Yes, keep the government out of healthcare. But this article is really about something else: the cold-blooded calculation of the value of a life. And that is something that is absolutely appropriate.

I recall a case in New Hampshire: there was a child who needed a liver transplant, and this would (for a reason I no longer remember) have to be paid for by the state government. Liver transplants are not peanuts, life expectancies are not long, and the transplant itself plus subsequent treatment is very expensive.

New Hampshire decided "no", sorry, that will empty our healthcare budget for the year - the same money would be better spent helping thousands of others. This decision was, in my opinion, absolutely correct.

Of course, it caused a firestorm. Life at any price! It's a little girl! New Hampshire sadly gave in. Of course, if it's your little girl or your husband, you will feel differently. But, in the end, one of the responsibilities of government is to step back and look at the big picture.

Back to the British health care system: yes, it is a mess. I have lived there and I know a lot of people who do live there. If you choose to rely on the public system, then be realistic about it: the health care is slow and stingy. You always have the option of paying for health care privately, and you can also take out private insurance.

Health care will be rationed either by availability or price.

Socialized medicine chooses the availability option, the US much less so.

Many people think the idea of rationing via price immoral. However, they need to reflect on the fact that socialized health care is where medical innovation goes to die.

Twenty-six prominent British oncologists wrote a letter to The Sunday Times saying that the institute assessed cancer treatments poorly and that patients were remortgaging their homes to buy drugs freely available in other countries.

Amazing to think there are 26 Brits smart enough to be oncologists, but too stupid to realize there is no such thing as free.

(Somewhat OT -- Our government is guilty of trying to push the same notion on us -- for those of you old enough to get Social Security "statements", you will be glad to read that your employer paid half of your contribution for free.)

>>Amazing to think there are 26 Brits smart enough to be oncologists, but too stupid to realize there is no such thing as free.

Maybe check your Nobel Prize stats before making dim jokes about stupidity and British science, Hey Skipper?

Jody - you might want to check your national pride at the door and get some remedial reading comprehension lessons instead.

Unless you don't find it the slightest bit odd that someone could handle the complexities of oncology and not have the foggiest notion of TANSTAAFL.

>>Jody - you might want to check your national pride at the door and get some remedial reading comprehension lessons instead...

Back 'atcha with brass knobs on, Brian.

Those at the sharp end of prescribing treatment are right to take a hard squint at drug prices & raise hell.

It's not about oncologists jabbering about a "free lunch". It's about wondering whether they can reduce the price of a rip-off lunch.

If YOU had read further, you'd see the industry prices charged for drugs can be negotiated down.

Sometimes, these negotiations have more muscle because of shit like this becoming public (from Amy's same article):

"Celgene's first big seller was thalidomide, a decades-old medicine now used as a cancer treatment, which is so cheap to manufacture that a company in Brazil sells it for pennies a pill.

Celgene initially spent very little on research and priced each pill in 1998 at $6. As the drug's popularity against cancer grew, the company raised the price 30-fold to about $180 per pill, or $66,000 per year. The price increases reflected the medicine's value, company executives said."

Jody - how very socialist of you to think that a company is obligated to sell something cheaply rather than get all they can for it.

You know why viagra is so expensive? Because old limp-dicks will pay big bucks to get stiff, and pfizer then has all the money they need to fund research into other drugs.

I'd not be surprised if Celgene is taking all that filthy lucre and turning it into research on the next cancer cure.

Research costs money. Which is why the bulk of drug research is going on in the US right now, since just about every other country has put price caps on drugs that make it impossible to recover the cost of research, never mind fund future work.

Brian,
I often think you are far more nimble at many of these exchanges than I, but your comment (above) is really spectacularly obtuse.

It's not "socialist" to approve of negotiating with drugs manufacturers over prices!

And it's not at all sane to be lauding "allyoucangetism" as the defining triumph of robust capitalism at present, to put it mildly!

Truly - no snark - read Amy's article! There is more to it than you seem to assume.

I really think that if you aren't willing to pay for health insurance, then you have to accept the decisions the government who is paying for your care makes regarding it. I do pay for private insurance, but my lifetime cap is 2 mil. So, that's what my life is worth. I'm about halfway there already. Others have different caps, depending on what they pay for or what is given them free. I don't see the issue. If you are unwilling to insure your life (health), then you are pricing yourself pretty cheap, aren't you? WHy should the government do any differently than you yourself do?

