Thursday, March 31, 2011

Tough Decisions

When should the government deny expensive, end-of-life medical treatment for the elderly?  Never?  Does the specter of "death panels" cloud our common sense, and will it hasten the demise of our broken financial system?  I don't know the answers, but I do know that we have some VERY tough decisions to face.  Here is a case in point:

The federal health insurance program for the elderly moved Wednesday to pay for an expensive vaccine recently approved to treat men with advanced prostate cancer.

The Centers for Medicare and Medicaid Services proposed paying for the vaccine, known as Provenge, which costs $93,000 a patient.

*snip*

Provenge, which received Food and Drug Administration approval in April, is the latest in a series of new, high-priced cancer treatments that appear to eke out only a few more months of life, prompting alarm about their costs. Provenge appears able to extend patients’ lives by about four months.

I've bolded the main points in the article.  Can we, as a fiscally bankrupt nation, afford to pay this exorbitant cost for every man suffering from prostate cancer, when it's not a cure?  What of our national conscience and compassion; can we psychologically and morally afford NOT to?

Tough decisions indeed.  Any thoughts?

24 comments:

  1. If it were my money I wouldn't spend it for the extra four months. I'd leave if for my heirs to better their lives... mine is over. Can that be extrapolated to any sort of national policy? In today's world, probably not. Though really, I personally wouldn't have much of a moral quandary over denying the drug to another, not when it is just for four months. There would have to be some extremely extenuating circumstances involved for me to agree to that extra four months, such as an in the wings cure, a baby being born, etc. Then again, maybe I'm just a soulless bastard.

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  2. Luther, you're not a soulless bastard; you're practical and you're not self-centered. Both are admirable traits.

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  3. Well, I'm all for R & D but what in the hell could make a dose of medicine COST $93,000? It's ridiculous, so is paying that amount to extend a life for only four months.

    Something stinks here.

    And Luther, I'm the real soulless bastard.

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  4. Oh, Fay... a challenge huh? I like those.

    I'm quite sure I'm a much more soulless bastard than you.

    Why, if I had the opportunity I'd vote against socialized medicine if I had the chance. What a bastard am I. :)

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  5. Lady Red, thanks. But don't tell Fay, okay?

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  6. Aha, so it turns out that the cost of developing and producing the vaccines has no relationship to the selling price.

    The drug company wouldn't dare to charge that price if the patient had to pay the cost.

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  7. Luther-Fay
    Luther-Fay

    Hmm, not seeing much soulessness in either case.

    Of course, I DO need new glasses ;)

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  8. You all are too funny! And soulless!

    We are a blog of zombie bastards...:))

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  9. Well, I'm all for R & D but what in the hell could make a dose of medicine COST $93,000?

    Enormously research, followed by enormously expensive testing, amortized over a very small market (advanced prostate cancer patients).

    R&D is a funnel. Many drugs are examined before some are selected for testing. Many are tested for every one approved. Drug companies have to pay for all of it, regardless of what works.

    Then they have to make a profit from those drugs that make it to market. That, or they go bankrupt, and the funnel stops.

    The other thing is that the "4 months" thing is a bit misleading. No other statistics are given, but I'll wager that not everyone drops dead after 4 months. Some - probably most - die sooner. And some lucky few live much longer. "Four extra months" is different from "a ten percent chance of a 2 year remission" or whatever the real statistic is.

    My father received insanely expensive end-of-life, last-ditch medical care. He received it three times! After the first time, he lived another eight years! The second time, he lived another four! (Statistically, he had almost no chance at this).

    I'm sure $93K a dose is worth it to some. I say let them buy it, or buy the health insurance that would cover it. The fact that the government is in the business of making these decisions shows the idiocy of it all.

    The Left will point and claim "rationing and death panels exist already! The insurance companies do it! What I fail to see is how it is a just and equitable thing when the government takes over these decisions. I see it only as a sociopathic will to power.

