The big problem in American health care besides not producing good results is that everything costs too damn much because no one is able or willing to say no. Evidence based medicine, pay for performance, reference pricing, narrow and multi-tiered networks are all attempts at introducing soft “No’s” into the equation but there are extraordinarily few hard no’s built into the system as someone is always willing to say yes and spread costs over everyone else.
A fascinating article in New York Magazine on why drugs cost so much in the US. It has a critical point about the power to say “No” on costs.
a committee already exists in England. Its technical name is the National Institute for Health and Clinical Excellence, or NICE, and it considers not only the benefit but also the cost in deciding what drugs will be covered by the U.K.’s National Health Service. Its decisions allow an implicit form of government negotiating over the price of drugs, because when NICE has turned down a drug as having too little clinical bang for the buck, companies have often come back to the panel with a lower price.
As a result, a British cancer patient usually pays substantially less than American patients. Gleevec costs about $33,500 a year in England, according to NICE; the U.S. price ranges up to $92,000 (according to the Blood editorial). Tasigna, a newer CML drug, costs about $51,000 in England, while the U.S. price ranges up to $115,000. Sprycel, another new CML drug, costs nearly $49,000 a year in England, while the U.S. price ranges up to $123,000.
More to the point, NICE has recently said no where Medicare has been forced to say yes. In January 2012, NICE declined to approve Avastin for both colon and breast cancer, and last June, NICE reached the same conclusion about Zaltrap as Sloan-Kettering’s physicians?it declined to cover the use of the drug, considering it too expensive.
The US even in the Obamacare world does not have a wide-scale entity that can directly say “No”.
IPAB has the ability to say that pricing is out of whack and it can change pricing models but it can not say no. The Patient Centered Outcomes Research Institute is forbidden by law from establishing cost effectiveness thresholds. It can generate cost and effectiveness tables but it is not allowed to do long division between these two tables. Medicare can not say nyet. The only entity with significant market power and the ability to say “No” is the Veteran’s Administration, and shockingly their drug prices for the drugs that they cover are amazingly low in the American context.
Rob in CT
No Death Panels? Awww, you promised!
;)
Jeff Spender
Setting aside the fact that this is a Yahoo! news article…I’m not entire sure how to think about this.
http://finance.yahoo.com/news/judge-declines-halt-obamacare-insurance-subsidies-183920540–sector.html
catclub
Those are big cost (per patient) drugs, and the factor is only 2-4 between US and others.
There are others where the factor is dozens or hundreds, and those are the ones that are used by millions. NYT had the article on how much a clear breath of air costs – asthma inhalers.
kc
The US even in the Obamacare world does not have a wide-scale entity that can directly say “No”.
You mean like a Death Panel?
kc
@Rob in CT:
Curse you, Rob! :D
(I’d delete my post, but WP isn’t showing that option)
kc
@Jeff Spender:
Jesus Christ, are you kidding me? Those red state governors really must despise their people.
catclub
@Jeff Spender: It is good news. The states will have another wooden shoe to throw in the works with the lawsuits. Their own citizens will be injured by the shrapnel.
If people end up losing their subsidies, simply because the government in their state refused to set up an insurance exchange – they might actually blame the responsible party.
If they never get insurance – since without the subsidies, who would even bother to buy – they will never feel the loss. This is good news.
some guy
wasn’t getting Big Pharma on board one of the very first priorities of the Obama team during the ACA battle? I wonder how much that particular tactical decision will cost the average healthcare consumer?
some guy
@catclub:
prednisone for my dog is almost free, for my daughter not so alomost free.
Phoenician in a time of Romans
You should also consider the role of PHARMAC in the NZ system.
Just Some Fuckhead, Thought Leader
If the US had a NICE, it would be staffed by Pfizer, Merck and Eli Lilly and we’d be paying even more for drugs.
BGinCHI
This can’t be right.
The free market just does not make mistakes like this.
Jeff Spender
@catclub:
What gets me is that one guy wants to dismantle the whole thing because he wants to go through 2014 without insurance, and he doesn’t want to pay the $18 a month he’d have to pay as a premium or the $12 a month he’d have to pay as a penalty for not having it.
