The moral, financial dilemma at the heart of health care

If such a thing were possible, it would be useful to set aside partisan sentiments for a few minutes to discuss profound questions about life and death, the obligations that we have to each other as human beings and the morally difficult choices that technology increasingly forces upon us.

Let’s begin with a new report from the nonprofit National Institute for Health Care Management Foundation. It reports that Americans “spent nearly $2.5 trillion on health care in 2009, reaching an all-time high of $8,086 per person. This per-capita spending represents an almost two-fold increase since 1997.”

Those numbers, while startling in one sense, pretty much confirm what most of us already knew. But here’s where things get more sticky:

“Spending is highly concentrated among a relatively small portion of high-cost users, with just 5 percent of the population responsible for almost 50 percent of all (health care)spending. At the other end, half of the population accounts for just 3 percent of spending.”

The tricky part, of course, is how quickly and unexpectedly any one of us can jump from one category to another. You can go for decades as part of the 50 percent that consumes just 3 percent of spending, and with one diagnosis or accident suddenly become part of that 5 percent that consumes almost 50 percent of the health care dollar.

In fact, absent sudden death by accident or heart attack, most of us will at some point make that transition from the 50 percent to the 5 percent, as will our loved ones. It is the human condition.

I feel a chart coming on.

The healthiest 50 percent of Americans account for just 3 pennies of every health-care dollar spent, while the sickest 5 percent account for 50 cents of every dollar spent on health care.

The healthiest 50 percent of Americans account for just 3 pennies of every health-care dollar spent, while the sickest 5 percent account for 50 cents of every dollar spent on health care.

———————————

Now let’s move from the statistical to the actual. The New York Times reports today on three new drugs developed to treat late-stage prostate cancer. The drugs do not cure the cancer, but they do prolong the lives of those afflicted.

Without the drugs, men with late-stage prostate cancer have a median life expectancy of a year and a half. With the new drugs, that can be extended by roughly six months, with a decent quality of life.

However, as the Times reports:

” … the price of these drugs has already stirred concerns about the costs of care among patients, providers and insurers. For example, Provenge costs $93,000 for a course of treatment, while Zytiga costs about $5,000 a month. Another of the new drugs, Sanofi’s Jevtana, costs about $8,000 every three weeks.

With other pricey drugs on the way, said Joel Sendek, an analyst at Lazard, “We could be talking easily $500,000 per patient or more over the course of therapy, which I don’t think the system can afford, especially since 80 percent of the patients are on Medicare.”

Medicare has been conducting a year-long review of Provenge, and is expected to announce on Thursday that it will cover the drug. Private insurers are expected to follow that lead. But as the Times reports, the fact that Medicare even decided to study the question became a point of controversy. “Medicare officials denied that price was the reason for the review,” the story reports. “But some patient advocates and politicians portrayed the review as a step toward rationing.”

So there’s the situation. Those men with sufficient financial resources can of course make their own decision about whether to spend $500,000 for another six months of life. But what about the rest of us? Is that an acceptable use of taxpayer money and health-insurance premiums?

And if it isn’t acceptable, what mechanism should we create to make such difficult decisions on our behalf?

I’m not looking for partisan rhetoric or bumper-sticker responses here. These are decisions that we as a society and a nation have to confront. At what point, if any, do we decide that the marginal gain in lifespan is no longer worth the investment?

Who makes that decision? And on what basis?

– Jay Bookman

486 comments Add your comment

carlosgvv

June 28th, 2011
9:07 am

The key word in all this is “profit”. When healthcare is for profit, Doctors and hospitals and drug companies will deliver as little as possible and charge as much as they possibly can for their products and services in order to maximize profits. Predatory Capitalism cares about nothing except money. It’s just that stark and just that simple.

Normal

June 28th, 2011
9:09 am

Well, In the first place, I’m not sure a mere six months of extended life is worth $500,00.00 dollars. That would break my savings, and thusly my families inheritance..If it were me, I’d pass.

Call it like it is

June 28th, 2011
9:14 am

Jay I will have to stay your stance on this along with Tuckers somewhat confuses me. Both of you are the first ones to scream about illegals getting rights and they deserve a chance to have a good life here in American, then you turn around and hidden within the lines one would think you just rather have sick people die, versus tax payer money being spent on them to extend life. So if you have a love one, to whom is stricken and you can extend their life would you not do so? What happens if a cure is found in that time period?

Adam

June 28th, 2011
9:15 am

A CHART! YAY!

MountainMan

June 28th, 2011
9:15 am

Everybody wants people to be responsible for their decisions. Prostate cancer can be treated fairly effectively if caught early with simple tests. People that don’t go to the doctor then end up finding the cancer at a late stage. Then it requires very expensive treatment. It may be rationing but if you don’t go to the doctor and then show up later with end stage cancer, do you deserve the expensive treatments?

Granny Godzilla

June 28th, 2011
9:16 am

One of the shockers for me in my Mr. G’s treatment for prostate cancer was the Doctor telling us that if men live long enough most all of them will eventually have prostate cancer.

At 500 grand for six months that could be a pretty expensive tab for us as a nation.

Let’s make a deal, I’ll stay out of y’alls prostates if y’all stay out of our uterus (what’s the plural uteri?)

ByteMe

June 28th, 2011
9:18 am

I feel a chart coming on.

Take two aspirin and call me in the morning.

B-dum-bump.

Adam

June 28th, 2011
9:18 am

But some patient advocates and politicians portrayed the review as a step toward rationing.

