Cherrypicking health care anecdotes

Yikes.  I know there is much more to the policy question than this story, but it is worth keeping in mind:

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…

Officials said that allowing Mrs. Hirst and others like her to pay
for extra drugs to supplement government care would violate the
philosophy of the health service by giving richer patients an unfair
advantage over poorer ones.

Patients “cannot, in one episode
of treatment, be treated on the N.H.S. and then allowed, as part of the
same episode and the same treatment, to pay money for more drugs,” the
health secretary, Alan Johnson, told Parliament.

And that is The New York Times.  Is Atlas Shrugging?

Addendum: More discussion here.


This kind of thing is stupid. But it doesn't undermine the case for an intelligent plan for universal medical coverage. I favor Hillary Clinton's, provided the subsidy for those mandated to buy insurance is adequate. Obama's plan is more modest, but still much better than nothing. And nothing is what we'll get if John McCain is elected.

There are some extremists out there who agree with this kind of policy- we should all get the same healthcare. I think it crazy and those people scare me, but I don't think that's what we're talking about here in the United States.

The reason cited here was equity, but they often have an economic reason. Allowing people to purchase medicine privately might drive the costs up for government in one of several potential scenarios.

If you want it "free", be prepared for lines and rationing. Then get your checkbook ready, for paying Uncle Sam.

Tyler, I don't think you quite understand how the NYT's core audience will interperate this story - they will not see this as a consequence of the failure of government planning, but rather the failure of not ENOUGH government planning. Namely, the failure to nationalize the drug companies and the failure to nationalize health care.

Atlas is not shrugging. The problems of failed statism can only be solved by MORE statism.

That shocks me. I would like some sort of universal plan, but if one cannot rise above that, what's the point of building wealth?

(But surely a plane ticket to India was cheaper than $120K in the first place.)

"if you nationalize health care in the U.S who is gonna foot the bill for the world's medical innovations?"

Scientists, perhaps? You know, those same folks who have been playing with quantum particles, staring at far off galaxies, and deconstructing bacteria out of sincere interest and intellectual curiosity (certainly academic salaries are not a pittance, either). I'll bet you can come up with at least a few scientific breakthroughs that didn't take place because of a profit motivation. Guess who the #1 country in cardiological research is right now? France. Weird, huh.

The notion that our instinct to discover will disappear if an absurd profit cannot be made is, well, absurd. Perhaps research will focus instead on real problems, rather than trying to invent a new disorder every month to market the new drug to. That theory is at least as reasonable as the notion that medical innovation will dry.

seems exactly how it should work: you get free basic care, and if want extra, switch to private care.

You don't get to waste the time of the basic plan doctors by using them as experts on your custom treatment: feel free to use the basic plan and then pay a private doc to enhance the basic plan, tho

I guess I spent too much of my life in universities, because this kind of egalitarianism doesn't surprise me at all. I know lots of people who insist that no public school should be allowed to spend more per pupil than any other, and I was once on the losing side of a faculty vote that prohibited students from taking exams on a computer because maybe the poorest students wouldn't be able to afford computers.

What are the chance that the medication would help?

Doesn't seem like that much of a problem since she can go abroad, not that I expect it will do much good.

Holy crap! I knew the Canadians pulled stuff like this, but I thought that the Brits were different. Isn't the idea of the NHS that it provides a minimum standard of care, and wealthier Brits buy supplemental insurance that provides a higher standard of care? Or does supplemental insurance in Britain just pay for private rooms and regular pillow-fluffings? Can an upper-income Brit please clarify?

Floccina raises an excellent point. These anecdotal arguments (a al Michael Moore) glaze over the most important question - did the drug have a reasonable chance of improving her quality of life? It's very possible that the cost simply was not worth it. Another way of asking this question is, "if she were American, would her insurance company have paid for the avastin, or rejected her claim because her doctors couldn't prove medical benefit?"

I am not defending the policy which is most likely wrongheaded, but my understanding of the general logic is this:

If you go private (which you always can) you go private - in for a penny in for a pound.

If you go public, then likewise you are public on the whole deal.

This avoids the taking up of a private option itself creating a burden on the NHS, which the NHS wouldn't have facilitated. It is normally applied to post operative care, that is you can't have surgery privately, and then expect the NHS to cover follow-up checks on your surgery, complications arising from it etc.

Why private surgery deserves to be treated differently from, for example, accidents caused by driving very fast and very expensive is not obvious.

Are the British still allowed to buy their own bandages, or must they visit the NHS for that?

If it helps clarify, in the US avastin is only in "late-stage" trials for metastatic breast cancer according to Wikipedia, but really that has no bearing on availability in the UK.

But really the lady could be stuck in a catch-22. The avastin has only been shown to work on breast cancer in concert with standard chemo. She's already selling her house, will that raise enough to cover both avastin and chemo, or just the avastin, which may not work without the chemo? It may stop new tumors from growing (it inhibits blood vessel growth), but it won't kill the ones already there I think. But she never got private insurance that might have covered this or allowed out of pocket expense, because she had the NHS. And it's not like she's taking advantage of the system while having hundreds of thousands of pounds stashed away that she can pull out when she needs the good stuff. She's going to the extreme step of selling her home to save her life.