It’s fucking less than a dollar a day.
What is wrong with these fuckers?
azlib
What a surprise! Funny how “no” often gets to “yes” when an entity with clout in the market can say “no”.
piratedan
@Jeff Spender: they suffer from BPS – Black President Syndrome
pseudonymous in nc
[mcardle]but that kills research! what do you mean the marketing budgets are huge?[/mcardle]
In the UK, specialists can make a case-by-case request for treatments that NICE doesn’t consider worth the money as a general treatment option, but it has to be based upon clinical factors, not just “let’s try this latest and greatest drug and see what happens”.
The telling quote there is from the UC economist who says that for cancer, “patients are willing to bankrupt themselves to try something.” I know people who didn’t bankrupt themselves, but spent every penny they had, and it didn’t make a blind bit of difference to the outcome.
namekarB
@Jeff Spender:
Also carried the *&^%&* advertisement links. Would hope that a cut and paste would at list strip out the ads.
Just Some Fuckhead, Thought Leader
@pseudonymous in nc:
Sounds like a death sentence for Dick Cheney. I’m sold.
Richard Mayhew
@some guy: depends — if you assume that PPACA or something like it could have passed without PHRMA’s support or at least neutrality, a lot — if you assume that PHRMA was a veto player or at least a part of a potential veto coalition, then consumers are no worse off then they would have been.
What is the counterfactual?
Belafon
@Jeff Spender: I can’t wait until they notice that the law does not require you to take insurance on the days ending in “y”.
Higgs Boson's Mate (Crystal Set)
@Jeff Spender:
Just what I thought when I read the article. This guy is a typical dumbass Republican voter (Excuse my redundancy): he’d rather go uninsured than spend a whole 60¢ a day for coverage.
CA Doc
This inability to say no is completely baked into our medical culture. Patients want the drug from TV when there are generic alternatives, or an MRI for an injury that will probably do great with just tincture of time and physicians comply, because there is no incentive not to, except on the grand scale of being complicit in the poor stewardship of our nation’s healthcare resources. And when you have just a few minutes in the room and that patient is going to fill out a survey about you tomorrow, it isn’t surprising that stewardship is not the doc’s highest priority. Saying no takes way more time than saying yes.
Everybody in the equation is going to have to “Think globally, act locally” for this to change.
Keith G
My brother was a very talented physician who worked both in private practice and in the academy. He was very rigorous and convincing in the data he would bring to bear when explaining that the more universal medical care becomes, the more uncomfortable folks might become with the systemic need to say “No”.
It’s not that “no” hasn’t been said in the past, but those were faceless technicians saying no in thousands of conversations from cubby holes in hundreds of different offices.
When/if healthcare is provided through a single payer system, the “No” will be coming from a single, very official, entity. That will presumably more rational, but many will find that more that a bit worrisome – especially if you are the one who might be told no.
Litlebritdifrnt
One of the first things my Mum did when she found out that I was coming home in November was make me an appointment with my dentist to get my crown glued back in. None of this “oooooh, tut, tut, tut, we will have to do at least $1,500 worth of x-rays etc., etc., before we can do that” that I got from the US Dentists. Mum checked and they can glue it back in for about $95.00.
I was talking to my neighbor the other day and she was saying she had a dangling tooth, and went to the Dentist to get it pulled. They too told her that they couldn’t just “pull it out” but they had to do a comprehensive exam, and x-rays and etc., etc., that would cost her a fortune. She told them to stuff it, went home and pulled it out herself.
BGinCHI
@Higgs Boson’s Mate (Crystal Set): Progress is just a few funerals away.
dr. luba
@catclub: Inhalers used to be 2-3 dollars each (generic). Now that the propellant has been changed (HFA), companies have gotten new patents, and they are about $50-60 each. I can buy them in India for 2 dollars still, even with the HFA.
There is absolutely no justification for this price increase.
Litlebritdifrnt
@Just Some Fuckhead, Thought Leader:
What gets me are the ads. I mean come on, you couldn’t go to New Zealand before because you had to make a monthly trip to the Doctor? Or you couldn’t buy an RV and go to Arizona for the same reason? WTF.
