When the treatment you need costs more than you’re worth

Derek Hunter Contributor
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If you were dying of cancer, how much money would be too much money to spend to extend your life? That’s a ridiculous question, of course, because there is no price tag that could be put on more time with loved ones, but that’s exactly what the government does every day when they decide whether or not to allow “off-label” use of certain drugs, which set the guidelines private insurance follows.

Citing Britain’s National Institute for Health and Clinical Excellence, as “a pace-setter in evaluating medical advances,” the New York Times has decided to sweep the Food and Drug Administration’s effort to ration and restrict cancer drugs under the rug.

To the Times, the costs of the life extending drug Avastin are “too high for the limited benefits,” i.e., up to six more months of life.  This is a peek into our future.   To women with breast cancer, the cost of life does not fit in the new budgetary constraints of nationalized health care.

Adding insult to injury, the Times puts a price tag on life arguing that $4,750 a month to live is too much to bear.

This isn’t an issue of government paying the cost of these late stage drugs.  This is an issue of the government deciding that private insurers — who were in cahoots with the Obama administration on the government take-over of our health care system — will approve these drugs for coverage.  If the FDA makes Avastin an “off-label” drug, most insurers will refuse to cover the costs, leaving only the rich to be able to afford the treatment.

“Off-label” use is when a drug is found to be effective in treating something for which it was not tested and approved by the FDA. These discoveries are usually accidental, someone with one condition suddenly finds their treatment helping them with another ailment, but is a standard practice in medicine. Perhaps the most well known example of this is Viagra, which was originally used as a treatment for hypertension and in the course of using it for that was discovered to aid in the area that made it famous.

Prescription drugs are powerful things, chemicals that react differently within different people. A drug that is effective in treating cancer in one person may not work in another. That is why there are so many drugs that treat the same ailment. But they aren’t cheap. The average drug costs more than $800 million and over 10 years to bring to market, which is why they cost so much.

With the government moving to take over more and more responsibilities in the health sector, that cost is become more and more of a concern to people completely disconnected from the doctor-patient relationship. As that happens, there will be more examples like Avastin, particularly for the elderly.

The government will inherently bias spending decisions towards treatment for younger, more “productive” citizens. And treatment to give dying patients a little more time or a little more comfort just aren’t worth it.

This position has been the president’s all along.  During an ABC health-care forum in 2009, the president questioned whether his grandmother should have received the hip replacement she needed while suffering a terminal illness.

In an April 2008 interview with The New York Times Magazine, Obama suggested much of the cost of health care in America comes from the elderly and those with chronic illness.

“That’s where you get into some very difficult moral issues,” Obama said – specifically considering whether “in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question.”

If you have a year to live, would you want that year spent in pain every time you walked anywhere? The “value” of a treatment is easy to dismiss when it’s not you having to deal with denial of treatment. Only you won’t be on the deciding end of that equation, you’ll be on the decision end.

When it comes to what is the best treatment for anyone’s particular situation, what has the best chance of working, what will provide the highest quality of life, etc., no one is better suited to make the best decision than the doctor and the patient. But those difficult decisions are now more often being made by unnamed bureaucrats and government appointed panels. They don’t know you and they don’t care; they aren’t paid to. So what happens to you when the treatment you and your doctor agree would benefit you costs more than some bureaucrat thinks you’re worth?

Derek Hunter is a Washington based writer and consultant. He can be stalked on Twitter @derekahunter.