have the same insurance as the other employees. They sometimes have conflicting interests to consider, but they are not just mean greedy people. It's time people grew up about this stuff.; 8/24/10, 8:52 PM
bagoh20 said...: I don't think health insurance should be the responsibility of employers at all, but it is, so we need to treat it with the life-threatening importance it deserves.

It also needs to be appreciated that an uncompetitive company will insure nobody and employ the same.

It's not easy, which is why we should handle it privately and not expect others either government or employers to make these decisions for us.; 8/24/10, 8:59 PM
Eric said...: Is there a law that says that prevents the private purchase and sale of Avastin?

Not in the UK, but try to keep up. It will be illegal in the US if the FDA yanks it off the market, which is what the administration is trying to do. They can't come out honestly and say it costs to much, because the politics would be bad. But if the FDA takes it off the market... problem solved!; 8/24/10, 9:13 PM
Freeman Hunt said...: Rich, might there be a selection bias at work in the sort of claims files that reach your desk?; 8/24/10, 9:20 PM
Irene said...: Eric said: "Not in the UK, but try to keep up. It will be illegal in the US if the FDA yanks it off the market, which is what the administration is trying to do. They can't come out honestly and say it costs to much, because the politics would be bad. But if the FDA takes it off the market... problem solved!"

Exactly.

Like bagoh20, I am biased. I am probably alive because I took part in an Avastin test study.

Some commenters in the old Avastin/death-panel thread needled my observation about Avastin because I participated in a clinical trial gauging its efficacy for *ovarian* cancer, whereas the FDA announcement hinged on whether to deny Medicare coverage for the drug for *breast* cancer patients.

Both the Susan G. Komen Foundation and the Ovarian Cancer National Alliance raised alarm bells about the FDA's proposal to rescind approval of Avastin.

It's not about the type of cancer to which the drug applies. It's about choice. Should the government rescind coverage of approved cancer treatments?

Physicians use Avastin for many cancers, including colorectal, breast, lung, kidney, and brain cancers.

If we apply a cost-benefit analysis of Avastin to breast cancer, then it's not long before the government decides to stop paying the cost for other cancer treatment.; 8/24/10, 9:50 PM
Rich said...: Freeman Hunt said:

"Rich, might there be a selection bias at work in the sort of claims files that reach your desk?"

Without doubt there is, and that is a fair point (not that you need me to tell you that). By definition I only see denied or terminated claims, because those are the claims about which there would be a grievance.

OTOH the claims I do see contain quite compelling evidence, taken as a whole, of shoddy and fraudulent behavior on the part of insurers. And they are also, coincidentally, likely the ones where an employer might be asked to go to bat for an employee. And in the minority of cases where the employer cares to get involved at all what I see -- with unmistakable frequency-- is "whatever happens don't do anything which would raise our premium."

I do not claim to be unbiased or impartial. Indeed I would like to once again refer the folks here to my admittedly polemic blog for more information, and from sources other than myself.

It may help to know that I got this way by representing insurers for 13 years before switching sides and hanging out my shingle. I could no longer defend this sort of conduct in court -- even though it was "legal" -- and live with myself. To my lasting shame it took me that long to act on my own values.; 8/24/10, 10:00 PM
Chennaul said...: It is now on the Wednesday morning front page of the Daily Mail's [UK] website-

Betrayal o Rationing watchdog accused of talking down wonder drug Avistin's power to save lives

Cancer Patients:Cancer specialists and charities rejected the claim by NICE that it only prolongs lives by an average six weeks as 'spurious'. They say some advanced stage bowel cancer patients with very short life expectancy have lived for four years after being prescribed Avastin and are expected to survive for much longer.; 8/24/10, 10:48 PM
Peter Hoh said...: Trey @ 11:04 -- go ahead and argue that people should pay cash for drugs like Avastin. I tried on an earlier thread like this, and was accused of being a socialist who wanted people to die or something.; 8/24/10, 11:34 PM
Peter Hoh said...: I see Randy has already been accused of promoting the recent health care program.

We are in serious need of reading comprehension reform.; 8/24/10, 11:36 PM
Peter Hoh said...: Yes, there is a mechanism to change decisions that have been made by bureaucrats. It involves people calling their congressional representatives and demanding change. It involves the company who makes the drug lobbying Congress. And it involves 60 Minutes doing a feature about the poor, suffering people who have been denied the life-saving drug that would have made their lives better.