If any rationing occurs, it is because of the overinflated price of the drug, NOT that Medicare doesn’t want to cover it.

It’s the COST, stupid.

The Leg Lamp is a "major award"......

June 28th, 2011
9:18 am

I realize one’s health is in a totally different category, but this financial dilemma of what we can and cannot afford is something we face every day. Here’s a few I’ve faced in the past:

* Do I pay more for the “safer” cars for my 16 year old or do I find an affordable, gas efficient smaller cars? I paid more for a bigger car with lower MPG so her safety would be greater in the event of an accident.

* Do I spend money to send my children to private schools or make the best out of the local public schools? We decided to stay with the public school, which in our area is actually pretty good. The mix of extracurricular activities is somewhat limited, but the scholastics are solid.

* My son would have been a much better basketball player had we put him with an AAU team. Top notch instruction, year round basketball, playing in front of recruiters, etc. He may have even been good enough for a scholarship (we’ll never know), but the annual cost, travel expenses (2-night weekend hotel stays out of state were common), equipment, restaurants, etc, and consuming most of his time contributed to us believing he shouldn’t do it. So I guess we didn’t give our child the “best” of what was available, but we made a solid choice.

As I said, these examples don’t equate to life extending options, but I’ve accepted the fact that money plays an important part in the “quality” of life issues. Too bad others don’t do the same.

In the example you presented, Jay, I wouldn’t spend $500K for 6 additional months of life even if the money was readily available and considered just a drop in the bucket in my portfolio.

Doggone/GA

June 28th, 2011
9:19 am

“Who makes that decision? And on what basis?”

The drug makers make the decision. It is THEY who sets the price. If they think they can get $8,000 a month that is what they will charge. If it’s made clear to them that they are not going to sell enough of the drug at that price to be profitable…they will either take it off the market, or find ways to make it less expensive so they DO sell more of it.

Real Scooter

June 28th, 2011
9:20 am

Normal

June 28th, 2011
9:09 am

I feel the same way. And good morn sir!

Jay

June 28th, 2011
9:21 am

Leg Lamp, I wouldn’t either, although it should also be said that neither one of us can state such a thing with absolute certainty until we’re actually in that position.

But on to the question: What mechanism would you create to make such decisions?

ty webb

June 28th, 2011
9:22 am

yeah, what Normal said. But if someone can afford it, then by all means, they should do it. But it would be extremely selfish(and I completly understand) for an individual or an individual’s family to force taxpayers to foot the bill. God bless anyone facing this decision.

Adam

June 28th, 2011
9:22 am

I’m with MountainMan. Early detection is the key. We need to start focusing on preventative care so that drugs like these are no longer even necessary.

Basically, if we can create a climate where anyone can go to the doctor to get seen for any small thing (yes, if they are willing to wait a bit), then people WILL start to go in to get checked out for “small” things, which may turn out to be things that save their life, and cut medical costs. Routine checkups would happen more often, allowing for early detection of things patients dont’ even know about!

Wouldn’t that be nice?

Bosch

June 28th, 2011
9:22 am

“One of the shockers for me in my Mr. G’s treatment for prostate cancer was the Doctor telling us that if men live long enough most all of them will eventually have prostate cancer.”

Not just that but from what doctors told me, 75% of men will die WITH prostate cancer — not of the disease itself, but will have it along with whatever does kill them. In terms of prostate cancer, the treatment is worse than the disease (in my cases, in my opinion).

Anywho, as carl wrote — as long as there is profit to be made from the sick, we will have huge costs associated with it, and as long as some people see healthcare as a privilege instead of a right associated with being a citizen of this country, things will not change — until, of course, a majority of people are not privileged enough.

ByteMe

June 28th, 2011
9:23 am

At some point, we as a nation need to get serious and make rational decisions about cost-benefits for overpriced drugs and procedures. Is the efficacy of the drug worth the additional costs to the nation? If not, then let the person buy their own drugs. Medicare (and even Universal Health Care) should provide a baseline of care; if you want more and can afford it, buy a supplemental plan from an insurance company.

BTW, we are not at the point of being able to make serious rational political decisions. Neither side will do that in public without name-calling and bomb-throwing.

Adam

June 28th, 2011
9:23 am

Leg Lamp: We decided to stay with the public school, which in our area is actually pretty good

PLEEEEEASE let some of your fellow cons know the public education WORKS, then, and does not need to be cut or defunded or abolished.

Adam

June 28th, 2011
9:26 am

Bosch: until, of course, a majority of people are not privileged enough.

This is already the case. We need to move away from for-profit healthcare. It’s killing people. Not just jobs, not just the budget, PEOPLE.

Aquagirl

June 28th, 2011
9:27 am

My son would have been a much better basketball player had we put him with an AAU team…… So I guess we didn’t give our child the “best” of what was available, but we made a solid choice.

Feeding your kid into the sports-shredder is only “best” for .00000004% of our population. Even if they hit the jackpot of skills they can turn out like LeBron James. So don’t second-guess your decision.

Interesting Observation

June 28th, 2011
9:27 am

This is a difficult issue. Man simply refuses to accept his inevitable mortality. He prays to God for a long healthy life here on earth and attends religious rituals and wraps his heart and head around religious doctrine to ensure a continued non-ending afterlife. Man is mortal and our system of health care delivery is profit driven. I sometimes wonder how moral it is to have a health care delivery system based on profit.