I knew that the entire medical system in the US was fucked the minute I saw those ads for a “prescription drug for insufficient eyelashes” really? Especially when you listened to the side effects. I was surprised that the ad didn’t end with “I now have long, beautiful, silky eyelashes, unfortunately I have to take my friend’s word for that because I am now blind”.
kc
@Higgs Boson’s Mate (Crystal Set):
I should have read the whole article before I commented the first time. I just assumed this was another challenge by dumb-ass GOP governors wanting to shaft their citizens. Instead it’s a challenge by some dumb-ass citizens wanting to shaft themselves.
My bad.
sparrow
@dr. luba: I think a big help would be to ban all marketing whatsoever for drugs or treatments, outside of a very controlled information release which is pre-approved by the FDA. Simply a prospectus sheet and a long report on the drug which is aimed at physicians, and no more. No lunches at the expensive restaurants, no meet and greet with the famous celebrities, no hot chicks bringing samples, and no freaking advertisements to consumers whatsoever. Basically, force the marketing costs down to zero. Now.
Gian
@dr. luba:
what are you willing to pay to be able to breathe?
that’s the justification.
the growth of the private for profit medical megacorporations post the Nixon era has seen a lot of things change.
doctors earn less on average, adjusted for inflation by a lot compared to 45 years ago a lot less.
getting medical treatment has gotten more expensive, a lot more expensive.
Sure, some of that is that an MRI costs more, or the latest drug out of trial did cost something for R&D.
But in many ways it’s just simple micro econ.
price-elasticity of demand is pretty low to non-existant for some treatments.
megacorps want mega profits and they don’t make them by paying employees more (doctors) or by providing the service they were paid in advance to provide. (and if you can deny the service long enough the request goes away when the requestor dies…) We have death panels, and they’re focused on shareholder equity.
kc
@Litlebritdifrnt:
I made an appointment for a routine teeth cleaning a while back, and I had to call at least 6 dentists before I found one who would do it without insisting on X-rays and all that crap first.
Higgs Boson's Mate (Crystal Set)
@Litlebritdifrnt:
Every now and then I’m unavoidably confronted TV ads. Some of the drug ads are appalling:
VOICEOVER: Don’t feel shy and uncomfortable, take Damital!
SECOND VOICE: Side effects include full blown AIDS, projectile vomiting, incontinence, cancer, hair loss, heart attack, and respiratory collapse. Stop taking Damital immediately and call your doctor if you stop breathing or die.
Sad_Dem
Does Balloon Juice capitalize the titles of its posts according to the Chicago Manual of Style? If so, “No Is Nice.” Cap the “I.”
Face
Sounds like communism.
Foregone Conclusion
The problem is when NICE does say ‘no’. There have been quite a few cases of NICE refusing to spend money on cancer drugs which could extend life for a relatively short period (we’re talking months or weeks) because they are very expensive and that this isn’t a good use of public money. You can imagine how those individual patients feel about it, and how loudly they shout to their elected representatives. You can also imagine how doctors grouse about not being allowed to prescribe whatever overpriced medication the damn well pleased by meddling bureaucrats. Personally it normally makes sense to me, because every health system has some form of rationing, and rationing logically is better than doing it in response to arbitrary, politically-driven rules, or (the traditional American way!) by personal income. But folks don’t always see it that way.
Roger Moore
@Keith G:
The problem is that there isn’t enough money to say yes to everything for everyone. Right now, our system tells most people yes to most things, but it tells some people no to anything because they can’t get insurance. Obviously the people who are used to hearing yes to anything will be upset to hear no to one or two things, but that ought to be outweighed by the people who will now have insurance and will hear yes to getting treatment at all.
burnspbesq
@dr. luba:
Perhaps not economically or theraputically, but legally there sure as shit is. The US has the strongest and longest patent protection for new drugs of any major industrialized country. The result is that US patients essentially fund all of the world’s new drug research, and everybody else gets a free ride.