It's pathetic that the woman's going to die for someone else's principles, principles that largely seem based on class warfare. In this instance the UK's safety net has become a suicide pact.

You know, those same folks who have been playing with quantum particles, staring at far off galaxies, and deconstructing bacteria out of sincere interest and intellectual curiosity (certainly academic salaries are not a pittance, either).

You don't have to spend half a billion dollars to prove to NASA that your newly-discovered galaxy won't hurt anybody.

I wonder how Terry Schiavo fits into the rightwing world view on health care.

In the UK, you're not allowed certain health care.

In the US, it's forced upon you by wingnut lawmakers.

I made the first Andrew comment, and none other til this one.

I should amend my first comment. Although most chemotherapy is wasted money, who would not buy that lottery ticket, even if it cost all your resources?

But, Avastin may be effective, is a new approach to attacking tumors, and I think has shown some success, even though it is "experimental" (What treatment with a 4% success rate is not properly considered "experimental?"). Everything is experimental in medicine. You try stuff and it works or it doesn't. That's called an experiment. Legislators want to treat it like a Six Sigma project.

So, the government is likely paying for inneffective treatments, while not allowing this patient to pursue one with a higher probability of effectiveness.

I particularly liked this:

Patients “cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs,† the health secretary, Alan Johnson, told Parliament.

“That way lies the end of the founding principles of the N.H.S.,† Mr. Johnson said.

Iow, the health of the NHS is more important than the health of the people it's supposedly treating.

Then the tragedy turns to farce at the end of the article:

But in a final irony, Hirst was told early this month that her cancer had spread and her condition had deteriorated so much that she could have the Avastin after all - paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense.

"And finally, I'm amused to see the standard nonsense about how Canadians (or Brits, or Germans, etc.) really hate their health care systems and are longing for what we have here. Canada, Great Britain, Germany, etc. are democratic countries with a voting rate better than ours. If their health care systems were unpopular, one of their political parties would propose that it be scrapped in favor an American style system. Does anybody really believe that's going to happen?"

American-style? Doubtful. But you must not pay attention to the news if you don't think that the quality of health care provided isn't an issue in either Canada or the UK. A quick google news search turned up numerous articles on Canadian health care, such as this:

Tony Blair, meanwhile, made an election issue out of making reforms to the NHS.

So this notion that politicians aren't talking about it and voters aren't concerned in the UK and Canada is quite bogus. (I have no idea about Germany)

Joey: As an engineering/computer science researcher, I didn't really see a problem with Andrew's argument. Care to enlighten us with some of the details?

OK, let's take "copycat drugs." Lipitor would be defined as one of those. It's also far more effective than the earlier statins. And having multiple statins on the market provides competition and lowers prices for consumers, whether they are individuals or national health services. Arguing that researching "copycat drugs" is inefficient is just plain stupid.

[On December 5, 2007, the FDA voted 5-4 that Avastin's risks outweighed its benefits for women with advanced breast cancer.]

Funny, the Wall Street Journal editorial page had an article about that today.

It seems that, once the patient is diagnosed, Avastin increases t_healthy, the amount of time before the cancer spreads further and healthy becomes significantly worse. However, it decreases t_sick; once it spreads, the patient dies quicker. The FDA regulatory process mostly cares about mortality rates and t_total = t_healthy + t_sick. Avastin most likely increases t_total by a small amount, but current small studies have not shown an effect large enough to be considered significant.

In response to Colin, I agree that the quality of health care is an issue in Canada and the UK. It's also an issue here, but an unreported one. Millions of people in the US are not getting preventive care because they can't afford it. They go to the doctor when they're sick, and that's it. Economists like Cowen always talk about the economic losses associated with social welfare programs. Do they ever think of the economic losses caused by not having them?

PS: that's "simply" in the first sentence.

Also, you tell 'em, Joey. (I'm serious here. I've worked in basic bio research myself, in a well funded lab, and money was overwhelmingly important. From speaking with post-docs who were trying to start their own labs, I can tell you it doesn't become less so when you don't have any. Quite the opposite.)

Again, the awful nature of this episode has NOTHING to do with the NHS not giving her the drug. That's fine. That's standard rationing. Whether it's the government or an insurance company, cost/benefit decisions are necessary. It doesn't matter that the NHS wouldn't pay for it, nor does it matter how effective the drug is.

The point is that the NHS wouldn't allow her to buy it herself, a power insurance companies don't have. Denying a person the ability to spend their own money based on their own decisions about their own health and claiming to do so in the name of "fairness" is just plain wrong. Truthfully, it may well be a mistake for her to spend so much on an ineffective treatment, but that's her choice and it's literally life or death. It's one thing for the government or an insurance company to say "We won't spend that money on you." It's quite another to say "You can't spend it on yourself."

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