ByteMe

June 28th, 2011
9:29 am

As to Jay’s specific question about mechanism: probably use the same one that insurance companies use to determine if they will offer a certain benefit in their health packages… or the same one that corporations use to determine if they will fix a faulty product that’s killing 1 in 10,000,000 people by accident. Oh, wait, that would be “rationing” if the government does it. :roll:

Normal

June 28th, 2011
9:30 am

Scooter,
And good morning back at cha! :)

independent thinker

June 28th, 2011
9:33 am

Jay- I would love to see your reaction to the fact that the World Health Organization in Geneva (WHO) placed the US at no. 35 in overal Quality of healthcare due to our lopsided and misguided financing of healthcare.Do some simple research on other countries that have universal healthcare or competitive mandatory HMOs like Israel that are ahead of us on the list and you will begin to understand why. Your buddy Kyle went beserk when I published this statistic on his blog calling the authors a bunch of left wing nuts We pay doctors an exorbitant amount of money because of the love -hate dance with insurers and few medical professionals really care about quality care unless paid at top private rates by those who can afford it. Saint Ronnie tried to shove universal care under the rug with an absurd unfunded and socialist mandate called EMTALA requiring all hospitals to treat any living person who crawled into an emergency room regardless of payment. Michelle Obama found a a loophole in this for UNiversity of Chicago Hospital as their attorney by directing the poor to neighborhood clinics which increased under Bush. No one discusses any of these facts because health care is so politicized and we have a broken national health care policy. That is why WHO puts us at no. 35.. Your reaction???????????????

kitty

June 28th, 2011
9:33 am

I went through something like this with Tamoxifen. Several years ago Tamoxifen cost a friend of mine with cancer over $800 per month. They couldn’t afford it. When I was diagnosed with breast cancer two years ago and was put on Tamoxifen the first time I went to pick up the prescription I was absolutely terrfied it was still $800. It cost me less than $10 as a generic. There is something very wrong with that in my opinion. Very wrong indeed. AT $800 I doubt I would have taken it.

Message from Matti

June 28th, 2011
9:34 am

I watched my friend die an indescribably horribly painful death after three years of chemo with an unimaginable price tag. Those QUACKS knew they couldn’t save someone when it was already all in the bones, but they make their living saying, “okay, let’s try one more thing” and then pumping toxic sludge into veins while uttering false glimmers. I’m still so angry I can barely speak of it. They did NOT ease her passage as they should have. They made it much worse than it had to be. Why? Money. I hate them. I hate them all.

thomas

June 28th, 2011
9:35 am

Aquagirl

June 28th, 2011
9:27 am

What is so bad about LeBron James?

Doggone/GA

June 28th, 2011
9:36 am

“That is why WHO puts us at no. 35.. Your reaction???????????????”

I don’t know Jay’s opinion…but MY opinion is that once we have universal healthcare a lot of that will be addressed as part of the process. It won’t be neccessary to “find a way” any more.

Dearie

June 28th, 2011
9:36 am

Are we forgetting one other option? My 82 year old father had prostate cancer and had a choice of going with the rounds of chemo and radiation or having his prostate removed. He chose the certainty of survival and is now 87 and doing fine. Not everything can be fixed, and drugs are not always the answer. His is only one case. Maybe we could hear from others about their decision process. Glad to have my Dad with us.

Left wing management

June 28th, 2011
9:37 am

carlosgvv nails it. When healthcare is subject to a regime of a profit-driven market logic, that prefigures everything else. And frankly, that system is so powerful in this country that I don’t see it changing without some sort of social movement that tends towards the revolutionary.

But as usual, technological advance comes along here as a destabilizing element in what would otherwise appear to be an unstoppable system. It acts both as something that promises boundless profits for the profiteers at the top yet also, in the Utopian promise of extended life and safety from calamity it seems to promise, threatens to destabilize the actuarial realities of the precarious precarious insurance system. Thus it amounts to Utopian crack in the foundation insofar as hope is held out to all the people and not just the most fortunate, and this even though we are still some ways away from the most radical breakthroughs that might someday come in medical technology, e.g. a long-term treatment for the most serious types of cancer, etc.

But a serious economic calamity could certainly change all this in a hurry.

Jay

June 28th, 2011
9:38 am

Independent:

I agree.

Normal

June 28th, 2011
9:38 am

Y’all did hear of the recent Supreme Court desision that if you take a generic drug and it harms you, you cannot sue the manufacturer. You can only sue if you are harmed by a Brand Named drug. One wonders why…

thomas

June 28th, 2011
9:38 am

Message from Matti

June 28th, 2011
9:34 am

I had a similar situation with a family member.

However for all of my anger there were just as many who were happy to have been given those extra few days.

Alot of medicine today is not aimed at a cure, it is usuually to treat symptoms.

Are u saying we should eliminate all treatments that are for the relief of symptoms or all treatment that will not cure the person?

RAMBLE ON!!!

June 28th, 2011
9:42 am

haha, Jay’s using the NYT as a resource again. The National Enquirer would be more reliable.

ByteMe

June 28th, 2011
9:42 am

Y’all did hear of the recent Supreme Court desision that if you take a generic drug and it harms you, you cannot sue the manufacturer.

That wasn’t quite the decision. It had to do with the level of side-effects documentation that the generic manufacturers had to do since all they were doing was manufacturing a compound created and tested and tracked for years by another company. Just the same as generic manufacturers do not need to go through the years of testing on the compound before it gets approved. The rules for them are different, because their role in the process is different.

