Thursday, February 25, 2010

Rationing Health Care is Bad for Cancer Patients

       The current bill before  the house and Senate does a disservice  for cancer patients. It is not correct to say,  " it's true that some people are covered well, but many are not" as I have heard said by people who should know better. It's more correct to say that ,"most Americans  are covered well in the current system." This is especially true of cancer patients. So be careful what you do to change it.
      Cancer patients suffer most when they try to change jobs and are denied health care in a new job because of a preexisting  condition or when the amount they can spend on health care is capped. Like most Americans, they are also concerned about cost of insurance as well.
      In prior postings I exposed the numbers game used by those who support this bill for what it was, a bogus use of numbers to scare the American people into reform they don't need and don't want. There are not 47 million Americans uninsured. Even President Obama has begun to use a lower figure, 30 million,  a little embarrassed , I think , to be caught  using a number no one bothered to check ( this is still an overestimate). The American Cancer Society should feel some embarrassment for doing the same thing.
     But what is as clear as can be is that there is no way the current House and Senate proposal can stay within budget without rationing care. And people I know close to the administration say to me " get real, Vince, rationing is coming". They barely hide this although they don't trumpet it for fear of scaring more people away. They do admit to the need to cut billions from Medicare though.
     The preferred method to decide what to ration is to use "Comparative Effectiveness Research"(CER) to decide what should be approved. A billion dollars has been allocated in the bill for this. The best way to characterize CER is to say that it compares yesterday's therapy with that of the  day before yesterday. It is always behind the curve. The newest approaches need not apply. Cancer patients always get the short end of the stick when care is rationed.
      Look at the UK's National Institute of Clinical Excellence ,(acronym ,NICE -British doctors refer to it as "not so nice"). Their decision to deny coverage for the use of the drug Erbitux in patients with head and neck cancer was one example of  a feckless disregard for cancer patients. There are more. Studies have shown an enormous, statistically significant, difference in survival for those who are irradiated with Erbitux compared with those who don't receive it. Yet they denied coverage.  They actually don't even question the data, they just say it is not cost effective to use it. In other words if you have the misfortune of having head and neck cancer in the UK, you are not worth saving.
      This is the system the bill tries to emulate. It includes commissions to determine standard of care ( in the cancer field, " standard of care" is a moving target ) and authorities to the secretary of HHS that would allow her to limit the use of new technology even without  CER, as NICE did in the UK with Erbitux. The new drug from Plexicon, to which every patient with metastatic melanoma should have access, wouldn't even be considered for CER.
      They know they will need to ration care to pay for this version of health care reform. At the most exciting time in the history of cancer research, when new clinical advances are being made every day in the cancer field these provisions would  stop clinical innovation in its tracks.
      What is needed for the cancer patient is a stepwise approach that preserves the best of the current system and provides more security . Like most people I could write a bill in  ten pages to do this, not the  2,700 pages in the current bill.
      Prevent denial of coverage for a preexisting conditions, remove caps on the amount of coverage and allow insurance to be purchased across state lines. This would do it for cancer patients and save hundreds of millions of dollars as well.
       It's the many mandates included in some state's policies that drive up cost. Purchasing across state lines would allow more people to buy less expensive policies that suit their purposes. This might mean giving up some of our precious  mandates but  isn't it is better to cover more cancer patients well, than force policies on them with too many mandates that are too expensive to buy? 
      Frankly I don't see any organizations purported to be speaking for the interests of cancer patients telling the congress the specifics of what they need and, most especially ,what they don't want. We need the three things mentioned above and we do not want  a system that will require rationing of care .
     Oh , and by the way, the Congressional Budget Office estimates the new bill would still leave 10 to 19 million people uninsured , which is more than are truly uninsured now.

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