Jody, I think you read it wrong too. I got that he was saying it was odd they were so smart in the one way, but so stupid in another that they don't realize nothing is free. Like, researching future drugs isn't free. The money they make from the ones they already have, funds the ones they want to make later.

>>I got that he was saying it was odd they were so smart in the one way, but so stupid in another that they don't realize nothing is free. Like, researching future drugs isn't free. The money they make from the ones they already have, funds the ones they want to make later.

Seriously?

You think leading oncologists working in Britain today "don't realize...researching future drugs isn't free"??

Is that what you're saying, momof3?

Look, I originally nudged Hey Skipper for his "dim joke" about the apparent stupidity of these British oncologists. I understood it was a feeble bit of hyperbolic comment humor.

These prominent cancer are not stupid: they're angry about what they consider profiteering.

But saying these campaigning oncologists probably idiotically believe drugs development costs nothing - or whatever it is you're saying here - is like saying plumbers don't know where water comes from.

It's just...stupid.

they're angry about what they consider profiteering.

What they consider is irrelevant.

In a truly free society, a thing is worth what someone will give for it. And if the drug companies figured they could sell that much more of a thing at a lower price (while keeping or increasing their net profit), they would do so.

When you have a system like Britain's where prices are set by fiat, or a system like the US where the prices are simply paid whatever they are, there is no incentive to find what the market will bear.

Get the government completely out of the decision loop, and get the insurance companies to act like insurance companies, and you'd see change. Because I would then be able to shop or negotiate for the best deal.

So yes, I'm saying that absent sarcasm on the part of the oncologists, they really do expect that the company exists to provide the drugs, not to make a profit. It's a fundamental misunderstanding of business that is shared by most people.

...To illustrate my point more clearly, momof3, Dr. Karol Sikora is one of the "top London oncologists" named in Amy's linked article who is especially annoyed about too-expensive drugs.

And you seem to be saying he's probably - oddly!!- unaware that all drug r & d costs heaps of money, right?

Can you read even part of his resume (below) and still be sure he never stumbled across this information?

"He studied medical science and biochemistry at Cambridge, where he obtained a double first. After clinical training he became a house physician at The Middlesex Hospital and registrar in oncology at St Bartholomew’s Hospital. He then became a research student at the MRC Laboratory for Molecular Biology in Cambridge working with Nobel Prize winner, Dr. Sydney Brenner. He obtained his PhD and became a clinical fellow at Stanford University, California before returning to direct the Ludwig Institute in Cambridge. He has been Clinical Director for Cancer Services at Hammersmith for 12 years and established a major cancer research laboratory there funded by the Imperial Cancer Research Fund. He chaired Help Hammer Cancer, an appeal that raised £8m towards the construction of the new Cancer Centre at Hammermith. He became Deputy Director (Clinical Research) of the ICRF. From 1997 to 1999 he was Chief of the WHO Cancer Programme and from 1999 to 2002, Vice President, Global Clinical Research (Oncology) at Pharmacia Corporation...

Seems to be there could be a happy medium... a state insurance that covered the basics, and additional insurance people could purchase if they wanted to. The little New Hampshire girl would be covered by the latter.

Profiteering? It's certainly not that. And I suppose that we should, from now on, just to avoid angering Jody, read the resumes of all people being quoted before responding AT FACE VALUE on their statement. Or does it just need to be british people we do that for?

The men SAID the drugs were freely available elsewhere. That they assumably know better wasn't at issue, was it?

Momof3,
Problem is, I think, that you need more than half a brain to correctly read a statement (your caps) AT FACE VALUE.

Apparently, you are the one in need a brain top up!

Yes - to quote you - the oncologists said "the drugs were freely available elsewhere."

Meaning - these drugs are WIDELY available elsewhere, you dope!

They certainly did NOT mean "at no cost because everyone knows cancer drugs don't cost anything!"

The full quote (not used by Amy - but only someone not thinking straight - like you - would assume Britain's prominent oncologists MUST be so stupid they surely meant cancer drugs don't really cost anything!)
is:

We have seen distraught patients remortgaging their houses, giving up pensions and selling their cars to buy drugs that are freely available to those using health services in countries of comparable wealth."