Belafon
@Roger Moore: Also, like the consultations the Republicans turned into death panels, people do need to hear that some things just aren’t going to work.
jl
@burnspbesq:
” Perhaps not economically or theraputically, but legally there sure as shit is. The US has the strongest and longest patent protection for new drugs of any major industrialized country. The result is that US patients essentially fund all of the world’s new drug research, and everybody else gets a free ride.”
Not sure what the economic justification is from that argument. To the extent that many novel drug mechanisms are discovered and efficacy proven by government funded research, the drug companies, big and small get some free ride too.
What would be better, that people in the U.S. fund the later safety and effectiveness in general patient population research and pharmacy company profits, or that everyone all over the world pays a little bit more?
Or, find an alternative to current U.S. patent protection practices?
Not saying that you are defending the current practice, just saying that I don’t see much of an argument for an economic justification for current practices.
FlipYrWhig
@Roger Moore: I have to think that’s why a huge part of the Team Obama approach to health care tout court has been pushing very very hard on preventive care and routine stuff. Because when those efforts go well, you forestall the arrival of moments where “no, it’s just not cost-effective” has to be said. Spend a lot more money saying yes to cheap things on the front end and then you reduce the much more painful part of deciding when to say no to expensive things on the back end.
Roger Moore
@sparrow:
And the Roberts Court will say that’s a violation of the First Amendment, the same way it’s a violation to prevent unlimited spending on political advertizements. That’s how they overcame the previous ban on prescription drug ads, and that was with a more liberal court than the current version.
catclub
@Gian: “doctors earn less on average, adjusted for inflation by a lot compared to 45 years ago a lot less.” Huh?
So why do US doctors earn 2 and three times as much – on average – as doctors in France and Germany?
US medical schools constrain the supply of doctors much more than US law schools, and it shows.
jl
Oops, forgot about the bad p h r m c eee world. Try again.
” Perhaps not economically or therapeutically, but legally there sure as shit is. The US has the strongest and longest patent protection for new drugs of any major industrialized country. The result is that US patients essentially fund all of the world’s new drug research, and everybody else gets a free ride.”
Not sure what the economic justification is from that argument. To the extent that many novel drug mechanisms are discovered and efficacy proven by government funded research, the d r u g companies, big and small get some free ride too.
What would be better, that people in the U.S. fund the later safety and effectiveness in general patient population research and d r u g company profits, or that everyone all over the world pays a little bit more?
Or, find an alternative to current U.S. patent protection practices?
Not saying that you are defending the current practice, just saying that I don’t see much of an argument for an economic justification for current practices.
catclub
@Roger Moore: So single payer will say: advertise as much as you want, but the single payer will pay ZERO for drugs that are advertised.
I can dream.
MattR
@Higgs Boson’s Mate (Crystal Set): My favorite eTrade ad ever (and possibly the inspiration for all the fake side effects included in Colbert’s recurring “Cheating Death” segment)
FlipYrWhig
@some guy: right, they should have confronted the pharmaceutical industry head on, because surely there wouldn’t have been 100 gazillion commercials about how the President is bent on stopping your doctor from using the modern medicines that would cure your suffering. The players they coopted and sidelined are the ones that killed all the previous attempts to reform health care.
Face
@Sad_Dem: Fo’ riz? You’re doggin the capitalization of a damn blog post? I wish I had as much free time as you…. ;)
jl
@catclub: Biggest components of growth in health care expenditure in U.S. has not been MD or other personnel costs, has been in drugs, medical equipment and inpatient costs. So, I don’t think there is a big conflict in many (though not by any means all) U.S. doctors’ real incomes falling compared to comparable nations. U.S. income and many (though not by any means all) doctors’ incomes still being higher in real terms than in comparable industrialized high income countries.
Edit: U.S. specialists and surgeons still very highly paid, primary care docs have lost ground, though.
pseudonymous in nc
@Keith G:
And again, the point needs to be made that the “single, very official, entity” would be one that can (and is) held accountable through elections.
