There is much to complain about with the US health care system. But there is no question it is the driving force in the world behind the continual advancement of medical knowledge and skill. But that innovative energy could well be dissipated by the cost/control/ rationing boards that Obamacare would impose on both private and public insurance policies alike.
I thought about this when reading a story in today’s paper about how two breast cancer drugs extend the life of terminally ill patients for five or six months. From the story:
Some women with very advanced breast cancer may have a new treatment option. A combination of two drugs that more precisely target tumors significantly extended the lives of women who had stopped responding to other medicines, doctors reported Friday. It was the first big test of combining Herceptin and Tykerb. In a study of 300 patients, women receiving both drugs lived nearly five months longer than those given Tykerb alone. Doctors hope for an even bigger benefit in women with less advanced disease and were elated at this much improvement for very sick women who were facing certain death.
The headlines calls this test “good news,” and it is. But this is the very kind of medical advance that would be stifled by rationing—both in the delivery at the clinic and in the development.
Why is that? Today, once a treatment is approved by the FDA, insurance companies can’t refuse it. Imagine, the outcry if, for example, Aetna or Humana refused to extend the life of colon cancer patients by paying for a chemotherapy that gives another 9 months of life. There would be hell to pay! The lawyers would pour out of the woodwork. The government regulators would bring them to heel! That’s because the burden of proof would be on the insurance company to demonstrate why it won’t provide the treatment—and woe betide the PR spokesman who invoked quality of life!
Yet, should the government refuse coverage based on quality of life, the denigrating judgment would be likely to hold because the entire burden of proof would shifted. And the system would be clearly be predicated on quality of life. Most bioethicists, the very people who would be appointed to and advise the cost/benefit/best practices boards, reject the equality/sanctity of life ethic and embrace viewing medical delivery through a distorting quality of life prism. In the UK, for example, the rationing board NICE uses a “quality adjusted life year” (QALY) measuring stick, in which a treatment providing life for five years could be worth only one QALY year.
Once rationing were imposed, rather than being on the side of the patient, regulators would be on the side of the bureaucrats, and the lawyers would have far less chance of prevailing. That is because in a rationed system medicine becomes societal rather than individually oriented. And indeed, as just one example, when Ontario, Canada restricted a colon cancer treatment that extends life for nine months, there was some public disquiet, but no redress for those patients told their lives weren’t worth the money to pay for it. Ditto, the Barbara Wagner case in Oregon, in which a Medicaid bureaucrat refused life-extending chemotherapy, but offered assisted suicide. (Wagner eventually got the treatment free from the drug company.)
Should such a system be imposed on the USA, it would not only victimize the very sick, it would also sap most of the energy out of innovation. It often takes billions to bring a drug to market. If some of treatments derived therefom might not be covered even if they work, they won’t be developed. Thus Obamacare would eventually both stifle the delivery of efficacious medicine and its innovation. That would not only be disastrous for us, but for the world that looks to the USA for these kind of advances.
