Originally Posted By mawnck Because it's about time we found something different to argue about: >>If you're in the camp that we can fix Medicare and Medicaid, and that the funding problems they face are able to be patched, you need to answer for this: " Dendreon Corp. (DNDN)’s prostate cancer drug Provenge should be covered by the U.S. government for use in older men, regulators said. The $93,000 treatment regimen is “reasonable and necessary” for men with advanced, castrate-resistant prostate tumors who have minimal or no symptoms of the disease, the Centers for Medicare & Medicaid Services said today." Note this well - this drug does not cure prostate cancer.<< >>So what we're saying here is that you and I will be forced to pay about $25,000 a month for any man who is at least 65 and contracts this particular form of the disease that is amenable to treatment. That treatment will not change the outcome, and we will pay the nearly $100,000 to give this person four more months of life, on average.<< >>We don't have the money and as we continue to develop more and more treatments like this the problem becomes more and more acute. We cannot afford to buy every 70 year old man a quadruple bypass, nor to pay $100,000 for every prostate cancer sufferer to obtain four more months of life. The money simply does not exist.<< >>The "open checkbook" fashion in which we "practice medicine" in this regard at the present time is absolutely unsustainable. We are left to choose between that conversation now, and forced collapse of the medical system in the next few years if we do not.<< <a href="http://market-ticker.org/akcs-www?post=183294" target="_blank">http://market-ticker.org/akcs-...t=183294</a> Somewhat more at the link. As the resident Liberal-tarian, I approve this message. Discuss.
Originally Posted By davewasbaloo As a former Health Commissioner of the NHS, these things need to be evaluated on need and the evidence base for successful interventions. If there is a cost benefit for intervention, it is a no brainer, we should intervene. If there is a balanced returns of investment across all clinical and social area that improves outcomes for individuals (such as reducing pain/discomfort), then it is still worth doing. If there is an implication to public health (e.g. epidemiology/education etc.) or a strain on other parts of the economy (e.g. people not able to work, receiving food stamps etc.), then we should intervene as it costs the population less as a whole. To support someone who is HIV positive, the medication costs about $500k from diagnosis to death. This is something an individual cannot afford. If it is shared across the population, it costs less and enables the patient to work and add to the economy. By not providing this level of care, there is a disinsentive for a patient to disclose their status, thereby risking further infection. Similarly for an elder breaking a hip or someone with cancer. Often when comfort interventions (meds/surgery) are not used, the costs are higher through emergency room admissions and other critical interventions (in the UK, one ER episode costs on average $75,000 exluding post care in the community). And there are Long Term Conditions such as hypertension, diabetes etc. early intervention slows the development of debilitation and also reduces costs as well. It is cheaper to monitor and treat patients, then have to amputate diabetics, or deal with AE admissions for stroke. Sadly, this level of discourse is very rare in the US it seems, certainly through media channels. But there are huge interenational studies on these matters where ideology can be a huge barrier, if people are truly wanting to maximise their economy and personal economic ambition. And don't get me started on things like pre existing conditions or genetic issues impeding insurance coverage, or lack of career progression in the US as people are frightened of losing juobs. Talk about a real sacrifice of liberty.
Originally Posted By mawnck >>As a former Health Commissioner of the NHS, these things need to be evaluated on need and the evidence base for successful interventions.<< >>Sadly, this level of discourse is very rare in the US it seems, certainly through media channels.<< I think we're on the same page actually. Would you agree that Ticker Guy's example is one that wouldn't fall under your criteria? Or am I missing something?
Originally Posted By davewasbaloo Ya, although this talk of "death panels" is a real red rag. They already exist in the US. They are called insurance actuaries, and they tend to kick into effect much sooner than state provision. State provision is not out to generate a profit, insurance companies are. There is a huge difference. Why the GOP support people making a profit out of people's suffering and talk about afordability, while state socialist care generates little profit and costs a population less, always leaves me scratching my head. Especially when many of the talking heads and figure heads claim to be "good Christians". It is a difficult one however, as I asserted, sometimes comfort interventions have an economic benefit (e.g. enabling the carers to work more before the eventual demise in this cancer sufferer's case, or the bipass may ensure someone is able to live a more productive and less expensive life compared to potentially having multiple heart attacks.). the way we do it in the UK is if the evidence for a treatment is good, a health policy is adopted. when the money gets tight, as a board, we review the policies. If we do not think there is a benefit for providing a treatment and it is unsustainable, we can still offer the treatment at a cost to the patient (or an insurance policy if they choose to have private medical cover). It is not an all or nothing equation that the GOP and FOX present. and the myth then lives on. I am annoyed at the Health Care bill because it did not go far enough. Forced insurance is not the answer IMHO, this just propogates the american medical robber barron business further (not that the UK is perfect, we have our issues too on the recharge tairiffs for General Practitioners for example).