@Foregone Conclusion:
Up to a point: there’s certainly the Daily Mail yelling about “lifesaving/miracle cancer drugs”, hiding the fact that a) it fundamentally hates the NHS; b) it’s famous for “[X] GIVES YOU CANCER” headlines; c) the drugs often at best extend life a few months. But there’s also still the sense that your care isn’t being “rationed”, because by that stage, you’ve usually had all manner of treatment without ever seeing a bill.
pseudonymous in nc
@catclub:
More specialisation. More incentive to specialise because that pays off the tuition faster. Atul Gawande’s talked about this. This creates all sorts of skewed incentives, because the bedrock of a healthcare system is its general practitioners, and those people have to be seen as something other than “bottom half of med school” or “couldn’t hack it as a specialist”.
A friend of mine is a GP in London. He has a very comfortable living. As he should.
JPL
@Litlebritdifrnt: Left you a message down below. The dog story is hilarious.
A few years ago I had an ingrown toenail that I could not take care of and finally called a podiatrist. Since I have insurance with a high deductible I wanted to know the cost but they couldn’t tell me until they billed the insurance company. Fuck repubs who just say price compare because you can’t and they assholes to even say that.
The news just interviewed someone who has signed up for ACA and is going to save 1000.00 a month and now only has to pay 500. She is thrilled since she is a cancer survivor.
also, too, the 500 dollars is for the gold plan
gelfling545
@Higgs Boson’s Mate (Crystal Set): Reminds me of Garrison Keillor’s fictional prescription drug council ad: Are you taking drugs? If not, maybe you should.
LanceThruster
We should just stick to trusting Prescott Pharmaceuticals.
Prescott Pharmaceuticals: The tingling tells you it’s working,
the class action lawsuit tells you it’s Prescott. ~ Dr. Stephen T. Colbert D.F.A.
Robert Sneddon
One factor in British healthcare that lead to the formalisaiton of NICE is an attitude not prevalent in the US medicine, that eventually it’s time to give up. I don’t know — does the US have the equivalent of MacMillan nurses?
My mother’s decline and death from pancreatic and liver cancer was made easier by having home visits from a MacMillan nurse. Because we had that sort of support we didn’t hang on to the bitter end, we let “Nature take its course” rather than engage in pointless hospitalisation, chemotherapy and radiotherapy to gain her an extra month or two of debilitation and discomfort.
After discussing things with the nurse and her doctor (who made regular home visits) we changed her pain control medications to “wake” her up for her 40th wedding anniversary, knowing that doing this would shorten her time left but she was aware and cogent on the day for visitors and presents and she slipped away a couple of weeks later.
MomSense
@FlipYrWhig:
Exactly! Sen. Rockefeller had introduced legislation year after year that dealt with re-importation of pharmaceuticals and drug costs but even he voted against the amendments dealing with the very same issue because he knew that the only way to pass the ACA was to neutralize big pharma by not addressing it that time around.
Roger Moore
@Robert Sneddon:
The US does have a formal system of hospice care, which is generally for people who are given 6 months or less to live. There are even “death with dignity” (i.e. physician assisted suicide) laws in a couple of states. So there is at least some recognition that there comes a time to focus on quality of life rather than quantity.
JoyfulA
@Roger Moore: There didn’t used to be lawyer ads or doctor ads either, except for “tombstones”: So-and-so has now opened an office and is available for consultation.
I can’t remember what used to be on the back of phone books, only that we used to get only one phone book.
Of all the dumb things teabaggers want to revert to, you’d think they’d pick some of these that I could go along with.
FlipYrWhig
@MomSense: People like doctors and miracle drugs a hell of a lot more than they like politicians. When Bill Clinton tried this, remember, his position got out-argued by _insurance companies_, OK? People HATE insurance companies, and their side still won. Letting doctors and pill-makers join the “antis” would have been a one-way ticket to oblivion.
liberal
@burnspbesq:
LOL. That’s using a very elastic definition of “research”.
liberal
@FlipYrWhig:
Sadly, a lot of preventive care doesn’t do much good either. (Some exceptions, of course—blood pressure meds for extremely high blood pressure. Good management of asthma.)
liberal
@Gian:
Of course. It’s perhaps the main reason that the “patient choice” method of getting health care spending to come down is bull$hit.