And as soon as you can say "deficit spending," Congress will tell the bureaucrats to cover the drug.

And we'll continue to spend money we don't have like there's no tomorrow.

How soon until someone accuses me of being an Obama apologist on this issue?; 8/24/10, 11:42 PM
amba said...: Avastin is brutally expensive and buys most patients at best a few months of life (yes, there are exceptions). Who IS going to pay for it?

Regardless of whether the system is private or public, containing costs AND having unlimited access to expensive treatments (especially those that are relatively ineffective) is simply a contradiction in terms. Does everyone have a "right" to get Avastin? Do only those who have been financially successful in life (through effort, inheritance, or whatever) deserve it? (If you're not financially secure, no excuses, you're a loser and a parasite and you deserve to die.)

Death panels on all sides. But it's stupid to be having this conversation about Avastin, which does most patients rather little good. Anyway, at some point -- when? -- it will go generic and become far less expensive.

vw warsplat -- blood and guts; 8/25/10, 12:48 AM
Dustin said...: I gotta ask you people who keep saying this is just about cost containment:

Do you live in a cave? Under a rock? Are you just being dishonest?

Do you people really not understand that if the FDA withdraws approval for a drug that I cannot just obtain some with more money?

This is not just about cost containment. This is about how Obama politicized everything. Removing approval for a drug based on price is not the FDA's mandate. It's wrong. The admin should just own the obvious, that they won't be paying infinite dollars for everything people need. Socialists run out of money eventually... not because any particular socialist failed to figure out how to find infinite money, but because it's a stupid system.

That the FDA was already involved to the extent it was is a severe problem, to my view, and I hope you folks who are crowing about hypocrisy from the right put down your NYT and find a real source of information.; 8/25/10, 4:55 AM
billm99uk said...: Yes, there is a mechanism to change decisions that have been made by bureaucrats. It involves people calling their congressional representatives and demanding change. It involves the company who makes the drug lobbying Congress. And it involves 60 Minutes doing a feature about the poor, suffering people who have been denied the life-saving drug that would have made their lives better.

That's pretty much what we got in the UK when NICE decided against providin the anti-breast cancer drug Herceptin. Politicians like being re-elected y'know.; 8/25/10, 7:52 AM
former law student said...: There’s case law from the Supreme Court that no one has a “right” to Social Security benefits just because they paid FICA

The holding from Flemming v. Nestor (alien, deported for having been Communist Party member, could be denied Social Security benefits) was that due process required a rational basis for any such denial.; 8/25/10, 11:49 AM
former law student said...: I hope we never see the UK's NHS in the US -- it has proven itself a failure time and again. As pointed out, Avastin ... [is ] routinely used in other European countries. However, until more Americans learn foreign languages, the NHS and the Canadian health care system will continue to dominate any universal health care discussion.

Reading more about Avastin, I see it also substantially increases the risk of stroke and heart attack. So you would have to weigh this risk for your dying patients as well.; 8/25/10, 12:00 PM
knox said...: Once an employee is hired and enrolled in the employer’s plan then the employer will tend to be entirely indifferent to to any concerns other than premium costs; it will not have much incentive to worry about the quality of the insurance or the good faith of the insurer. The only countervailing concern would be if prospective employees researched the health coverage offered by the employer and made their decisions based on that, which I don’t think will be a very significant factor, especially from the employer’s perspective.

Not my experience, at all. My employers and my husband's employers have all been quite conscientious about the plans they offer and very forthcoming if they make any changes.

At my last job, my employer regularly brought our insurance broker in to talk to us about our options, the HSAs available to us, etc.

I personally have never had any procedure or treatment rejected by my insurance, and I've had a few health issues over the years.; 8/25/10, 12:16 PM
knox said...: Like bagoh20, I am biased. I am probably alive because I took part in an Avastin test study.

Love ya, Irene. So glad you're here.; 8/25/10, 12:18 PM
knox said...: They sometimes have conflicting interests to consider, but they are not just mean greedy people. It's time people grew up about this stuff.

Thank you. I think it's cynical and, frankly, weird the way so many seem to think working people are just chasing the dollar and abusing their employees. It's an immature, "Wall Street" point of view.