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  10. Hey Zeus, Fay. That article you linked is very confusing. Sure, it is a what the market will bear, the market being insurance or government paid. On the other hand, a lot of money was spent to get to that point.

    But here, a different thought. What if some in the 'government' were feeling some political heat. Meaning, some seeing the concentration of money directed toward breast cancer, AIDS, etc. were causing people to think. About priorities. Signifiers.

    We've become a minefield here, dialog between citizens.

    Sorry if I'm making no sense, overdid my allotment of 'survivalist in a drunken state' tonight. Again.

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  11. Oh, and as a practicing capitalist with investments in biotech, I beat all a y'all in the soulless bastard competition. :D

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  12. "zombie bastards"

    Love that. :)

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  13. Fay, I posted above without reading the link you posted in (6). I'll check it out now.

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  14. If you all are going to have a "who's the biggest soulless bastard" contest, I'm making popcorn. :D

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  15. Oh to hell with you Lewy. I'd beat you, too. In a soulless bastard competition. :)

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  16. Lady Red, fire up that popcorn maker. :)

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  17. "We've become a minefield here, dialog between citizens."

    I wasn't clear.

    I meant a nationwide dialog. Not TCKT.

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  18. Fay,

    I read the abc news link. I think "no relationship" between price and research costs overstates the case. I'm betting this relationship holds: you can't sell the stuff at a loss.

    On the one hand, in general I'm a huge fan of "what the market will bear" pricing - on the other hand, "the market" in this case is distorted beyond all recognition.

    But even in an insurance market which was closer to "free" (and competitive), you will get some very high prices for certain medicines. That's the nature of insurance - sometimes very large payments are made to people, when they've paid their premiums, and bad things happen to them.

    In the case of this particular drug, I'd say I like it - the whole field (customized immune system therapy) is exciting - and massively expensive. Somehow those $1.2B research costs have to get recouped.

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  19. Hmmm, well my plot to increase traffic and comments seems to be working...bwahahaha...

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  20. LOL - who knew?! All you had to do was bring out the zombies! :-)

    Sooo... you gonna change the picture caption to "cranky old farts, brilliant young ladies... and zombies?

    ON topic - Lewy's right about the R & D realities for drug companies. A friend is head statistician for a major drug company, mostly dealing with crunching numbers for cancer drug clinical trials. This is the kind of thing she deals with - they might be able to produce a drug that will prolong life by a few weeks or months, but at what cost? And is it a drug that with a bit of refinement and a few years more work could give a few years? It's a tremendously costly field, and even after years of work, they may find nothing that will be commercially viable.

    But should the government be paying for it for everyone? That's a whole 'nother kettle of fish!

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  21. Hmmm, well my plot to increase traffic and comments seems to be working...bwahahaha...

    I see.

    So, not content to be merely one of us zombie bastards, you have to be a zombie bastard troll?

    Sheesh.

    ;)

    ---

    Lyana - your friend has mad skillz with teh maths. If a drug company statistician screws up, the company suffers or goes bust.

    If a bank derivative analyst screws up, the bank... oh, right... it gets bailed out... :(

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  22. lewy, she's amazing - I always thought I was pretty good with math until she started to explain some of the stuff she does... She also happens to be an incredibly gifted artist - one of those all-around brilliant people who would make you feel like a mental midget if they weren't just so darn nice and down-to-earth.

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  23. In the end, the question of whether we can afford to pay for these treatments or not is not up to us.

    As soon as our creditors decide that that "National Debt" is NEVER going to be repaid and quit buying our bonds, one of two things will happen: Either the federal government will experience a "sudden stop" in funding that will render us unable to pay for a HELL of a lot more than just expensive prostate treatments, or The Ben Bernank and the Fed will crank up QE6.023x10^23, which will devalue the currency and cause a massive spike in commodity (read: food and energy) prices...and Egypt has shown us that, as soon as people are not able to pay for the necessities of life, they WILL riot.

    In both circumstances, the notion that we would EVER have been able to pay for $96,000 prostate treatments for every American on Medicare will seem...well...quaint, really.

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