rationing

-By Warner Todd Huston

In a few days the Food and Drug Administration (FDA) is expected to release its final decision on whether or not 17,000 women across the country will have the same access to the breast cancer drug Avastin that they now have. Several congressmen, thousands of doctors and patients, and many small government activists stand against this perceived example of Obamacare-like rationing.

As reported last week, with this Avastin situation five Congressmen have become alerted to the threat that government is instituting cost-based rationing of healthcare and have become alarmed at the effects that will have on the sick. It seems that this FDA decision will set the table for the rationing war to come under Obamacare unless that legislation is repealed or inhibited.

Avastin is, admittedly, an expensive drug. But are we ready for government to decide if your lifesaving medicines are “too expensive” to be allowed for use? Is that the cost-based road down which we wish to travel? And how far down that road do we go? How much cost-cutting do we want government to indulge where it concerns our health? And should government even have that role in the first place?

These are questions that the Avastin decision evokes.

Aside from the letter mentioned above written by the five congressmen, Representative Jack Kingtson also sent a letter to Chairman Rosa DeLauro of the House Appropriations Committee, Subcommittee on Agriculture, Rural Dev., FDA, and Related Agencies. Rep. Kingston asked the chair to schedule an oversight hearing on Avastin.

Because of the implications of removing the breast cancer indication from the Avastin label on women currently undergoing treatment, I believe it is imperative that we hold a hearing on Avastin during the upcoming lame duck session.

Mr. Kingston is worried that the FDA is moving hastily and so are many doctors and patients. Sadly, Rep. DeLauro has ignored Mr. Kingston's request. She is a great supporter of rationing and Obamacare after all.

The son of one such patient recently wrote an op ed in The Hill pleading with the FDA not to end support for the drug with which his mother is finding success. Josh Turnage ended his piece saying, "The FDA can still change course and preserve the right of breast cancer patients to make an informed choice. If someone you loved were diagnosed with breast cancer, wouldn't you want the right to choose this drug?"

Now, many of the critics of the drug's supporters say that it is fearmongering to worry about the FDA delisting the drug for breast cancer. The say that the limitation to just breast cancer will not impact the availability of the drug all that much. But this ignores the great impact that government action has on a thing.

Already several insurance companies are moving away from supporting the drug with just the threat of government action.

• Regence Blue Shield, the large regional plan in the Pacific Northwest recently published an Avastin policy listing the breast cancer treatment as “medically unnecessary.”
• Utah Public Employee Health Plan a small regional payer in Utah has begun to deny all Avastin claims but has not yet bothered to publish a written policy.
• Health Care Service Corporation the parent company of Blue Cross/Blue Shield of Illinois, New Mexico and Oklahoma recently published an Avastin policy that restricts use of Avastin.

Because of the government's actions -- even as limited as those actions are thus far -- thousands of patients are finding the availability of their drug being limited.

This is a perfect example of what will happen to the medical field if these sort of government actions increase under Obamacre. Please do call your representatives and senators on this issue before the Dec. 17 deadline and let them know how you feel.

(Here is a Roche Company update sent to investors on where they stand on the matter)

so gone from this site

I know the Left likes to ridicule anyone who mentions Ayn Rand or Atlas Shrugged. They especially like it when conservatives or Republicans say something about "Going Galt".

It seems to me that one reason for this is a (deliberate?) misunderstanding of what we -- or at least, I -- mean when we say that.

By "Going Galt", it seems to me, we (mostly) mean that someone will not take that next step, make that investment of time, effort, thought, or money, to make their mark in the world and make a difference.

Like Rand's great philosopher Hugh Akston who became a short order cook in a roadside diner, rather than using abilities to their utmost, someone who "goes Galt" might simply choose to do something else, rather than take the extreme Galt/Wyatt/Mulligan option of completely removing themselves from the reach of the looters and the moochers.

In that light, I think Obamacare is going to cause us more problems than many have been imagining. . . .

I have heard from a surgeon whom I trust and respect (though I don't know his source for this information) that much more than half of all surgeons are 55 or older.

Given the basic premise that people do things based on the incentives involved, and given the further premise that Obamacare (or, if it fails, the next incarnation of it) will reduce the financial and professional incentives to become a doctor, my friend believes strongly that we will be in for medical rationing simply because we will not be able to find enough doctors, regardless of what happens due to gov't bureaucratic manipulations.

My friend spent 14 years -- FOURTEEN YEARS -- after college training to become a doctor, then surgeon, then getting his specialty skills.

What makes people think that we will be able to find "volunteers" to go through such a rigorous and lengthy program, all the while incurring massive amounts of debt for the cost of their schooling and training, just so that they can be asked to work 36-hour shifts* for whatever salary a bureaucrat determines they are worth?