It puts a very personal, nasty spin on these sorts of discussions. Good lord, do you think that poorly of your neighbors? Of the businesses you patronize? There are rotten apples, sure, but going about your life thinking most working people are greedy, uncaring assholes is sick and depressing.; 8/25/10, 12:24 PM
Rich said...: knox said:

"Not my experience, at all. My employers and my husband's employers have all been quite conscientious about the plans they offer and very forthcoming if they make any changes."

Not to get to pedantic here, but ask your employer if they've agreed to an insurance policy which contains any language to the effect the insurer "has discretion to interpret the policy and determine eligibility for benefits." If they have, then they've sold you down the river whether they realize it or not (and I believe most do not). If they've bought a policy with that provision or a similar one they've just gutted their employees' ability to enforce the promises made by the insurance company, and the insurance companies know it. Example here.

I do find it incongruous that many here find fault with those who expect any sort of largess from business or employers, and invoke caveat emptor readily, yet express incredulity when someone observes business actually acts that way, i.e. precisely the way we think they should act. The businesses who've responded to Obamacare with predictions they'd have to gut their employees' coverage as a result did not cause anyone here to either doubt they'd do that or find fault with them for doing so.

I don't think they're evil, I just think they're profits first, employees second, as they have to be.; 8/25/10, 1:40 PM
Irene said...: Hi Knox!

*woof*; 8/25/10, 2:24 PM
Phil 314 said...: c3, once again you (and others) miss the fact that with private companies providing goods and services, you can choose to continue doing business with one company, you can choose to do business with another company, and you can even choose to do business with no company at all.

When a law forces you to pay the government for a service (e.g. Medicare, Obamacare), you do not have a choice to stop doing business with them and therefore cannot choose to take the money you were paying to the government and instead pay it to a private company or keep the money for yourself if those options would better suit your situation.

If the government's service is so spectacular (or at least superior to the private services available), then let them offer it in competition on the marketplace without coercing people to participate. People who want to pay the government to take care of them can choose to spend their money in the government plan, and people who do not want to pay the government for health insurance can choose not to do so.

(Also, your shtick of pretending to be above any partisan discussion and "helpfully" pointing out that there are no easy answer is obnoxious and tiresome.)

I understand your point about the different "freedoms/privileges" a private company and the government have. My point is that political positions don't eliminate the reality that a significant surgery is generally out of the reach of most people's pocketbook ($50,000 - $100,000 or more) so access to high tech/high cost care is an issue. On the other hand resources aren't infinite. I don't hear a lot of serious discussion of how one addresses these conflicting issues.

As for my "schtick", I honestly don't know how to respond. If challenging you and your clarity of vision with unresolved questions (i.e. what very costly, marginal technologies shouldn't be paid for.)is obnoxious and bothersome then I wish you well on the "moral highground". I know its much easier to answer "out of principle" and not deal with such "obnoxious" issues as "balancing a budget".; 8/25/10, 2:58 PM
Phil 314 said...: This comment has been removed by the author.; 8/25/10, 2:59 PM
Phil 314 said...: AC;
Maybe this will be a simplier response.

you can choose to continue doing business with one company, you can choose to do business with another company, and you can even choose to do business with no company at all.

When the cost of an intervention is $200,000 and your insurance doesn't cover it and no insurances cover it then "choose" may not be the best description of what you're doing.

And the reality is once you discover that your insurance doesn't cover Avastin your ability to "choose" another company is essentially zero.; 8/25/10, 3:06 PM
Phil 314 said...: Ritmo;
Twenty bucks says that the 7% saved through further efficiencies wouldn't touch the amount spent by private insurers on marketing, executive compensation and administrative overhead.

Unfortunately, everything that you included above is included in that 7%. Life would be SO much easier if we had one, big easy target to go after (you know that evil corporation that sucks up 80% of the dollars that SHOULD go to healthcare but instead go to someone third mansion on the French Riveria).

But nope, not reality.; 8/25/10, 3:11 PM
AC245 said...: c3 said...
When the cost of an intervention is $200,000 and your insurance doesn't cover it and no insurances cover it then "choose" may not be the best description of what you're doing.

Well, sure, I agree that "choose" might mot be the best description in that scenario.

I think "being forced into a twisted hypothetical which conveniently supports c3's viewpoint but is wholly disconnected from the real world" would be a better description.