Originally Posted By RoadTrip I think there is a time to let nature take its course. My mother was recently diagnosed with pancreatic cancer. She was told by her doctors that they had never done that surgery on someone older than 74. She is 82. They said if she wanted the surgery they would do it. She declined. So I know my mom will die. But she was 82... she would have died of something sometime soon anyway. A more difficult decision is with someone like my wife Rosie. She was just 57 years old when she was diagnosed with colon cancer. If we had TRULY KNOWN her chances of survival I doubt she would have endured the chemotherapy that she did. After her initial surgery we were told that cancer was found in 14 lymph nodes. We were never told how slim the chances were for her survival. Basically, she was dead. I so wish that SOMEONE had told us the truth. It would have been so much better to have the final months of her life without experiencing the devastating side effects of chemo. Rosie, I love you. I'm sorry.
Originally Posted By TomSawyer I wish the NIH would fund pharmaceutical research so the costs of developing these new medicines and treatments weren't so expensive.
Originally Posted By Dabob2 "They are called insurance actuaries, and they tend to kick into effect much sooner than state provision. State provision is not out to generate a profit, insurance companies are. There is a huge difference." Exactly, Dave. I'm so glad that you, someone with knowledge and experience in the field of social medicine, chimed in. No system is perfect. But our current system is more imperfect than most. This is an important discussion to have, and as medicine allows more people to live longer, but at great cost, there will be tough decisions to be made. But other countries show us we can make those decisions, and frankly, I trust someone like Dave to do the right thing far more than I trust a for-profit insurance functionary.
Originally Posted By pecos bill Sorry about your wife RoadTrip. I think a big problem is that people are not given the option for euthanasia. So instead of a quiet, dignified and relatively peaceful death, the only option is to plug ahead with treatments that too often only prolong the misery. I have never quite understood why our pets can be treated with more humanity than ourselves.
Originally Posted By Longhorn12 >I have never quite understood why our pets can be treated with more humanity than ourselves.< YOU OBVIOUSLY DON'T UNDERSTAND. THAT'S SUICIDE! AND! AND! ABORTION! AND THAT'S AGAINST GOD! HAVN'T YOU EVER READ THE BIBLE! THAT'S THE ONLY RELIGION EVER CREATED WE HAVE TO RESPECT IT! ALSO ABORTION!
Originally Posted By davewasbaloo Reading back through this, I hate using a netbook on a slow internet connection. Too many spelling errors, and due to the slowness, I want to quickly post. Grrr. sorry, makes me look like an idiot.
Originally Posted By Longhorn12 >makes me look like an idiot.< Not at all. We all mess up at some point. >Longhorn is being sarcastic.< I am, but I would be lying if I told you I haven't heard that argument before. My grandfather dearly wished that he was allowed the option to end it peacefully. Instead however he slipped into a constant state of confusion due to lack of oxygen in his brain because he only had one working lung and it wasn't at even at 50% It was another 6 weeks on an oxygen tank before his heart finally stopped. I never got to really say goodbye to my grandfather because he wasn't allowed the option to end it before he became incapable of speaking and other basic skills.
Originally Posted By pecos bill My sympathy Longhorn, for what your Grandfather was FORCED to endure. I share your contempt and loathing of those responsible for the perpetuation of such misery.
Originally Posted By Labuda "I wish the NIH would fund pharmaceutical research so the costs of developing these new medicines and treatments weren't so expensive." I don't know if this was mentioned in the linked article, but part of the reason for the high cost of Provenge has to do with the fact that it has to be specially made for the immune systems of each patient. And, while it does not cure the cancer, it has been shown to extend patients' lives by something like 4 to 6 months based on what I know so far about this.
Originally Posted By Kevin Flynn Very interesting thread. Interesting insight davewasbaloo. Very good insight and very informative.