The real issue is lack of competition.
The Pale Scot
Access to exorbitantly priced drugs could be related to how well you have taken care of yourself. Chain smoking chip eating boozer, sorry, bub. Vegetarian and modest exercise routine, what do have in mind? In this country anyway, overweight gun toting drunks get new hearts.
Roger Moore
@liberal:
You left out several of the very best examples of effective preventative care, like vaccinations and contraceptives. It’s not exactly the same thing, but early intervention for acute problems often helps to prevent them from getting worse and causing secondary problems, e.g. proper wound treatment helps to prevent nasty infections. Giving people access to good primary care is very cost effective because it helps to prevent those kinds of problems.
Lurking Canadian
@kc: I could understand if the law was requiring states to subsidize their poor getting coverage. I mean, I would disagree, but I can sort of put myself into the mindset of a governor who would say, “The Feds can’t tell me how to spend state money; that’s for the state legislature to decide”.
But these assholes are saying, “Poor people in my state can’t have coverage even if it diesn’t cost me a dime!” That’s just brutal, boot stomping a human face stuff. I don’t understand how these guys can show their faces in polite society.
Steeplejack
@Sad_Dem:
Ha-ha-ha-ha-ha! What are you huffing? Balloon Juice capitalizes its post titles according to no style at all. Ditto for punctuation of titles and posts.
If you got exercised at this, here’s something that will really make your head explode.
Felonius Monk
Gee, health insurance for $18/month —- I guess that cuts to deeply into this idiot’s booze and oxy habits.
Elizabelle
@Felonius Monk:
I’d be a little skeered of Mr. David Klemencic, floorer.
A profession which takes some math skills — good measurements help.
Commenting at Balloon Juice since 1937
Can’t the insurance companies say no? My employer offers one option. The provider can offer whatever they want. Why don’t they tell us to pound salt over drugs that are that expensive?
Elizabelle
@Robert Sneddon:
Very sorry to hear of your mother’s cancer and death.
We do have good hospice care available in the U.S.; how widely available I cannot say.
A big insurance company (Aetna?) did a study a few years ago — they allowed terminal cancer patients to use both what treatment was available to fight the cancer AND hospice care, and found that patients tended to choose less aggressive courses of treatment and use hospice more.
It turned out to be more cost effective.
The issue seemed to be patient choice. Patients and their families appreciated having the option, and more say in the course of their treatment.
Mnemosyne
@Felonius Monk:
You’d like to think that this guy would get laughed out of court for complaining about a whole $18 a month he would be forced — forced, I tell you! — to pay for his health insurance, but sadly, no.
For some perspective: here at the Giant Evil Corporation, even the lowest-priced (bronze-type) plan requires employees to pay $40 a month. I’m going to be paying about $100 a month as my employee share. And he’s whining about $18 a month?
gian
@catclub:
http://www.hks.harvard.edu/news-events/news/articles/chandra-physicians-salaries-study-jama
If you actually look at the us data… yes income for docs has gone down in the USA. With higher equipment costs and economies of scale for an HMO
There are barriers to entry too.
If you graduate with a ton of student loan debt getting a loan to buy or rent the equipment to hang out a shingle seem super scary or just impossible.
So instead of being his or her own boss the doc works for the megacorp.
Another Holocene Human
It all comes down to a fundamental lack of trust. Americans can’t say no to any intervention or price because they are paranoid (and not without reason) about being denied appropriate care to save the shirt of their medical insurer, whether it’s a private insurer or the public/charity.
When everyone is covered by national care, then it’s in everyone’s interest to tell BigPharma chasing copycat drugs that their new hotness is no better than the old hotness or actually worse, so fuck no we’re not buying that. (insurance co’s do this to a lesser extent, but there’s so much payola involved, not to mention the “irrational” consumer convinced they need the brand name either because of their paid off doctor or worse because of direct to consumer advertising, that it’s by no means effective)
But when it’s all too easy to get denied care because of money, then not only is healthcare a positional good (meaning rich people will keep bidding the price up) but those in the middle with the tendency to rattle their chains will fight like hell to get the “best” care out of paranoia that the denials are wrong.