Moderate Line

June 28th, 2011
9:44 am

Excellent point Jay. There are two issues here that need to be addressed.
1. A single payer system will not lower cost unless someone makes hard choices. It can be seen that Medicare is unwilling to deny any expense for someone. As long as that occurs the system will become less and less financial viable
2. Our current delivers invest more in care which is focused on greatest revenue not what pays off on extending people life’s.

It doesn’t appear to me that either the left or right is willing to address the problems of our current system.

dwaynel

June 28th, 2011
9:44 am

An individual should make that choice, but with the possibility of the govt. controlling healthcare in the future (should obamacare not be repealed or found illegal which I believe it will), then the govt. will be making that choice and that is wrong!

Left wing management

June 28th, 2011
9:48 am

Ramble: “haha, Jay’s using the NYT as a resource again”

I agree in part. But when you have a right-leaning corporate media structure as we do, you have to do what you can.

independent thinker

June 28th, 2011
9:48 am

I was wrong – we are no. 37:

“”"Evidence that other countries perform better than the United States in ensuring the health of their populations is a sure prod to the reformist impulse. The World Health Report 2000, Health Systems: Improving Performance, ranked the U.S. health care system 37th in the world1 — a result that has been discussed frequently during the current debate on U.S. health care reform.

The conceptual framework underlying the rankings proposed that health systems should be assessed by comparing the extent to which investments in public health and medical care were contributing to critical social objectives: improving health, reducing health disparities, protecting households from impoverishment due to medical expenses, and providing responsive services that respect the dignity of patients. Despite the limitations of the available data, those who compiled the report undertook the task of applying this framework to a quantitative assessment of the performance of 191 national health care systems. These comparisons prompted extensive media coverage and political debate in many countries. In some, such as Mexico, they catalyzed the enactment of far-reaching reforms aimed at achieving universal health coverage. The comparative analysis of performance also triggered intense academic debate, which led to proposals for better performance assessment.

Despite the claim by many in the U.S. health policy community that international comparison is not useful because of the uniqueness of the United States, the rankings have figured prominently in many arenas. It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.3 These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?

Comparisons also reveal that the United States is falling farther behind each year (see graph). In 1974, mortality among boys and men 15 to 60 years of age was nearly the same in Australia and the United States and was one third lower in Sweden. Every year since 1974, the rate of death decreased more in Australia than it did in the United States, and in 2006, Australia’s rate dipped lower than Sweden’s and was 40% lower than the U.S. rate. There are no published studies investigating the combination of policies and programs that might account for the marked progress in Australia. But the comparison makes clear that U.S. performance not only is poor at any given moment but also is improving much more slowly than that of other countries over time. These observations and the reflections they should trigger are made possible only by careful comparative quantification of various facets of health care systems.”"”"”"”"”"”"

from New England Journal of Medicine —Ranking 37th — Measuring the Performance of the U.S. Health Care System”"| January 6, 2010 |
(Kyle Wingfield believes they are all socialists out to destroy us)

The Leg Lamp is a "major award"......

June 28th, 2011
9:49 am

Jay
June 28th, 2011
9:21 am

True, Jay. We’ll never know until we’re faced with it.

The mechanism? I don’t know if I totally understand your question, but to me it’s a quality of life issue. Would my last 6 months be consumed with pain, constant visits to doctors office, in and out of the hospital for treatment, while withering away? I’m not really afraid of death. I’m actually more afraid (if that’s the proper term) of the dying process.

My father would always laugh and say he didn’t want to live one day longer than the time he would be able to put on his pants by himself. Fortunately for him, he went out on his own terms.

For what it’s worth, I had an uncle pass away earlier this year. He chose to cling to life for as long as he could. During his last 9 months of life he spent 8 months and 1 week in hospitals, rehab, etc, and he was in constant pain. That was his choice, but I don’t think it would be mine. After his death one of my cousins said if nothing else, my uncle hanging on that long prepared her mother to accept sleeping in a bed by herself. I hurt for my aunt, but I thought “how sad”.

Keep Up the Good Fight!

June 28th, 2011
9:51 am

Jay, its always a difficult question to ask, when do we say “we are not going spend the money to keep you alive”. There is no easy black/white answer. No bright line. This is something that a society must always wrestle with.

There must be a number of mechanisms in place. Allow Medicare to bargain prices. Allow some of these drugs to be sold at cost. It should not be the decision of a group of people who have a profit motive but it should have a fair open set of guidelines. There are doctors and medical people who would gladly donate time and energy to help, we know that. Remove the greed behind the current system. There is no single answer. There is a sliding scale.

Is it worth $500k to extend a man’s life for 6 months if that same money can be spend to provide a child an organ that will give life for years.

Nuances like these do not translate well to bumper stickers or to 30 second sound bites but we must find the answers. Its obvious the current system has serious limitations and serious discussion need be made.

Left wing management

June 28th, 2011
9:53 am

Moderate line: “It doesn’t appear to me that either the left or right is willing to address the problems of our current system.”

Not true. If you count Obama and the Democratic-led congress at the time the Affordable Healthcare Act passed to be “left” (highly debatable, but can be assumed for this discussion), then that bill most certainly does represent a serious attempt to address the problems of the current system, however problematically.

kimmer

June 28th, 2011
9:54 am

Hey carlos, certainly capitalism obligates companies to try and maximize profits but there is one other aspect of capitalism that you are ignoring and that is competition. Competition drives companies to provide more value in goods and services to persuade the consumer to choose them instead of their competitor. Health care is no different. It isn’t perfect but it is 10X better than the government monopoly model with numerous examples that back it up.