This complex row is (in part) about the confusing way different health authorities in different European community countries assess WHICH new cancer drugs MIGHT be effective and therefore allow their prescription under EACH country's different rules.

The story is not about very stupid British people!

The story is not about very stupid British people!

Well, maybe if you guys spoke English we'd be able to communicate better.

>>Well, maybe if you guys spoke English we'd be able to communicate better.

Don't tempt me, you sonofabitch:)

(Actually, brian - I love the meaty thwack of US insults...Brit equivalents are so fucking arch & prissy!)

Jody, you are a fucking idiot. That meaty enough? You don't get the point. Yeah, it was a bit mocking brits. You all are so open to it.

He wasn't saying it was widely available elsewhere you twit, it's widely available in britain to those who can pay. Availability was not even sort of the point. If you must live here, learn to speak like us please.

>>He wasn't saying it was widely available elsewhere you twit

Momof3,
The exact quote was "to buy drugs that are freely available to those using health services in countries of comparable wealth."

So I'm not sure of your problem?

A further quote from the same oncology consultants statement which makes the "elsewhere" (i.e. other countries in Europe)even more explicit is: "We now spend similar amounts to Europe on health generally and cancer care in particular, but less than two thirds of the European average on cancer drugs.

"It just can't be that everybody else around the world is wrong about access to innovative cancer care and the NHS right in rationing it so severely."

Anyway, I thought you were arguing the stupid British experts thought the drugs were "free"?

Sorry - 2nd par should also have been ital - to show it was part of the same consultants' statement.

Fact: Researching drugs cost money, & LOTS of it.
Fact: Those who do the research deserve to make bank on their work because they spent many years learning a difficult skill.
Fact: Getting approval on the drugs that are developed can take years.
Fact: There is only a window of 10 years in which the manufacture of that drug is exclusive to the company that developed it. As such, the price must be high to cover the cost of its development & ensure a profit...which goes in no small part to developing new drugs.
Fact: Approval is no protection against a legal suit if something DOES turn out to be wrong.

Its an uncertain business on the forefront of research with millions of dollars spent on failed experiments and millions more spent on those which succeed which then have millions MORE spent getting approval, with all relevant employees collecting their salary in the meantime, with only 10 years to make that money back with enough to spare to research the next lifesaving drug.

Don't like that it costs quite a bit...boo bloody hoo.

Nobody lives forever, some people aren't even going to live a long time, and trying to ensure that some of those people do, is guaranteed to ensure that some of us live shorter lives or have difficulty tending to our own.

We're past the point in this country where we should start coming to the realization that soon or late, we are all going to die, we'll lose people we care about and the people we care about will one day lose us. Sometimes we can delay death, but we shouldn't do so at the cost of crippling life.

I don't understand the uproar. I've had private insurance that doesn't cover brand-name drugs. It was about 50 bucks a month cheaper than the plan that did cover brand-name. The "expensive new pill" has likely not been made generic yet. Socialized medicine isn't going to be as comprehensive as private. Covering everybody has gotta be damned expensive, so of course you get the bargain plan.

You don't like it? Suck it up and pay the extra for private supplementary insurance. Don't cheap out on your health insurance and then bitch when you suddenly get cancer and it doesn't cover everything. That's what reading is for. It tells you shit that you need to know, like, for instance, 'your life is only worth 2 million to us and after that, we don't give a shit if you die'.

I find it more and more annoying when people go all bleeding heart about something and just completely ignore the cost of what they demand. This attitude is why we have massive consumer debt. People want what they want. Add a "moral" justification and there's not enough money in China to save us.

First of all (as per the article) there are no ‘freely available’ drugs on hand (unless you include inexpensive, yet highly effective, blood pressure and cholesterol medications that are over 10-15 years old). As for oncologists (i.e. called heme-oncs, because they treat both blood and body cancers) they are a bunch of $%!=#@ ghouls! I have had years of experience with these death-eaters that only want another data point in their study of the latest ‘anti-cancer’ drug. But everyone is magnanimous when it comes to other people’s money. I will acquiesce that some of these studies have yielded effective medications (especially in pediatric populations). However, how much extra percent tax are you willing to pay for these miraculous modalities? Five percent? Ten percent? Fifteen percent? Do you think that these and all the other big-ticket (and small-ticket) items are cheap?