And sometimes the denials ARE wrong. That’s the worst part about it.
Another Holocene Human
@Commenting at Balloon Juice since 1937:
Some insurers do. My current insurer requires you to show medical need to take the fancy patented drug when there is a generic alternative (an example would be epileptics as the inert ingredients vary between drug companies and epileptics often have substances that trigger their seizures–I’ve also heard of problems with generics for thyroid patients). If not you pay more if not full price.
However, my prior insurer’s schedule of what drugs cost was completely capricious and I suspect reflected some deal spinning and payola with big drug companies, ie, we’re trying to goose Claritin sales so we’re giving you a massive deal. Or where total price and copay bore no relationship to each other.
Another Holocene Human
@Felonius Monk: The bottom feeding right wing organization that put him up to it must have outbid the government at $36/month. //
Another Holocene Human
@Robert Sneddon:
No, we don’t. All the support my family ever got were sympathetic neighbors and sympathetic residents at the hospital. (And merciful employers.)
In the US we have shame cancer charities which enrich the families which run them and shady Tijuana “clinics” that sell cancer “cures” but actually bilk desperate and dying people selling them false hope and treatments that were outlawed in the US for being harmful and ineffective. (Such as laetrile.) I mention Mexico but some of these assholes brazenly operate in the US now, too, although it’s easier to be an autism scam artists because nobody cares about autistic kids. If they get beaten or injected with urine or fed woowoo diets or given inappropriate hormone treatments people just pet their parents and tell them their heroes for suffering through all of that.
Back to cancer there is this guy selling a pancreatic cancer “protocol” that actually dramatically shortens life versus conventional treatment and worsens quality of life and … nobody’s stopping him.
Doctors governing themselves has been an abject failure.
Another Holocene Human
@kc: doing xrays is kinda standard. my current dentist did them on intake because it can show tooth damage that isn’t apparent from a visual inspection. fortunately, my teeth were fine. the practice is very honest (and hires gentle dental hygienists, not sadists), and my semiannual cleaning fees are very low. I do pay slightly more once a year for annual xrays and dentist’s exam. I asked once about how tight my teeth are and I guess the dentist could have totally tried to sell cosmetic stuff at that point but instead he said my teeth were very healthy and functional and I was really quite fortunate compared to many other patients. I was quite in awe but felt a lot better about my teeth. I don’t think there’s anything shady about doing intake xrays since it can reveal places where cavities are about to form and stuff like that. However, I can understand having only so much money and just wanting the cleaning. I know dental schools often have days where you can come out for low or no cost.
I had a friend who bought dental cleaning tools on the internet and tried to clean his own teeth. I think it was more a mental thing than a money thing because his parents would have paid for him to go. He had a bit of OCD about his teeth being clean and he was also avoidant of people. When he finally went to a dentist the hygienist discovered that he had been chipping and bashing up dentine thinking that it was plaque. The more damaged it became, the more he attacked the tooth matrix thinking it was rough plaque depositions. I think he ended up needing fillings….
Tehanu
@Just Some Fuckhead, Thought Leader:
If the US had a “NICE”, the Republicans would take it over and turn it into the “NICE” in C.S. Lewis’s book That Hideous Strength. This would not be a nice thing.
pseudonymous in nc
@burnspbesq:
That’s a tenuous argument, given how the same patent regime encourages research into me-too drugs and extended release formulations and other stuff that’s designed for the US market. And that’s even before considering the cost of marketing direct to non-professionals, which is pretty much unique to the US.
At least you’re not saying “if US patients stop paying extortionate prices for drugs, the research will stop!” which is the McArdle extension of that line of thinking.