RedEye

June 28th, 2011
9:54 am

Another question that should be asked is why are drugs so expensive? The answer lies within the FDA, since they create all of the red tape the pharmaceutical companies must go through and thus drive the cost of drugs higher and higher.

The Leg Lamp is a "major award"......

June 28th, 2011
9:55 am

Aquagirl
June 28th, 2011
9:27 am

We didn’t second guess our decision. I wanted my son to have an “all around” experience during his teen years. Instead of him spending all of his summer playing tournaments, we had him take summer jobs. It was good from a maturing and responsibility standpoint.

I guess the point I was trying to make was that we are constantly faced with “can we or can we not afford it” decisions. This example doesn’t equate to life and death medical decisions, but again, I accepted long ago that money factored in to most decisions and I, nor my children, were entitled to the “best” of everything. I grew up with squat from a material perspective, but I had the greatest parents ever and a wonderful childhood to boot.

Message from Matti

June 28th, 2011
9:57 am

thomas @ 9:38,

I’m not saying either. I’m saying what they did to my friend was wrong. I cannot even get my fingers to type the details of her last days. Where were they in the middle of the night while the nurse was saying, “sorry we can’t give her any morpheme because her blood pressure is too low?” They were enjoying the holidays with their families, unconcerned with what the “new drugs” had done to her. I hate them. I hate them all.

ByteMe

June 28th, 2011
9:57 am

The answer lies within the FDA, since they create all of the red tape the pharmaceutical companies must go through and thus drive the cost of drugs higher and higher.

Yeah, because who wants to have all that testing done on their drugs anyway?

Recon (2nd.and 3rd.)

June 28th, 2011
9:57 am

I’m a cancer survivor and I’ve counseled cancer patients. That by no means makes me an expert as it relates to Jay’s questions, however, I know a little bit as to how those stricken with cancer think. As Jay points out this new prostate cancer drug only provides a few more months of life. This is true with most commonly used chemo therapy drugs. At some point for patients undergoing medicinal cancer treatments quality of life that’s left to live becomes more important than continued short term survival. Patients need to work with their doctors and their families. Working with their doctors means asking the tough questions. Doctor is this drug therapy curative or is it only going to prolong my life a few more months? Doctor what are the side affects and what effect will it have on me and on my family care givers? Doctor I know you don’t like this question but on average, how much time do have with or without therapy? Ultimately the decision must be made by the patient in consultation with the doctor and the patients family based on what’s best objectively for the patient and his or her family.. From the scientific perspective if there is an insufficient number of patients taking the newer medications it isn’t possible to improve these medications or determine their effectiveness over the long term. Doctors sometime take that scientific view because they want to learn a drug’s effectiveness for treating future patients, so often they may not provide the patient with all the information as to what they should expect during the course of their treatment. Patients and their families need to ask the hard questions.

Thomas

June 28th, 2011
9:58 am

first- there should be no dramatic health care changes without immigration reform. To do so is at best reckless and ignorant. Second, statistically reduce folks on meds. It is impossible to fathom that more than 20% of us need prescription anti depressants (life can be tough- don’t avoid it), give Pfizer a long term patent and charge $10 a pill for men to be satisfied, etc. Reduce fraud and abuse.

your done- cost curve is normalized

stands for decibels

June 28th, 2011
9:59 am

Is that an acceptable use of taxpayer money and health-insurance premiums?

no.

Joe Mama

June 28th, 2011
10:00 am

As recently as last year, I was on a medication that retailed for $1000 – $1500 PER DOSE. We knew going in that the medication was not a cure — as there is no cure for what ails me.

Given that, do you suffer and give in, or do you take the medication?

Frankly, I think Jay’s right. None of you *really* know until you’re placed in that situation. And I’ve been there.

RedEye

June 28th, 2011
10:00 am

“Yeah, because who wants to have all that testing done on their drugs anyway?”

Well it’s hard to have it both ways right? So don’t complain that the big pharma companies are ripping everyone off, when the system they exist in creates a false market.

One of the biggest changes they can make is to get rid of the 20 year patent on new drugs, which is ridiculous.

Left wing management

June 28th, 2011
10:01 am

kimmer: “Hey carlos, certainly capitalism obligates companies to try and maximize profits but there is one other aspect of capitalism that you are ignoring and that is competition. Competition drives companies to provide more value in goods and services to persuade the consumer to choose them instead of their competitor. Health care is no different”

Wrong.

Health care couldn’t possibly be more different.

As the free-market defender Paul Krugman noted in an interview with Fareed Zakaria:

..if you get to the late chapters in your textbook in Econ 101, you get to stuff about possible market failures, lack of information, market power, monopoly power, the various reasons why markets can fail. The thing about health care is every single one of those market failure arguments applies with a vengeance in health care. This is just not a case where the market can — does a very good job. We have actually seen that, right? The proof of the pudding is the United States still has got — we have the most privatized, most market-based health care system in the world. We also have the most expensive health care system in the world. That’s — in a way, the data are trying to tell you something. This is not a case where — where the — I’m a big believer in free markets. I think they do wonderful things in the market for wheat. They work pretty well in the market for cars, in the market for electronics. But health care is just not an appropriate domain for free-market ideology.

ty webb

June 28th, 2011
10:01 am

We’re all dying. Disease and sickness speed up the process and are symptoms, but to date, nonone(private enterprise or the federal government) has found a cure for aging(though ponce de leon looked for it). It’s simply immoral to ask that my neighbors(taxpayers) foot the bill for simply delaying the inevitable. The mechanism is simple healthcare providers give the patient the price for treatment, and the patient either pays it or doesn’t. Either way the patient is going to die.

carlosgvv

June 28th, 2011
10:01 am

kimmer

Is that why we spend far more money on healthcare than any other industrialized Western Nation?