My friend loves his work. He does it for the satisfaction he gets from it.  (Now.) But when asked if he would have gone through everything he went through solely for the satisfaction of the job, he says no.  The potential to make a good living for himself and his family was definitely part of the attraction to the career choice in the first place.

There are other jobs he could have loved and been accomplished in performing, while paying well.  Plus they would have afforded him much more time to spend with his family as his children grew up, rather than having to spend significant portions of not just days but nights as well away from home and on call.

The point I want to leave you with is that we can expect to lose men such as him from the medical profession if we insist on making them gov't cogs rather than free actors, capable of making what they can in a market which rewards them for their dedication, efforts, sacrifices, and skills.

Beware what you wish for, Obamacare supporters.  You might just get it . . . and then the supply of producers whose efforts you have appropriated will dry up, relieving you of the burden of looting them.

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* Yes, I know the 24+ hour shifts don't last forever.  And that they are concentrated in the early years of training, but does that really make anyone think that people will jump at the chance to perform such arduous tasks for the pittance the DC paper pushers are willing to fork out?  Really?

Let’s put aside our right-leaning suggestion box for a moment and put the challenge straight to the left as follows… (Warning: intellectual honesty check.) Will your bill:

1. Control Costs? If you have any third-party payer system, you’ll have a situation in which people overconsume. Because they have no incentive to be bargain shoppers, they won’t shop for bargains. Costs will continue to go up. Subsidized healthcare ensures people will continue consume more of what they don’t have to pay for directly. That’s the major driver of costs in healthcare. How will you deal with this problem—which is the main problem (not “administrative costs”?)

2. Avoid Using Price Controls? Bureaucrats determining prices will, as it always has, mean gross distortions (that whole supply and demandt thing). In the absence of real prices, resources don’t get allocated properly, because prices are a way to deal with dispersed, complex information. This is the problem we saw in the Soviet Union and it’s a major problem for the Canadian system. Will your system use price controls?

3. Avoid a Special Interest Bonanza? Any subsidized, government-provided reform will mean healthcare becomes a Freddie and Fannie phenomenon. Private companies that serve the government insurer will become special interests. They will game the system and rape it, as they have in so many other spheres of our life when colluding with government. Their prices will go up (unless controlled) and their profits will remain private. Losses will get covered up by continued subsidies and cost-shifting through higher taxes. This may also mask the cost-spiral (for a while). Eventually, heavy rationing will ensue or taxes will go through the roof. Is this bill healthcare corporatism?

4. Avoid Rationing Healthcare (Limiting “Access”)? If the government really wants to control costs, it will have to ration care. The problem is, we need a system in which individuals ration their own care, not bureaucrats with little or no connection to the individual. I ration my own healthcare (by shopping with my HSA dollars) and I prefer to keep it that way, despite the protestations of leftish types who believe they can make better decisions about my healthcare than I. Rationing means quality goes down and access gets limited.

5. Avoid More Deficit Spending? President Obama seems to be betting on energy taxes (cap and trade) to pay for what would amount to massive increases in government spending on healthcare. If the cap and trade bill doesn’t pass, will the government be able to pay for healthcare reform by simply cost-shifting to the wealthy? Or will taxes go up for everyone and big time rationing happen? The American people are at their end with the record deficits. Are you willing to push the envelope?

If your healthcare bill can’t pass this simple 5 question test, it’s not a good bill.

This week the Congressional Budget Office projected enormous cost increases under the current congressional plan for national health care. It was promoted as saving taxpayers money, but the CBO estimates a cost over $1 trillion and it is likely to raise the tax burden for many Americans to close to 60% of their already dwindling incomes, as government bureaucrats balloon the cost of what is already the most expensive health care system in the world. The devastating financial impact of ObamaCare for the nation and every citizen is now overwhelmingly clear. But just in case you still harbor any illusions about how disastrous current proposals for national health care would be, I thought it was time to revisit the other cost — the cost in human suffering and loss of life under socialized medicine.

A key element of the cynically misnamed Affordable Health Choices Act, which is the plan currently being rushed through congress to meet deadlines and criteria set by President Obama, is rationing health care using Comparative Effectiveness Research (CER) methodology where government bureaucrats would set up schedules by which treatment would be allocated based on statistics and cost to benefit ratios rather than the interests and needs of the specific patient. Decisions on care would be matters of policy based on group effectiveness rather than on a case by case basis and doctors would have to abide by these decisions without regard to the welfare of the patient.