Yes, medications cost much to research and develop. Yes, pharmaceutical companies do deserve to recoup those costs and some profit (otherwise why would they be in business?). During medical school one has to go through several classes that cover the statistics and economics of medicine. One of the things studied is how much society is willing to pay to extend the life of one person by one year (and there are various figures of how much this is). Overall, what are *you* willing to spend a year on this? An extra $1000 a year, maybe $2000 or even $3000? More? What are *you* willing to spend? Many posters vilified Amy about broaching the subject of paying for those with Down’s syndrome, commenting on how cruel and callous it was even bringing up the topic of the financial (and emotional) costs involved (and the, gasp, insinuation that it does actually cost a sholad of money that offers little, or no, return). I know, I know—those cruel, heartless doctors who are so cold and callous, only seeking to somehow turn a dollar for ourselves (or something as equally self-centered). I guess I should take a drive in my Ferrari to make me feel better!

Fortunately or not, I can say that England is ahead of the curve on this one. From the words that cost me entrance to one of my interviewing medical schools (with a particularly naïve, IMHO, Family Practitioner): “society cannot afford to pay everything for everyone”. You can talk about how heartless it is to think otherwise. You can call any other that disagrees a believer in ‘eugenics’. You can call us cruel. You can call us callous. But you cannot deny the fact that this costs money! And at the end of the day, as you are blissfully blogging, how much are *you* willing to spend and where do you wish to spend it?

“society cannot afford to pay everything for everyone”.

Truer words were never spoken, Doc. And anyone who disagrees is lacking in the common sense/smarts department. o.O

I wonder how they feel about the welfare they are paying for the Muslim immigrant's four wives?

When you get the government involved in making decisions about your life, you are unlikely to be happy. I wish New York would allow me to buy catastrophic medical coverage. Alas, I'm evidently not as smart as the boys in Albany about my needs.

There is a way to "get government out of your life" for the bulk of medical issues: pay for it yourself.

And I think I have the solution.

Here's the message I sent my Senator:

-----
Dear Senator Graham:

I believe I have a model for health care which could revolutionize the industry, improve efficiency and even put you in the White House. Bold claim, no? Well, let's see.

I think you and your staff know the issues with health care today, so I won't bother you with outlining the status quo. I'll get to the point.

We should set up the "Medical VISA Card".

For easy consideration, here are features and points, in no particular order:

1) This card would either be issued by an existing Federal agency or designee to every person attaining majority, and to the guardian of every person for whom one is appointed, or be elective. There would be benefits to this - see below. I call this a VISA card just because that company has all the assets in place to do this already.

2) The card would be usable ONLY for prescription medicine and for visits to licensed doctors and dentists.

3) The card would have a nominal limit. Reaching this limit would trigger agency review of the use of the card. Think, "$20,000", or a value determined by the person's economic status.

4) The balance would be due from the holder to the agency, exactly as bank and other credit cards apply today.

5) An interest rate on outstanding balances would be established to collect two things: direct cost of the program, and an investment fund to be used for catastrophic illness and disability. A minimum payment would be required of the holder monthly.

6) Legislation could require preference for reducing the card's balance, to prevent holders from running up bills on other credit cards, paying them and leaving the Medical VISA Card unpaid.

7) Card holders could be setup with on-line and telephonic instructions for getting medical attention, and encouraged to avoid using emergency rooms for routine care. Emergency rooms can require the medical card to divert patients to other clinics.

8) Unlike with credit cards - which purpose is to make money for the card company - Medical VISA card holders could be encouraged to invest in their own, portable (not job-dependent) medical insurance through building a positive, interest-paying balance in their medical account.

9) Make no mistake about the fundamental nature of this card: up to the spending limit, the holder MUST pay. People simply won't be careful with other people's money.

Senator, people understand credit cards, however woeful the current credit situation might be because of public confusion between ownership and possession. I myself am mystified by my own Blue Cross, Blue Shield statements, which routinely say my treatment cost twice what anyone was paid.

It's time to re-establish the patient-doctor relationship. This will do that.

I recognize that a lot of work would be necessary to turn this into reality; I don't pretend to know this field as well as you and your staff must, just to run your office.