Message from Matti

June 28th, 2011
10:03 am

Joe Mama,

I am truly sorry to hear that. :-(

RedEye

June 28th, 2011
10:06 am

The “free-market” does not exist in the healthcare field in the US. Healthcare is the most regulated industry by the government in the US.

ByteMe

June 28th, 2011
10:06 am

So don’t complain that the big pharma companies are ripping everyone off, when the system they exist in creates a false market.

I don’t complain about “Big Pharma”. I’ve worked with the industry and know what they go through to get drugs to market and then to track them after. It’s a lot of hurdles, but those hurdles help force the companies to do their best work. Competition isn’t going to do it, just because there would be too many bad operators willing to pump-and-dump their company to make some short-term profits.

One of the biggest changes they can make is to get rid of the 20 year patent on new drugs, which is ridiculous.

It’s 12 years from the date the drug is approved by the FDA. That’s the period of exclusivity. Was in the HCR bill. Feel better now? :)

Meh....

June 28th, 2011
10:06 am

So did the champion of universal healthcare (aka the manslaughtering Ted Kennedy) deserve all that expensive healthcare at Duke University for his malignant brain tumor that extended his miserable life by a mere 12 months at all that expensive cost???

Typical liberal, do as I say, not as I do….

The Leg Lamp is a "major award"......

June 28th, 2011
10:06 am

Adam
June 28th, 2011
9:23 am

It’s an “exposure” issue we faced. The public school offered very little extra curricular activities outside of the basic. Boys have baseball, football, basketball, wrestling, track, cross country and golf. And there are very, very few clubs in which to be involved. At the private school our son would have had choices that included sports like volleyball, lacrosse, tennis, swimming, gymnastics, and rubgy to name a few. Activities/clubs would have included your choice of three foreign languages, rifle, an incredible music program, a more extensive math program, photography…..the list was endless. So what was best? We actually had the finances for the private school, but felt the overall “high school experience” would be better served in our public school. So, did we prevent our child from having the “best” education? Maybe, maybe not – depends on how you look at things.

Take it one step further. Let’s assume for a minute that my son could have been accepted at Harvard or another elite institution. If we didn’t have the money, would we have “deprived” our child by sending him to Georgia, Georgia Tech, et al? I don’t think so.

Money factors into EVERY phase of our lives, medical/health included. We are just not entitled to the best of everything. It may not seem “fair”, but it’s reality.

Jay

June 28th, 2011
10:07 am

Redeye, getting rid of the patent window would do far more than the FDA could do on its worst day to shut down new-drug development.

Fatalist

June 28th, 2011
10:09 am

You have to die sometime from something.

I don’t really agree with Jay’s framing the argument with the “live or die” subtext. We have always had end-of-life and cost-vs-value issues in health care as with other insurable events. The imputed actuarial data in the chart shows the costs and insurance needs.

This is a matter of how much insurance you want, you can afford, and/or should be required. The real issue is how are health care cost kept in check. For certain, the US current system is broken and needs a radical make-over.

Left wing management

June 28th, 2011
10:11 am

Meh 10:06:

The quasi-barbaric right gurgles to life this morning …

Just sayin..

June 28th, 2011
10:11 am

So did the most famous champion of universal healthcare (the manslaughterer also known as Ted Kennedy) deserve all that expensive healthcare from Duke Univ for his advanced brain cancer to extend his miserable life for a mere 12 months????

Typical liberal, do as I say, not as I do….

ByteMe

June 28th, 2011
10:12 am

LWM: feeling quasi this morning? :) We have a drug for that.

Granny Godzilla

June 28th, 2011
10:12 am

Aquagirl

June 28th, 2011
10:13 am

I accepted long ago that money factored in to most decisions and I, nor my children, were entitled to the “best” of everything.

One of life’s great truths there, Leg.

What is so bad about LeBron James?

Thomas, he’s living proof money can’t buy class. A tool with lots of money and fame is still a tool.

The Leg Lamp is a "major award"......

June 28th, 2011
10:13 am

Just sayin..
June 28th, 2011
10:11 am

Kind of tough on ol’ Teddy boy, aren’t we? Rather than using such a derogatory name, why not say “he was an excellent swimmer”. :cool:

Jeffrey

June 28th, 2011
10:15 am

Helpful yet not surprising data. I find the correlation to health care expenditures and distribution interestingly consistent with personal income tax revenue and expenditure distribution. Extending life at any cost seems to be somewhat unique to our culture. Culture is difficult to change. Comments about insurance company profits are exaggerated to the extent that state and federal regulations require licensed insurers to maintain financial ratings which require capital contributions not required by federal government programs (which are in essence bankrupt on current account basis) I’m not suggesting insurers efforts to slow the claims process and other tactics to improve profits are not disingenuous yet at the same time, track records suggest the federal government has no clue how to operate an insurer (see Social Security, Medicare, Medicaid, Federal Flood, Freddie and Fannie) all of which would be insolvent if required to maintain liquid capital surplus similar to licensed insurers.