I really don’t like that kind of ‘free ride’ assertion. Americans can collectively decide not to pay through the rectum for drugs any time they like, if they’re willing to elect politicians who’ll trim the margins of big pharma.
zoot
No? what is there to say no about to plutocrat-run corporations sucking the financial life-blood out of the average American at every opportunity? How else are otherwise useless, no-redeeming value plutocrats running corporations to maintain their lifestyles if not by forcing Americans to pay for their crap services and products.
pseudonymous in nc
@Felonius Monk:
Ah, don’t focus on Mr Flooring Guy so much as the wingnut orgs that are pulling his strings and funding the legal side.
@Another Holocene Human:
Macmillan is a private charity, but it’s pretty well intertwined with the NHS, and covers all sorts of support services well before it’s time to consider hospice care.
The fundamental problem with American healthcare is one of trust, which is also why “skin in the game” arguments are bullshit. You’re already second-guessing the motivation of your doctor to some degree, because there’s a bill headed your way at the end of it. Can you trust that your doctor is prescribing name-brand over generic because she got invited to a “conference” in Florida by a pharma rep? Can you trust that your insurance company is substituting something on the formulary because of a sweetheart deal?
Richard Mayhew
@Commenting at Balloon Juice since 1937: Real easy, your company says no to Drug #1, the company down the street says “yes” and gets the good press and good reputation as the company that does everything to keep their members alive while Company #1 is a money grubbing company that wants to see its members die quickly.
karen
I have COBRA. I was bleeding but was supposed to be done with periods. The gyn gave me an endometrial biopsy and told me I had pre-C cells and needed to get a D & C to clean out my uterine wall. Because I’m top heavy and have asthma and Rheumatoid Arthritis they wanted me to get an MRI first to see if they had to shove a breathing tube down my throat if I’d be paralyzed. The insurance company denied it and between me and my doctor we had to beg the insurance company to approve it. WIthout this my D & C would not have been done and those cells could become cancerous. So please, don’t tell me about how insurance companies have trouble saying no, ok?
karen
@Roger Moore:
But then liberal sluts wouldn’t pay the price and die like they deserve to, amirite?
mclaren
Once again, provably false. Plenty of people are able to say no — the problem is that when someone in the broken U.S. medical industrial system says “No,” the system views that as damage and routes around it.
Example: patient gets hit with a sky-high bill and says “I won’t pay.” The hospital has already got the patient’s signature and plenty of cash up front from the patient (if not insured) and if insured, it has the patient’s insurance company on the hook, so either way, the hospital gets paid for its $20 cotton balls and $10 aspirin.
Example: doctor prescribes expensive medication and patient says “No.” Doctor refuses to prescribe any other medication, patient can’t get medication without a prescription, patient tries to go to Canada but gets stopped crossing the border and has the cheap meds stolen legally by U.S. border cops.
Example: insurance company gets hit with outrageous medical costs for routine procedures and says “No.” All the doctors and hospitals collude to cut out the insurance company from their business in that geographic region and the insurance company goes belly up because it can’t offer to reimburse people for medical care in that region.
Plenty of ways to say “no” in America’s broken medical-industrial complex. But those “nos” simply mean that the corrupt colluding cartels that run America’s mafia-style medical protection racket simply bypass anyone who says no, and either let the sick person die, or lock the hospital out of dealing with those doctors, or lock the insurance company out of doing business with any of the doctors or hospitals in that geographic area. It’s like dealing with a protection racket run by the mafia. Anyone can say “no.” There are plenty of ways to say no. The problem isn’t the ability to say no. The problem is that you have a burned-out hulk where you used to have a mom & pop business if you say no.
Ruckus
@Foregone Conclusion:
When my sister was dying of breast cancer the Dr offered her 2 possibilities, hospice or massive chemo. She asked what the outcome of the chemo would be. The best answer was 3, maybe 4 months of being sick and then dying. The fact that she had relapsed 3 times over 6 yrs and the cancer had become invasive made her choose hospice. The number of people who tried to or wanted to talk her into chemo was unbelievable. I had to talk several of them down by telling them they had no say in this, it was her life, her death and her decision.
My point is that many people have such a fear of death that they will do anything, even if the outcome is only pushed off a relatively few days and those days are pure misery. Someone some where has to be the adult in the room. It can be painful and it may go against your grain to say enough is enough but it is a reality that has to happen.