But I suggest that this is a good start.

Very Respectfully,

(me)
-----

If you think this is a good idea, pass it on.

Please remember that it is not possible to "keep government out the health-care business". Because of law, it will forever be involved, and so we must make the best of that.

I donate to St Jude's, and City of Hope, quite frequently. I've had family treated at both. Family that died, but got experimental treatment that *could* have saved their life, free. They would have died anyway. In both cases, they lived longer than expected due to the treatment. And the drs learned a bit about how to help the next person better. Why aren't there more of these institutions?

I don't have a lot of money. But I am quite philanthropic, and put my money where my mouth is when I can.

>>Family that died, but got experimental treatment that *could* have saved their life, free...Why aren't there more of these institutions?

Maybe, momof3, because clinical cancer treatment is never free?

And charities aren't bottomless money sources for the sort of experimental clinical cancer research which isn't sufficiently cost-effective for the big drugs companies to fund?

As you've pointed out here: "researching future drugs isn't free".

Jody:

It's not "socialist" to approve of negotiating with drugs manufacturers over prices!

Strictly speaking, it is not socialist. Rather, the government is, in effect, forming an inverse cartel.

Let's say the government is one consumer out of thousands, but purchases drugs on behalf of thousands. (In other words, it is a single purchaser for half of all consumers).

Then, it negotiates (if there was ever a word that deserves scare quotes in context, that is it), a significantly lower price.

Can you guess what will be the very next thing to happen?

The drug maker will raise prices for all the other consumers.

As a consequence, some of those purchasers will choose to join the government cartel.

Which is the start of a self-reinforcing cycle, until the government controls the entire market.

Unfortunately, the end result of It's not about oncologists jabbering about a "free lunch". It's about wondering whether they can reduce the price of a rip-off lunch. is the death of medical innovation.

You later provided the full quote that only reinforces my point:

We have seen distraught patients remortgaging their houses, giving up pensions and selling their cars to buy drugs that are freely available to those using health services in countries of comparable wealth."

These doctors, who no doubt have sufficient intellectual horsepower to be outstanding oncologists have nonetheless completely lost site of the fact that the drug costs money: lots of it.

And since there is no such thing as a free lunch, someone, somewhere is paying for it.

Health care will be rationed either by limiting availability (per the UK) or ability to pay (per the US).

That is the crux of the problem, which the UK docs completely failed to take on board.

Hey Skipper,
I understand your model of an "inverse cartel" - thanks - but I don't attach such sinister implications to the process of negotiation as you!

We'll just have to agree to disagree about the financial illiteracy of the UK's leading campaigning oncologists on this one.

(But thanks for being courteous).

Jody:

Sinister or not, the implications are inescapable. Drug research is expensive and risky; the drug companies will get the return on their investment somehow.

So, whenever you hear someone saying the government will "negotiate" lower drug prices, the consequence is indistinguishable from extortion.

As long as there are others to pay the higher prices, then they will be the losers in the "negotiation".

When there are no longer enough others, then drug research ends.

Both the socialist and private health models have their moral conundrums; however, the latter is the only one that doesn't converge on stasis.

Skipper and Jody:
If you have a statement from your insurance company, like the "Explanation of Benefits" BC&BS sends me, take a look at it. Then, notice how much more they charge a person not on your plan.

Then, notice that the provider charges a sum, the insurance company pays some smaller amount... and it's somehow now paid in full?

>>When there are no longer enough others, then drug research ends.

Hey Skipper,
I can't tell (from the above) whether you're simply bringing your model of 'dark semi-socialist forces gathering to create inverse cartels' (f you can follow my precis!) to a remarkably tidy theoretical conclusion?

Or whether you're describing - in outline terms -something that has already very specifically taken place in Big Pharma research?

(It seems too obvious to me that there is an alternative to your dire outcome of "then drug research ends". The alternative being "prices drop to a level acceptable").

I'm trying to match what you've said to any recent critical drug scenario I know - and not doing very well! Do you have a specific case in mind?

Or whether you're describing - in outline terms -something that has already very specifically taken place in Big Pharma research?

I am describing the inevitable; it is the consequence of cartelization of any commodity. In this case, the commodity is money -- gov't to the drug companies: this is the money you will get for your drugs. It is no different than a cartel for labor (see UAW, et al).