And the reality is once you discover that your insurance doesn't cover Avastin your ability to "choose" another company is essentially zero.

It's amazing how you can dictate what "the reality is", based solely on a slanted hypothetical situation you conjured out of thin air.

Truly impressive.; 8/25/10, 4:13 PM
AC245 said...: c3 said...
I understand your point about the different "freedoms/privileges" a private company and the government have. My point is that political positions don't eliminate the reality that a significant surgery is generally out of the reach of most people's pocketbook ($50,000 - $100,000 or more) so access to high tech/high cost care is an issue. On the other hand resources aren't infinite. I don't hear a lot of serious discussion of how one addresses these conflicting issues.

You don't seem to understand much, actually, based on this comment. The "serious discussion" is whether people should be allowed to allocate their resources in a manner of their own choosing, or if the government should take those resources by force for reallocation. Some of us are in favor of people being able to spend their money they way they choose, rather than having the government forcibly confiscate and redistribute it -- even if this means that some people can afford things that other people can't.

As for my "schtick", I honestly don't know how to respond. If challenging you and your clarity of vision with unresolved questions (i.e. what very costly, marginal technologies shouldn't be paid for.)is obnoxious and bothersome then I wish you well on the "moral highground". I know its much easier to answer "out of principle" and not deal with such "obnoxious" issues as "balancing a budget".

Asking how to "balance the budget" in a discussion focused on whether people should be allowed to choose how to spend their own money or be forced to give it to the government to spend doesn't challenge me or my "clarity of vision". It simply demonstrates that you either aren't paying attention to, or don't understand, the discussion.; 8/25/10, 4:29 PM
Phil 314 said...: The "serious discussion" is whether people should be allowed to allocate their resources in a manner of their own choosing, or if the government should take those resources by force for reallocation.

So I understand your position are you suggesting that someone on Medicare is allocating "his" resources?; 8/25/10, 8:28 PM
AC245 said...: So I understand your position are you suggesting that someone on Medicare is allocating "his" resources?

I think I've been pretty clear about what I've been saying, and I'm not really in the mood to play the "so what you're really saying is..." game.

Why not drop the whole "both conservatives and liberals are just avoiding the real issues!" shtick and instead actually state your position?; 8/25/10, 8:56 PM
Phil 314 said...: Why not drop the whole "both conservatives and liberals are just avoiding the real issues!" shtick and instead actually state your position?

My position:
Republicans have been less than honest in discussing how to improve access to healthcare for those who can't afford it (i.e. the 50 year old recently laid off white male)

At the same time Democrats have been dishonest in saying how improving access and getting tough on insurance companies will control costs.

And more to the point, neither Republicans nor Democrats want to take a hard and honest look at our most establish government run health insurance, Medicare. Neither party is willing to discuss the hard choices that need to be made to keep the program solvent past 2018.

PS I'm a little confused about your clarity on this thread since your only comments have been in response to my comments. And since you're only responding to me in this thread and I'm not clear what your trying to say other than "we have choices" and "I don't want the government to take my money and make choices for me", no I'd say you haven't been clear. Unless what I just described is the only point you wanted to make. If that is the only point you wanted to make then fine. That's a conviction, hopefully you don't see it as a "solution" or a "plan".; 8/25/10, 11:43 PM
AC245 said...: c3 said...
My position:
Republicans have been less than honest in discussing how to improve access to healthcare for those who can't afford it (i.e. the 50 year old recently laid off white male)

At the same time Democrats have been dishonest in saying how improving access and getting tough on insurance companies will control costs.

And more to the point, neither Republicans nor Democrats want to take a hard and honest look at our most establish government run health insurance, Medicare. Neither party is willing to discuss the hard choices that need to be made to keep the program solvent past 2018.

So I ask you to drop the whole "both conservatives and liberals are just avoiding the real issues!" shtick and state your position, and you respond by stating that your position is your shtick of criticizing Republicans and Democrats. Apparently you have nothing of your own to offer on the topic besides sniping at what everyone else says.

:yawn:

As I said two days ago:

Your shtick of pretending to be above any partisan discussion and "helpfully" pointing out that there are no easy answer is obnoxious and tiresome.

Your repetition of that shtick over the past two days hasn't made it any less obnoxious or tiresome.; 8/26/10, 1:49 PM