Normal

June 28th, 2011
10:21 am

I’m going through this with my mother. She’s nearly 91 and has had a return of cancer. She has a mass in her liver and a mass in her stomach cavity next to the pancreas. At her age there are not many options. The Doctors say chemo might prolong her life a short time, but…She also has Alzheimer’s and we are afraid of what could happen there too.

Some in my family don’t want to tell Mom because of the Alzheimer’s, but I feel she need s to know and while she has most of her senses make her own decision. The chemo will hurt my family and me but it’s Mom. I’ve been wrestling with this for a couple of weeks now.

Sorry if I’m whiny…

RedEye

June 28th, 2011
10:21 am

Jeffrey,

Spot on with your comments regarding to culture. If we as a society truly wish to decrease the cost of healthcare in this country, then we will have to fundamentally alter our preceptions on the type of care we wish to receive.

DEA

June 28th, 2011
10:22 am

To all the lefty fools who say that the drug companies are charging too much or that the drugs cost too much: go develop a drug yourself and sell it for less. Easy fix.

None of the government-educated, government-employed, Democrat-voting filth in this country has ANY clue as to what cost goes into:

- the development of the drug itself
- making up for money lost on other drugs which didn’t pan out
- making it through the government regulatory hurdles
- paying for the potential cost of all the ambulance-chasing legal leeches who will sue to make money for themselves

You don’t like the way the drug companies are operating? Start your own or shut the hell up.

Message from Matti

June 28th, 2011
10:23 am

Normal,

No need to apologize. This stuff hurts.

Granny Godzilla

June 28th, 2011
10:23 am

“Democrat-voting filth”

There’s your sign…..this time in neon.

Kamchak

June 28th, 2011
10:24 am

None of the government-educated, government-employed, Democrat-voting filth in this country has ANY clue as to what cost goes into:

Not intended to be a factual statement.

Granny Godzilla

June 28th, 2011
10:24 am

Normal

My thoughts and prayers are with your Mom and you.

Jezz A. Bell - The Phoenician SinSation

June 28th, 2011
10:26 am

Adam: PLEEEEEASE let some of your fellow cons know the public education WORKS, then, and does not need to be cut or defunded or abolished.

Did you see this >>> “The state Board of Education’s charter schools committee has recommended that 11 campuses whose operating agreements were voided by a recent state Supreme Court decision be allowed to open in August……..Nine schools will receive state and federal funding for students, but no local funding.

What is it about Georgia/Capitalism/Everything For Profit No Matter How Crappy It Is/Spend, Spend, Spend?

AT

June 28th, 2011
10:28 am

One of the problems is that our technological capabilities have surpassed our ability to pay for them. Check the article linked below, detailing part of the manufacturing process for a drug that helps prevent organ transplant rejection. There 780 steps in the manufacturing process alone.

Just because we have the ability to save a life with and organ transplant doesn’t mean that we have the resources to do it for everyone. The “Big Pharma” and evil profit rhetoric is already circulating, but it isn’t really part of the problem either. We can send men to the moon, but we can’t send everyone there, just because they think they have the right to demand it. The health care problem is similar when you make it an “everybody” problem and remove the personal element where compassion and our duty to those close to us comes into play.

The solutions and choices won’t be easy, but for me, it comes down to having the freedom to make those choices myself, according to my wishes and abilities. Putting a bureaucracy in charge is a dangerous thing to do.

http://www.automationworld.com/perspective-8737

SOUTHERN ATL

June 28th, 2011
10:28 am

Maybe more time needs to be spent in the labs to create a more generic form of the drug. This may assist with the competitive pricing.

Joe Mama

June 28th, 2011
10:29 am

Normal — “Some in my family don’t want to tell Mom because of the Alzheimer’s, but I feel she need s to know and while she has most of her senses make her own decision. The chemo will hurt my family and me but it’s Mom. I’ve been wrestling with this for a couple of weeks now.”

If you haven’t already done so, get a POA, a health care POA and any end-of-life instructions down on paper ASAP. There are plenty of good attorneys who can help expedite the POAs for you.

Left wing management

June 28th, 2011
10:29 am

ByteMe: Yes! Quasi indeed! Just not quasi-irritated. That’s full bore. :)

DEA: “None of the government-educated, government-employed, Democrat-voting filth in this country has ANY clue as to what cost goes into”

My how quickly the hard-right gurgles to life this morning, straining as it does to articulate an actual human sound as opposed to a vague croaking. Keep on going guys! Evolve before our eyes! :)

Doggone/GA

June 28th, 2011
10:30 am

“Maybe more time needs to be spent in the labs to create a more generic form of the drug. This may assist with the competitive pricing”

Generic drugs are already “created” – by the original developer. All that happens when a drug is “generic” is that the original patent owner no longer has exclusive rights to market it, and other drug factories can then copy it. It is exactly the same as the brand name drug, it just doesn’t carry that brand name.

Stonethrower

June 28th, 2011
10:30 am

Hey DEA! Research how much drug companies spend on advertising vs R&D, then get back with me.

Joe Mama

June 28th, 2011
10:31 am

DEA — “None of the government-educated, government-employed, Democrat-voting filth in this country has ANY clue as to what cost goes into:”

I know that a fat pile of profits, bonuses and salaries go into it.

“You don’t like the way the drug companies are operating? Start your own or shut the hell up.”

No.