The impact of rationing in other nations where it has been introduced as part of the national health care system has been horrendous. It attempts to reduce the financial cost of the system by a trade-off which increases the cost in lives lost and individual suffering. Two nations with many similarities to the United States which have resorted to rationing health care are Great Britain and Canada. In both nations the human cost has been high and the results are easily quantified.The failure of rationing comes down to two basic problems — denial of treatment and very long wait times. Both of these can result in suffering and death for patients, especially those with critical and chronic conditions which are treated easily and routinely in the United States today, but which often result in death in Great Britain and Canada.One telling scenario of denial of care comes with cardiac patients. In the United States if you come into a hospital with an arterial blockage you are usually scheduled for an angioplasty or a bypass in a matter of days, because that is the best way to achieve a long-term solution to the problem. In Canada and Britain the common response is dictated by a shortage of surgeons and facilities, so you are given beta blockers to try to keep your heart functioning and sent away. If you're lucky you'll survive the months that it takes to get you scheduled for surgery or maybe come into the hospital in the middle of an actual heart attack when your chances of surviving the surgery are lower but they may actually operate. Or even better, if you live in Canada they may slap on a heart monitor and have an ambulance drive you to the US for treatment as they do with hundreds of cardiac patients every year. The sad reality is that many who are denied immediate surgical treatment for heart problems just die.In the US a coronary patient is four times as likely to receive surgical treatment as in Britain. In the US only 5% of Americans are made to wait more than four months for surgery. In Canada 27% wait four months or more and in Britain 36% wait four months or more. While the base rate of coronary disease in the US is higher than in other countries because of diet and lifestyle, the rate of survival for those diagnosed with coronary problems is much higher than in other countries because patients get the best and most appropriate treatment more quickly.

The same pattern holds true with cancer. Overall Britons and Europeans in general die at a higher rate from all forms of cancer than US citizens and the difference is dramatic in cases where early detection and treatment are important. For example, women with breast cancer in Britain have a 46% death rate as opposed to 25% in the US. Men with prostate cancer in Britain have a 57% mortality rate while in the US only 19% die and the death rate is declining rapidly because of early detection. It's the same with colon cancer. In Europe as a whole there is only a 8% survival rate, in Britain there's a 40% survival rate and in the US there's a 60% survival rate. With cancer of the esophagus only 7% survive while in the US 12% survive, although it's still one of the most deadly forms of cancer. Both long- and short-term recovery and survival rates for all forms of cancer are also significantly higher for US patients. Rationed care has limited diagnostic facilities like MRI machines and has created long wait times for specialist doctors. In fact, 40% of cancer patients in Britain never get to see a cancer specialist at all, and the National Health bureaucrats have denied basic tests like pap smears and ruled out powerful chemotherapy medicines as too expensive, all of which has cost lives. With diseases like cancer where early detection and treatment are vital,  resource rationing means a lot more dead patients.

The human cost of delay of care caused by rationing is particularly significant. One key element of this is the wait time to see a specialist who can provide the best treatment for specific ailments. In the US 74% of patients get to see a specialist within four weeks. In Canada only 40% get seen that quickly and in Britain only 42%. In many cases these delays can cost lives, but the cost of suffering has to be considered as well. In both Canada and Britain the wait times are even longer for conditions which are not life threatening, but can be very painful and seriously reduce quality of life. In Britain a hip or knee replacement can take more than five months and in Canada it can take as long as eight months. That's a very long time when pain is literally crippling.

An unsurprising irony is that as our congress looks at health care reform, activists in Canada, Britain, and a number of other countries are also looking at health care reform. The difference is that they are trying to figure out ways to introduce more choice and more market elements and reduce rationing at the same time we are plunging headlong into the same mistakes which they made a generation ago and which they now realize have left them with unacceptable failures in their systems with thousands of preventable deaths every year and millions stuck on waiting lists for essential treatment.

This is how bad it can get with government-run, single-payer systems, which may have a cost in lives and suffering, but do at least bring down the cost of health care. Imagine how much worse it could be with a combination of government bureaucracy and rationing and the high prices of private insurance and you have some idea of what ObamaCare will be like. It is likely to have all the flaws of socialized medicine while preserving most of the shortcomings of our current private insurance system, because the thousand-page bill which congress was considering is largely authored by lobbyists for the health care, pharmaceutical and insurance industries. It's like yet another bailout for these industries at a high cost in life, suffering and taxation to the American people.

Even the far left agrees that the health care plan currently being rammed through congress serves the interests of big insurance, medical and pharmaceutical companies while doing more harm than good to the average citizen. It rations and reduces the quality of medical care. It massively increases costs and forces small businesses and individuals to purchase insurance plans at inflated prices which they cannot afford or pay substantial penalties which they also can't afford. It passes many of these costs on to the public in huge tax increases. It doesn't solve the key problem of inflated insurance and health care costs and is projected to still leave 20 million people uninsured.

This may be the most monumental legislative disaster ever given serious consideration in the notoriously profligate halls of congress. This plan is not what the American people have in mind when they think of health care reform. It ignores their needs and sets their interests aside to pander to statist radicals and big business. The American people deserve better.

Chris Dodd's committee.: We "heart" rationing care.

No word on whether Senators will get "enchanced customer service" from the public insurance option.