If the cartel insists upon paying less for the drug than the company could otherwise charge, then the company will raise its prices elsewhere to maintain its return on investment.

If it cannot, because the cartel controls too much, or all of, the market (see UAW, et al), then the return on investment will do down correspondingly.

That return is what fuels drug research. Reduce the return, reduce the research.

Which brings us to this: The alternative being "prices drop to a level acceptable"

The critical word in your statement is "acceptable". Before proceeding another pixel, you need to define just what you mean by acceptable.

My definition is whatever price the drug company can get for its product, in a market where there are many competing companies.

That will result in higher prices, and far more innovation.

Alternatively, the fastest route to lower prices is to eliminate patent protection, and allow pricing to be driven by generics.

What do you suppose will be the return in research investment under those circumstances?

It is also worth noting that gov't imposed pricing is a form of intellectual theft that differs in no significant particular from what goes on in China.

----

Radwaste:

... and it's somehow now paid in full?

Who the heck knows; how much did the treatment really cost?

Several years ago, my daughter had symptoms from out of nowhere that indicated potential intra-cranial bleeding.

Trip to emergency room, followed by overnight stay in hospital that included MRI.

Now, did that MRI , which took all of a half hour, really cost $13,000?

I dunno, but somehow I doubt it.

The outcome? All in all, I think I am just as happy to not ever have been a teenage girl going through puberty.

A couple years ago I had some surgery that required four post-op days in the hospital. For what it "cost", I could have hired a full-time private nurse, had a doc on call, and spent the time in a four-star hotel for much less.

My insurance company paid the bill; I have no idea how much it really cost.

>>The critical word in your statement is "acceptable". Before proceeding another pixel, you need to define just what you mean by acceptable.

Great point, Hey Skipper.

And I can't think of anything more productive than transparency on both sides of the "acceptable" question - and a mutual willingness to listen - when oncologists (responsible to patients) and drugs companies (responsible to shareholders) disagree.

Jody:

The logic inherent in the law of supply and demand is immune to "a mutual willingness to listen."

The only reason the drug in question is available at all, never mind at a price offensive to oncologist sensibilities, is because the company (read, really, as its stockholders) felt there was sufficient chance of a good return on investment to make the risk worth it.

So, when I meant that you have to define what you mean by acceptable is that the more gov't enforces a price lower than what the market will return, the lower the return on investment will be.

The risk, however, remains unchanged.

Satisfy the oncologists complaints, and they will no longer have to worry about new drugs, expensive or otherwise.

What feels good isn't necessarily so.

>>What feels good isn't necessarily so.

Hey Skipper,
The "feel good" factor is an exceptionally complex calculation in evaluating the value of cancer treatment - at every stage.

Cartels (inverse or otherwise) are illuminating when one is discussing commodities like, say, diamonds. Not so handy for medicine.

So, yes, we have a fundamentally different approach to the basics here. And looking - as I have been recently - at the disastrous effect of the American economy on endowments for non-for-profit institutions supporting vital lab-to-market place research into the next wave of cancer treatment, arguments about the pricing of future available drugs may be moot anyway.

The plunge in the value of endowments is horrendous.

AN MRI doesn't "cost" $13,000 to do. They are charging you the cost of the multi-million dollar machine. And the cost of the person who gets paid to fly in from 5 states over to fix it at a moment's notice (and they BANK! That's how I stay home with 4 kids!)

Also, the people who run it, read it, etc etc. Mostly, you are helping pay off the machine that will almost certainly be obsolete before it's paid off. Then it will be sold to a broker who sells used equipment other countries with less healthcare money.

As to the lower prices your insurance pays: when a dr or hospital agrees to accept X insurance, they agree to X insurance's price list. That is what the insurance will pay for that procedure, and they can not charge you any above that if they have agreed to accept X insurance. They do this, because an insurance bill is a guaranteed paid-in-full. They KNOW they will get that money, so they are willing to take less since they are dealing with no hassles. When they bill someone with no insurance, they are going to have to deal with late pays, payment plans, and bankruptcies. There is no guarantee they will ever get their money. Plus, you can almost always negotiate down a medical bill if you will pay on it consistently.