SOUTHERN ATL

June 28th, 2011
10:32 am

Generic drugs are already “created” – by the original developer. All that happens when a drug is “generic” is that the original patent owner no longer has exclusive rights to market it, and other drug factories can then copy it. It is exactly the same as the brand name drug, it just doesn’t carry that brand name.

So are the generic brands as expensive?

poison pen

June 28th, 2011
10:32 am

Jay, it sounds to me that the Govt made the decision for us when they approved the drug.

RedEye

June 28th, 2011
10:34 am

So are the generic brands as expensive?

No, but generics cant come to the market until the patent protection for new drugs expire.

Doggone/GA

June 28th, 2011
10:34 am

“So are the generic brands as expensive?”

No, because the generic drug maker doesn’t have the cachet of the brand name, and also has not had to do the R&D or the advertising

@@

June 28th, 2011
10:34 am

The moral, financial dilemma at the heart of health care

And with the U.K.’s single-payer system, you can have either or…but not both. Where’s the morality in THAT?

Paying Patients Test British Health Care System

Although the government is reluctant to discuss the issue, hopscotching back and forth between private and public care has long been standard here for those who can afford it. But a few recent cases have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits.

One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview.

“I said, ‘Where does that leave me?’ He said, ‘If you pay for Avastin, you’ll have to pay for everything’ ” — in other words, for all her cancer treatment, far more than she could afford.

It’s being reported that Hugo has prostate cancer. He’s receiving care in Havana. Not doin’ too well by all accounts.

Jezz A. Bell - The Phoenician SinSation

June 28th, 2011
10:35 am

What is so bad about LeBron James?

Nothing. It’s amazing how some people expect more from a player than they do from their own dang politicians isn’t it? I’m amazed and dumbfounded all the time how people can have poutrage over something an ATHLETE has done, (mostly to himself) and shrug over what a SENATOR can do, ( to everyone).

Aquagirl: Thomas, he’s living proof money can’t buy class. A tool with lots of money and fame is still a tool.

He’s a man. What do you expect? Blagovech, Gingrich, Abrahamoff, Cheney, etc. can all fall into that “tool” category; and they most definitely don’t have any class; yet they’re not denigrated for their decisions as much as a a professional athlete, actor, actress, etc. is. Our culture is lacking something……..

USinUK

June 28th, 2011
10:36 am

Normal – I’m so sorry to hear about your mom – I didn’t realize it had spread that much. Having lost my mom to lung cancer, I know what you’re going through and am sending you and your fam my love (and loads of hugs)

Doggone/GA

June 28th, 2011
10:37 am

“Jay, it sounds to me that the Govt made the decision for us when they approved the drug”

They approve the drug, not the price

poison pen

June 28th, 2011
10:38 am

Normal, Went thru this with my Dad many years ago, we listened to what his Doctor said what was best and followed thru with it.
You are blessed to have had your Ma for 99 years, mine left when I was 2.

ByteMe

June 28th, 2011
10:38 am

They approve the drug, not the price

And, in fact, our corporatists in the government have decided they can’t negotiate the price.

The Leg Lamp is a "major award"......

June 28th, 2011
10:40 am

SOUTHERN ATL
June 28th, 2011
10:32 am

You have to be careful thinking “generics” is the cure all. A friend is a cardiologist and he once told me to be wary of some generics for heart conditions (my father had one). He said while the generic contents of the actual medicine may have been the same, the fillers used in the tablet could have devastating results on certain patients. As a result, he was very matter-of-fact with this patients about which drugs to use. He knew the contents of various generics and would only recommend those if he felt the patient would not suffer any negative consequences.

USinUK

June 28th, 2011
10:40 am

as far as the topic at hand – I agree with Carlos – when profit is the goal, the pharma companies will focus all their efforts on TREATING illnesses rather than CURING them – nothing like a life-time (or, at the very least, long-term prescription to bring those $$$s in)

… and, like it or not, this is why there are “death panels” at every level – in insurance companies, hospitals and at the government level to draw a line over what should be treated and how.

SOUTHERN ATL

June 28th, 2011
10:41 am

RedEye
No, but generics cant come to the market until the patent protection for new drugs expire.

Yes, I understand that but it is a no win situation with limited resources. Most poor/working class people will not be able to afford the treatments and Medicare will not be able to sustain the cost associated with the treatments. Maybe the government can work out a deal with whoever owns the patent!!

poison pen

June 28th, 2011
10:41 am

Doggone/GA

“Jay, it sounds to me that the Govt made the decision for us when they approved the drug”

” They approve the drug, not the price ”

That is true, everyone can get the price down by not using it, the choice is yours.

USinUK

June 28th, 2011
10:41 am

poison – urgh. I’m so sorry you lost your mom at such a young age. I had mine until I was 27 – miss her every flipping day.

Jimmy62

June 28th, 2011
10:41 am

I agree that these sort of end of life care decisions need to be thought about, and the balance between what is right for the old people, and what is fair for the rest of us is difficult.

And Obama showed his cowardly ways by trying to hide that these things needed to be discussed. He could have responded to the death panels controversy by talking about how decisions do have to be made and that death panels are not the right thing to call it, but that sort of thing does need to be considered. Instead he let the media attack Palin for him, and ridiculed her himself.

And now you want to have a responsible non-partisan discussion about it. Too bad you weren’t this honest when Palin tried to talk about it. Then you just wanted to make partisan attacks.

RedEye

June 28th, 2011
10:44 am

Southern ATL,

“Maybe the government can work out a deal with whoever owns the patent!!”

Who do you think creates the patents laws?

The government.